Being a care giver in my book is the hardest job in the world. Imagine going to work one day and your boss tells you that you can no longer leave at the end of the day. You will no longer be paid for the work you do and you must expect to be woken up during the night at any given time to do your job. Hear is the real zinger! Your boss also informs you that you no longer have a job description and that you must expect to fail at everything you do because you will not be given any training.
I remember when my daughter had Leukemia at the age of four. My wife Beth and I felt as though we had been sentenced to live in this bubble for two years and our prison guards were medical doctors and social workers. Our entire sense of being revolved around our faith in God and making sure our daughter Morgan was going to live through this. We had been given a sense of purpose that was not asked for much less desired. Even though we had thousands of people praying for us and the support of friends, family members, social workers, and doctors, it felt as though no one else in the world could do the job for us. We had to learn to embrace the mission, understand that we were not perfect, that we would make mistakes, but we were not alone. We had to remind ourselves that this was too big for us to handle however; we had the means to deal with this.
After a period of time went by, I began to understand that I must have another sense of purpose, a purpose other than being the dad of a child with a life threatening illness. I began to understand that by having another purpose, I could be stronger for my daughter and my family. It is like taking a trip on an airplane with a child. The flight attendants always instruct the parents of small children to put the air mask on themselves first before helping their child. I needed to come up for air!
I believe that “Any real meaningful purpose in life is most often, not recognized until after some of the most difficult training and preparation has taken place”. In other words, I had no idea at the time that my experience as a care giver would someday lead me to the work I do now. I was certainly dumbfounded to discover that I gained the skills necessary to empathize with the care giver of an individual with dementia. Is a person called upon to do a job based on their future potential or their background? By giving things over to God, we are free to embrace failure knowing that there is a sense of purpose behind our every move. The trouble is as human beings, we have the desire to know what that purpose is in advance.
The sense of purpose for you can be anything you desire. Some people audit a class at the local Community College. Some people join a Bridge Club or facilitate a small group for their church. People join civic groups or organizations that support their favorite hobby or interest’s. I’ve had people who joined gardening clubs, fishing clubs, hunting clubs, golf clubs, reading clubs; you may even find a new career. We were designed to have rest.
Is the paradox becoming clearer to you now? One sense of purpose is identified by looking back at your experiences. The other sense is identified by looking forward to what is comfortable to you. In my opinion, both are equally as important, we just need to begin our search.
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I have worked with hundreds of care givers and never have I experienced such a care giving warrior as this person whom we will call Ruth. Her husband is a retired law enforcement officer who was diagnosed with Alzheimer’s disease several years ago. He has a heart as big as hers and is the epitome of what we all pray for if our loved one is diagnosed someday with this disease. It is what I call a match made in Heaven.
In my experience, the Christmas Season is the most difficult time of the year for the family who has a loved one with dementia. If we could only know what is in store for the next year. I have had this conversation many times with my fishing buddies. The question is: “What would the world be like if we new what God had in store for us every day of our life?” Would your best friend be calling you to say that they could not drive today because they new they were to die in an auto accident? Would your daughter tell you that she would not date the man you approved of because she new that he would experience several tragedies in the future resulting in his own alcoholism? The world would be a mess!
Ruth has chosen the humble path of servitude and has accepted the cards she was dealt. When she promised her husband that she would stick by his side until death do us part, she meant it! What she did not promise was that she would do it with a positive attitude and a big heart. What a fortunate man! What follows is here Christmas letter to her friends and family:
“YOU’LL BE IN OUR HEARTS THIS CHRISTMAS SEASON- 2008”
We don’t have all of our Christmas decorations up yet but as we continue putting them up here and there, our hearts expectation is that Christ will do something new in all of us this special season.
We are reminded that Mary & Joseph were real people and they were deeply affected by all that took place. Likewise, Christ’s presence should deeply affect us. He is our God, our Savior, our friend, our King. He has come! He lives today! He is! That is indeed reason to celebrate!
