Dementia in Elderly Mother?

Parent Cafe
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<p>I’m a psychologist who works with old people. (Do not construe any of the following as medical advice.)</p>

<p>It is correct that a definitive diagnosis of Alzheimer’s Disease (AD) can only be concluded postmortem. But we can guess at a diagnosis of AD versus Vascular Dementia (VD). AD is characterized by problems centering around short-term memory, and by a progressive and uniform decline in overall functioning. VD centers around executive functioning–the ability to plan an organize–and can be more sudden in onset, and step-wise in decline. People with VD may retain greater cognitive awareness–e.g., not forgetting loved ones names–over time than those with AD.</p>

<p>AD is at least four times more prevalent than VD. And, sadly, if you are 85, your chances are one in two of developing some symptoms of dementia.</p>

<p>People can have mixed dementia–exhibiting symptoms of either. There are also other dementias, such as those associated with Parkinson’s or brain damage from alcholo abuse.</p>

<p>There are also conditions that mimic dementia.</p>

<p>Depression can yield dementia-like symptoms–psuedodementia depression. Sucessfully treat the depression and the symptoms resolve.</p>

<p>Illness at any age can cause delirium. In older people, infections such as pneumonia or urninary tract infections, can mimic demential. Again, treat the disease and the symptoms resolve.</p>

<p>There are also many people with “mild cognitive impairment”–sort of like losing a few miles on your fastball, but you can still get the ball over the plate–a condition that puts you at greater risk for dementia, but which can also remain stable for years.</p>

<p>Forgetting is common at any age, and not as severe with old age as many like to think. As I like to say, “It’s not forgetting that’s the problem, but forgetting you forgot.” I regularly forget where I put my keys, but I told my wife to be concerned only when she sees me wandering around the house not knowing what I’m looking for. (My son tells me I have to be nice to him because someday he will be picking out my nursing home.)</p>

<p>I can, without controversy say, there is no effective treatment for AD or VD. Again, do not take this as medical advice, but drugs such as Aricept and Namenda are a multi-billion dollar boondoggle perpetuated by the pharmaceutical industry. They are marginally only more therapeutic than garlic was against the bubonic plague. It would be a much better use of scarce resources to spend the money on research and palliative care. Aricept, for example, may make a tiny difference, but a difference that has no meaningful consequences in the real world. By way of analogy, my wife is quite nearsighted. Suppose there was a drug that would enable her to see the big E on the top of the eye chart without her glasses, I still wouldn’t get into a car with her unless she had them on. Similarly, there are many studies that show, for example, that taking Aricept will keep you–on average–out of the nursing home for two weeks longer than if you were on no anti-dementia drugs. In the UK, based on findings such as these, anti-dementia drugs can be prescribed only by psychiatrists or neurologists, and not by primary care physicians. Aricept can only be used for the mildest of dementias, not for moderate or severe ones, and Namenda is not prescribable for therapeutic purposes. It is restricted to research purposes only.</p>

<p>My take: [Dementia</a> Drugs | When it comes to dementia, forget the drugs - Los Angeles Times](<a href=“http://articles.latimes.com/2009/mar/19/opinion/oe-rosofsky19]Dementia”>The comfort prescription)</p>

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<p>I agree you should get a baseline, but be prepared for some anger directed at you for even making such an outrageous suggestion. My MIL is declining and in a chat last week with her neurologist he mentioned that people high intelligence / higher education tend to find ways to “hide” their symptoms for a longer time period - like using a more creative answer to a question like this “Esther, do you know where your jewelry is?” “Yes Edwin, it is where we always keep our valuables” If you didn’t think too deeply about it, she came off sounding as though she knew the answer when in reality she had no clue.</p>

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<p>geripsych, my father has been on on Aricept for something like seven years. My mother believes that it’s the Aricept that’s keeping him so cognizant. I think she’s nuts. Is it possible for Aricept to keep someone with true AD mentally sharp for so long?</p>

<p>I’ve tried to explain to my mom that in the time she’s had my dad on Aricept that I’ve had friend’s parents who were diagnosed, put in a nursing home and die. Meanwhile, family to whom she’s told about his “Dx” remark at family events that he seems “just like his old self.” Uh, yeah, because he doesn’t have AD. It’s very frustrating, but she wants to have an excuse for when he behaves like a PITA. He was a PITA when he was 50 so why she thought he wouldn’t be at 83 I have no idea. She allows him to drive hundreds of miles to his hunting lease alone. What makes her think that someone who’s had AD for several years should do that? It’s when she said friends have talked to her about maybe putting him in a nursing home that I lost it with her.</p>

<p>Sorry for the hijack, LasMa, but I had to get that out!</p>

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<p>thanks for the article on B12. We think MIL declined on the quicker side particularly in the last year. We watched a movie with her on Saturday night, on sunday morning she has no recollection of it. She asks ocer and over when my daughter graduates and what she is applying to school for. (nursing). She seems complacent about it but she and my husband are highly into denial. main mechanism of coping. However her chaulking it up to what happens when you get old, makes her resistant to devices that could be helpful.</p>

