Got back for the psychologist and the MicroCog Assessment - is that the same as the MME? - shows that he was average for a man his age 70 - 74. But for someone that was 34 - 37 years old he was low average.
Now I know I'm not imagining this because just today we stopped a Subway to get a sandwich and when the clerk asked him what veggies he wanted on his sandwich he couldn't tell her and he's had this same sandwich for years. Plus he is the bartender for a service club he belongs to and he put away the cash box before we left in the morning and he has almost taked the cabin apart and he can't find it and his driving is jerky. So what gives or is this one test and I need to wait and see what the others say.
Patience is not something I have alot of regarding this. I'm want an answer. This sucks!!!
I don't know what the MicroCog Assessment is. The MME (mini-mental exam) is a series of questions they ask that target different areas of the brain to determine how each is affected. I don't have a lot of faith in that test -it is accurate if the person is in advanced stages, but many people in the early stages manage to use strategies to score higher than they really function.
Having worked in the Special Education field for over 20 years, I am very familiar with a variety of cognitive tests, and have administered many. Just my opinion, but I feel that complete cognitive testing by a neuropsychologist, along with the spouse's input as to daily functioning, is the best indicator of the stage in which the person is functioning.
Amber, I often feel I'm the one who is losing it. I have even gone over some of the test questions from the MME and have practised counting backwards in 7's starting with a hundred which is one of the tasks! This morning I was convinced our front door lock was broken but had forgotten to undo the bolt at the top and bottom. I think we are under so much stress that we do stupid things. I hope you get some answers soon. At least it puts things in some perspective.
Or the really fun part, naming glasses, watch and pen. I started counting backwards by everything just to keep my brain going. I also spell any words I can think of backwards.
I'm so glad I'm not alone! Our answer is apple, table, penny and I also can spell world backwards! We see the doctor today. I just hope he makes enough time for us as I have so many questions about meds. Will report later. Inge
I really do think it is useful for us caregivers to give ourselves one of the many mini-mental tests you can find online. And then think about the questions our LOs can't answer. I think it is useful especially when you are looking for a diagnosis. In addition, there are multiple stages of [fill in the blank] out there. Take a look at those too because it is the combination of the two ways of looking at dementia that give the clearest picture.
It also helps if you know the stages to take a log with you to the doctor so you can give him something to look at. It was especially helpful at my husbands most recent appointment (last week) because there wasn't anything major to report. So I know that my feeling that he is on a long plateau is right. I think there are minor slides in abilities, but they really are minor.
The more you educate yourself, the easier it is to discuss all of this with the doctors.
Right on, Starling. I always fax a "report" (log) to the doctor a few days before our appointment. He is so grateful and is able to deal with any issues I may have in a better way. So far, it has worked out wonderfully well.
Do the Neurologists/Psychologists just come up with ANY three words, or is there a significance in the fact that they all seem to ask that the same (almost) words be remembered....I know it's always apple, penny, (NEWSPAPER) table. (4) ...The first time I heard this, I immediately thought to myself that I'd remember the words by thinking: "Sitting at a TABLE, eating an APPLE, reading a NEWSPAPER that I bought for a PENNY. I told my husband how I'd remember those words that day - as we were driving home. WELL, about a week later, we went back to the doctor's office and an associate of hers asked him to remember the same few words. I looked across the room at him BUG EYED..nodding... (sign language for "remember how to remember those words". ) Of course, he ignored ME..and a few minutes later, couldn't remember a single one. That was about 4 years ago!!!
Who learned the lesson from this!!! Of course, it was ME!!! .... Ya can't teach Alzheimer's people NEW TRICKS! I was trying to teach him how to remember. If I could master that trick, I'd be a wealthy woman, living on a Caribbean Island - with a cute bronze skinned guy serving mojitos and sliced bananas at my beck and call!
Apple, Penny, Table were the 3 words used at IU Med Center. When we changed Neurologist to be closer to home...the new Neuro gave my husband chest, nickle, glasses as the 3 words, guess what words he recited... Apple, Penny, Table & was as proud of punch. That told me the 3 word test was a worthless test.
Again, I am wondering..why these same words? I'm going to email our psychologist and ask if there is a specific reason ALL of our doctors use the same words. (chest/table..could it be the doctor asking the questions was from another country?) ie, Divan/Sofa... bureau/chest..
I emailed our doctor re: the similarity of words they ask the patient to recall in the Mini Mental Tests. Thisis her reply, verbatim: _________________________________________________ The Mini Mental Status (or State) Examination (MMSE) is a 30 Item screen of cognition. Folstein's version of the MMSE is most commonly used. In that version, the three words are "ball, flag, tree". The test is widely used, so MDs are trained to administer it early in their medical career - hence the consistency of administration across practitioners. There is some variability based on what version the MD originally learned.
