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  1. #1
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    Addenbrookes ACE-R...........please explain

    After much begging I finally got my dads GP to recommend him to the over 65s mental health team. As mum is in denial still, and will not take him to the GPs for tests, they came to the house.

    They sent a copy of the report to my parents which states the MMSE is 21 - it was 27 one year ago but it also states Addenbrookes ACE-R is 73............i can't work out (a) what the test is or (b) if this is proof he has dementia/alzheimers.

    They have both declined a CT scan and ANY help from CMHT.

    I'm beyond angry/upset/frustrated/tearful with mum, she just won't allow help for dad.

    Can some one explain the Addenbrookes thing? Thank you.
     

  2. #2
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    Hi Tracey

    Took me a while to find it but the ACE-R test is:

    The ACE-R is a brief cognitive test that assesses five cognitive domains, namely attention/orientation, memory,verbal fluency, language and visuospatial abilities. Total score is 100, higher scores indicates better cognitive functioning

    You can get more details if you Google ACE-R Test.

    Hope this helps




    Quote Originally Posted by Traceych68 View Post
    After much begging I finally got my dads GP to recommend him to the over 65s mental health team. As mum is in denial still, and will not take him to the GPs for tests, they came to the house.

    They sent a copy of the report to my parents which states the MMSE is 21 - it was 27 one year ago but it also states Addenbrookes ACE-R is 73............i can't work out (a) what the test is or (b) if this is proof he has dementia/alzheimers.

    They have both declined a CT scan and ANY help from CMHT.

    I'm beyond angry/upset/frustrated/tearful with mum, she just won't allow help for dad.

    Can some one explain the Addenbrookes thing? Thank you.
     

  3. #3
    Hi

    I understand that the MMSE is out of 30 so last year 27/30 would be very good. Anything under 24 shows signs of cognative problems. I think that medication can be given from around 20?
    Last edited by Onlyme; 24-03-2012 at 06:05 PM. Reason: put under 21, meant 24

    Lemony xx


    When life gives you lemons make lemonade.
     

  4. #4
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    Sorry I forgot that bit = was chuffed in finding the ACE-R thing!! and you are right the MMSE is out of 30 . My mothers last one was 11 but she is well looked after by her carers and me so I dont worry too much


    Quote Originally Posted by Onlyme View Post
    Hi

    I understand that the MMSE is out of 30 so last year 27/30 would be very good. Anything under 21 shows signs of cognative problems. I think that medication can be given from around 20?
     

  5. #5
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    Thank you.

    The ACE-R site said anything below 82 means dementia is present!

    That coupled with 21/30 means he must get help now, with or without their consent........doesn't it? Please tell me the GP can't ignore that?
     

  6. #6
    Quote Originally Posted by Traceych68 View Post
    They have both declined a CT scan and ANY help from CMHT.

    I'm beyond angry/upset/frustrated/tearful with mum, she just won't allow help for dad.

    Can some one explain the Addenbrookes thing? Thank you.
    I had the same with MIL. She thought that FIL was just getting old when he knew he had memory problems and therefore she wouldn't get him any help or take him to the Dr. He went downhill due to lack of medical intervention and died because she just thought having pneumonia was normal. When she became ill herself she wouldn't have any help and told the SW that I would be there to do my duty. I used to cry with the strain and frustration of it all. Everything I set up she managed to undo or cancel.

    Lemony xx


    When life gives you lemons make lemonade.
     

  7. #7
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    I found this about ACE-R scores on this site:-

    http://www.webmedcentral.com/wmcpdf/...e_WMC00843.pdf

    The ACE-R is scored out of 100.
    Scores in the mid 80’s suggest serious cognitive
    impairment or dementia. Most healthy elderly
    individuals will score in the 90’s. The ACE-R can
    identify patterns of cognitive and memory impairment
    that are useful in differentiating Alzheimer’s disease
    from fronto-temporal dementia variants, vascular
    cognitive impairment, and Lewy body dementia.

    This would be combined with blood tests and scans to help determine the diagnosis.
    Try to get your Mum to agree to get help for your Dad as they may be able to prescribe medication to help slow down the progression of the disease if he does have one of the above. Best wishes, Nita.
     

  8. #8
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    Is your mum legally allowed to overrule your dad's right to treatment? That doesn't seem fair.
     

  9. #9
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    The test you refer to is the Addenbrookes Cognitive Examination (Revised), often referred to as the ACE-R.

    Like the MMSE (Mini Mental State Examination) it seeks to establish whether a patient has function within the "normal" range or has deficits.

