MMSE scores and influencing factors

[BeverleyY]

I posted a while back that I was confused about my Dad's MMSE score of 11. Reading many posts/factsheets/websites, the score didn't tally with Dad's current state.

I requested that the CPN re-do the test (it was last done last May). Before she started, I explained certain factors such as English not being my Dad's mother tongue, his poor hearing, his lack of formal education (he was in a German labour camp as a child) etc.

The CPN allowed me to assist in the asking of the questions as she also concurred that the person that carried it out before had an extremely strong accent that even I could barely understand, let alone my Dad!

She was very understanding, and at the end of the test she revealed his score was actually 16/17.

She also revealed that their report before flagged the fact that they themselves didn't reconcile his score of 11 as being representative of how he presented himself.

We talked about medication, and she did say that she was happy to re-refer him to the consultant so that I could discuss medication.

However, given Dad's stability at the moment, I have chosen not to pursue that route.

He does have poor short term memory, he doesn't know the date, but that to me, is harmless. My biggest fear is that if we tried medication, and it didn't help his short term memory, that it would then be withdrawn and the withdrawal could cause a deterioration - the CPN actually agreed that this was a possibility, and her advice was that as there is no anxiety, depression or paranoia present, leave the medication alone for now.

I really think that today, I proved to her how language really did have a massive influence on the scores. Something, that they never challenged, despite being confused by their own results

Beverley x

 

[elaineo2]

Hi Beverley,i can understand where your coming from with this one.When dad had his mmse i was sure he didn't understand the consultant,the consultant was from a foreign country,with a thick accent that i found difficult to comprehend.let alone dad.I wasn't allowed to help dad,i know its policy as i work with mmse's day in day out.but for someone unable to understand an accent or for consultants to be unable to communicate effectivley with clients must qualify for assistance from family.dads score was 16,but am not so sure now!!!!a resident of mine,who was far more advanced than dad got a score of 17.i was bloody mortified.how?????????????????perhaps its because the communication skills were ok?i will never know now dads gone,but my word this ones got me going!thanks elainex

 

[117katie]

Had the same problem.

Question: when were you born?
Answer: 1066 followed by giggles.
Question: no,can you give me an estimate.
Answer: 3 yards. BECAUSE SHE WAS A DRESSMAKER USED TO CALCULATING HOW MANY YARDS OF CLOTH SHE WOULD NEED TO MAKE A DRESS/SKIRT/SUIT of whatever.

Scored low because she was HUMAN and CHEEKY and because CONSULTANT did not know where she was coming from.

But I did, and I was told by CONSULTANT that I was not allowed to help HER.

Please, Consultant, I was trying to help YOU. To understand ....

Katie

 

[Skye]

Beverley, well done!

You've certainly proved your point. It was so obvious, so why didn't the consultant challenge it at the time? Glad you made them listen.

Love,

 

[christine_batch]

I to had the same problem with Peter's first Consultant.
Now I am usually good at accents but he had me in a spin.
Had I been taking the test, God only know what my score would have been?

I wrote a letter in as constructive way that I could - pros and cons and then I received a letter to say Peter had a new Consultant who was brilliant.

But the fact the original Consultant made Peter feel stupid and he was very upset when we left and NO ONE was going to get away with that.

Christine

 

[Margarita]

My biggest fear is that if we tried medication, and it didn't help his short term memory, that it would then be withdrawn and the withdrawal could cause a deterioration - the CPN actually agreed that this was a possibility, and her advice was that as there is no anxiety, depression or paranoia present, leave the medication alone for now.

deterioration is going to happen with or with out medication , so I can't understand the logic with the CPN agreeing with you when he said that its possibility, of course it a possibility ! with or with out medication they a deterioration going on

I find it very surprising that a CPN can make a comment about medication , what the effects would be when it is withdrawn , his not a specialist in medication its down to the consultant that is a specialist in medication for AZ to know what the effects of with drawing medication would be like .

I would of thought anyway that a memory nurse would do a MMSE scores Not a CPN , as my mother having another one on the 18 March , by the memory nurse . but then every area if different .

