Psychiatrymiddle twist
An 84-year-old woman is referred for assessment of memory loss. Her daughter says she has become withdrawn at family gatherings and often answers questions inappropriately, but she still manages her own shopping, cooking and finances. She denies low mood, and her appetite and interests are unchanged. She scores 18 out of 30 on the Mini-Mental State Examination, losing marks on repetition, the three-stage command and serial sevens, but full marks on the written and drawing items. She asks for questions to be repeated and watches the examiner's face. Otoscopy shows bilateral cerumen impaction. Which one of the following best explains her test result?