Our daughter Shelly was here with us for two months this last summer. What a joy to have her here. We were happy to have our son Ben visit us also in the summer as well as a more recent visit. It is good that our daughter Karen still lives close by so she can stop in frequently. We are thankful for the many things our children do for us and the love they share with us.
The Lord has given us a good year because of his Loving Presence. We are doing ok physically, however, we both are learning to adjust and accept the progression of Larry’s dementia. Despite the many daily difficulties that contend with, secure in our love and knowing God is always with us, we are mostly content. Maybe it’s the pleasure of making another person happy. But we know it is in part, the encouragement we receive from family, from friends, from support groups, and the daily blessings from God.
The Lord is teaching me to release to Him my hopes and desires so that He can bring them to pass. I find that God takes yesterday’s hopes and challenges me to let go of them for a greater display of his Grace. Daily He says “let go, and trust Me. Watch me work”. My chosen scripture (Which has been printed in large letters on my dining room area wall) is found in Proverbs 3:5 “Trust in the Lord with all your heart…” May this scripture be yours in the 2009 year!
We wish you a Christmas Joy. And may the Spirit of the Season fill your heart during this special time.
Can you find anything about this letter that has to do with meeting her own needs? When families often ask me what are the qualities necessary to be a good care giver? The answer can be summed up into one word, “Grace”.
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Delirium is a sudden, fluctuating, and usually reversible cognitive disorder characterized by disorientation, the inability to pay attention, the inability to think clearly, and a change in the level of consciousness.
Delirium is an abnormal mental state, not a disease. Although the term has a specific medical definition, it is often used to describe any type of confusion.
Because delirium is a temporary condition, determining how many people have it is difficult. Delirium, which is usually a sign of a newly developed disorder, affects about one third of hospitalized people aged 70 or older.
Development or worsening of almost any disorder can cause delirium. Any person can become delirious when they are extremely ill or are taking drugs that affect brain function. However, delirium can result from less severe conditions in older people and in people whose brain has been affected by a stroke, dementia, or other disorders that cause nerve degeneration. In such people, delirium can result from a relatively minor illness, such as retention of urine or feces; sensory deprivation, such as that due to being socially isolated or not wearing glasses or hearing aids; or prolonged sleep deprivation. For example, the sensory and sleep deprivation that occurs in intensive care units (ICUs) may contribute to delirium. This disorder is sometimes called ICU psychosis.
Being in the hospital can also contribute to or trigger delirium. About 10 to 20% of older people develop delirium while they are in the hospital. Delirium is also very common after surgery, probably because of the stress of surgery, the anesthetics used during surgery, and the analgesics used after surgery. The most common reversible cause of delirium is drugs. (NIMH)
Delirium may occur in persons with a normal brain but is more common in those with underlying brain disease, such as dementia. It is more common in the elderly, probably due to changes in neurotransmitters, geriatric cerebral cell loss, and concomitant disease. Delirium may be due to primary brain diseases or diseases elsewhere in the body that affect the brain; causes are usually metabolic, toxic, structural, or infectious. Regardless of cause, the cerebral hemispheres or the arousal mechanisms of the thalamus and reticular activating system of the brain stem become physiologically impaired. Disruption of sleep and extreme stress superimposed on acute disease may worsen symptoms of delirium (as in intensive care psychosis).
Treatment
Symptoms are usually reversible when the underlying cause is identified quickly and managed properly, particularly if the cause is hypoglycemia, an infection, an iatrogenic factor, drug toxicity, or an electrolyte imbalance. However, recovery may be slow (days to even weeks or months), especially in the elderly.
All unnecessary drugs should be stopped. Identifiable disease should be treated, and fluids and nutrients should be given. A patient suspected of alcohol abuse or withdrawal should be given thiamine 100 mg IM daily for at least 5 days, to ensure absorption. During hospitalization, such patients should be monitored for signs of withdrawal, which can be manifested by autonomic disturbances and worsening confusion.
