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

[Zakinthos]

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.

[joanofarchitrave]

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.

[Zakinthos]

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).

[CMOTDibbler]

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

[terrywoganstrousers]

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?

[RillaBlythe]

Was going to say the same as terrywoganstrousers.

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

[fridayfreedom]

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.

[Zakinthos]

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!!

[Zakinthos]

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.

[joanofarchitrave]

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.

[Zakinthos]

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

[joanofarchitrave]

Sorry about your mum's sight . 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 . 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?

[Zakinthos]

She has had memory problems for the past year now and I can't blame it all on the urine infections, although she has had a few. I tend to find that she is more 'vacant' when she has an infection though. Thanks for the link,I will have a look. Taking her to see her younger 84 year old sister on wed as she wants a few jobs doing too!

[twentyten]

Feel for you Zak- it's hard. Have you looked at Wiltshire farm foods? Good to keep in the freezer. M&s meals are good too. What about you having a cleaner? Could your mum pay? You must look after yourself and your dc's age uk do great stuff- day centres etc. you deserve your life too. Loads of support here ,

[Zakinthos]

Thanks twenty. Had social worker assessment today who gaves lots of good advice too and is referring mum to age uk as dm may be eligible for a mobility allowance. I have looked at Wiltshire farm foods and may give them a try if she can reliably work her new oven. Social worker is also going to ask gp to refer to memory clinic. She has a cleaner once a fortnight and I suggested increasing to weekly visits but she doesn't think she needs it (as she can't see the mess!). I'm working on her with this though! She told the social worker that she was not having any problems at all with her memory and I felt really bad having to say that she does, in front of her. She is just not aware of it.
I am also going to investigate a power of attorney - I didn't realise that it is best to get it in place BEFORE dementia sets in. Social worker said it will only become valid once dm not mentally able to deal with finances etc.
Thanks so much everyone for all the advice - very much appreciated.

[duchesse]

I have not much advice or comments, except to say that if you could, maybe you could work out what she is going to need on a fairly regular basis (say monthly, and stuff like loo paper and washing up liquid and frozen stuff maybe) and have it delivered to her directly. It sounds as though she's beyond being able to work out what she needs and going to fetch it from the shops, so maybe having it delivered to direct would work? That way you wouldn't need to shop for her individually each time after having had to work out what she needs.

[achillea]

Hi Zak, my Mum had a GP memory test done recently which was similarly basic. But he also did a short term memory test where he got her to remember a number and then told her he would ask her again, had a chat to her and then asked her to recall the number. She didn't remember but the GP said that it wasn't a fair test etc and made excuses for her.

Did the GP do that test? They really should test short term memory too.

[Zakinthos]

Duchesse - I think you're right, I need to get more organised. She used to be the kind of person that would never let anything run out and would always have 'one spare' of things. The good news is, is that she likes the 'appetito' hot meals she has tried out and she has agreed to have two of these meals delivered a week.
Achillea - The gp didn't ask her to remember anything - short term memory was not tested at all but we are still waiting for a clear urine test after Two courses of anti biotics, and gp said this could affect her memory. However she has had a problem developing over the last 6-12 months so I think it is not just due to a urine infection. Will see if gp will refer to memory clinic when we go back on thurs.

Thanks again

[pippop1]

My MIL is in a similar state (v short memory) from the sound of it. We do all her shopping and just check what she's going to run out of. Why not buy e.g. 20 toilet rolls so you won't have to buy them all the time.

You can get medication delivered to her door in a dosset box. A plastic sectioned box with the days and times marked on so she can see if she's taken it or not. Combine with a radio controlled clock which shows the day of the week and date and that will help her.

We now have carers going in twice a day to give medication and make/heat up a meal. They use a key safe (little box with code to open its door) outside her house which contains her front door keys. Otherwise she can refuse to let them in.

[gingeroots]

zakinthos - my mum has very little sight and mainly uses a microwave and a small table top electric cooker .

There are a lot of ready meals that can be microwaved - tho having said that I visit every day and get the meal out and peel off the film etc ( when she lets me ) .

Other things that have helped are these

www.rnib.org.uk/shop/Pages/ProductDetails.aspx?category=talking_clocks&productID=CC5301 one by the bed and one where she sits

www.rnib.org.uk/shop/Pages/ProductDetails.aspx?category=corded_telephones&productID=DH216X01 took her a while to get used to the 3 memory buttons ,she was pressing the label ,not the pad beneath the label

www.rnib.org.uk/shop/Pages/ProductDetails.aspx?category=utensils&productID=DK12701

www.rnib.org.uk/shop/Pages/ProductDetails.aspx?category=tactile_labelling&productID=DL1501 on the cooker

www.amazon.co.uk/Breville-VKJ142-Hot-Cup/dp/B001L5SSGQ?tag=mumsnet&ascsubtag=mnforum-21 lots of different ones around ,get one where you can adjust amount dispensed and with a lid that it is fairly easy to open .My mum fills hers with a plastic jug .

