Seeking Thoughts on AD Liklihood

anw123

Hello,

I am seeking advice on whether the below behaviors seem in-line with a possible dementia diagnosis. I know that there is no way to say for sure, but I'm currently reviewing options to address my mother's situation and want to know what path to take first.

Background: My 67 year old mother's concerning behaviors began suddenly last September when she began accusing her husband/my father of stealing her and my family's social security numbers. This quickly progressed into a very elaborate cheating theory, where she accused my dad of cheating on her with many many people (including her own sister) without any actual evidence. It then progressed into her believing my dad was trying to kill her, again with no rational reason or explanation why she thought that. 

At that point, I encouraged my dad to move out of the house as she was convinced that she was in danger and I was actually concerned for my dad based on her actions. She was extremely angry and irrational, creating malicious storylines of what she believed was happening/had happened in the past. Would go from crying to screaming and yelling very quickly. 

Her wild stories about my dad had slowed down over the last few months, but are now coming back up. She has mentioned thoughts of self-harm and referenced "shooting all cheaters if she had a gun," as well as become convinced that my dad's sister is actually responsible for my father's behavior and was saying she was going to "tell my *$%& cousins the truth about their mom" at my wedding this coming December.  

On top of all these emotional outbursts, it is clear that my mother's memory is very affected. She cannot keep appointment days/times straight, has missed paying bills, will ask me the same question over and over, admits that she can't remember anything, and gets very confused/cannot comprehend new information. 

Physically, she has lost probably 60 lbs over the last year, but she also is going through a divorce with my father that she initiated and clearly is emotionally distressed, so not sure what specifically is causing the weight loss. 

She currently lives alone and is seemingly high-functioning in other ways. She takes care of the house, the yard, her dog, goes to the local Y daily, can have normal phone conversations most days, etc. She sees a therapist weekly who I have had to contact a few times after the threats she has made towards herself and my aunt, but I believe she needs either further psychiatric help or review by a medical doctor for possible dementia.

Unfortunately, my mom is not open to suggestions that she needs help or is part of the problem here, instead everything is my dad/aunt/or my fault. If I try to suggest that she should get additional help, she is very defensive and accuses me of "taking my father's side" and not believing her. 

Looking for any advice on whether this sounds like possible dementia and tips for encouraging her to speak with her doctor about further testing. She is still very high-functioning and I live across the country from her, so it's hard to use a fib or to take her there myself, but I'm thinking of asking her to meet with both myself and her therapist together and bringing it up that way, but not sure if I should be encouraging a mental health evaluation or physical dementia evaluation at this point. 

Thank you. 

loveskitties

So sorry for a really tough situation.

First, what kind of "therapist" is she seeing who does not take active action with a patient who is expressing doing harm to herself and/or others?  Does not sound like anyone with a medical degree.

The threatening to do harm is the most serious part of this drama.  It sounds as if she needs to have a psyc exam as soon as possible.  Has she made these threats to others who live closer who could/would initiate action such as calling 911 and having her admitted for a psyc eval?

Most of the behaviors you mention are seen in dementia patients, however you indicate they came on suddenly.  There could be an underlying medical condition such as a brain tumor which could be the cause.  She definitely needs to be seen by a medical professional, sooner rather than later, to determine cause.

I am guessing there are no legal documents in place like a DPOA which would allow someone to press the issue of medical treatment.  If not then the only way to get it started might be the call to 911.

I am sure others will add their thoughts.

Wishing you the best resolution possible.

anw123

Thank you so much for your reply and thoughts. 

My mother told me today that I'm the only person she tells these thoughts to and only shares a little bit with her therapist, though I have called/messaged her therapist after these comments but they were not explicit enough threats for the therapist to take immediate action.

However, the therapist told me if they were more direct threats, then I could let her know and she would call. I do continue to try and impress upon the therapist that my mom needs further help. 

Yes, no legal documents at this point. But I agree that my next step needs to be an evaluation and will continue to work toward that, I'm just forced to approach it very cautiously with my mom as she has threatened to cut off contact with me before for much more minor "actions against her."

Thanks again, your comments and suggestions are very appreciated! 

Quilting brings calm

First…. Being a long distance away does not preclude you from calling the appropriate police department and asking for a wellness check on someone threatening to harm themselves or others. I had to do just that a few years ago.  My sister ( who has issues)  called me from halfway across the country ( drinking) and told me and my spouse that she was hitting her leg with a knife because she wanted to ‘feel Something ’. . I had no idea what kind of knife.  While my husband kept her on the phone, I used our land line to call the police in her town.  They persuaded her to go to the hospital and she was kept for a three day psych hold. Turned out to be a  normal silverware knife ( the ones with the rounded edge). 

As to your question….it could  be dementia, thyroid issues, B12 levels,  medication side effects. tumor, etc.  Blood tests can rule several of those out.  My step-dad (81) accused my mom  (83) of having an affair because she supposedly talked in her sleep.  Turned out his B12 levels were low and he now gets B12 shots( tablets wouldn’t work).  He’s still got issues, but the shots help some.  He still says her sister  tried to seduce him.  Which is not true but has cost my Mom her sister. 

