1. Lucille

    Lucille Registered User

    Sep 10, 2005
    542
    Hello

    I was wondering if anyone had any thoughts about MMSE tests in terms of how much prompting the CPN (or whoever) gives the person with AD. My mum had a test recently and the score was good. However, I was surprised as in the last few months she seems to have deteriorated noticeably. I know we cannot attach too much weight to the tests as there are other factors involved, but I was quite surprised she scored so well (and pleased, of course!).

    Anyone else any thoughts on this? Or, maybe similar experience where test seemed high compared to reasoning/mental ability of person tested?

    Thank you!
     
  2. Grannie G

    Grannie G Volunteer Moderator

    Apr 3, 2006
    69,596
    Kent
    Hi Lucille,

    When my husband had his tests, there was absolutely no prompting. The results were quite good, 20, but he IS good in certain areas, eg. politics, news and numbers, but poor in other areas, eg location.

    It`s very difficult to know how acurate these tests are but they are standard tests, so the statistics must have some meaning.
     
  3. jenniferpa

    jenniferpa Volunteer Moderator

    Jun 27, 2006
    39,439
    Hmm: I've seen this test adminstered 3 times by 3 different people and didn't see any prompting. However, any test like this could be skewed by such prompting and I think I've read on the boards that this does happen sometimes. Having said that, no amount of prompting would have helped my mother with this: in those areas that she has deficeits, prompts would sail right over her head. She's still good on numbers, and can spell backwards, but everything else is pretty much of a wash.

    Jennifer

    P.S. Honestly, I don't think this is much of a test: mummy scores quite high because her stroke damage is very localized, but that's not an accurate reflection of her abilities (or lack thereof).
     
  4. Natashalou

    Natashalou Registered User

    Mar 22, 2007
    426
    london
    not sure

    what this test is but my mum had a simple q and a test the other day , things like "what is your name" "how old are you" "where do u live?" apart from her name she struggled with all the answers, and the care officer just sat there. She was gettin so upset, I propmted her so heavily I may as well have answered , but the carer put "yes" as if the answer had been given correctly by her!
     
  5. Grannie G

    Grannie G Volunteer Moderator

    Apr 3, 2006
    69,596
    Kent
    Well that`s the worry isn`t it. There`s no point in tests if they are not standardised in the way they are conducted.

    This is not a criticism of you, Natasha, how can you be expected to sit there and not help your mum out when she`s in distress.

    But the person conducting the test should have noted your mum had assistance in answering.
     
  6. Lucille

    Lucille Registered User

    Sep 10, 2005
    542
    Thanks, all. You are right, of course. Where deficits occur in particular areas, then the score will be lower. I guess because my mum is a nightmare with money (yet can still count it and knows the difference between fiver, tenner, etc), it's more her reasoning that's gone. Also if she's put on the spot : a simple question like what did you eat for your tea? She can't remember and makes something up, probably based on a Sunday dinner she ate four years ago :) Ah well, thanks, anyway.
     
  7. Michael E

    Michael E Registered User

    Apr 14, 2005
    619
    Male
    Ronda Spain
    The nerologist who Monique visits every 6 months no longer does a 'formal' test.

    He now asks questions within the conversation like where does she live, what is her birthday, What year is it, what day of the week it is, what month... As Monique can answer none of these questions and immediately becomes aggressive and demands who the hell he thinks he is trying to make her look stupid he stops...

    I suppose the test has some value in the earlier stages but I am not quite sure what the value is? Does it have a bearing on what drugs are administered? Monique has Ebixa and Aricept which are the only two which actually have some bearing on the progress of the condition..

    The rest are a cocktail to stop depression, anxiety anger and schizophrenic symptoms... And we seem to arrive at those doses by discussion and later with the GP who sees her every couple of months... Thank goodness for spell check!
     
  8. Nebiroth

    Nebiroth Registered User

    Aug 20, 2006
    3,518
    AFAIK the NICE ruling about the prescription of drugs like Aricept specifies that it can now only be prescribed in the "moderate" stage, and defines this by a certain MMSE score.
     