No coincidence. M*****K******, M.D. ___________________________________________________
When my wife was seen by the neurologist 4+ years ago the three words were: brown fox, snowball, and 35 Pine Street. See, I remember them :-) What I don't remember is how many she could remember at the time.
There was ONE time I nearly LOST IT in the doctor's exam room. We had a "Fellow" from Korea come in to ask DH questions. This is his least favorite part of going to the Medical Center. Lots of docs parade in and out of the room and it takes forever.
The Korean doctor was checking his speech. She asked him if he could please repeat after her these words: "Mefrodisk Epriskropral". H asks, "Pardon Me?" She repeated the words a bit louder" "Mefrodisk Epriskropral" ... H looks at me with "those eyes"..and I was sitting there, holding my breath, biting my tongue. (You know how we want to help them.. but can't)...
I had to butt in and say, "Honey, she wants you to say "Methodist Episcopal"...which he WAS able to say. Much better than the Korean doctor ever could. She needed to select some other words to test patients speech with.
Reminds me of the time I was trying to buy a lap top and the poor lady from India was trying to tell me I could get one at Walmart on Okeechobee Road. You don't want to know how that came out!
My husband just cannot understand people speaking with an accent, he has never been able to. He particularly could not understand a nurse who came in for the night shift ten years ago, who spoke with a Scottish burr. Hell, *I* couldn't understand her either.
My name is Clare. Many Asians (a word, Nancy, I prefer to "Oriental") have trouble with LLs. They pronounced them RR. Or sometimes vice versa. So I had been introduced to this girl named Rina, or was it Lina? I never did understand. Meanwhile, when I order sushi, forget and say I'll pick it up, my name is CLARE. They just can NOT pronounce it. OTOH, who among us can roll their RRRs like the French do? or lisp like Castillian Spaniards?
Clare, there are some people here in the U.S. who speak so fast that I can't understand them! Being a Southern lady, I am used to speaking a little more slowly!! (I refuse to give age ANY credit!) And don't get me started on the computer repair phone people! Not only talk fast, but I had trouble understanding some of what they said as well. Heck, I had trouble talking to some people in England when we were there! I've had my hearing checked and it is okay. Guess I'll have to credit age after all!
I told my doctor last week that I cannot hear as fast as he talks. He was impossible to understand..never took a breath. Teenagers talk fast, too. I'm always asking my grandchildren to slowwwww down.
Yesterday the neurologist gave my hb the MME. She said he scored 25 out of 30. I sat by him as he answered her questions. Didn't have all the same ?s as the first time, and I don't know what his score was then. She did it because I asked how we could tell if the Aricept and Namenda were working, I think. Anyway, our family knows he is NOT normal. He's lost his driver's license, he didn't know what season we're in, but did not we're in May but not the day. (If I didn't work "outside the home part-time," I probably wouldn't know days, either. He couldn't subtract 7 from 100 (didn't understand what she meant), but he could subtract 7 from 10. Didn't know what county we live in; didn't get the town correct, either; but we live in the country between 2 towns we frequent for shopping, etc. and he explained that to her. When we go into a store he follows me like a toddler.....well, anyway, ...He told her he had dementia as he pointed to his head.
My dh hated those tests. He is so severe that they no longer apply but you are right. It is so hard for them and we want so badly to answer for them in hopes that they will say they made a mistake and dh does not have alz. In 2004, (three yrs after dz), my dh had a mini stroke. While at the hospital, the drs asked me questions about his gate. They had noticed in their testing that he had some of the symptoms of nph (normal pressure hydrocephalus). They did a spinal tap and dh really improved!!! Thought a shunt would be helpful. Of course, We wanted this to be the answer and so we talked and decided to have one implanted. It did relieve some of his symptoms but the underlying dementia was still there. I also recall a story told to me by a coworker. Her 5 year old son had a stroke and in speach therapy, they kept telling her that he was not progressing very well. On the next session, she asked to watch as the therapist did the therapy. Turned out, she had a very southern drawal and even she could not understand some of the words. As wonderful a person as the therapist was, Mom asked to change therapist and she interviewed her before beginning to work with her son. He progressed beautifully and today you would never know he had a stroke.
