My 4 year old has dementia.
Dementia is again a hot topic at present and about to become hotter with the imminent release of the National Dementia Strategy .
One of the aims is to increase public awareness of dementia, so they realise that nanny isn’t just getting old, but actually has a condition for which some help and assistance can be provided. So we can expect lots more elderly relatives to be dragged to the surgery just because they forgot where they put their spec’s. (on your head…) Obviously this is a good thing (mostly).
When granny arrives what do we do with her? Well obviously we listen to the story, and send her for a whole heap of blood tests to rule out anything acute or chronic that may be causing confusion and we do an examination of her mental state.
At best the Mini Mental State Examination (MMSE) is subjective. It has 8 questions with a top score of 30, but I challenge anyone to get 30!
Firstly today’s date…urm, where’s it written… oh yes the display on my phone…I NEVER know what the date is. It does NOT looks great when I’m testing granny, that I have to look around to see if she is right or wrong… (Fair enough if she tells me it’s 1941, and calls me “dad” I have a bit of a hint things may be going badly), but I always think that if I wasn’t working Monday to Friday, I wouldn’t know what day it was.
Recently I did a MMSE and asked what season it was, well it was late September, black as your grandfathers, and it had been snowing. My patient said “Winter”. Of course I didn’t laughed in his face and said, “NO dummy it’s Autumn”.
The question I would struggle on most is “Begin with 100 and count backwards by 7’s”. Holy Carp. I don’t know my forwards 7x table, but if I can’t do it backwards from 100 I score low on the MMSE. It’s OK though, there is an alternative question for this one…
Spell the word “world” backwards. Try saying that to a deaf old lady. It’s not easy to understand let alone do! Incidentally, the answer is not: “W.O.R.L.D.B.A.C.K.W.A.R.D.S. ”
I recently heard of an alternative assessment tool. The Clock Drawing test. It is pretty much one of those “It does what it says on the tin” kind of tools. Draw a clock, with numbers and set the time to ten past eleven.
Scoring is out of 5:
1 point for the clock circle
1 point for all the numbers being in the correct order
1 point for the numbers being in the proper places
1 point for the two hands of the clock
1 point for the correct time.
My 4 year old drew her first clock last week, and unfortunately she appears to have early onset dementia, scoring only 1 (scores of 4 or 5 are acceptable)….and I am not sure of the significance if you draw a cuckoo on it!
My highlight from doing MMSE has to be the part of the test where you ask the patient to “write a sentence”. It can be anything…
My patient on this particular occasion wrote: “You’re a funny sort of chap”. No signs of dementia in her case then!