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Can Anyone Help Me - Re: MMSE?

Discussion in 'Researchers, students and professionals' started by Dearth, Oct 25, 2005.

  1. Yep - me again mithering! :D

    In a couple of weeks, I'm doing a teaching session on using the MMSE... basically, it's along the lines of how best to do it/addressing the person's own abilities and educational background/anxiety during the 'interview' and how it can affect scoring/different scorers giving different marks depending on the answers etc. etc.

    I would very much like info. from people who have done the test themselves, or carers/partners who have been present when they've been done.

    I would also like to use any comments made on this as part of my 'presentation' - I therefore ask that you consider this before replying - this will be presented in front of a small group of students and a lecturer.

    ANY info. most appreciated on any aspect of the MMSE.

    Thank you in advance!

    :)

    N.
     
  2. angela.robinson

    angela.robinson Registered User

    Dec 27, 2004
    520
    Mmse

    hi ,when JIM had his last test ,i wast old to stay with ,a social worker to see if there was anything i wanted to discuss ,i did ,but was concerned about what was going on with JIMs test i said i prefered to be in with him ,but was told they could not stop me ,but would prefer i did not ,as i would distract him ,i insisted on being with him ,so the ss took me to him and the test had already started ,i sat quitly at the back ,but had to speak out when i noticed his glasses on the table """"no one had thought to put them on him , i also noticed that the photos (of a very young maggy Thatcher )that he would not have known before his illness ,was laminated and was in full glare of the sun ,just simple things that would make a lot of difference to the responses he would give ,needless to say ,his score was very low and they said they would not be doing any more ,however he was very much aware of things and was left on aricept at that stage i must add although i can not remember the score the first one was also quite low ,yet to me ,his understanding of things was very good ,it was more his physical skills that was going downhill this continued till his last year,then the mental aspect kicked in good and proper ANGELA
     
  3. Bets

    Bets Registered User

    Aug 11, 2005
    100
    South-East London, UK
    I'm sure you have thought of this, but please ensure that the tester is aware of any hearing difficulties the person may have, and adjust your voice level, position, etc., accordingly. I seem to remember at least one question on the MMSE (is there a sentence repetition?) where an inability to respond correctly may be due to an inability to hear correctly.

    Bets
     
  4. That is something I am aware of, but it is worth highlighting as you know.

    Thanks for posting that... it's going to be included in my talk/session... as is how you say something such as "What county are we in?"... I've done that and changed the words to "Where abouts in the country do you live?" and got the answer... whereas if I'd stuck with 'county' then it would have got a 0!

    The one you mention re: reptetion is: NO IFS, ANDS OR BUTS... at times I've had to slow myself down to do this one because I can stutter at times... not easy to repeat it the way I say it, with those extra b-b's! :D

    And Angela... I think maybe some frown upon another being present in case there's 'help' given... an example from my practice is that I had to 'tell off' the daughter of one lady who was trying to help her mother... I made a joke of it saying I'd make her leave the room (it was her house!) and told her mother "Anymore cheating from you and I'll throw YOU out too!" - I wasn't being nasty, we all had a good rapport and I think that helped immensely!

    Thought I'd share that bit with you!

    :)

    N.
     
  5. angela.robinson

    angela.robinson Registered User

    Dec 27, 2004
    520
    YES ,but i am sure YOU would have been aware that the person should have their glasses ON if the patient was in your sole care?.after that i sat in on everything .angela
     
  6. Brucie

    Brucie Registered User

    Jan 31, 2004
    12,413
    near London
    I know from a couple of the tests that Jan had that I sat in on - well, I really wanted to jump in to help, but didn't.

    The benefit - if you can call it that - for me was the realisation that her condition was really bad.

    You see, when we care for them at home - with no outside help at all - we sort of move in to fill the gap that their waning abilities leaves. We may not even realise we are doing it because it is such a natural thing to do [even down to forging their name on their cheques! "well she wanted the cheque written but just couldn't do it herself"].

    When a third person is probing things we of course want to leap in and help - and that's when we realise that is what we do all the time with almost everything.

    It is a devastating realisation, but there's no point ducking it.

    I still recall the tests. To see a highly intelligent woman unable to copy a simple drawing and looking blankly at the paper is quite heartbreaking. There's a lot of heartbreak in this. :(
     
  7. Don't get me wrong... I'm ALL FOR another person sitting in... in fact, I reckon it can reduce anxiety (which can also impact on the answers given).

    As to the comment you made Bruce:
    When a third person is probing things we of course want to leap in and help - and that's when we realise that is what we do all the time with almost everything.

