“Doctor, do you diagnose dementia? Because I need someone who can diagnose dementia.”
A man asked me this question recently. He explained that his 86 year-old father, who lived in the Bay Area, had recently been widowed. Since then the father had sold his long-time home rather quickly, and was hardly returning his son’s calls.
The son wanted to know if I could make a housecall. Specifically, he wanted to know if his father has dementia, such as Alzheimer’s disease.
This is a reasonable concern to have, given the circumstances.
However, it’s not very likely that I — or any clinician — will be able to definitely diagnose dementia based a single in-person visit.
But I get this kind of request fairly frequently. So in this post I want to share what I often find myself explaining to families: the basics of clinical dementia diagnosis, what kind of information I’ll need to obtain, and how long the process can take.
Now, note that this post is not about the comprehensive approach used in multi-disciplinary memory clinics. Those clinics have extra time and staff, and are designed to provide an extra-detailed evaluation. This is especially useful for unusual cases, such as cognitive problems in people who are relatively young.
Instead, in this post I’ll be describing the pragmatic approach that I use in my clinical practice. It is adapted to real-world constraints, meaning it can be used in a primary care setting. (Although like many aspects of geriatrics, it’s challenging to fit this into a 15 minute visit.)
Does this older person have dementia, such as Alzheimer’s disease? To understand how I go about answering the question, let’s start by reviewing the basics of what it means to have dementia.
5 Key Features of Dementia
A person having dementia means that all five of the following statements are true:
- A person is having difficulty with one or more types of mental function. Although it’s common for memory to be affected, other parts of thinking function can be impaired. The 2013 DSM-5 manual lists these six types of cognitive function to consider: learning and memory, language, executive function, complex attention, perceptual-motor function, social cognition.
- The difficulties are a decline from the person’s prior level of ability. These can’t be lifelong problems with reading or math or even social graces. These problems should represent a change, compared to the person’s usual abilities as an adult.
- The problems are bad enough to impair daily life function. It’s not enough for a person to have an abnormal result on an office-based cognitive test. The problems also have to be substantial enough to affect how the person manages usual life, such as work and family responsibilities.
- The problems are not due to a reversible condition, such as delirium, or another reversible illness. Common conditions that can cause — or worsen — dementia-like symptoms include hypothyroidism, depression, and medication side-effects.
- The problems aren’t better accounted for by another mental disorder, such as depression or schizophrenia.
Dementia — now technically known as “major neurocognitive disorder” — is a syndrome, or “umbrella” term; it’s not considered a specific disease. Rather, the term dementia refers to this collection of features, which is caused by some form of underlying damage or deterioration of the brain.
Alzheimer’s disease is the most common underlying cause of dementia. Vascular dementia (damage from strokes, which can be quite small) is also common, as is having two or more underlying causes for dementia. For more on conditions that can cause dementia, see here.
What Doctors Need to Do To Diagnose Dementia
Now that we reviewed the five key features of dementia, let’s talk about how I — or another doctor — might go about checking for these.
Basically, for each feature, the doctor needs to evaluate, and document what she finds.
1. Difficulty with mental functions. To evaluate this, it’s best to combine an office-based cognitive test with documentation of real-world problems, as reported by the patient and by knowledgeable observers (e.g family, friends, assisted-living facility staff, etc.)
For cognitive testing, I generally use the Mini-Cog, or the MOCA. The MOCA provides more information but it takes more time, and many older adults are either unwilling or unable to go through the whole test.
Completing office-based tests is important because it’s a standardized way to document cognitive abilities. But the results don’t tell the doctor much about what’s going on in the person’s actual life.
So I always ask patients to tell me if they’ve noticed any trouble with memory or thinking. I also try to get information from family members about any of the eight behaviors that are common in Alzheimer’s. Lastly, I make note of whether there seem to be any problems managing activities of daily living (ADLs) and instrumental activities of daily living (IADLs).
2. Decline from previous level of ability. This feature can be hard for me to detect on my own during a single visit. To document a decline in abilities, a doctor can interview other people, and/or document that she’s reviewed previous cognitive assessments. I have also occasionally documented that a patient is currently unable to correctly perform a cognitive task that is related to her career or education history. For instance, if a former accountant can no longer manage basic arithmetic, it’s reasonable to assume this reflects a decline from previous abilities.
3. Impairment of daily life function. This is another feature that can be tricky to detect during a single visit, unless the patient is very impaired. I usually start by finding out what kinds of ADLs and IADLs help the person is getting, and what kinds of problems have been noted. This often means talking to at least a few people who know the patient.
Driving and managing finances require a lot of mental coordination, so as dementia develops, these are often the life tasks that people struggle with first.
In some cases — usually very early dementia — it can be quite hard to decide whether a person’s struggles have become enough to qualify as “impairment of daily life function.” If someone isn’t taking his medication, is that just regular forgetfulness? Ambivalent feelings about the medication? Or actual impairment due to brain changes? If I’m not sure, then I may document that the situation seems to be borderline, when it comes to impairment of daily life function.
4. Checking for reversible causes of cognitive impairment. I mentally divide this step into two parts. First, I consider the possibility of delirium, a very common state of worse-than-usual mental function that’s often brought on by illness. For instance, I’ve noticed that older people are often mentally assessed during or after a hospitalization. But that’s not a good time to try to definitely diagnose dementia, because many elders develop delirium when they are sick, and it can take weeks or even months to return to their previous level of mental function.
(My approach to considering dementia in older adults who are confused during or after hospitalization: Make a note that they may have underlying dementia, and plan to follow-up once the brain has had a chance to recover.)
After considering delirium, I check to see if the patient might have another medical problem that interferes with thinking skills. Common medical disorders that can affect thinking include depression, thyroid problems, electrolyte imbalances, B12 deficiency, and medication side-effects. I also consider the possibility of substance abuse.
Checking for many of these causes of cognitive impairment requires laboratory testing, and sometimes additional evaluation.
If I do suspect delirium or another problem that might cause cognitive impairment, I don’t rule out dementia. That’s because it’s very common to have dementia along with another problem that’s making the thinking worse. But I do plan to reassess the person’s thinking at a later date.
5. Checking for other mental disorders. This step can be a challenge. Depression is the most common mental health problem that makes dementia diagnosis difficult. This is because depression is not uncommon in older adults, and it can cause symptoms similar to those of dementia (such as apathy, and poor attention). We also know that it’s quite common for people to have both dementia and depression at the same time.
In many cases, there may be no easy way to determine whether an older person’s symptoms are depression, early dementia, or both. So sometimes we end up trying a course of depression treatment, and seeing how the symptoms evolve over time.
It’s also important to consider the older person’s mental health history. Paranoia and delusions are quite common in early dementia, but could be related to a mental health condition associated with psychosis, such as schizophrenia.
Is it Dementia or Mild Cognitive Impairment?
Sometimes, when an older person is having memory problems or other cognitive issues, they end up diagnosed with “mild cognitive impairment.”
Mild cognitive impairment (MCI) means that a person’s memory or thinking abilities are worse than expected for their age (this should be confirmed through office-based cognitive testing), but are not bad enough to impair daily life function.
The initial evaluations for MCI and dementia are basically the same: doctors need to do a preliminary office-based cognitive evaluation, ask about ADLs and IADLs, look for potential medical and psychiatric problems that might be affecting brain function, check for medications that affect cognition, and so forth.
I explain more about MCI in this article: How to Diagnose & Treat Mild Cognitive Impairment.
But remember: in practical terms, if an older person’s memory problems have gotten bad enough that he can’t grocery shop the way he used to, or she can no longer manage her finances on her own…those qualify as impairment in daily life function. And so, a diagnosis of “mild cognitive impairment” is probably not appropriate for those cases.
Can Dementia Be Diagnosed During a Single Visit?
So can dementia be diagnosed during a single visit? As you can see from above, it depends on how much information is easily available at that visit. It also depends on the symptoms and circumstances of the older adult being evaluated.
Memory clinics are more likely to provide a diagnosis during the visit, or shortly afterwards. That’s because they usually request a lot of relevant medical information ahead of time, send the patient for tests if needed, and interview the patient and a family member (or other knowledgeable “informant”) extensively during the visit.
But in the primary care setting, and in my own geriatric consultations, I find that clinicians need more than one visit to diagnose dementia or probable dementia. That’s because we usually need to order tests, request past medical records for review, and gather more information from the people who know the older person being evaluated. It’s a bit like a detective’s investigation!
Can Dementia be Inappropriately Diagnosed in a Single Visit?
Sadly, yes. Although it’s common for doctors to never diagnose dementia at all in people who have it, I have also come across several instances of busy doctors rattling off a dementia diagnosis, without adequately documenting how they reached this conclusion. (It’s also common for them to hardly document anything in terms of the older person's cognitive state, other than “confused, didn’t know the date.”)
Now, often these doctors are right. Dementia becomes common as people age, so if a family complains of memory problems and paranoia in an 89 year old, chances are quite high (at least 60%, according to UpToDate) that the older person has dementia.
But sometimes it’s not. Sometimes it’s slowly resolving delirium along with a brain-clouding medication. Sometimes it’s depression.
It is a major thing to diagnose someone with dementia. So although it’s not possible for an average doctor to evaluate as thoroughly as the memory clinic does, it’s important to document consideration of the five essential features of dementia that I listed above.
If You’re Worried About Possible Alzheimer’s or Dementia
Let’s say you’re like the man I spoke to recently, and you’re worried that an older parent might have dementia. (Remember, most dementia is due to Alzheimer’s or a similar underlying brain condition.) You’re planning to have a doctor assess your parent. Here’s how you can help the process along:
- Obtain copies of your parent’s medical information, so you can bring them to the dementia evaluation visit. The most useful information to bring is laboratory results and any imaging of the brain, such as CAT scans or MRIs. See this post for a longer list of medical information that is very helpful to bring to a new doctor.
- Write down worrisome behaviors and problems, and bring this documentation to the visit. You can start with this list of 8 behaviors to track if you’re concerned about Alzheimer’s.
- Consider who else might know how your parent has been doing and behaving recently: other family members? Close friends? Staff at the assisted-living facility? Ask them to share their observations with you and jot down what they tell you. Share these notes, along with the names of the informants, with your parent’s doctor.
- Be prepared to explain how your parent’s abilities have changed from before.
- Be prepared to explain how your parent is struggling to manage daily life tasks, such as work, house chores, shopping, driving, or any other ADLs and IADLs.
- Bring information about any recent hospitalizations or illnesses.
- Bring information about any history of depression, depressive symptoms, or other mental illness history.
By understanding what it takes to diagnose dementia, and by doing a little advance preparation when possible, you will improve your chances of getting the evaluation you need, in a timely fashion.
And if you have an aging parent who is refusing to get evaluated for memory loss or other concerning symptoms: my free online training for families (see below) covers how to get past this, and includes a nifty PDF summarizing what to say and not say to your parent who may have dementia.
Memory Loss & Safety: How to Have Better Talks & Fewer Fights With Your Aging Parent [Free Training]
Worried about an aging parent with memory loss? Struggling to help them make needed changes, so they can stay safe and live well?
In this free online training for families dealing with cognitive changes, Dr. Kernisan will cover better ways to talk to a parent with memory loss, and how to address driving and other safety concerns -- even if your parent is resistant.
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This work by Leslie Kernisan MD & Better Health While Aging LLC is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Based on a work at BetterHealthWhileAging.net.
thank you. My 86 year old mom has been having erratic behavior all of a sudden – after a series of traumatic incidents, such as my dad going into hospice, her caring for him relentlessly, then being hospitalized herself with vertigo, etc. My concern over her meds as well as possible neurotoxins affect from fumigating their house this past fall (ants infestation) has me checking into possible external causes. A very clear and insightful post.
Yes, quite possible that the things you mention are contributing to your mother’s mental worsening. Dementia usually does not come on “suddenly.” Good luck investigating those contributors, and helping your mother get the rest and support that will allow her brain to recover to its best capabilities.
Also check for Urinary Tract Infection. This can send seniors off the rails extremely quickly, especially if they’re not staying hydrated.
A urinary tract infection can definitely be a cause if sudden onset confusion in an older adult, and if there are any other symptoms like a change in the frequency of going to the toilet, pain or burning with urination, or new incontinence, we would check a urine sample.
We always want to make sure it’s an actual infection and not asymptomatic bacteriuria, as Dr. Kernisan discusses in this article: https://betterhealthwhileaging.net/urine-bacteria-without-uti-in-elderly/
Sounds like my Dad and Therese’s Mom had many of the same symptoms. It took many months for Dad’s doctor to diagnose his Alzheimer’s, It wasn’t until after my Mom’s passing – I guess they were able to hide it (unknowingly) from the world.
Good information on dementia.
There is so much I could write about this article. It’s really interesting to see what is termed dementia, vs delirium. My mother is a very complex case. But what is especially interesting about her case is she has a pattern of having seemingly mental anxiety which is related to an untreated illness. She often has the mental anxiety go away when the cause of the illness goes away. Dad often would side with doctors who would say, it’s all in your mind and she’s get nerve pills to treat anxiety over real symptoms. This happened a few times but she also had some episodes where she was treated for mental illness likely depression and bad thoughts many years ago after pregnancy. So she had a few cognitive problems, like being bad with math since an accident as a child.
