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My Medicare Advantage plan sends an NP around to my home every year to check my general health. This year for first time (I am 81) it included a test of remembering three words while drawing a clock that said 2:15. I passed this okay, but I do carry one ApoE4 gene for late onset Alzheimer's--although neither of my parents lived long enough (62 and 80) for dementia to be obvious. Nor did my grandparents who all died in their early 80s of heart attacks or colon cancer. I am also taking some online tests each year through Brain Health Registry that I find extremely difficult but they don't tell me how I am doing. Is this clock thing really important, and how do you know if you are developing AD versus normal cognitive decline with age?

Please feel good that you passed those tests. If you don't pass, then you need further evaluation by a physician. Early treatment of dementia is the most effective treatment, so it is good that they are doing the screening. The test of remembering 3 things obviously tests memory but also attention and motivation. The clock test is a very easy test to administer and score and is predictive of a problem that needs to be followed up with further testing. It's considered a problem if any of the following occur: wrong time, no hands, missing numbers, repeated numbers, numbers in the wrong order and refusal to do the task. The clock test specifically test executive function. This would be planning, organizing, prioritizing, predicting the result of an action, impulse control, emotional control. Loss of executive function is often the first thing family members notice about a loved one when they are developing dementia. I mentioned to my dad's doctor that I thought he was developing dementia. I was shocked when I saw the clock that he drew. You might want to google "clock test images" to see how this can go. As a scientist, I can tell you that is is normal for the researchers to not tell you the result of the data they collect on you. Thank you for participating in this research. The current research says that people who engage in a variety of activities, especially new activities, that are mentally challenging may delay the development of cognitive decline. (By the way, the three words my dad was tested on 9 years ago, I can't seem to forget them!)
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Reply to Toadhall
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Hugs, Arleeda.

We can't help beginning to feel very vulnerable and anxious, hm? - especially during phases when there just seems to be a sea of troubles facing us and our loved ones.

You've taken the right steps, and your daughter is a responsible, sensible and eminently qualified person. I'm sorry she's going through this with her father.

The rest of it really is just life, you know. I don't think there is an answer.
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Reply to Countrymouse
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Yes this clock drawing is important if you leave it in its environment i.e. the MMSE or Mini-Mental State Exam , what you are writing about is de "Mini-Cog test" were you where asked to retain 3 words and draw clock showing all 12 numbers and place the needles on the exact time mentioned by the doctor. This is a brief test that helps your doctor to decide if you should undergo a further examination. So if your physician did not call you back for tether examination I think that you are still OK in life.
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Reply to YvesCals83
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When you go on Medicare, you have the opportunity, within the first 12 months, to have a
Welcome to Medicare physical. Although many do not know about this or take advantage of it, it is important and completely covered by Medicare.

Yes, the clock is important.
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Reply to Llamalover47
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I believe this is a test to establish baseline as one is Medicare eligible.
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Reply to Llamalover47
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When mom did she had 9 numbers on 1 side & 3 on other but most looked like short hand to point I was asked if she knew that which I knew she didn't - mom was an artist so it was very telling that she had lost spacial acuity where she couldn't draw anything like a circle & time was off too - she failed the test but there were 20 items in all & failed most of them
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Reply to moecam
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I think they are doing this to establish a base line so when you go in next year and you draw the same clock, remember the 3 words given they know there has been no change. If however you have difficulty with either they might be more inclined to recommend further testing.
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Reply to Grandma1954
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You said they don't tell you how you are doing. Come right out and ask them. If they him and haw around, ask them why won't they tell you. Get assertive if you need to.