thick black felt tip pens

an anglepoise lamp with this light bulb www.energybulbs.co.uk/products/Day+Light+Bulbs/Daylight+Spiral+Bulbs/DAYLIGHT+Spiral+Bulbs/BioBulb+SAD+Daylight+Bulb+25W%3D100W+ES+/936376506

bowls and milk jugs with a dark interior glaze so that she can see her porridge and milk

And what really has made a difference is the new style dosset box from chemist ( Boots ,Lloyds ,Day Lewis ) which is a blister pack .
It's for a week and has 4 large cells/blisters for each day - morning ,lunch ,tea and bed .

I have to cut the blister pack up into 7 strips ( one for each day ) and she has one strip each day . Otherwise she was randomly opening blisters from different days .
She opens the first cell with a knife over a dark brown sort of pasta dish and feels the tablets with her fingers .

( previously she had same system as your mum ,diuertics by kettle ,lunch time meds by microwave ,but it wasn't working .... )

And get her put on register for blind/partial sight because it's easier then to get a Taxi card ( in London ) and if Soc Services /your local council has a low vision service she might get some stuff free . My mum got the vibrating water level thing ,a talking clock ,etc .

And leave a plastic ,sports top bottle of water next to her and encourage her to drink more .

[gingeroots]

OP - sorry my post seems to manage to be a bit bossy and know it all .

I mentioned about visiting my mum a lot ,not to sound smug ,but because I recognise that even something simple sounding like a microwave dinner can easily fail an elderly ,confused ,poor sighted person .

I visit my mum a lot partly because I can ,but there's nothing altrustic about it .Rather the opposite - lots of emotional stuff ( still hoping for her approval ) that I should have left behind many years ago .
It's not something I'd recommend or am proud of - my own family have suffered and emotionally it's very unhealthy for me .

But I've picked up lots of knowledge

[Zakinthos]

Gingeroots - thank you SO much!! That is very helpful. People often suggest things but then I have to say but she can't SEE to read labels etc. Those orange bumpy things and that talking calendar clock are just what I need for her!! She is forever checking asking me the day when I go round so this will be great. She seems ok with making tea at the moment. She sometimes forgets to take the tea bag out but otherwise can see the level I think or feels it with her finger.
How do I get her put on the register for the blind/partially sighted? Do I have to go back to the opticians or ophthalmologist?
Thanks a million

[gingeroots]

With my mum the optician didn't suggest or refer her or anything - although she has no sight in one eye and practically none in the other .
I asked the GP who referred her to the hospital and it was the hospital that did it .
But I see the RNIB has it all explained here
www.rnib.org.uk/livingwithsightloss/registeringsightloss/Pages/register_sight_loss.aspx

With the clock if you press it once you get the time ,if you keep your hand on it it tells you the date .

It's a struggle to get my mum to have anything new ,partly because she always assumes it will make her life harder rather than help .
I have to introduce things gradually and she does get used to them.

The medication thing has made a big difference ,my mum is so much less breathless I don't believe she was taking half her tablets before on her old "system" .
Tho I thought I was checking and was on top of it .
Here's the link to blister packs
www.medicineblisterpacks.co.uk/free_sample.php
Tho I do have to cut them up into individual days .

[CMOTDibbler]

Another vote for the blister pack - Boots make my mums up like this now, and she is actually taking all her tablets and v easy to see if she's missed any. And (maybe not a concern for you) theres no tablets lying around, so no chance of taking too many.
An unexpected side effect of getting onto this system is that the pharmacist (who has always been great tbf) now has my mum flagged up as needing extra care, and has been phoning the GP to try and sort out some other things which has been a boon.

If there is a local group for the VI, they may have a lending library of devices to try. My friends dad is blind, and he runs a group who do this

[gingeroots]

And with the blister pack you don't have to remember to get repeat prescriptions - the chemist does it all .

[Zakinthos]

Thanks everyone. I went back to gp with my mum today. Urine sample now clear, finally. I mentioned to gp about not testing short term memory last time and she said she had wanted to do it when the sample was clear, so she did another test and my mum only remembered one item out of the three she had to remember, despite repeating them to herself a few times initially. Gp now referring to memory clinic. Dm still has a lack of insight into her memory difficulties though but I have started asking her question back to her if she has already asked me the same thing 10 times. Eg. What time are you coming to collect me? I then say ' what time do you think I said mum?' and she is actually often correct! Sometimes I think she just needs reassurance as things not clear in her memory.
The pharmacist showed me the blister pack today. It looks ideal. I now have to get gp to 'authorise' the blister pack and then he will sort it all out.
She's digging her heels in though about increasing the frequency of the cleaner - will have to keep working on this one.

Many thanks again - such great support and very much appreciated.