How often does you LO's neuro do a mini mental test? My DH's neuro did one on the first visit but hasn't done any since. He checks his walking now and then and his peripheal (sp?) vision but doesn't do the clock or the count backwards tests. I am wondering if he did these tests would it give a better idea of where my DH is. Sometimes I feel like we are just treading water!
Well, if there's one thing I've learned from postings on this board--Ability to perform well on the MMSE has only a very rough correlation to the functionality and decline of our LOs. It interests me only from the standpoint of how my h performs relative to how he performed on prior tests. So, it might be useful to compare a person to himself, but it's not very useful for comparing a person to other people.
It also doesn't tell us anything about how to manage our caregiving or what steps we might need to instigate. That's entirely on-the-job discernment.
Actually, Jeff is only seeing the neuro team 1x/year at this point, since there doesn't appear to be any need for med management, etc.
The thing about this gig is, you ALWAYS feel like you're treading water or in limbo (unless you're in the midst of a spiraling decline...pretty rare I think.) Getting an updated score on the MMSE will in no way be a predictor for you of how long the path stretches ahead, or what equipment you should bring.
DH.s neuro saw him only two times. Said his primary could handle everything from there on,said he could not offer any help to us and if I wanted to try any alternative remedies to go ahead.I .m really not concerned what stage he is in,the outcome will be the same. I take evey day as it is.
my experience is also the same that once the neuro has started documenting decline its obsolete to really do anything else. unless they have a major setback that would be like stroke or med adjustments for behaviour issues, i dont think the medical community really can do too much more. the only real reason i continued to take DH in 2/yr was for renewing prescriptions. the drs know its a no win situation and they decline to offer much other than support to the caregiver.
WE have an annual appt coming in Feb and then will decide about the computer testing. I want to see it done this time so I can get an idea of how much of a decline there is as I see some changes. It would help then to know about meds. Our neuro is very good and supportive. Unless something happens then we have the once a year visit. It is so odd, DH will ask what something is or how to use it but when it comes to aviation and math and metric system he is spot on...it is just the recent recall that seems to be getting worse as well as balance issues..I think our neuro will be very helpful if and when it comes to the assisted living situation..he does not dance around the mulberry bush he is straight forward.
Sid was seeing his neuro every 6 months, and was given the mini mental each time. USELESS. Absolutely useless unless there is a major drop from 29 to 18 or something like that. No matter how much Sid declined at home, he always aced the mini mental. Finally, on the last visit, his true functioning showed up on the mini mental, and he did drop from a 29 to a 21. The doctor was concerned. I was not. The test simply caught up with his outside functioning.
Just my opinion, by WE, who live with them 24/7, have a much better idea of their functioning than a quick test.
I know the mini mentals are not written in stone. My question was do the neuro's still check the patient from time to time and if so why. I probably didn't phrase it properly in the first post. I know my DH is worse but when I ask the neuro he always says mid stages. DH doesn't know what day it is and asks every day. He has to stop and think how to turn on the electric kettle, has just about forgotton every one we knew, cannot explain himself and is searching for the words he needs when he is trying to tell me somthing. Most times I have no idea what he is talking about....BUT he can still take care of ADL's and there is nothing wrong with his appetite although he has lost weight from 186lbs to 150lbs.
My wife has been followed by her PCP from the start, after 3 neuro visits. We don't do any testing. Her doctor relies on my observations, and makes sure I am doing OK. Since there is nothing that can be done for AD, what is the use of testing?
Jean--This (http://www.alzinfo.org/clinical-stages-of-alzheimers) is the most comprehensive description of the 7 Stages that I know of online. By comparing your husband to the info here, you can come up with a better idea of what stage he's in than your doc can.
My husband was going every six months, now going to yearly unless something happens to warrant going sooner. His neuro has done the MMSE every time but does not include the clock the last 3 visits. Why, I do not know. But, she also does not say much about it. In fact, the only way I know the score is to look over her shoulder or wait until I get the doctors report. I always go to the admin office after every doctor visit to request the report - that way I have his complete medical file.
I agree with others, it really does not matter what the score is cause it doesn't say a lot. My husband is down to 20 but he still drives fine - just can't remember how to get to places so he can't drive alone. There are places online where you can get the test if you want to do it yourself.
Go read the stages but do not get hung up on them as we have all found out, our spouse can be in more than one stage. It all depends on what part of the brain is affected of which we do not need a doctor to tell us.
2006--Mini Mental part of NeuroPsych testing score was 11.
