Medical Forum / Diseases and Disorders / Alzheimer's / September 2005
3 words - remembers 1 word
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Dee Randall - 08 Sep 2005 04:53 GMT A visiting nurse asks a patient to remember three words at the beginning of her visit, telling her patient that he should remember them and she will ask the patient at the end of visit what the three words were. The visit lasts about 15 minutes.
The patient can remember but one word. The patient relays that the nurse told him that this was "fair for a person of 80." But I'm wondering. What do you think? Thank you for any comments. Dee Dee
Dennis P. Harris - 08 Sep 2005 08:58 GMT > A visiting nurse asks a patient to remember three words at the beginning of > her visit, telling her patient that he should remember them and she will ask [quoted text clipped - 4 lines] > told him that this was "fair for a person of 80." > But I'm wondering. What do you think? This is a meaningless test. There is a far better one:
http://www.hartfordign.org/publications/trythis/issue03.pdf
Dee Randall - 08 Sep 2005 16:24 GMT >> A visiting nurse asks a patient to remember three words at the beginning >> of [quoted text clipped - 11 lines] > > http://www.hartfordign.org/publications/trythis/issue03.pdf Thanks for your response.
I see that what I was describing above is a part of the test you say is a good one. The nurse did ask some of these questions, because he remarked about the nurse asking about the seasons and states. The patient's remarks about her asking this was something like, "Did she think I'm nuts?" If I decide to ask him the questions, I'm wondering what "Serial 7's" is. Does this mean, 7, 14, 35, etc? Maybe I need this test, heh?
We don't expect the patient has alzheimer's, but perhaps some sort of dimentia due to chemo and radiation, two bouts of two different kinds of cancer - cured. I'm not aware how good the patient's attention span was before these treatments, so now might be a good time to start asking the patient some of these questions, as he trusts me to give him this sort of test. I did it with the 3 words, myself. Thanks, Dee
Songbird - 08 Sep 2005 20:51 GMT If I
> decide to ask him the questions, I'm wondering what "Serial 7's" is. Does > this mean, 7, 14, 35, etc? Maybe I need this test, heh? I think it is "Count to 100 by sevens," so 7, 14, 21, 28, etc.
Songbird
Evelyn Ruut - 08 Sep 2005 21:11 GMT > If I >> decide to ask him the questions, I'm wondering what "Serial 7's" is. [quoted text clipped - 3 lines] > > Songbird I don't think I could do that all that easily myself! Well maybe I could
:-) Don't know.... But the clock face drawing is a very good test. That is where you ask the person to draw a clock face showing a certain time. They usually can't do it if there is impairment.
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Evelyn Ruut - 08 Sep 2005 12:47 GMT >A visiting nurse asks a patient to remember three words at the beginning of >her visit, telling her patient that he should remember them and she will [quoted text clipped - 6 lines] > Thank you for any comments. > Dee Dee I agree with Dennis. That one single test was inadequate. When my mother in law was tested they used a lot of different kinds of little manual tests like that, and they included a blood test as well as a brain scan.
I also want you to know that in EVERY single test, the doctor told my mother in law she did "well for her age" which was so she wouldn't be afraid. She was terrified they would say she was "crazy". So be aware that it is probably somewhat common to reassure the person, even if they do show deficits.
Another thing to consider is that you can't rely on what the patient relays to you. If they are having memory problems they could be making it up to cover what they don't remember. My mother in law was very good at that, until my husband began accompanying her to all visits. When he would say "No, the doctor said (whatever it really was)" she just gave him a blank look, because she honestly didn't remember what he said.
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Songbird - 08 Sep 2005 15:19 GMT > I also want you to know that in EVERY single test, the doctor told my > mother in law she did "well for her age" which was so she wouldn't be > afraid. She was terrified they would say she was "crazy". So be aware > that it is probably somewhat common to reassure the person, even if they > do show deficits. My mom recently had an MMSE done, which showed a 10 percent decline from the year before. When I got the results from the doctor, I told Mom the results very gently, and she just about burst into tears, not because of the results, but because "I must be going crazy because I thought I got them all right. The girl agreed with me on every one, I thought."
I had to explain that she may not have agreed, she was acknowledging. "And if she told you that you were wrong, you might have gotten nervous and missed more," I said. "She wanted you to do the best you could."
That seemed to calm her.
Of course there are some idiots who do think forgetfulness is normal for aging.
In short, sounds like more tests are needed.
Songbird
Evelyn Ruut - 08 Sep 2005 16:13 GMT >> I also want you to know that in EVERY single test, the doctor told my >> mother in law she did "well for her age" which was so she wouldn't be [quoted text clipped - 20 lines] > > Songbird Exactly. Well told, Songbird.
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Best Regards, Evelyn
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Dee Randall - 08 Sep 2005 16:25 GMT >>A visiting nurse asks a patient to remember three words at the beginning >>of her visit, telling her patient that he should remember them and she [quoted text clipped - 24 lines] > would say "No, the doctor said (whatever it really was)" she just gave him > a blank look, because she honestly didn't remember what he said. Yes, I understand. My m-i-l always said, "I used to KNOW, but I don't remember those things now." Whoops, I'm starting to say this more and more with reliance on the internet for info that I feel too lazy to store in my brain. Dee
Tumbleweed - 08 Sep 2005 16:52 GMT >A visiting nurse asks a patient to remember three words at the beginning of >her visit, telling her patient that he should remember them and she will [quoted text clipped - 6 lines] > Thank you for any comments. > Dee Dee I'm wondering what the point is Dee dee?
