Comment Author sandy D Comment Time 1 day ago edit delete
The MMSE has a total of 30 points. 26 or < is considered as dementia. The average loss per year for a patient with AD is 6.5 points. Most patients under 14 do not recognize people outside of their caregiver and not always the caregiver. This info is obtained from a long term study of Alzheimers dementia. An 11 would be comparable to somewhere in stage 6. Hope this helps some
Comment Author dking Comment Time 1 day ago edit delete
In June 2005, we went to my wife's general practioner. I told her that I was starting to notice memory problems. She gave the MMSE and my wife scored 30. "See, you don't have Alzheimer's, you are too young". Fifteen months later, when DW scored 18 with the same doctor, the look in the doctor's eyes was the scariest thing I had seen in a long time. My wife was 49 at the time.
Does anyone have any idea how someone could be scored on these tests if they have other conditions which prevent them being able to answer properly, even if they were otherwise okay? My husband's broad spectrum learning disabilities eliminated quite a few of the number questions(he never could count by 7s backward or forward, nor by any other number), and he has always mixed cities, states, and countries. He's never been good with names, so identifications have always been tricky. I know they found Stroke scars, and his memory is receding and patchy in places. Latest indications from conversation are that he is somewhere in the mid-1990's (calls current dog by old dogs name, as example). I don't doubt his diagnoses at all. I'm just curious as to how they got there given his combination of problems.
Comment Author sandy D Comment Time 14 hours ago edit delete
There are many factors that go into the neuro testing. First is your initial IQ and education level. One of the problems with the MMSE is if someone is very intellegent, they will be able to pass that test easily until they are late in the disease, also if they have learning disabilities, those will impact the testing to some degree but it would be very unlikely that an individual would have deficits in all the areas impacted by AD and nowhere else. When they do the testing, they are looking very specifically at areas of weakness that correspond to the areas that are impacted by AD. The testing results should correlate with the PET scan results. If the tests results are not classic, they usually will ask about their past history..usually the question is something on the order of ..Have they always had problems with??? or did they have problems in high school. That helps them to explain the differences. The MMSE is not used for diagnosis, or at least should not be used for diagnosing but only for a quick way to assess the progression of the disorder once it is diagnosed. Even among the different types of dementias, there are differences in areas of weakness with the testing. IT is surprisingly accurate.
Comment Author Sunshyne Comment Time1 hour ago edit delete
Sandy D, there have been a couple of studies which found the MMSE is NOT reliable for assessing progression. And when you think about it, that makes sense. Symptoms can bounce around all over the place, depending on many different factors -- level of stress being a big factor that really affects my husband's performance on the MMSE, and the way in which the test is administered. I imagine that the scores collecting over many months can reliably show a trend, but too many people think the change between, say, the original MMSE score and the results from the test given three months later are meaningful, and often it isn't.
Comment Author sandy D CommentTime 21 minutes ago edited edit delete
Your absolutely right regarding the MMSE. If a patient "studies" before the test they can have a much higher score, in fact one patient in the clinic we go to did not qualify for a research study because his spouse prepped him with all the answers before he came in and he scored too high. You can have a good day and score much higher and a bad day will do terrible. I know my husbands neurologist does not test every time but gives enough time between them to possibly see the progression. He still does the full neuropsych testing once a year to see the real picture. The MMSE is just a tool to follow. When I mentioned accuracy, I was not talking about the MMSE but the full neuropsychological testing that should be done on all patients as part of their work-up for AD. That testing is to evaluate different areas of the brain which helps to sort out AD from other disorders. Someone who is mentally retarded would flunk the MMSE but not have AD. The neuropsych testing sorts that type of thing out and also helps identify AD in those whose intellegence and education allow them to pass the MMSE with flying colors despite having AD. Hopefully this clarifies what I said.
So, sandy D, a lot of the spouses who post here wonder what value there is to having the full-blown neuropsych testing every year. It's obviously needed for a proper diagnosis, but what about after that?
My husband gets tested out the whazoos every year for the longitudinal study (and on top of that, was getting tested every few months for the clinical trial), but that's to help other people in the future, it's not really to help him. And -- aside from having one tester who caused a total meltdown, and who I've been assured will never get near him again -- he rather enjoys the tests. Other posters here have encountered doctors who deliberately stress their AD spouses, and the testing is very upsetting. Is there any value to the patient, do you think?
