MMSE scores and influencing factors

[117katie]

That is exactly what I was told, Beveryley, by the Senior on duty that day, the Charge Nurse, the Deputy Ward Manager.

When I complained to the WARD CONTROLLING FORCE, .. as I am still doing to this day, ... they told me to put in a FORMAL COMPLAINT, which of course one has done over and over and over again!

Staggering stories, what?

Katie

 

[Margarita]

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.

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.

Only think with that is that an eye consultant is not a consultant , specialists in medication tables for AZ medication.

so am wondering how would he know what the effects of that kind of medication would do to someone who has diabetic , so really he can only speculate .

I would of thought you would of needed a consultant that is a specialists in AZ drugs .

I saw a doctor that not my normal doctor and he had to look up the medication Exbiza in a medical book, when I spoke to the memory nurse she said that she going to bring a long a woman that is a specialists in the type of medication for people with AZ .

Your both hate me for saying this , but at the end of the day my mother dose not have a lot of pleasure left in life , so when at day center they offer her cake & she wants it let her have it.

If she wants that extra biscuits, I let her have it . I use to worry about it so much , but not any more .

I had to leave my mother with my daughter while I pop out .

My daughter ask me to tell my mother not to keep asking her when Margaret getting home and going to the door looking for me all the time . So I told my mother not to do all that, she said OK don't be long I left.

An Hour later I got a call on my mobile from my daughter .

she said that " Nanny said that she has to pray with her so that Margaret does not come back late as she will die if she gets no food because she diabetic so pray please with her

She only eaten an hour ago I told her to give her Edam cheese 2 cream crackers.

when I got home , my daughter said to me that Nanny ask did Margaret tell you to give me that , My daughter said No she never.

So My mother said Good don't tell her lol

 

[BeverleyY]

I would of thought you would of needed a consultant that is a specialists in AZ drugs

Your both hate me for saying this , but at the end of the day my mother dose not have a lot of pleasure left in life , so when at day center they offer her cake & she wants it let her have it.

If she wants that extra biscuits, I let her have it . I use to worry about it so much , but not any more .

I actually think an eye specialist would have a better idea of the damage certain drugs can do to the eyes - after all, the psyciatric team know the effects of drugs on the brain.... all they know is that they read certain drugs are contraindicated with Glaucoma. They don't know how the eye's actually respond to drugs. The eye consultant would be able to work out whether the make-up of the drugs would/could affect the eye.

As for the biscuit/cake thing, I've had conversations with my husband (and the CPN yesterday) about this.

I said.. part of me thinks... why not let him have it, after all what is the point in prolonging his physical health, only to let his mental health deteriorate (personally, I would rather for him that he dies of something physical before that happens) BUT the reality is, that if I did let him have what he wants, and then he has another stroke, it may not kill him but it may well advance his Dementia chronically and leave him with a terrible quality of life. As I said before, we don't have parallel lives to compare to so we have to make the best of this one life they have.

For me, I think my priority is to keep the risk factors eliminated, pray he doesn't have another stroke and that by keeping his sugar down it slows the progress of this disease.

Beverley xx

 

[BeverleyY]

That is exactly what I was told, Beveryley, by the Senior on duty that day, the Charge Nurse, the Deputy Ward Manager.

When I complained to the WARD CONTROLLING FORCE, .. as I am still doing to this day, ... they told me to put in a FORMAL COMPLAINT, which of course one has done over and over and over again!

Staggering stories, what?

Katie

Keep complaining until heads roll!

Beverley x

 

[snooky]

Hi Beverley,
You obviously have your dad's diabetes well and truly under control and good for you. My poor friend, who never looked after herself, and we nagged and nagged her, to no avail, is now on an insulin drip that is keeping her alive and she only has a day or so to live (she is only 49 yrs). She worked herself into the ground and wouldnt listen to anyone, even though we kept on, and it is hard to think that her body has now given up. You have a brilliant attitude and good for you - your dad is lucky to have you.
Nic xx

 

[Margarita]

BUT the reality is, that if I did let him have what he wants, and then he has another stroke, it may not kill him but it may well advance his Dementia chronically and leave him with a terrible quality of life. As I said before, we don't have parallel lives to compare to so we have to make the best of this one life they have.

