Memory Clinic Experience

[FlatOutAgain]

Took Mum to the memory clinic yesterday. She has been decling for years but more recenly she went off the edge of a cliff.

She worked as a barmaid for many many years and her mental arithmetic is very good and clearly she is hardwired with numbers. It was no surprise she got those questions correct albeit very very slowly.

She was asked to remember 5 words two of which were face and red. She could not remember any of them each time she was asked. The consultant then started to prompt her to ridiculous levels. She kept asking about the colour and mum said 'Oh my favorite colour is red' and so she got a tick. This was followed by the consultant miming the face and moving her hands around it and saying things like its part of your head. Mum said 'hat' amongst other things and eventually she got face so yet another tick.

She had no idea what day it was and after several stabs at the month she gained another tick. She thought is was summer which is correct and then just started reeling off months.

I kept quiet as I did not want to upset Mum and maybe I should have asked if this is the usual procedure.

She has no concept of what is happening whatsoever and already has no recollection of the clinic yesterday. It turns out that she can find her way home so another tick for that box. She can't hold a conversation, she calls out ambulances as if they were taxis, everyday she has health issues (she is fine) and my Dad's life is a complete and utter misery.

I was very disappointed with the appointment and although I had the option to speak I did not explain everything as Mum was getting upset as she kept saying she was a burden.

She now has a follow up scan and a second appointment in a few months. In the meantime the consultant will write to her GP to recommend ADs.

Is this a common experience?

thank you

It sounds like the consultant was doing a MOCA test which has the words Face and Red in it.

You only score points for recalling the words without cues, so although the consultant went on to give your mum a lot of help with recall - which is part of the test - they will have noted that her first answer was wrong.

Clearly they did think there was an issue as they have booked a scan.

Sadly keeping quiet was probably not a good strategy as the consultant doesn't know your mum is telling them wrong information if you don't say so. However the right outcome - a scan to see if she has dementia - seems to have happened in the end.

You do need to tell the dr at the next appointment what it is that your mum has problems with specifically. My mums biggest deficit was in word finding and recognising things when she first went to the memory clinic, so the standard test she didn't do too badly on - but when they did tests which focussed on her deficit areas it was apparent just how damaged her brain was. They did prompt her to see if she could work things out eventually, and I believe that is standard and part of the assessment process.
Dementia and depression can coexist, and a friends dad has been a lot less anxious since he went on ADs, so although his dementia gets worse and worse, he is happier in himself.
Your mum obviously scored low enough in the tests to warrant the scan, and I think they take everything into account at the next appointment

Thank you for the replies. I had an appointment prior to the clinic with Mum and the GP., who did not prompt her during the session.

The GP 'thinks' it may be 'massive health anxiety' and this is causing her to shut down as she focuses on her health regardless of what is happening around her. Her physical health is fine and she has reached 82 with remarkable physical health. She cannot get through a day without a health issue and I have tried to get her to stop calling ambulances and medical professionals but it gets so bad even Dad calls them as he cannot cope.

She is obsessed with medication and often thinks she is having a heart attack or simiar.

@CMOTDibbler intersesting that the AD's helped your friends dad and I have my fingers and everything else crossed they may work.

My DH is a tremendous support but it is still not easy trying to deal with everything. My Dsis lives 2hrs + away whilst my Dbro lives in another country. They rarely phone or get involved and have not even checked to see how Mum got on yesterday which is disappointing. I have lasting PoA in place for my parents both financial and health as I am making more and more decisions on their behalf.

Thank you again

On the calling ambulances thing, I had a stage where dad was calling them inappropriately as he had terrible anxiety on mums behalf and just went into a flat spin. So with the help of the district nurses and the (short lived, but great) community team who were set up to keep people out of hospital who were frequent fliers, a flow chart was set up and laminated which went through things to do - feel a bit hot? Take temperature (thermometer tied to the bookcase) if x, everything is fine, take a layer off. If y, take a layer off, have a cold drink and retake in an hour, if z, then go to next. And so on. It changed with time, but as it was a big official sign, it really cut down the calls. Previously dad had been told off for being a persistent caller, but that just ramped up his anxiety even more

I think any diagnosis will be based on the scan and that is scheduled so she is on the right track. The antidepressants might make her life much easier if it dials down her anxiety about her health, mum should have had them years before, they made such a difference to her life.

Thank you again. I spoke at length with the paramedic on the last ambulance visit a couple of weeks ago. Its mostly every Sunday but this week I took them out so she did not have time to dwell on her health too much. The paramedic said they were bound to attend even though she has a history of call outs, just in case. Her 5th ECG in around a month yet again showed she was fine. Once she has been told she is fine then the anxiety reduces until the next morning when it all starts up again.

@Knotaknitter Would you be so kind as to let me know how your mum was affected and what the ADs did to help and also which ones there were? Sorry to ask so many questions - thank you

When I do tests with a patient (not the MOCA) I will aim for them to get to the right answer somehow, but I will note what it took to get there. All that information is useful. The scan is part of the assessment too. And it really sounds as if ADs may make life better. My GP likes Sertraline for anxiety with depression and it's working well for me. They can take a little while to work but the effect on anxiety can be faster - i literally felt calmer the first day.

I use this same assessment, as a previous poster said your mum won't have gained a point for any recall that requires a prompt. I will also often use the prompt given and then perhaps other cues as it's useful for me as a clinician to see whether the word can be recalled with assistance (and to what level of assistance). Any diagnosis of dementia is made based on multiple sources of information - so a cognitive screen like your mum did, plus neuroimaging like the scan that's been arranged, plus a clinical history, plus information from family members etc. I can completely understand why it would feel concerning for you if you don't feel her performance on the screening test reflects the changes you see day to day. At this stage I would be inclined to trust that the professional administering the assessment was doing so correctly, you can always mention what you've said here though both to them and to the GP next time you see them so that it's documented that you don't believe your mum would have recalled the information without any assistance?