[Music]
[George] The Mind Deconstructed: Mental Health and Wellness with Dr. Kaz and George.
[Dr. Kaz] The statements of Dr.
Kaz and George are not a substitute for medical care and our opinions are our own. If you are experiencing a mental health emergency,
please seek assistance from a professional in your area.
[George] You can contact us via Twitter @MindDeconstruct. I'm your host George, with me is Dr. Kaz.
Dr. Kaz Nelson is an American Board of Psychiatry and Neurology certified psychiatrist,
licensed to practice medicine in the state of Minnesota and an assistant professor in the Department of Psychiatry at the University of
of Minnesota Medical School. On
today's episode: "George's Cognitive Screening."
What? Wait. Wait a minute. Wait a minute.
George's cognitive screening? [Dr. Kaz] That's you, yes. [George] That's me. Am I getting screened today?
[Dr. Kaz] We're gonna check you out and see how you do. [George] Huh, okay. So to start off with,
again, we want to thank our listeners
(there's a few of you out there)
so thank you so much. Feel free to share this podcast with your friends and family as we have done,
anyone who might be interested in the field of psychiatry. I do hear from a lot of people that
they have a passing interest in psychiatry, and they're really enjoying
kind of hearing some of the inner workings or thoughts of a psychiatrist has, so I think
you're providing a good service by doing this. [Dr. Kaz] Thank you. [George] So far
I think we're still having a lot of fun doing this. [Dr. Kaz] Yeah, this is great!
I appreciate you been willing to help me get the word out about these things, George. [George] And again,
we're available on Twitter @MindDeconstruct. We are available on Facebook: The Mind Deconstructed.
[Dr. Kaz] We've got a podcast group.
Sign up, you'll get updates, learn when every episodes released. [George] You could also visit our web page- The Mind
Deconstructed (dot)
libsyn(dot)com. "Libsyn" is l-i-b-
s-y-n.
dot-com
[Dr. Kaz] Yeah, you can comment on episodes, or leave questions, or just let us know what you think.
[George] So today: "George's Cognitive Screening." Why am I going to be doing a talking of screening today? [Dr. Kaz] Well, I've been getting a lot of questions,
particularly with some of the hot topics in the news regarding
President Trump's recent examination, and he had some cognitive screening done, and so there's a lot of questions:
What's a cognitive screen? Is that the same thing as a psychiatric examination or a mental health screening?
[George] What about a diagnostic assessment? I hear about those two. [Dr. Kaz] Yep, another term that somebody might run across is diagnostic assessment or
neuropsychological
examination. All these things that we mentioned are actually different things
and so I think it might make sense to define some of these things today,
help you understand how they might be different, why you might use one instead of another, what these
screenings and examinations-what questions do they answer? And then for fun (a little bit of fun) we're gonna be giving George the exact
cognitive screen that President Trump received reportedly by his physician. [George] Okay.
I have never heard of a cognitive screening. I've heard of all those other things
we've talked about and and just so our listeners know (since I'm going to be taking the cognitive screen)
I don't know what any of the questions are going to be. We haven't talked about this beforehand.
We're not staging anything. [Dr. Kaz] No, if this reveals something concerning about you, George, we're gonna
have a lot more to talk about in the next episode. [George] And maybe, maybe we will publish it. [Laughter]
[Dr. Kaz] This is a non-political podcast.
It's focused on mental health and well-being and helping people understand mental health and well-being and so we're
gonna explore this territory because it was in the news and there were terms being used in relationship to the President
and I would like to do my public service and helping everyone understand what those terms mean. [George] To start off with,
what is the cognitive screen that the president took? What is that looking for? [Dr. Kaz] Zooming back a little bit, a comprehensive
psychiatric or
brain health/mental health evaluation has a lot of different components to it.
We look at mood, behavior
and then also thinking patterns and another word for that is cognition. So
what President Trump received was a cognitive screen, so just a
area of mental health and fitness was screened and the screening tool that they gave was something called the Montreal
Cognitive Assessment
Or "MOCA," M-O-C-A for short [George] Aand then also that was not conducted by a psychiatrist, that was his primary physician. [Dr. Kaz] Mmm-hmm.
