Scores well on mmse but stage is different

hiya

I’m new here but have been finding help through reading discussions. Thank you all.
My husband falls into stage 4 on memory/abilities etc. He has times when he calls me by other peoples names, can be disorientatated, can’t cook, can’t do any form of finance, cannot sort/remember medicine etc. The doctor performed deeper neurological testing to diagnose as mmse was 25 and didn’t match his abilities. His abilities have significantly declined since diagnoses, however, he still scores 23 on mmse. Has anyone else had this experience?

M1

Welcome to the forum. The mmse is only a screening tool, and there's a phenomenon called showtiming, in which pwd rise to the challenge in social situations such that their deficits are minimized. A very experienced member here named harshedbuzz tells about how her dad could do serial sevens till the cows came home and scored great on the mmse but then got in the wrong car on leaving the doctor's office. Similarly, the stage classifications are only approximate, and it's not uncommon for people to overlap. Generally for planning purposes i think it is wise to approximate the stage by the worst behaviors.

Sorry you find a need to be here, but it's a supportive place. Wish you well.

Joe C.

Hiya, Welcome but sorry you needed to seek out our community. I always had trouble getting my wife to go to neurologist appointments and get testing done. I found the Alzheimer’s FAST assessment chart online which based the stage assessment on what an individual can do functionally. If you google Alzheimer’s FAST chart you’ll find numerous versions of it. This help me track DW’s progression. All the best.

Quilting brings calm

Yes. Mom was diagnosed with mild cognitive decline three years ago My mom’s MMSE score has actually improved the last two years. Medication for anxiety and depression seems to help it. She was 25 the last time. However she is typically a stage 4 - mild dementia- in her behavior and function. She lives ok in AL, but she’d never be ok in independent living. I think she’d score a lot lower if she took the 2.5 hour neuropsych testing.

Whyzit

I’m always surprised at the test results for my DH too. On closer examination the results reflect his training as an engineer. He uses his drafting skills first developed in jr high to do the figure drawing and clock drawing. So depending on education and training the MMSE probably doesn’t reflect where he is realistically.

hiya

Thank you all for your replies. I hate you are all going through this process but there is comfort in knowing you are not alone. I can relate to your replies. The day before, my husband handed me a calculator and asked which tv it controlled. He called me by his siblings name the morning of his appointment. During the Dr visit, everything fell into place. Show timing is the perfect phrase:). Hoping you are all having a good weekend.

GG06

@hiya I understand, and feel, your frustration. We started the process of getting a diagnosis the end of February 2023. I say “we” but my husband has anasognosia, so like many others in forum, I’ve been the one doing my best to drive this crazy train. Anyway, in March we were able to get an appointment with a neurologist who does not specialize in dementia. I just wanted a doctor to start the ball rolling with an MRI. She gave my husband the MMSE and he scored a 29/30. He was barking during a portion of the visit. His MRI showed slight atrophy in the right anterior temporal lobe. He had a 4 hr neuropsych testing with a diagnosis of FTD - with behavioral and semantic variants. We switched practices to a memory care center in May where the NP gave him the Montreal Cognitive Screening Test. He scored a 20/30. Last week he was 16/30. She confirmed the neuropsychologist’s FTD diagnosis. I would be interested to know what your husband would score on the Montreal Cognitive Assessment

Glad you posted hiya.

Dio

My DH did well in the neurologist's appointment. The doctor noted that DH passed all these tests with minor errors. Oh boy! Six months later, I had to place him in memory care.

SDianeL

My husband is stage 4 but some behaviors are stage 5. As some people already mentioned, behaviors overlap the stages. I say my DH is stage 5 because he has some of those behaviors. If you talked to him you would never know he has dementia. Many people are shocked. They compensate and hide it well. He took the 3 hours evaluation and they found visuospatial difficulties and said he should not be driving. He can't use a phone so he can't stay alone. He can't remember names or relationships. He called his daughter's son her brother. He asks me the same question over and over and over. He still does his medications but it takes him half an hour because he counts the pills over and over and over and over. He had 3 nighttime events of hallucinations almost like sleepwalking. I would keep a list of his behaviors as you notice them. I found when I went with him to his doctor appointments I would forget some and feel rushed, so that helped me make sure the providers know how he's doing based on his behavior. I also send them online messages when any new behavior arises so they can note the file.

toolbeltexpert

As someone said showtiming can vary the results greatly. My wife was a 19 in her first ever mme 2 month later it was a 14 if I remember correctly. The second test was at a nursing home. I near cried watching. I said never again.

ButterflyWings

Yes, show timing and high cognitive reserves can serve our LOs well in a pinch. Of course, if you spend even a long weekend watching them closely 24/7 you will get a very different picture than a short screening tool can provide.

Our diagnosing physician said DH was "overcompensating" quite a bit during the first year of our quest for early answers, when they did an MRI and several other tests and gave him the "all clear, nothing to see here" sending him home relieved to know (in writing from a major research hospital) that he did not have dementia.

We were back a year later because clearly something was still very wrong (and getting worse) and lo and behold...MCI with likely Alz...proved to be just that via spinal tap and the progression since then is as predicted.