My mother on last stage of medication now they no more that can be done , deterioration has been happing with medication anyway , but more slowly not so harsh . now medication is not working.

all that going to happen now is her care needs are going to get higher .

 

[BeverleyY]

I to had the same problem with Peter's first Consultant.
Now I am usually good at accents but he had me in a spin.
Had I been taking the test, God only know what my score would have been?

I wrote a letter in as constructive way that I could - pros and cons and then I received a letter to say Peter had a new Consultant who was brilliant.

But the fact the original Consultant made Peter feel stupid and he was very upset when we left and NO ONE was going to get away with that.

Christine

Nicky, Dad's CPN was visibly embarassed even asking him some of the questions.

She said they are patronising, and are often very distressing for the patient. Asking them to name the objects being held in front of them (handbag, pen etc..) must be worrying to them as they are thinking 'god, do they really think I am 'that' crazy'. That is how Dad was today, she asked what the item was, and he burst out laughing and said, now you are just kidding me, for god's sake, it's a bag!

I actually felt terrible for him putting him through a set of questions that insulted his intelligence really.

He most certainly never had any trouble counting back in 7's from a hundred, and didn't object to that question, but being asked to read 'close your eye's.. well, that again had him laughing.

Sad thing is, I could see that his laughter was masking his humiliation

Beverley x

 

[BeverleyY]

deterioration is going to happen with or with out medication , so I can't understand the logic with the CPN agreeing with you when he said that its possibility, of course it a possibility ! with or with out medication they a deterioration going on

I find it very surprising that a CPN can make a comment about medication , what the effects would be when it is withdrawn , his not a specialist in medication its down to the consultant that is a specialist in medication for AZ to know what the effects of with drawing medication would be like .

I would of thought anyway that a memory nurse would do a MMSE scores Not a CPN , as my mother having another one on the 18 March , by the memory nurse . but then every area if different .

My mother on last stage of medication now they no more that can be done , deterioration has been happing with medication anyway , but more slowly not so harsh . now medication is not working.

all that going to happen now is her care needs are going to get higher .

We discussed what the consultant had said last May about medication, and the reason we re-discussed it, is because my Dad doesn't have AZ he has Vascular Dementia. That is a very grey area when it comes to medication anyway.

All the risk factors have been reduced or eliminated, and she herself said that just because he has Vascular Dementia, there is not absolute cast iron guarantee that he will deteriorate.

Whilst it is unlikely that he will manage to get to the end of his life without a decline, if he manages to stay healthy and not have another stroke, then maybe... just maybe... he will remain in the phase he is now.

Beverley x

 

[Margarita]

Whilst it is unlikely that he will manage to get to the end of his life without a decline, if he manages to stay healthy and not have another stroke, then maybe... just maybe... he will remain in the phase he is now.

that does sound postive

withdrawal could cause a deterioration - the CPN actually agreed that this was a possibility, and her advice was that as there is no anxiety, depression or paranoia present, leave the medication alone for now.

also Just
could not understand the attitude of a CPN saying leave medication alone , because they no anxiety, depression or paranoia present,

as AZ medication is not giving to a person to stop that happening, its just given to slow down the progression of the disease .

as to control anxiety, depression or paranoia present, would be ant depression tablets and ant psychotic drugs


if I am wrong will someone please correct me .

That is a very grey area when it comes to medication anyway

Yes that only happen in the UK

 

[BeverleyY]

as AZ medication is not giving to a person to stop that happening, its just given to slow down the progression of the disease .

as to control anxiety, depression or paranoia present, would be ant depression tablets and ant psychotic drugs


if I am wrong will someone please correct me .




Yes that only happen in the UK

Maggie.. my Dad doesn't have AZ, therefore the medication is not relevant. They are not licenced for Vascular Dementia. The things that slow down the decline for this are things like: keeping diabetes, blood pressure, sodium levels and cholesterol down PLUS taking aspirin. All of those elements are under control now - so, in theory, eliminating the risk factors could slow the deterioration.

