Your mom has probably already gotten the mini-mental testing done at her referring doc's. Mini-mental are the ones with the 3 word memory test & the clock drawing. For my mom, the neuropsch involved testing was over a 5 year period. Now her MDs at the time were affiliated with the medical school and so she was involved in a dementia study of 90+ yr olds. Started when she was living at home, then when she moved to IL and stopped when she went into NH. It was immensely helpful. Once she hit a certain # in testing, it got repeated and then she was discharged from the program as she had plateaud out on changing her testing numbers. I was in an adjacent room watching the testing via video feed with medical students and the gerontology residents. It was really heart wrenching seeing mom work really hard to answer the questions and her frustration at not being able to process.
You will likely be interviewed. If you can detail specific "incidents" that have you concerned it could be helpful. Dementia signs fall in the groups below. Signs of Dementia: Recent memory loss - ask you the same ??’s over & over. Difficulty performing familiar tasks - cook a meal but forget to serve it. Put on pants but not panties. Problems w/language - may forget simple words or use the wrong words. They can’t finish a sentence. (If their bilingual, this can be an issue for testing.) Time & place disorientation - get lost on their street. Can't get out the the parking lot of the grocery store they have gone to for decades. Poor Judgement - forget simple things, like to put on a coat before going out in cold weather. Problems with abstract thinking - Classic example is balancing a checkbook, people w/dementia may forget what numbers are and what has to be done with them. Misplacing things – Putting things in the wrong places like iron in the freezer or a wristwatch in the sugar bowl. Changes in mood-fast mood swings, going from calm to tears to anger in a few minutes. Irrationally suspicious, paranoid or fearful. Loss of initiative-may become passive
DEMENTIA TESTS: 3 main tests. Different yet similar…. 1. Folstein aka Mini Mental State Exam (MMSE) - 30 point test. Looks at math, memory, orientation, basic motor skills. MMSE is copyrighted & needs training to do, so usually done by gerontology neuro MD’s, or trained staff. Score is 27 or more=normal; 21-26 mild; 10-20 moderate; under 10 severe. Folstein has issues for bilingual persons - even if they were bilingual when children.
2. Mini-Cog: a 3 item recall & a clock drawing test. 2 -3 minutes to do. Should not be used alone as a diagnostic. Usually used to base a referral on. Most geronotolgists do the mini each visit to document changes.
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. Gives a score from 0 – 29. Highly reliable.
Other tests: If Frontotemporal dementia is suspected, can have an Addenbrooke’s Cognitive Exam done. Some places will do a motor skills ability score - like the laundry basket sequencing activity.
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.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. 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 got tests & scans done annually for 5 years for the study group she was in, we were very fortunate to be in it. If they suggest that your mom participate in one and you have the ability to get her to the appointments and commit to a 2 - 3 year study, please do so. Good luck and take your iPad or kindle too.
You expect to sit in a waiting room for four hours. It is not the sort of thing they want you there for. Too many patients will look to their family member for answers. Even for the mini-mental, mom kept looking at me and the MD was relieved that I kept my mouth shut.
Big difference between a neurologist and a neuropsychologist. Neurologist is an MD and does clinically based tests. Neuropsychologists generally have PhD and do cognitive/reasoning/memory testing. Different fields, different training, different testing. Neuropsych is what takes a long time.
A neuropsych is a several hour battery of tests, not just of memory but of reasoning, problem solving and the like. You will not be present. You may be asked some questions separately about your mom's mental state and ability to manage everyday tasks. Bring something to read and be prepared to hear lots of complaints afterwards about how stupid the questions were. Make sure she has a good breakfast, goes to the bathroom beforehand and have her bring a sweater in case the room is cold. After several weeks, you'll be asked to attend a debriefing session with your mom. In other words, you probably won't get immediate feedback; these are tests that have to be scored and analyzed.
We took my mother for an evaluation to diagnose her dementia. It took 4 hours with a lunch break. They write a lengthy and detailed report, which was later used as evidence for guardianship.
