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March 13, 2010

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online doctor

we had a neighbour with dementia, her grand children don't know how to handle her so i think tips from here will make them help.

Sue

Hi Doctor: Good to hear from you. With the dementia information changing so quickly, we have to rely on each other to keep up.

Thanks for writing,

Sue

caregiver ca

Do you all know "All Alzheimer's is dementia but not all dementia is Alzheimer's. And what you guess is dementia may not be dementia at all."

Sue

Hi Caregiver CA: yes, you are correct. Alzheimer's is the most common form of dementia but there are many different types. By the time a professional might use a cognitive test for screening, many other things would be eliminated.

Thanks for your quote, Sue

Tim

For what it's worth, there is standardization data for the MMSE adjusting score interpretation for education and age. See Crum, et al., JAMA 1993;269:2386-91.

For some reason this information- published 17 years ago- has not made it into the common knowledge pool for using and interpreting the MMSE. The MMSE was developed without the various checks and balances now considered necessary for the development of psychological tests- it was literally created overnight and put to use the next day (McHugh, Folstein and Folstein, 1975) with the statistical analysis being done on the back end rather than as part of the test development process. The end result is a test protocol with severe floor and ceiling effects and markedly uneven sensitivity to deficits throughout the range of scores.

The SLUMS is in part an effort to redress the deficits of the MMSE (along with many other tools such as the Blessed, the SPMSQ, the Cognistat, etc.). My clinical experience with the SLUMS is that it seems to be prone to making people's cognitive deficits seem worse than they are (in part because the interpretation of what the score means tends to follow that used with the MMSE, but a SLUMS score of 20/30 has different meaning than an MMSE score of 20/30). I think that may be because- at least in terms of face validity- the SLUMS is heavily weighted to tap working memory (1/3 of the points from questions directly tapping working memory).

All brief measures of cognitive performance need to be interpreted with a grain of salt and critical decisions should probably not be made based upon them. Dementia is, as you have pointed out, a complex syndrome with dozens if not hundreds of underlying causes. And each person's deficits are unique, especially in the early to middle stages.

Thanks for trying to point to reliable, useful information about dementia for caregivers and professionals.

Sue

Tim: This was incredibly helpful!!!! Trying to make complicated info simple for use quickly is not easy.

This issue of how to standardize the tests has bugged many of us for a while. Thanks for directing me (us) to the reference for MMSE.

Thanks also for reminding all of us how any of these tests are just guidelines and should be used, in your words, "with a grain of salt and critical decisions not be made based on them",

Again, thanks for sharing your real world expertise in a complicated topic area,

Sue

Margaret Schmale

Is there a test to check a person's physical stability? A 95 year old lady wants to remain in her home by herself, but the only daughter would like to relocate to a qualified assisted living for the safety and sociability.

When should a person not be allowed to stay by themselves any longer?

Sue

HI Margaret: A great question!

A neurologist or family physician would be the best one to make that determination. Just because a person is 95 doesn't mean she can't live alone safely. I work in a subacute unit with short stays to home and we had a gentleman last week who was 101 and had a 95 year old girlfriend!

To answer your question about when a person is no longer able to live at home, this is a very individual situation and should involve the advice of a physician or other health professional. Factors that weigh into the decision are whether a person is safe at home and what care support they may need.

Thanks for writing, Sue

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