Tuesday, November 28, 2006

109 a better Alzheimer's test (actual tests to look at)

This is from Saint Louis University. Supposedly this test is BETTER than the other test for finding early dementia. I took it and had no problems. But I'm not even 40 yet.
A study showed this test spotted early stage dementia in more people (no stats given.)
This is the test, taken from the SLU site:

Saint Louis University Mental Status (SLUMS) Examination

1. What day of the week is it? (1 point for the right answer)
2. What is the year? (1 point)
3. What state are we in? (1 point)
4. Please remember these five objects. I will ask you what they are later: apple, pen, tie, house, car. (No points yet)
5. You have $100 and you go to the store and buy a dozen apples for $3 and a tricycle for $20.
* How much did you spend? (1 point)
* How much do you have left? (2 points)
6. Please name as many animals as you can in one minute. (No point for naming 0-5; 1 point for naming 5-10; 2 points for naming 10-15; and 3 points for naming more than 15.)
7. What were the five objects I asked you to remember? (1 point for each object remembered.)
8. I am going to say a series of numbers and I would like you to give them to me backwards. For example, if I say 42, you would say 24.
* 87 (0 points)
* 649 (1 point)
* 8537 (2 points)
9. (Draw circle.) This circle represents a clock face. Please put in the hour markers and the time at ten minutes to eleven o'clock.
* (2 points for hour markers labeled correctly)
* (2 points for correct time)
10. (Show a triangle, a square and a rectangle.) Please place an X in the triangle. (1 point)
11. Which of those objects is the largest? (1 point)
(note: no picture of objects given or described)
12. I am going to tell you a story. Please listen carefully because afterward, I'm going to ask you some questions about it.
Jill was a very successful stockbroker. She made a lot of money in the stock market. She then met Jack, a devastatingly handsome man. She married him and had three children. They lived in Chicago. She then stopped working and stayed at home to bring up her children. When they were teenagers, she went back to work. She and Jack lived happily ever after.
* What was the female's name? (2 points)
* When did she go back to work? (2 points)
* What work did she do? (2 points)
* What state did she live in? (2 points)
SCORING: High school graduate: Normal: 27-30; Needs more evaluation: 20-26; Dementia: 1-19.
Less than high school diploma: Normal: 20-30; Needs more evaluation: 14-19; Dementia: 1-13.


I found a copy of the other test, the Mini Mental State Examination on this site. I've looked for it before so I'm not sure if this is a new page or what, but this is it:


Orientation
What is the (year) (season) (date) (day) (month)? 5
Where are we: (country) (city) (part of city) (number of flat/house) (name of street)? 5

Registration
Name three objects: one second to say each.
Then ask the patient to name all three after you have said them.
Give one point for each correct answer.
Then repeat them until he learns all three.
Count trials and record. 3

TRIALS
Attention and calculation
Serial 7s: one point for each correct.
Stop after five answers.
Alternatively spell 'world' backwards. 5

Recall
Ask for the three objects repeated above.
Give one point for each correct. 3

Language
Name a pencil and watch (two points).
Repeat the following: 'No ifs, ands or buts' (one point).
Follow a three-stage command: 'Take a paper in your right hand, fold it in half and put it on the floor' (three points).
Read and obey the following: Close your eyes (one point).
Write a sentence (one point).
Copy a design (one point). 9

INSTRUCTIONS FOR ADMINISTRATION OF MINI MENTAL STATE EXAMINATION

Orientation
1. Ask the date. Then ask specifically for parts omitted, for example, 'Can you also tell me what season it is?' Score 1 point for each correct.
2. Ask in turn, 'Can you tell me the name of this place?' (town, country, etc). Score 1 point for each correct.

Registration
Ask the patient if you may test his or her memory. Then say the names of three unrelated objects, clearly and slowly, about one second for each. After you have said all three, ask him or her to repeat them. This first repetition determines the score (0-3) but keep saying them until he or she can repeat all three, up to six trials. If he or she does not eventually learn all three, recall cannot be meaningfully tested.