Yes I know about parallel lives, was not saying that I was only telling my side of the story with my mother so
next time shall not share in any of your threads

As my mother heart is strong as an Ox , after she saw my father die of a heart attract , she thought she would die of one , that she went to the doctor he had to send her for test at the hospital to give her peace of mind . he was the one who said her heart strong as an OX very good health , but to this day when she very distressed she holds her hand to her chest saying she having a heart attract.

 

[hendy]

Hi Beverley and all
I'm with margaret I think on this one.
I used to worry about my dad's sugar levels, but I never once denied him a treat here and there. Now though its a different matter he is in later stages of the disease. His diet is controlled and he's only allowed plain biscuits etc To be honest it makes his day if he gets a chocolate biscuit(or three) sometimes we take in cream cakes!!I have given instructions to the night staff that Dad should be offered a cold beer! He is struggling to maintain quality of life. What else can I do? I think its the dementia that gets them in the end. I dont think it was the occasional chocolate biscuit. Everybody's got different priorities I suppose.
take care
hendy

 

[BeverleyY]

Yes I know about parallel lives, was not saying that I was only telling my side of the story with my mother so
next time shall not share in any of your threads

As my mother heart is strong as an Ox , after she saw my father die of a heart attract , she thought she would die of one , that she went to the doctor he had to send her for test at the hospital to give her peace of mind . he was the one who said her heart strong as an OX very good health , but to this day when she very distressed she holds her hand to her chest saying she having a heart attract.

Maggie, I was saying about parallel lives meaning that it's hard for us to make the right choices because we don't know the outcome of if we had made a different choice.

I very much appreciate your side of the story, and would very much like you to share in my threads. Different experiences and viewpoints are what makes this place tick. My comments were in no way meant to challenge your approach to diabetes, they were purely saying how I currently deal with the situation.

What I should make clear, is that at this moment, my Dad is only in a moderate stage of this illness. He has poor short term memory, but that is about all. He did go through acute confusion in January when I was convinced that everything was deteriorating dramatically, but that appears to have been due to my Mum being very ill, then dying plus my Dad having a chest infection and UTI. Luckily, the confusion etc. has vanished and he has returned to 'normal' so to speak.

When I say I control his diet, I don't have the poor man on lettuce! I just tend to limit his diet to 6-8 biscuits a day (rich tea, digestives which he actually really likes), one scone and his meals - and yes, I do give him the odd bit of chocolate.

When I say I limit it, I mean I don't allow him to eat with wild abandon - which he would do. His blood sugars were raging at 28-30 at one point

So, for now I think 6-8 biscuits allows him to maintain a decent(ish) sugar level whilst giving him the odd bit of enjoyment, but more importantly helping to hopefully slow down any decline.

Once my Dad is in the end stages of this illness - be assured I will be giving him packets of chocolate hobnobs by the dozen if that is what he wants. At that point, I won't deny him anything because there will be nothing left worth fighting for.

Beverley xxx

 

[Margarita]

we don't have parallel lives to compare to so we have to make the best of this one life they have.

Just that I assumed parallel lives to comparing - meaning that I was comparing my life with yours .so I was pushing my view on to you as I am walking in your shoes, but in a different parallel .

Which just sounded wried, dismissive, rude to me that all .



So its all a Misunderstanding , as all I was doing is sharing my experience with you, so you can have more options to look at.

My comments were in no way meant to challenge your approach to diabetes, they were purely saying how I currently deal with the situation.

May be it I that give out to many challenging , option asking to many challenging question, strange you would perceive your post about diabetic as challenging .

I did not perceive any of you post challenging when it came to talking about diabetes , as I also was just sharing my own
experience how I felt about it with my mother .