Pam is absolutely right about the cognitive function tests - the best thing you can do is make yourself scarce. Even your being in the same room is likely to distract your mother because she'll keep looking to you instead of concentrating as well as she can on the test.
I don't know if our Memory Clinics (I wish they wouldn't call them that because they're actually Brain Function Clinics, but anyway) work to quite the same system, but the other thing they did was interview us together (with my mother's agreement). This was partly to get accurate information about how she was functioning generally; partly to gauge how much she understood of what the clinic was all about and how much she wanted to know about her own condition; and partly to give me their assessment of how her dementia was progressing.
My experience was that it was interesting and useful, but yes do take a good book!
If you're concerned about mobility or hearing or sight or any practical issues like that, just flag them up to whoever takes charge of your mother - these people know what to do.
I tell my younger patients that a good neuropsych is like getting an owner's manual for your brain. It gives details of strengths and weaknesses of brain function in much more detail than just an IQ test or MMSE, and a full battery is at least a half day full of both face to face and paper and pencil type tests. In your situation it is probably very worthwhile to help resolve the different perceptions of you and your siblings. It may not on its own provide a specific medical diagnosis but may have a pattern more consistent with Alzheimer's, vascular dementia, traumatic brain injury, stroke, depression or ADD. It will look at different types of memory, attention, concentration, executive function, reasoning, perseveration, spatial perception, and processing speed. It usually can provide recommendations on how someone will learn best in school, and in elderly adults, what kind of supports may be needed. It might or might not indicate that driving is inadvisable; if relevant deficit areas are not terribly severe, a behind the wheel evaluation is still important for that as well. It can provide a really big piece of the puzzle for you.
Willows, it seems to me that the docs who specialized in brain function diagnosed your husband correctly. A doctor who is trained in the care of the elderly and not a specialist in cognitive function is not a place to go to counter a dx of dementia from some who specializes in that field. I'm sorry he has this sad disease.
You can expect a lot of baloney and a lot of wasted time! The more you diddle with doctors, the more frustrated you will become. They don't know squat! After my husband had been diagnosed with dementia by our primary physician four years ago, she sent him on to a neurologist for confirmation, who diagnosed him with Alzheimer's. I decided on a third opinion, as did my husband, who was still able to think rationally at the time. I took him to a gerantologist (I did not spell that right), who deals with elderly people. She had a nurse run a battery of oral and written tests on him, and she said he "passed with flying colors." She said to him, "Nothing wrong with you!"
Well, she was wrong because four years later, he is now holding a fake ticket in his hand waiting for a train to take him home (he IS home). I know more about his condition and what to do for him than a whole room full of doctors.
I would have to ask who referred your mom for a neuropsych eval? Does she live on her own, or with you or in a nursing home? And, how old is your mom? My mom was living in an independent apartment in an elderly community. She fell twice in two days. I insisted that she go to the emergency room. Anytime they fall, a Brain MRI is usually ordered to so if there was a stroke, etc. In my mom's case, the Brain MRI showed too much spinal fluid in her brain which caused Normal Pressure Hydrocephalus. This condition causes memory loss and problems with walking (at some point). My mom's memory problems were not dementia and it was just that she would forget how to use the microwave to heat up the food I brought her, plus other things. Just memory problems but not dementia which is what some would want to call it. She has been in and out of nursing homes to rehab and then come back home to me. We have a problem with that too. In older women, they can no longer articulate the symptoms of a urinary tract infection (it hurts when I pee). I googled the symptoms of a UTI in an older woman and they become delusional and way out there. I had to tell the facility when my mom had a UTI because they did not understand what an older woman's would be. Every time I told them to test her for a UTI because she was talking crazy, i.e., did I know that this CNA washed up on the beach yesterday; did I know that they were performing sex change operations on the third floor of this hospital; that she had read (which she can't even do anymore) that I had registered to have an abortion (I'm 65) or that I had registered to get a divorce, etc. Because of these crazy comments, she has twice had neuropsych evals and they determined that she needed medication and they put her on this medication without even discussing it with me. All this time, she had a UTI and that was causing her delusional comments, not a psychiatric disorder. Plus, if her memory fails, my mom does not want to be prescribed any meds for that. She is a little old lady and has every single side effect of any medication they prescribe. Just make sure you are doing what is best for your mom, even if that is not what the doctors want you to do.
