1. elaineo2

    elaineo2 Registered User

    Jul 6, 2007
    945
    leigh lancashire
    Sorry all,just had to post this.As some of you may be aware my Dad had the MMSE " weeks ago.The score being16/30.He is very "with it" as we may say,He knows exactly where he is,the time etc.He is not like a resident i am about to descrobe.This resident refers to themselves a a third person all the time.Giving them medication is a task within itself."what do you want ***** to do with them"is what they are like day in day out."where does **** go now?"**** will be eating and ask for food!.i cannot believe their MMSE score was one point higher than dads.This resident has no concept of wherwabouts,day or time.I am unsure that the MMSE is reliable.love elainex
     
  2. Brucie

    Brucie Registered User

    Jan 31, 2004
    12,413
    near London
    In my layman's opinion, the MMSE only has relevance when used in combination with observations of the person's physical and mental wellbeing, their behaviours, on a day by day basis.

    Even given that, the ups and downs of the condition may lead to variations in scores.

    It is just one test, of many tests.
     
  3. BeckyJan

    BeckyJan Registered User

    Nov 28, 2005
    18,972
    Derbyshire
    I believe it is only a simple measure of 'that' person, not one person against another. My husband was down the Alz. line even with a score of 27 - I did my own test on him two weeks ago and he scored 22 - but he doesn't know what day it is, etc etc. But he can still count and spell backwards! - I think in my husband's case when he cannot do that then we will know he is at rock bottom. If people cannot count or spell easily in the first place, what does it really measure?

    The MMSE does not measure his disorientation in time and place, or his confusion about who people are and whether they are dead or alive!

    When our CPN does the memory test, she gives me as carer, a questionnaire to complete - this allows me to give details of how I see his changes in behaviour. I know this is used to measure his decline just as much as the MMSE.

    So to answer your question, no , it is not completely reliable - just a measure required by the Govt. to assess whether a person qualifies for medication!!

    Best wishes Jan
     
  4. jenniferpa

    jenniferpa Volunteer Moderator

    Jun 27, 2006
    39,417
    The other thing to remember is that a person can vary dramatically day by day or hour by hour, and all sorts of things can skew the results. The environment, the accent of the person giving the test, stress that they've picked up from others (I seem to rememebr that you said your mother got increasingly distressed as the test was administered) and also, frankly, and unwillingness to answer what might be considered "damn fool questions" all might affect the results. Also, if say, your resident is particularly strong in one ares (say numbers) that could well give a higher result than would otherwise be merited. My mother consistently scored 23-25 on this test purely because the parts of her brain that dealt with numbers (and actually spelling) was completely unaffected by her strokes.
     
  5. connie

    connie Registered User

    Mar 7, 2004
    9,519
    Frinton-on-Sea
    Having done so well, for so many years......MMSE now cannot be done on Lionel.

    Today, certainly 'recognised' me. We counted from 1-10, sang along with a particular song on radio 2.

    I know where Lionel "is", now no longer need the MMSE to tell me.
     
  6. elaineo2

    elaineo2 Registered User

    Jul 6, 2007
    945
    leigh lancashire
    Thankyou all for your replies.I questioned wether the care team leader on shift when the mmse took place actually gave an account of the residents behaviour.Wandering into other residents rooms,inappropriate sexual behaviour to name 2.I didn't get a direct answer as to wether this was prtrayed to the CPN.We are awaiting the consultants report."NO" was my reaction.This has to be mentioned to run alongside the mmse!I do get uptight when staff have concerns and do not voice them when confronted by an authorative figure!"if you see it,say it" is my motto.We are there to care,not to let things go!Heavens help the saff when i go in tomorrow afternoon.I am completley dismayed at their withholding of information that will in the long run,help the resident.I am mad now.love elaine
     
  7. Cate

    Cate Registered User

    Jul 2, 2006
    1,370
    Newport, Gwent
    Personally I dont set much store by the MMSE as a 'stand alone' test.

    Mum can do any kind of mental maths you care to throw at her, but then her background years ago was finance. Ask her days of the week, whats my name, and any other family members name, and she is totally confused, cannot do days of week etc., etc.,

    Now that mum is still on 'medication strike' I wont let the CPN's near here to do this test, there is no value to them doing it, so whats the point. I know how mum is better than they do. Whilst being prescribed her Aricept depended on it I went along with it, but I dont know.
     
