How can she seem so sharp?

Holly H

My mom has always been highly intelligent and insightful. It's obvious that she is declining mentally and has said things that are clearly delusions and paranoia, but her intelligence and ability to discuss current events is still amazing.  I can be having a conversation with her and things are totally normal and the next minute she's telling a story that is obviously not possible (she saw flames outside her window and sparks coming from her TV caused by a windstorm is one story she retells). I feel that she has anosognosia, but it baffles me how she can seem so coherent and reasonable so much of the time but have no idea that her stories about the sparks flying from the TV are delusions. Dementia is such a rollercoaster. She is also accusing my brother of taking the deed to her house and putting it in his name. This is likely a result of her own paranoia and some level of subconscious knowledge that she is declining and fearful that she will lose control of her possessions and situation. And while we have read to not argue and try to distract, we laugh at this advice as it seems those that wrote it do not know our mother!

I'm wondering if others can share their experiences with this stage or dynamic of dementia where their loved one can seem so sharp and so clear and so reasonable yet also tell these delusional stories and be so fixated on something that is not true. 

Thanks

Fairyland

No experience, if anything the opposite with my mom, but from my obsessive reading maybe it’s FTD or another type? Do you have a clear diagnosis?

Holly H

I should add - she does have word finding issues and short term memory lapses. She repeats herself a lot and has had increasing trouble with executive function tasks. So it's not like there aren't other things... it's just that she can seem so sharp and reasonable one minute and then tell these delusional stories the next.

M1

JP it's interesting, I've freqeuently heard the analogy of "loose wires," where there's sometimes some connections and sometimes not.  We're well into stage 5 here (no true delusions as yet, but a lot of sundowning, wordfinding difficulty, confabulation), and yet this morning we had a very reasonable conversation about upcoming need for outside help.  It won't last, but I keep hoping that some of it will stick.  She tells me every day how appreciative she is of my help, which also tells me that she is more aware of her deficits now than she used to be.  I have no explanation for why it varies so much from day to day.

harshedbuzz

JP-

Highly intelligent often means additional cognitive reserve- her baseline for knowledge should be greater than average which means she may hold onto certain kinds of knowledge longer than you might expect. She may also be able to "showtime" which is when a PWD is able to present as much less impaired for short periods of time- usually with doctors, friends and non-caregiving family members. 

My dad was very like you describe your mom. He was a bright guy, a former history and poli sci teacher. Every neurology and geri psych appointment began with orientation questions including "who is the president?" he not only knew he offered commentary. At home, he heard kids playing upstairs, accused me of all manner of crimes committed by his late sister and mine, couldn't tell the remote to the TV from his phone and repeated the same stories- verbatim- on a continuous loop. 

The last time he took the MMSE, about 6-9 months before he died he scored about as well as would be expected for a man his age and level of education. I watched him do serial subtraction by 7s faster than my mom could. He bragged all the way down the hall and elevator about how well he'd done- "off the charts" he said. And then he got into some random car when I turned my back at the valet stand. 

I get the silent chuckle at the well-meaning advice here. BTDT. But I also tried some of it. Dad had lost $350K in the market day-trading early in the disease. This number stuck with him and led to a confabulation that I had sold his house for $350K less than it was worth because I am stupid. Initially, I defended myself and tried to explain (silly me- reasoning with a PWD) that the market had tanked, etc and it always ended badly. But then one afternoon when this conversation got him suitably riled up (I wanted a video for the geri psych to show him how agitated and aggressive dad could be at home), I apologized as so many had said to do. I said something along the lines of "Gee dad, I'm sorry. I didn't mean to sell the house for less than it was worth. I promise I won't do that again". He didn't know what to do, so he forgave me.

I will say, the period when dad was still semi-with-it some of the time was the most challenging part of the dementia journey for me. Things were actually easier in many respects as the disease progressed. 