Attention and calculation
Ask the patient to begin with 100 and count backwards by 7. Stop after five subtractions (93, 86, 79, 72, 65). Score the total number of correct answers. If the patient cannot or will not perform this task, ask him or her to spell the word 'world' backwards. The score is the number of letters in correct order, eg dlrow 5, dlowr 3.

Recall
Ask the patient if he or she can recall the three words you previously asked him or her to remember. Score 0-3.

Language
Naming: Show the patient a wrist-watch and ask him or her what it is. Repeat for pencil. Score 0-2.
Repetition: Ask the patient to repeat the sentence after you. Allow only one trial. Score 0 or 1.
Three-stage command: Give the patient a piece of plain blank paper and repeat the command. Score 1 point for each part correctly executed.
Reading: On a blank piece of paper, print the sentence 'Close your eyes' in letters large enough for the patient to see clearly. Ask him or her to read it and do what it says. Score 1 point only if he or she actually closes his eyes.
Writing: Give the patient a blank piece of paper and ask him or her to write a sentence for you. Do not dictate a sentence, it is to be written spontaneously. It must contain a subject and verb and be sensible. Correct grammar and punctuation are not necessary.
Copying: On a clean piece of paper, draw intersecting pentagons (as below), each side about one inch and ask him or her to copy it exactly as it is. All ten angles must be present and two must intersect to score 1 point. Tremor and rotation are ignored.


A score of 20 or less generally suggests dementia but may also be found in acute confusion, schizophrenia or severe depression. A score of less than 24 may indicate dementia in some patients who are well educated and who do not have any of the above conditions. Serial testing may be of value to demonstrate a decline in cognitive function in borderline cases.

This is the test my father has described to me, more or less, in Bob-speak.
There are other different types of tests on at this link.

Disclaimer: I'm not a health care professional and I have no experience administering these or any other tests. This is just for information. If you think you or a loved one has AD, please go to your doctor and take these tests with him/her.

Monday, November 27, 2006

108 Thanksgiving, dad & grandma -style

We had Thanksgiving at my mom's house, as usual. My mother-in-law brought shrimp cocktail, stuffed mushrooms and a lovely cake. My dad loves shrimp cocktail. He would have eaten ONLY shrimp for his Thanksgiving meal if we hadn't taken the platter away. Then he didn't know what anything was. He would point. He said "I don't know what this is, but it's good" about the stuffing, but then he was picking it out of his mouth (and putting it into the stuffed mushrooms serving platter of all places). He also picked the mushrooms out of his mouth.
My grandmother was her obnoxious holiday self. She claims to be "sick" and that we "don't understand" how sick her medicines make her. My mother and I tell her constantly to just stop taking them them, but then she's "sick" in a different way. There's no winning. She actually drove herself, in spite of the rain, but then complained that she was tired, she was missing her nap, etc. She treats my dad like he's 5, she either talks down to him or around him, and I don't like that. (Not that I never talk around him, but I don't talk to him like he's a baby.)
The cake was to celebrate my husband getting a new job. My grandmother picked up a knife and hacked a random hunk of out it before Will even got to see it, and then got angry that it was chocolate, and went on a tirade about how she can't eat chocolate. Will just sat there in shock. "She ruined my cake," he said in disbelief. Funny that she eats chocolate ├ęclairs every Sunday and never complains. But on Thanksgiving, chocolate makes her sick. Then she left. Apparently the next day she called my mom and was angry that she didn't get any of the dessert my mom made me ( graham cracker-pudding-chocolate yummy melange). We didn't offer it to her after her anti-chocolate rant. Why would we? She is getting so very rude, and she seems to think that's okay because she's 88. Ruining the cake is only part of it. On Sunday nights when we're over, she puts on this tape of country music (which Willy and I HATE) at full loud volume and does her "exercises" (simple stretches) totally ignoring us. She has ALL DAY to do this stupid tape, why does she wait until we're there? She sees me for 2 hours a week, and that's how she choses to spend that time? She knows we hate the music and basically sit there gritting our teeth until she's done. If I got up and left when she turned it on, then I would be the rude one. I don't get it. She also doesn't do the puzzle. She does her "exercises" while we do the puzzle for her. I don't even want to stay anymore and work on the puzzles anymore. She picks these ugly dark paintings and they aren't fun to work on.
Friday Will had off from work so the four of us went out for lunch at the Pacific Buffet. Where my dad had, of course, more shrimp cocktail. They didn't have his "shells" (clams). Will said he saw my dad get kind of lost, he went to the other side of the dining room where we sat last time instead of where we were this time. Dad was scooping ice cream with the little plastic eating spoon but he thought it was funny. He explained how he thought the spoon was going to break (in Bob-speak). My mom said he was in a terrible mood that morning and she almost left him home but that got him even madder.
Will and I went to a movie and that night I went back over to do a puzzle. I had seen some cheap puzzles at Big Lot and my mom braved the Black Friday crowd with my dad and they picked some up. He choose a Noah's Ark puzzle for the animals. As soon as we started putting it together he lost interest and wandered off. He pointed to the picture of Noah and said "He's the guy! look, he's got the little thing." (Meaning, baby sheep he was carrying).
He also did something VERY funny. I had been there about half an hour, and we were eating our tea and crumpets (water and the chocolate graham cracker dessert) and my dad says "I saw that girl today. They said they were coming later." I had no idea what she was talking about. Then my mom said, "That girl is your daughter and she's sitting across the table from you." He looks over, says "hi!" very cheerfully, shakes my hand, and then says to my mom "I told you." It was hilarious.
Some days you have to laugh, or you cry.