Your mom has probably already gotten the mini-mental testing done at her referring doc's. Mini-mental are the ones with the 3 word memory test & the clock drawing. For my mom, the neuropsch involved testing was over a 5 year period. Now her MDs at the time were affiliated with the medical school and so she was involved in a dementia study of 90+ yr olds. Started when she was living at home, then when she moved to IL and stopped when she went into NH. It was immensely helpful. Once she hit a certain # in testing, it got repeated and then she was discharged from the program as she had plateaud out on changing her testing numbers. I was in an adjacent room watching the testing via video feed with medical students and the gerontology residents. It was really heart wrenching seeing mom work really hard to answer the questions and her frustration at not being able to process.
You will likely be interviewed. If you can detail specific "incidents" that have you concerned it could be helpful. Dementia signs fall in the groups below.
Signs of Dementia:
Recent memory loss - ask you the same ??’s over & over.
Difficulty performing familiar tasks - cook a meal but forget to serve it. Put on pants but not panties.
Problems w/language - may forget simple words or use the wrong words. They can’t finish a sentence. (If their bilingual, this can be an issue for testing.)
Time & place disorientation - get lost on their street. Can't get out the the parking lot of the grocery store they have gone to for decades.
Poor Judgement - forget simple things, like to put on a coat before going out in cold weather.
Problems with abstract thinking - Classic example is balancing a checkbook, people w/dementia may forget what numbers are and what has to be done with them.
Misplacing things – Putting things in the wrong places like iron in the freezer or a wristwatch in the sugar bowl.
Changes in mood-fast mood swings, going from calm to tears to anger in a few minutes. Irrationally suspicious, paranoid or fearful.
Loss of initiative-may become passive
DEMENTIA TESTS: 3 main tests. Different yet similar….
1. Folstein aka Mini Mental State Exam (MMSE) - 30 point test. Looks at math, memory, orientation, basic motor skills. MMSE is copyrighted & needs training to do, so usually done by gerontology neuro MD’s, or trained staff. Score is 27 or more=normal; 21-26 mild; 10-20 moderate; under 10 severe. Folstein has issues for bilingual persons - even if they were bilingual when children.
2. Mini-Cog: a 3 item recall & a clock drawing test. 2 -3 minutes to do. Should not be used alone as a diagnostic. Usually used to base a referral on. Most geronotolgists do the mini each visit to document changes.
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. Gives a score from 0 – 29. Highly reliable.
Other tests: If Frontotemporal dementia is suspected, can have an Addenbrooke’s Cognitive Exam done. Some places will do a motor skills ability score - like the laundry basket sequencing activity.
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.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. 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 got tests & scans done annually for 5 years for the study group she was in, we were very fortunate to be in it. If they suggest that your mom participate in one and you have the ability to get her to the appointments and commit to a 2 - 3 year study, please do so. Good luck and take your iPad or kindle too.
I don't know if our Memory Clinics (I wish they wouldn't call them that because they're actually Brain Function Clinics, but anyway) work to quite the same system, but the other thing they did was interview us together (with my mother's agreement). This was partly to get accurate information about how she was functioning generally; partly to gauge how much she understood of what the clinic was all about and how much she wanted to know about her own condition; and partly to give me their assessment of how her dementia was progressing.
My experience was that it was interesting and useful, but yes do take a good book!
If you're concerned about mobility or hearing or sight or any practical issues like that, just flag them up to whoever takes charge of your mother - these people know what to do.
Well, she was wrong because four years later, he is now holding a fake ticket in his hand waiting for a train to take him home (he IS home). I know more about his condition and what to do for him than a whole room full of doctors.
Don't waste your time or your money! Bleh1
See All Answers