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 Mini Mental Exam Results 
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Joined: Wed Sep 30, 2009 8:25 am
Posts: 227
Post Mini Mental Exam Results
I just received a report from my MIL's neurologist which included the results of the mini mental exam. She scored 0/30. I know this means that she has extremely limited cognition and memory, but I don't know how this relates to Lewy Body prognosis or where she goes from here. Will her Parkinson's symptoms now increase in severity? Does anyone have any experience with this? Can I expect her decline to accelerate at this point? Wish I had a crystal ball. Oy vey.

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Donna (age 56) caregiver for mother-in-law Margaret (age 88).


Tue Jul 19, 2011 9:43 am
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Joined: Sun Aug 29, 2010 5:46 pm
Posts: 610
Post Re: Mini Mental Exam Results
Donna, my mother has had the MMSE and another similar test done several times, and her score is always lower than the last time. Over the last year, it has gone from 18/30 to 11/30, but I don't really know what this means in terms of her prognosis.

I am no expert but it seems to me that the test is basically a snapshot of how the person is doing cognitively at the time, and over time it does demonstrate a history of the change in cognition. I've never been given the impression that it has any predictive value. So I don't know that you should expect a big change in your MIL just based on her 0/30 score.

Oh, wouldn't we all love to have that crystal ball? I sure understand that wish!

Julianne


Tue Jul 19, 2011 10:38 am
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Joined: Fri Dec 31, 2010 3:07 pm
Posts: 1039
Location: Minnesota
Post Re: Mini Mental Exam Results
Do you think that test result was representative? For example, was she having a "bad day"? Is she currently experiencing any illness? Since cognition fluctuates day to day or hour to hour with ol' Lewy in charge, a single test result might not be accurate -- or rather it might only be accurate for that hour.

Did the neurologist just send a report without discussing it with you in detail? We always get a lengthy written report a few weeks after Coy's visits, but they never contain surprises -- just a summary of what we discussed in the visit. Can you call the doctor to discuss these issues?

I am not aware of any corelation between the mini mental test and progression of parkensonisms. Maybe someone else has seen some research.

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Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012


Tue Jul 19, 2011 10:39 am
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Joined: Fri Aug 11, 2006 1:46 pm
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Location: SF Bay Area (Northern CA)
Post Re: Mini Mental Exam Results
It sounds like your MIL was unable to take the exam.

Typically an MMSE is not the best exam to use in LBD because those with LBD can often do better on the test than you would think someone with dementia would do.

It could be that your MIL has Alzheimer's Disease.

An MMSE is a test of mental status, mostly memory. It has nothing to do with motor symptoms.


Tue Jul 19, 2011 11:54 am
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Joined: Wed Sep 30, 2009 8:25 am
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Post Re: Mini Mental Exam Results
She is definitely classic Lewy Bodies, if one can call it classic. She typically does pretty well on the mini-mentals. She was mostly non-verbal the day we went. "Showtime" is now a thing of the past. The doc was more concerned with her seizures and progressive lack of sensation in her lower extremities. Not fun for her I am sure. Keeping her with us as long as we can. Just never heard of a 0/30 score before.

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Donna (age 56) caregiver for mother-in-law Margaret (age 88).


Tue Jul 19, 2011 1:02 pm
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Location: SF Bay Area (Northern CA)
Post Re: Mini Mental Exam Results
0/30 is the score the test-taker gets when he/she is unable to even take the exam. The test-taker may just look at the test-giver.


Tue Jul 19, 2011 1:23 pm
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Location: SF Bay Area (Northern CA)
Post Re: Mini Mental Exam Results
Also, "classic LBD" includes Alzheimer's pathology. The majority of those with LBD have Alzheimer's pathology. Only the neuropathologist can determine which is more severe at the time of brain autopsy.

It's quite rare to have "pure DLB." Renata thought Jerome had pure DLB but there's no way of knowing for sure.


Tue Jul 19, 2011 1:25 pm
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Joined: Wed Sep 30, 2009 8:25 am
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Post Re: Mini Mental Exam Results
Too bad I can't even mention brain autopsy to her son and daughters. They can't face these decisions. Avoidance of all things unpleasant.

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Donna (age 56) caregiver for mother-in-law Margaret (age 88).


