March 30, 2021

Yesterday was John's appointment with the neurologist. There's nothing earth shattering in these appointments, but it's interesting. And difficult to see how he performs on the MMSE - the Mini Mental State Exam. It's a 30 point test that's used to measure cognitive impairment. They test him at each appointment, which are twice a year. His score always declines over time. This time John scored a 12. He was unable to answer questions about the day, date, month or even year we're in. He guessed the season is spring. He couldn't write a simple sentence. He couldn't copy a basic sketch of a couple shapes. He could spell 'world' forward, but not backward. Of the 30 points, 25 and up is considered normal. 20-24 is mild dementia. 13-20 suggests moderate dementia. Less than 12 is severe dementia. So he's borerline moderate to severe. That's not encouraging. I asked if his medications could be increased, hoping that could ease some of his frustrations. The Dr said they're at the highest recommended level. We talked about driving because John remains very frustrated about not being able to drive. The Dr was surprised they hadn't notified the DMV yet about his condition, so I assume they'll be doing that soon. The DMV will then revoke his license unless he passes a behind the wheel test. John insisted that he could pass it. So the Dr suggested he try some online written tests to see if he was ready for the behind the wheel test - trying to save me the unnecessary trip to the DMV. Since John has recently denied he has Alzheimers, the Dr explained that it's hard to know what you don't know, and encouraged John to welcome help when it's available, and to accept help from me and trust me with all these issues. John had a good attitude at the appointment but when we walked out of the building afterward he said "Well I guess I might as well be dead." Cheery I know. I try to encourage him to find joy. Our circumstances are what they are, we can only choose our response. Easy for me to say though - I'm not the one losing my mind.