Well, as with all screening tools, they can be delivered by a variety of professionals
and so there are a lot of different help disciplines that are trained to screen for cognitive disorders, and that's great, but that's something
that's a little bit different between a screening tool and a full
evaluation, you know, that there's certain blood tests that are screening for certain things like diabetes,
but not diagnostic. You often have to do much more
in-depth testing to really
say whether someone has true problems or not. [George] So if the president hadn't gotten 30 out of 30, he'd have maybe had to have
seen a specialist for some sort of cognitive decline issue. [Dr. Kaz] Well, with this screening test
it's good at catching very major things,
but not subtle or slight things and so if somebody really had concerns about
different aspects of somebody's brain health or brain functioning in terms of their ability to think or
calculate or use logic or remember things, then you'd probably
arrange something more in-depth like neuropsychological evaluation
which is a several hour test that involves puzzles and
remembering things and testing all different aspects of the brain. So
something like that will generally show much more subtle or nuanced results as opposed to the screening test
[George] Okay, so what about a diagnostic assessment then? [Dr. Kaz] That's a term that's often used by
psychotherapists or therapists, and that's a really in-depth
conversation/evaluation that a therapist might have somebody to
assess for the presence of different mental health or psychiatric diagnoses. Can a therapist make a diagnosis of someone?
[Dr. Kaz] Absolutely.
They make diagnoses and treat mental illness every day. [George] Yeah. [Dr. Kaz] And
psychiatrists do that as well. When a psychiatrist does an in-depth evaluation there's oftentimes more of a medical component
assessing for different medical
illnesses that might be contributing to
somebody's mental health difficulties, and that's called a psychiatric
evaluation and so somebody might have both a diagnostic assessment and a psychiatric evaluation.
Often times, they may come to the same conclusion, but not always. [George] Do you do like CAT scans? Like
brainwave tracts, things like that? [Dr. Kaz] As part of a comprehensive evaluation if there's certain symptoms that warrant it will absolutely
order different types of brain scans, including CAT scans/MRI. Newer technology is called functional MRI
and that's not used in regular clinical use at this point
but is being explored in a lot of research
protocols and might be something that we use in the future.
And then if we have concerns for abnormal brain activity, sometimes we might even order a
EEG or
Electroencephalogram, and that's something neurologists would even use to screen for things like epilepsy. [George] Do you remember when we were in
undergrad and we were research assistants for that study
and we had to put the cap on people with jelly and the electrodes on their head?
[Dr. Kaz] Yes! [George] Is that an EEG? [Dr. Kaz] No, that's something called an
ERP or
event-related potential and that looks at
electrical activity just really on the very surface of the brain, but yeah
we had to put these little caps on people and abrade the skin
and put on jelly and their hair was a mess afterwards and did some sort of fun
psychology studies in the very deep basement of one of the psychology buildings that was good times.
[George] Yeah,
I think the location probably affected the amount of people we had in
that study like, "You want to come into the basement of the social science building and put a cap on?" No.
[Dr. Kaz] Yeah,
well a lot of the psychology studies are actually based on undergraduates because of
their participation (some of these studies of students) so that's an interesting fun fact.
[George] So did we cover them all? Diagnostic assessment, neuropsych assessment...
[Dr. Kaz] Evaluation...[George] psychiatric evaluation.
[Dr. Kaz] And then cognitive screening
(the smoker that we'll be doing right now).
[George] Yeah, so the the MOCA again stands for the Montreal Cognitive Assessment. This was developed by Dr.
Nasreddine.
This is available for free and I've double-checked the permissions here that MOCA may be used, reproduced, and distributed without permission
for educational use and for this educational podcast, that's the purpose that we're going to be presenting this material.
It's something that's used a lot by health professionals because it's accessible.
It's possible that you may be in a clinic one day
and they want you to do a MOCA screen and probably listening to this podcast isn't going to ruin the accuracy of
doing that test,
but, if you are worried about that at all you could ask them for an alternate version
because they have a few versions of this for people who might be familiar with the original that I'll be going through today with George.
[George] Okay, so are we ready? [Dr. Kaz] We are ready. [George] So I've flipped it over. [Dr. Kaz] Yep.
