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Don’t Ask Do you know what day it is? Do you know where we are? Do you know what year it is? Box 3-4 Responding during the MMSE When conducting an MMSE, you will ask the patient a series of questions. Regardless of the patient’s response, give positive praise or comments. If an answer is incorrect, do not correct the patient. This will only add to the patient’s confusion. NEUROLOGIC ASSESSMENT The neurologic examination of the person with dementia is essential, as dementia is a neurologic disease.

No resistance should be felt. • Akasthisia. Akasthisia is readily observed by watching the patient sitting in a chair. If akasthisia is present, the person will shift about restlessly, unable to sit still. Many patients will express that this urge to move feels uncomfortable. This symptom is also a common side effect of psychotropic medications and an indication that the dose or type of medication should be re-evaluated. • Dystonia. Dystonic postures are extreme and can be a result of high sensitivity to neuroleptic medications.

REALITY: More often, patients are lethargic. 6 DEPRESSION Depression Defined Another common and serious complication of dementia is depression. Many think this is a reasonable reaction to realizing that one has dementia or a reaction to moving to a nursing home. This is unlikely the case, because of the diffuse brain damage suffered by patients with dementia. Common Features of Depression in Dementia • Low mood • Irritability • Non-sad; patient won’t complain of feeling sad Change in bladder function?

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