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<p>Here is the link to the Mayo’s articles, coping skills for caregivers, brain images, etc.</p>

<p>[Dementia</a> - MayoClinic.com](<a href=“Dementia - Symptoms and causes - Mayo Clinic”>Dementia - Symptoms and causes - Mayo Clinic)</p>

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<p>Las Ma, watching a Mom change in front of you is very difficult as it requires us to change as well. My heart goes out to you on this.</p>

<p>FWIW: I had a different kind of conversation this week with my 84-year-old Mom, who’s been diagnosed with dementia after a very rough year of quite noticeable decline. She was also caretaker to my Dad whose end-life years were taken by Alzheimers, so she’s seen it all. Earlier, through him, I learned that, while I deeply missed his intelligent presence in his final years, I loved him just as much when he no longer made any sense. In fact, in the end, all that was left was the love - no more words. Is she heading to the same place? Time will tell. </p>

<p>I’ve had scores of convos this season with Mom, always trying to figure out her status, tweak her environment, or bring her cheerful news. I was very played out/tired from it. My children picked up on it, and S-2 had this wisdom for me about his grandma: “Hardly anybody gets to be 84 without ‘something’ going wrong, either mentally or physically.” I realized it was up to me to accept that fact about aging. Everybody’s got something, and now this is what she has. </p>

<p>So next time I spoke with Mom, and she got tangled in a forgetfulness dilemma, I asked her sympathetically, “Is the forgetting hard on you?” She said, yes it is, and we talked a little bit about why (she said: embarassing and upsetting). I said as reassuringly as I could: “It’s okay. It’s okay to forget stuff. It’s really okay.” I was going for Robin Williams at the end of the movie “Good Will Hunting.” (“It’s not your fault…”). I just tried to express my complete acceptance of her situation, which we compared to “having bad ankles.” (dont ask me why ankles - just the idea that “everybody’s got something”). </p>

<p>That got it more out into the open. Problem is, of course, even that convo will be forgotten by her, but it’s a new tool that I have in my mind. It helps me to think this way, and I’m sure I’ll use that line again (and again…). “It’s okay.”</p>

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<p>Thank you so much for that, paying3tuitions. They’ve both had a lot of health problems, but they get such wonderful care from doctors who keep patching them back together. It’s easy to think that they can keep on going forever, and that everything can be fixed if we just pursue it aggressively enough. I like the “It’s OK” orientation.</p>

<p>Thanks all for your suggestions on talking to her about this. I see now how I can frame my concerns as being related to something else besides memory. I also like the “Do you have any concerns?” or “You don’t seem like yourself” approach. In fact, now that I’m thinking about, it’s been a while since I’ve been with her to see her primary, and fortunately, she always likes me to go to the doctor with her. I can easily suggest that we go together for a checkup; I don’t think that will raise any red flags at all.</p>

<p>However I get her there, I will speak to the doctor beforehand (yes, I’m an authorized contact) and brief her about what I’m seeing, and I’ll be armed with all of the possibilities you’ve listed. Also good to know that Aricept isn’t the miracle drug which the ads portray it to be; we won’t pin false hopes on that if it turns out to be Alzheimers. </p>

<p>They are in an Assisted Living facility, so Mom is not exactly Dad’s caregiver, but she’s definitely his minder – she tells him when it’s time to go to meals, what to wear, makes his appointments, keeps an eye on his health, hurries him along when we’re going somewhere, and just generally keeps him out of trouble. They are well looked after and there are expert eyes on them all the time, and staff will know when/if the time ever comes that either of them needs to be moved to Memory Care (thankfully, in the same facility). </p>

<p>lastminutemom196, I think you might be on to something. These problems with Mom began right after Dad returned home from an extended stay in skilled nursing last summer. I noticed immediately a big mood change in her; she was suddenly very easily frustrated and discouraged in her own recovery from a broken leg, snapping at the AL staff, refusing to follow her PT’s instructions, letting the apartment get messy, grumbling about everything – all very out of character for her. She confessed to me that she had enjoyed not having to babysit Dad for those several months, and she now had to assume that burden again. That was in August; it was another month or so before I started noticing forgetfulness. </p>

<p>MomLive, you’re right about the difference between normal forgetfulness and this kind of memory loss. She’s always done the “I can’t remember where I put my purse” (we all experience that). Now she’s doing what my dad does; things like asking me several times on the way to an appointment where we’re going, or at a restaurant asking several times if we’ve ordered yet. She doesn’t do that nearly as often as he does, but it’s definitely new.</p>

<p>But it was a very small thing this week which decided me that we need to look into this. The three of us had an appointment to see a financial professional and when I got there to pick them up, Mom was dressed in jeans and a sweatshirt. When I told her she needed to get dressed, she said, “I’m wearing this” and seemed surprised when I said it wasn’t appropriate for the occasion. It sounds inconsequential, but dressing up for appointments is so ingrained in her that it made the hair on the back of my neck stand up. That wasn’t my mom.</p>

<p>And D, just home for break, saw Grandma today for the first time since August and noticed not so much memory probems, but a marked personality change: “When did Grandma get so rude?” which is something that’s been glaring to me and has also been mentioned by the caregivers at AL. So I know it’s not just me. Off to the doctor we will go.</p>