The environment should be as quiet and calm as possible, preferably with low lighting but not total darkness. Staff and family members should reassure the patient, reinforce orientation, and explain proceedings at every opportunity. Additional drugs should be avoided unless needed to reverse the underlying condition. However, sometimes agitation must be treated symptomatically, particularly when it threatens the well-being of the patient, a caregiver, or a staff member.
Few scientific data are available to guide the choice of drugs to treat delirium. Low doses of haloperidol (as little as 0.25 mg po, IM, or IV) or thioridazine (5 mg po) can help in managing the delirious patient. Larger doses (haloperidol 2 to 5 mg or thioridazine 10 to 20 mg) are sometimes needed. Newer drugs, such as risperidone, can be used instead of haloperidol for oral therapy but are not available IM or IV. Short- or intermediate-acting benzodiazepines (eg, alprazolam, triazolam) can control agitation over the short term; benzodiazepines may worsen confusion, but if required, the smallest effective dose should be used. All psychoactive drugs should be reduced and then eliminated as soon as possible so that recovery can be assessed. (Merk, 2nd Edition)
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A client I had been working with shared a letter with me she had received from her son who lives across the country. She cares for her husband who has Alzheimer’s disease. On this particular visit, she said that her son wanted them to move to the East Coast so that he could care for them. When I asked what he did for a living, she said he was a successful, but very busy Software Engineer. She had some concerns about a letter he had sent her and wanted to share it with me so that we could discuss it. I knew this would be interesting since most engineers are linear thinkers.
Keep in mind that this couple had only given some thought to the concept of moving to the East Coast in the past. At this time, they were not even remotely able or ready to take it to the next level. They have long standing relationships with their doctor’s, have an extensive social network, and a specialized dementia care program in which her husband attends two days a week, a program that specializes in increasing blood flow to the brain which has been proven to slow the progression of the disease. This program allows her to take a break during the day and it provides her husband with much needed socialization with people who are trained extensively in dementia care activities. Activities that increase blood flow to the brain include the following: Socializing, Diet, Monitoring of other conditions, Physical Exercise, Proper Diet, Exercises for the Brain, and Music.
Let’s take a look at an excerpt from the letter so that you yourself can examine his intentions. The names of the individuals as well as any other identifiers in the letter have been removed for privacy purposes otherwise; I have not changed a word from title to conclusion.
“Long term Planning for Mom and Dad” (This was the title of the letter)
“Premise:
Staying at 1234 Lane under the current conditions is not tenable for much longer-less than one and one-half years in the absence of persistent illness or significant crisis. At age 85, Mom is reaching the limits of her ability to maintain the house and care for Dad. A breaking point is on the horizon, and only if we become proactive will we be in the position to dictate the terms under which we live in the future rather than having those terms dictated to us by circumstances out of control.
A priority in our decision making is to be able to provide Dad with the quality of care and quality of life he currently enjoys. He receives extremely high quality care and thus he has to accept that in order to continue some semblance of such care, some sacrifices must be made.
Rationale:
Mom cooks, cleans, shops, drives, monitors medications, oversees all of Dads doctor’s appointments and handles the house along with everything relating to Dad. Some of these responsibilities are new as a result of Dad’s inability to drive, but most of them she has been upholding for decades. In either case, Mom is reaching the limits of her ability to maintain them. With each passing month, she is pushed closer to a breaking point at which she will be unable to provide care either for Dad or for herself. In short, Mom needs help!
Solution:
Either we begin using financial resources in Washington to hire help and alleviate the responsibilities on Mom, or we move Mom and Dad closer to family assistance. (Whose financial resources will be used?) Both options have drawbacks; no idyllic solutions exist. Either option we choose carries with it burdens and losses. For instance, the concern for the first option is the speed at which financial resources will be drained and the difficulty of maintaining safe and quality assistance. For this and other reasons, we believe the solution of relying on family help incurs the least amount of loss and maximizes the potential for gain. For this reason, we believe moving Mom and Dad to the East Coast is preferred.”