  9. erik

    erik Registered User

    My mother is tested twice a year at a local hospital. The test is done by a nurse and I'm not even allowed in the room when she is tested. The doctor then has an "interview", first with my mother and then with me. It seems to me they use the results of the MMSE test mostly to keep track of the progression of the disease.

    My mother's score was relatively stable the first 2 years (with Aricept), but now she seems to be dropping 2 points on the test every 6 months.

    Erik
     
  10. Tender Face

    Tender Face Account Closed

    Mar 14, 2006
    5,379
    NW England
    Hi Lucille ..... yup very similar sentiments on this ... just one thing might be worth mentioning which I have never really thought of before ...... both Psych-Ger and CPN have 'awarded' mum a point (not sure what the right term is?) after struggling for several minutes, and after much prompting (by them) ... and I have thought 'Nonsense - no way in the world she would have got there without that help' ..... then she has been praised highly for 'getting there in the end' ... perhaps I'm guilty of looking at MMSE more like a 'quiz' and if mum doesn't get the answer right first time she doesn't 'deserve' the point!!!!!!?????

    Perhaps the ability to 'get there in the end' (or not) is part of the MMSE assessment?

    So understand Natasha, too, how can anyone sit back and not help when you see them struggling? It would make me feel a lot easier when I am present for the tests to think the extent of the 'struggling' and needs for prompts was part of some scientific measurement and not just to persecute (which is what it seems like :( )

    Love, Karen, x
     
  11. Skye

    Skye Registered User

    Aug 29, 2006
    17,000
    SW Scotland
    John hasn't had the test for three years, because of his lack of communication. Before that, I wasn't allowed in the room.

    I don't know how they'll decide when he's no longer eligible for medication, but when they try I reckon I'll be able to put up a pretty good fight, as they'll have no evidence. :)
     
  12. Brucie

    Brucie Registered User

    Jan 31, 2004
    12,413
    near London
    As far as I can see it is simply a measure - one of the few that can be used from time to time for a patient, and that can show a certain loss of mental facility.

    The MMSE may have some value in that GPs who are not experts in the area of dementia can give the test and get something out, relevant or not.

    More to the point, it may be that the demeanour of the person being tested is more important than the numeric score. Do they get mad? do they clam up? do they bluster? do they give wrong answers? do they give no answers? with just a little help, can they find the way to answers? how does a relative who is in attendance cope? does the result back up anything a relative may have said about the patient?

    I suspect that - in the right hands [and that is the key] - the MMSE is much more than a score between 0 and 30.

    Like all such tests, it should not - in my opinion as a non-expert - be used in isolation.
     
  13. twink

    twink Registered User

    Oct 28, 2005
    265
    Cambridgeshire UK
    I always went in the room with Steve when the psychiatrist did the test but I promised I'd keep my mouth shut. Every time Steve was asked a question he looked at me but I just smiled encouragingly if that's possible and looked away. He knew he didn't do well in the tests and he got distressed and wanted me with him. The last one he had was last October and he scored 6. I doubt if they do them now as he doesn't really communicate, he just talks all the time to himself or anyone who's there about work. He was put on Exelon for a while but he was quickly put on the highest dose and the psychiatrist said it wasn't working after just a few months so he took him off it.

    Sue
     
  14. BeckyJan

    BeckyJan Registered User

    Nov 28, 2005
    18,972
    Derbyshire
    Our CPN has explained that the test is a 'State' requirement so that the medication can be justified. As carers we are expected to complete a lengthy questionnaire at the same time the MMSE test is given - the consultant praised me for my honesty in the last one and said she valued that more than the result of the test.

    Yes my husband has been helped along with one or two questions, but while he can spell World backwards and count backwards without a problem, his score is in the region of 25. BUT he cannot always find his way around the house, he forgets almost everything now - cannot always distinguish one daughter against another without prompting. He can hardly walk, needs help with dressing, etc etc. Without looking at the score on the test it is fairly obvious he is at least in 'middle' stage ( I put him at 5/6 out of the 7 stages).

