challenges in the clinical diagnosis of alzheimers disease influence of family coaching on the minimental state examination the minimental 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 425 percent of the caregivers 175 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