15 June 2025
On Friday Liane the Physical Therapist gave Joyce another MoCA test. It was requested by "one of the doctors."
Likely not Dr. Khanna from the Memory Clinic. I'd just been in touch with her by email to set up a virtual visit on July 7 with Joyce. And previously she'd told me those test scores don't matter as much as behavior in evaluating a person's situation. At least after an initial appraisal.
In fact, everyone gives the test a little differently. It's the same tasks, of course, but the instructions vary. There were a few times I wanted to edit Liane's instructions but I kept my mouth shut.
I was watching for behaviors.
Before we went to the gym for the test, I ran Joyce down to the scale (that's another story)*, telling her it was Friday the Thirteenth. That was going to come up on the test and I thought it would help her remember it.
I quizzed her a little more. She knew the year, the name of the facility, the city it was in. She'd had trouble with that in the past.
And when she did the test, she was able to draw the clock face correctly for the first time. She couldn't place the clock hands correctly but later she told me what time it was from the round clock on the wall in the room. Go figure.
She couldn't alternate (the world missing in the instructions) between ascending numbers and letters (she got the ascension right but without alteration) or recognize the line drawings of a lion, rhino and camel.
She didn't remember Friday the Thirteenth or the year.
But she listed lots of words that began with 'F' and repeated complex sentences with some flair. She couldn't remember the five words she had been told earlier (face, velvet, church, daisy, red; the trick is to put a story together using each word).
Later I went to photograph the test for Dr. Khanna (because they use different systems) and Cassie told me she scored the same so they aren't seeing any deterioration.
Well, I don't know. It isn't that good a test, I would argue.
And to illustrate the point, as soon as I got in the car, Joyce called. And when I got home and out of the car, she called again. She wanted to know if I was coming today.
I tried to remind her I had just been there and she had taken the MoCA test. She didn't remember.
But wait, there's more. She was alarmed because she didn't have an Ace bandage over her wound adhesive bandages. The Ace bandage keeps the edges of the adhesive bandages from rolling up and the bandage falling off (which, yes, has happened there). She said the nurse said there were none.
There's a whole bag of them on her night stand. Binita knows that. So we had a knew nurse who didn't have Ace bandages on her cart and didn't know to look at the night stand for replacements.
So was it the dementia or the worry that caused her to call to see if I was coming? (Yes, it could be both but she doesn't usually call to see if I'm coming, does she?)
I told a friend that you can't conduct much of an argument with dementia. It has its own rules of evidence.
But one thing I have seen over and over again is that people suffering from dementia are aware of their diminished capacity.
After the MoCA test, back in the room before I left, Joyce was crying. "It's so humiliating," she said. "Thinking the year is 2024."
Which amused me. Of all the things to kick herself for, it was the year that bugged her. She writes it on her checks, of course. But that's the only time she encounters it.
I'd be more upset about not recognizing a lion, rhino and camel. That could get you in trouble.