It's a piece of paper (a form) that we've printed off from the
official website
that developed this MOCA exam. [George] I have a strong desire to
do this for speed-timed speed. [Dr. Kaz] Right. The time to administer
this is approximately 10 minutes, but this is not a timed exam, so if people need to take their time to do it
that's perfectly okay, and sometimes people lose points if they try to go too speedy.
[George] Yeah [Dr. Kaz] Let's begin! [George] Tell me what to doc. [Dr. Kaz] Alright.
I'm gonna point your attention to that first box on the page and give you these instructions.
Please draw a line going from a number to a letter in ascending order.
Begin here, and
draw a line from 1 and then to A and
then to 2, and so on, and then end here. [George] End here? Oh, there it is. Okay, so
2...B. 3...C
4...D...5...E
Which is also the end. [Dr. Kaz] All right. [George] That seemed to work okay. [Dr. Kaz] Okay,
we'll move on. Copy this drawing as accurately as you can in the space below. [George] Okay, so there is a shape in
the box and I'm gonna attempt to reproduce that shape. It is a cube
(I haven't drawn a cube since high school art)
but I think it's going okay, I'm almost done. I've got like one more line left. What do you think? [Dr. Kaz] Let's see.
Yeah, I'd give you a point for that. [George] I got my point? Okay. [Dr. Kaz] Yeah, you got your point.
Next
draw a clock,
put in all the numbers, and set the time to ten past eleven. [George] Okay, digital?
[Dr. Kaz] That would be cheating. [George sighs] Okay. [Dr. Kaz] Analog, baby. [George] Analog clock. [Dr. Kaz] This is gonna be a problem for later generations
who don't know what that is. [George] I started with the twelve, then the six, then the three, then the nine.
[Dr. Kaz] This is something that's very
sensitive and able to pick up people who
maybe have had a stroke or different brain injuries. [George] But so the hour hand is just a little past
eleven and the
number hand (the longer hand) is gonna be pointed at the ten. [Dr. Kaz] That was actually worth three points,
so you did it! [George] Nice. [Dr. Kaz]  Nice! All right. Five out of five for visuospatial
executive functioning charge. [George] I've always been pretty good at visual spatial but let's keep plugging away.[Dr. Kaz]  All right.
This is the one that they made fun of on the news a little bit. (George laughs)
I'm going to point to each of these here, and I'd like you to tell me the name of this animal.
[George] Lion,
rhinoceros, camel.
[Dr. Kaz] Or, dromedary is acceptable as well. [George] Oh good, I would not have gotten that point.
[Dr. Kaz] Sometimes people have trouble actually recalling the name of things even if they know what it is, so this isn't a matter of intelligence.
It's judging the brain's ability to
recall words and speak them, so it's not to really be minimized. [George] Okay. [Dr. Kaz] This is a memory test.
I'm gonna read a list of words
that you will have to remember now and later on.
Listen carefully. When I'm through, tell me as many words as you can remember. It doesn't matter what order you say them in. [George] Okay. [Dr. Kaz] Face,
velvet, church, daisy, red. Tell me as many as you remember. [George] Face, velvet, church, daisy, red. [Dr. Kaz] Okay.
I will ask you to recall those words again at the end of the test. [George] Okay.
[Dr. Kaz] I'm gonna say some numbers and when I'm through, repeat them to me exactly as I said them. Two, one, eight, five,
four. [George] Two, one, eight, five, four. [Dr. Kaz] Now I'm gonna say some more numbers,
but when I'm through, you must repeat them to me in backwards order.
Seven, four, two.
[George] Two, seven, four. Oh, ahh... two, four, seven. Two, four, seven! [Dr. Kaz] (laughing) We have to check and see if I can give you a point for that.
I'm gonna minus you a point for that. [George] Yeah...I'm as stable a genius as the president. [Dr. Kaz] Okay (laughing).
Next, I'm gonna read a sequence of letters. Every time I say the letter A,
tap your hand once. If I say a different letter, do not tap your hand. F, B, A, C,
M, N, A, A,
J, K, L,
B, A, F,  A,
K,
D, E, A, A, A,
J, A,
M, O.
