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Elderly parents
Original poster

Gp's 'mental test' on my 90 year old dm

36 replies

Zakinthos · 04/08/2012 21:41

Questions were :-
What day/month/year is it?
Who is prime minister?
When was the 2nd world war?
Who is reigning monarch?
What is your address?
Subtract 7 from 100, then subtract 7 from your answer and so on.

She did ok (said year was 1912 but corrected herself when gp queried it, knew day and month as she had asked me in waiting room, 1 error with maths which gp let her off.)

Gp says that she 'passed the test' and does not have dementia which is great.
However her short term memory is dire now and gp did not test this really. For example, I gave her her new pack of antibiotics to take. She took one and then literally 30 seconds later, she picked them up and said 'what are these?'. I told her and she said 'have I taken one?'. I have to keep telephoning her to remind her to take the pills. Today, I went round to her house to remind her that 'appetito' were coming with a hot meal (she is trying out this service). We discussed this at length. When I left (20 mins later), I said 'don't forget appetito are coming so don't make anything to eat yourself'. She said 'oh yes, good job you reminded me, I was just going to get some lunch!'

I just worry that this is the start of dementia. Was the test the gp did appropriate? Or is this normal memory loss? Every time I see her she says the same things but is still good with dates things happened (has always been good with dates). She never remembers to tell me when she runs out of things either so I might go round there and find she has no loo roll and is using kitchen towels. I am just finding it very hard to run her life as well as my own (and my dc's). I have to do all her finances now, shopping, cleaning in between cleaner visits as she will only have a cleaner once a fortnight, reading her post (as eyesight very bad), take her to appts etc. and I work as well part-time. How do other people cope? She is still able to wash and dress herself so does not need a carer.

OP posts:
joanofarchitrave · 05/08/2012 21:20

Sorry about your mum's sight Sad. This link is a Managing medication guide from the RNIB - I'm not sure any of that is appropriate but you never know.

There are adapted scoring systems for the MMSE when it's done for people with sight difficulties, so maybe your GP used that. Also the subtracting 7s is an alternative to the word spelling, i find Blush. But the lack of the recall of 3 items does seem to make the test incomplete.

Do you think that your mum's memory has improved now the UTI is settling down?

Original poster
Zakinthos · 05/08/2012 20:04

Thanks for your detailed reply Joanofarch. My mum has a social services assessment tomorrow so I will post again after this to let you know the outcome. She has very bad eyesight and can't see to write, read etc. (has wet macular degeneration in one eye and bad dry md in the other eye). Gp didn't ask her to write/draw anything in view of her eyesight or spell anything backwards.
I'm not sure about the medication box as its so hard for her to read things. She manages by keeping water tablets by her bed to take in am, other tablets on particular shelf in kitchen. It's just when new tablets are involved such as course of antibiotics.
I think I will definitely see if her cleaner can come once a week at least. She can afford it. I do her shopping online and she is ok with putting it all away herself.
She had her first appetito meal yesterday and said it was quite nice so that's good. Today she seemed quite 'with it' - it does seem to vary. Seeing gp again on Thursday (to check that urine infection has gone) and to check bp as she didn't want to check her bp last week in view of urine infection. I will ask about memory clinic referral.
Many thanks

OP posts:
joanofarchitrave · 04/08/2012 23:17

Did the GP ask your mum to draw a shape? Or to spell a word backwards?

There isn't actually a lot of evidence that the mini mental state examination (MMSE) is that sensitive anyway, although obviously it gives some idea how the patient is thinking. If parts of it have not been completed, then there is no way IMO that the GP can exclude dementia. And anyway, whether or not your mother officially has dementia (memory loss alone would not be enough to have this diagnosis), there are problems.

I totally get that it's hard to talk about this in front of your mum. Would it help to start sentences with 'I'm worried because X happened....' rather than 'You did this...'?

I wonder what other support you can get for your own life. I would contact social services re a care assessment, has she had one of these? Whether or not she's eligible for funding, they should know about organisations or ideas for help.

I think getting your mum to agree to more frequent cleaner visits is absolutely essential and key to you feeling less awful. Does she like/get on with the cleaner? Can she afford more visits? I think you need to do a little shameless emotional blackmail about how tired you are and how much you want your mum to be able to rest. Does she think you won't come to see her as much if her cleaning is done? Do you think she would take this more from another relative (sometimes, annoyingly, a male one?) I think you need to try and tackle this head on, I know some people do manage to run two households but I have no idea how and I don't see that you should have to. IMO having a cleaner once a fortnight is actually worse than not having one at all in some ways... Have an amount in your head (three times a week? to include doing the shopping/taking in and putting away a regular internet shopping order as well?) and go for it.