It allows the doctors who are following our LOs to do something. I'm not even certain mine needs to go to any doctor other than the family doctor anymore. They can't do anything for him; and I won't let them do much to or for him anyway.
briegull, luv, maybe you'd feel a little better if you took another aricept... :-)
Seriously, guys, I'm asking a doctor's opinion. Maybe there's something we're missing. Sandy D is a fresh voice, she may have a totally different perspective.
Maybe Starling is close -- maybe they feel they need to track the patient's progress in order to prescribe medicines, and how else are they going to do that with an AD patient? Maybe it's a medical ethics thing.
Complete neuropsychological testing is not necessary unless they are involved in a drug trial, then it is needed to assess improvement. If a drug trial is involved, the doctor has no say in testing. The drug companies set the protocol as to when and what to test, and at what intervals.
No doctor is going to force your spouse to undergo extensive testing after diagnosis. So if you don't want it, you decline.
The only real reason other than research based to have multiple is to confirm the diagnosis. If the 2nd set is more compromised than the first, it confirms the diagnosis. Some people find it as a more concrete way to follow the progression of the disease. There are so many ups and downs and it is so slow in its progression, it is sometimes hard to see what stage they are dealing with. For those individuals that need some type of guideline for the progression, it is helpful.. There is a point when a neurologist really is not needed..Joan is right. When you are comfortable not having the tests just say no..they cannot make you have them..
Sounds like testing may have value to determine results in research setting or in verifying progression, if needed. Makes me comfortable with the fact both Drs. agree any tests Ron has now will be event driven. There's no sense in putting him through them if we already know the results will not generate any changes in treatment.
At this point I let him do the extended mini-mental (with additional and optional questions). None of the doctors have asked for any other kinds of testing except regular blood tests to follow the medications. All of that is coordinated through the family doctor - both tests and prescription follow ups. It is my way of making sure everything stays reasonable.
But frankly, I don't see much reason to continue with mini-mentals. The last one put him right at the border between Seriously and Profoundly Demented. If he forgets what year it is he tumbles into Profoundly Demented, and I think he just had a lucky guess on that one.
So, am I hearing correctly? If my husband is not involved in any testing, and we're just taking our Razadyne and Namenda, and watching him slowly die, that there is no longer a reason to go to the neurologist? I can just have the once a year check-ups with his primary care physician, unless something else happens?
My WW (age 57) refuses to do a "formal mini-mental" - she knows things are going south, why rub her nose in it. A good neurologist can ask questions in such off-handed manner that the patient has no idea that they're being "tested". I'm an optometrist who works in a clinic with M.D.s - trust me, M.D.s like to put a number on everything.
My h. has been improved with some cognative skills the past 2 months so I decided to give him the MMSE test that scores to 30. He tested at 18 today, the same score as January of this year.
He could not do the write a sentence or draw the picture. He attempted but you couldn't tell which was which. He has always did bad on the picture but last spring he could write his name (rather shakly). Could not even attempt to count backwards or recall the 3 items we talked about earlier. However, he did do a 3 stage command with no problem.(Take a paper in your hand,, fold it in half, and put it on the floor. He was doing pretty good today with his talking, etc. If he had the test on his "off days" or maybeeven in the Doctors Office, I think it would be significantly lower.
Last week we were at a reunion and an Assistant Living Owner was there and she said he didn't look or act like their AD patients. I have that same idea, but he does have some kind of Dementia and I don't know that it makes much difference what kind.
Just for my own information I am going to give him the same test every couple months. He told me today he would like to see another Doctor about the top of his head. I told him we had seen 6 Doctors but he said he would like to see one that didn't have his history. Kind of throws you when you know it is a "no win" situation.
Someone gave 3 sites for the MMSE tests--one for 30 pts and I think there were two for 50 pts. I can't seem to locate them. Anyone out there know what I'm talking about?
I looked at both those mmse's and one said 23 out of 30 shows some dementia, the other said 15 is normal for elderly. last time at the doctor, he scored 16 out of 30. I'd like to see something that tells me what the scores really mean.
There are similarities to both tests. The 30 test is easier for me to give him. The 15 you mentioned is for the number of animals the average elderly person can name.
My H tested 18 on the 30 test. He cannot count backward or spell backwards, write his name or draw a picture. Recal the 3 items very many times. He can do the 3 part question, knows the presidents, his age, birthday but not the day of the week, nor the date (neither do I). Recognizes items and what they are used for. Knows when he is supposed to take his meds but cannot fix them. Knows all family members, histories, friends from long ago and current. (Personally I don't think he has AD but other kinds of dementia.)