All right, good job! [George] Okay! Yeah...(speaking quickly) Face, velvet,  church, daisy, red! [Dr. Kaz laughing] Didn't ask you yet!
Now I will ask you to count by subtracting 7 from 100 and
then keep subtracting 7 from your answer- [George] Oh no! [Dr. Kaz] -until I tell you to stop. [George] And it's not timed? [Dr. Kaz] No. [George] Okay. [Dr. Kaz] Take your time. [George] So 93,
86,
79,
72, 65. [Dr. Kaz] You got it (laughs) I have a confession to make that
when I was in a college class (even though I was a junior in high school because I had the privilege of taking some college
classes at that time) I
volunteered to participate in a activity and this was the activity that is assigned
and I had a complete panic attack and couldn't calculate
and
embarrassed myself greatly and caused a scene in the middle of class
so I have a little bit of a physical reaction to that question. [George] Yeah, that one kinda scared me
but not because can't subtract. [Dr. Kaz] Some people don't even want to try to do that, but we encourage them to do their best.
I'm gonna read you a sentence. Repeat it after me exactly as I say it.
I only know that John is the one to help today. [George] I only know that John is the one to help today.
[Dr. Kaz] Now I'm gonna read
you another sentence. Repeat it after me exactly as I say it. The cat always hid under the couch when dogs were in the room. [George]
The cat always hid under the couch when dogs were in the room.
[Dr. Kaz] Tell me as many words as you can think of that begin with a certain letter of the alphabet that I will tell you at
a moment. You can say any kind of word you want except for proper nouns,  like Bob or Boston,
numbers or words that begin with the same sound but have different suffix. For example, love, lover, loving. [George] I
can do that or don't bother to do that?[Dr. Kaz laughing] Don't do that. [George] Okay. [Dr. Kaz] I will tell you to stop after one minute. Now
tell me as many words as you can think of that begin with the letter F. [George] Wait,
hold on! How many words do I need for full credit? [Dr. Kaz] I'm not allowed to tell you that. [George] Well, for the listeners.
[Dr. Kaz] I'm gonna stop you if you get the certain threshold. [George] Okay. [Dr. Kaz] F. [George] Face,
function, fun,
fishing, fish,
forest, farm,
focaccia...[Dr. Kaz] That's not a word! [George] Focaccia bread? (both laughing)
[Dr. Kaz] Oh, focaccia.
[George] Yeah yeah, both of them!
[George] Fathom, fart.
[Dr. Kaz laughing] Okay, you've got enough.
[George] Oh, well that wasn't so hard! [Dr. Kaz] Yeah, you need to get at least 11 words. [George] Okay.
[Dr. Kaz] Now, tell me how an orange and a banana are alike. [George] They're both fruit...do you want more than that?
[Dr. Kaz] Nope, no that's good. You got a point for that.
[George] Good. [Dr. Kaz]  I read some words to you earlier, which I asked you to remember...[George interrupts] Face, velvet, church, daisy, red!
[Dr. Kaz laughing] Tell me as many words as you can remember.
Yes, you got them. I didn't even have to give you any clues, so you got 5 points for that. That's good.
Tell me the year
[George] 2018. [Dr. Kaz] Tell me the month.
[George] January. [Dr. Kaz] Tell me the exact date. [George] Cause it was...I feel like it was the 24th yesterday,
so it's probably the 25th today,
but I'm not a hundred percent... so Monday... [Dr. Kaz] Is that your final answer? [George] No, no, no, no! Monday was the 22nd,
22nd, 23rd, 24th...it's the 27th today. [Dr. Kaz] You got it.
[George] Yes! [Dr. Kaz] And the day of the week. [George] Saturday [Dr. Kaz] Now tell me the name of this place, and which city it's in.
[George] We are in my home in the city that it's in.
(Dr. Kaz laughs) I'm not disclosing that!
[Dr. Kaz] I know you know what city you're in.
Alright. Adding this all up,  your final score is 29 out of 30.
Anything above 26 is considered normal.
So you can tell from doing that exam if you had a score below 26 it probably would indicate some
some pretty major area the brain that's having some trouble.
[George] You know I get a lot of phone messages that work and when I try to write them down
I often get them wrong the first time I write them down like if I'm [Dr. Kaz] If someone tells you a phone number or something?
