Could a moca test be wrong? Or I am in denial?

Breezey4024 · April 11

hi everyone I am new to the forum. This is my first post. I am a caregiver right now to my 86-year-old dad who has moderate dementia and I am struggling with processing and handling everything going on over the last few weeks. He was in the hospital then a rehab (foot infection) now back at home and the wheels have come off the bus.

He is really struggling with the car keys being taken from him. He is FIXATED. His short-term memory is absolutely gone and today I realized he wasn’t taking his medicine. He also is acutely aware of if we move anything (I keep calling it the ‘who moved my cheese’ effect- is that common?). For example - move a pillow or a basket or a towel.

We’re bringing a home health aid in and he is resistant to all of it, but I’m starting to look at assisted-living/memory care knowing that there will be probably a waiting list.

I’m not confident that the doctors have diagnosed him at the right level of dementia. He did do the MOCA Assessment with a social worker at a geriatric clinic and got a seven out of 30 but he’s able to dress and feed himself and gets around OK. He thinks he can drive but he can’t so we took the keys once we got the Moca test results. His short-term memory shot and he does not think anything is wrong with him.

I am just surprised that he got a 7 on that test and is still able to take care of himself. I don’t know if I have a question. I’m just looking for some understanding if that’s possible or if the moca test was wrong I just can’t tell.

He’s so furious with me at the moment about the car but he cannot drive and that’s a hard line I am sticking to. He has said he will kill himself if I don’t give him his keys and that it would be my fault (his words). He is not known for this type of threats ever in his life. Dr. Did just prescribe a low dose of Lexipro that we will start this week.

This just sucks beyond belief. I’m the only family member he has and I’m completely burn out already. Plus I work full time and have a family of my own. He lives alone (in a small house that I own) and I just don’t think it can be for much longer. He doesn’t wander so that’s a good thing. I have POA for him and I have been managing finances - he does the utilities bills.

Everyone on here is so knowledgeable and helpful. I’m grateful to join the forum. Thanks for listening if nothing else.

H1235 · April 12

Welcome. I’m not familiar with that test, but I’m sure someone will come along that can give you some insight. I have attached a chat staging tool that I think is very helpful. At the end of each stage it give some information that might be helpful for the level of care needed. I’m so glad you have taken the car keys. That is tough, but you have done the right thing. It’s also great you have the DPOA. Many people with dementia have an inability to recognize their symptoms or limitations. This is called anosognosia. It makes things so difficult! Trying to convince someone with dementia of their limitations is almost impossible and is sure to cause problems. I have also attached 10 absolute s of dementia care that might be helpful. I think it’s important to consider a move before there is a problem. Could he get out if there was a fire, would he know he has to or would he just try to put it out, would he try to fry bacon and start a fire? You said he is paying his utilities, have you verified this is being done? With a short term memory that is gone I would wonder. He is very vulnerable to scammers. I didn’t really answer your question, but I hope something here is useful.

https://static1.squarespace.com/static/6372d16ea4e02c7ce64425b7/t/63f7b80d80d8aa3e3aa4a47d/1677178894184/DBAT.pdf

harshedbuzz · April 12

@Breezey4024

Hi and welcome. I am sorry for your reason to be here but pleased you found us.

Dementia is about so much more than memory. MOCA is designed to be a quick screening tool that teases out deficits in memory as well as those in reasoning. MOCA is a good tool, but it's a just snapshot of a moment. It's not perfect.

IME, MOCA showed dad to be much less progressed in his dementia than I thought he was based on his at-home baseline. Dad scored in the MCI range about 6 months before he died— he remained verbal and ambulatory until the end, but was incontinent and very confused and confabulating by this point. He bragged all the way down to the lobby about how he scored "off the charts" (seriously, he could subtract serially by 7s like it was his job) and then toddled off when I turned my back to turn in my ticket at the valet stand. When I turned around he was getting into some random little old lady's car.

There are things that can skew the results. Dad brought a high IQ and graduate education into dementia which resulted in what's called cognitive reserve. People with less education do tend to get lower scores in the same stage as others with more years in school. If he wasn't cooperative because he was too anxious or angry, he would get a lower score. If the testing was done in the hospital or SNF, he might have had delirium that impacted his ability to take the test.

An SSRI like Lexapro could be useful but bear in mind it could be 4-6 weeks before you know if it's a good fit. Dad was on a different SSRI when diagnosed and we had to add an atypical antipsychotic to dial back the kind of behaviors you are describing. He also took the loss of driving hard and carried on until the day he died about. Seriously, the very last thing I said to the man hours before he passed was to promise to bring his car next time I came to visit knowing it would make him happy in the moment but that he'd forget immediately. Speaking of cars, it's likely become a visual trigger. It's best to disappear it. If you're the POA, sell it. If not, park it at your house for now and tell him it was recalled at the dealer awaiting a part.

When it was time for dad to go into a facility, we did not discuss it at all. We just made it happen. If he's threatening harm to you or himself, it would be appropriate to call 911 and have him transported to the ED for transfer to a geripsych unit for a short stay to sort out medications. I used to tape dad on my phone to share with his geripsych since dad always showtimed in the office.

Good luck.

HB

Anonymousjpl123 · April 12

I’m not sure if MMSE and MOCA are similar, but back in November my mom scored 9 and I thought it was way off. She can’t take care of herself (she is in MC) but at the time of the test she could still write a full grammatically correct sentence about the weather. I couldn’t understand. These tests are a snapshot and measure things we don’t necessarily get.

Everyone is different and manifests dementia in different ways. Some people (like my mom) keep their language in tact for a long time because they have high “cognitive reserves” - -a lot of stored up language — but cannot do things like get dressed, eat, or toilet by themselves. Others have high levels of functioning but no memory or cognitive/verbal function.
it’s good you are planning for higher levels of care: it sounds like he will need it soon. Glad you found this place. A lot of good knowledge here from people living it firsthand.

Quilting brings calm · April 12

The quick tests leave a lot to be desired. My mom scored high enough on the MMSE that the NP in the neurologists office kept diagnosing her as mild cognitive decline. When anyone around her daily knew she had dementia. . Your LO might not be able to process the test questions, or to draw… but yet be able to do things like find the bathroom, etc. Honestly, the internet sites that discuss stages and functionality do a much better job of telling you where your loved one is on the progression.

Could a moca test be wrong? Or I am in denial?

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