What's your experience of memory span in late mixed dementia plse?

[AlsoConfused]

I think Mum's effective memory is 6 seconds of less (based on her repetition of the same short sentence - which can go on for an awfully long time). From your experience of loved ones at the same advanced stage of dementia would you think I might be right ... or am I just misinterpreting the situation? How did you reach your own judgements on your loved one's effective memory please?

For some time Mum hasn't even known who her husband is much of the time (even though they've been married for nearly 70 years).

 

[cragmaid]

I guess that it depended whether Mum was engaged with the subject or just drifting along in her own little way . I gave up wondering about any of the standard or measurable definations by the end stage because it just was no longer important to me.

 

[AlsoConfused]

I think it probably wouldn't be important to me either, ordinarily.

The issue's come up because of this dratted CHC funding application. Communication is cognition-dependent B H*****care points out so inability to remember anything for more than a few seconds does impact on the rating of the Communication domain.

 

[Saffie]

I think that memory comes under Cognition for the CHC assessment.
Communication is more about literally, being able to communicate which my husband was not able to do well before nearing endstage dementia.

I have the DST in front of me and there is no mention of memory span for communication ann neither is there in the Checklist either.

 

[nitram]

I agree with Saffie.
I regard cognition as the process of acquiring information, retaining it, and then using it.
With a short memory span, cognitive powers are greatly reduced.

 

[AlsoConfused]

Agreed, Saffie and nitram.

The point I'm making - and B***** Healthcare make - is that if you've lost almost all your cognition you can't communicate effectively either, whether in words or non-verbal signals. To a considerable extent the two go together.

I'm trying to get hold of a Clinical Psychologist's take on the effective memory span for (mythical) typical patients with advanced dementia but it isn't easy. I thought perhaps TP members might be able to chip in with their observations?

I remember once seeing a virus on a public computer rapidly erase the text of teaching material while I was reading it. If the memory span of someone with advanced dementia fades as rapidly as that text did then they won't be able to communicate because what they want to say will have vanished before they can get the words out.

 

[LYN T]

I'm only speaking from experience here.

A high score in cognition wouldn't necessarily have any baring on communication but it could do -it depends on the intensity/complexity etc (as ever). Pete had a severe in cognition and a high in Communication; Pete had aphasia (receptive and expressive) -obviously due to brain damage, so there was some crossover in the two domains. He wasn't given a severe in communication because at the time of the checklist he could show communication in other ways. Like drinking from other residents cups (shows he needs a drink) taking their food at the lunch tables (hungry) rubbing tummy (constipation) etc. All of that showed that he was able to communicate in some way.

As I have said before the CHC Team were very (unusually) clued up on the crossovers between the domains.I would say though that aphasia is classed a separate symptom of brain damage from Alzheimer's-or so I was told. I never quite understood that as AD was what was causing the organic damage. I suppose that many Dementia sufferers do not actually lose their power of speech-or understanding of speech -even if they forget what has been said /they have said within a few minutes/seconds.

Perhaps someone will be able to explain this much clearer than I can.

Also confused-do you have something specific that you think your Mum's lack of cognition should be cross referenced to the communication domain?

Love

Lyn T

 

[BeckyJan]

I would say that the memory span is 'unpredictable' which is an important factor in assessing CHC

 

[Saffie]

is that if you've lost almost all your cognition you can't communicate effectively either

,

However, your reference was to memory span, not the complete loss of all cognition and poor memory span doesn't necessarily mean that someone is unable to communicate.

 

[LYN T]

,

However, your reference was to memory span, not the complete loss of all cognition and poor memory span doesn't necessarily mean that someone is unable to communicate.

I knew that someone would be along to explain in a nutshell what I garbled on about.

Thanks Saffie

Love

Lyn T XX

 

[AlsoConfused]

I'm struggling with these ideas ... so I might well be sounding very woolly myself!

Mum can't effectively communicate to others as your Pete could, Lyn. When Mum was in pain from her tummy (and she must have been in a lot of pain) she didn't give any signals more specific than facial grimaces and restlessness. Mum chats a lot but she doesn't say anything meaningful about her wants and needs.

There's no test one can do (as far as I know) to discover whether someone's cognition is as poor as their memory span - and vice versa. For what it's worth, though, I think there wouldn't be much difference between Mum's poor score on the general domain of cognition and her score on the narrower issue of memory span.

 

[Spamar]

Hi alsoconfused, in answer to your question, OHs memory appeared nonexistent at the end. Even before he went into the carehome, his memory was only a very few seconds. He was only in the home 3 months.

 

[Saffie]

I'm struggling with these ideas ... so I might well be sounding very woolly myself!

Do you have an actual DST form and the guidance notes for completing it?
That's really essential to understand how the assessors will be looking at the domains and will make things clearer.
Of course, it still doesn't mean that they will view things in the same light as you are but there's no guarantee of that anyway.

 

[AlsoConfused]

Thanks spamar, that's the type of information I think will help me. It's very difficult to stand back from one's own situation and determine whether you're really seeing what you think you're seeing!

 

[AlsoConfused]

Thanks Saffie.

Yes I've got the information on the DST. What I'm still working on though is my counterblast to the CHC Checklist where I feel serious mistakes were made by the assessor to our disadvantage. I'd like to shore up our defences. The assessor told us Mum had got through the Checklist and her ratings ... but we haven't had anything in writing and no-one's telling me when they might produce something.

I've had help from TP members on the DST - including a "worked example" (for which many thanks, you-know-who!).

It's all a time-consuming nightmare.

 

[Saffie]

A short or even near non-existent memory span will not warrant CHC funding though unless it has a major impact on other domains. My husband was unable to communicate in any logical or meaningful way for a long time before he died so I had no idea how long his memory span was.
I wish you luck in your challenge.

 

[AlsoConfused]

I wish you luck in your challenge

Thanks, Saffie, I'll need it! There are very few times when I've worked as hard as I have done now simply to put a document together!

 

[Slugsta]

Lyn T - my Mum had a small stroke 3 years ago which affected the speech centre. As a result she has expressive dysphasia. This is very separate from her increasing confusion. The dysphasia makes it very difficult to find the correct words but she knows the meaning of what she is trying to say.

When I saw her last she wanted to buy "A ticket" which turned out to be a stamp to put on the envelope she showed me. That was down to her dysphasia. The fact that the envelope was addressed to herself was a result of her confusion.

Does that answer your question- or have I got the wrong end of the stick?

AlsoConfused - I wish you success in your quest.

 

[Saffie]

Thanks, Saffie, I'll need it! There are very few times when I've worked as hard as I have done now simply to put a document together!

Oh I know, I've been there but never got the chance to use it a the DST meeting was postponed and my husband died before it was rearranged.

 

[AlsoConfused]

Thanks all.

For info, I'm arguing Mum ought to be an A on Communication and that the assessor's B rating is bizarre.