Mary...I have trouble understanding people who talk fast also. When I first got my computer and had to call on problems it was very hard to understand what they were telling me. I finally told them I was and old lady (true) with a hearing problem and to please speak loud and slow. They usually were patience with me and we worked through the problems. One lady got so frustrated with me that she e-mailed me detailed instructions. It also works to play old and senile on the phone with some of my nuisance calls. My late sister was a wiz at this and after she got the caller confused she would hand the phone to her husband and he would pick up right where she left off. I don't know who was getting the most enjoyment out of the situation...the caller or them.
I was relieved to read Joan's mentioning how high SID scores on an MME, but how he doesn't function the best. A month ago my hb scored a 25 and I was told that's "normal." HA. He can't drive, can't solve problems, but can read a 3 step instruction on a piece of paper and follow them. He can't follow detailed or oral instructions or "fix" stuff. Last night he watched a CUBS game for the FIRST TIME in his life that I'm aware of. It's slow and easy to follow. He can't follow involved story lines. (When he starts watching golf, I'm outa there.) He follows me in stores, doesn't know people he has known, etc., etc., you get the picture. So, I was enlightened by and encouraged by Joan's explanation of MME.
Just for fun, I gave my mom (87 yrs old), the mmse test yesterday and she scored a 26. Now she does not have dementia, but she did have trouble counting backwards by 7. I downloaded the test online, and I was truly amazed that anyone would use this test to measure dementia...I realize that they may read more into the test than was actually there, but it is so simplistic that I cannot believe that it is relied on so much....I would think they had a more sophisticated test, and that it would be more involved. Good news is that I scored a 30, but I did have trouble with answering what hospital and which floor am I on....so did my mom......we did it at home.... Anyway, my opinion of the test is that it is a quick gauge to measure decline, but not at all accurate or meaningful...It measures nothing about driving capabilities, judgment, reasoning, or following more difficult instructions, and if it is relied upon for diagnosis, then it is no small wonder that getting an early diagnosis is so unavailable..
Well, I thought I wrote an answer to phranque. It seems to have disappeared into cyberspace, so here it is again.
Three cheers for phranque!!!!!! You hit the nail on the head when you wrote "It measures nothing about driving capabilities, judgment, reasoning, or following more difficult instructions, and if it is relied upon for diagnosis, then it is no small wonder that getting an early diagnosis is so unavailable."
That is what the doctor acknowledged. I love that guy.
My husband's neuro says just what you're saying, Joan, that there are FT ALZ patients, and other kinds as well. That's why he says "dementia" not Alzheimer's most of the time in relation to my husband who scores 16 but is very verbal, often making sense! (and often not!)
Believe it or not, I was given a MME as a prequalifier to be discharged from the hospital after my recent fall. Apparently, having suffered a concussion, I did not do too well on one I don't even remember taking. (Morphine will do that to your memory.) I remember being given 3 words, dog, snow, slippers. Then the therapist rattled on for what seemed an eternity & I just blanked out whatever she was talking about & focused on those words. I was going home, damn it! But really, had I not stayed focused on those words, I would not have been able to pull them out of thin air. Then I was not asked to count backwards by 7, but rather given a series of about 10 numbers (it seemed like 10) which no way could I repeat. Told the woman I was never good with numbers. Being oriented to time, person & place & recalling those 3 words got me out of there. Is it normal for them to rattle on & then come back to the 3 words? I was lucky I knew what she was up to.....
There is another test I read about and I think it starts with an S but now I can't remember the rest. They talked about it being more intensive and perhaps to be used in place of or as well as the MME. Some university name I think.
Once again you folks have saved my sanity. My DH was tested again last week and I was told that there was no changes from the test he had 4 years ago, so why have I seen so many changes, not big changes, just little things that someone that is around him everyday would notice. He can do those tests easily, can spell "world" forwards, backwards and probably sideways if they asked him to, but they don't ask him what he did the day before, when the last time he saw his kids, or what we had for our last meal, if they did he would be completely lost. So all your comment have, once again, made me feel much better, thank you all.
At each regular check-up appointment with our PCP, he always asks questions of DH - every day things, like what did you have for breakfast/lunch, etc., where is your son living now, what day is it - just stuff like that. DH can rarely answer correctly to all of them. But I feel these types of questions are more beneficial than any of the other tests given for dementia.
As I have mentioned in the past, my husband always done well on MME test. He still declined every year. Then when we changed Neurologist he gave him his version of the 3 words to remember....my husband recited the 3 words that he had been given in the past, not the 3 words he had been told 5 minutes eariler. As the Neurologist commented, he was able to memorize the previous 3 words, since he had been ask them so many times. That proved to me the test was not reliable. Of course now, my husband would not be able to answer any of the questions presented to him,other than his name.
