13 on MoCa More Tests This Week

Cinsababe

After 5 months wait, we finally had our appointment at the Medical University of SC memory clinic. I know DH has been progressing but I was shocked that he only scored 13 on the MoCa. His last test a year ago he scored 27. But last week he could not remember who the president is...he joked and said, "we don't have one." The doc chuckled and then insisted he give the name, which he could not.  It made me realize he has probably been using his humor to cover a lot. He also could not give the date or day or city we were in. He couldn't draw the clock or time or remember the 5 words given...even with hints and multiple choice and failed all of the math and number challenges and so much more.  Beyond the written and spoken test he could not repeat any of the patterns the doctor performed with his hands or even place his hands on his knees when instructed. This was all so surprising to me.

We are going back down this week for blood work, an MRI and another appt. with the doc. Meanwhile I fell down our front steps on Christmas and broke my foot. It made me realize how unprepared I am if something happens to me even temporarily...what do I do with him?  MUSC had me fill out 5 pages of what he can do by himself--there is so little.  He can't drive or shop or prepare meals or medication or even take his medication unless it is handed to him. He still dresses himself, usually in dirty clothes and tries to hide the fact that he has constant small potty accidents. I can't let him be unsupervised for even a few minutes or he is doing something ridiculous or dangerous. Trying to get on the roof to remove leaves, power sanding our plastic bathtub because he sees a spot of dirt on it, chiseling the top of the bathroom door for some unknown reason, and today, while I was in the kitchen for 10 minutes, trying to take the back of the washer apart because he didn't like the way it was slightly vibrating...I was doing a heavy load and it was still going while he was taking it apart!

He tried to take the shower apart last week and when I said "let's not do that today." He punched me, knocked me on the ground and told me he was going to put the screw driver through my chest.  Fortunately the MUSC doc started him on Zoloft and he seems to be a little calmer, but honestly, being disabled myself, I don't know how much more I have to give. 

What happens if I can't, won't or am unable to do this? How bad does it have to get until it is time for outside help?  Or permanent care?

Stuck in the middle

You need to get out of there right now, before you end up in the ground and he goes to State Hospital.  Today.

LadyTexan

I agree with Stuck. It is dangerous. get out now.

Emily 123

The time is now, is it not? 

''I can't let him be unsupervised for even a few minutes or he is doing something ridiculous or dangerous''

Iris L.

The first priority of dementia care is safety--both for the PWD and for the caregiver.  The home should have been dementia-proofed, meaning remove all dangerous items, such as guns, knives, bats, anything that could be used as a weapon.  Also secure dangerous cleaning chemicals and other things that could be mistaken for beverages or food.  Limit use of the stove, matches and power tools etc.  

Obviously he is in need of very close supervision.  Medication can be one tool for handling aggression. A geriatric psychiatrist is the specialist with the expertise of the psychoactive drugs that are used.  These drugs take time to build up in the system, thus hospitalization for a few weeks is often required.  

Afterwards, he may need a team of 24/7 caregivers in a memiry care facility.  But no facility will take him if he is threatening.  

You have a lot of work to do.  Have you seen an elder attorney for POA and to arrange finances for Medicaid?  Read about the stages of dementia, he has been declining all this time and will decline more.  Read about incontinence.

You need to be alert to call 911 for paramedics to take him to a geriatric psychiatric facility for an out of control PWD.  Do not allow him back in the home.  It sounds like he will need to live with 24/7 care.

The horse is already out of the barn.  Your situation is so precarious you should be in contact with a Care Consultant right now!  One is available 24 hours a day at the Helpline  800-272-3900.  Keep posting.

Iris L.

Tfreedz

Do not second guess yourself or overthink this, you know it has gotten “too bad” already.

There have been other posts on here with very detailed safety measures, please look for the threads. Basically, always have a charged phone on you, a safe room you can lock yourself into, and possibly a “go bag” in your car. Do not hesitate to call 911 from a locked room next time he displays even a hint of aggression. Explain his condition and insist he go to psych ED. In the meantime, I would remove or lock up any and all tools, sharp objects, weapons that he could use. I would also start to actively look for placement but that is just my opinion. I hope the meds keep him calm and non aggressive for you!

BTW- I love the picture of the two of you, I am so sorry you are dealing with this!!

Ed1937

Cinsababe wrote:

 He punched me, knocked me on the ground and told me he was going to put the screw driver through my chest.  

That part bothers me a lot. You absolutely can't be around him unless you are sure he will not be a threat. He could easily put you in a hospital, or worse. Then he would be put in some type of facility. If you can't be sure he is not a threat, I'd say it's time to place him. I'm sorry.