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<p>SIL highly recommends “The 36 Hour Day” for any family member who has a loved one with Alzheimer’s or dementia. </p>

<p>The book seems to be widely available, but just saw the paperback version on overstock.</p>

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<p>My 84 yr old dad has started being more forgetful and the things he was always bad at (like fixing something or any technological device) he is now hopeless at. However, he can still do the NY Times crossword puzzle every day in pen. </p>

<p>He is incredibly stubborn, always has been, so my mom, at their doctor’s appt., brought up the subject by saying how since they are getting older their not so good at remembering things now and could he recommended something for them. The doctor picked up on what she was doing and mentioned aricept. No argument from my dad. :slight_smile: </p>

<p>My mother is still sharp as a tack. She just got a smart phone last spring and she can do things on hers I haven’t been able to figure out how to do on mine!</p>

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<p>^I always tell my husband, who dislikes technology and rather than taking the time to learn it, would rather complain about how horrible it is that people now use email and texting as a major source of communication that keeping ‘up with the times’ is a way to keep your mind sharp. I think your Mom proves my case! :)</p>

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<p>My MIL fired her MD because she did not like my SIL speaking to her PC without her there. So it is a slippery slope. Itis hard to take care of them, not hurt their pride, encourage independence, etc… My SIL would speak to her doc then they would all see the doc together. so just be discrete.</p>

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<p>I spent more than a year battling with my mother’s dementia issues prior to her death (from another cause). It was so hard. She did not have Alzheimer’s. She did have issues with low sodium and other chemical imbalances, but these were rectified and she was still … quite a mess, I guess would best describe it. She had no executive decision making skills. She had delusions at times. She would call me to tell me that my father was chasing her around the house trying to have sex with her (my mother who couldn’t even bring herself to talk about sex with me when I was growing up). She hoarded certain things, couldn’t keep track of time, obsessed about certain things, repeated herself, got agitated at night, couldn’t sleep, got nasty with my dad & her friends, couldn’t follow a recipe, took 3 weeks to pack up the few Christmas items she had managed to put out … just so very many things. Her MD was an idiot. I talked to him, but he didn’t want to work with her once she got difficult. I did talk to her heart doctor, who pointed me to Mayo Clinic. She went to Mayo, where they were unable to determine what was going on. Their best guess was that she was in chronic pain and it had altered her brain chemistry. She was well aware of what was happening, although she wouldn’t always remember what she had said (I believe this was more “didn’t want to remember”). She hated, hated, hated what was happening to her. During one episode, she ended up being involuntarily committed … which was horrible. They put her on meds that didn’t help, and she was humiliated by the whole situation. In the end, we found out that she had multiple undiagnosed broken bones. She had so many other health issues, she would say “I hurt” and everyone would figure it was the diagnosed issues. She was small and frail, so she could break a bone by hitting something or falling - which I am sure she did & didn’t tell anyone about.</p>

<p>My heart goes out to you LasMa, and all who are dealing with dementia. There is no magic pill, in most cases, and it is such a sad end to a beautiful life. Remember, you are not alone.</p>

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<p>My mom is in rapid decline this past year (mid-70s). Dad took her to a doctor who said it was “mild”, but she can’t remember anything for 10 minutes. I don’t know if she put on a good show for him, but he did a few tests and sent her home with “early Alzheimers” as the diagnosis.</p>

<p>It is SO sad. I will be there a couple days prior to Christmas to help with the cooking, but knowing this is probably her last “cognizant” Christmas just breaks my heart.</p>

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<p>^Maybe you’ll be lucky. My Dad’s initial decline was fairly rapid, but then he just settled into a happy state where he had very little short term memory, but he recognized everyone, and actually became a better tempered person as time went on. The period where he would go driving and get lost was awful, but once he gave that up, while it was sad, he seemed to be enjoying life and it was hard to feel that bad about it.</p>

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<p>mathmom, I’m hopeful that will happen with my dad. Our visit over T’giving was so pleasant. He was talkative and in a great mood. He’s having a bit of a physical decline, but he was interested and interesting (though he talked A LOT).</p>

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<p>I’ve heard, and experienced, dementia as a disease that is hardest on the people around the afflicted one. Unless there are other medical issues causing physical pain, the afflicted person might be the least unhappy of all the family. </p>

<p>To me, the transitions were upsetting but there were also plateaus. There, the afflicted one was cheerful and oblivious. Remember the two old sisters in Arsenic and Old Lace - the word there was “pixilated.” This does drive everyone wild with all the roller-coastering events of each day, but it can help to keep in mind that the person at the center of that commotion is not unhappy.</p>

<p>If the person becomes depressed/sad, delusional or afraid/paranoid, there are different psychiatric medicines to treat for those, if and when the time comes.</p>

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<p>I amazed how often people report that their parent’s personality did a 180 after dementia set in. Some get nicer, some get less nice. I’ve always wondered why that happens.</p>

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<p>^^ Same here. My dad, who’s had some kind of dementia for more than a year ( type never diagnosed) has never been happier.</p>