[George] Yeah, and I write it down five seconds later. I
get like one of the numbers wrong half the time. [Dr. Kaz] Yeah, well and we have a well known issue with word retrieval problems in our family
so that's hereditary. (George laughs)
Why would two people with word retrieval problems have a podcast that's anybody's guess, but we're brave. And we know you don't judge.
What does that tell us? Besides that I'm not in cognitive decline?
[Dr. Kaz] One of the reasons why I wanted to go through this today is because I wanted everyone to know
what was being talked about in the media so our president might have had a brief cognitive screen
but we don't have any information about him having a
psychiatric evaluation or neuropsychological testing or anything like that so he had one of the domains of
well-being tested in a superficial way.
[George] So the reason we're even talking about this and the reason the president even took a
cognitive test is that there's this debate going on in the psychiatric community about
diagnosing someone who isn't your patient and
there's a group of psychiatrists who have been actively talking about potential
psychiatric illnesses, or issues the president may or may not have and then there's the American Psychiatric Association who traditionally,
ethically, I don't think you guys were allowed to talk about that. [Dr. Kaz] Yes, there's a pretty well accepted rule
(t's actually called the Goldwater rule) that the American Psychiatric Association has
put forth and that its members agreed to and that's based on political events. [George] That's based off of Barry Goldwater? [Dr. Kaz] Yeah. [George] That's crazy.
[Dr. Kaz] Say something other than that's crazy-stigma free language. [George] Oh, that's..
[Dr. Kaz] Remarkable! [George] That's remarkable! That
my mind went to the right spot when you said Goldwater. [Dr. Kaz]  Yes, there at that time were, you know, people making psychiatric
diagnoses about that politician, and it potentially impacted his political career and
after that point they said we're not going to do that, it's unethical to do that and that's been adhered to
for a while and then recent national events people have questioned whether
for people who really understand mental health and psychiatric well-being, do we have an obligation if we see somebody
(particularly in a position where they have their finger on the nuclear button so to speak or
literally) do we have an obligation to actually say
"Hey,
there's maybe risk of danger here or high risk behavioral patterns or psychiatric symptoms
potentially that have been observed and we actually are ethically obligated in certain cases to
warn people when there's a risk of danger to self or others and so so that's the debate and
Mandy Lee is an assistant professor in forensic psychiatry at Yale School of Medicine who testified to members of
Congress not giving the president a diagnosis. She
adhered to the Goldwater rule in not making a psychiatric diagnosis of the president
but said that based on her training and years of experience
in assessing risk, she saw signs that made her concerned that there could be
risk of somebody in such a position of power. [George] That's kind of walking the line with the Goldwater rule. [Dr. Kaz] Right. [George] She's raising  alarm
but she's not saying what exactly the president may have and I mean we've heard a lot of diagnoses from cable news host. So,
how do you feel about the Goldwater rule? [Dr. Kaz] I
agree with the Goldwater rule. I
observe the Goldwater rule,
and I do feel like there are other ethics that we need to adhere to
regarding
assessment of
safety and risk and
there are these rare cases where these two ethical principles come up against one another and I think it takes a lot of good dialogue,
what's the right and most ethical way to proceed? [George] We're not gonna be making any diagnoses for the president today.
[Dr. Kaz] That's right, right. [George] Which is fine. Well. I'm a little disappointed that I got 29 out of 30 today.
I think if I'd have been focusing a little harder. Maybe not in this specific circumstance
maybe I could have gotten that last point but I
think you know, like you said, missing one or two is not a big deal. [Dr. Kaz]  It was perfectly normal.
[George] Thank you. Right, that speed is not the key to that sort of thing, but...[Dr. Kaz] Yeah.
You don't have to feel any shame you got a normal score anything above a 26 is
considered to be relatively normal, and I think you're very courageous in
taking the risk of showcasing your cognitive
capacities here today on the podcast so I appreciate your willingness to do that. [George] Thank you.
Thank you for joining us today. This podcast was produced by Kaz and George. Music by Paul. [Dr. Kaz] He's the best!
[Music]
[George] Contact us and send us your questions on Twitter @MindDeconstruct.
[Music]