Yes, there is another test from St. Louis University.......It is called VAMC SLUMS examination. I'm not sure what all of the letters stand for, but obviously, St Louis University something something. I asked for a copy of the test. I do believe it is more detailed than the MMSE, but I'm not sure. It is also based on level of education. I'll have to Google it. Anyone else know about this one?
That is the same test my husband had his last pcp appointment at the VA. The doctor said they are required to give it to all patients now. Not sure if that is all or just those over a certain age. If I remember right he scored a 27 on it. His MME test have ranged from 24 to 26.
The problem with my husband taking the test is they base it on education. Even though he graduated from high school his reading level has never been good, so when in his first neuropscyh test came back 4th grade level reading that is about right.
I sat in when DH as administered the MMSE 2 different times with 2 different Drs. when being Dxd with his mental Illness and when being qualified for Soc. Sec> Disability. With his pre-existing significant learning disabilities, I couldn't figure out how they could get a valid reading. He has never been able to read or write other than signing his name. He could repeat short number sequences (4 digits) frontwards or backward, but not longer number sequences. When ask to remember 3 things the best he ever got was 2. He could draw a clock, but refused to try any other shape drawing. When asked to name 5 states or cities, he named a combination of cities, states and countries. He can still read a regular clock but he reads so many minutes after or to. Doesn't get 10:55--that's 5 to___.
Our three words are 'ball, flag, boat.' I can still remember them. DH couldn't remember them at all even after the dr gave him lots of hints. He could spell world backwards and he could count backwards. Didn't know where he was, why he was there, the name of the town he was in (he's lived here for 46 years),his phone number, wedding anniversary, my birthday, That was almost 2 years ago. Last spring, the neuro didn't give him the MME. I don't know why.
Went to Neuro last week. DH scored an 18 and the dr. was probably being generous. Couldn't remember year, month, date, did get day of week. Didn't know town, street, got floor of hospital and the name. No words, no world and couldn't even do "no ifs ands or buts" for the first time. Only got 2 of the three step directions and couldn't identify names of common objects. I live with the man. I know he's going downhill. I also agree that the MMSE doesn't really tell us what we all want to know, but hearing his score did send me into a tail spin of sorts. Somehow, having a dr. say it out loud made the slip so much more formal and real than the things I see every single day that have simply become my new normal life. Still haven't made my way back emotionally yet.
I'm convinced more than ever that the MME isn't reliable just as IQ tests aren't reliable because of so many variables in each person's life and situation.
To me the mmse test is like giving an iq test to an autistic child......the results are very bland, and not very indicative of all skills....Some may pass the mmse test with a high score, yet they have no judgment or reasoning abililities, or they have other incapacitating problems...mmse tests should only be used as a questionable diagnostic tool, not as a professional evaluation of a person's mental state....Driving, for example, involves many complex decisions, sharp visual skills, spontaneous decision making, and the ability to remember rules of the road....one may score well in mmse, and yet be unable to drive a car.
I agree, Frank. My DH has scored fairly high on the mmse, but he does not drive - even he says he doesn't have the capacity anymore! His reasoning is way off, does not make good judgment calls, can't handle finances, etc. Not a good indicator as far as I am concerned.
They need to revised it so that there are questions/task that test the whole brain area. As we have seen here, everyone is affected in different areas of the brain.
The problem is that the MMSE is designed to be a brief, rough assessment, and it may be that people--including the medical pros involved--are putting too much stock in it.
Emily you nailed it. I think it was just a basic fast screening test meant to merit further investigation. However, it became the standard of the industry so to speak, and there is not a more intensive test. I think we should enrol our spouses in 3rd grade, and give them the school tests, and see what grade level they are at.....
The problem with the MMSE is that it is supposed to be a screening exam. Something the doctor's assistant at your PCP could give to everyone over the age of 45 who walked in the door. It is useless once you've gotten to the neurologist's office. Take my husband. He scores extremely low, but he takes 2 hour walks and comes home on his own (and the doctor is OK with it), is not incontinent, dresses himself, bathes and shaves himself, eats on his own with a knife and fork. His language skills are his low point, and follows the MMSE. But he ranks high on his daily living skills.
Literally the only thing I have to do for him is cook meals and serve them, remind him when the shower day has arrived (he won't take one every day and I'm not fighting that), and put clothes out for him every day.
My wife has just taken a test for the 3rd year. The test last about an hour and a half. It sounds like the MME but is longer. She has dropped 5 points each year. This year she said she did not want to take it any more. The test is very hard to watch take place. The tell a story and then ask her questions about the story. The keep telling it to her and she can not answer much of the questions. She got really frustrated this time and left crying.
The test has been done at UT SW medical school each year.