He possibly has cognitive issues, but is a lost cause in terms of diagnosis. He won’t go and his doctor ignores my concerns concentrating on his numerous physical ailments instead.  My Mom is the loved one that brings me to this forum 

harshedbuzz

Yikes!

A few things need to happen, like, yesterday.

1. Mom needs to be medically evaluated. A PCP can run the basic blood tests to R/O vitamin and hormone deficiencies that mimic dementia/mental illness. If there's a personal history of mental illness a geriatric psychiatry consult should be sought as well as being evaluated by a neurologist. She might be be served by a major city's teaching hospital Memory Center which would have resources under one umbrella and better coordination of care.

I realize she isn't going to agree to this, so you may need to trick her into it. One strategy would be to have her transported to a geriatric psych unit during one of her outbursts. If she's genuinely uncooperative, you may need to go the guardianship route which could force and evaluation. One caveat, many PWD have the ability to showtime when needed- that is, for them to get their act together just long enough to seem OK to doctors, judges, and such. To overcome that, make a couple of video recordings of her acting out to share as needed. 

2. Legally, someone is likely going to need to act on her behalf. This means POA (or guardianship), health care directive, HIPAA waivers and familiarity with her finances. I would also be looking into whether she is competent to initiate a divorce; she may not be. Or perhaps she needs to have a GAL assigned to protect her in the process. 

HB

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MN Chickadee

I wouldn't be surprised if she isn't as high functioning as you think. You aren't seeing her day to day living quarters, what she is eating, if she is safe in the kitchen,  or what she is up to in the middle of the night. If it were me I would "come for a visit." Stay with her to see how she really is doing on her own. While in her city I would privately consult an elder law attorney (needs to be one in her state since rules vary by state) either alone or with your father, but not with her. The attorney can advise the best legal route to protect her if POA documents are non-existent. If it comes to going for guardianship you would definitely need a good attorney. Many of us have to be very involved in getting our LO in to a doctor for diagnosis. You would likely have to make the appointment, fly in for it and use a therapeutic fib to get her there. Send documentation of these issues ahead of time so you don't have to air all the dirty laundry in front of her. Document outbursts on video or audio so you have proof.  Send the doctor a list of what has been going on and for how long by fax or mail beforehand. Certainly give her no warning of the upcoming appointment. Maybe it's a wellness check that Medicare requires. Maybe it's a check for blood pressure or a bad knee or hip or some other issue or an appointment for you and she is along for the ride. Do whatever you have to do to get her to the clinic. A PCP can do the initial tests and bloodwork, from there she may need a neurologist.  Given her immense delusions she may have a form of dementia that is not Alzheimers. There are other types where memory loss is not the first sign, but instead delusions and strange behavior are. If this is the case you really do want a proper diagnosis because they can be a bit more challenging to treat, and require careful medication management. Often a geriatric psychiatrist is the best person for that. 

If she is ever a danger to herself or others, call 911. The EMTs will bring her to the ER for a psych evaluation hold. From there you may be able to get her transferred to a geriatric psych unit for evaluation, diagnosis, and medication management to get stable. Sometimes it does take a crisis to get them help, but I hope it doesn't come to this for you. 

anw123

Thanks everyone for the replies.

I did stay with her for about 4 days in July and while she has tons of papers/notepads all over the house, everything else was reasonably in order.

The biggest signs I noticed were just repeat questions, taking us to the wrong place for a spa appointment, never remembering what day/time she had things scheduled.

She also has recently had her bloodwork done and the doctor was monitoring her for protein in the urine. I did read today that this can be a sign of kidney failure and can cause symptoms of confusion and cognitive decline. Her doctor has her coming back in 3 months, so I think my next step will be documenting my concerns along with evidence to her PCP and trying to be in town for her appointment.

I was hoping that the therapist could suggest something as I know my mom really trusts her and takes her advice, but was told by my mom today that her therapist recommended yoga for helping her control her emotions...so no help there. 

Really appreciate all the advice and certainly if there is another episode of threats, I will let my mom know that I need to report this to 911.

Iris L.

Unfortubately, many professionals are notorious for treating the medical and neurological evaluation of dementia lightly.  Did the doctor perform a Mini Mental Status Exam (MMSE)?  You can Google.  For many patients, difficulty with written material, mail, bills and other financial matter are signs that may appear before significant memory loss.  Hence scads of papers all over the house.  Please check into bill-paying.

Most PWDs have anosognosia, which is unawareness of having dementia and cognitive difficulties.  Psychotherapy is limited due to lack of insight.  Please read alz.org regarding the diagnostic process and also about home safety.  Check her cooking and stove safety.  Check the refrigerator for expired food.  There is so much to look into.  Read a lot of threads.  IMO, three months is too long to wait for follow-up.  

Iris L.