I also subscribe to the loose wires theory M1 mentioned. Clarity can appear seemingly out of the blue and with no obvious trigger and then fade as quickly as it came. My parents actively fought getting dad diagnosed and I only prevailed in getting it done because dad slipped into a psychotic episode when left alone for a couple days. Mom came home from her sister's funeral to a house that looked ransacked and dad telling crazy stories about having killed someone. I put my Plan B into action and asked her to drive him north to PA Welcome Center just north of DE; his local hospital had missed his diagnosis a week before. I met them there and drove them to the Hospital of the University of PA's ER. Dad was totally out of it thinking he'd taken my mom to a psychiatrist practicing out of the Welcome Center because she's crazy, then he was telling me about the 20 odd homes he owns in states he'd never been to and about how he was the good-bad guy for killing the bad-bad guy when we passed by Franklin Field, and he raised his head and said "hey, there's Franklin Field". 

HB

Jo C.

Hello Jennifer and a very warm welcome to you.  We had a similar set of dynamics that occurred with our Loved One, (LO).   It was a problem issue that I just could not understand for quite some time as it kept getting worse.  My LO was initially misdiagnosed as having Alzheimer's Disease, but things did not seem to quite fit.

Just wanting to be sure of what was happening as things became worse, I got an appointment with an excellent Neurologist who sees dementia patients as a routine part of his practice.  He did an in-depth exam/assessment, ordered a SPECT Scan, (prior MRIs had been negative), and when test results were in, it turned out she did not have Alzheimer's Disease; she actually had a behavioral variant of FTD.  That explained a lot.  She was also on a med used in Alzheimer's Disease but is contraindicted in FTD; it was discontinued as it tends to ramp things up. That did help a bit with free floating agitation.

My LO was indeed able to retain much of her capabilities and conduct some of her usual ways of being without missing much for a very long period of time.  Little bit of a short memory issue but not deeply profound; however, the strange beliefs and florid blaming with fixation on such beliefs were a real issue.  Once she tagged on to something, it hung on and on and on.   FTD had begun to cause delusions, (rigid false beliefs), that were SO far off base and often non-sensically bizarre.  Unfortunately, as time went on, the ability of being able to conduct her wants and desires while judgment and reasoning was deeply compromised and driven by delusions became a significant issue not only for matters within the home, but she began to try to plunder finances, etc.  Had to watch everything very closely as we had some close calls that she had managed with sneaking and hiding what she was doing.   The delusions became the most difficult thing to work with as they eventually became overwhelming. The blaming for outlandish things was terrible and drove her to mistrust and made things so difficult.   Basically, because I was the one doing the most for her, I was often the target of her anger and blaming.

The Neurologist seeing the severity of what was happening and that all lesser measures to deal with it were unsuccessful, prescribed medication which made a dramatic difference which also helped my LOs quality of life as she once again was able to have some peace without the turbulence of the delusions.   If they are driving us to distraction, imgine what it must be like to live inside their heads, not only believing all those delusions, but FEELING them.  Hellish for them and they do need to be helped to relief.

When you see the dementia specialist again, you might want to ask for the diagnosis for type of dementia to be re-assessed and confirmed again, that will give some strength as to which way to head as the dementia evolves.  If you share the level at which the behaviors have gone and that lesser measures do not help, it may be that a med would be helpful and one can always start low and go slow when doing that.

I could not talk about my LO in front of the physician, so I would write a detailed but succinct memo re issues and get it to him by fax about three working days prior to the appointment.  I always indicated it was time sensitive for an appointment, and then checked a few hours later to ensure it had been placed on the doctor's desk.  I carried an extra copy in my handbag to the appts. just in case the doctor had not read the faxed one.  I would excuse myself to use the restroom; go to a staff member and have them check with the doctor to see if he had read the memo; if not, I then gave them the copy I had with me.

Dementia is not an easy, clear cut process.  It is complex and often convoluted.  We learn as we go, often flying by the seat of our pants, but eventually we find our way as best as can be under the circumstances with a little (or a lot) of help.

Let us know how you are doing, we will be thinking of you.

From one daughter to another,

J.

Stuck in the middle

My late mother had VD.  She told me she was having difficulty separating her dreams from reality.  Later she developed delusions, such as that her son who never wrote or called was a NH employee and didn't speak to her because there was a rule against relatives of patients working there.