  8. Margarita

    Margarita Registered User

    Feb 17, 2006
    10,824
    london
    #8 Margarita, Oct 4, 2007
    Last edited: Oct 4, 2007
    My mother score was a 10 last year with medication , my mother knows all family members name , recognizes all of us and can still sigh her name , read large street shop sigh , also read out front page of paper because its in large print .

    but does not know what year or day it is , only physical thing she can do for herself is go to the toilet and feed herself , walk around with zimmer frame

    I would also total agree with BeckyJan when she says
     
  9. Grannie G

    Grannie G Volunteer Moderator

    Apr 3, 2006
    68,665
    Kent
    My husband scores 20.
    What significance does the score have when in relation to everything, he repeats the same question almost as soon as I have finished answering it.
     
  10. 1234

    1234 Registered User

    Sep 21, 2005
    43
    bradford
    shocked by high scores

    I am so surprised how high most people have scored in the mmse test, trev has scored o now and only 7 2 years ago, amazes me when the symptoms seem so similar, hope you all have the best day you can andenjoy a little peace love pam
     
  11. Petrus

    Petrus Registered User

    Aug 7, 2007
    61
    Northumberland
    Please Be Careful - Plus a Tale

    The MMSE looks simple and straight forward; not something for which you need training to administer and interpret; right? WRONG

    Below I give three URLs including one for the organisation who owns the intellectual property rights to the test (there are many other URLs but they say much the same thing). Worth a quick look. Some key points to emerge:
      1. It is a screening test
      2. It must be combined with other information for diagnosis and many other purposes (of course, such additional information my well be "in the sufferer's notes")
      3. It is widely used geographically and across illnesses
      4. It must be administered with care (and training)
      5. It must be normalised for age, educational level
      6. In the right circumstances it is useful; by itself it is not definitive
      7. I
      would add:
      • Like any measurement it has error associated with it (i.e. the numbers are not precise)
      • A simple number will not define how the sufferer will operate in everday situations
      • It almost
      certainly needs to be normalised for culture (difficult to do)​
    A cautionary tale: When J. was diagnosed by an Old Age Psychiatrist consultant (in part using the MMSE), medical colleagues not practicing in this area but very senior researchers (including 2 University Profs.) were concerned that the diagnosis was not correct - J. was declining much too quickly, or so they thought. They counselled me to ask for a second opinion; ideally from a neurologist. The GP and consultant understood my request and immediately arranged for J. to visit a special diagnoatic clinic in Newcastle upon Tyne run by a University Prof. of international renown. Part of his staff was a specialist psychiatrist. The MMSE was a key part of the 3 hours of testing and discussion (the CT, MRI and SPECT scans had been provided by the first consultant).
    The diagnosis was confirmed; the psychiatrist said it would not be worth running an available set of additional tests (take 9-12 hours to administer); when told they were already underway by the first consultant, he said might as well continue but, FROM ALL OF THE INFORMATION AVAILABLE, he would predict ... He was correct.
    As a result of discussion, I got leads on the topic of rapid on-set or aggressive AD; my original colleagues subsequently did some reading on the subject and improved their own knowledge.

    This cautionary tale provides three large lessons - each of which you will have experienced (as I have):
    TODAY:
      1. Nobody knows what causes AD so the experts are struggling
      2. Those actively engaged in the field are much more knowledgeable than the balance of the medical world- and certainly than non-medics (like me)
      3. In the words of the neurologist, "There is nothing can be done for J. other than
      tender, loving care"

    Given lesson 3, I am deeply concerned that far too little research is being done in this area and there is inadequate support for families (and professionals) seeking to provide it.

    URLS:
    http://www.minimental.com/
    http://www.tufts-nemc.org/psych/mmse.asp
    http://en.wikipedia.org/wiki/Mini_mental_state_examination
     
  12. Petrus

    Petrus Registered User

    Aug 7, 2007
    61
    Northumberland
    Apologies

    Sorry formatting in above post is messy. I pushed the wrong button as I was tidying it up (formatting is not the easiest thing to do on the site).
     
  13. Nebiroth

    Nebiroth Registered User

    Aug 20, 2006
    3,518
    Whenever my dad has done the MMSE we have also been asked to complete the assessment questionnaire for carers.

