What happens during a geriatric psychological evaluation?

My mom is in a gerontology program affliated with a medical school and has done and repeated all of the 3 main dementia tests which are different yet similar….

1. Folstein aka Mini Mental State Exam (MMSE) - 30 point test. Takes about 10 - 20 minutes & looks at math, memory, orientation, basic motor skills. MMSE is copyrighted & needs training to do, so usually done by gerontology MD’s; residents, student MD’s or trained staff @ teaching hospital; or nursing home with teaching hospital staff. Score is 27 or more=normal;21-26 mild; 10-20 moderate; under 10 severe. Folstein has problems for bilingual persons.

2. Mini-Cog: a 3 item recall & a clock drawing test. 2 -3 minutes to do. Should not be used alone as a diagnostic.

3. Memory Orientation Screening Test (MOST): 1. Memory -3 word recall; 2. Orientation - to year, season, time, month etc.; 3. Sequential – memory for a list of 12 items; 4. Time – organization and abstract thinking using a clock face. Takes 5 - 7 minutes. Gives a score from 0 – 29. Highly reliable.

Other tests: If Frontotemporal dementia is suspected, can have an Addenbrooke’s Cognitive Exam done. Not all dementias are the same: orientation, attention and memory are worse in ALZ; while language skills, ability to name objects and hallucinations are worse in other dementia’s. Some med's - like Aricept - work better with ALZ ; other meds - like Exelon - work better with Lewy Body Dementia.
My mom has Lewy and her dementia and how it plays out in the middle phase is very different than an ALZ patient. But imho when they get to the latter stages of dementia no matter what type the breakdown on cognitive functioning is all the same in that they can't "connect the dots" to eat or get dressed or potty.

Data analysis found the MOST to be more reliable over time and more accurate in identifying cognitively impaired patients than either the Folstein Mini Mental State Exam or the Mini-Cog. The MOST also measures changes in a patient’s memory over time. This permits the doctor to identify progressive loss or positive responses to treatment. The med's can't stop the dementia but can slow down the progression.

Having a baseline tests done & repeated is really helpful to be realistic about what careplan to take. Same with scan on brain shrinkage & what part of the brain.

My mom, who is 89, had a geriatric psych work up last summer, mostly for my peace of mind, because I knew that due to a small stroke, she'd had some cognitive issues. I'm a school psychologist, so I know a little bit about this sort of stuff. There were two parts to the exam; a neurologist looked at my mom's brain function from a medical standpoint (mental status exam--do they know who they are, where they are and when it is), counting backwards, drawing a clock, writing a sentence. These tasks tell a neurologist about what is intact.

The other part was a battery of psychological tests; I was asked not to stay, because the presence of another person in the room affects the accuracy of the testing. Having done this sort of testing myself, I know this to be true. There was a stardard IQ test and some more specialized naming tests, sort of like, what shines in the sky at night sort of questions. These sorts of functional naming batteries get to the heart of cognitive dysfunction quite well.

My mother, who has mild cognitive dysfunction, said to me right before we went in for the "de-briefing" "well, I'm not crazy, and if they say that I am, I'm going to disagree with them". I assured her that we didn't think she was crazy, and that we just wanted to see what was up and to get a baseline measurement.

What goes missing in many elders (from stroke, from mild dementia, etc) is what's called Executive Functioning--seeing the big picture. I'll give you an example. My mom can lucidly and fluently write out what medications she takes at 8, 12, 4, 6, 8 PM and Bedtime, but can no longer produce a chart that says 10mg Coreg 2X daily, 20 mg Lissinopril 4X daily. She can't manage the data and put it into a different format.

I was fortunate in that the docs at the rehab place I brought my mom for this evaluation were interested in what I had to say and seem to have incorporated it into the diagnosis. Try not to see this as an adversarial relationship; the place where your mother resides should also be able to give them input into her behavior so that they can look at all aspects of what may be causing her problems.

You can see from the above that the very simple "test" that most md's do to "rule out" dementia are not as thorough or subtle as the test batteries described above. The bottom line for me is, if you THINK that there is some decline going on with your parent's cognitive and reasoning ability, figure out a way to get this kind of testing done. Otherwise, you're likely to end up, as did one of my cousins, with a doc who told her that her father's mental problems were actually HER problem with her dad and that "nice people like her parents" couldn't have dementia. My uncle died of his ALZ a few months ago. There is a lot of ignorance out there.

I have observed an alzheimer's expert walk up to a patient and yell:
"How the h3ll are you, (her name)?

