Challenges in the clinical diagnosis of Alzheimer's disease: influence of "family coaching" on the mini-mental state examination.

The Mini-Mental State Examination (MMSE) is a commonly used clinical tool for evaluating the cognitive aspects of mental function. In this study, 40 consecutive patients presenting to a memory disorder clinic and their caregivers were evaluated for coaching of the patient with respect to MMSE content over the 24 hours prior to clinical evaluation. Caregivers completed a questionnaire concerning MMSE practice sessions with the patient prior to the physician encounter; then, the patients were asked to spell the word "WORM" backwards instead of "WORLD" during the MMSE test. Some or all of the MMSE content was reviewed with the patient prior to the interview by 42.5 percent of the caregivers; 17.5 percent of patients spelled or attempted to spell "WORLD" backwards instead of "WORM". These results demonstrate that coaching of patients prior to administration of the MMSE is not uncommon, and that this needs to be taken into consideration when forming therapeutic decisions based on MMSE results.