Friday, November 17, 2006

107 new study about angioplasty

I just saw this on CNN. It seems that "Opening arteries days after heart attack seems not to help" which of course means my dad went through that horrible time at the hospital for nothing (see entries 100, 101 & 103).
The highlights:

New research has overturned one of the most fundamental beliefs among doctors treating heart attacks: that opening a blocked artery is always a good idea, even days or weeks later.
Instead, the study revealed that doing this too late may not help, and there were disturbing hints that it might even be harmful. People who had balloon angioplasty to open an artery three to 28 days after their heart attacks fared no better than those given standard medicines to prevent a second attack.
The results don't apply to most Americans suffering a heart attack, but suggest that 100,000 of them a year might be able to skip the expense and risk of angioplasty and take medications instead, doctors said. ....
Angioplasty did seem to help prevent chest pain years after the procedure....People need to be clear about why they're having the angioplasty" and discuss with their doctor whether it is being done to try to improve symptoms or to try to prevent heart attacks and death.... The study also underscores the importance of fast medical help for heart attacks.

So I guess we did it for the right reason...to get rid of his chest pain...and for the wrong reason...to stop another one from happening.

Wednesday, November 15, 2006

106 raking leaves the Alzheimer's way

Thank you all for your comments & suggestions on the Medicare thing. We did write to Congresswoman Rosa DeLauro (email) and she sent a (snail mail) letter the same day with all the forms we needed to authorize her to step in and help. Meanwhile my mom kept calling Medicare during the more "acceptable" times and finally got through to a person who CLAIMS it is fixed but everything has to be re-submitted by the doctor and the hospital. So I am not convinced we are out of the woods yet.
Then my grandmother got a letter from Medicare saying they were cutting her benefits because an audit showed she had more than $10,000 in "stocks and investments" which she doesn't. She wanted me to take care of it. I know nothing about Medicare and insurance. Why me? My mom ended up going over there and making the calls. Of course because she's not my grandmother, that causes its own set of problems. She's got POA for my dad, but not my grandma, who's mostly competent. It didn't exactly get resolved, but my mom said they kept questioning my grandmother's address so she's thinking they mixed her up with someone else.
I asked my mom if I could borrow the leaf-blower to do my yard. Instead they decided to come over on Saturday and help. Which is fine, great, all that. I was feeding the birds so I didn't come out right away. As soon as I did, my dad looked up at me and said "Hi!" in absolute astonishment, as if to say "what's SHE doing here?"
I took the leaf blower and did my garden and my Meditation Circle. My dad raked the section of my yard closest to the house and my mom raked up by the garage.
My father picks up every twig, stick and fallen branch.
Every one.
He breaks it very carefully into pieces about a foot long.
And places them on the nearest table.
I have one wooden picnic table and two round resin tables. All three were piled high with carefully broken twigs, all aligned parallel with each other.
Then he starts carrying the leaves up into the back, where we have a big compost-kind of pile. He gets confused and then brings the leaves back to the leaf pile in the middle of the yard and puts them there. In fact, I think he may have been bringing leaves FROM the compost pile TO the yard for a while.