She did however say that there was the possibility that his Dementia was mixed (i.e a small portion being AZ) - but, we talked about the lifespan of drugs and how they only 'slow' (if they even work at all) for a period of time. Once they stop working, that's it.. so, there is an argument to put of trying them until you really need them. Slow it (if they work) when you really need it slowing as things get worse.

There doesn't seem to be anything really conclusive when it comes to medication and Vascular Dementia - plus, they are all contraindicated with my Dad's Glaucoma. The last thing I would want is for him to be blind aswell as confused.

We can't run parallel universes, so there are always the 'what ifs' and the truth is... we just don't know. Try to push medication now, then if it didn't work and he deteriorated, thinking.. what if I had left well alone. What if he started, and went blind... what if I don't start them, and then he deteriorates.. what if what if what if... and NO professional that can give any firm answer, because they simply just do no know themselves.

Take it as it comes now I think.

Beverley x

 

[117katie]

A couple of phrases I'd quite like to banish from the English language:
"What if", hotly followed by
"if only".

Katie

 

[lesmisralbles]

Take it as it comes

Hi Beverley
Ron will not be taking any drug's as an experiment, to see if they work
They will leave him alone.
I honestly beleive, that he should not have been given some drug's several year's ago
A few month's ago he was given LORAZEPAM the help his sleep, MAD, MAD, MAD.
He need's no help sleeping, he need's help to keep awake. But, I need help to sleep, cannot take anything, in case he need's me in the night.
Go girl - GO
Luv Barb X

 

[elaineo2]

dear Beverley.there is conptemption of your beliefs on my part,but can i say that you vehementley deny that theres any cause for concern.theres a/z?perhaps?no matter what stage the A/Z is at hun,its there.what stage is it at?don't deny yourself or anyone with the disease,the treatment that may well make a change in their life.love elainex

 

[jenniferpa]

Elaine - Beverley's father doesn't have AD - he has vascular dementia. As such there aren't any medications licensed in the UK for treament of the dementia symptoms. Now some of the AD meds are used in other countries even for people with vascular dementia with some success, but as Beverley says - most of the management is about reducing/removing the risk factors.

 

[Margarita]

Beverley says - most of the management is about reducing/removing the risk factors.

I am wondering what are the risk factors, as that not how Beverley worded her 1st post .

So I can see your point now Beverley

There doesn't seem to be anything really conclusive when it comes to medication and Vascular Dementia - plus, they are all contraindicated with my Dad's Glaucoma. The last thing I would want is for him to be blind aswell as confused.

I know with medication like Exbiza they do say not to give the medication , if someone has heart problems , but your father got a bad heart anyway ?

So I wonder what , the other 3 AZ medication says and the risk in taking them when someone has heart problem and
diabetic .

they are all contraindicated with my Dad's Glaucoma. The last thing I would want is for him to be blind aswell as confused

you make a good point they when you said that .

I was told from my doctor who a clinical neurologist , that if Exbiza was taken away from my mother it could give her heart failure , but not blindness .

( so if I took it anyway its be like me saying well AZ is going to get her anyway , so it be better to let her die of heart failure )

he last thing I would want is for him to be blind aswell as confused.

That would happen anyway if the sugar leaves level are not control, the eyes always need to be
monitored when someone has diabetes . as my doctor said if not mum could go blind .



( so your father could end up blind and confused anyway, but if can still see the logic in going to see eye specialist he be OK )

My mother would not go to her second appointment to check her eyes from a eye specialist , as they found high level of Glaucoma in her eyes / Cataract (sp ) , so it seem that my mother is going to became blind, before she pass-away pass-away.

as she so confused now anyway , she can't see the logic of going to see the eye specialist and it would be to distressing for her anyway to much to have the Cataract taken anyway .

so she going to end up confused and blind , but then angina she may not because who knows what the future hold, something else may kill her before that happen , she could get hit by a bus!

Only Joking you do need humor

 

[Margarita]

for my own experience in life from seeing my mother sister come out of a dietetic coma that gave her a stroke, coming out of it she was like a vegetable then 4 weeks later she had another stroke that still did not kill her but was nearly brain dead , so they gave her morphine she died 9 days later I would rather see my mother pass away with AZ .

also before that seeing my father come out of a heart attract and 2 stroke

So then if they could give me a 1001 present , that taking my mother of Exbiza that would give her a massive heart attract that would kill her out right , like it did at the end with my father .

