Q: My mother is showing signs of forgetfulness and confusion. She constantly repeats questions and is often very confused. It’s easy for my sisters and me to see that her short-term memory is declining and we’re worried that she lives alone without any assistance.
When we took her to her physician, a Mini Mental State Examination (MMSE) test was performed and we were very surprised to learn that she scored a 28/30 — indicating no impairment. Now my mother insists that she doesn’t need any help. How is this possible? Do doctors really rely on this test?
A:You’re not the first one to be surprised about the results of a loved one’s MMSE, and perhaps you should delve more deeply into your concerns. I contacted Dr. Bonnie Levin, the director of the Division of Neuropsychology at the University of Miami.
“The MMSE is most useful as a screening measure, and not as a stand-alone test for dementia,’’ she said. “A complete work-up for dementia should include a comprehensive medical and family history, a medical evaluation, appropriate laboratory tests and careful mental status work-up.’’
She elaborated: “Like most screening tests, the MMSE has strengths and weaknesses. It's been shown to be relatively unable or insensitive to detect mild cognitive problems, when the earliest stage of dementia is beginning and interventions are the most effective. Also, the MMSE is biased toward picking up problems that involve memory and orientation, and less likely to pick up problems involving reasoning, judgment, planning, or organizing one’s thoughts.”
Keeping all this in mind, perhaps you and your sisters could talk to your mother about your concerns and suggest a more complete evaluation. Should you do this, I'd suggest that one of you accompany her to corroborate information that she provides in the event that she may lack insight into her own potential cognitive difficulties.
Nancy Stein, Ph.D., is the founder of SeniorityMatters.com, a local caregiver advisory and referral service for South Florida seniors and their families. You can contact her at nancy@