Last score for full Mini Mental was 4.
Last Spring, at Dr. Appt. Nurse gave a couple questions during the check-in. Spell "World". Followed by Read this to me, as she handed him a paper. He failed both.
In all instances the testers were informed DH is multiply Learning Disabled and cannot read nor write.
The Stroke Scars they found were more conclusiive as evidence of his Va D, In my mind,than the MMSE.
USELESS. Torture for your LO, because all it does is remind them of all they cannot remember, accomplish, say or do. It's for the benefit of researching thousands of AD patients and somehow, it marks the decline that takes place.
I loved my husband too much to do that after the third time.. and it made no difference at all. His doctor claimed she could no longer treat him with meds if she didn't have this report and I challenged that and won! She needed to treat his symptoms, not the grade on a psychologist's report.
Who cares if they score 25, 15 or 5 on the MMSE. Nothing changes. I wanted him to continue to have self-esteem, and reminded him over and over what a smart guy he was... and often would brag on his career accomplishments in the presence of others, for no other reason than to make him feel good about himself. That MMSE does NOT do that, quite the contrary.
I repeat, it was a USELESS waste of time and it's not fair to do that to our LO's.
I agree, waste of time..my DH has had MMSE every six months, due again in March. At first did well in the Dr's opinion, DH went from 18 to 20, was was able to get his meds on the consession list. Last time his score was 15, so since he scored less, no more consession meds...would have to pay full price What's the point of these tests, they should come and live with him for a couple of days...that's the real test of how he's doing! Today is one of those days...not good.
Despite H's many, many tests, and four full neuropsych evals, I don't think he ever had this test. The drop in the iq has been recorded, and the other tests such as the clock drawing, etc. as well.
As I have noted in previous comments when the MMSE has come up, and have noted in a few journal articles ... this test was never designed to test for dementia and it is being misused as a test for Alzheimer's. In my wife's case, she receives a battery of cognitive tests, including the MMSE, once a year because she is enrolled in a longitudinal study at a major NYC hospital. On her last battery, 12 subtest scores were at the 0-1% level. But bless that MMSE ... she was still at a 26!! The MMSE is meaningless when it comes to testing executive functioning and so many other skills.
When my husband was seeing the neurologist regularly he only did the MMSE once a year. He believed that doing it more often than that was not necessary. He always checked his reflexes and balance and strength. He would ask me questions about what I observed and what I felt needed to be discussed. I know we were lucky to get a good neuro the first time around.
I found the MMSE very helpful since my DH was very good at social chit-chat and moving the conversation away from things he couldn't answer. The last time he was tested was by a med student under the direction of the PCP. My PCP told the med-student to engage in conversation then do the MMSE. Ha, a great conversation and then the first question, "what year is it?" hesitant answer 2005? Yikes. Afterwards my DH would always ask me how he did and I would say fine. I found the MMSE a good validation tool for me to judge how he was doing from the last time.
Maybe someone has already mentioned that our spouses learn the questions and the correct answers. I saw my husband rehearsing for the next mini test. Even when he could no longer feed himself, he knew how to spell "world" backwards. Early on in the game, he used to spell world " h-t r-a-e" just to see the look of bafflement on the doctors' faces before they clued in he was spoofing them.
I got the date wrong. Coco, the snow is gone, but the road conditions were so bad, I didn't make it to class one morning. You know that Dunbar is hilly as it slopes down to the Fraser River, and I live at the top of one of the steepest hills. I looked out my kitchen window a week ago Monday (heavy snowfall and lots of thick ice underneath) and saw four cars splayed across the street, one blocking the exit of my garage. More cars came, trying to get up or down the hill, and sliding into the already stranded cars. Then Busters Towing Company came, a couple of cops, and of course every stray dog and small boy in the neighbourhood. My lawyer neighbour, whose brand new SUV, a Christmas gift to his wife, was pinned in by his cleaning woman's car (no snow tires), dragged out wicker garden furniture to block off the street from any other vehicles entering. So that meant no cabs were coming in, either. The plus side is that our street has been cleaned and sanded ever since. We had snow for about 4 days; then I finally got in a young man to shovel my sidewalks, and it rained the next day, and all snow disappeared. The Fraser Valley where your sister lives was badly hit, and many of the schools closed.
Has your husband been diagnosed by a neurologist specializing in memory disorders? Has he had a mini-mental? I am no fan of that test. Up until recently, no matter how badly Sid was functioning at home, he always aced that test.
It's supposed to give a snapshot of how one is functioning in different areas, but it is notoriously inaccurate.
