Compassion Versus Accuracy: Lenient Scoring of the Spatial Orientation Items on the Mini-mental State Exam Lowers Sensitivity.

The Mini-mental State Examination (MMSE) is a commonly used screening tool for cognitive impairment. Lenient scoring of spatial orientation errors (SOEs) on the MMSE is common and negatively affects its diagnostic utility. We examined the effect of lenient SOE scoring on MMSE classification accuracy in a consecutive case series of 103 older adults (age 60 or above) clinically referred for neuropsychological evaluation. Lenient scoring of SOEs on the MMSE occurred in 53 (51.4%) patients and lowered the sensitivity by 7% to 18%, with variable gains in specificity (0% to 11%) to psychometrically operationalized cognitive impairment. Results are consistent with previous reports that lenient scoring is widespread and attenuates the sensitivity of the MMSE. Given the higher clinical priority of correctly detecting early cognitive decline over specificity, a warning against lenient scoring of SOEs (on the MMSE and other screening tools) during medical education and in clinical practice is warranted.

Reappraising Past and Future Transitional Events: The Effects of Mental Focus on Present Perceptions of Personal Impact and Self-Relevance.

This research examined how instructions to focus on the concrete details (experience focus) versus broader life significance (coherence focus) influence present perceptions of transitional impact and self-relevance for past and future transitional events. Participants (Study 1, N = 119; Study 2, N = 251) selected a past or future transition and wrote about it using either an experiential or coherence focus. Participants then rated the event on transitional impact, self-relevance, and other phenomenological characteristics. Individuals instructed to use a coherence focus on a past transition reported higher levels of material and psychological impact and rated the event as more self-relevant, compared to those instructed to use an experiential focus. The manipulation did not influence ratings for future events. Controlling for temporal distance and emotional valence did not alter the findings. Future transitions were regarded as more personally important than past transitions. Appraisals of the impact and self-relevance of transformative past events (but not future events) are affected by the mental focus adopted at retrieval. The findings are considered in light of essential differences between remembering and forecasting and support the notion that a coherence focus promotes adaptive self-reflection by affording people the cognitive means with which to reconcile transitional experiences.