I have feared for some time now that I am developing some form of dementia, and the following check-list seems to confirm it:-
Ten early symptoms of dementia:
- Memory loss ****
- Difficulty in performing everyday tasks ****
- Problems with language ****
- Disorientation in time and place ***
- Poor or decreased judgment ***
- Problems with keeping track of things ****
- Misplacing things *****
- Changes in mood or behaviour ***
- Changes in personality (not aware of any – but would I be?)
- Loss of initiative ****
The asterisks indicate how badly I am affected * = only slightly, ***** = train wreck.
It’s worth pointing out that not all dementia is Alzheimer’s – though most forms other than Alzheimer’s are unknown to the general public. There is a wealth of information, not just about Alzheimer’s, on the Alzheimer’s Society’s website. It’s also possible that what I’m experiencing is a worsening of my ME. That’s certainly true of the physical aspects, but I’m not convinced that it’s the case mentally.
Aphasia (can’t find the words I need), can be a big problem, and, at its worst, it makes it almost impossible to hold a conversation. This has been a speech problem for as long as I’ve had ME, yet it has worsened substantially over the past year, and has now spread to my typing, which was previously unaffected. Similarly, my spelling has gone to hell and my vocabulary, normally quite a lot better than average, seems to be diminishing (only a little, so far, but it’s not a good sign). My overall intelligence seems little affected; if it was, I suspect I’d be unlikely to be so aware of other changes, or so distressed by them.
Last week, things took a turn for the worse when, on two occasions I picked up the TV remote and just sat looking at it, wondering how the hell it worked. In addition, returning from a shopping trip in horrible weather, I sat in the car with the engine running, wipers front and rear going, lights and radio on – and for a few minutes I had not the slightest idea how to turn it all off. This is getting scary – what would happen if, even for only a few seconds, I forget which controls do what in heavy traffic?
However, were I to present to my GP I would be subjected to what must be the most banal and mildly insulting test yet devised – The Mini Mental State Examination (MMSE). Click on the link, below, to see it.
This test is, to me at least, staggeringly simplistic, and one would have to be quite severely compromised to “fail” it, yet if I don’t, I may not get the investigations I believe I need. I estimate that I’d score about 32 points on this test, normal score being 25-30. I would have to score 24 or lower to be taken seriously, and that’s not going to happen. As this test is usually applied by the patient’s GP and, presumably, a high score would militate against any further investigations, I find myself wondering how much early-onset, as yet relatively mild, dementia goes undiagnosed until such time as the patient’s brain is mush?
On the other side of the coin, one of the tests in the MMSE is the drawing of two slightly overlapping pentagons, the overlap forming a diamond shape. Now I’m someone who can’t even draw a straight line without a ruler, so this is going to be a shambles, and give a false positive for dementia (all else being equal).
In addition, the MMSE is quite substantially affected by the intelligence and education of the patient, or the lack thereof. Among the caveats listed is this gem:-
- People from different cultural groups or low intelligence or education may score poorly on this examination in the absence of cognitive impairment and well educated people may score well despite having cognitive impairment.
In my case, I missed a great deal of schooling through illness (as much as 20-30% in an average year), so I have no formal educational qualifications. I don’t consider myself badly educated, though (but a doctor might wrongly perceive me as such, based on the lack of academic quals), as in the 47 years since I left school I’ve more than made up for any shortfall in my education. I have a fairly high IQ, too (though perhaps that should be had – I shudder to think what effect 23 years of ME has had on it, but it can’t be good). My IQ was tested by a psychologist who did his best to prove that what turned out to be ME was in fact a psychological problem. Fuckwit!
The MMSE has, it says “…been validated in a number of populations.” What, exactly, does that mean? How many is “a number”? Three? 10? 300? What? It’s an utterly meaningless statement. “A number” is a phrase I hate, incidentally, because not only is it meaningless, it’s also lazy.
The test starts by asking the following:-
- What is the year, season, date, day and month (1 point for each; maximum total 5 points).
- Where are we: town, county, country, which hospital, surgery or house, and which floor (1 point for each; maximum total 5 points).
You’d have to be severely impaired not to know any of that, though I usually have to check what day it is, and can never remember the date. Is that a sign of dementia, or is it just that my days are all the bloody same, with little to distinguish today from yesterday or tomorrow? I honestly don’t know.
Another test is counting backwards from 100 in blocks of 7. Simple on the face of it, probably less so under stress, and it’s something I’ve always been crap at (it’s one reason I don’t play darts – the other reason is that I’m rubbish!). The alternative to this test is to spell “world” backwards. Give me a break! There is no comparison between the two tests; none whatsoever.
And this language test is amazingly inept:-
- Ask the individual to write a sentence of their choice on a blank piece of paper. The sentence must contain a subject and a verb, and must make sense. Spelling, punctuation and grammar are not important (1 point).
Spelling, grammar and punctuation aren’t important? Of course they bloody are – they’re essential to the structure and understanding of language – a simple comma, misplaced, can completely change the meaning of a sentence. One of the earliest signs that all was not well was that my punctuation and spelling deteriorated (even the simplest email has to be rigorously edited for errors before it’s sent, as do my blog posts), yet these people think it’s not important! Were I to post an item uncorrected for spelling and punctuation, it would be unreadable, and I’d hate for people to think I don’t know any better, because I damned well do (before ME struck I was an adult literacy tutor, and a good one, too), and it does matter.
Anyway, it’s clear that I need to get myself investigated, and soon, but this idiot test fills doesn’t fill me with confidence. And, of course, anyone in my position, with Internet access, will already be familiar with it if they’ve done any research at all, which pretty well negates its value. Not that I think it had much value in the first place – a test that doesn’t work on the intelligent and/or well-educated is utterly useless. It seems, though, that the test’s writers believe that it will work for most people (otherwise, why bother?), so are they saying that they believe that the majority of people are unintelligent and badly educated? It certainly looks that way. Doesn’t exactly give you a warm glow, does it?