Later in life she was addicted that is took nerve pills for many years, also tied to resolvable illness that was undiscovered. In getting off those drugs she took a drug that gave her a debilitating illness that stopped her ability to walk. Hardly at all. So my father and I have to wait on her and get her everything. My dad is very old and my mom is old as well. 90 for dad and 76 for mom.
Without going into to many details. There was known diagnostics and hidden diagnostics made by a psychiatrist. Those hidden things were kept from me by the will of my parents and covered up, or the psychiatrist put diagnosis opinions in his notes without telling my parents. This remained hidden in her record.
Now over the years my mom has seen well over 30 doctors for her physical debilitating illness and she has basically the same results, her nerves are damaged and she will never walk without pain that is extreme. She has burning foot syndrome, likely caused by a side effect from a drug that destroyed not only her life but ours as we are stuck wrung for her. She takes a lot of drugs, some off label to treat the effects of the disease/syndrome. Two drugs she takes are Ativan and also Cymbalta. Cymbalta is being taken at 30mg dose per day. She also typically gets 3 hours sleep per night, and naps at times during the day. Without Ativan she cannot fall asleep if stressed and she’s used to taking the equivalent of four 1mg doses per day. She takes heavy pain mess each day. We are talking Norco and a duregesic pain patch. The pain patch is fentanyl 50mg every three days but was 75 mg every three days before the hospital visit. She also takes lisinopril 10mg a day for blood pressure. The blood pressure is will rise due to pain. Level 7 normally up to level ten during a pain flare. She also has environmental chilling of her feet.
She also is very demanding, but of course a part of this is due to being immobilized in a lazy boy and has a strange setup that took 3 hours to get in and out of to go to the restroom. She has home care givers come to the house. She can’t be in a warm environment for long. She basically has a ton of problems and some come from adapting to the foot peoblem, a result of adapting and doing behaviors to compensate for foot pain or reduce it. For example when you don’t want to spend more than two or three times going to the bathroom because it’s a three hour ordeal you limit your fluid intact. Sitting long hours can cause more problems with your body. The cold air for the feet which burning foot sufferers end up using chills the rest of the body, so you’ll have to bundle up and experience aches and pains. Chilling the room makes our family a bubble house family because the cold air leads to isolation. We have had to feed her special diets and meals because her pain is related to diet as well. Salty and sweet or spices or even hot foods can cause pain flares. She lost her teeth and has to have chopped and chilled food. Some foods set her off.
She had some minor problems she wanted to get taken care of and went into the hospital for those. She can be very demanding. If her Cymbalta is increased to 60mg a day, her requests that are always demanding with Cymbalta added go to 30 requests per minute, even a staff of four people could not keep up with those demands.
She has suffered a mania from lack of sleep before. Sleep deprived for three or four days when overdosed on Neurontin given off label to try to cure her foot problem. She experience sleep deprived delirium and was hearing things. I’m aware of this and saw it. I’ve had a kind of rem sleep delirium myself a kind of sleep deprived rem state where the mind races without sleep or when fatigued a lot. It’s like sleepwalking while your awake. Mixing dreams with reality forming an alternate reality. I have my own theory but just as a normal person, and that is sleep deprivation can drive the mind I to a rem state while awake. Maybe that’s delirium. If you are alert enough you might take notes and even have interesting dream like thoughts that are like a kind of cognitive drawing.
In the last hospital episode she was interested and demanded to go to the hospital for a non emergency, that could be handled by ER but didn’t have to be. I found out relatives who don’t live with us we’re hearing complaints from mom about our not meeting her every wish and filling APS social worker complaints against us as some kind of abuse or neglect charges. Didn’t know who that was. Didn’t know the exact charge as they would arrive, take notes and leave and say the charges would be dropped.
When we got to the hospital mom was dropped off her medication for procedures and some required things like colonoscopy tests. These won’t work with someone who takes three hours to go to the bathroom. Mom was not getting much sleep. And she only got 10 to 12 hours over a week. Her medications were changed and without Ativan her sleep deprived delirium like symptoms and racing mind were happening. And I saw this decline before so I was worried about it.
They were not feeding her enough and she was complaining about everything and not on any one topic, like rem state dreaming while awake. Every complaint was accurate and made sense to me but the topic of context was absent as she would switch topics constantly. I found out that she wasn’t getting Ativan because they were afraid of side effects and could not sleep until she got that. Drugs used for common recovery caused her burning foot flares to move around the other parts of her body, as evidenced by skin temperature readings. The family had to do the medical chilling and I ended up bringing food I made from home in coolers to feed her.
I caught a social worker lying to me, covering up something. I didn’t trust her from that point on. My dad and I were left for a week trying to stay in my moms room and support her care and we were losing sleep.
The hospital made a few mistakes and when my. I’m complained and I started to complain, well we became problems in their eyes. I’m sure of that. They abused her feet when I left her alone and then covered it up in the records. Then they tried to railroad us to a nursing home quickly. And we said we can’t trust the nursing home unless we check it out because you guys aren’t taking good enough care and we can’t trust you. So they gave us a chance to stay one more day for a mental health evaluation. That night I realized mom wasn’t going to ever pass it. Because she had not been getting enough rest and there was no point in testing her mental state she would fail. We decided to leave in the morning and reject care. I talked it over with mom and dad. But we were held against our will with a threat of hospital guards. I didn’t understand why. Mom failed the test and the staff who promised that we could decide if she didn’t pass the test pressed us for a placement into the nursing home because she had dementia and families will not see it and choose to deny it. We agreed. Once in I found that relatives filed for guardianship. Because we had no living will or poa that we could recall and none was signed during admission.
Mom was put in a room that was 84 to 90 degrees hot when she normally is in a 60 degree room with air conditioners and fans blowing over her burning feet.
Dad and I and mom were out of the frying pan and into the fire.
The transport van lady didn’t fasten down her wheelchair and had the heat on High during the entire ride to the nursing home. We had to pay for transport, because they didn’t trust us or that’s the common way things are done. Moms blood pressure was 193/83 from the transport to the nursing home.
We were stuck in legal limbo and the state had guardianship rights over her care and my relative drove up to file for guardianship to take car of mom and later admitted to “save us from ourselves”. Mom was losing more sleep in there and I was as well. My heart felt like it was going to fail. I found that my relative filed for control of 50 percent of our finances, by virtue of the wording.
I ended up asking the nurse to retest mom to find out if she had dementia, stating I didn’t think she had it and that it was a false diagnosis. It she passed the evaluation and was able to sign herself out. I wanted to see the hospital and all medical records to figure out what was going on. What did I find. I found out that my father and I were charged with neglect by my relatives. They were treating us as part of the problem and there were two plans. A public plan and a secret private plan apparently. This private plan was determined to diagnose my mother as having dementia in order to get her out of our care/neglect. The problem was the hospital and nursing home actually cares less, abused her and covered it up. I have absolute proof of this. Everyone in the hospital was lying about this. But the record didn’t lie. The measure,mets didn’t lie. And the evidence and facts I uncovered didn’t lie. What happened was selective half truths were used to frame my father and I as neglecting my mom when medical professionals have said we are the best caregivers they have ever seen. Yer we were being accused behind HIPPA privacy and didn’t see that. We didn’t know but were being tried behind e scenes without any chance of defense. Relatives trying to help us were setting us up and twisting us into a series of catch 22 scenarios. They even lied when making excuses after the facts and never apologized.
I found out the hospital entered a diagnosis into the system before my mom was tested which stated dementia as the diagnosis. A letter was written to the nursing home and signed with lies that mom had dementia as a diagnosis and was treated for It in the past 24 months which is a lie. That she was diagnosed with it, five days before the psychiatrist saw her. She was on three times more blood pressure medication than she normally gets and was losing sleep. Basically dementia was used as an excuse to kidnap my mother from our care. Now I do admit we neglect some of her requests because there are many of them. She has a complex case with many ailments and many drugs being taken. A discussion with a neuro psych clinic person in the phone resulted in them admitting if we went to get her tested we’d never get a proper diagnosis with all the drugs she has to take for her burning foot syndrome. In the backstory of this my relatives decided to make my dad and I villains as we reacted we were attacked through emails and texts saying my dad had dementia as well. That’s just another way to get him in a nursing home as well. Dementia can be used to get guardianship and steal assets from the person. It’s a rising trend by those who have no respect for the elderly or their care.
It’s important to have care givers keep an eye on seniors who might be easily exploited by those seeking to take advantage of them. How did the hospital get involved with this. One of the accusers was a social worker and set us up with the medical workers behind the scenes. So we were tried by a kangaroo jury behind the scenes. And the lies are evident in the records and flaws point not only to neglect and mistakes by the medical system, but a plot and purposeful use of a false diagnosis to take control.
Now I understand is someone is really abusing someone then something has to be done. My point is subjective emotions were manipulated behind e scenes and once the ball started rolling there was virtually no way we could stop it.
This makes me so mad, I’d like to sue the heck out of everyone involved. I even wouldn’t mind going around that and going directly to the criminal court system and file because the conspiracy was so wide ranging end full of lies and bs. The biggest problem I have is my relatives even though they did this would be implicated and it’s difficult to say how far the courts would go. This kind of stuff happens all the time But people don’t have time to figure this out, and would rather move on with their life. The problem I have now is the past medical records could harm her future care. Things written that are false may show up in future records. Everyone has a right to their opinion. I’ve had eight medical professionals say my mom doesn’t have dementia and some claim the doctors and relatives who did this have dementia instead. It becomes a thing that is so difficult to unravel.
I’m ready to write a book about this and almost feel like going for the publishing of the true story in all its details without revealing the actual names. I almost feel new laws like laws to allow patients to have a recording via video and audio of their entire stay which are secured for future evidence needs to be allowed. After all a police officer may have to wear a body cam to document life and death decisions. If a police officer needs body cams to protect him and the citizens, why should a medical professional not wear one. They can be judge and jury and harm or kill you and hide it and hide the evidence.
I feel like we got a taste of socket healthcare instead of US healthcare. Supposedly the patient and his loved ones are supposed to be given truthful information during their care. We got a lot of lies and stonewalling. My advice is beware and get good references before going to Mickey Mouse hospitals.
Wow, sounds like you have been through a lot.
I would agree that your mother is a “complex case.” In particular, it can be hard to diagnose dementia in people who take a lot of potentially mind-altering medications. Also true that sometimes there isn’t a lot of transparency when it comes to diagnoses or medical information. I hope things get sorted out — or at least improve a bit — soon.
Once the elderly start with unmanageable mental problems, real life of the law and greed of medical insurance is mind blowing.
Best advice? Give all money and property to the youngest heirs in the family. Way ahead of time. Otherwise….. you lose.
My mother fell two months ago and fractured six ribs and hit her head. She is 93. The hospital took X-rays, told me to take her home and give her some Advil. I was flabbergasted. Shouldn’t they have kept her overnight at least because of her head injury? Now she has started scratching her head saying there is some kind of cradle cap on it. She has dug sores in her head and is losing her hair. We took her to her Dr. he ask her if it itches and she says no. He prescribed Zanex .5 for her nerves. She is still scratching. Could this be caused by something else????
Digging sores in her head sounds concerning. She says it’s not itching: what reason does she give for her scratching? It sounds like she might benefit from a little more investigation from a clinician, to figure out what is driving her head-scratching behavior.
Xanax is a benzodiazepine sedative/tranquilizer drug. Like all benzos, it’s on the Beer’s list of medications that older adults should avoid or use with caution, because benzos tend to worsen thinking and increase fall risk in people your mother’s age. As a geriatrician, I only use benzodiazepines as a very last resort, when all other options have been considered and if we decide the likely benefits outweigh the risks.
So I would recommend you follow-up with her doctor and ask more questions. You may also want to consider a second opinion from a geriatrics clinic, a dermatologist, a geriatric psychiatrist, or just another generalist physician (preferably one who is careful and thoughtful).
Last but not least: Advil is also on the Beer’s list of medications to use with caution. Unfortunately, it remains common for doctors to prescribe risky medications to seniors, without having discussed risks and alternatives with patients and families. So keep asking questions and doing your own research, as you are doing. Good luck!
My mother just celebrated her 75th birthday but had a lot of trouble remembering how old she was. You stated that although it’s common for memory to be affected, other parts of thinking function can be impaired. Do most nursing homes offer memory care or options for patients with dementia?
Memory care is common in assisted-living. There are a number of sites online offering help in choosing a suitable facility.
I would recommend your mother be carefully evaluated before you look for a facility.
I didn’t read anywhere that you ultimately refer the patient to a neurologist specializing in dementia. My father had Lewy Bodies dementia. Is a primary care physician qualified to solely diagnose dementia. I would argue that they are not. My father died prematurely because he was not properly diagnosed and was prescribed medications that adversely affected him. Had he been referred to a neurologist specializing in dementia, he would not have been prescribed this medication, and he would have died from a natural progression of the disease. He was a victim of a primary care physician, who was too arrogant to admit that they were not qualified to solely diagnose dementia thoroughly. Do you not see this as an obstacle to adequate care?