I have reply to you PM

wishing you all the best xx

 

[Tender Face]

Hi folks .... lots of thought provoking stuff in this thread for which thanks .... but to get back to the very beginning, yes Beverley - in full agreement there are influencing factors .... I can vouch that mum would score lower on an MMSE early in the morning than she would later in the day even ..... I suspect if she were asked to take the test in less familiar surroundings than her normal armchair (home assessments) we would see a difference again because of her anxiety and so on .....

Mum is due her next MMSE shortly ...... and I understand her entitlement to medication might depend on her 'score' (mum has been diagnosed with Alz + LBD and was first prescribed Aricept even when her score was a magnificent 24) ...

I've forgotten now whether it is actually better or worse for her to score higher or lower in terms of securing medication? (I'd put my bets on an 18 or so at the moment - but with a new CPN undertaking the test I have no idea whether she will rise to the occasion or be so riddled with anxiety she struggles past single figures) ...

I certainly feel with a new CPN I ought to be present even if I have to struggle to bite my lip (I was asked to leave the room last time) just to make sure I am there to control her anxiety ...??? We have had floods of tears before now with questions within and outside of the MMSE being asked of her and her feeling totally incapable ......

Love, Karen, x

 

[elaineo2]

Gonna bow out on this one.too much to say that may offend others beliefs,and i will not offend anyone who has hands on experience of a/z and dementia.each person is different and i respect that.although i knew the questions dad was going to be asked at his mmse i never divulged them or prepared him for it.a false score otherwise!the higher the score the better is the rule with the test.love elainex

 

[Skye]

I've forgotten now whether it is actually better or worse for her to score higher or lower in terms of securing medication?

Karen, according to the (not so) NICE guidelines, medication should not be prescribed until the score is 20 or below, and should be discontinued when it reaches 10. So your mum should be firmly in the right range.

Some PCTs allow 'variations', so some people may get meds outside the 20-10 range.

Because of John's variety of dementia, he could remember all the questions himself, and would practice them endlessly before a test. He'd even write them out on piece of paper and practice on the way to the clinic. Then of course he would panic, and his language would fail. Thankfully, they decided that the test was not appropriate for him, so we were spared further agonies.

 

[sue38]

Some PCTs allow 'variations', so some people may get meds outside the 20-10 range.

This happened with my Dad. His last score was 8, but like Hazel's John, because of his particular type of dementia which affects his language skills, the Consultant had no problem with keeping him on Ebixa.

 

[Skye]

Sue, the 20-10 range is just for the three main drugs. There is no range for Ebixa -- according to NICE, it shouldn't be prescribed at all! Though those already on it can continue as long as the consultant thinks it is effective.

Thank Goodness for some understanding consultants who are prepared to bend the rules!

 

[sue38]

Sue, the 20-10 range is just for the three main drugs.

Thanks, Hazel, I didn't know that.

 

[Tender Face]

Thanks Hazel and Sue ....I know I felt we 'snook in the back door' at the time mum was prescribed Aricept - just around the time of the latest NICE guidelines ... that and coupled with the fact she was out of 'range' - gosh - how lucky .... Thanks both of you for illustrating that thankfully, consultants do not necessarily determine medication on the basis of the MMSE alone .... (as mum's clearly didn't originally)...... one minor item crossed off my 'worry list' for now,

Karen, x

 

[jackie1]

I would just like to add two things:

1. From my experience although the consultant carried out the MMSE test and reported the result it was only a very small part of all the tests/observations that they did. I feel sure that while the consultant feels John is getting a benefit that he will remain on Reminyl. (his score last year was 13)

2. I think only individual carers can know what is best for their loved ones. All dementia sufferers are different and have different needs. Exisiting/new medical conditions complicate matters further. We are all doing the very best we can. We can't predict the future nor do we have the benefit of hindsight, we simply have to follow our instincts and hearts.

Jackie