Unfortunately, parents are being subjected to this way of thinking everyday. The generation of people I have the honor of working with have several character traits in common. Lets take a closer look at the traits I admire the most: They keep their promises including “Until death do us part!”, They do not want to burden others with their problems, They have learned the hard way how to manage their money, They have a strong sense of commitment and loyalty to people they trust, It takes time and the correct actions to build their trust, They have a strong faith in a higher power, They understand the value of close relationships and understand that true love goes beyond what is on the surface, They understand that love is strengthened by the trials they have experienced together, They respect and listen to people who want to help them such as doctors, nurses, firemen, pastors, etc, They have a deep sense of honor for our country, They know how to laugh at themselves and with others, They still feel they are invincible, They have a strong desire to give and not take and they have humility, and above all else, they have a remarkable sense of grace!
Can you see these same traits in the letter written by the son to his parents? Something that is hard for most of us to understand is that it is impossible for us to know what others are thinking because we have not had the same experiences. Most of us were not raised by our grandparents, our parents were!
“Life is not about outcomes, but fragments of time in which we are designed to experience.” Reed Henry
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The fourth and final skill is called Integration. The act or instance of combining into an integral whole. (Webster’s) So now we have to pull all of our information together and actually attempt to institute change. Rather than discussing what integration is, I have decided to provide you with some case examples so you can see what integration actually looks like. The most important thing to remember at this stage is that you may or may not be correct in your findings.
The biggest mistake you can make is to be unwavering in your thoughts. Use all of the previous skills we have discussed, Attending, Empathy, and Confrontation before you begin to integrate your thoughts and feelings. Once you feel you have done this, ask the person if it is possible you are correct using an I statement. Example: I hear you saying you are having a lot of anxiety and are not comfortable about having to speak in front of a large crowd next week. You may get it right, you may not. Be prepared to accept either and move on. If you are not correct, continue to dialogue using the other skills until you think you can integrate again. Once the person confirms your integration, you have shown them you are a true listener!
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The third basic counseling skill is Confrontation. It is not unusual to think of confrontation as a negative experience or the perception of a negative experience. When somebody tells you they’ve had a confrontation, do you think about a tense, angry argument or possibly even a brawl? Most people do. Even my Webster’s Dictionary tells me that “confront” means “to come face to face with, especially with defiance or hostility.” In radical contrast, counseling textbooks refer to confrontation as “an act of grace” or “a true act of caring.” This is one of those annoying times when a specialized, professional use of a word is nearly opposite to the way people normally use it. Still, the concept of “appropriate” or “loving” confrontation is critical to what counselors, family members, good friends, and spouses do.
In order for this to work though, we must have utilized our previous skills of attending and empathy first. Confrontation means telling people about inconsistencies that they may not yet has spotted for themselves. It’s hard to do, harder to do it right.
Timing is critical. Effective confrontation can only happen after two people have had a chance to get to know each other. As a counselor, spouse family member or friend, you know that first impressions are often off base and almost always superficial. It takes some time to feel into another person’s experience and even more time to sense when they are ready to face and work through their more difficult issues. People need some time to size up whether the counselor is competent, caring and honest. It takes time to build trust, but only trust can allow the person to accept and integrate information that might be frightening, even painful. Appropriate confrontation can only happen in an atmosphere of trust. How many of you can do this? This is exactly why “Boundaries” are important.
There are two main circumstances in which we might offer confrontation, two very different kinds of inconsistencies: those between what we say and how we feel, and those between what we say and what we do. Sometimes a person tells you they feel a particular way, but their voice, facial expression, posture and the general feelings you are getting from them seem to be saying something else. If you feel the person is ready to take another step in self-understanding, you might choose to tell them what you’ve noticed, and what you think it might mean. I have used this when working with a spouse who refuses to believe that anyone else can care for her husband who has Alzheimer’s disease. On the one hand they are exhausted and their doctor has said “Your going to have another heart attack” and on the other hand they still hold onto the belief that they can continue to do the job. If you offer empathy, remember to be sure to own your inferences, present them tentatively, and gracefully accept correction from the person. Your role is to invite self-exploration, not to compel it.
