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In Mrs. K's case (as in terms of all patients to whom the test is administered) her educational attainment and age need to be considered.
Mrs. K's rating was low - 14 points - and although this does correlate closely with dementia, caution has to be exercised since other mental disorders can also lead to low readings on the MMSE testing. It was also taken into account that physical problems, such as deafness, fatigue, concern, inability to concentrate, inability to hear or read the instructions properly or to understand them, or perhaps a motor or visual deficit that affected writing and drawing skills may interfere with test results. As far as possible, we tried to correct for these occurrences.
What I would recommend is one or other of similar clinical tests for corroboration. The 6-item Cognitive Impairment Test (6CIT) may be an option. This instrument, also known as the Short Orientation-Memory-Concentration Test, or the Blessed Concentration-Memory-Concentration Test, is constructed from six items that test memory, calculation, and orientation, The Clock Drawing Test (CDT) or Mini-cog may be another option the latter focusing on Mrs. K's word recall. The CDT screens for visuospatial, constructional praxis and frontal / execution brain impairment whilst the General Practitioner Assessment of Cognition (GPCOG) also tests memories if recent events and orientation.
My endeavor would be to assess areas where Mrs. K. showed limitations and then to refer her for the specific test that focuses on those limitations. In this case, I would refer Mrs....
K. To both the CDT and GPCOG tests in order to decide veracity of the findings of the MMSI and where we go from there. These tests when used in combination would also enable us, with greater certainty to separate mental illness and delirium from cognitive impairment.
I could also use the Confusion Assessment Method (CAM) to more reliably distinguish cognitive impartment from delirium. The CAM focuses on inattention, disorganized thinking, and level of consciousness. To monitor Mrs. K's progress, I might use the IQCDE which assesses long-term cognitive decline from questions asked on everyday tasks to a carer.
For prevention and treatment of mild cognitive impairment and Alzheiemr's disease in elderly subjects the following seem to be useful: dietary measures, physical exercise and mental activity are always helpful. Satins may be used for incident dementia, whilst Donepezil, but not Vitamin E, may benefit persons with mild cognitive impairment. Experimental treatments that may be helpful for Alzheimer's; include dimebon, PBT2 and etanercept. Herbal treatments are controversial (Andrade & Radharkrishan, 2009).
References
Dementia link. An introduction to the cognitive tests http://www.bgs.org.uk/Publications/deliriumtk/contents/pdfs_word_files/intro_cognitive_tests.pdf
Andrade C, Radhakrishnan R. (2009) The prevention and treatment of cognitive decline and dementia: An overview of recent research on experimental treatments. Indian J. Psychiatry.;51(1):12-25.
http://www.ncbi.nlm.nih.gov/pubmed/19742190
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