I am wondering what exactly should the diagnosis procedure for dementia be.
I recalled my late FIL had verbal test in office for 3 hours and given his serious symptoms, he was diagnosed right away by the psychiatrist in the behavior center with early stage of Alzheimer's.
Today I heard some funny tale from my Mom. She said she and Dad were in the GP's office some 2 years ago and suddenly a nurse/intern came in saying she wanted to practice so she asked Mom some questions and Mom failed, and the "student" asked Dad the questions again and all were in the same office???
It sounds ridiculous to me and I don't think this is proper for MMSE and they were not prepared (it was outpatient visit for checkup.)
I would think that the MMSE test is done properly given proper instructions and acknowledgement. If the person is in early stage, he/she should be told there is such test.
I think this test my parents did was too fast and not professional enough. It took only a few minutes.
You are talking about two different things here. The MMSE is just a short 30 question test that doesn't need any preparation. You can look up MMSE (Mini Mental Status Exam) and see the questions ask. It can actually be woven into any conversation. It can be identified as a cognition test and just ask straight forwards. Identifying it as a cognition test, in some cases, will scare some and why some doctors just do it without identification when they suspect the patient is suffering cognitive decline. Mom's doctor never identified the MMSE as a cognitive test. They knew, if they had, she would refuse to take it. She had a clue there was something wrong and she was determined to hide her inabilities. Recently, new diagnostic recommendation, have added the MMSE to the standard treatment protocol for any elderly patient. Hopefully it will become as common as blood test, weight, and vitals. It is nothing more than a first step screening to determine if there might be a problem.
What your Dad had was a much more extensive cognitive evaluation. The MMSE is used to determine if this testing is necessary. After the low score on Mom's MMSE she also had the more extensive testing. There are actually two of these long cognitive test sessions. Mom had a total of 6 hours of testing with an hour break between them. With these test, the doctors were able to tell me exactly what areas of her cognition she was having the most difficulties and which were still functional. After these extensive test was when I received her diagnosis.
The MMSE is nothing more than a short test that any doctor can do to determine if there is the possibility of cognitive decline. It is quick, easy, and inexpensive. It takes the longer series of test to determine what those problems are and how serious they are. These extensive test take longer and are more expensive so they don't need to be done unless a problem is indicated. So consider the MMSE nothing more than a screening test. The extensive cognitive testing is what determined if the decline is present and to what extent.
The Following User Says Thank You to Gabriel For This Useful Post: ninamarc (04-05-2013)
I think the GP should probably explain to my sisters later about what is going on.
Dementia was not diagnosed and validated. It is just a doubt. He told my Mom to take the multi-vitamin. (Guess it is for B6/B12.)
Sometimes I think the GP thinks people are stupid so they don't explain everything.
So there is no drugs like aricept prescribed as asked by my sister. It tells me that
the GP didn't think such failed MMSE test by my Mom is a big deal. But he didn't really talk about it.
It is suspicion of dementia, not dementia for sure but my 2 sisters went along like Mom has dementia! Now I dare ask them what type???
I mean, for example, MCI is not dementia but also a mild cognition impairment.
This is the problem with seeking diagnosis and treatment for dementia related diseases. The medical professionals don't even take the result of a standardized screening test seriously enough to refer them to those that can diagnose!
So Mom made a 24 out of 30 on a cognitive assessment test? Let's just pretend it's ok and go forward. The problem is that you can not go forward. You only have the doubts and questions of before... does she doesn't she? Some doctors go ahead and prescribe medication to treat dementia but yet do not put the diagnosis on the chart or tell the family. Some don't even give the medications. The very sad part is, the medications do a better job in the early stages. The stage where doctors are ignoring the problem. In the later stages when we all know what it is without a doctor's help, these medications are not nearly as beneficial but get prescribed frequently.
The multivitamin is a JOKE. There is not enough B vitamins in a multivitamin to make a difference. If there is a B vitamin deficiency (which can be easily determined by blood test) then it takes a lot more than what is in a multivitamin to make a difference.
If your sister are with your Mom, and they understand dementia, then they probably already know what is going on. They know Mom has cognitive impairment (dementia). What they don't know is the type or cause. My major complaint with the medical community and their lack of ability to recognize, diagnose, and treat dementia related cognitive decline is that there are causes that are very treatable especially if caught early.
This is why I encourage those who suspect their loved ones suffer from cognitive decline to find a doctor that will do the appropriate testing to rule out treatable causes and to then give a definitive diagnosis. If doctor one just passes it off as dementia then go for a second option. Find a doctor that specializes. Go to a memory clinic, geriatric psychiatrist, geriatric neurologist, or dementia specialist. Do not stop with the GP who may have absolutely no idea what to do for your loved one except pat you on the back and tell you to come back in 6 months. Ask for referrals!! Change doctors!! Whatever it takes.
Mild Cognitive Impairment is just that... Mild Cognitive Impairment. It is one of the dementia diagnosis. It may be the early stages of something more sever that is not diagnosable at the moment. It tells you that you are in the early stages of something that may or may not develop. It means you need to be under the care of a cognition specialist, tested again in 6 to 9 months to see if there is a progression, and followed up with to determine if it is progressing. This is the critical stage when medications and follow up can help. The problem is, most ignore the the symptoms (doctors and family) until the problem is more advanced. That is why an early MMSE, with proper interpretation, can be so important. Even a score of 29 should be followed up with further testing, repeated periodically, to determine the advancement of the cognitive decline.
I htink a lot of this has to do with awareness. Many do not understand this disease, unless they have had a loved one with the disease. Doctors do not have hope to give. There is no cure or treatment. It is a diagnosis worse than cancer. It is a terminal illness with no sure fire diagnostic test. You can't take a blood test and know you have it. For these reasons many doctors why away. So we the care givers keep trying to educate
The last thing I heard from my sister is that that test was very casual and Mom didn't "fail" it but didn't do well either. Not sure what it is. The GP doesn't help explaining. No drugs given as requested by my sister. Basically my 2 sisters just guessed Mom has dementia and told her that!! It is just suspicion and I told them that Mom needs to be diagnosed when there is a chance. I found there are 2 issues here: the sisters and the GP.
I think what my other sister did was wrong: she told my Mom in her face in the family party that she has Alzheimer's and blah blah blah? Not sure what she wanted to accomplish. So I wrote them in emails saying it doesn't work that way. It needs to be diagnosed.
The thing is what was that casual test? It may not even be MMSE. Like I said, it was done by the "intern". Mom didn't fail anything but she had trouble with this time thing. She said she was not prepared...
The MMSE does not have to be given by the physician. It can be given by anybody that understands the test and follows the simple instructions given. Mom didn't do well is all you need to hear to know she needs further testing. There is no way to "prepare" for that test. It ask day, date, who is president, draw a clock, count backwards, etc. These are things we do every day. Those with dementia will make "excuses" for not doing well. They might make sense if you do not understand the test. A common excuse for not doing well on a test is that we were not prepared. Sounds good, but doesn't apply in the case of the MMSE. It is like being prepared for a blood test, there is nothing you can do If the intern ask Mom questions similar to the MMSE on line, it was the MMSE.
As for sisters, because of the symptoms you can suspect but you do need a diagnosis to be sure it is not something that can be treated. That is because the diagnosis rules out all those other conditions with treatments. That is why you should not just jump to conclusions and perhaps what you need to tell the sisters