Cinsababe

I appreciate all of ya'lls input...always. I have followed much of this advice in the past and have locked just about everything up in the shed.  I thought the screwdriver was safe, but now it is gone too. He is registered with our local police so if they get called to our address they know what is up and will send an ambulance to pick him up. This was by far his worse episode and it did catch me off guard. The dementia specialist gave him a stern talking to and told him the next aggression the police would have to be called which scared him and he later said it "hurt his feelings" LOL that I told the doctor about it. 

We have everything set up legally and the CELA says he will be eligible for medicaid. But who pulls that lever? How do we get from here to there? He still doesn't think there is anything wrong with himself. He thinks the things he does make perfect sense and that I am the ridiculous one.  How bad is a 13 on this test? Is it a doctor that says it is time?  Is there an in between that isn't too costly?  I can't just walk away and leave him here in the house, that would just be neglect and I would never leave him anyway. I have to take good care of him.

As for the picture it is probably my favorite. We have been married less than 3 years. Early on I was always taking selfies of us on our adventures. On that day he said, "not another picture!" And I said, "just one more." Right when I snapped the pic he turned and kissed me...how quickly things can change...I hate this disease.

M1

You're getting a unanimous message here C. He probably needs a psych admission to get the aggression under control and then placement. You need to let the psychiatrist know what happened asap. Do not ignore this. Please be careful.

Iris L.

Cinsababe wrote:

The dementia specialist gave him a stern talking to and told him the next aggression the police would have to be called which scared him and he later said it "hurt his feelings" LOL that I told the doctor about it. 

I hope you realize he won't remember any of this.  How does a "stern talking to" affect a degenerative brain disease?  IMO, the doctor is doing you a disservice by not confronting you with the reality of the seriousness of his decline.

 He still doesn't think there is anything wrong with himself. He thinks the things he does make perfect sense and that I am the ridiculous one.  

You must get an understanding of anosognosia.  He truly does not think anything is wrong with him.  If you confront him with reality he will become upset.  Do not tell him he is doing things wrong or making a mess.  You have to learn a new way to communicate with him.

How bad is a 13 on this test? Is it a doctor that says it is time?  

Your situation will say when it's time, not the doctor.  You are there every day.   The numbers on the MMSE don't mean much, it is a screening tool.  Have you read the seven stages of Alzheimer's?

You seem to be overwhelmed.  Things are spiraling out of control.  It will help you to read a lot of threads.

 Iris

Quilting brings calm

To me, a score of 13 indicates at least moderate dementia.  A drop of 14 points in a year means it is very fast moving.  I think he needs  geriatric evaluation, along with some scans to see why this is moving so fast. I’m concerned that a dementia specialist thinks ‘ a good talking to’ is going to make him listen and understand.  I’m concerned that he’s playing with power tools with a score of 13.   He is  no longer capable of understanding reprimands or safety issues. 

Please read some  of ‘billS’  latest posts about his wife and safety issues.  This will be you very quickly,  so quickly that you won’t be able to place him soon enough. 

Gig Harbor

He definitely sounds like a danger to you. Talk to an elder care attorney to see the steps you need to do to get him on Medicaid. You want to protect your assets and only spend his. Since you have only been married for 3 years it might make a difference in how much you need to spend down. Try to visit memory care units in your area that have Medicaid beds and get his name on a list for one of them. He may calm down with medication but you need to be prepared if he doesn’t. Good luck and stay safe.

jfkoc

Please do your research right now for placement. You do not want to have to do that in an emergency. Right now you are red flagged for an emergency.

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ButterflyWings

Dear Cinsababe, 

I agree with all those urging you to protect yourself from this imminent danger and get out (call to have him admitted via ER maybe, due to being a danger to others (you) and to himself if you have to leave him alone for your own safety). Be firm in your request that he needs to be evaluated in a professional setting, NOW. You are talking life or death right now, with this level of violence. Is this the first time he’s threatened or attacked you? He needs a geripsych eval now- having “punched you, knocked you down, and threatened to put a screwdriver through your chest” - you are not safe. I’m so sorry you have been going through this. 

Don’t feel bad, you cannot possibly imagine and hide all the potential weapons that someone (edit: with dementia and) homicidal ideation might use to do harm in an unguarded moment. He can’t control his brain and neither can you. But you can take the caring and experienced advice of those who have seen, and survived, a lot. 

