Had DH's neurologist appointment this morning. Of course they always do the mini-mental and he passes it with flying colors. Today when asked what year it is he answered "2005"; today's date "March 25, 2005". Counting backwards by 7 has always come easy for him but he REALLY struggled and never did get 79-7 or below. All the instructions for the test had to be repeated at least 3 times before he understood them. According to the Doctor of Neurology who makes big $$$$$ for these office visits said "You're doing great. Come back in 6 months".
Sheila, it was after just such a visit to my wife's neurologist that I fired him and decided all her care would be done by her PCP. This has been much better, and she has a PCP who really "gets it".
P.S. as you may know I am a retired Primary Care Physician.
worked in a hospital with specialists in several fields. Sheila, sometimes, the primary guys are more knowledgeable about a lot of stuff. I still maintain only an autopsy will give a definitive diagnosis. My dh absolutely refuses to take any more meds. Did the Aricept w/Namenda. Then the exelon patch. Claimed it didn't help him. I don't think it did either. We will wing it. Dr. told me that if dh gets into an angry or violent state, to call him right away and he will prescribe something that will help. In the meantime, I keep him in a routine which helps. Likes to go to store, doesn't like eating out anymore (can't read the menu) although I force him to go to McDonalds (no menu). He is for his age (84) physically good so he enjoys vacuuming, washing floors. I tell him he is like a cleaning lady who is satisfied to work for nothing. I even let him shovel snow because he loves it and doesn't remember being told he shouldn't do it. Because of our ages, all our friends are gone. That's life.
Sheila, I'm with Marsh. After the diagnosis, and the prescriptions for the meds, there is nothing the neuro can do for them. Giving them tests over and over just frustrates our spouses and really doesn't tell us much. Their actions tell us more, and the PCP can take care of any medical problems that come up. We stopped seeing the neuro a long time ago.
Our most recent neurology apt. was very similar to yours. (http://thealzheimerspouse.com/vanillaforum/comments.php?DiscussionID=5226&page=1#Item_7)
It's interesting that you mentioned the instructions had to be repeated 3 times in order for him to understand them. I did a lot of language cognitive testing in my career. I know that all tests have different instructions and criteria for administering them, but the idea of the mini mental is to test memory and simple comprehension. They shouldn't be REPEATING the questions. If he doesn't understand the question in the first place, THAT'S A PROBLEM! They shouldn't be giving credit. Our tester doesn't repeat the questions, but she gives Sid lots and lots of time to answer, and then lets him change his answer. Our neurologist also told Sid he was doing fine.
Fine? Hmmm, let's see. This afternoon he went on an outing with his Alzheimer buddies. It was my turn to pick them up from the van. After I dropped them all home, I asked Sid how he liked the day. He said, "I don't remember. Where did we go?" But he got a 29/30 on the mini mental.
I think a PCP may be a fine choice if you are fortunate enough to have a patient who is compliant and doesn't have significant behavior problems. My husband has displayed difficult behaviors for several years now, has hit people when he was overstimulated or felt threatened, etc. He is currently in a care facility having his medications adjusted with the target of reducing anxiety and making him easier to care for. His neuropsychiatrist, who diagnosed him 6 years ago and has been treating him since, is supervising his care there. There's no way a PCP could do that (that I'm aware of).
I don’t have a choice. My DH refuses to go back to the neurologist & it’s because of the mini memory test. He HATED it. I’m very fortunate that our PCP (who we have been with for over 30 years) said he would prescribe whatever DH needs.
I'm in the process of changing my husband's care over to the VA system. Due to the way they prescribe, he needs to see a geri-psychiatrist for his behavioral meds and a neurologist for his dementia meds. I have no problem with that. His pcp doesn't really have a clue when it comes to dementia. When they gave him the mmse, he didn't seem to care at all, he got a 2 out of 30 and they only asked each question once.
I took DH to the neurologist on Monday. He scored a 23, last time, 17. I just looked at doctor and told him some of my concerns. He admitted that the test did not really mean anything. I still can't believe it. He does not know the date, the telephone number, the year,or how many children or grandchildren we have. He does not know that our 50th wedding anniversary is in July. He does not know what day of the week is.He told me if he added Namenda it would only make a difference for about 6 months.
Add us to the PCP w/no neurologist column, too. Stopped neuro last August, I believe, as there was no point to seeing her so she could ask hb how he was ("fine") and say "okay see you in 3 months." No meds except for high bp and sleeping (which I think isn't working well right now). Physically does well. PCP is also med director of 3 nursing homes near us. Said if behavior becomes aggressive, let him know post haste.
Deb112958 - My Dh's care is provided by the VA. His PCP and I took him off the the dementia meds, and the neurology dept finally stopped hounding us to come in. All his care is provided by his PCP. I just wanted you to know that I'm quite pleased by the care he receives at the VA.
Like many here have stated we too went to a neuro only for the dx. Since then we have only went to the PCP every three months. She is presently on namenda/aricept routine and is currently midstage. Our PCP takes care of everything she needs. I see no reason to change that. We feel that since he also has regular rounds at the area nursing homes and has specialized in geriatric care that he is more than qualified. We are very happy with his care of this dreaded disease. He does not sugar coat anything and she is closely monitored and reaching him is quick and convienient. My advice would be to stick with the care you feel is most rewarding and eases your anxiety. This journey is by far the most difficult thing you will probably face in your lifetime at least that is what I have discovered.
Thanks Diane V. So far everyone has treated my husband with respect even though he has no clue what is going on. I'm glad your husband is being treated well also.
After my husband was admitted the the psych unit by a highly over-reactive neurologist, I got him released as quickly as possible. We stopped by our PCPs office on the way home. I asked him if we (meaning the doctor and myself) could handle this on our own. He told me he was willing if I was. He gave us our prescription for Seroquel and the rest is history. I never regretted it for a minute.