I am going to use the same test in the future for comparison. At this point a one point drop will be pretty major. When they get down to 10 they are in late stages with incontenence, not know family and friends, etc. At least that is how I understand it. I think they can score pretty good in some areas and not in other areas.
Thanks--I think I'll give him the test a little later on. I made some copies of the #30 test. I'm just curious. He's having a terrible time with the date, day, year, etc. We did our absentee ballots last week and he keeps asking when we are going to vote. I think this will probably be the last time he votes. Really is sad. He always is readdy and willing to exercise his right to vote. I'ts very important to him.
Most researchers agree that the MMSE can be a useful tool for identifying cognitive impairment, although it may misdiagnose some patients. That's about all they agree that it can be used for.
(1) MMSE scores can be highly variable, for all sorts of reasons -- the way the test is administered, whether the patient is stressed, medications, home environment, and so on and so forth.
(2) Several studies have shown that the MMSE is NOT an adequate tool to monitor CHANGE in the individual patient. At the very least, multiple scores must be collected by a qualified clinician over a period of 2 to 3 years and the average slope of change calculated to determine whether there is a significant change in impairment.
(3) It is very inappropriate to list scores the way About.com did. Interpretation of the scores MUST take into account other factors, such as the level of education the patient has, his/her ethnical background, etc. For example, some researchers argue that the standard cut-off score shown here (23) is only appropriate for patients who had 8 to 15 years of education. For a person with 8 or fewer years of education, the cutoff would be 17 (i.e., this person would be NORMAL with a score of 18). For persons with higher educational levels (i.e., 16 or more years) a cutoff score of 27 appeared more appropriate. I am sure that the scores for patients such as carosi's husband simply cannot be interpreted properly at all. Elsewhere, we've discussed that people who do not speak English as their native tongue may score poorly on some questions, even if they are healthy.
(4) Studies have shown that the MMSE can NOT discriminate between moderate and severe AD. The test is primarily useful in the earlier stages.
To me the test is the best I have and I use it "with a grain of salt". I will use it again in a couple of months just to see if there seems to be any changes. Sort of like I get on the bathroom scales every day, just for moral support. I agree education and language would influence the test and everyone is different.
I think doing it myself with the same questions, and on a decent day, I will get a pretty good reading. Better than after a 2 hour trip to the Neuro and he is wore out and confused.
Imohr, I do the same thing :) Lynn was in the low single digits at his last neuro appt.. same doctor gives the test. But, I just couldn't accept it. So I too started to give this test to him myself. He still only scores between 9 - 12. But he was much less flustered at home than driving all the way to the doctors to be "drilled" as he calls it.
My DH does not do terrible on the MMSE, but the neuropsych results showed that his memory impairment and executive dysfunction was severe and that his overall impairment is diffuse and should be considered moderately severe. To the casual observer, my DH might appear mostly normal. He has always been good at faking it. For example, his parents didn't teach him the basics before he went to school. He still managed to pass in school. Notably, the teachers did not realize he did not know how to write in cursive until he was in the 5th grade! He somehow managed to bluff his way through. He did not finish high school (only got to the 10th grade), but he passed the GED without studying 15 years later. They say his IQ is now 79 and say that he probably only lost 5-10 points. They said that based on his education. However, I believe very strongly that they are underestimating this decline - especially since he became a commercial heating & air conditioning specialist without ANY training. He just taught himself. You can't do that with only an IQ in the 80s.
My point here is that these tests are all highly dependent on the original IQ until you get to the end, when all of the AD patients can't remember anyone or do well on any of the criteria.
The neuropsych test results were very interesting for me because (1) they were right on the money in terms of his deficiencies based on my personal observations; (2) identified the areas in which my DH has greater problems; (3) identified the fact that what was once his greatest source of strength when it came to learning (visual/hands on) is now his weakest skill - he actually "learned" less than 40% of what he was expected to be able to learn and lost 2/3 of what he learned within 30 minutes; and (4) helped me to better understand what he is not able to do.
My husband's doctors -- the ones who are very qualified in AD research and care -- haven't given him an MMSE in three years.
Maybe I can explain it this way:
The questions in the MMSE are designed to detect disfunction in different parts of the brain. There are "clusters" of two or three questions for each type of disfunction, for example, impairment of memory, language, spatial ability, set shifting, etc. The goal of the MMSE is to detect the beginnings of impairment in one or more of the different parts of the brain; and to get some insight into which parts are affected, which can be useful in deciding which tests should be done to determine the type of dementia that may be involved.