Other times, a person tells you they want or believe one thing, but their behavior seems unlikely to bring them to that goal, or to be inconsistent with those beliefs. They don’t seem to you to be walking their talk. Again, confrontation means telling them about the inconsistency that you perceive, caringly and as gently as possible.
Here are some sensible guidelines for confronting inconsistent behavior. Pick a calm and grounded moment for both of you. Speak gently. Only address one or two key areas at a time. More is more than a person can process at once. Only discuss things the person realistically could change. Be as specific as you can about how the behavior is interfering with the person’s stated beliefs or goals. Do not confront someone as a family or couple. This must be done one on one to begin with. Check that communication was clear. Have the person restate what you said if possible. Allow time for discussion of what you have presented. Be prepared to handle a defensive or angry initial reaction. Be as firm and as patient as stone.
When working one-on-one with an individual, about either feelings or behavior, never confront them unless you are willing to deepen your involvement with them. Normally, offering loving confrontation means volunteering to be there with the person as they work through the implications of whatever they learn from what you share with them. It means volunteering to be even closer to them than you were before.
Special thanks to Judy Harrow (Confrontation: “The Dark Mirror”)
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The second basic counseling skill is “Empathy”. Empathy is often confused with the word “Sympathy” which pertains to sharing the feelings of others or to be affected by the nature of the problem. Unlike Empathy, Sympathy is felt on a deeper level. Once again, this information is basic and can be used or applied as you see fit. You can also improve your communications with everyone you meet by learning these skills.
Empathy: Intellectual identification with or vicarious experiencing of the feelings, thoughts, or attitudes of another person. (Webster’s) In other words, the helper gets into a person’s world and looks from inside out rather than outside in. When you empathize with someone, you walk along side him or her instead of pushing or pulling them regardless of your own feelings. Empathy means understanding another person so well that you identify or feel like him or her. The Indians expressed it as: “Walking a mile in another person’s moccasins.” It is listening so intently and identifying so closely that you experience the other person’s situation, thoughts and emotions. Good therapists do this, so do good friends (Berger, 1987).
A good listener must respond, letting the talker know he/she was understood. This responding is empathy. It is even more complex than listening; no one is perfect. You don’t have to be perfect, but the more accurate an empathizer you can become, the better. Often, when we are upset, we want to express and share our feelings with an understanding person. So, the good empathizer focuses on the talker’s feelings, not on his/her actions or circumstances.
Let’s look at some of the purposes of empathy and why it is so important yet difficult to master.
1. It shows you care and that you understood the other person. Thus, people will enjoy talking to you and willopen up more. Imagine what this will do in your personal relationships!
2. If you have misunderstood, the talker can immediately correct your impressions. You learn more about people and what is holding them back from telling them the whole story.
3. It usually directs the conversation towards important emotional topics. It opens the gate!
4. It lets the talker know that you (the listener) accept him/her and will welcome more intimate conversation.
5. It invites him/her to tell his/her story and vent his/her feelings. This is the essence of reminiscing.
6. Since it is safe to talk about “deep” subjects, the talker can express feelings and self-explore, carefully considering all his/her deep-seated emotions, the reasons for those feelings and his/her options. Thus, it is therapeutic. You are beginning to get it!
7. It reduces our irritation with others because we understand. To understand is to forgive.
8. It may even reduce our prejudice or negative assumptions about others because we realize we now have ameans of finding out what another person is really like. Furthermore, we discover everyone is understandable. Do not assume you now have the power.
9. It fosters more meaningful, more helpful, closer friendships. People can actually trust you.
Empathy is one of the more important skills you will ever acquire especially when you are listening to someone with Dementia. It is amazing how few people do it well. If you can teach your children this, you will raise incredible people!
