Mom Terrified of Cognitive Tests

AoliSauce

Hello, I'm totally new to all of this. My mom (69) has been showing memory issues for the past few years. She had a MOCA Assessment with a LCSW showing mild to moderate cognitive impairment a bit over a year ago. She had a brain MRI that wasn't abnormal around the same time. I've just gotten her to go in with a new PCP that she really likes and we had a nurse visit today to get some updated basic cognitive tests.

For background, my mom has had a variety of trauma in her life. She has very low self-esteem when it comes to her intelligence already and has pretty severe "white coat syndrome" in medical settings. Even just a basic "clock" test makes her start breaking down in frustrated tears and she spirals about it well after we have left the exam room.

Thankfully my mom is the kindest person I know, so she is never aggressive or rude. She just freezes and completely crumbles when she can't answer a question on these tests. The nurse said she should do an updated MOCA with a LCSW and possibly needs weekly updated exams. Her Dr. also wants do a neuropsychological exam in the near future. I know that is a very lengthy process filled with cognitive tests all day.

I don't know what to do. She dreads the cognitive tests and it seems to cause her so much distress and trauma. I want her to get an accurate diagnosis but I don't know if the stress that all this testing causes is worth it. I also don't know what effect this anxiety could have on accurate test results. Is there another option or accommodation she could get that would cause less harm to her? I'm also not sure how to accurately convey all this to her Dr. at her appointment. Any suggestions and advice would be so welcome. Thank you for your time.

​fesk

I am sorry you both are dealing with this. Is your mother on an antidepressant/anti-anxiety medication? Perhaps, calming her anxiety in general would help before tackling the cognitive testing (it may even improve the outcome). An antidepressant that helps with anxiety may be very helpful for her.

Also, I have never heard of weekly cognitive testing. Once a month at best after a diagnosis has been obtained. There's no need to make your mother go through weekly testing. I would recommend the lengthy neuropshych testing. I believe this will only be one time. It may be upsetting to your mother but may be helpful in diagnosing the type of issue she is having and affect treatment. Go with her to support her and the stress will not stay with her.

Try to give the doctor's office a note with your concerns or communicate through the portal so you do not need to discuss as much in front of her if possible.

I wish you the best of luck.

H1235

Welcome. My mom did the long neurology testing. She also had bloodwork and an mri. After she was diagnosed with vascular dementia we had a follow up appointment with the neurologist every 6 months. Only very simple 5-6 question tests were done a the follow ups. I asked point blank what the purpose of the visit was. They told me they were not strictly necessary, but some people just like to come in and touch base. We did not go back. There may come a time (if not already) when your mom needs medication for anxiety, depression or hallucinations. You will need a doctor who is willing to prescribe these kinds of medications (not all doctors are). Will her current pcp? If they are certain it’s some form of dementia and nothing treatable, I would refuse the testing. I can definitely see where the stress of the testing may cause her symptoms to worsen and affect the accuracy of the results. I think it would be good to tell the doctor your concerns. I found a note through the patient portal worked well. I have also typed up a note and handed it to the nurse before an appointment. This way mom didn’t have to hear the discussion. I also liked that I could think through what I said and how I worded it. I hope you can find an answer that works for you and your mom,

​fesk

The post above reminded me, you should rule out all medical reasons first that could be causing these issues. Then have the neurological testing.

I think there is value in testing and follow up visits (not weekly). My mother was on two medications for Alzheimer's which I do think slowed her progression, retained skills and gave her a better quality of life. She started on one medication and after some time the second was added. It was the follow up visits that determined when the additional medication would be useful. She saw a geri psychiatrist. She had a neurologist too, but I have found them to be very negative. The geri psychiatrist was most helpful.

I also think not all medications are appropriate for all types of dementia, so having an accurate diagnosis could be very important. Treatment options may differ.

Again, best of luck.

caregiving daughter

It's the neuro psych testing that to me would be the most valuable. Yes, it is several hours and it could be extremely frustrating for a person with cognitive decline. Having the probable diagnosis is valuable. You could ask your clinician if they would put your mom on dementia medication without the testing.

Emily 123

Hi,

Generally the neuropsychological exam will also include a MOCA, so you shouldn't need another if you can get in to see them. The testing will take 2-3 hours, but on the plus side they do a lot of these, and so should be able to help ease your mom along. They will usually ask you to wait elsewhere so that her responses are one-on-one with the tester.

What the various tests do is provide an outline of where your mom might have some cognitive losses, and they use that profile to identify the most likely causes. So, for something like Alzheimer's, the testing would show that her short term memory has been affected and they would say her symptoms fit a profile for Alzheimer's.

As others have said, It's always helpful to provide the neuropsychologist with a summary of what's going on ahead of time, and you can mention your mom's anxiety and white coat syndrome. I think monthly exams seem like a lot to put your mom through in her current state of mind. What's more important is how your mom is functioning in her day-to-day living. It's reasonable to ask her PCP to initiate or tweak any current anti-anxiety meds to help her be in a more comfortable frame of mind.