This is simply unacceptable. The MMSE is a very brief (usually it takes no more than 5 minutes to administer) screening tool used by psychiatrists and psychologists who are in a hurry, and have no time (for whatever reason, legitimate or not) to do a thorough evaluation. It is very easy to learn how to do; I have told people that I could teach a 5th grader to do it. It is called the "Mini" mental status exam for a good reason: it is in fact a very quick and superficial procedure. It is to be contrasted with a full mental status exam, which takes a significant amount of time (and, to do properly, requires a lot of training). More importantly, it is NOT designed (or validly used) for the assessment or diagnosis of dementia; it neither confirms nor rules out the presence of dementia (or any other psychiatric disorder, for that matter). Many people who have dementia (especially those whose dementia is significantly but not totally disabling) will "pass" the MMSE, and many patients who do not have dementia will "fail" the MMSE. The rate of "false negatives" (people who "pass" the test even though they have dementia) is extremely high.
The psychiatrist who examined my mother in the hospital, having been asked to give an opinion as to whether she was capable of making her own health care decisions, spent 5 minutes with her, and offered the opinion that she was, indeed, capable of doing so. When I asked her how she could possibly have arrived at such an opinion, after examining a woman who had been refusing her medication, pulling out her IV, and telling physical therapists to "get the fuck out of [her] room," the psychiatrist replied that she had used the MMSE.
When I admitted my mother to the nursing home, after her discharge from the hospital, I asked the in-house physician whether they did a full evaluation of cognitive functioning on each patient, upon admission. He said they did not... but that, "sometimes," they used the MMSE.
After my mother was admitted to the nursing home, I insisted that the physician order a consult for an evaluation of her cognitive status by a neuropsychologist. He called in a psychologist who is NOT a trained neuropsychologist; this psychologist made one attempt to talk to my mother, but she refused to talk with him. He immediately gave up any attempt to assess her, but suggested that her physician prescribe an antidepressant medication.
Yesterday, when I spoke on the phone with a nurse who offers her services as an independent consultant for geriatric patients, I told her I needed a full evaluation of my mother's cognitive status. She asked me: "Has your mother ever had the MMSE?" I did not retain her to do the consultation.
The good news: I did finally find a nurse (Gini Toyne, RN, MBA, of Creative Care Consultants) who does consultations in geriatric cases. It turns out that she genuinely understands dementia, and has contacts with an excellent neuropsychologist AND a neurologist who specializes in dementia. She will work with my mother and me, to get my mother properly evaluated and placed in an appropriate facility.
The message to all of you who might be dealing with a parent who has memory problems or other cognitive/behavioral changes that are troubling: Do not rely on any medical professional who tells you that s/he uses the MMSE to evaluate your parent's cognitive status. That is a huge red flag; it tells you that the person who is telling you this is inadequately trained in the evaluation of dementia. The professionals who are best trained to evaluate patients for dementia are neuropsychologists. This is a highly specialized field, and most psychologists and physicians (including most psychiatrists, and most neurologists) are NOT competent to do this kind of evaluation.
Here are the APA Guidelines for the evaluation of dementia.
1 comments:
I am so grateful for having come across your blog. It will be read often! I am the care giver for my father, who has Alzheimer's, I have been told. I have no reason not to believe that after my readings, and after living with him for 11 months. Your site is full of more for me to learn and think about. Thanks!
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