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Oh my, my doctor has been giving me the clock test at least once a year for about 3 years. It was explained to me I was part of a study and would I help them out. So far I have passed. LOL
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Amen, stillsaneinSD! You are most definitely right whe you say that people need to realize that the dementia patient is still a person with feelings and some self-awareness, and you need to find comeone with compassion. My mom's GP sent her Medical Assistant in to give mom the test! Mom definitely has dementia, classed moderate and progressing. When the MA tried administering the test, mom looked at her and said, I still have enough brains to know what you are doing, you are giving me a test to see if I have dementia! Since I know what you are doing my mind must be clear. I canot be bothered taking your test today, I have other things to do. Maybe some other time. The doc had a sheepish grin and I laughed out loud! Score one for mom! Meantime, on another occassion a psych evaluator put mom through a lenthgy battery of tests over three meetings at her house. My mom found it so challenging and intriguing and she so clicked with the evaluator she wanted to keep meeting with him and wanted to keep doing more cognitive exercises. His evaluation was the most thorough, illuminating, educational and helpful eval mom has ever had! I learned a great deal about where my mom is and what is going on with her - it has made me far more insightful in caring for her and her daily behaviors and reactions. His eval opened doors for services with DSS and agencies without dispute.
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My Dad refused to take my Mom in for a memory analysis long after it was obvious she had serious deficits. Once he was diagnosed with a brain tumor and I became responsible for both of them, we had to go to her GP for a diagnosis so that I could become Trustee for their Trust.
She did extremely well until the clock test, which measures planning capabilities. She was very aware that she was being tested for a mental exam and continually complained that her husband thought she was crazy and wanted to put her in an asylum.
I had to take her to another doctor later for the same evaluation, pursuant to our Trust requirements. This doctor was so much more compassionate. She asked questions in a way that made Mom feel the doctor wanted to know about her, that she was interested in who she was and not that she was being tested. It helps a lot to discuss the test ahead of time with the doctor and make sure they are compassionate and realize that the dementia patient is still a person with feelings and some self-awareness.
I believe my father waited far too long to have this test done, but after the first test and the lack of compassion the first doctor had, I understand why he delayed. My advice is to discuss with the doctor ahead of time how this test is to be conducted, and make sure you are comfortable with their approach.
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My mom gets very defensive when you mention her cognitive impairment and short-term memory issues. She is trying to preserve her dignity and independence and do what I can to assist that. So, rather than talk to her doctor about her in front of her and dispute what she tells the doc, I type up a short concise list of concerns for the doctor, including any physical or mental status changes and put it in an envelope. When we go to the appointment, I hand the envelope to the secretary/assistant and say, this is the information for the doctor on mom's current status and concerns. When mom asks, I tell her it is the paperwork that will provide the doctor with necessary information for her proper and thorough evaluation and treatment, e.g. current meds, any complaints or changes since the last visit, etc. She is satisfied with that and doesn't lose face. THe doctor responds subtely as most understand the seniors sensitivies and sensibilities. Good luck!
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Your profile indicates you are caring for your mother... so are you the one that takes her to her doctors' appointments? If so it's very simple. On her visit to the primary care -- indicate to him/her what you've noticed. I took my mom to her doctor's appointments, she never learned to drive (THANK GOD, comes in handy now). I would remind her to tell the doctor that she needed to ask about whatever was bothering her at that time. When she would come out, I would wait in the reception room, I would ask her did you tell him about -- whatever it was. She would say no, I forgot or no I feel fine now. After about 3 visits of this, I finally went back in with her to tell the doctor -- she is not fine, she is having this and this -- it was a small list. But he was glad that I told him about her health concerns and he did a test with her. Now we knew what the problem was.