Tue Jul 19, 2011 2:41 pm
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Joined: Fri Jun 19, 2009 11:23 am
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Post Re: Mini Mental Exam Results
The neurologist gave LO the mini mental exam again the last time we saw him. I could tell that LO was getting frustrated and did not do well. On the way home from the appointment that day LO was very quiet and withdrawn. Refusing to make a stop at the bank or even get lunch. At home I tried to get him talking again and I said "that was a nice doctor" and my LO replied "but I flunked all his tests".
My question is: How long should I allow this testing to be done if it makes him feel like a failure. The results tell me what I already know, the short term memory and problem solving abilities are declining. I truly do not believe LO is aware of his decline and is so happy and sweet when it is just him and I alone. I would like to get other opinions about if we should continue with the neurologist and allow mental testing. I had made up my mind after that visit to never allow anyone to put him through that stress again but I would like to hear some other opinions.
Thanks Mary


Wed Jul 20, 2011 9:49 pm
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Joined: Fri Jan 15, 2010 9:33 pm
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Location: Vermont
Post Re: Mini Mental Exam Results
Mary - I think you should share your concerns with this dr. He can ask questions without having to make it look like it's a test. My dad refused to take the mini mental, so the drs. and CNP would slip the questions in during their routine exam. At first, he'd study the answers to questions he knew he'd be asked at his appts. I think drs. should be aware that if the person is still pretty conscious of what's going on around them, they should anticipate what would make the patient uncomfortable and not do anything that would embarass the patient. Sorry this happened (again). Lynn

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Lynn, daughter of 89 year old dad dx with possiblity of LBD, CBD, PSP, FTD, ALS, Vascular Dementia, AD, etc., died Nov. 30, 2010 after living in ALF for 18 months.


Wed Jul 20, 2011 10:01 pm
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Location: SF Bay Area (Northern CA)
Post Re: Mini Mental Exam Results
Mary,

How did your LO know he "flunked"? Most professionals that administer the test do not inform the patient of the score, unless it's a high score.

Most neurologists I know stop having the MMSE administered after the patients reach a certain (low) score. You can certainly tell the neurologist to stop administering the test as the harm it causes is too great.

It is both sad and surprising that your husband is enough aware of his own situation to know he didn't do well.

Robin


Wed Jul 20, 2011 11:22 pm
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Joined: Sat Jan 03, 2009 2:59 pm
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Post Re: Mini Mental Exam Results
Mary,
I am wondering how your husband knew, Did the doctor confirm to You that your husband didn't do well? This could be just a case where your husband *thinks* he didn't do well, if it were me I would be calling that doctor today and getting the results, I really don't put alot of stock in that test anyway when it comes to this illness, In all the yrs my husband had that test it was all over the charts!

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Irene Selak


Thu Jul 21, 2011 7:56 am
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Post Re: Mini Mental Exam Results
I think it is quite possible for a low scoring individual to be aware that s/he is "flunking" the MMSE. My mother saw her neurologist in April of this year and he gave her the Montreal Cognitive Assessment (MoCA), which is similar to the MMSE. She had dropped to 11/30, down from 18/30 in 2/2010. My mother was quite aware that she was unable to answer many of the questions, and she would look over at me with sort of apologetic look. I just gave her an encouraging smile.

The neurologist was very kind and did not make a big deal of her not being able to answer. But I have no doubt that she was aware that she was not testing well. The neurologist didn't say anything about how she scored. He just moved on to the next part of his examination. I didn't know her score until I received a copy of his report.

Julianne


Thu Jul 21, 2011 10:19 am
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Joined: Tue Mar 29, 2011 3:02 pm
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Location: East TN
Post Re: Mini Mental Exam Results
I would say…from my limited experience….when it comes to self evaluating performance….

as a patient…..

always trying to play catch up with normal folks…..and acutely and chronically aware that I am….

the one time you can believe me….is when I tell you I know I didn't get it right…..

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Craig - Patient - Male - 56 years old - Lewy Bodies diagnosed on March 23, 2011 - cognitive disorder NOS dx 2007 - RBD REM dx 2007 issues for 20+ years - intention tremor 1974 - other issues many years


Thu Jul 21, 2011 11:30 am
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Joined: Fri Jun 19, 2009 11:23 am
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Post Re: Mini Mental Exam Results
Thank you all for a reply. This is exactly what I was looking for. No the neurologist didn't say a word about how he did or what his score was. I'm not even sure if this was a mini mental test. It was the one that he had to draw a clock and remember three words to come back later to try and remember. Of course there was a lot more to it than that. It took about 45 minutes.
Very discreetly, when LO wasn't paying attention, which is very often, the neurologist said to me, "his short term memory is declining" I knew that!!!

Julianne, my LO did the same as your mother, looking at me for the answers. Of course if he gets anxious, he will do poor. Didn't even know the year, but knew city, state etc. LO has always been afraid of making mistakes, but still this man graduated at the top of his high school graduating class with two years of college. He has always had a fear of making a mistake and will avoid things if he feels he will fail.

I know what I have to do now. Thank you everyone. Craig, I wish LO could articulate like you do.
Mary


Thu Jul 21, 2011 11:54 am
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