This is the third in a series of articles about the issues that arise over time in older people who experience mental declines -- and how you, as a family member or friend, can help.
Jeanne came downstairs and heard her mother, Edith, say -- in the tone of voice one would use to encourage a 2-year-old -- "That's right! Very good! Keep it up!"
She walked into the living room to find her husband laughing and her mother looking very pleased. There were no young children in the room. They were standing around a battery-operated toy car that Jeanne and Albert kept handy to occupy their grandchildren when they visited. It had openings in its sides shaped like squares, circles and triangles. When a child put an object through the correct opening, the car would announce, "Circle!" or whatever the shape was.
Edith was busy feeding the plastic objects through the car's windows -- and each time, she praised the car for giving the right answer.
Jeanne shot Albert a look of disbelief. He shrugged, still smiling. Edith, 81, was intelligent and well-educated. She was known for her love of art, music and history. She had never been known for whimsy.
Although Jeanne had started handling Edith's finances, she had thought that her mother's problems managing her checkbook reflected an isolated issue. Little else about her mother's behavior -- until this visit -- struck her as unusual.
But that wasn't the only odd moment during Edith's visit. Earlier, Jeanne had asked her mother to lie down on the bed she'd made up for her to see if the new mattress was comfortable enough. Edith lay on top of the covers, and immediately got up.
"Oh, I could never sleep here!" she exclaimed.
"It's too scratchy!"
A moment passed while Jeanne tried to wrap her mind around this answer.
"Mom, when you actually go to bed, you'll be lying between the sheets, not on top of the wool blanket."
"Oh!" said Edith, embarrassed.
Later, Jeanne described this conversation to Albert.
He said, "Your mother has forgotten how to work a bed. I don't think that's a good sign."
A few days later, Jeanne took her mother home to her independent-living apartment in a continuing care retirement community. Then she headed for the office of the director of resident services.
"Sally!" she said. "Something is very wrong with my mother's thinking." She told the director several stories from her mother's visit.
"Oh, don't worry," the director assured her. "We run tests of the residents' cognitive functioning from time to time. Your mother always scores in the normal range. You don't have to be concerned."
"Sally," Jeanne said, "my house is very small. Yet my mother was completely unable to find her bedroom, despite my taking her there half a dozen times a day for one reason or another. She has stayed in the same room many, many times before. This time, even after several days, she still couldn't find it. This is not normal."
Sally assured Jeanne that she would keep an eye on Edith.
The test Edith was given is called the Mini-Mental State Examination, or MMSE. It is often used to screen for mental decline in the elderly.
A study about its accuracy was originally described in the Archives of Neurology and then a summary was posted on a website of the U.S. Department of Health & Human Services.
It explained that the test tended to miss signs of early cognitive decline in people who were highly intelligent and well-educated. That's what happened in Edith's case.
It's important to realize that only someone familiar with an individual is likely to notice early changes in mental status. It is not a job that can be turned over to the family doctor.
What can you do to help?
First, you might make notes about specific changes in your friend's or relative's behavior to give to the doctor.
Second, you might ask the individual's doctor to order a more comprehensive assessment of mental functioning. Like tests used to identify learning disabilities in children, these multi-hour tests can pinpoint specific gaps and prompt the creation of a care plan.