    I can appreciate that... even as the 'assessor' I've felt that I wanted to help... when someone asks you "that's right isn't it?" and you can't say one way or the other... it's like being some kind of ruddy gameshow host at first: "I'm sorry... I'm not allowed to help/are you asking me or telling me?" etc.

    As to the 'heartbreak' aspect... it must be devastating to see a loved one 'go downhill' and to be informed of scores that only confirm what you are already aware of.

    N.
     
  8. Norman

    Norman Registered User

    Oct 9, 2003
    4,348
    Birmingham Hades
    comment you made Bruce:
    When a third person is probing things we of course want to leap in and help - and that's when we realise that is what we do all the time with almost everything.

    the heartbreak also is when they look at you for help,the one who has helped them,protected them all through their married life.
    And now they cannot really understand why you have let them down.
    Why you are subjecting them to this ordeal.
    You feel a real louse,you want to apologise to them ,say I am sorry sweetheart.
    They will have forgotten all of it before you leave the building,but you won't, you will still have some heartache from the experience.
    Norman
     
  9. Brucie

    Brucie Registered User

    Jan 31, 2004
    12,413
    near London
    yes Norman, and that goes all the way through the process, doesn't it?

    I still feel a louse, being so helpless. The looks that say "please help me..." and the knowledge that you can't.

    well, no-one ever told me what the tests were, or what the scores were, and therefore what the scores meant.

    I had to assume it was pass/fail and since Jan was so incapable of answering virtually anything by the time she had her tests, I reckoned it was a fail. Yet she seemed so normal otherwise at the time. Looking-wise that is. Life was laready very challenging.
     
  10. That's very bad practice!

    :mad:

    I observed someone doing an MMSE today (with the patient's consent) and it went okay... he got 29/30.

    Afterwards, I went back and told him the score and what the test had been done for.

    I HATE all this "You have to ask to find out" cr*p! I've ALWAYS informed folk of the reason for the test and said, "If you want to know the scores/how they compare with previous ones then I'll tell you once I've added 'em up - if you don't want to know, then that's fine too".

    At least give people the option and let the Carer/Loved One know too!

    ****! That's made my blood boil that... sorry to 'go off on one' but it truly has!

    Thanks for highlighting it though... I'll include NOT doing that in part of my teaching session... okay, so it's not going to help you personally I'm afraid, but at least it might help future practitioners in not making the same error!

    N.
     
  11. katieberesford

    katieberesford Registered User

    May 5, 2005
    114
    south wales
    Hi

    David's psychiatrist at his Memory clinic has always been one for informing the patient and carer about all the tests, i.e what they are for and the results.

    Because of the "Freedom of Information Policy" now in force at all hospitals etc. all patients should be sent a copy of the letter being sent to the GP on a patients progress.

    If this isn't happening then ask for a copy of the letter being sent to the GP so that it can be kept in your own folder!! All patients have a right to this info as a matter of patients rights.

    Working as a secretary in a large teaching hospital I should know.

    Hope this helps.

    Katiex
     
  12. JANICE

    JANICE Registered User

    Jun 28, 2005
    23
    SOUTHAMPTON
    Just to back up Katie's comments, I too work as a secretary in a hospital and our Consultants send copies of clinic letters, discharge summaries etc to the parents of our babies.

    When Keith saw the Consultant in August this year she sent us a copy of the letter she sent to the G.P. as during the consultation Keith got a bit angry and said he didn't know why he was there etc so she said she felt it would help him if he had it in writing to confirm what had been said at the consultation. I have to say he seemed a lot happier once he had it in writing, it seemed to help him understand a bit more.
     
  13. Any more info folks?

    I'm compiling the session shortly and I'd very much appreciate input... and a big THANK YOU to all who have already replied - very much appreciated... and not only will I be doing the teaching session at University, I will be doing it for staff on the ward - so the info will actually be used in practice.

    :)

    N.
     
  14. Update on this...

    I've just sent an email to Dr. Marshal F. Folstein - one of the folk who created the MMSE!

    Now some people may be chuffed to meet their idol (I did with Tom Baker - and got his autograph), but for me it's getting input from folk that I can use to further my knowledge/practice effectively... this was the case with correspondence I had with Dr. Hunter 'Patch' Adams, and to Christine Bryden, author of "Dancing With Dementia".

    I'm not putting this info in simply to name drop... it's to let you know how serious I am about my learning... I've asked a couple of questions re: the MMSE to Dr. Folstein and hopefully will get a reply... this will certainly help my teaching session no end!

    :)

    N.
     