You may need to step up and let her primary care doctor know that you are noticing certain problems that you think need diagnosing.
Hope this helps, and others are giving you good bits of wisdom that they have learned along this way.
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I noticed my husband changing. I mentioned I was worried about my bad short term memory and suggested we both go to a gerontologist to get evaluated. I would appreciate his support. We both went, at the same time. I took some paperwork of his from another hospital. Found out he has had a stroke that we didn't know about. We are going to get the results of MRI and CAT scan on our brains next week. I think what helped is he was going with me, and I got evaluated also. He was also supporting me. I had the MRI, he had the CAT scan because of a pacemaker in his heart.
Every time I write the word CAT scan. I think of the old joke about the lady that took her duck to the Vet. He said the duck was dead. The lady just couldn't accept it and wanted tests done. After a long battle, he said ok. Called in his Black Labrador Retriever who sniffed the body all over. Shook his and left the room. Then a Cat came in and sniffed the duck and shook his head and left the room. The doctor said the duck was indeed dead and that would be $500.00. The lady was angry at the price, and the Vet said. "You wanted more tests, well you got a Lab report and a Cat scan." Sorry, had to put that in.
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I started noticing little red flags like, getting into more fender benders, calling me crying that she forgot where she parked her car. She was also a nurse and I was friends with one of her co-workers and she told me she noticed Mom getting worse. I told Mom I was concerned about her and she even conceeded that she knew she was changing. I had to also let her know that I was worried about her driving and that she could hurt herself or others and risk everything. So, she agreed to go to the doc for a memory test to which she failed pretty badly. That was when she had to face facts. I arranged for her to live with me "per her request" and assumed the caregiver role. She does not have Alzheimers but her dementia has progressed over the years since she has been living with me. She still does many things fine on her own, but transportation, finances, shopping, caring for her overall health is now my responsibility and I feel such relief knowing she is with me and has all her needs attended to.
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The folks who chimed in already have offered solid advice. And a few different approaches. I hope you find the right path.....the one your mother will respond to, as opposed to resisting.

All I can really add is -- I agree that the MME is inadequate. I've seen versions of this test online. I guarantee you my mom could draw the hands on a clock, correctly identify a picture of an apple and count backwards from 100......until the day she died. And my mom had two forms of dementia!

I encourage you to work behind the scenes to arrange more complex neuro testing.
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I highly recommend the appointed individual be someone with whom your family member has the best rapport, trust, and is most likely to agree with. "Sometimes" parents do better saying yes, to a non-family member. One suggested example is to instruct the individual//family member to say "we have noticed a few changes in your "memory, mood ...". State a few changes, but avoid overwhelming or scaring the individual). You might want to continue by saying, "we understand that you may not notice this, but I have known you a long time and I think it is a good idea to have a doctor's appointment. We think a doctor will help. A doctor will look for medical explanations, first. Sometimes it is as simple as a side effect of a medication, and can be resolved quickly. Sometimes it takes more tests, and a Specialist, but the appointment is a good first step to help you and your family. If you want, I will go with you and stay with you during the appointment. I can help explain to the doctor what I am seeing, and after your appointment then we can go out to your favorite..."

If your family member is on a Statin medication (for cholesterol), please request that the doctor consider this as a possible adverse side effect and can impact cognition (happened to my husband). Please DO NOT make any medication changes. A doctor should evaluate and advise, BEFORE any medication changes are made. There are individuals on Statins that do not experience cognitive changes. Your doctor will also do a brief cognitive test (perhaps the Mini Mental Cognitive Test). This test is fair. A good doctor should be able to rule out medical first, and discuss alternative neurological options next, if indicated.

Wishing you and your family member the very best.
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I was recently told that many doctors do a version of a MME at a routine physical.
I am not particularly fond of MME's because I do not think they show much unless the decline is very obvious. And some people happen to do well for a longer period of time.
If there is a way that you can inform the doctor that you think there needs to be further evaluation I am sure between you and the doctor you can come up with a need to refer your Mom to a Neurologist or a Neuropsychologist for further evaluation.
I am sure you Mother is just as concerned but is fearful. As would anyone that fears a fatal diagnosis.
Talk to your Mom and see if she has noticed any problems and talk.
That is the one thing I wish I had been able to do..get my husband to TALK. I would have loved to know what his thoughts and fears were, what he wanted me to do and most important what did he want to do before he could no longer enjoy the time we had.
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My husbands Medicare supplemental plan ( Keep Healthy Benefits) allows for an annual in home physical exam by one of THEIR nurses, even though he still sees his regular doctors. A cognitive test is part of the exam. Check your moms benefits
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When we were advised by the geriatric psychiatrist who was seeing mom to have her evaluated for cognitive problems, we told her that the doctors wanted to get a " baseline measurement" against which to judge her memory and other functioning in the future.
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If the parent notices problems, says things like "Why is my memory so bad lately," you can offer to schedule some medical tests.

Otherwise I'd come up with some other reasons for the doctor's visit and not mention "mental tests."
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The patient with dementia does not know they have deficits and will completely deny anything is wrong. They are "just fine". We had mom assessed while she was in the hospital after a serious fall. You can have this done as part of the annual physical with a referral from the primary MD to a neurology clinic.
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