Personally, you seem ok to me. My husband who has Alzheimer's drew the clock face 2 years ago fine. This year all the numbers were on the right side of the clock.
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Reply to MaryKathleen
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It is important as a starting point. If you can't do the three words and the clock it is indeed, time for my examination. :(
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Reply to Teri4077
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Ah...well now I can see more reason why you're concerned.  LBD is scary.  You should encourage her to find out what resources will be there if and when finances start to come up short for care.  None of us wants to be a burden to others, but it is something out of our control, and really the best plan and revenge is to enjoy each day and not let worry and fear suck the good out of it.  Find something fun to do.  My mom is 96 and developed some dementia at a later age but she is continent and somewhat functional.  My dad is 101 and he has clearly found the keys to doing so:  He is active, engaged, volunteers, gardens, mows the lawn, washes the car, watches the news, reads the paper, visits neighbors and goes walking or playing golf.  And look at you!  You're on the computer and have found this site and are using it!  So you are amazing as well!
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Reply to robinr
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Lots of good other answers. Sometimes people get test anxiety and are stressed just taking the test.  Just because others in your family had some potential and how you tested doesn't mean you're going to have issues.  The worst thing is to have stress.  AND to remember, though they might get pissy, that you're in charge of you, and you can refuse the intrusive behaviors like home visits these health plans offer.  There is some evidence that screwing up the clock test might be an indicator, but if you are truly concerned, get yourself an appointment with a neurologist who is an expert in this area, and personally, I would stop short of any invasive testing with dyes or similar.  You can also appoint a health care proxy/power of attorney, and change that when you want to know you will have that protection.  Don't worry!!
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Reply to robinr
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In my wife's case, the test by a neurologist, after having failed the same test with our pcp, led to the ct scam that confirmed her FTD and PPA. Which led to me hiding her car keys and the neurologist prescribing a med that should have slowed the disease. Sadly when diagnosed it was too late for the med to help. The neurologist decide to terminate the clock test after she started writing random number that exceeded military times and later hours were coming before earlier hours.
She is ESL person and now she communicates very little in english.
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Reply to OldSailor
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Yes I got the same thing this year. I did it but I think I will refuse next time. Just another government beaureucrat rule intruding on our lives.
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Reply to careinhome
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Isabelsdaughter Oct 18, 2018
Totally agree
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You have some good answers here, especially the first one. Your question is so clear and cogent there is no sign whatsoever that you are moving toward dementia. With reference to the mental test, it is an indication of cognitive ability. However, even people who make mistakes with remembering or drawing the clock do not go on to develop dementia. In England, what is known as Mild Cognitive Impairment (MCI) only leads to dementia 50% of the time. Furthermore, as a friend said to me: "If you forget the location of your car keys, that is not a sign of the slide into dementia. Rather, dementia begins when you don't know what car keys are used for!"
It is important to know that just because several members of your family have developed dementia late in their lives, that does not mean you are more likely to get it, even with the APOE4 gene. It is only Early Onset Dementia (roughly before the age of 50) that there is a 50% chance of others in the family developing dementia, as explained in the film "Still Alice." Cheer up! You're still doing well.
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Reply to BritishCarer
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To me, the “mini mental duet” is not so much about passing per se but about having it in your health chart to see changes over time and what the progression is like as it can help give an indication as to which type of dementia.

For my mom, her first happened unplanned.... she had torn a muscle cleaning windows; her regular internist - which did NOT do minis ever - sent her to see othopedic surgeon & his practice was within UTHealth Science Center system; ortho MD sent mom to be be evaluated by gerontology practice - also UTHSC- before he’d schedule surgery and this was more about her to be ok to be cognitive to do rehab, cause if she wasn’t competent & cognitive enough for 2-3 mos of post surgery rehab he wouldn’t do it. My mom was in really good health with no chronic diseases. Gerontology did full on work up and mom ended up getting into a study on nonagenarians. Mini mental every 4 mos, annually full ACE (Addenbrooke) & Battery 100. Everything pointed to her having Lewy Body Dementia. And on retrospect, she was pretty classic Lewy. The medications for Lewy are different than for Alzheimer’s, so knowing she was Lewy was important. She was on Exelon as aricept doesn’t work for Lewy. Also the most common prescribed psych meds are totally adverse for Lewy.

The testing tech told me that the more “Dali” like for the clock and the more extreme the clock melt, the gerontologist could use to actually determine where a patient was in their Alz phase over time by looking at past drawings. The ones with Lewy could clock draw pretty well till death.

Another thing about any of the Dementia “testing”, if your first language was not English or you grew up in a bilingual household, your test results could be somewhat inaccurate as they skew English only. My mom was fluently bilingual (an ESOL program volunteer in her 70’s) but as she aged reverted more to her first language or code switched in conversations.

If your really concerned about your dementia probability, I’d suggest you get an Addenbrooke / ACE done as it’s a pretty solid test & score is pretty spot on in my experience.
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Reply to igloo572
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Arleeda Oct 18, 2018
Is your UTHSC in Texas or Tenn? I am in Memphis TN and there is one with those initials here.
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Do not worry about it. I have a non-Medicare plan. My insurance company has been doing this for the last few years for everyone who is on any type of medications so my son, in his 20s, had the same test 2:15 on the clock and remember apple, pencil and baby. This is the first year they are doing it for healthy individuals, so the call me 4 times a day to set up the appointment and I just auto-reject calls.
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Reply to tacy022
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On a sort of "cogito ergo sum" theme, perhaps one way of being reasonably confident that you're not suffering from AD is having such an acute awareness of what to look out for. If you were in the early stages, I suspect you might have lost interest in monitoring yourself so closely, for a start.

I'm all for responsible self-help, but is this beginning to cause you needless - even possibly counterproductive - anxiety?

Perhaps the best thing to do would be to appoint a health proxy and leave it in their hands and God's.
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Reply to Countrymouse
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Arleeda Oct 16, 2018
I do have health care proxy in my RN daughter. Right now she is dealing with her father (my first and ex husband) in nursing home for two years with what she diagnosed as Lewy Body dementia. She knows that he never wanted to end up like this and is concerned about finances running out. I just hate to put her through all of this a second time. My second husband had vascular dementia but reasonably good memory. He just lost his sense of direction and "executive functioning." He ended up with major stroke and died 3 weeks later as he could no longer swallow and his living will prohibited gastric feeding tube. I only hope I will be so lucky.
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