With so few questions on any type of functioning, it is difficult, if not impossible, to measure the level of impairment once a problem has started up in that type of function.
In the much more detailed evaluations that are done for the longitudinal study, there are five types of disfunction that are measured in the neuropsych evaluation: memory, verbal/language, abstraction/problem solving, visuospatial, and attention. My husband's short-term memory loss has been rated "severe" (the worst of five levels of impairment) for the past three years. He ranks as "mild" in the other areas, which is a decline from the previous year in two areas (although he had the same ranking back then) and "no change" in the other two.
He is solid stage five, with occasional glimpses of stage 6.
Then, there are also nursing and neurological evaluations. They don't send these results, presumably because they feel they're too technical for the average caregiver to understand.
The longitudinal study does not rely solely on tests -- not even these detailed tests that take several hours over two days to complete -- because they do NOT reflect the ability of the patient to function in the real world. Instead, they also use my observations -- while my husband is being tested, I go through a series of questionnaires and interviews. (I would disagree that his short-term memory loss should be ranked severe. Giving him the lowest "score" leaves him with no place else to go, and he most assuredly can get a lot worse in the memory department.)
When they send me the neuropsych results, they emphasize that the "level of impairment" applies specifically to cognitive impairment, not to overall level of functioning in daily life.
The same would hold true for the MMSE, which is a very abbreviated test of cognitive impairment. It cannot tell you what your spouse's level of impairment is when it comes to what really matters -- that is, when it comes to how s/he actually behaves. And it cannot tell you about declines in other types of brain function, at all.
I think it was Mawzy who very recently said she felt her husband had declined, but she couldn't quite put her finger on exactly what it is that makes her feel this way. I assume that's why she's interested in locating the sites for the tests.
Mawzy, you know far better than an MMSE (no matter who it's administered by) whether your husband has slipped a bit. If your gut says he has, then he probably has. Don't drive yourself nuts with a test that really isn't going to shed any light on the subject, and might just upset you unnecessarily -- your husband might not do well, not because of his level of impairment, but simply because he may not be reacting well to the way you administer it, or he senses and reacts to your nervousness, and/or because you may not understand how to interpret the results. There's far more to interpreting the MMSE than coming up with a total "score".
Instead, try keeping a log or journal of your observations. That could be far more helpful in determining whether a new problem is developing, and if there is, what might be done to help your husband.
I agree with Sunshyne that you can't really track dementia with the MMSE. It was intended as a tool for a fast and dirty cognitive evaluation.
If you want to try a log, here is information from Big Tree Murphy:
http://bigtreemurphy.com/Journal.htm
I like how she groups things so you can actually verbalize what is changing and when it is changing. I did a single one of these just before my husband's last neurological visit (probably his last) and the doctor was very impressed with it. I'll do it again in early December for the family doctor and give him both.
My husband has seemed SO much more alert since I started him on the trazodone - remembering things, places we drive by that he'd ignored many times in the past year, watching videos with interest (he's now watching MadTV, of all things, and laughing. MOST unlike him!). This morning I gave him the short Mini-mental. Would you believe he ACED it! Not the day of the month, but October, Halloween, fall, year; World backwards, the sentence, the directions. I did prompt him on animals - what animals do I see at the zoo? And he said he couldn't copy "the overlapping pentagons" - but that's what he CALLED them!
Of course at lunchtime he said he was going to send his father an email and tell him about something he'd seen at his favorite car body-shop - which of course we haven't been to in months; his father has been dead for 20+ years, and HE hasn't used email in 2-3 years. He was also looking all over the freezer to find the .. what you put on bread.. mustard? Yes..
Sunshyne- you are right on. It is important to remember that the MMSE is NOT to diagnose alzheimer's. It is used more to track an individuals decline. My husband scored 30/30 when he was diagnosed. The neuropsych testing is really needed to diagnose.
My DH had an appointment with his neurologist today and scored just 5 on the mini mental. 8 months ago he scored 15. Of course I have seen him getting worse but I was still shocked at the number. I think he's stage 5/6. Decline seems to be accelerating. HIs doc wants him to get a new MRI.
The test results seem to be all over the place. The neuropsych eval said my DH has severe memory impairment and severe executive dysfunction with a diffuse overall cognitive impairment that "should be considered moderately severe." But I would still place my DH in the 4 to 6 range - more often on the 4 range (of course, that is with Namenda & Aricept in play now - he was only on Aricept when the neuropsych eval was done).