    Our CPNs worry that there is too much emphasis on the MMSE test. Obviously if my husband ever got below say 15 then he will be in a poor state - I and everyone else will know that without the need for the test result. It is only at that point I believe they may wish to take him off medication - I will face that situation when and if it happens.

    I would suggest you keep notes about the occurences that worry you - the ones that show up things like disorientation, confusion - then supply some of those details at the time of the test.

    Sorry to ramble - just been out for Easter Sunday lunch. (My husband scores well on the test but he has not accepted that it is Easter:eek: :eek: ) Beckyjan
     
  15. Lila13

    Lila13 Registered User

    Feb 24, 2006
    1,342
    My mother was tested 3 times in 4 months. I wasn't allowed in the room, so that I wouldn't influence her. (I didn't want to go in, I was encouraging her to be as independent as physically possible.) I wasn't given a numerical score, perhaps they told my mother her score, but as when a nurse weighed her my mother said she was 7 pounds telling her a score wouldn't be much use. The first doc said she was fine, nothing wrong with her. My mother had a strop with the second so I don't if there was a numerical result. The third time was when my brother took her and that was when Aricept was prescribed. On that occasion she (rather surprisingly) knew the day of the week, date and month, but insisted the year was 1666.

    Lila
     
  16. Skye

    Skye Registered User

    Aug 29, 2006
    17,000
    SW Scotland
    I dread to think what John would score if they gave him the test now -- 0 probably. He can't read, write, spell (forwards or back), count, tell the time or date, does not know where he lives or his phone number, and has no knowledge of the news, though he insists on watching it every evening.

    I would say he is firmly into stage six. But he shows no signs of physical deterioration, has no behavioural problems, and no-one meeting him would know there's a problem -- until they spoke to him!
     
  17. twink

    twink Registered User

    Oct 28, 2005
    265
    Cambridgeshire UK
    He sounds exactly the same as Steve Hazel.

    Sue
     
  18. Skye

    Skye Registered User

    Aug 29, 2006
    17,000
    SW Scotland
    Sue, it must be so difficult for you, you're so much younger.

    Steve's illness seems to be progressing quite quickly? Let us know how you're getting on.

    Love,
     
  19. Lucille

    Lucille Registered User

    Sep 10, 2005
    542
    Hi again

    It's great to get so much feedback! I think Bruce you are right when you said something about the person's demeanour. Mum does get v.stroppy when asked certain things. She changes her mind about things so often in such a short space of time that I feel like I've been in a tumble dryer!!

    Her score has dropped three points since last time so it doesn't seem bad. But, when taken with her personality changes and the way she handles things, I guess the CPN gets a 'measure' from these as well.

    Thanks, again all - and Michael E for the 'thank goodness for spell check' - what a wag!! :D
     
  20. twink

    twink Registered User

    Oct 28, 2005
    265
    Cambridgeshire UK
    Steve did get quite bad very quickly Hazel. I've said it before but he was driving until August last year, he drove fine, just didn't have a clue where he was going. He was getting quite ill and then one Friday evening he just went downhill. He was pacing and crying and seeing things that weren't there. I know we're not the only younger people on TP. It always surprised me, the number of people in their late 40's and early 50's who have this disease. there's a lady in the home now and she's much worse than Steve and she is 53 years old. She looks over 70.

    He went into the care home 3 weeks ago, almost 4 now. He cried every moment of every day for almost 3 weeks and one of the carers who he's taken a shine to called our GP and said it's just not right that he's still crying constantly and she said he's on a lot of medication. The GP came and took him off some of it and it seems the change for the better was almost instant. I've not had the chance as yet to talk about this with anyone except the carer who is really lovely. Steve is back to talking about work as he did when he was in the hospital. It doesn't make sense what he says, he looks at a bare wall and talks about getting that unit and putting it somewhere else but he's not crying which is just great. He can't hold a conversation, can't answer any questions, didn't recognize his daughter last weekend but then he hasn't seen her for 6 months. He's not been able to write his name, tell the time, read or anything for about a year now.

    Love Sue
     

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