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1. Attending: to be present and ready to serve. (Webster’s)
Examples of good attending: Sharing a meal together, Prayer, Listening to anything they have to say. Non-Attending communicates disinterest, disrespect, abandonment, rejection, and arrogance. Communication is 55% facial, 38% verbal, and 7% non-verbal. Too often, we find ourselves wanting to jump right in and solve the problem. The moment you speak, you change that person’s agenda. Good attending communicates respect, availability, and reinforcement. The consequences of this are contentment, fulfillment, healing, togetherness and a collection of needed information to find, explore, and understand the problem. A note: If the person has dementia, good attending will often require you to listen to the same story over and over again. It is critical that you listen each and every time as though you have heard it for the first time. Things can become compounded when the person has poor hearing that cannot be remedied with a hearing device. Or what do we do when the person cannot see us?
Good attending is inherently designed to move the person from where they are to where they want to go. You can best accomplish this by being relaxed, have an open posture that conveys your intent, leaning slightly forward especially if they are hard of hearing, have consistent eye contact, and sit squarely. Something that’s very difficult for people to do is to allow for pauses no matter how long. Allow for strong feeling’s including tears, even if they are your own. Touch is critical to all of us. Our world of political correctness is killing us. If you are afraid of giving someone a hug or holding someones hand, ask for their permission. Think about the infant babies who die from the lack of touch.
So many people have such a difficult time just being with someone even though nothing is being said. Some of the best times I have had with friends and family are times when very few words were spoken. Just being present conveys to the other person that you desire to be with them because they mean something to you.
These are the 12 most common blocks to good listening: Comparing, Mind Reading, Rehearsing, Filtering, Judging, Dreaming, Identifying, Advising, Sparring, Being right at any cost, Derailing, and Placating. Avoid these pitfalls and you will be on your way.
Next time we will learn what the second skill is to socializing. It might be easier though to ask your grandparents.
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The world is no longer as it should be. People use to sit on the front porch and visit one another 1 on 1 or as a group. Where I grew up in the Midwest, people rarely left their house unlocked. You could walk in with out knocking and even help yourself to the fridge if you were hungry!
I am saddened by the number of people who have no one to visit with on a frequent basis. Even worse is the fact that some people enter into care facilities because they are lonely, especially in rural communities. The article that follows was published in 1998. How many people could have lived longer since then if they had been visited more often? Studies are now showing that socializing with others may help to prevent Alzheimer’s Disease or other types of Dementia. We already know that socializing helps to slow the progression down for those that already have it.
Many of the families I work with say that they have lost all of their friends since being diagnosed with Dementia. I believe the reason for this is out of fear. Fear of hurting their own ego or fear of hurting the other persons ego because they may just make some mistakes. Well stay tuned because help is on the way! In my next blog, I will begin to lay out for you some simple concepts of socializing. Interestingly enough, these were the same concepts we were taught in one of my first graduate level classes. How did we get so far from where we were?
One final thought for now. Did you realize that by allowing someone else to help you, you are giving them a gift!
Loneliness Health Hazard for Elderly
NEW YORK (Reuters) — Loneliness can raise the risk of nursing home admission for the elderly, according to a new study.
“Extreme loneliness was a significant predictor of admission to a nursing home among rural older men and women,” conclude researchers at Iowa State University in Ames, Iowa, and the University of Iowa College of Medicine in Iowa City.
Their study, appearing in the current issue of the journal Psychology and Aging, focused on the four-year histories of over 3,000 rural, elderly Iowans averaging 74 years of age at the beginning of the study (1981). The researchers used standard psychological questionnaires to assess levels of loneliness, depression, and social interaction in each of the participants.
Study subjects were then re-assessed once a year over the next four years.
They discovered that “individuals who were the most lonely… at the time of the (original) interviews were more likely to be admitted to a nursing home over the subsequent four-year period,” compared with their less-troubled peers. This effect remained even after the researchers adjusted for the incidence of other known predictors of nursing home care, including age, income, depression, mental and/or physical health status, or extent of social contacts.
The study authors speculate that loneliness might hasten nursing home admission in a variety of ways.