    The MMSE is an indicator, a way to put a number on things, but that is all. As has been said, some people completely lose their abilities in one or more particular area but retain "normal" abilities in others. My dad still has his mathematical ability, for example, and can do the "spell it backwards" test with ease. But he falls completely down on the short term memory test ("remember these three things") and also becomes very disoriented when it comes to time and often has trouble naming things, which is very frustrating for him (and us when we are trying to work out what the "wassname with you you-know-what thing" actually is. He wanted a slice of cake the other day, but it took us about twenty minutes to work out that this was the "you know, the brown squidgy thing we had today")

    He does quite well on the MMSE, but the consultant and CPN have noted that he does have particular weak areas.

    Also, the MMSE does not cover behavioral problems, like agression, depression, and so on, whereas the carer questionnaire does.

    My dad's worst problems aren't covered by the MMSE at all, because it doesn't over his psychotic symptoms of agression/paranoia at all.
     
  14. Grannie G

    Grannie G Volunteer Moderator

    Apr 3, 2006
    68,665
    Kent
    I have never been asked to complete a Carer`s Questionnaire since first diagnosis.
     
  15. BeckyJan

    BeckyJan Registered User

    Nov 28, 2005
    18,972
    Derbyshire
    Really surprised by this, Sylvia. It might be worth you asking about at your'memory clinic' cos the things you relate on 'your thread' would be ideal material for our CPN. Having said all that maybe they can assess the situation as much as they need anyway. As long as the medication is there and support when needed, what else can they do??!!

    We have another MMSE next week - I wonder what the result will be!

    Love Jan
     
  16. Grannie G

    Grannie G Volunteer Moderator

    Apr 3, 2006
    68,665
    Kent
    Thanks Jan, I`ll mention it.

    Love xx
     
  17. Petrus

    Petrus Registered User

    Aug 7, 2007
    61
    Northumberland
    Carer's Input

    There are different ways of getting carer's input - it need not be a questionnaire.

    It is generically known as a "Global Assessment". The New Oxford Textbook of Psychiatry notes (vol.1 p.391) that global assessment has its origins in the US and "is finding its way into clinical practice. The underlying premise is that an assessment by a clinician, often supported by an informant history, provides information on severity that neither a cognitive assessment nor a functional assessment alone can provide."

    The informant history is usually from the carer, can be obtained in a number of different ways and should be up-dated regularly. In J's case the medics and social services people always ask me for my observations about J. They usually do this without J. being present. (They also always ask me how I am doing).

    As a lay person, it seems to me that this is sensible, good practice. It hardly needs to be taught, I would have thought.
     
  18. Grannie G

    Grannie G Volunteer Moderator

    Apr 3, 2006
    68,665
    Kent
    Perhaps the 4 or 5 pages of A4 Diary, I send in advance of the appointment acts as a Carer`s Assessment. Possibly, it is always acknowledged.
     
  19. Margarita

    Margarita Registered User

    Feb 17, 2006
    10,824
    london
    #19 Margarita, Oct 4, 2007
    Last edited: Oct 4, 2007
    My mother awoke from her nap this morning asking me , have they arrived meaning day center bus . Mum always forget that she does not go on a thursday .

    so she went though the days of the week with me for the days that she does go, she getting very confused about how many days she does go ,

    So I ask her to look at my hand and count to Ten , she got to 4 and could not remember what came after 4 , changing the subject and saying Oh those people

    I did not push her to count any more . put me on a right downer . I'm not pushing for mum to do that test MMSE any more , as I don't like the reminder that she slowly leaving me in her mind , just let it be .

    thank- my lucky stars that mum on late stages medication for AZ
     
  20. elaineo2

    elaineo2 Registered User

    Jul 6, 2007
    945
    leigh lancashire
    What a wonderful response!Thankyou.Mum and I were asked lots of questions about dad and his pattern of behaviour.The questions were very intrusive (although had to be asked).This made mum very uncomfortable.I however,have a way of answering questions so as not to make anyone feel uncomfortable. Especially "dad" in this case.This is where i feel the "questionnaire" would be an advantage,to protect the feelings of sufferers.I can only do this because i am trained to do it.How awful must it be for those "put on the spot" in front of the sufferer.love elainex
     

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