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Dee Randall - 09 Sep 2005 04:16 GMT >>A visiting nurse asks a patient to remember three words at the beginning >>of her visit, telling her patient that he should remember them and she [quoted text clipped - 8 lines] > > I'm wondering what the point is Dee dee? Don't worry about any point, Tumbleweed. I got nice answers from everyone; I appreciate them. The answers were courteous and to the point, and alleviated any anxiety I might be feeling over the matter. They sensed it. Don't worry about answering me again, in any manner, because you're killfiled, as of this minute. I don't need your kind of help. Dee Dee
Mary_Gordon@tvo.org - 09 Sep 2005 13:35 GMT Rather than trying to be snippy, I suspect Tumbleweed is asking for more of the backstory to the situation such as... did the nurse do the test because the family expressed concerns?
M.
Evelyn Ruut - 09 Sep 2005 13:45 GMT > Rather than trying to be snippy, I suspect Tumbleweed is asking for > more of the backstory to the situation such as... did the nurse do the > test because the family expressed concerns? > > M. Yes, exactly. I don't think he was trying to be snippy either. Dee, I hope you un-killfile Tumbleweed. He is an OK guy and a valuable poster here.
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Tumbleweed - 09 Sep 2005 14:20 GMT >>>A visiting nurse asks a patient to remember three words at the beginning >>>of her visit, telling her patient that he should remember them and she [quoted text clipped - 11 lines] > Don't worry about any point, Tumbleweed. I got nice answers from > everyone; I meant what was the the point of the nurses test. Why was she doing it? No criticism of you was meant at all!
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Evelyn Ruut - 09 Sep 2005 14:32 GMT >>>>A visiting nurse asks a patient to remember three words at the beginning >>>>of her visit, telling her patient that he should remember them and she [quoted text clipped - 14 lines] > I meant what was the the point of the nurses test. Why was she doing it? > No criticism of you was meant at all! I am replying to Tumbleweed just in case Dee has really killfiled him, so Dee can see there was no mean spiritedness meant at all. In fact I did wonder the same thing, why the nurse was doing it.
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Mary_Gordon@tvo.org - 09 Sep 2005 13:25 GMT It certainly isn't any kind of helpful OR meaningful assessment of cognition or memory.
The first time we mentioned seeing some very slight signs of a problem with my MIL to the family doc, he did a couple of quick and very revealing tests in his office. I should mention that at this point, all we were aware of was some slight memory issues. She seemed entirely normal other than asking the same questions, having to be reminded of dinner dates etc. - she was paying her bills, keeping her house clean, driving her car - living her life as she always had.
He asked her a number of questions similar to a truncated Mini-mental status examination (the MMSE). She did fairly well. However then he drew a little stick figure of a house (the kind we made as kids, that shows the end with a triangular roof as well of as the sides of the house in an approximation of a 3-D rendering). He asked her to copy it - essentially, she drew a bunch of chaotic lines - she just couldn't connect them to make anything that looked vaguely like the little house.
He also did several clock faces with her. On one he drew a circle, put a 12 in the circle at the top spot and asked her to put the rest of the numbers around the edge, and put the hands on the clock in a specific time. Instead of putting the numbers around the edge, she put 3, 4, 5, trailing off sideways beside the 12 (obviously thinking it was 1, 2 rather than 12). He then drew a clock face with the numbers in place and asked her to show 3 oclock. She wrote in two zeros beside the 3 (like it was a digital).
It was really shocking. It showed that it wasn't just memory at all, but some really scary cognitive stuff going awry.
What the nurse did was less than useless - there are quick easy tests that can be very revealing.
Here is more information, including a version of the MMSE anyone can use. http://www.alzforum.org/dis/dia/tes/neuropsychological.asp
Here is an article on the clock face test - it is such a simple thing, but actually very accurate as a quick screen. http://www.findarticles.com/p/articles/mi_m3225/is_n5_v41/ai_9101119
Mary G.
Deborah - 09 Sep 2005 14:04 GMT > Here is an article on the clock face test - it is such a simple > thing, but actually very accurate as a quick screen. > http://www.findarticles.com/p/articles/mi_m3225/is_n5_v41/ai_9101 > 119 > > Mary G. Here's an article from the site Mary links above that you'll find especially interesting:
http://www.findarticles.com/p/articles/mi_qa3958/is_ 200402/ai_n9351223
Anthony Shipley - 10 Sep 2005 06:50 GMT >What the nurse did was less than useless - there are quick easy tests >that can be very revealing. No, it's a very specific - and quick - test to assess simple mental capabilities. I just had another of them to see if there was any change in my state.
One of the test require the patient to write a sentence. Easy for most of us, of course. I presume it requires a meaningful sentence with proper punctuation etc.
The first time I had that I replied "This sentence no verb" because, I think it seemed so menial compared to my capabilities.
As far as I know, I've provided the exact answer all the other times I've been (even as recently as a few weeks ago). Because, in the beginning, I didn't know anything about it and, probably expected to be asked a verbal question about it, it just tickled my sense of humour. I think I'll phone up and ask how they marked it....
So what do you think? Is it a sentence, or, if not, how does a sentence claim to have no verb?
>Here is more information, including a version of the MMSE anyone can >use. [quoted text clipped - 5 lines] > >Mary G. -- 2 + 2 = 5 for sufficiently large values of 2.
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