My mom started to carry the leaves from his section and he was standing there confused and she accidentally conked him in the head with the rake handle as she went by. She felt bad, but this is how he is. He hasn't the sense to duck or get out of the way. (When I am leaving their house or my grandmother's, he will stand right behind the car or right in front of it, waving and waiting. Sometimes he walks away and then wanders back. I'm afraid I'm going to hit him some day.)
My mom gets impatient with him, and I know she shouldn't, but I can see why. Sometimes he just doesn't GET it. She's saying 'hurry up and finish, I want to go home' and he's just standing there watching us work. Then he goes to pick up some leaves, and there's a branch, and he has to go through his breaking up the branch routine. He hands ME the pieces. I say "I don't want twigs. I don't save twigs." And I throw them back into the leaf pile, which gets him all upset.
After he left I found twigs piled everywhere. It was like being in Karl Wagner's short story "Sticks."

Tuesday, November 07, 2006

105 Medicare nightmare

My mom got a bill for $22,000 from Medicare saying they were NOT covering my dad's angioplasty/stent/stint (however the hell you spell it--I can't even get 2 people to agree on how to SAY it) . Their reasoning? My mom has a job and therefore has other insurance. Which she hasn't for 2 years.
Like a dutiful daughter I went over yesterday and called Medicare.
Can I give you some advice?
DON'T ever call Medicare.
A polite recorded voice told me there was high call volume and all representatives were busy and I might have to hold for a while. Fine. The voice then suggested I call back at another time, and gave me some options. I held on. The voice said again that all representatives were busy, suggested I check the Medicare web site for help, and then hung up on me.
This happened three times. I was on hold various times, from a minute or two to close to twenty.
Total bullshit.
So I went downstairs, went to the Medicare web site, and they have NOTHING. No contact form. Everything directs you to call the SAME number that just told me to check the website instead and hung up on me.
I hate government. I've voting today. Any incumbent, I've voting out. No one could be worse than who we have now.
As far as my dad goes, he's been really quiet. He asks me all the time "when are you coming again?" and I tell him the date and time, he looks at his watch and says "what's today?" So I'll explain. "Today's Friday. I'll see you at 5:00 on Sunday at Grandma's for dinner." "Okay." He shakes my hand, pats me on the shoulder.
One day recently, when I was explaining when I would come over again, he said, looking sad, "You're really busy, huh." It makes me feel so guilty, like I should move back into their basement. Yeah, like that would work. But then on Friday when he said "When you coming again? About a week?" and I said Sunday, he was happy.
But when I went over yesterday to call Medicare, he didn't even come and talk to me until I was leaving, and then he only waved.
A couple of weeks ago, I went over on a Wednesday night for dinner and then stayed to do a puzzle. My mom decided to take the dog for a walk. My father got very upset. "I don't like it when she's not here," he said to me, prowling the house. "I don't like it at all." I explained that he wasn't alone, I was there with him, but that didn't matter.
However, my mom was surprised when this weekend, he was talking to someone on the trail where they were walking with the dog, and he said "my wife" (he doesn't know her name, though--she's "hey" and "they"). My mom said he was trying to talk about me, but he couldn't remember my name or say "daughter". So I guess he does know who we are, to a certain degree. But he doesn't respond when I call him "dad" anymore so I call him "Bob."