Lloyd was diagnosed by a neurologist. Our first visit, he handed Lloyd a pen and Lloyd had no idea what to even do with it. I have looked at the mini-mental on line and I know for a fact he would score a zero. Lloyd is not really functioning at all. Everything has to be done for him. The only thing he can still do is walk and go to the bathroom with help. Occasionally he can still hold a glass and take a drink, but that is pretty much it.
my husbands family doctor gave him the mini test and fail all of it , later the doc. told me his short term menory was bad . but his neurologist doc. said he just dont but a whole lot of faith in the mini tst . what do you think about this?
I agree with his neurologist and others who've posted here. If you want to compare hb's tests from various times, it might be interesting, but it really doesn't describe function. I think Joan's Sid did well on it, but didn't function so well. And, someone today said their spouse drew a grandfather's clock in detail. My hb hasn't seen a neurologist for a couple years. I stopped taking him when it seemed unnecessary since our gp could do the same thing; and there's no getting better.
I think the test is too easy...my revisions would be: 1.What is the date 76 days ago? 2. What season is it...(only correct answers are Christmas, halloween, thanksgiving, fourth of july, tourist season, easter, school season, ) 3. What day of the week is it?? Score 10 points if they say today) 4. What town,county and state are you in...(bonus points if you are on a cruise, and give gps coordinates. 6. Count backwards from 100,000 by subtracting 237 each time. 7. Spell the word "aequeosalinocalcalinoceraceoaluminosocupreovitriolic" backwards. 8. Draw a picture of yourself, and be sure you add glasses, beards or mustaches, and wrinkles. 9. Repeat the following "peter pepper piped a pickled pepper and prefers to pick prunes. 10 What time frame are you in...past, present, or future....score extra points if they ask for a present!!
Scoring is very easy... perfect score to those who refuse to take the test and say it is worthless.....(this indicates no mci or dementia) passing score if they crumble up the paper after a few attempts fail- if they speal world backwards, draw a clock, draw a pentagon, or remember three words that you did not even mention....
Oh Phranque - so glad you are hanging around. I would fail the test by a mile - too much thinking!!
As for the MMSE - it only measures certain areas of the brain - mostly short term memory. I think it is good to put red flags up for most (does not include Joan's Sid) to do further testing to rule out.
In October my husband scored a 20, down from 22, but he is still high functioning. It does verify that his short term memory is a problem.
The first time our FP administered the Mini Mental Test, my DH came home and proudly announced he had passed with flying colors!
I asked what was on the test and then discovered that "flying colors" is apparently a very subjective characterization.
The doctor asked who the current Secretary of State was. DH answered, “Madeline Albright.” Well I suppose if you were living in the year 2000 that would be correct. Colin Powell, Condoleezza Rice, and Hillary Clinton may take offense at having been so easily forgotten. For anyone else that wrong answer might have been no big deal. I'm sure there are plenty of people who have never known who the Secretary of State is. But for my DH, that wrong answer was troubling; he was a political junkie.
The doctor asked DH to count backwards by 7's. He started missing at the 3rd number and the doctor stopped him and said, “Do you want to try that one again?” He then let DH begin over. Heaven forbid he acknowledge DH’s difficulty! Then he might have to figure out what was causing it, and treat it.
My opinion is that the widespread use of the MMSE shows us what an extreme lack of good diagnostic tools exists for AD. The advantages are that it is quick and cheap, but as practically everyone has said, not very reliable in some patients. We visited my husband's neuro every 3 or 4 mos. for 6 years, because his challenging behaviors required careful medication management. I never asked about the MMSE score--it was irrelevant to me.
About a year ago,DH was in for his check-in with his Neuro-Psych Dr. The nurse took usb ack, checked DH'sBP, Temp., and asked a couple mini menal Questions.
When she asked him to spell "world", I couldn't refrain from reminding her,"He's multiply Learning Disabled--can't read or write."
She then handed him a laminated sheet and asked him to read to hjer.
I bowed my head in disbelief. The last Mini Mental Score we had, a couple years ago was 4.
After the initial DX I can see no reason to administer this test. The test reveals no relevent information the MD couldn't obtain form any one us and what difference does it make documenting the patient's decline. Meds are ordered in response to symptoms, not test results. One thing the test assures DEPRESSION for all concerned. Best advice was when Neuro said due to Liver and Cancer dx he could not place DW into trials in the future. He said, " stick with PCP. There are few weapons in the war on AD and he know when to fire them."