They point to research that suggests that “loneliness may hasten the deterioration of an individual’s health status through its (negative) impact on the immune system.” The Iowa team say chronic loneliness may also help trigger depression, “demoralization and (the) associated effects of neglect of self-care.”
Alternatively, they speculate that nursing homes may offer hope to some of the lonely elderly. Especially in rural areas (where nursing home residents and staff may already be familiar to newcomers), “those who are extremely lonely may enter a nursing home to seek companionship with others,” according to the study authors.
Study senior author Dr. Robert Wallace of the University of Iowa says “interventions to prevent loneliness should be explored in order to keep older people independent.”
He and his colleagues believe that many of elderly living in rural areas need better access to transportation so that they can more easily stay in contact with relatives and friends.
Community groups need to be encouraged as a means of bringing still-independent individuals together. Regular involvement in group activities seems to help ward off a dependence on nursing home care. For example, the investigators discovered that elderly churchgoers experienced much lower rates of nursing home admissions compared with those who did not regularly attend services.
SOURCE: Psychology and Aging (1998;12(4):574-589)
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I am often asked what the first steps are to getting tested if you or a loved one has concerns about memory loss. First of all, be very proactive! You would be surprised at how many times I hear a doctor say “It’s just part of old age” or “She seems fine to me.”
Their are many things that mimic symptoms of Alzheimer’s Disease or other forms of Dementia so the first step is to have your primary care doctor perform a focused physical and order some blood work to determine if anything is out of the ordinary. This lab work must include the following: CBC, Basic metabolic profile, TSH, Vitamin B12, and STS. An abnormal Thyroid condition or Vitamin B12 deficiency may be the underlying cause of memory problems. The doctor should also be given access to a list of all the medications as medication toxicity can cause cognitive impairment.
The doctor will need a complete history from both the patient and other loved ones so insist on being in the room during the visit or bring someone close with you. If the person has a history of brain injury or space occupying lesions, a CT or MRI will be necessary as well.
The Mini Mental Status Examination should always be a part of this visit. The main reason for this short test is to establish a baseline of your cognitive functioning. Be sure and ask for a copy of the test after it has been scored for your own records. The test has five sections: Orientation, Registration, Attention & Calculation, Recall, and Language. A perfect score equals 30 points. A score of less than 21 should be a reason for concern. The test in and of itself is looking for problems in memory both short and long term, language problems, organizational problems, sensory input deficits, and problems with executive functioning. Below, you will see what the test looks like. I do not recommend you give this test to someone whom you believe has memory problems without the primary care physician’s approval.
Mini Mental Status Exam (MMSE)
Name________________________________
Maximum Examinations (1 point per right answer)
ORIENTATION
Ask the patient what (year) (season) (date) (day) (month) it is. 5 Points
Ask the patient where he/she is (province) (country) (town or city) (hospital) (floor). 5 Points
REGISTRATION
Name 3 common objects (e.g., “apple”, “table”, “penny”). Take 1 second to pronounce each word. Then ask the patient to repeat all 3 words. Give one point for each correct answer. Then repeat them until he/she learns all 3. Make a maximum of 6 trials. 3 Points
ATTENTION AND CALCULATION
Ask the patient to subtract 7 from 100 and keep subtracting 7 until you tell him/her to stop. (93, 86, 79, 72, 65)
OR
Ask him/her to spell “WORLD” backwards. The score is the number of letters in correct order (D_L_R_O_W). 5 Points
RECALL
Ask the patient for the 3 objects repeated above. Give 1 point for each correct answer. (Note: Recall cannot be tested if all 3 objects were not remembered during registration.) 3 Points
LANGUAGE
Show the patient a “pencil” and a “watch” and ask him/her to name them. 2 Points
Ask your patient to repeat the following:
« No ifs, ands or buts. » 1 Point
Ask your patient to follow a 3-stage command:
« Take a paper in your right hand, fold it in half, and put it on the floor. » 3 Points
Ask the patient to read and obey the following :
Close your eyes. 1 Point
Write a sentence. 1 Point
Copy the following design. 1 Point
Totals
Initials
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