I would do it , but then no one came really know that not even doctors or any specialist he just tell me she would have a heart attack, but it may not kill her ( god it can drive me mad ) so I am leaving her on the medication and letting nature ride it .

 

[hendy]

Hi Beverley
I read with interest your post about mmse tests and also about your dad's situation. There are some simlarities Dad has Vas dem and other problems including Diabetes. He also has a history of Glaucoma. I can totally sympathise with your concerns re medication. I think my dad is at a later stage in his decline.Reading your post I am glad I didn't have to witness Dad taking the test a few years ago. He scored full marks for ages even though his condition was obvious. Staff used to tell me it was because he 'high fucntioning' ( he was a pharmacist and ironically he was the most qualified on the ward to manage patients medicine!!) Sadly its not the case now. I couldn't believe that the 'professional' involved didn't take into account that your Dads english was a second language - how crass!!

Dad is at the stage where he can now no longer take medication of any kind, they have even withdrawn his diabetic meds(type2) There is no question that he ha declined but thats the disease not the meds. Infact, the meds he was on were very tranquilising and I thnk this contributed to his problems with hind sight. Now he is not tranquilised and has an awareness that he didn't have before which causes sadness, but I can talk with him (just about)and he still knows who I am. I have read your other threads and there is alot i can be sympathetic about( especially trouble with sisters!!) I'm sure we could write a book about them!
I hope things go well with your Dad's care
take care
hendy

 

[BeverleyY]

Thanks for your replies.

As Jennifer confirmed, there is no medication for Vascular Dementia, and only a possibility that Dad has a bit of AZ.

Thankfully, his Glaucoma is well managed. He goes for regular visual fields checks, and follow up's with the consultant (next one on Monday). I will ask the eye consultant Monday what his opinion is on the risk factors of AZ drugs, just in case we revisit that at a later stage. If they believe Dad does have mixed Dementia and if drugs are ever licenced for Vascular Dementia, then I would rather take the eye consultant's view on the risks, rather than the AZ specialists view. After all, the eye consultant should surely be better placed to calculate risk to sight.

As for Dad going blind because of the Glaucoma, as I say, it's well managed because I have his diabetes well and truly under control.

I know he might want more biscuits, but hell... I want a lot of things I can't have (like my Mum to be alive, and my Dad to be healthy).. so, missing out on a few biscuits won't kill my Dad.. but having too many will (in one way or another).

Seems there are a lot of similarities Hendy. I think an overwhelming message here is exactly how dangerous an illness diabetes is.

My Dad has had it since he was 42, and then my Mum developed it in her 60's. Ultimately, it was what ended my Mum's life indirectly, and is probably the major cause of my Dad's problems.

Yet... still people feed their kids cr*p!

Beverley x

 

[117katie]

Questions to anyone who has any info to offer

What would do if you were told that

1. "those biscuits don't matter", nor does "the cake" that he/she wants and desires and eats with joy? Why don't they matter? Well, because he/she's "on medication for diabetes, so cakes and biscuits don't matter".

2. Especially if you are told that by the Charge Nurse/Deputy Ward Manager in the mental health care assessment unit, where your 83-year old with Vascular Dementia is being held?

ALL OFFERS GRATEFULLY RECEIVED, FOLKS.

Katie

 

[BeverleyY]

What would do if you were told that

1. "those biscuits don't matter", nor does "the cake" that he/she wants and desires and eats with joy? Why don't they matter? Well, because he/she's "on medication for diabetes, so cakes and biscuits don't matter".

2. Especially if you are told that by the Charge Nurse/Deputy Ward Manager in the mental health care assessment unit, where your 83-year old with Vascular Dementia is being held?

ALL OFFERS GRATEFULLY RECEIVED, FOLKS.

Katie

Huh??? Are you saying that they said that eating those things is ok as the medication counteracts them?

If so... well, I would be reporting them to their superiors.

If that is what they said... then... Grrrrrr

Beverley xx