Dad's MMSE, January 2011

I'd heard of mini mental state examinations, or MMSE's, through work.  They're designed to test memory and cognition, scored out of 30 with anything less than 26 indicating possible problems. Anyone with unimpaired faculties would sail through it: of course I know it's Tuesday, that100 - 7 = 93, and that the prime minister is the devil incarnate, I mean David Cameron, sorry, slip of the tongue. 

It was interesting to watch my own father take his MMSE, and disturbing to observe where he cocked up.  The mental arithmetic was fine, but then he has often worked with figures so one would expect no less.  He fought in World War II so obviously he knew when it started ... except he didn't, tried to guess and got it wrong.  That shocked me, as did his spectacular failure to remember, for just a few minutes, five words that the therapist repeated to him: Red, Velvet, Church, Daisy and Sesquipedalian (all right, I can't remember the fifth word now but it's a month ago, give me a break).  For each of the five the therapist gave him a  hint - "it's a sort of building" - and three possibilities to choose from - Dennis, was it church, hospital or school? and each time he guessed  wrong.  To be honest, this alarmed me because until that moment I would not have said that his short term memory was as impaired as some of his other cognitive functions.

This was the weirdest one: Dad was asked to draw a clock face and put the numbers on.  Easy peasy.  Then draw on the hands, showing ten past eleven.  Dad couldn't work out how to draw the hands at all.  He just did a bit of scribble at on edge of the circle, not even close to the 11 or the 2 where the hands should have been.

Dad was given a score of 21, which he accepted with the kind of sanguine resignation I've come to expect from him.  Not whoops, that wasn't very good but OK, 26 is a pass and I didn't make it, whatever. Now, I know that MMSE tests are not and do not claim to be a precise indicator of dementia and its extent; I've also learned since that he's likely to be tested again, in case they caught him on a bad day or there were some other reasons for his confusion on the first test which might have cleared up by the next occasion.  But for what it's worth 21 is a score that places Dad towards the bottom end of "mild" dementia and not far above the top of "moderate".  So the question that's ringing in my ears now is: just how long has this been going on and why didn't I spot it before?  It's not as if I was in denial, I was on the lookout for indicators.  Truth is I just cannot, from 130 miles away, keep the kind of regular contact with him that would have enabled me to spot the warning signs.  But haven't other people, who do see him more regularly, noticed his mental deterioration?  This is an interesting one, more posts to come, but the simple answer is: noticing signs of decline is one thing, interpreting them as dementia something else entirely.