Please don’t let anyone try to minimize or normalize this, including the professionals. I have dealt with some Drs, lawyers and even law enforcement who sometimes see (edit: domestic violence as just) a strong male vibe (or an argument that will simply blow over) and no big deal, when it can be deadly in an instant. Agreeing with the others’ wisdom here. Please do not second guess yourself. Let us know how you are. 

toolbeltexpert

I love your picture as well. I have been doing that as well. I have gotten a few of the best pictures of my DW.  Sometimes all WE have are those pictures.stay safe

Jo C.

Cinsababe, I am sorry for what you are experiencing and it is so very unacceptable.  I am also recalling your earlier Threads from a year ago when you had been married two years.

You explained that you are a devout Christian woman; your first husband died.  This present husband you met in church and he wooed you not too long after you were widowed and wooed you heartily in what you described as a, "whirlwind romance, BUT  he failed to inform you of somethings extremely important which he knew very well:

He has Biplolar Disorder and had been on Lithium for 40 years prior to your marriage; he also had onset of dementia prior to the marriage. He purposely did not tell you.  You believed you were marrying a devout Christian man who was very much going to be a good husband - but what you got was a man with a significant mental illness as well as dementia.  You stated he kept trying to have sex with you constantly which had developed into a highly negative situation day and night. You mentioned he was also deeply addicted to pornography and indulged in frequent dangerous masturbatory practices.   From your writing, it seemed that your world was caving in and you were at a loss.  You chose not to annul the marriage which could have been done.

 Finances I think, may have been part of that decision if I recall correctly.  However; you are now in a situation that is frankly SEVERELY dangerous. This is not a good quality of life for you as you decribe it.  Due to the danger, there may be NO time to waste  in removing yourself or him from that house.   If he suddenly acts on his violent thoughts and abrupt urges, and threats, you will not have time to call and have the police arrive; he already would have attacked you and caused grievous bodily harm or heaven forbid; have killed you.

 There is no hiding from or minimizing this; the doctor's advice was not helpful  if you told him of all the dangerous aggression and threats and if he was aware of the BPD as well as the dementia. One thing that may help; your husband could be referred to a GeroPsych Unit on an inpatient basis and have his meds adjusted as well as being reassessed on a 24 hour continuum.  At that point you could work with the Psychiatric Social Worker at finding an alternative living situation for your husband that accepts Medicaid.  The social worker at the care facility can assist in filling out the Medicaid application.

 Some of the impulse behaviors you shared may be driven by the BPD.   In such a dual diagnosis with dementia, it is a very complex set of dynamics.

Also, it would be best for you to see an Elder Law Attorney asap.  You need to find out what your rights are AND perhaps even find out about the division of assets if you decide not to continue with the marriage or what will be necessary if he is to live in a facility that can best manage his issues.  The attorney can help to position you best.

 In the meantime, please carry your fully charged cell phone with you at all times; have a room with a door that can be locked if you cannot leave the house if being in danger; remove all tools, knives, scissors, bats, golf clubs, etc. that can be used as instant handy weapons. All guns if any must be removed from the house.   Even kitchen knives should be locked up out of his ability to grab.  If you can sleep in a different room with a locking doorknob, that would keep you safer at night should he decide to attack you as you slept.  It is that much of a concern.  It is also a good idea to pack a "Go Bag" with some clothing, a bit of money, a credit card, grooming items, etc. in the trunk of the car should you have to suddenly leave the house in an instant. Of course; you would need the keys with you or in a place instantly retrievable.

Yes; you are a Christian woman; I cannot imagine God wanting you to be in such a situation as it now exists.    I am so sorry that this man did not tell you of his BPD prior to marriage; that is probably why the "whirlwind" romance; that is pretty much poorly controlled BPD behavior.  He will move on the impulse of the second; whatever his mind feels he will be fixated and go with it and will go at it with gusto.

 Please do get to safety first thing; and please, get yourself to counseling so you can get assistance for your own dynamics being in such a dreadful situation.

 Let us know how you are, and please, please stay safe,

 J. 

 

abc123

I am terribly sorry you are in this dangerous situation. I remember your post from the past also, I feel like you have been misled by this man from the very beginning of the relationship. 

You have gotten excellent feedback from some very wise people, some of whom have had to deal with dangerous situations themselves. For your own well being, I hope you will take it to heart. I'd also like to mention that Zoloft is prescribed for depression, panic attacks and OCD. Just my 2 cents, I think your husband needs serious medication before he hurts someone and you find him involved in the legal system. 

Please keep your safety and your needs first. It would be so sad if something violent were to happen to you. You are both in my prayers.