In many cases, a primary care clinicians should be able to make a preliminary diagnosis of dementia. Now, in this article, I don’t go into the additional issues that PCPs — or any clinician — should check for once they conclude an older person likely has dementia. But actually, checking for hallucinations and signs of Parkinsonism would be among them. Such features are common in Lewy-Body dementia, and do indeed mean one should avoid medications that interfere with dopamine in the brain.
Whether to refer to a neurologist or specialist depends on many factors. If a patient or family has any concerns, it’s certainly reasonable to ask for a second opinion or a specialty consultation. But specialists don’t always get things right. There is probably no substitute for doing a bit of one’s own research, as this helps one prepare to ask better questions.
A separate but related question is, to what extent is it important to have the underlying cause of dementia identified? I think PCPs should be able to diagnose dementia, but determining the underlying cause is indeed much harder. In people who are older than, say, 80, I don’t particularly try to identify the sub-type of dementia. That’s because mixed dementia becomes very common as people get older, and I don’t find that it’s useful (meaning helps me better care for the person) if we get specialty consults to try to identify the underlying cause.
Instead, I think it’s important to check for certain features that will affect care, such as visual hallucinations, parkinsonism, or other signs of Lewy-Body dementia. Again, this is because such features means it’s more important to be careful about certain types of medications.
It is also important to inquire about what types of difficulties a patient or family is encountering, and then create a care plan that addresses those. There can be a lot of variation in symptoms within a type of dementia. Now are PCPs equipped to deal with this? Probably not, but they need to get better. In the meantime, it’s multidisciplinary dementia clinics that are best, because they usually have nurses and social workers who are trained to help families with common challenges.
In terms of obstacles to adequate care…there are so so many of them, when it comes to the care of older adults. People with dementia are routinely given medications that are suboptimal or not recommended by best practice guidelines, often by PCPs, but also often by neurologists! I describe issues related to medications in dementia in these posts:
4 Medications to Treat Alzheimer’s & Other Dementias: How They Work & FAQs
5 Types of Medication Used to Treat Difficult Dementia Behaviors
In short: I agree that it’s risky to solely depend on PCPs for adequate dementia evaluation and care. But referring everyone to a neurologist is probably not the answer. Instead, we need for PCPs to be better trained, families need to be ready to ask a lot of questions, and most of all, we need more dementia clinics that are equipped to help families with the many common challenges they will encounter.
My 73 year old mother has thought (feared) she’s had Alzheimer’s for about 6 years. Just last week she saw a psychologist to take screening tests to check cognitive function and memory. She scored below (mildly) normal aging memory problems. She is also had ADD, anxiety and lately had suffered some depression (as she’s lost all three of her brothers and her mother in the span of 5 years, two of them died 3 days apart, also a close sister was diagnosed with Parkinson’s and best friend with cancer, also was dealing with her mothers Health issues) she had gone off her anti anxiety medication for about a year all on her own. We got her back on it in April and she said she has been feeling a lot better. We’ve all noticed improvement but still memory issues and also confusion at times. We know when she took that test she was super nervous, and as my dad said, “crumbled” while being asked questions. He knows that she could answer some of them while not under the pressure and fear of taking the test to semi diagnose for Alzheimer’s or dementia. We will be getting full blood tests done, checking for thyroid issues and b12 Deficiencies, also I think it’s so important she checks in with a psychiatrist to adjust or check her prescription for anxiety medication to see if it’s still the correct Dosage and/or medication. I believe it has been MANY years since she’s seen a psychiatrist for medication.
So, my question(s) are…. is it possible for someone to show many symptoms of early Demetria/Alzheimer’s and the cause be solely depression and/or side effects of medication? She has trouble with numbers (although math was NEVER her strong suit) and remembering dates, etc. she gets a little confused at times, forgetful (but not horribly), she had forgotten how old I am …just knew general age. I’m just wondering if these signs could be a cause of a lingering depression that’s been undiagnosed for years? Her symptoms have gotten worse, but mildly worse. And like I said, she got really bad last fall after two family deaths back to back and then improved after getting back on anti anxiety meds. Although I’m still not sure this is correct dose for her now, or even best medication as I think her needs and other things may have changed with age?)
Would depression or side effects to meds mimic THAT closely Dementia?
Thank you.
Depression and/or medication side-effects can certainly cause cognitive symptoms that can mimic dementia.
For people your mother’s age, I have found that it’s very common for depression or stress or grief to make brain function worse.
That said, I’ve also found that it’s rare that people with such symptoms (and of this age) are otherwise entirely cognitively normal. Usually, further evaluation suggests that they either have an underlying mild cognitive impairment, or underlying dementia (often very early/mild stage).
There is a concept related to brain function that is called “cognitive reserve.” Basically, a younger or healthier brain has extra processing power, so even if it’s impaired by stress/grief/medications, thinking and memory will remain pretty good. Whereas a brain that has developed damage due to very early Alzheimer’s (or a variety of other problems) will have less reserve. So it takes less stress for the person to become noticeably worse in their thinking.
In short, I think you are right to suspect that the other factors are playing a role in your mother’s symptoms, but there’s still a good chance that her brain is not entirely normal and healthy for her age.
Regarding anxiety and anti-anxiety medications: anxiety certainly makes a person’s thinking worse, so it’s important to help her find ways to manage that anxiety. However, one of the most common classes of medication used for anxiety is benzodiazepine drugs, such as Xanax and Ativan. Those do help with anxiety but they also impair mental function. So I generally recommend that older adults be very careful about relying on those long-term, especially if they’ve had any memory concerns. I have more information here:
4 Types of Medication to Avoid if You’re Worried About Memory
Thank you so much for your response and this info. I appreciate it.
She is taking celexa, which is classified as an anti depressant (I read it’s sometimes used to treat anxiety as well…although I feel those two often go hand in hand) I didn’t see any side effects listed that would cause confusion or memory loss though. Do you know anything about Celexa ever causing those symptoms?
Citalopram (brand name celexa) is indeed an antidepressant, of the SSRI class (selective serotonin receptor inhibitor). SSRIs do have anti-anxiety effects.
Citalopram and sertraline are actually a top choice for geriatricians, if we need to treat depression or anxiety in an older person. SSRIs are generally “well-tolerated” and studies have found citalopram and sertraline, in particular, have fewer drug interactions than the other SSRIs, and also tend to have fewer side-effects.
I would not expect citalopram to cause any significant confusion or cognitive worsening.
However, you should know that pretty much all antidepressants — including SSRIs — are associated with an increase in fall risk. In many cases, it still is reasonable to continue with the SSRI, especially if anxiety treatment with cognitive behavioral therapy isn’t a feasible option. (Psychotherapy works when people stick with it and have a decent therapist.) That’s because the benefits of helping the person with their anxiety — esp if the med seems to be working — often outweigh the concern about fall risk.
I think it’s good that you’re planning to have a clinician re-assess your mother’s medications. Good luck!
Hi
My wife (age 62) was asked about 4 months ago to obtain a medical evaluation for problems with her memory at work. There are several things that are making an evaluation of the cause of her symptoms difficult. She is a computer programmer and seemed overwhelmed. Her employer sent a letter written by a non-medical person that said she was exhibiting signs of early Alzheimers because she sometimes forgot her password and asked a lot of questions. We feel that may have biased the primary care MD and neurologist not to fully investigate other causes. Just before this happened, she was starting to finally get treatment for untreated, severe generalized anxiety disorder and just started a small dose of Lexapro. The psychiatrist that interviewed her also said that she also had untreated PTSD stemming from witnessing a fatal shooting at close range. She has had symptoms of anxiety for over 30 years. Sometimes it is better, sometimes it is worse but it has been there as long as I have known her. (We have been married for over 30 years) The incident with PTSD happened over 30 years as well. She also has untreated sleep apnea first diagnosed over 30 years ago as well. She says that the CPAP mask makes her claustrophic and she won’t wear it consistently. She started the assessment for memory loss with the primary care doctor and a referring neurologist. Based upon one MMSE (25/30) , a CT Scan (which was normal) and a MRI that showed some atrophy (we are not sure where) she was believed to have early onset Alzheimers and he was prescribed Namenda. He does not have trouble with grooming, driving, getting lost, knowing the season or date or any of the other symptoms usually associated with Alzheimers. If she is nervous he searches for words but again but can usually remember things minutes later. She has always had severe test anxiety. She almost did not graduate from college because she was afraid of a required test. So these symptoms have gone on for years. Because we wanted a more thorough evaluation, she is now being evaluated through a university memory clinic. She was extremely nervous during the Mini-Cog (given by a medical student) and didn’t score well. For example, she stumbled over the serial 7s but did it perfectly when we left the clinic. We also have a 22 year old son with schizophrenia that has caused upheaval at home. He is now in a treatment facility but is still a handful to deal with. The university has ordered a sleep study, PET scan, and blood work. I know that she could have age related dementia (which I know is not reversible) on top of cognitive difficulties with anxiety, PTSD and untreated sleep apnea (which may be reversible). But before she is labelled as having cognitive deficits due to Alzheimers, do you think she should have these other conditions treated ? What would be a suitable length of time to tell whether the memory loss is really from these other factors ?
62 is young for dementia. I think it’s good that your wife is now being seen at a university memory clinic, they should be able to do a more in-depth investigation. Normally such clinics will also perform (or refer for) in-depth neuropsychological testing.
It is really common for people to do cognitively worse when they are anxious, and evaluating people like her can be tricky.
Whether or not she might have an underlying problem such as Alzheimer’s, it’s important to treat everything to the extent that you can, because you want her to be able to think her best. I would especially recommend you look into non-drug treatment for anxiety, as many of the anxiety drugs (especially benzodiazepines) tend to make cognitive function worse.
Regarding Namenda: studies have not shown that it’s effective for people with mild/early dementia. I have more information on dementia drugs here:
4 Medications to Treat Alzheimer’s & Other Dementias: How They Work & FAQs.
In people your wife’s age, whether or not they have Alzheimer’s often becomes clearer over time…people with Alzheimer’s will tend to get worse over the coming year, whereas cognitive impairment that is not due to neurodegeneration often remains stable or even improves.
I would recommend you request and keep copies of all lab results, radiology results, and so forth. This will make it easier to get a second opinion or do your own research.
Good luck sorting it out. I especially hope your wife will find ways to alleviate her anxiety and feel ok despite all the health and life challenges she is facing.
Thank you so much. Your response makes sense. I will come back to this posting to let you know the results
Hello, if I may, I need to ask for advice. I apologize in advance if I’m not clear enough. I’ll try to tell as much as I can without repeating myself.
For about a year now, my mother has been displaying a lot of erratic and uncharacteristic behavior. She’s talking to herself (not in a “thinking out loud” way, but more like a whole conversation), occasionally sees things that aren’t there, has reported hearing noises, such as birds chirping or running water, when at the time there are no such sounds occurring, or at least aren’t heard by others. She’s also been accusatory and agitated. She accuses people (myself included) of theft, of controlling her, forcing her to do things, or wanting her dead. I don’t want her dead, nor does anyone else in the family, nor her friends. Mom is also confused a lot. She has forgotten things like the date, my age, my weight (that’s another topic though), the date, and whether I’m married with children (I’ve never been married and don’t have any children.) and is swearing rather frequently, including inside stores and even around children. “Swearing like a sailor” as the saying goes. I know that a lot of people do swear, and she has sworn before, but never to this extent, if that makes sense. Mom has also been saying that people are doing x, y, or z, when said thing has either never happened, didn’t happen the way she said it did, or involved other people instead of her.
Mom never set up legal aid, like power of attorney or anything. She believes that “it would give someone else control over her life.”
I would speak to her doctor, but she retired a little over two years ago, and that was before all of this began. She refuses to get another doctor, and believes that she’s okay. Mom also gets mad anytime someone even mentions doctors, and has also said things like “You can’t control me!”, or “You just want me dead!”, or “You’re after my money!”
If you ask her about one of her “moments” (for want of a better word), she thinks that nothing happened; she didn’t say ____, didn’t do ___, etc.).
I know that I cannot force her to see a doctor, and I don’t plan on trying, but I feel that I’m getting to my wits’ end. I don’t want to jump to conclusions, but I worry that she has some form of dementia.
Is there any way I can get her to see a doctor, and find out what’s going on?
Thank you in advance.
Well, you don’t say how old she is, but I agree it sounds worrisome. The things you’re describing are not uncommon in the earliest stages of dementia. But, they can also sometimes be caused — or worsened — by other health issues, such as medication side-effects, or electrolyte imbalances.
Some of the false beliefs, hallucinations, and suspicious thinking you describe fall into the category of “late-life psychosis”, and I explain the most common causes here: 6 Causes of Paranoia in Aging & What to Do.