  15. Rosalind

    Rosalind Registered User

    Jul 2, 2005
    203
    Wiltshire
    I had an idea my husband found my presence unnerving, so asked him if he would rather I was not in the room. He hates the tests, as I suspect they make him aware of his problems but he said having me there did not help, so I loitered in the corridor.

    I agree with Bruce that it does draw the carer's attention to the sufferer's decline. A year ago, sitting in a room with a rich autumnal beech tree with golden brown leaves right outside the window and very visible, my husband said it was spring, summer and winter, but not autumn. This is the sort of thing that makes one despair.

    Having sat in on a number of tests, I think the words Apple, Penny and Table are etched on my brain, but he has never been able to remember them in any test since the problem started.
     

  16. Interesting that you should mention that...

    The words of course can be varied if necessary... such as in the spell "World" backwards...

    I had reports of one assessment in which the patient said "I know what comes next... you want me to spell WORLD backwards" to which the assessor asked the patient to spell another word backwards instead.

    Apparently, the patient could do the WORLD one no probs. but other words... not so high scoring.

    That suggests to me that although there were cognitive difficulties, the test had been remembered verbatim... as one would a nursery rhyme maybe.

    So I took that on board and would vary it as applicable... same with the three objects.

    I know husband couldn't remember them Rosalind, but your post reminded me of this bit of info, so I thought I'd share.

    Thanks for the info about not being in on the assessment by the way... maybe I'd want my wife to leave the room should I undergo a similar situation.

    It's certainly given me more to think about - much appreciated.

    :)

    N.
     
  17. How's this?

    I got a reply from Dr. Folstein (one of the originators of the MMSE)...

    Might sound daft but I asked how to apply the 'write me a sentence' question properly...

    When performing the "Write A Sentence" in the MMSE - I've heard people say "I want you to write me a sentence but it must contain a subject and a verb" and the person being tested has been confused at this (no deficits in educational background, simply difficulty in understanding the question posed) - I myself always say: "Write a sentence... anything you like!" and further add reassurance if necessary such as: "I can't help you sorry... you have to think of something... anything at all - as long as it makes sense to you"

    Here' the response:

    The subject verb comment is intended for the scorer not the subject. The intent is to score only complete sentences not fragments.

    marshal folstein


    Brief I know, but it's answered my question and I'm happy that I've been scoring this correctly... AND I have the words of it's creator to back that up!

    :)

    N.
     
  18. jc141265

    jc141265 Registered User

    Sep 16, 2005
    836
    Australia
    Primary sources

    It can be such a kick when you get the info straight from the source can't it?

    I recommend trying it as it gives great satisfaction and makes you feel more confident about information, when so much of dementia information can be outdated or based on personal biases, or just lacking when it comes from general practice doctors.

    We have done it when researching possible medications, when we have read about research, or when we have wanted to know more, such as the chances of Dad's dementia being genetic....look up a web page that has a primary researcher's name on it or is about the drug company, do a google search for that researcher/company and usually researchers will belong to a University or some kind of organisation and companies will have their own websites, that can often have their email address or other contact details on it as well.

    Not all reply, no doubt they are very busy, but you will be surprised how many do.
     
  19. connie

    connie Registered User

    Mar 7, 2004
    9,519
    Frinton-on-Sea
    Dear Neil, the first time Lionel was asked to write a sentence he put "I AM NOT GA-GA YET". These days he cannot always put pen to paper. Connie
     
  20. :D
    Connie - that raised a smile here, and I hope not inappropriately... as I cannot evaluate the context it was written in... it just made me think of something that I'd do such as "I have to write some silly sentence for your benefit"...

    Therefore, if this was not his humour showing through in writing that I apologise and intended no offence!

    The whole MMSE DOES look patronising at times and that's why I feel getting a genuine rapport first with people is important... you know, you show someone an object and say "what is that?" and you get a look back that could almost say "are you trying to extract the urine here, sunshine?" - I make sure that I say these are standard questions and they may seem silly when that happens and generally all goes okay because of that.


    As to your comment Nat... it DOES make you more confident about information - especially when someone throws in a conflicting opinion... and you can quote the 'horse's mouth' so to speak - not to pee the other person off but to say "look, here's what the expert says... so if you think I don't know what I'm talking about - he/she does - this is what they said"... oh okay, I DO take a small amount of pleasure in doing that, but who can blame me?

    :D

    If you want to see the 'teaching session' that I will be doing on Monday, have a look here... also, I have given you all an acknowledgement in there for your kind help - very much appreciated!

    http://com5.runboard.com/balzheimers.finformation.t18

    :)

    N.
     

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