Prior to this, the patient was rocking, experiencing sundowners, unreachable as she repeated, "Oh Jesus, oh Jesus, oh Jesus, oh Jesus.
Key word: unreachable/alzheimers.
Wait! You're thinking, just another bad doctor, rude, poor bedside manner?
The patient's response? She stopped rocking, stopped repetitive moaning, in her frail condition, she lifted her head up to look him in the eye and smiled.
He walked away and ordered the nurses to medicate her for the anxiety and distress she was experiencing. There you have it-a true story-the doctor could not have reached her or made an accurate assessment if he did not perform this sort of shock therapy type of assessment.
Take from this what you will. But that is only part of what happens in a geriatric psychological evaluation.

I'm not an expert by any means. My mom is/was just like your mom -- only still living independently -- she refuses all help. My mom had a brief evaluation by her physician and then he sent her to elder psychiatrist/neurologist for 2nd evaluation. I wasn't allowed to be present (my mom refused) but maybe you can be there. They asked her questions; draw a clock, repeat words, count backwards, asked basic dates, times, current events, etc. My mom passed most so was diagnosed with mild dementia. They put her on low dose Aricept. Later prescribed Namenda but she refused to take Namenda. I agree with you that an evaluation and geriatric psych is a good idea (my mom thinks he was a quack however); at least they can evaluate her for depression, meds, dementia or other neurological issues -- if nothing else it sets a baseline for future evaluations of her progression. I hope the best for you; but in my mom's case (89) the meds haven't helped and the hallucinations, delusions, paranoia periods have just escalated and last longer. Meds will only slow the progression if she has dementia or AZ it won't "fix her back". But the evaluation will at least hopefully give you some answers and a starting point. Try to be in the exam if permitted so you can evaluate the dr for yourself. I wasn't there but wish I could have been; they couldn't release info to me so I had to depend on her physician who gave me only basic info (she wouldn't give him permission to release info to me either). WIshing you and your mom luck; please keep us posted. Many hugs to you.

I don't know what the report said but psych doc took mom off seroquel and put her on Trazodone. I had asked her GP who is suppose to be geriatric to do that and he didn't. I take Trazodone myself to sleep. Msyb she will "snap back". My prayers.

Depacote is a mood stabilizer, very different med from either Trad. or Seroq. But give it a chance. You might want to find a psychopharmacologist, someone who knows alot about the effects of these drugs. In the end, nurses know an awful lot, empirically, about who needs what.

I'm a long-time physical therapist, now retired, with 33+ years working with patients in their homes. My father had Alzheimers, and many of my clients over the years had various types of dementia issues.
1) Sudden onset issues with memory, behavior changes, and the like, or a sudden worsening of dementia issues: get tested for urinary tract infection- this is a frequent problem that may be overlooked, and as people are hugely reluctant to admit to incontinence and bladder problems (or may forget that this is going on), may not be caught unless tested for. Ask MD to rule this out, if you are the caregiver (or if it's your issue!)
2) Gradual onset of memory loss/ confusion, when combined with shuffling walk, and urinary incontinence: this triad of symptoms points to possible "Normal pressure hydrocephalus": cerebrospinal fluid is created as normal, but is not drained/recycled as normal, and there is a build-up in the interior of the brain, causing these symptoms. Tested for with a brain scan (that shows enlargement of brain ventricles), and then with a spinal tap to decrease the pressure: if symptoms are decreased/alleviated: BINGO, and they put in a permanent shunt to drain the fluid and the issue is solved. There is a time limit to how long this can go untreated without causing permanent damage, however, so: ASK- and mention those 3 symptoms (shuffling, memory loss/confusion, and urinary incontinence) and get a neurology referral. "lot of people end up being institutionalized that could have been saved from that damage if caught in time" - this from a teaching neurologist.
3) Document as specifically as you can what you're seeing that is "off": what is being forgotten, in what situation, in what environment, etc. Can (s)he no longer manage complex manipulation of information (as the medication listing noted above), if distracted cannot perform tasks where they formerly could, word-finding problems, time distortion, unable to orient to situations, people; unable to adhere to instructions, even when given appropriate cues (written, diagrams, verbal, etc.).
This is an exhausting issue to deal with for a caregiver. It is complex, and saying it's "thankless" doesn't even begin to touch the anger and anxiety that it raises for people who are losing control of their decision-making and independence. My advice for caregivers is to try to get support from others who understand what you are going through. Check local Councils on Aging, Elder Care groups, and Alzheimers support groups: a wealth of information and support. Best wishes, and care for the CAREGIVER, as well! ~ Shelley

Maddi, there are some "health grades" type of sites on which patients can comment about doctors. You might want to consider that, especially if the ACC actually recommended him. Maybe he's good for prescribing meds, but to me that's hardly the sum total of what a doctor should be doing. And obviously he needs to work on his bedside manner.

We should all feel able to ask the doctors questions ... I hope you do.