In the article on paranoia, I also cover some of the ways you can try to get help, when the older person is refusing to see a doctor. Sometimes it’s possible to persuade a person by bringing up some other aspect of their health, you would have to see what kind of reason might seem persuasive to her. Otherwise, if things get very bad in terms of how an older person manages their home, family sometimes calls Adult Protective Services.
It is a difficult situation. Try to avoid arguing and reasoning with her and instead try to be reassuring. Good luck!
Oh, I’m sorry. I didn’t mean to leave that out. My mother is 66.
Unfortunately she refuses even if the visit would be about something else, so I’ll have to see what else I can try. I’ll read that article you’ve shared as well.
Thank you for your reply. I apologize for this taking me a while to get back to.
Another possibility would be to see if you can get a health professional to visit and assess her at home. You would have to see if that type of service is available in your area, and you might have to pay out of pocket for it.
Although she doesn’t have a diagnosis, since her symptoms are concerning, you could try calling your local Alzheimer’s association for advice on how to get a reluctant older person assessed. Good luck, it is a difficult situation.
My father will be turning 83 this year and we have noticed changes including not remembering to take his medication (cholesterol, diabetic, aspirin as well as glaucoma eye drops). Thought we worked on a good system but noticed that he was either not taking at all or maybe more than once in a day. Here is some notes I took with me to the neurologist appt. Phone conversation with Dad when he was in Florida (lived part year in Florida) mentioning that he had been driving around a lot and had been in Texas and Alabama, but I knew he never left Florida. Was told by close friend in Florida – he tried twice to pack up his Ford F250 and leave Florida to drive to New Jersey. Thinking New Jersey was 4 hours away (Dad is a retired truck driver). The friend took keys from him after taking ride to Walmart shopping center with him and Dad not knowing how to get back to trailer park. Flew from Florida to New Jersey on May 5th, friend took him to airport and then got a security pass to take him to gate. Arrived in New Jersey and I met him at security desk. He had called my brother on cell phone to tell him he arrived as he thought he was picking him up. Didn’t recognize my car. Have had the car since 2011. Talked to me in the car about coming up through Virginia as they had to take a different path because his boss had spies watching them. At my house brought in his luggage and about 3 hours later he asked if we needed to bring in luggage. Unpacked his luggage and found that he did bring the Metformin with him but not Lisinopril, baby aspirin or Simvastatin nor Cosopt or Latanprost, or his shaving gear or deodorant but packaged bath towels, curtains, and rags. I did have back up of medication since it seemed he wasn’t taking the correct dosage. Had hoped I had him back on schedule when he left the end of February to go to Florida. Sunday morning, I saw he took his medication and eye drops but I ran to CVS later that evening and when I came back he told me he took his medication. Don’t know if he took it twice or not. For Mother’s Day went to Harrah’s Chester to the steak house and did some gambling afterwards. His sister-in-law came up to me about 10 minutes after we arrived to say that instead of using player’s card for the machine he asked her if he could use this card, which happened to be his debit card. She had him put it away in his wallet and retrieved his player’s card instead. I spent the rest of the evening with him. He also left me to go to cashier to cash in ticket. Was supposed to come back to me but ended up in an entirely different area but found his other sister-in-law and she called me to say he was with her. Saw a neurologist and the memory test scoring was a 13 out of 30. Mentioned Alzheimer’s. Ordered a MRI and blood work. MRI conclusion: No acute intracranial abnormality on non-contrast MRI of the brain. There is advanced chronic small vessel ischemic disease of the white matter. There is advanced atrophy and venticulomegaly. Have a follow-up appointment coming. Can you give me feedback and direction of questions to talk to neurologist about?
Sorry for delayed reply. His symptoms sound concerning and consistent with dementia. The MRI is suggestive of a vascular dementia component. Mixed dementia is very common in older adults so he may have a combination of Alzheimer’s and vascular dementia.
You could ask the neurologist to clarify if there is any signs of Lewy-Body dementia. This matters in that people with LBD tend to be quite sensitive to certain types of antipsychotics (should they ever become necessary to manage behavior, which hopefully won’t be the case as they are supposed to be used as a last resort).
Otherwise, I would recommend connecting with the Alzheimer’s association or some form of dementia support group. You will need to process the diagnosis, figure out how to support your father, and especially start planning to manage his care now and in the future. Good luck!
Why diagnosing Alzheimer’s today is so difficult—and how we can do better
I can understand the current concern with glucose metabolism in the brain and possible damage, however, in a brain that is glucose deprived, astrocytes in the brain also generate ketones that can be used by neurons. I think a more precise if not accurate measurement would be to measure the rate of adenosine triphosphate (ATP) production. ATP levels fluctuate depending on brain activity. This may be beneficial in determining abnormal brain activity or neural activity at the molecular level. Calcium, sodium, and potassium ions continuously passed through the membranes of cells, so that neurons can recharge to fire. ATP supplies the energy required for these ions to traverse cell membranes. An imbalance of these ions can cause swelling, damaging cells leading to strokes and possible the disease process of Alzheimer’s.
This brings me back to the importance of measuring Calcium, sodium and potassium levels and their relationship to ATP levels and ultimately the development of amyloid plaques caused by astrocytes themselves. The amyloid plaques that accumulate and can cause neuronal loss and damage have been reversed to a degree in mice by reducing beta-secretase. I think this may be a promising treatment in the near future along with other advances in the progression of the disease process.
Thanks for commenting. Yes there is a lot of interesting basic science research being done on the pathology of Alzheimer’s. The kinds of measurements you describe might be relevant for research purposes — or for clinically testing interventions applied during the early pre-symptomatic stage of Alzheimer’s — but right now are not applicable to the clinical evaluation of older adults with memory impairment or other cognitive complaints.
Hello
I don’t even know where to begin..my 87 year old mother has always lived in denial for many things throughout her life. I believe that’s her defence mechanism for stressful things raising 6 kids. She has been active and healthy until complications from a femoral bypass 2years ago left her with a terrible infection that finally made it necessary to remove her leg. This woman fought colon cancer at 83 and came back stronger than ever after having all but 8 inches of her colon removed. My brother had colon cance at the same time as well as esophageal cancer (he was also in remission for non Hodgkins.
I say this because I want to show a picture of her stresses.
Last year, 2weeks after mom had her leg removed (was home from the hospital on day 4 because she did so well!) my alcoholic sister died suddenly. She mentioned to me a few days earlier that she thought my sister was coming in her house though a window and sleeping with my mom’s partner. When I went to tell her that my sister had passed, she s remedies to not hear me and said “b” her partner was in napping for a long time and I think “D” is in there with him. My husband and I couldn’t believe what we just heard, I had to be firm with her and explain that D was dead. The very next day, I had to break the news to this lovely woman that my brother had succumbed to cancer, right after we told him about our sister. (He was dying from oral cancer His 4th cancer..he was 62 and my sister was 61.
I’m sorr this is long. Mom has believed since all of this that someone is concerned Ming in her house and using her things, sleeping under the bed, eating her food. One tine she called me at work because half a banana wa gone and she asked if I ate it. Her partne4 is fed up and I believe helps to “feed” her paranoia by saying things like “ yes, my girlfriend can drive my car but you can’t”. I had a geriatric dr assess her when she was just n rehab for her leg. The social worker was shocked when I was old her this..she said she never would have guessed because she spent a lot of time with her and saw a youthful, vibrant go getter. The cat scan came back “normal for her age”. The said she doesn’t have hallucinations but delusions and seems to be in denial. They wanted to put her on risperadol but when she saw that it was written down “to stop hallucinations, she would not have anything to do with it and told me she would not be sharing anything with me again.
She was better for a while and is walking with a prosthetic..now the paranoia has returned and she is not holding back like she did…she is leaving notes in her drawers saying “keep out whore” and making notes of everything that is missing.
I should add that recent blood work shows decreased kidney function and liver problems. And her diabetes is out of control
She will not go back to the geriatric dr because she was “labelled”. I don’t know where to turn now…her family dr is retiring and gas neve4 been much help.
Sorry to hear of your mother’s difficulties. I can certainly see why you are concerned. Given her age and the health problems you describe, her paranoia probably reflects her brain malfunctioning due to lots of reasons happening at the same time. It’s pretty common for people to have some small vessel changes to the brain by age 87, especially if they have diabetes, plus she might have some other health issues that are worsening this as well.
I explain the main causes for paranoia here: 6 Causes of Paranoia in Aging & What to Do.
Re how to behave with her, you might want to tell her partner that trying to reason with her or bring her back to reality generally doesn’t work. He doesn’t have to agree with every false thing she says, but it’s usually possible to diplomatically address the emotion and provide some type of validation and reassurance. That is what she needs the most, a reassuring emotional connection and also a stable routine and environment.
Antipsychotics such as risperidone sometimes help with florid delusions and paranoia, but they almost never make an older person “normal”; it’s more that they can take the edge off the worst of it.
It is definitely hard to get someone like your mom to the doctor. I offer some suggestions in the last part of the paranoia article linked to above. Good luck!
Hi, I have believed my Mom, who will be 84 in December, has been experiencing dementia for over two years. She had been under a lot of stress with caring for her husband due to Parkinson’s. He passed away in August 2017. We had hoped her memory issues were the result of stress but they continued to get worse. In late June 2018 she moved to a home closer to us (eight doors away). People who do not see her every day do not realize she has issues. Some of the examples are: she drove to an airport which should have taken no more than 1.5 hours. It took her over five hours to arrive and she never called any of us for help. She keeps calling things the wrong name i.e. calls the microwave a computer; calls the kitchen island a work bench; calls the bar (where you sit in a tavern) “the bench”. She forgets words and may or may not come up with the word(s). I call her every night on my way home from work. She can tell me the same thing three times in a 15 minute call. She has to write herself detailed notes, often, and still forgets. She has difficulty balancing her checkbook. Could take her hours to days to figure it out. She has problems comprehending what she reads. Recently prior to having surgery they provided her with things to do to enhance her recovery. She made four copies and read the material dozens of times; marked up the copies with highlights, underlining, circling, notes on the side and she still did not correctly follow what they wanted her to do. One of the things was if she was taking two types of specific medications she needed to stop taking them a few days prior to surgery. Instead she quit taking ALL of her medications cold turkey for six weeks, including the newly prescribed and filled medications to help enhance her recovery. Two days after surgery they gave her a little test. She answered everything correctly except for who is the president of the United States. She told the doctor it was Nixon. The doctor believes she has early onset Alzheimer’s dementia. Her older sister also has it. Her primary physician saw her today and said she has been under a lot of stress and will wait awhile and see how she does. Your thoughts? Thank you
Sorry to hear about your mother’s situation. Her symptoms do sound concerning, especially since it sounds like they’ve been going on for quite some time. Stress will make her worse, but it sounds unlikely to me that only stress would be causing this.
Doctors do sometimes want to wait and see how things evolve, although that is often because we see people and we don’t have a knowledgeable informant available who can tell us how things have been going and changing for the past 2 years. Also possible the doctor wants to wait if her cognitive tests are borderline. But then again, the symptoms you describe sound pretty significant, and unfortunately pretty typical for dementia.
It’s still important that she have a careful medical evaluation for other causes of cognitive impairment; sometimes medications or other health issues are making people worse than they otherwise would be, and if the brain is damaged, every little thing you can do to improve the function is important. I describe the evaluation in more detail here: Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check.
This time while waiting for a diagnosis can be very stressful for everyone. Good luck to you and your mother.
Just recommended this page as the best first-place-to-go for everyone with a memory concern. Thank you for your commitment to helping us make better medical decisions for our family members and ourselves. Your thoroughness and compassion comes through in every one of your articles and podcasts. Thank you for sharing your gift with the world!
Thank you, I’m so glad you find this article helpful.
My parents are worried that my grandmother might have early stages of dementia. You provided a lot of great tips. I loved your suggestion about writing down behaviors and issues that are worrisome. Bringing these documented problems or issues to a neurologist might help the doctor when it comes to diagnosing an issue.
Thank you, glad you found this helpful.
You are an angel. Thanks for all your help to the world.
I agree, Dr. K is a wonderful resource and has helped many people. Thanks for sharing your kind words!
Hello. My mother just turned 88 last month. She was widowed for the second time March 2017. Caregiving my step dad depleted her but she has “bounced back” so to speak. What concerns me are several changes I see: In July 2017 I found out she had a male friend staying at her house, not by her telling me, but by a neighbor. I have met this fellow, as well as my 2 grown daughters, and none of us feel comfortable around him, for many reasons and experiences. My mom says “the good outweighs the bad”, which concerns me. For the past 2 years she cries more easily. For example when her recipe wasn’t turning out, and over who is eliminated on Dancing With the Stars. She didn’t used to cry over things like that. She is forgetting words, can no longer give me directions if I ask her where to go, and sometimes just seems a little “blank”. We have always been close. Now I have found several times where she’s lying to me or keeping things from me. I have been doing a lot of reading, I have the book by Virginia Morris you suggest. I have met with a consultant, talked with her lawyer and taken care of other business. I can’t shake my uneasy feeling. I’m half way across the country, and an only child. It’s agony. Any suggestions, insights? Thank you for this blog!
