Have you ever wondered why MMSE score is important?

Written By:  Gayle Horton

The Mini Mental State Examination is a widely used method for assessing cognitive status. The evaluation of cognitive functioning is important in clinical settings because of the high prevalence of cognitive impairment in older adults today.

It is used as a clinical instrument to screen patients mental status, but also to follow the course of an illness and to monitor mental decline over a period of time. It assesses orientation, immediate and short-term recall, language, and the ability to follow simple verbal and written commands. It also provides a total score that places the individual on a scale of function.

There is an inverse relationship between the MMSE score and age of the person and years of schooling. Someone with a college degree may score as high as (29) at a younger age and decline with age and cognitive impairment to score (14) or lower.

People often ask if you can improve your MMSE score, and I would suggest that you should be happy if the score does not change with the use of memory enhancement medications. People with a lower MMSE score should probably not be living alone. I am concerned about their judgment in an emergency, would they even remember how to call 911, let alone take their medications appropriately. Families often try to ignore the test scores as the person continues to decline over time, but it is much better to try to prevent a crisis rather than pick up the pieces.

My Journey

Written By:  Gayle Horton

After writing many blogs to help families and caregivers searching for information about Alzheimer’s disease, I feel compelled to share with you why this is important to me.

When I was two years old my parents were asked to move into a farm house to care for an elderly uncle who had become mentally unstable. As a child I liked spending time together because he enjoyed coloring with me for hours and dressing my dolls on demand. I was unaware of my parent’s difficulty in managing his behaviors, of not bathing, hiding food in his dresser, or setting the electric coffee pot on the stove. Looking back now I am convinced that he had Alzheimer’s and no one understood how to help him in the 1950’s. My uncle lived with us for twelve years and only spent the last year of his life in a nursing home because of medical problems.

My dear grandmother also played a significant role in my life and I had the privilege of growing up near her. I learned the importance of respecting our elders as well as learning how much they have to share with us.

During my childhood I talked about being a nurse and my interest never changed. I worked as nurse’s aid at the local hospital while I was in high school and during summer vacations. I have many fond memories of the “old days” when we had time to give special care to older patients.

After going to nursing school, getting married, raising two children, and moving around the country following my husband’s career, I was able to stay involved in health care focusing on the older adult population.

After thirty years I felt the need to leave health care for many reasons, but I knew that I had to work with older adults. In 1997, I opened Solutions for Seniors and began consulting with families about aging issues. The Alzheimer’s Association told people at that time to get their affairs together and not tell anyone about their symptoms of memory loss. During this same year Aricept was released as the first drug to help with memory impairment.

Today, I believe the earliest evaluation and treatment can make all of the difference to help manage the early symptoms of dementia and maintain quality of life.

In 2010, The Journey Remembered DVDs were tested and developed to help families and caregivers provide appropriate entertainment for people with Alzheimer’s and dementia. The internet offers a fascinating opportunity to share information, and now I have many friends who have “liked” my blogs. I thank you for sharing my blog’s and posts with your friend’s and family.

When should you stop driving?

Written By:  Gayle Horton

Any person experiencing memory loss and forgetfulness may not be safe enough to drive on the road. I am surprised how many adult children continue to allow their parents to drive and do not think about the dangers involved.

Driving is powerful and it involves using a deadly piece of equipment, which symbolizes independence and a part of adulthood. But the focused concentration and quick reaction time needed for safe driving declines with age.

Alzheimer's disease accelerates this process dramatically. If you are caring for a loved one who has Alzheimer's, you may need to rethink allowing them to drive.

Diminished short-term memory causes many drivers who have Alzheimer's to get lost, even in familiar areas. The most dangerous part of driving is the decline and the ability to judge distances and predict traffic problems. A driver who has Alzheimer's may also have trouble understanding all of the visual cues. An event like a person walking a dog on the sidewalk may distract the driver from watching the road and oncoming traffic or even worse not seeing a pedestrian.

The opinions from authorities vary on whether driving should be allowed after an Alzheimer's diagnosis. For some people, it may be easier to give up the wheel early on, when they can still grasp the potential hazards. On the other hand, people in the early stages of the disease may be able to safely limit their driving to short daytime trips in familiar surroundings.

If your loved one continues to drive consider the potential of them becoming an unsafe driver. Look for difficulty navigating to familiar places, changing lanes, or making turns. They may be confused by which pedal to use, brake or gas at appropriate times. Observing traffic signals and remembering what to do at the appropriate time can be very difficult for them. Their thinking and processing will be slower and making quick decisions of what to do if a car pulls out or a child runs into the street. Patient’s with Alzheimer’s experience visual disturbances and may hit the curb while driving or even cross over the yellow line. Older adults usually travel at a slower rate of speed which can anger other drivers on the road and cause an accident.

If you are not sure whether it is safe for your loved one to drive, ask yourself whether you would feel safe riding in a vehicle driven by this person. If you are still not certain; would you feel safe having your children ride with this person driving? If the answer is “No”, then you know it is time for him or her to retire from driving.

