Dementia Coach

Is it Alzheimer’s Disease? An overview of the Mini Mental Status Exam

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

Post Diagnosis: The 3 big mistakes that are made by family and friends.

1. Walk Away- I cannot tell you how often I see this among close friends of someone with Dementia. This includes members of the church congregation, civic clubs, neighbors, business associates and even family members. More often than not, the care giver is in a sense, banished to an unexpected role they did not see coming

This response comes from fear of the disease itself and the fear that you might make a mistake. One of the first things I tell a care giver who is new to this process is that they must embrace the fact that they will make mistakes. Failure is how we learn what not to do!

If you have a friend or family member who has memory problems or has been diagnosed with Dementia, get educated and do the best you can when visiting knowing it is alright to make a mistake. The care giver needs you now more than ever and need people to walk along side them.

2. Assume the person can no longer make decisions for themselves- Mom or dad has been making decisions for themselves for longer than you can remember. Yes, the disease will eventually rob them of thier ability to think rationally however, if it is Alzheimer’s Disease, the decline in functioning will be slow and steady. Of course it depends upon when they are diagnosed and many many other factors. The idea is to meet them where they are at and allow them to participate in as much as they are capable of. Research shows that people with Dementia know they are losing their abilities. This is a frightening experience for the individual and their dignity must be maintained.

3. Sell the Farm- I see this more often than not. The adult children are busy with their own lives and want to have the security in knowing that someone other than them is looking after mom or dad in a facility. As a Gerontologist who specializes in Dementia Care, my goal is to work with the family and the primary care giver to keep mom and or dad in the home as long as possible.

They need to maintain the social network they have spent years to develope. They will remain stable much longer in a familiar, structured, routine environment.