Well, what you describe does sound potentially concerning. The ideal would be for her cognition to be evaluated, and also for you to try to ensure she isn’t too vulnerable to financial exploitation. Both are easier said than done. Regarding her cognition, there’s a whole medical aspect to the evaluation but the health providers will also need information on what she is struggling with, and how it has changed over the past few years. I have more details here:
Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check.
I have more on financial exploitation here:
Financial Exploitation in Aging: What to Know & What to Do
To help with the agony and uneasy feeling:
– could you go stay with her for 1-2 weeks, and carefully observe the situation? It might help to see if you can get specific about what is off.
– Can you have the consultant — or someone else with suitable expertise — meet your mom and weigh in regarding how concerned you should be?
Good luck!
Is there a way you can reverse the posts so that the most recent is at the top?
Unfortunately, the current software being used for the site does not allow us much flexibility in organizing comments. We will probably eventually move to a different system, but it’s expensive and time-consuming to do so.
Is it possible a motorcycle accident 40 years ago has put my mother into an early (she’s 65) stage of multiple types of dementia? She’s functioning mostly ok she still works but she prefers to sleep most of the time when she is home or just watch TV or be on Facebook consuming herself with what is wrong in the world. She’s very hostile she only gets along with people if they have something to offer her and if that stops she accuses them of anything like being greedy or using her and stealing from her (she called me at work to accuse me of stealing a hope chest full of Target Christmas dishes (nothing fancy or expensive) because she couldn’t find them after not seeing them for almost a year). She has always trusted me with everything and I’m always there for her when she gets sick or has a surgery I’m her youngest of 4 kids and I care so I am her nurse if she needs it. I just don’t know what is going on if it’s because I still live with her (I pay most of the mortgage it benefits us both) we have opposite shifts so rarely see each other but when we do she is fast at yelling at me for something/anything. Or if she is truly showing signs of a mental health issue. Her doctor that we both shared was helpful to talk about things I notice with mom but she retired almost 5 years ago and her current doctor is retiring too so nobody is following up on how she is after having a mini stroke several years ago. Maybe she is fine and I’m just worried for nothing and just need to leave her alone and go off on my own life like the rest of my siblings have. But I worry because she wants to retire and sell the house we have struggled for so long to keep in the family and drive around the country just her and her dog like the free spirit she always wanted to be in the 70s before the motorcycle accident and before having kids. If you have any insight I would appreciate it and am open for anything even if it will hurt my feelings that’s ok I just need to hear a perspective different from family.
Sorry if things are becoming more difficult with your mother. If she had a head injury years ago, that can make the brain more vulnerable and is associated with an increased risk of cognitive problems.
It’s not clear from what you describe that she has developed significant memory and thinking problems, but it sounds like her personality is becoming more difficult and perhaps she’s becoming more suspicious of you. This could be caused by mental health issues (some of which can be related to having very small strokes in the brain) or could be due to other changes in the brain or even other physical health problems.
Honestly, she needs more medical evaluation. I hope you can help her get it sooner rather than later, because if she becomes more suspicious, paranoid, or confused, it will be even harder to get her to see a health provider. I have more here:
6 Causes of Paranoia in Aging & What to Do
Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check
For help coping with your worry and with the stress of living with her, I would recommend seeking out an online support group. There is a very active forum at AgingCare.com, where you can get ideas and also encouragement on how to set reasonable boundaries and think of your own needs while still trying to help your mom. Good luck!
Hi,
I have been having a difficult time with my husband who is 62 years old now for the last two and half years. Our lives have changed drastically. His personality has flipped for the worst. In 2016, he accussed me of having an affair in 2013 again. We dealt with this problem, and I thought it was over. So, I was totally confused. All I could do was cry. During this time, he would say things then he would tell me that he never said them. By the time February 2017 rolled around, he forgot my girlfriend of 33 years. In the moment, he could not remember her and he was totally confused. That is when I realized that something might be going on. I started to notice changes in him. He would mix up names including our children, he would leave our garage door open and the house unsecured, he mixed up things in church, and he continued with accusing me of having an affair. He is delusion. The way he processes information is not normal. He has moved out of our home which is against our spirtual beliefs. He is a Pastor in our church, and he forgets the words when he is singing in church. His friends are starting to notice changes in him. He has shared with his friends that he writes notes to remember, but he cannot find the notes. To make matter even worse, my children are starting to realize that something is going on with him. He is constantly getting dates and conversations mixed up with them. I have been trying for a year in a half to get him to go to the neurologist. His internal medicine doctor ordered a CAT Scan in June 2017 and that came back normal. He was told to go to the neurologist after the CAT Scan. He went to the Neurologist and took the memory test and left. He never saw the neurologist. He scored a 27 on the test. In March 2018, he went back to the neurologist alone, and called me to say that nothing was wrong with him. I don’t know if he took another memory test. Then, April 2018, he was diagnosed with coronary heart disease. Last month, he loss consciousness in his place alone. Then, three days later, he had a severe headache. Both incidents sent him to the ER. After the second ER vist, they referred him to the Neurologist and for a CAT SCAN. He did not go to the appointments. My daughter had a talk with him about all the problems, but he assured her that he is going to the doctor and nothing is wrong with him. My question to you is how do you get someone to go to the neurologist who doesn’t think anything is wrong? He is so stubborn, and I am worried that something serious is going to happen to him. I just don’t know what to do. Any suggestions.
Sorry to hear of your situation, it sounds very difficult. Well, given all the changes and problems you describe, it does sound very concerning and I can’t imagine that he’d be told “nothing is wrong” after a careful history and exam. (In fact, an appropriate evaluation should solicit information from family and others, because impaired older adults are notoriously poor reporters of their abilities.)
There is unfortunately no easy way to get someone to go to the neurologist when they are reluctant or convinced everything is fine. Some families still manage to coax the person to go. Some are able to get the doctor to ask the person to come in; whether the older person complies with the request is variable. Some resort to some deceptions and/or white lies to get their loved one to the doctor. Some hire a doctor to come to the house and do the assessment, but it’s not always easy to find a qualified health provider to do this.
It is usually easier to find a geriatric care manager to hire and come to the house; they are not physicians and cannot make the diagnosis, but they often do have ideas about what can be done to move the evaluation along and address safety issues.
I also recently heard of one man who was finally able to get his older father to the doctor because the father’s driving was reported to the DMV, and he had to get a medical exam in order to potentially keep driving.
In short, you have to keep trying various things. I generally recommend trying to connect with others who have been through this, which means either other family caregivers (there are online communities) or a geriatric care manager. You could also try contacting your local Alzheimer’s Association, they have a support line and may be able to give you suggestions. Good luck!
Thank you. I will keep trying and hopefully I will have a breakthrough soon.
My dad has hepatic encephalopathy due to end stage liver disease, he is currently listed for transplant. He also has diabetes. He has gone through several episodes that have hospitalized him over the course of the past year and a half. With each episode, he takes 3 steps down and recovers 2 steps in mental function. His daily life has been significantly impacted by this condition. He can no longer buckle a belt, work a faucet, he can’t reliably run phones, or electronics. He no longer manages his finances, and is now living with us as he is no longer safe to live alone. He left a bowl of oats on the gas stove and went to bed, and he has slept for 24hr at one point. He is now losing the ability to dress and toilet himself, he cannot administer his own medications or test his sugar. When Dr.’s talk to him, he can talk a good game, he can pull the date out of the air, and he can sound competent to them with the ability to laugh and joke around with them. But in the same day, he can get mixed up and pee in my clothes hamper, or walk into the pantry thinking it’s the bathroom.
We have reached a point where we will need to provide him with some kind of health aid care while we’re at work. It’s thousands per month and exceeds his monthly income. We are not able to pay this. He owns a house and has some savings, but is not willing to part with it. I don’t think he is capable of making the proper decisions to liquidate these assets to provide care. Would trying to obtain a dementia diagnosis be reasonable here?
Sorry to hear of your father’s situation. It sounds to me like you are concerned about “self-neglect“, meaning he’s living in a way that you think puts his health and safety significantly at risk. Also sounds like the main reason he is impaired is his end-stage liver disease and hepatic encephalopathy, rather than a permanent and progressing neurodegenerative condition such as Alzheimer’s dementia.
Self-neglect is usually pretty challenging, as it’s often hard to determine at what point it’s justified for the local court to override an older person’s autonomy and enable someone else to make decisions. If you are worried about his decisions, I would recommend bringing it up with his usual health providers and also learning more about how self-neglect and guardianship is often handled in his jurisdiction (it tends to be extremely variable from place to place). You can report him to Adult Protective Services if you’re truly concerned; what they’ll do is quite variable.
You could also try contacting your local Area Agency on Aging to see what they recommend. Local geriatric care managers and/or elderlaw attorneys may also be good sources of information.
We have a podcast episode discussing self-neglect here: 066 – Interview: Addressing Potential Self-Neglect in Older Adults.
Basically, there is no easy way to intervene. I would recommend starting by learning more about what it would take for you — or someone else — to be able to override his choices, and that will be very dependent on how things are done in his area.
Last but not least, remember that you don’t necessarily have to hold yourself responsible for the outcomes in his life. You should try to help and you should try to be there for him, but it’s often not possible to control all the outcomes and sometimes we have to accept that people we love made choices that resulted in worse outcomes for themselves.
Good luck!
My father will be 82. He doesn’t remember what he eats from day to day. He still takes care of his personal hygiene , he still manages his finances. He tells me when he doesn’t remember who I am then take him to the dr. Is almost as the previous day is wiped out. I”m worried , he’s not. I moved back home the first of the year. Am I correct in worrying ?
If he sometimes does not remember who you are, that does sound worrisome. I would recommend evaluating him specifically for the 8 behaviors that indicate memory and thinking problems. I also have more information on what a cognitive assessment should include here: Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check. good luck!
My husband is 63, retired from Public Safety x 3 years. In the last 6-9 months I have noticed changes, now both our Adult children that don’t live with us have separately expressed concern about things they have noticed. Struggling for the right words, sometimes never finding them..so we end up almost playing charades trying to help him with the word. Long term memory is so accurate back like 40 years ago and beyond. Short term memory is horrid, sometimes no recollection of conversations we had an hour prior. If it is a conversation from the day before, very common for him to not remember any of it…. We went to a neurologist, he asked him 7 questions, literally who is the president, what city are you in etc….I get it that can reveal issues in someone much more elderly. Of course he got the answers correct. I brought along notes of some examples of what we as a family have observed. Calling street names here in our development street names from a City we lived in 30 years ago, calling our dogs by the name of dogs we had 20 years ago…Dr. said he answered the questions correctly and he is fine!!! I left feeling like a fool, yet the bizarre behavior continues, and my husband now tells me I am the “crazy one”. If something is going on with him, my gut tells me it is, I wanted to catch it early. During the visit with the Dr. he handed my husband a piece of paper said fold it in fours, and hand it back to me with your right hand. He folded it in half and handed it back with his left hand…. ugh. I guess now I just wait for something more significant to happen, before getting help in addressing it. The “kids” are so concerned and feel I should take him to another Dr.
Sorry to hear of these issues coming up. Honestly, I think it sounds concerning and worthy of adequate evaluation, and what you are describing does not sound like adequate evaluation. You may want to try seeing a different doctor. The alternative is to ask the current doctor some extra questions, or ask him specifically to go through what I list in this article: Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check.
Developing a new poor short-term memory at 63 is not “normal aging”.
I will say, however, that when memory is affected, it’s almost always short-term memory, so maintaining a good memory for what happened 40 years ago is not surprising, and does not mean he’s ok. Good luck!
Dr. Kernisan, I have an elderly (88 yeas old) Aunt who has lived alone since her mom died in 2005. My Aunt has never married and no children so I am her next of kin.
She lives a state away from me so I’m on the road an average of once a month and sometimes twice to check on her. She has been on the dementia journey for a couple of years. Her friends and I have been working together to keep the “train on the tracks” so to speak , but it is getting increasingly more difficult. My main problem is that I can’t get her to the doctor for a diagnosis. She is physically healthy and sees no need to go. The only medication that she takes is synthroid. She recently changed doctors within the practice so they refilled her prescription for 90 days as a courtesy but she doesn’t take them regularly and they are lasting longer than the 90 days! She is convinced that all she has to do is call the pharmacist .
I honestly don’t know how to get her to the doctor. I’ve set up an appt. in the past and drove her there only to have her refuse to get out of the car, even after the doctor went to the car and tried to coax her out!
I am her POA but that means nothing unless she is compliant, which she isn’t. In fact she can be quite combative and easily agitated. I’ve been keeping records of her behavior with input from other close to her as well as my and my family’s observations.
Do you have any suggestions on how to get her evaluated? And IF I can get her to the doctor what happens if she refuses to take any of the cognitive tests that we’ve requested??
Any suggestions are welcomed. Thank you
Wow, your aunt is so lucky to have a devoted niece like you! What you’re describing is pretty common, and unfortunately, there are no easy solutions. If you have enough documentation of the problems she’s been having over the years and is having now, she could probably get a diagnosis of “likely dementia” just based on the health provider talking to her and some labs demonstrating that it’s not an obvious metabolic disturbance or thyroid issue.
