Of Maggots And Mental Status Exams

My most entertaining patient is a 67-yr-old monolingual Yup'ik-speaking man admitted for weeping ulcers on his lower extremities that were infested with maggots.  His legs are completely discolored with thick layers of exfoliating skin.  He has had several amputations due to severe frostbite: he is missing 2 toes from his left foot, 1 toe from his right foot, and 4 fingers from his right hand.  Despite all of these physical quirks,  he is frequently smiling and joking.  A young man from the patient's household is accompanying him during this hospitalization, but displays a curious lack of knowledge about the patient's baseline level of functioning ("I don't know, I just got out of jail" is his standard answer to our inquiries).  On his second day of hospitalization, the patient's primary caretaker called to tell us that she can't take care of him anymore (not that she was taking particularly good care of him to begin with, given the maggots on his legs).
Patient (via Yup'ik interpreter): Was she drunk when she called?  Because she always talks like that when she's been drinking.

To be fair, the patient's lower extremity ulcers are healing quite nicely now, possibly because of the neat work of the maggots: they're quite adept at digesting rotting organic material.  The hospital social worker is filing an Adult Protective Services report for elder neglect, and she asked me to conduct a mental status exam to facilitate the patient's placement in a nursing home.

Here's my dilemma: the traditional Folstein MMSE is a 30-point questionnaire often used to screen for dementia.  Questions include asking the patient to spell "world" backwards, to subtract 7 from 100 and keep subtracting 7 serially from the resulting answer, and to name the year/month/date/weekday.  Are these questions appropriate for a patient who doesn't speak English and has limited exposure to formal education?  I looked at the Mini-Cog Assessment Instrument for Dementia which is supposedly valid regardless of culture and educational status, but one of the items asks the patient to draw the face of a clock, then draw in hands to set the time to "10 minutes past 11 o'clock".  Is this relevant to someone who lives in a remote village in rural southwestern Alaska and uses the position of the sun and the moon to tell time?

Patient (via Yup'ik interpreter): These questions are making my legs itch.

You & me both, baby...