Ask the doctor to write a letter to the Department of Motor Vehicles in your state recommending that your loved ones license be revoked. The older adult will receive a letter instructing them not to drive; and now it is up to you the children to take away the key’s or disable the vehicle.

Depression and Dementia


Written By:  Gayle Horton

Many people assume mom or dads are depressed due to many factors or changes in their lives when in fact they are experiencing changes in their memory. It is not always easy to distinguish between depression and dementia.

Older adults face grief after losing a spouse, loss of their independence, and health problems, which can all lead to depression, especially in those without a strong support system. Depression is not a normal part of aging, but the loss of natural chemicals which aid in giving a person the ability to be more hopeful, can be a reflection of aging. Older adults tend to complain more about their physical pain rather than how they feel emotionally. The older generation has been taught to suppress their emotional feelings which can make depression in older adults much harder to diagnose. Depression can be associated with their poor health; and a high mortality rate which put’s them in a category of increased risk of suicide.

We all have times when we are feeling down, which is a normal part of life. But when emptiness and despair take hold of our thoughts and does not go away, it may be depression. The lows of depression make it tough to function and to enjoy life. Just getting through the day can be overwhelming. No matter how hopeless someone feels, they can get better. One of my older male client’s was dealing with serious cardiac issues and he was having difficulty enjoying his life, when I suggested taking an anti-depressant. He initially refused but he did finally ask his doctor for a prescription. A few weeks later he told me that he “now had a reason to smile again.” Some people describe depression as “living in a dark black hole” or having feelings of “not seeing any light at the end of the tunnel.” However, some depressed people don't feel sad, but they may appear lifeless or empty, especially in men who may also express anger, aggression, and restlessness.

Many older adults begin to sleep too much and they begin to have trouble concentrating and staying on task. They complain of feeling hopeless and helpless. Their conversations are often negative, and they can be irritable and short tempered. Some people replace eating with drinking alcohol which can lead to other serious side effects. Noticeable weight loss and loss of appetite can also be warning signs.

Depression varies from person to person, especially in older adults, but there are some common symptoms, and it is important to remember that these symptoms can be part of life’s normal lows. But the more symptoms the person has and the longer the person has been troubled, the more likely it is depression. When these symptoms are overwhelming and disabling, please seek help.

Depression can be very serious and can even be life threatening, so I do believe that any person with symptoms should be evaluated by a doctor or other professional to evaluate all of the symptoms to determine if memory loss plays a part in the depression.

The Multiple Forms of Dementia

Written By:  Gayle Horton

Dementia is a general term for a decline in mental ability, severe enough to interfere with the activities of daily living. It is an overall term that describes a wide range of symptoms. The more educated the person with memory loss is the longer they may be able to compensate for their losses as they attempt to cover up their memory impairment. Despite their efforts they do not have control over the changes taking place in their brain.

There are many other conditions that can cause symptoms of dementia such as thyroid problems, vitamin deficiencies, diabetes, etc., but when these conditions are treated their memory should improve.

Alzheimer’s disease is certainly the leader of all of the dementias. A person can be diagnosed with early cognitive impairment at a younger age, but it is more common in the older years. One in every two people will be diagnosed with Alzheimer’s at age eighty five, and one in every ten people will be diagnosed at age sixty five or older.

Vascular Dementia ranks second among the dementias and it often occurs after a stroke. A TIA or Transient Ischemic Attack, also called a Mini-Stroke can cause significant damage to brain cells. Mini-Strokes often go unnoticed when the older adult lives alone. These patients continue to manage their activities of daily longer than patient’s diagnosed with the traditional form of Alzheimer’s.

Lewy Body Dementia is a faster progression of cognitive impairment. This form of dementia is not as common and causes a more rapid decline which can be devastating to a family. The patient may have just toured Europe and in several months after returning home they can no longer walk and may be forced to need long term care.

Frontal-Temporal Lobe Dementia is a much slower progression of cognitive impairment. Family members and caregivers have a difficult time managing the care for someone with this type of dementia because it is not obvious that they are not competent to manage their own affairs. The patient begins to lose their executive function and act without using good judgment. Their behaviors may seem more like a teenager whose brain has not developed, and they may say something very unpleasant to anyone who suggests that they need help.

The more rare forms of dementias include genetic syndromes, medications, depressions, mental conditions, and infections. Symptoms of dementia can vary greatly but they all have at least two of these warning signs in common; memory loss, communication problems, language difficulty, ability to focus, difficulty staying on task, reasoning, judgment, and visual perception.

Family members often describe symptoms of memory loss as senility or senile dementia. These comments reflect the formerly incorrect belief that a serious mental decline is a normal part of aging. I hear family members say “Oh, my mother is as sharp as a tack!” But, while doing an assessment and asking more in depth questions it obvious that mom can not remember what she had for lunch. I often fear that the adult children do not want to believe that their parents could be losing their memory and they are slow to seek expert help. The earlier treatment begins the longer you may be able to slow the progression of the disease.