Could you get her to go if you tell her it’s absolutely necessary for her to get her synthroid refilled?
If she won’t go to the doctor, you could try to see if there are any health providers in her area who will come to the house and do an assessment. This is sometimes available if you pay out of pocket; some of these providers are physicians and others are psychologists. A local geriatric care manager often knows which health providers provide this service.
Otherwise, I would recommend starting to plan ahead for what you’ll do when she needs more care and supervision. In some states, a POA is not sufficient to place an older person in a supervised living situation; you should find out what is required in your aunt’s state. If she is refusing to address her health, you could also try calling Adult Protective Services in her state. Sometimes they are able to request or organize further evaluation of an older person’s mental condition.
I’m sorry that it can be such an uphill battle to get an older person the help they need. Good luck!
Hello! Thank you so much for taking the time to comment on all of these posts.
I am concerned for my Dad, he is 79. He had a broken neck from a car accident about 10 years ago, and he’s never really been the same. I think part of it is just general depression at his decline in abilities. He still gets around and is reasonably active, but he is a family practice MD that is no longer able to practice. He drives, he golfs, and putzes around in the yard. We moved him and my mother into a single level townhome 5 years ago, to be closer to us.
He is diagnosed bipolar and takes lithium, and drinks too much, and has a bit of that doctor syndrome where he knows everything (no offense) and has been difficult to convince to get an evaluation. I don’t think he tells the truth when he talks to his doctor anyway, that’s according to my Mom. I have said I will take him for a mental health evaluation but she just says there is no point. Can he really trick a doctor?
Anyway, I don’t know if it’s just getting old, at 79 should he remember everything? He will sometimes tell me the same thing 2-3 times in a visit, and he’ll often tell old stories, which are charming, but he doesn’t seem to remember that he told the same 3-4 stories last time I saw him. But at the same time, he remembers names and dates, he remembers all of his grandchildren’s names even though he doesn’t see most of them very often. He still drives but not well, he still golfs but not well, and he doesn’t eat very much anymore and has gotten thin. He’s crankier than he ever has been and he can’t hear very well, and isn’t great about wearing his hearing aids. My mom cares for him and has noticed his decline more than I have, but as previously stated, she doesn’t think he’ll go see a neurologist. If he isn’t going to see a doctor for an evaluation, what can we really do? I read some of these other posts and I think he is pretty good shape compared to some of the stories, but he just isn’t what he once was. Any advice?
Thanks for posting the question and no offense taken re “know it all” doctors, there’s something to it!
So…he may well be cognitively declining. Repeating the same story over again is potentially a symptom, but usually people who are declining will also manifest other symptoms that are on the “8 behaviors” list.
It’s possible that his hearing loss is a factor; if he won’t wear the hearing aids, you could look into using a Pocket Talker for some conversations. We’ve just recently posted an article on hearing loss, it’s here and explains the Pocket Talker: 4 Key Things to Know About Age-Related Hearing Loss.
Drinking “too much”, as you also know, is probably not helping matters, but it can be very difficult to persuade an older person to stop, especially if they are cranky or cognitively deteriorating. And, people with a history of mental illness can be harder to evaluate.
He could fool a doctor in that many of them can’t or won’t go in-depth and really make an effort to assess what is going on cognitively. This is why I recommend families prepare for the visit.
I’m afraid that the situation you describe is pretty common, and generally has no easy fixes. In principle, he should be medically evaluated, since you’re concerned. In practice, it can be hard to get an older person to the doctor and then the doctor may not do the evaluation that we’d recommend.
For these situations, I generally recommend trying to get the person evaluated. It can help to frame the evaluation as a way to help him get something he wants out of his medical care, like a check up to help him stay independent for longer.
Otherwise…since these situations are difficult and tend to drag on for months (or years), we have started a Helping Older Parents Membership community, to support people like you in working through these situations. To learn more, see here.
Good luck!
Thanks for your article. Very informative.
Our problem is our mom probably has dementia but refuses to acknowledge it or get any help. She is 78 and has always been negative and sticks her head in the sand when there is a problem. She has had a knee problem since 2013 and refuses to get it checked out because she is afraid of the prognosis (she probably needs a knee replacement). She still lives alone but since she was let go from her job a few years back (probably because she was making mistakes because she was forgetting things), she’s been depressed and stays in her apartment alone all day just reading. She still drives though. My sisters and I have tried to help her but she refuses help and will stop talking to us for weeks if we bring up the subject.
My sister and I just saw her the other night and she’s markedly worse than the last time I saw her. Asking the same questions, not being able to hold a train of thought and just not being involved in the conversation. Not her old self. She might have anosognosia. She was telling us about her cousin and how she is developing dementia (she told us the same story twice in the span of the evening) but seemed to not have any clue that her own memory was so impaired.
My sister texted my mom the next day and asked her if she would be willing to go to the UCLA geriatric center to get evaluated. My mom never texted her back, which means she is mad at my sister for insinuating that she has a problem.
What can you do for a parent who refuses to admit (or know) that they have dementia and refuses to go see a doctor?
Hi, I’m sorry for the delayed reply, we had a glitch in our system and we stopped getting comment notifications for a while there.
I’m sorry to hear of your mom’s situation. Unfortunately it’s fairly common, and it can be hard to work through it because there are usually no easy solutions. I cover approaches to try in this article: 6 Causes of Paranoia in Aging & What to Do
You should esp read the section “Tips on following up on safety issues and memory problems”, which includes suggestions on agencies you can call for help.
We also have a special membership program to provide families with ongoing support and guidance as they work through these situations: the Helping Older Parents Membership Program.
Your mom is very fortunate to have you looking out for her, even though it sounds like she’s unable to appreciate it right now. Good luck!
Hi
My dad had what appeared as sudden onset of Anomic Aphasia ( both expression and some issues with reading / writing ) . He also experienced some autobiographical memory losses , although this was fragmented . There does not appear to be any ST memory issues and his level of functioning does appear ok in terms of ADLs and he can still manage bills , although does need some assistance . He is also physically fit , no imbalance or weakness
He attended a Neurology Appointment (TIA emergency clinic) to rule out a TIA / CVA which resulted in a MRI scan and a very brief MME ( 10 questions )
The scan should moderate SVD – the Neurol list was vague and informed that she thought the issue was vascular , although did not mention bleeds infarcts etc .
I requested a referral to the memory clinic as in view of symptoms thought it was important not to rule out Alzheimer’s, as medication may help , although she said it wouldn’t as the problems was vascular. She increased his statins and added a different aspirin
My dad is 84 and my understanding is that Alzheimer’s is difficult to diagnose or in this case discuss on the results of a scan .
Would it be prudent to Perdue more vigorous testing via the memory clinic ?
Many Thanks
Hi SL. Looks from your IP that you are in England, so I am not sure what a memory clinic looks like there. It must be frustrating to be wondering about the type of dementia and whether treatment would help, but it can be very difficult to sort this out short of a brain biopsy, which we don’t really do.
In Canada, neurologists are very experienced in stroke care, but less so in dementia diagnosis, so seeing a specialist in dementia would probably offer the opportunity to ask questions about what is going on and how to move forward. They have Alzheimer Society in England as well, which can be an excellent resource.
Hi my partner who is 81,had a lobotomy at age of 26,since then he had been on diazepam 30mg a day up till 10 years ago he went down to 10mg a day,a recent visit to the doctor to get a note to change his will because of the arguments in the family,stressed he didn,t pass the memory test,the doctor did the blood test and a brain scan,which showed of being atrophy of hippocampi,so he was referred to memory clinic and on the day of the long test he scored 54 out of 100,the thing is al the tests we have done at home he passed,he said during the test which was too long he was nervous because he didn,t like the nurse as she was pushing him,didn,t hear most of questions as she woudn,t repeat them,we were present during the test and I agree,I can,t see anything wrong with him,maybe I live with him,do you think that long use of diazepam can be mistaken for dimentia,thank you
Sorry to hear about what sounds like a pretty stressful experience. The diagnosis of dementia is not just based on a test score or a scan, but also the story about how a person’s brain performance has changed from a previous level of function, and how that change affects day to day life. The tests that we do in an office aren’t supposed to be used as a “pass” or “fail” scenario, but add data to the overall assessment of a person’s brain health.
You are correct that testing conditions can affect a person’s score on a test, and stress can definitely impair test performance. Ideally, memory tests should be given under the most standardized conditions possible.
And it may be that long term use of medications like diazepam does increase the risk of developing dementia, and that current use of diazepam could also make a person seem more impaired than they are.
All of this to illustrate that dementia diagnosis is not straightforward and it’s reasonable to ask questions about whether the tests were done in the best way they could have been, and what information was used to arrive at the diagnosis. And remember that just because a person has a dementia diagnosis doesn’t always mean that they are not capable of making decisions, even important ones.
My mom’s 73, and since the middle of 2015 I noticed her starting to have memory issues, wild mood issues, emotional outbursts over things that never used to bother her, her style of speaking has changed some, she’ll forget things she did two hours ago, she sometimes stumbles over her own feet and will bumps into walls, things that were always familiar she now sometimes says has changed, despite those things not changing, she’s gotten lost driving around her home down, she once drove in the opposite direction of where she lived and was convinced she was going the right way, etc, etc.
With the urging of us kids, she went to get evaluated, and apparetly the doctor said she’d fine. Needless to sayt, we’re stunned. In our estimation, she has lost about 25% of her short-, mid- and long-term memory. She’s reguarly forgets how to use the e-mail program she’s been using for nearly 20 years. She forgot how to open files in Wordperfect and ended up over-writing some of her writings that she saved over the years (Luckily, I had made backups for her) she’ll fill bird feeders at noon, return home at 2PM and thank whoever is home for filling them. She claims someone keeps changing the angle of the flagpole holder outside the frontdoor because she said that position doesn’t look right, she become irate and starts yelling and pounding her fists on her legs if we take a road that has a lot of traffic (traffic had never bothered her prior to 2015. Then, weeks later, we’ll take a different route and mention to her that we made sure to avoid traffic, to which she’ll respond “I don’t mind traffic at all.”
She is a pathological liar, drama queen, and something of a hypochondriac. She also used to be very good at Scrabble until 2017, at which point even trying to let her win she couldn’t win. There are too many examples. She had issues balancing her checkbook, she sometimes has problems following any kind of story in a casual setting of 3-4 people. Often her response to something you’ve mentioned to her doesn’t remotely fit what was said; it’s as if she’s just saying something to say something. We’ve lost track of the number of times we’ve responded to her with “We’ve never said anything about what you’re talking about. Where are you coming up with this stuff?” She has said a few times over the past five years that she hears voices in her head and talks to them. Her mother and father had dementia and died from it via Hospice intervention at home. She claims she had two mini-strokes around May 2015. She twice said she had memory issues and that’s why she uses Post-Its and a daily planner for everything she does. She has Post-Its all over the place for daily things she has to do. If you ask her what she has planned for the day, most times she can’t tell you without looking at her daily planner. She developed OCD about eight years ago. She was hooked on NyQuil for at last four years because she said it helps her sleep. She also takes Tylenol PM pills. Recently, we found she’s been putting Baileys in her iced coffee during the day and going through a large jug every week. We’ve repeatedly urged her to stop with the medicine and alcohol because it will only had to her memory problems, and she agreed to stop using them.
I’ve heard that even people with onset-Dementia can be fine outside of their “safe” environment because they’re more guarded than around their own home or family. I find it impossible to believe a thorough evaluation of her memory was done if it only took 30 minutes and since none of her children were involved to provide insight into what’s been happening with her. She has a bi-polar personaility and gets depressed very easily. She’s still able to function fine despite the known issues, but we were hoping the doctor would find something to possibly help, in case it’s not dementia but something else that’s actually treatable. Not sure what steps to take now. Thank you.
Thanks for sharing your story, and what a story it is! In my work as a Geriatrician, I often hear about changes in memory performance, function, mood and behaviour, and even personality changes, such as the ones you describe.
There are so many complicating factors here including the pre-existing personality issues, substance use (alcohol and over-the-counter sedatives), and potential strokes. As Dr Kernisan indicates in the article, memory testing is just one part of diagnosing dementia, a thorough assessment would look at all of those other issues as well. This is often more than can be done in a primary care provider’s office so a referral to a Geriatrician would be a great idea. You’re right that input from collateral information sources, like adult children is invaluable in an assessment for dementia.
It can be frustrating but when there are all of those issues in the mix, we often have to try to clean the slate and re-evaluate when the alcohol and OTC’s are gone.
