A mental status exam can provide a quick memory screening, but it does not provide a definitive answer as to whether a specific memory impairment exists. Formal neuropsychological assessment is required to specify the nature and extent of memory impairment.
Memory is broadly de?ned as the ability to recall past experiences. Three types of memory are typically assessed in a mental status examination: remote, recent, and immediate. Remote memory refers to recall of events, information, and people from the distant past. Recent memory refers to recall of events, information, and people from the prior week or so. Immediate memory refers to retention of information or data to which one was exposed only minutes previously.
Recall of remote events involves reviewing chronological information from the client’s history. Some clinicians simply weave an evaluation of remote memory into the history taking portion of the intake interview. This type of assessment involves questions about time and place of birth, names of schools attended, date of marriage, age differences between client and siblings, and so forth. The problem with basing an assessment of remote memory on self report of historical information is that the examiner is unable to tell if the client is recalling historical experiences and information accurately. This problem re?ects the main dilemma in assessment of remote memory impairment: the possibility of confabulation.
The term confabulation refers to spontaneous fabrication or distortion of memories.
Confabulation often occurs during recall. To some extent, a certain amount of confabulation is normal . In fact, we have found that intense marital disputes can occur-for some couples, but of course, not ourselves-when memories of key events fail to jibe. It is clear that human memory is imperfect and, as time passes, events are subject to reinterpretation. This is especially the case if an individual feels pressured into responding to questions about the past. A client may be able to recall only a portion of a speci?c memory, but when the client is pressured to elaborate on that memory, confabulation can occur. Here is an example of confabulation on a simple test of remote memory.