Would your mum try something like this medication reminder box? You could also consider asking the pharmacist what other people with memory problems do to help with medication. Does she get her pills in a dosset box, all set up with the pills ready to take, like that alarm one?

Re the food thing, tbh I think the fact that she might make too many meals is not something to worry about. At least you know she IS getting regular meals, and if the cleaner visits are stepped up, there won't be an issue with rotting food.

I would certainly talk to your mum about going back to the GP and getting a referral to the memory clinic. Stress how worried you are - she's your mum, she won't want you to worry and she might eventually see that you're not going to let this go.

Original poster
Zakinthos · 04/08/2012 22:57

Sorry Friday, cross posted. I will def. ask gp or social worker about referral to memory clinic. She has attendance allowance. Blood tests recently done - no problems apart from slightly raised glucose level which gp not too concerned about. Just gave her advice (which she won't remember!). I will look into what an enduring power of attorney is - I am a third party account holder at present on her accounts. Many thanks everyone. Can't believe how quick you all responded and very helpful advice.

OP posts:
Original poster
Zakinthos · 04/08/2012 22:50

Thank you for your kind comments. Makes me feel better!! No, the gp definitely didn't ask her to remember 3 things. She did ask her to name some objects (just remembered this!) but never asked her to recall three things. I was surprised actually as I had read somewhere about this. She would have failed this definitely.
I will see how appt goes with social worker. It's hard to talk about her memory problems in front of my mum however as she doesn't think she has any problems. I have had a look at the Alzheimer's website and she does seem to be having some of the early signs of this. She has problems learning new things. Eg. Her cooker had to be condemned and while we we waiting for a new one, we got her a microwave. Despite lots of lessons, she couldn't remember how to operate it. Her new cooker has now arrived (same as old one but updated model) but now she has to hold the knob in for a few seconds after it has ignited (this safety feature wasn't on the old one) and she still has problems remembering how to do this. Hence why we are trying out appetito!!

OP posts:
fridayfreedom · 04/08/2012 22:37

as Joano said the test he did is only part of an assessment for dementia, it is definately not a definative test and should not be used to form a diagnosis.
I would definately ask for a ref to the local memory clinic or older persons mental health team, which ever is appropriate in your area, for a full assessment.
He should also do a full blood screen to check for any physical health issues which may affect her memory eg thyroid, vit B12, anaemia.
The team should take a full history inc family history of dementia, stroke, heart conditions as well as a history of the onset of the problems. Family should be included in this as the person themselves may lack insight or underplay the problems.
The tests only test part of the memory and some people PASS them but when asked about how they manage practically there is evidence of problems.
Is she getting attendance allowance? also if she is diagnosed with dementia she may be eligible for exemption from council tax. You may also consider looking into an enduring power of attorney.

RillaBlythe · 04/08/2012 22:31

Was going to say the same as terrywoganstrousers.

Your mum is really lucky to have you though, what a great advocate you sound like.

terrywoganstrousers · 04/08/2012 22:26

Are you sure that was the whole test? Part of the 'mini mental' test is that at the beginning of the test the doctor will ask the patient to remember three 'things' and then at the end of the questions ask if they can remember them. Did the GP not do this?

CMOTDibbler · 04/08/2012 22:24

I'd def talk to her GP about your concerns, but really, they can't do a great deal apart from signpost help.

If you have a carers centre locally, they may be able to tell you about things that are available.

And it sounds like you do loads for your mum. Wish I was close enough (geographically) to do that for my mum. Who is 72, and failed that test miserably Sad

Original poster
Zakinthos · 04/08/2012 22:15

Thanks Joano. I'm not sure what I want really. There's no one else but me (brother in different country and no help anyway). Her neighbours are good but I can't rely on them on a daily basis. They do things such as put her bins out, and just keep an eye on her if I am away. I have organised a social services assessment next week as they said it might be worthwhile to see if there is anything else they can help with. She has too much in her savings to get any free help though I think. She doesn't seem to be aware of her own memory problems so I know she will give the impression there is nothing wrong with her to the social worker. I just worry that I am not doing all that I should for her. Plus I feel guilty I don't take her out much. I have her round for dinner at my house but I have my dc's to think of as well (11 and 15).

OP posts:
joanofarchitrave · 04/08/2012 21:56

She is so lucky to have you. Is there anyone else in the family network helping?

IMO it is inappropriate to use any single formal test and say 'you've passed this, you don't have diagnosis X, therefore nothing is wrong'. It should be part of a bigger picture.

Did the GP say anything about short term memory? What did you want from them?

IMO the simplest thing to do is go back to the GP and say exactly what you are worried about (again) - her short-term memory and ability to cope without support. It sounds as if she should be referred for an assessment at the local Memory Clinic.

I wonder if you might find it helpful to ring the Alzheimer's society. I should think they deal every day with calls from carers of those who don't have an official diagnosis.