I found your post and I am writing this comment to you right now in hopes to receive a response. I have a 76 year old cousin who has nowhere to live has been living with different church members for the last year. She was a teacher for a long time and also took care of young children. She was laid off during the pandemic. The various families she’s been living with had her watching their kids in return for room and board. I don’t know what has happened recently that caused the family she’s with right now to take her to the doctor but myself and other family members have certainly noticed changes in her behavior over the past 2 years. The doctor these people took her to recently did diagnosed her with early onset dementia. My cousin has one child who is 30 years old. Unfortunately he is not the most capable of making the good choices or capable of even knowing where to go to look for help with his mother. He is an alcoholic with a long history of substance abuse issues as well as a long history with anxiety disorder which he is in treatment for. Hence the reason why I am attempting to start doing some research on his behalf. In an effort to attempt to assist and guide him with his mother’s best interest in mind. My cousin’s son is in San Diego. He has recently found a job, but his past work history is spotty at best. He has essentially relied upon his mother for financial assistance his whole life and this has resulted in my cousin to be broke. She could no longer afford rent, which again is why she has been taken in by different families from her church. Myself, immediate family, as well as extended family are all in the Bay Area and unfortunately nobody is able to take my cousin in. If I could i would myself, but I am not in any type of position to take this on. The only thing I can do, is do as much of the research and phone calls as possible to help my younger cousin with his mother. I am looking for resources, such as an advocate, Medi-cal or Medicaid information (ie. What assistance can be provided during early onset dementia). This article was incredibly informative and it’s clear that you genuinely care. I am going to pray to receive a response from you. as it stands right now the family that has currently allowed my cousin to stay with them wishes to drop her off at her son’s house in San Diego in 2 weeks. The son, lives in a studio apartment, in what sounds like a college dorm like apartment complex where the residents have all tested positive for coronavirus, and have already “recovered “. In speaking to him,
He, himself, nor the residents of his apartment complex are taking the current pandemic seriously at all. (Not social distancing, not wearing masks or gloves, partying at the pool daily with 50 or 60 other idiots.) In speaking to him last night, it is clear to me that the only plan he has thus far is to do nothing to prepare for his mother’s arrival. He literally told me that when the church family gets to his apartment complex with his mother, he is going to parade them through the complex, past the raging party by the pool, to his pigsty studio apartment with his cat and dog and his hope is that the church family will be so horrified by all this, they simply cannot leave her there with her son!! I have already told him that no matter what, they are leaving her with him. These people are not related to us in any way. They have 3 small children of their own. I am truly afraid that my older cousin is going to die as a result of her son’s complete lack of concern about the pandemic with respect to his mother’s arrival. It is clear to me that he doesn’t want to change his own lifestyle in any way, no does he want to take on this responsibility. I will do anything and everything I can in regards to leading the horse to water. Please, any direction or resources you could possibly provide me with would be greatly appreciated. Please help me.
Sounds like a very complex situation.
The first thing I do when I am faced with such a dilemma in my practice (which is in Ontario, Canada), is find out:
1.What the older person’s wishes are.
2.Whether the older person is capable of making a decision about where to live.
It may be that a person like your cousin is capable of making a decision to live with their son, and is able to appreciate the risks of doing so, even if the person is living with dementia.
This may be the case, especially if a person has gotten themselves into financial difficulties in order to support an irresponsible child. Capable people are allowed to make bad decisions.
Determination of capacity is usually done by a doctor or by a specially trained capacity assessor. Family members can apply for a capacity assessment, and it probably depends on the state or province that they live in as to how to go about that.
If a person isn’t capable of a shelter decision, then their substitute decision maker would make that decision for them.
A social worker can usually help to navigate these services and point families in the right direction.
What is another option for when the very long term family physician – seemingly – does not want to do a dementia test/evaluation? My mother is almost 90, has been exhibiting memory loss, mood changes, forgetting/seeing things, paranoia, has had strokes in the past 10 years and other family/friends are saying, she is not right and needs help. I went to her doctor – he said he did not see it, her ‘tests’ were normal and grudgingly scheduled a MRI which showed she had just had a small stroke…and he did not want to do anything else further with her.
This must be a very frustrating situation for you and your family. The symptoms you’re describing could be related to dementia, but other conditions like depression, infection, or medication side effects should be ruled out as well. And “just” a small stroke can warrant steps to prevent further stroke change, like reviewing blood pressure, cholesterol levels, the need for aspirin or other medications, and so on.
There can be many reasons why a primary care provider is reluctant to address a cognitive issue: not wanting to deal with driving or other thorny issues, a desire to preserve a long-term patient-physician relationship by avoiding the delivery of a painful diagnosis, projecting their own fear of dementia onto a familiar patient, therapeutic nihilism (a belief that nothing could be done even if the diagnosis was made), or other reasons.
Clarifying the degree of cognitive impairment is an important step in planning for an older parent’s future care, so persistence may be needed. In the meantime though, seeking help to accommodate a parent’s functional gaps, whether they’re due to dementia or some other cause, doesn’t have to wait for a diagnosis. I advise family members who are worried about an older parent’s cognition to get in touch with the Alzheimer Society or other social agencies to explore local resources.
This website – and this article – has been extremely helpful to me so thank you for utilizing your expertise to provide us with more knowledge around this issue. I hope it’s not too late for me to get some guidance.
My father (age 71) was hospitalized in July 2020. A neighbor found him and he was dehydrated and malnourished (my father has swallowing issues from surgery for oral cancer back in 2007, but he’s learned to manage them and we thought they were under control). I had him sent to the ER and when I went to visit him I learned he lost close to 50lbs! I ended up authorizing them to install a PEG tube because the doctors believed his swallowing issues relapsed and he wasn’t able to ingest food properly.
On top of that he was extremely confused. He kept mentioning my grandfather who passed away and all of these other dead people.
I had him transferred to a SNF so he could receive therapy to restore his strength and relearn to swallow. Once he got more nutrition in him it was very clear how confused he is. His short term memory is basically nil. He calls me like 20-30 tiles a day and often asks the same questions. He always asks if there is a wedding and gets very confused when I ask him who is getting married. And what’s very interesting is he brings up all of these people that have passed on (my mother/his wife, both of his parents). His mind has gone back to a place it seems where he has experienced no trauma.
After weeks of this, I had him evaluated by a neurologist. She ordered an EEG (results came back normal), gave him the MMSE via computer and she noted there was marked impairment (this was my father’s first time ever using a computer so I don’t think this have a completely accurate picture of his baseline) and the MRI revealed “mild small vessel ischemic changes in supratentorial white matter and few [specifically 2] small chronic infarcts in basal ganglia”. The doctor said she believes he has vascular dementia. He had a CAT scan when he was in the hospital and it didn’t pick up these silent strokes as she called them.
I guess my question is could this have happened this suddenly? Literally, one day I was talking to him and the next day he’s super confused. His primary diagnosis when he left the hospital was encephalopathy, and now it’s evolved to this. Other than the weight loss, he’s shown no other signs of cognitive decline. He paid all bills on time, made all of his appointments and had an excellent memory. It literally all changed within a day which is baffling to me. I’m feeling like I should get a second opinion and have a more thorough assessment done, but that could be me in denial.
I appreciate any insight you could share.
Thanks for sharing your story and I’m so sorry to hear that your dad has had such a rough time. When cognitive changes seem to happen suddenly, it could be related to a new stroke, and sometimes those aren’t picked up on a scan, even though we may see older, or chronic, changes.
But your story makes me think about delirium, which can be difficult to distinguish from dementia, as I explain in this video.
Delirium is almost always a temporary condition, due to a medical illness, but it can take weeks or months to completely reverse, and some older adults never seem to return to their previous baseline. The best thing when someone is recovering from delirium is to get into a routine, with as many familiar activities and faces as possible. It often takes months to determine what a person’s new “baseline” will be.
Thank you for responding Dr. Didyk. Was the neuro eval/diagnosis too soon? I’m here trying to determine his long term care options but I’m scared to make any drastic changes if it isn’t dementia. It literally happened over a matter of days. Prior to this my father was paying bills, driving, remembering perfectly.
Should I get a second opinion or proceed with him with this vascular dementia diagnosis? I’m curious if I should continue with a neurologist or a geriatrician.
Thank you so much for responding!
I’m glad you found the information to be helpful! In my work as a Geriatrician, I see folks like your dad all the time, and can provide a comprehensive assessment, which can really help to clarify prognosis and guide future planning. I’m all for a consultation with a geriatrician in a situation like you describe!
The other resource that you would find helpful is Dr. Kernisan’s Helping Older Parents Membership. It’s a unique and affordable program she founded to answer questions and support people helping aging parents.
The membership provides ongoing guidance from her and her team of professional geriatric care managers, to help you more easily get through your journey helping your aging parents. It also includes access to her popular Helping Older Parents Course and live QA calls with her. You can join the waitlist here.
I’m so glad I found this website! I’m in a dilemma. My 84 yr old father has minimal mobility in his legs and cannot walk, he has lost most of his leg muscles and PT have said there’s not much they can do at this point, so he’s practically wheelchair bound.
He’s always been stubborn and refused to ask for help so he would fall plenty. My sister is his care taker. Recently he’s been taking too many risks, like standing up in the middle of the night to go urinate even though he has a urinal bottle, standing up to shave, and standing putting on pants all refusing to call my sister for help. He’s fallen in 2 months more than 10 times, he’s gotten stitches, scrapes and bruises. We have explained to him about safety and how important it is for him to call for help. Recently he fell in the bathroom and my husband had to drive over to help my sis because she’s hurt her back from picking him up. Today he fell again and he broke furniture in his room for trying to lean on it. When I spoke with him, he was not concerned about the severity of this situation, he was more worried about the item he was trying to get in the first place. I mentioned we may not be able to care of him due to the safety issue and all he said was he’s not going to a nursing home, he’ll find somewhere to live. This is just one part of the issue, he has this obsession with his money and is constantly purchasing things online, random things show up that he purchases. He has canceled his debit card about 20 times because he will subscribe to things and then not know how to cancel, he will forget his password and cannot get into his bank then he calls the bank but because has has severe slurring No one can understand what he’s saying, he also has difficulty eating and constantly slobber, due to mobility in his mouth. I know he needs 24 hour care but I don’t know how to prove it, diagnose him or even what the next step is!! We need help!
Hi Leisha, and it sounds like you’re very right to be concerned. I’m all for allowing individuals to live with risk if they’re capable of making that decision, but it is vital to make sure that there isn’t a medical issue that is affecting an older adult’s judgment, before using the “tough love” option.
Forgetting things like previous purchases, or even a change in buying habits itself could be a sign of dementia , which could mean that your dad isn’t capable of deciding where to live, or what type of help he needs, or at the very least, will need help making those decisions.
A first step might be to try to emphasize the common ground that you kids have with your parent, such as wanting to keep him at home. It can be helpful to indicate that you need more medical information to keep him at home, and going to the doctor to get a thorough evaluation (preferably by a Geriatrician!) is what needs to happen.
You might also be interested in the Helping Older Parents Membership. The membership provides ongoing guidance from Dr. Kernisan and her team of professional geriatric care managers, to help you more easily get through your journey helping your aging parents. It also includes access to her popular Helping Older Parents Course and live QA calls with her. You can join the waitlist here if you’re interested.
I am upset. I brought my mother to the hospital because she is suffering of extreme knee pains. She has rhumatoid arthritis. Because her appointment with an orthopedist just canceled, and was prosponed in 6 weeks , it was best to call her doctor and ask to be admitted to the hospital. She was that much in pain.
What I am very concern is that after 4 days in the hospital trying to walk again, with prenizon, they did a cognitive test in an office …without telling me… some doctor called me, never talked about her physical treatment but rather said she will start medication for early sign of dementia, loosing her driving permit and going home the next day. Wow, with just 1 cognitive test? She did 21 but my mother is in pain, isolated in her home… yes her memory is not good but she manage her bank account,investment, call me every day, , and the only reason she told the doctors she was not able to do all task is because of pain but now the inflammation is gone but… dementia? Really? Taking her license? Never had an accident?
Please help …my mother is so angry and not able to go to church, grocery or breakfast with her friends by her own will kill her.
I can understand feeling angry and frustrated at your mom’s situation and I’m glad to hear that her pain has gotten better.
Many older adults can have worsening brain function when they’re under stress, like being in hospital, in pain, and taking certain medications. As a Geriatrician, I don’t suggest doing a memory test under those conditions, as the results might not be reliable. There’s also the risk of a person having delirium when in hospital, which can look a lot like a dementia, but is almost always reversible.
In a situation like the one you describe, it may be that there was some other information provided to the hospital team that led them to those conclusions. A more thorough evaluation that’s done when a person is back to their usual baseline is likely to be more accurate. That would be something to request from a primary care doctor, or through a referral to specialized Geriatric services.
In most regions, a family doctor can review the reports from the hospital and determine whether they can send paperwork in to the Ministry of Transportation to remove a suspension from a license.
My Dad is 63 and has been having memory loss and confusion. He went to a neurologist who believes he is suffering from dementia. He’s had bloodwork and a MRI that all have come back normal. I’m struggling to accept such a diagnosis at such a young age and so suddenly. He was also on a blood pressure medication that his PCP removed immediately after he complained of memory issues. Is this caused by his medication? Is is normal for symptoms to hit so young and suddenly?
I can understand being shocked and struggling to understand this diagnosis.