    The ACE-R test seeks to address weaknesses in the MMSE. The MMSE, for example, relies heavily on verbal testing and memory but neglects important areas such visuo-spatial skills or executive function.

    It is thought that the ACE-R by testing a wider range of skills is more sensitive to what may be the early signs of dementia and it more accurately identifies deficits in specific areas and thus may be more useful in identifying particular types of dementia, since some have the signature of causing problems in specific areas, sometimes before the most obvious ones are apparent.

    In short the ACE-R is regarded as being more sensitive, more accurate and more specific than the MMSE.

    However, a low test score on either is not definitive; some people, for example, may always have had scores below what is considered "normal" and the tests can be affected by factors such as innate intelligence, education and even how the patient feels that particular day or relates to the person giving the test. Both MMSE and ACE-R attempt to compensate for these factors.

    A low score on either test is not conclusive proof.

    Dementia is not a disease - it describes symptoms. The symptoms are caused by a specific disease or combination of them. For example, Alzheimer's Disease (the most common) or Vascular Dementia (the second most common).

    Since there is no definitive or specific test for these diseases, the diagnosis is a process of elimination (ie blood tests or scans for conditions which can be found in such tests), face to face examination and history.

    It is usually possible to make a reasonably firm diagnosis of something like Alzheimer's if:

    The symptoms the patient presents are typical

    The progression of those symptoms are typical

    The diagnostic tests reveal nothing to indicate something else at work

    Both MMSE and ACE-R are useful tools, but they are not definitive in themselves. If someone has a score than is lower than the "normal" range (which for MMSE is, I believe, 27-30), their score progressively drops over time and they display the typical problems of cognition and memory then a diagnosis of "dementia" is probable.

    My best guess is that your mum is frightened and in denial. She may have read about dementia, or known someone with it, and realises what the implications of it being found in her husband are

    It's also possible that your dad does not recognise his problems and thinks there is nothing wrong (which is extremely common) and/or is also in denial and that your mum is colluding in this (subconsciously or otherwise)

    In short they may both be hiding behind excuses like "it's just old age" and are avoiding seeing a doctor for fear of being told otherwise.
     

  10. #10
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    Quote Originally Posted by Chemmy View Post
    Is your mum legally allowed to overrule your dad's right to treatment? That doesn't seem fair.
    No, she cannot. However, what she can do is not co-operate if her husband is unable or unwilling to arrange treatment for himself.

    In other words, if your dad can't or won't make a doctor's appointment himself and it therefore falls to your mum to do it for him then her refusal to do so is in effect denying him.

    The doctor can't make unsolicited appointments or examinations and may be blissfuly unaware of your dad's reliance on his wife and her refusal, they almost certainly would assume it's your dad's choice not to.

    Unfortunately, it;s entirely possible that your dad is also in denial or refusing, and your mum is essentially colluding with this for her own reasons - which are almost certainly nothing to do with being uncaring but more likely denial and fear on her part
     

  11. #11
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    Thank you all for the information, it helps with he ammo to prove to mum there is a problem, it's not just 'old age'.

    She is very old school and believes he will be taken away from her', wrongly i know. They are together 24/7 and apart from immediate family do not socialise. She is frightened so it's easier to put her head in the sand.

    Thank you all again x
     

  12. #12
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    So sorry to hear about your dad's problems.

    I know it isn't the best argument but.... In the given financial climate social services etc will do everything they can NOT to put someone in a home because it can cost them too much! If your parents have enough money to pay for their own care social services won't even help unless heavily leaned on never mind insist on a home (as you can see on here from other peoples stories as they struggle to get help ).

    Would explaining that help your mum realise that your dad won't be 'taken away from her'. The other thing which might help is that if your dad gets a proper diagnosis there are some medications that can help. Sadly they don't cure dementia, aren't suitable for everyone and don't always help everyone but they could give your mum a little hope and incentive to let the scan go ahead.

    All the best for the future.
     

  13. #13
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    Hi Tracey

    You have received a wealth of information here and I am a great believer in knowldge is power so I hope it helps you convince your Mum to get help for your dad. The earlier the better.

    Best Wishes


    Quote Originally Posted by Traceych68 View Post
    Thank you all for the information, it helps with he ammo to prove to mum there is a problem, it's not just 'old age'.

    She is very old school and believes he will be taken away from her', wrongly i know. They are together 24/7 and apart from immediate family do not socialise. She is frightened so it's easier to put her head in the sand.

    Thank you all again x
     

 

 

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