MSE - ATTENTION, CONCENTRATION, AND MEMORY


The initial interview with a client is critical, not only for information gathering, but for rapport building. A skillfully done interview should help the professional: diagnose, estimate severity of problems, decide on a course of action, gain a dynamic understanding of the client, and engage the client in psychotherapy. A supportive, attentive, and nonjudgmental attitude can help pave the way toward a productive interview. As previously indicated, the MSE is a critical component of the initial diagnostic interview. The MSE serves not only to gauge a person's current level of functioning but also aids in diagnosis and can serve as a baseline for future reference. We will look at other areas of the initial interview in later segments. For now, let us finish with the MSE.


When focusing on attention, two general areas are under consideration. The first is the individual's ability to "attend", or the ability to pay attention for short periods of time without being distracted. The second is the ability to attend for long periods (concentrate). The ability to concentrate is primary in testing higher levels of functioning.


Attention can be tested in several ways. One is to simply observe the interviewee's ability to stay focused and attend to the interview. A more structured assessment of attention may be gleaned with digit span or a nonnumeric test. Digit span is simply listing a series of numbers (write them down as you say them), starting with three numbers. They should be spoken in a monotone voice, with one spoken every second in cadence. On the last number in the series, your voice should drop, indicating the end of the series. Start with three numbers (e.g. 3-7-1). Repeat two sets of three numbers. If at least one of the two series is repeated back, go to four numbers until the client fails both trials. Then do the same in reverse. The average is five numbers remembered. The nonnumeric test consists of reading a list of random letters and asking the client to tap his/or her finger when certain letters are stated. In this test, it is best to have a prepared list of letters.


Concentration can be assessed using serial number counting (subtracting 7, 5, or 3 from 100 consecutively). This may be hard for some people with lower educational levels, so days of the week or months said backward may be substituted. Simple multiplication problems may be useful, but these have the same limitations on premorbid intellectual functioning and general education level as the serial counting tests. Asking a person to draw a picture or do some math problems on paper will also give information as to his/or her concentration ability.


There are several different types of memory and ways of referring to them. In psychology, the terms short-term and long-term memory are used. The medical tradition refers to immediate, recent, and remote. Some also break this up to recent past and remote past. Unless you want to do a very comprehensive memory assessment (in that case, use a memory assessment instrument), then the immediate, recent, and remote memory should be assessed. Immediate memory assessments are the digit span (described above), asking the client to remember three objects (dog, house, ball) to be recalled after a 5-minute delay. A counting test where one asks the client to count to a number (e.g. 27) stop for 1 minute, continue counting where he/or she leaves off, stop at a specific number for 1 minute, (do this three times) is also useful. Recent memory refers to events of the last 24 hours, and remote memory is assessed by asking questions about early memories or dates of employment, etc.