Many factors can cause memory changes, including medications, alcohol use, mood disorders, stress, and other illnesses. A neurologist would probably be able to rule those other things out. Most blood pressure medications have few cognitive side effects, so it may have been a coincidence that the PCP stopped the medication. You would have to ask the doctor about that.
About 5-6% of all Alzheimer’s is early onset, that is, it comes on before the age of 65. I made a video about it, which you can watch here for more information. I would also advise contacting the Alzheimer’s Society in your area to get more info and support.
Went to my Moms to check on her this evening. We tried to get in the house but she had a table a microwave and few other items blocking the door. My sister stated this has happened before. It’s like she has a fear of someone coming in her house. I notice she is losing hearing. Today we buried her brother…let’s week we buried her nephew. She is the last living elder on our family side. My Mom is 77years old, she lives alone and still works as a CNA at the hospital. My and I are installing a Door Chime hoping that would at least make her feel better. We are concern and don’t know what to do or where to start. Our Mom is a person that will not tell you if something is wrong. And this Never been afraid of being ALONE ever.
I’m so sorry to hear about your mom’s distress. It sounds like she has had some major stressors in her life with the loss of close family members, and sometimes that can be a trigger for a depression or other mood issues.
Dr. K has a great article on paranoid thoughts that might be helpful.
I agree with your idea about checking hearing. Hearing loss can be a barrier to communication and can worsen the symptoms of cognitive impairment.
Dr. K has a new book coming out very soon which is a guide to helping an older parent. You can find out more, here: https://betterhealthwhileaging.net/education-and-support/when-your-aging-parent-needs-help/
You might also be interested in the Helping Older Parents Membership. The membership provides ongoing guidance from Dr. Kernisan and her team of professional geriatric care managers, to help you more easily get through your journey helping your aging parents. It also includes access to her popular Helping Older Parents Course and live QA calls with her. You can join the waitlist here if you’re interested.
Dr. Kernisan’s Helping Older Parents Membership (betterhealthwhileaging.net)
It sounds like you’re working together as a family to help your mom and she’s so lucky to have you. I hope these suggestions are helpful.
My sister (mom’s caregiver) has been telling me of my mom telling her of things I have never (or her) heard about before: My grandfather had a fake eye (we do not think this was true); best friends of my parents tried to kill them and told them they wanted them dead (again, not true to our knowledge). This especially comes out a lot where family (cousins of my mom) have tried to kill us and tried to kidnap us as babies. My mom only goes out for doctor’s appointments now…but it has been this way for years because one doctor told her she was allergic to everything and has no immune system. (This is before my dad passed away with Alzheimer’s 7 years ago). She really doesn’t like for us to visit because she is afraid we will bring something with us when we come to visit (8 hours away). Covid concerns have made it even worse. Is this just part of dementia or Alzheimer’s ? If so, it is so different than my dad’s declining years. The things she tells my sister (who passes them on to me to see if I knew of these things) seem so far-fetched and I really do not think they ever happened, too many to mention them all. Is there anything we can do?
It must be distressing to hear these stories from your mom (through your sister). People living with dementia can express stories like the ones you describe, which are sometimes based on real occurrences, or could be a be a blend of facts and fiction. Dr. K has an article about other things that can cause these experiences aside from dementia, which you can read here.
If these stories are distressing to your mom, it may be something that medication or some other treatment could help, and a doctor can help sort this out. A primary care provider might need advice from a Geriatrician or psychiatrist if it’s complicated.
One thing to know is that arguing with your mom if you’re not sure if her stories are accurate is likely to lead to conflict, so ids best avoided. I made a video about that here: https://youtu.be/CA9EzGfS5jk
My Dad just passed away, my 69yr old Mom has Rapid Cycling bipolar illness, she is putting a strain on me, she accuses me of wanting to kill her, I wanted to build an apartment in the basement she thinks I’m trying to shove her in a cave, she claims to be scared of me although I have never done anything, she seems to just hate me, she has attempted suicide multiple times and has blames me and I have been able to find NO SUPPORTS in my area. I’m unsure what to do, she doesn’t bathe, she smokes like a chimney, she’s on a plethora of medication and she smokes pot, she is becoming physically impaired, she slept at my house once and peed on my couch, she has 4 cats in a room that NEVER get out, she has 4 snakes in another room, I feel stuck and don’t know what to do??? PLEASE HELP,
I’m so sorry that you lost your dad, and it sounds like you’re really having a struggle with your mother.
When serious mental illness is untreated, it can cause so much suffering for the person experiencing it and the family. If someone is a danger to themselves or others, because of self-neglect or risky behaviour, the police or social services could be called to assess the situation and decide if the person needs to go to hospital for an emergency evaluation. Short of that level of risk, though, it can be hard to force a person to make changes in their lifestyle. Sometimes we have to wait for a crisis for real change to happen. It’s just heartbreaking at times.
Dr. K has recently published a book called: “When Your Aging Parent Needs Help: a geriatrician’s step-by-step guide to memory loss, resistance, safety worries, and more”. This is a practical guide to how to start helping an aging parent, even when you don’t know where to start. You can learn more here. The book can help you to set small goals and make progress towards helping your mom.
I have been diagnosed with memory problems and retired a bit early from stressfull work with refugees in the Middle East. I used to take low dosage Stillnox / Diazepam to help me sleep better during those years. I now understand there may be a link between the use of this and the development of Dementia /
Alzheimers. Is that true and, if so, is there anything I can do about that now? Would appreciate any solid advice. Many thanks
My 71yr old mum has had the initial test done at her GP (remembering list of 3 things, drawing something etc). Her GP seems to think she doesn’t have dementia but more memory loss due to living alone, depression & Covid lockdowns.
I get concerned when I am asked the same questions 4-5 times in a 40min phone conversation. I’m noticing slight changes in her abilities . Eg, a banana cake recipe she’s been baking for 20+ years, she’s had 3 failed bakes in the past 4 weeks.
Was always very good at sewing but these days seems to be mucking up simple things and having to start again or buy new material to try again.
I have already taken over her finances
Should I be sending her to a different GP or trying with a Geriatric specialist?
Should I be concerned?
I can understand your mom’s doctor wanting to give her the benefit of the doubt after all of the social isolation and stress of COVID. Certainly, those issues could affect an older adult’s brain performance, even to the point where it gets in the way of some tasks like baking and sewing.
I’ve even made a video about distinguishing depression and dementia, which you can watch here: https://youtu.be/Me7c-vTshEk
If the depression and social isolation are treated, and the cognitive symptoms improve, it’s less likely that there’s a dementia. But if they don’t, or if the changes become more serious, I would seek another visit or a visit with another provider.
It sounds like you’re doing a great job of keeping tabs on your mom and the kinds of observations you’re making are exactly what a Geriatrician would ask about when doing an assessment. You’re right to be concerned and involved.
My brother is 67 years old. in August of this year he went into the hospital for back pain. After many week sof test & not knowing the dr.’s finally found that he has a staff infection in his spine. This turned into an abscess. He slowly lost the use of his legs. He also became confused, he was treated with medication 7 his confusion cleared up. He has been on antibiotics to clear up the infection for 8 weeks. They took him for an MRI to check on the infection & he came back confused. his confusion has gotten worse in the last 3 days. He know his name, birth dat, address, relatives names, the president, etc. he thinks his hospital bed is an airplane, he think his nurse is a model on the airplane, the thinks he is working on different things. He was fine 3 days ago with his mind then all of a sudden this. Not kidney trouble, MRI of the brain came back good, MRI of the spine came back that the infection is almost gone. We are at our wits end with what is goin on. The neurologist said that he seem to be getting better each day.
I’m sorry to hear about all the difficulty your brother has had. It sounds like a very complicated hospital course.
Your description of what’s happening with the sudden and reversible episodes of confusion makes me think of delirium. Dr. K has an excellent article about delirium, which you can read here.. Delirium can happen in up to 30% of older adults admitted to hospital. It tends to fluctuate, so that people can seem fine one hour and very confused and drowsy the next. Hallucinations and misperceptions (like thinking the nurse is a flight attendant) are common with delirium too.
It’s a frightening condition, but it almost always gets better, although it can take days, weeks, or even longer to go away for good. Establishing a routine, encouraging someone to move around as much as possible, making sure he’s not dehydrated, and having the medical team review his medication list are all ways to prevent another episode of delirium from occurring. I made a video about this, which you can watch on YouTube here: https://www.youtube.com/watch?v=jtEBF6Jb6z8&t=145s
I hope everything goes well and your brother is home soon.
Thank you for the article. I live in India with my parents and grandmother. My grandmother is 90 she had very little auditory hallucinations last year but she recently had a fall which hurt her head and caused her to bleed. We got a CT scan done which showed a small subdural hemmorage. Given her age and how small the injury is a neurosurgeon adviced that the injury is small and would not need a surgery. Fortunately her drowsiness and other symptoms of hemorrhage have reduced.
However, her hallucinations have gotten a lot worse. She now has a lot of visual and auditory hallucinations such as hearing it rain all the time, seeing kids, her relatives with whom she has conversations with, ditches on the floor etc. recently she also hallucinates seeing dirt on her hands which she keeps trying to wash using 2 to 3 buckets of water.
My grandmother was never a great sleeper but after the head injury and once her drowsiness disappeared she constantly wakes up in the night and keeps talking (she hallucinates a lot of situations and keeps having her conversations) and now she also wants to wash her hands in the night because she sees dirt on her hands.
My parents and I haven’t been able to sleep at all properly a few weeks now because of this situation. Can you doctor please advise on what to do at home that could help in this situation. Thank you very much 🙏
I’m sorry to hear about your grandmother’s fall and injury.
When I see an older adult who’s had a fall and subdural hemorrhage, it’s common that it’s a setback cognitively and can lead to deliriumdelirium. If symptoms are worsening, I would consider seeing the doctor again to make sure nothing else is going on.
Otherwise, in a situation like this, I would advise trying to keep the routine as predictable as possible. Keep the environment calm and familiar. ensure adequate hydration and take the usual medications.
There are medications for hallucinations, but they can worsen drowsiness and have other side ffects, so we usually try to avoid them. You can read more about that here:
My 94yo Mother has lived in an Independent Living Facility for more than 4 years after losing her home to a fire. Recently, when speaking with her she mentions (1) people parking, turning their lights, shining them in her window, and looking into her bedroom — Therefore, Blackout curtains were installed; (2) She states possibly rats are running around the end of her bed at nights (states she can feel them running across her feet at night). She then hit the bed and they stop — More than 4 family members have dismantled her room and bed and nothing was found, My mother’s health is impeccable, she has Type1 Diabetes and wear glasses due to glaucoma. Sees her doctor on a regularly and takes her medication and inputs her eye drops as prescribed. I personally feel this is due to loneliness and/or social isolation. This is not something she will admit too, because she loves her independence. She’s visited regularly by other family and church members and appears to enjoy that time and when they leave.
Can the doctor please advise on what questions I can ask my mother or a better way to communicate when these types of conversations come up or questions or comments are made? I hope I provided the right information to understand my questions.
Thanks in Advance.
It sounds like your mother might be experiencing hallucinations. This can be a part of dementia in older adults, as I discuss in this YouTube video:https://youtu.be/cjj6NyuPyCI, but can also be related to misperceptions of natural phenomena, distortions from impairments in hearing, vision or the sensory nerves, or part of a delirium.
If this is fairly new, a review by her doctor specifically around this symptom is a good idea, if you haven’t already.
When your mother tells you about her experiences, a good approach can be to validate her perceptions (even if you suspect they are not real) and reassure her that you’re doing everything you can to keep her safe. Then move on to a more pleasant topic. It’s often counterproductive to try to convince the person that, for example, there are no rats. A delusion or hallucination is usually very hard to shake, and efforts to “prove” that it’s a false belief are almost always unsuccessful.
Hi, so I’m 20 years old with OCD and I think I’m kinda going crazy. One year ago I developed very aggressive “brain fog”, I feel like I’m in a state of confusion, I can’t focus and I feel like I went through a cognitive decline overall in the last few years, to a point where I struggle to do simple tasks as well. So recently I read some studies which claim that people with OCD have higher risk of developing dementia compared to people who don’t have OCD and now I’m even more convinced that I’m developing dementia. I also talked with a neurologist and basically he said that I’m too young to eventually develop a neurodegenerative disease but somehow I’m still worried. I also have to add that my grandma has Alzhaimer, which makes me worry even more.
I can understand being worried about developing dementia, and it sounds like your OCD has caused you to have symptoms that resemble those we see in people living with Alzheimer’s. I did come across this small study in Taiwan that found an association between dementia risk and OCD diagnosis, but this isn’t enough evidence to draw a conclusion: https://pubmed.ncbi.nlm.nih.gov/34004091/.
The biggest risk factor for Alzheimer’s disease, the most common cause of dementia, is older age. Even genetic factors, such as having a grandmother with AD is not as high a risk as simply living a long time.
If you’re worried about developing dementia, now is the time to commit to lifelong healthy habits, like exercise, not smoking, rating a healthy diet and building a strong social network. These habits can help with mental health symptoms as well.