Cognitive Tests - What Do the Results Really Mean?

JoanneRose

My dear Mom was diagnosed with Dementia about 8 years ago.  She is currently in an Assisted Living/Memory Care home.  In March 2020, her Cognitive Test results were 11 of 30.  Today I was informed, her most recent test resulted in 4 of 30.  With the isolation of this past year, my mom's health has deteriorated.  She no longer can communicate coherently.  I see her struggling so hard to get her thoughts out, but she cannot put a sentence together,  The last two visits I've taken old photos of her, her children, family, etc.  This makes her smile a lot!  She still recognizes me (at least on most visits), and seems to light up when she realizes it's me.

Can anyone explain to me what 4 of 30 cognitive tests results means?  I've read that 9 and below is considered severe dementia.  I've been very upset today - not knowing what to expect.  

Thank you very much for any experience you can share.

  

M1

I don't think they mean much in this setting really. It means she's not doing well, but you already knew that, right?  I don't think they have much prognostic value in terms of her life expectancy. I wouldn't repeat them, and I wouldn't let it upset you if you can. Frankly I think the only reason they do them is because you're there and they have nothing else to offer. Sorry if that sounds hArsh.

Quilting brings calm

It doesn’t mean anything that you can’t already see yourself.  It’s just a series of questions that the patient is asked. Correct answers get a point.  You already know your Mom can’t answer the questions.  Those questions don’t look at whether your Mom can dress or bath herself etc.  You can look up 7 stages of dementia and know which one  your mom is in based upon your own observations.  

harshedbuzz

JoanneRose-

Any cognitive test is just a snapshot in time of one aspect- cognition- of the progression of this damned disease. You and her caregivers probably have a better sense of where she is in the disease progression from daily interaction.

While the isolation and interruption of routines during COVID where/are not favorable for anyone with dementia, the disease would be progressing relentlessly even under ideal circumstances.

Pre-COVID and living at home with my mom as caregiver, I watched my dad score "average" for his age/education level. His serial subtraction was faster than my mother's. She did not have dementia. At this point he was still very verbal, knew some family (mom, my adult nieces and me, but thought my husband of 35+ years was "some guy Harshed is shacking up with" and mistook his urologist for my son) but was hallucinating, delusional, unsteady on his feet, semi-incontinent and uncooperative around hygiene, medication and eating.  

I'm glad she takes pleasure in the photo albums and visits. Music from her youth might also be a way to connect with her.

HB

Michael Ellenbogen

They mean nothing other then being able to compare all previously baselines.

MN Chickadee

It is a clinical tool doctors use to compare to the person's previous tests, and can be useful in legal issues where the POA needs the doctor to declare the person unable to handle their own financial affairs, but mostly it's not very useful information to the caregiver.  This link gives a more detailed description about the stages. Not everyone follows them the same, and if she has a a dementia other than Alzheimers she may follow a very different trajectory, but this gives you and idea. 

https://www.alzheimers.net/stages-of-alzheimers-disease/

JoanneRose

Thank you for your responses.  I appreciate your advise and comments.  You're right, the immediate caretakers and myself probably know better what my mom's state is - and it's definitely getting worse.  ~  I was concerned about the NPs assessment - 4 of 30, which included her stating that I should be considering a Hospice evaluation.  That is what put me over the top.

Again, thank you.

PS - Music advise....totally agree....!

Wilted Daughter

MMSE maximum score is 30. 

Points:

25-30 = normal cognition

21-24 = mild dementia

10-20 = moderate dementia

9 or lower =severe dementia

Three stages of  Alzheimer's disease: 1. Mild, 2. Moderate, 3. Severe

7 Stages of Dementia: 1. No cognitive decline; 2. Very mild cognitive decline; 3. Mild cognitive decline; 4. Moderate cognitive decline; 5. Moderately severe cognitive decline; 6. Severe cognitive decline; and 7. Very severe cognitive decline. 

At the severe stage typical changes are inability to care for themselves (feeding), severe motor/communication impairments and lost of ability to speak or walk. 

Please don't be alarmed it's the natural progression of the disease. If they are letting you know LO is in the severe stage it is for planning and care purposes.

Cynbar

You may want to take advantage of that suggestion for a hospice evaluation. If accepted, it would put extra help into the assisted living to give your mother support, in addition to their staff. She would have a nurse case manager to assist with her medical needs and make recommendations for her comfort, home health aides, a social worker and chaplain, and possibly other extras like music therapy when COVID allows. It does mean giving up hospitalizations, treatments and testing, but those are often too much for someone with advanced dementia. Hospice is not a death sentence, many people stay on for quite awhile. You can always have her discharged if it's not working out, but there is really no down side to trying hospice. It is a lifesaver for many posters here.

JoanneRose

"At the severe stage typical changes are inability to care for themselves (feeding), severe motor/communication impairments and lost of ability to speak or walk."

This is exactly where my mom is at... it's heartbreaking.  Due to C-19, I was unable to visit mom on a regular basis, to be aware of the natural progression of the disease.  So it was quite shocking to see her in a wheelchair and unable to communicate - other than random words.

The information regarding getting Hospice evaluated is appreciated.  Though - and I know this sounds unreasonable - I feel like I'm giving up.  Which I'm not.

Question:  If provided with Hospice Care, is it likely Mom will have to be moved from her current AL/MC home?

Thank you.  

Cynbar

It's not likely your mom would have to move, hospice services are provided in addition to what the resident is already getting. Ask her facility if there is a particular hospice they usually work with, that is a good place to start. The NP who suggested it can call in the referral, or you can do it and the hospice will contact her doctor/NP. And if the first hospice doesn't admit her, contact another for an eval --- there seems to be some gray area in the criteria for dementia patients/

harshedbuzz

JoanneRose wrote:

The information regarding getting Hospice evaluated is appreciated.  Though - and I know this sounds unreasonable - I feel like I'm giving up.  Which I'm not. 

There is only one outcome for this disease. At some point it becomes not so much giving in, but acceptance with a pivot to providing care the focuses on comfort for your dear mom and support for you. 

Question:  If provided with Hospice Care, is it likely Mom will have to be moved from her current AL/MC home? 

Probably not. In fact the MCF may welcome- or even expect- hospice services to be provided as your mom's need to hands-on care increase. 

Thank you.  

Rescue mom

I’ve had family who got hospice services while in ALFs in two states. In all cases, the facility was VERY appreciative of having hospice come in and help.