Now my wife with AD is convinced that a former employer is alive and will find her someone to repaint our woodwork if she can locate him.  She remembers her reclusive bachelor uncle surprising the family by attending our wedding in 1967, but she has forgotten her former employer's sudden death while she worked for his construction company.  Either that, or she confuses him with his partner, who is alive as far as I know.

I don't understand all that goes on in my head, and I understand less of what happens in the brains of others.  I don't know if it's like a flickering fluorescent light that's burning out or a jigsaw puzzle with missing pieces, or both.  And I can't ask, really.  How can any of us know what we have forgotten?

aod326

I agree with harshedbuzz - I found this period very difficult to deal with. I regularly missed that DH was having a "normal" few minutes and unwittingly said something that sounded non-comittal or even patronizing. That's because I was handling the dementia talk with lot's of "hmm's, oh's and really's".

The only thing I can suggest is to follow the advice for talking to someone with dementia: meet them where they are. On days when DH would talk to me about his wife (me), I'd act as if I was a friend and would try to be on the lookout for the point he moved back to realizing I was his wife. When he'd talk somewhat normally about a news item, I'd answer as if he was "old Michael", then act as if it was the first time he'd ever said it when he'd tell me about having a beer with Joe Biden when he was in his 30s. (Not true.)

Truly I found this middle-ground time more draining than when he no longer knew me, stopped being able to walk, etc.

Good luck.

jfkoc

Has Lewy Body dementia been ruled out?

Gallmeiers

We are experiencing something similar with sister. She has zero short term memory, can’t remember 5 minutes ago. Hoards everything, trash, unwanted paperwork and clothing, but unfazed that she has become surrounded by boxes and stacks of trash. Can’t remember to pay bills, organize meds, dial a phone or answer it. Doesn’t care about personal grooming anymore.  But yet, she can carry on a conversation with anyone, and make jokes. To outsiders she appears to be very high functioning. She doesn’t think there is anything wrong. We don’t have a diagnosis yet because she refuses to go to a neurologist.

toolbeltexpert

Gallmeiers wrote:

We are experiencing something similar with sister. She has zero short term memory, can’t remember 5 minutes ago. Hoards everything, trash, unwanted paperwork and clothing, but unfazed that she has become surrounded by boxes and stacks of trash. Can’t remember to pay bills, organize meds, dial a phone or answer it. Doesn’t care about personal grooming anymore.  But yet, she can carry on a conversation with anyone, and make jokes. To outsiders she appears to be very high functioning. She doesn’t think there is anything wrong. We don’t have a diagnosis yet because she refuses to go to a neurologist.

Gallimeiers welcome to the forum.  Normal chit chat is something  that is retained it doesn't have any depth at least with my dw and many pwd can "show time" for short periods, normal chit chat is a part of that. Explore the Alz.org site and you'll find some very useful and practical tips here on the message boards.  If you want to get more responses or need to vent hit the add topic. My dw hasn't  had a diagnosis either. she won't  go. Sorry you have a need to be here, but you're  in a good place.

MrsAnnabelLee

My mom has been the same throughout the course of the disease and it made early decision making very difficult. I would constantly ride this roller coaster of "does she need help? Yes! Wait - no she's fine!" and it was tough. Even now, we are at the end of stage 6, and while the next step should be a vocabulary of about 7 words, she is still able to hold conversations.

A couple years ago when it seemed like she had it all together, I visited her. I saw her most days, but typically I'd just pick her up from the driveway and take her places. On this day, I went inside her home to find she had spent the last couple days letting her house fill with natural gas from her stove. She stated she noticed an odd smell but tried to fix it with plug in air fresheners. The firefighters told me one wrong light switch would have sent her into the street. After this incident I moved her into independent living and that's where I saw the truth - she was doing much worse than I realized. This person who had done reasonably well on her own up until that incident could not walk out of her new apartment, turn around, and find the door she just walked out of. Without the familiar setting of her home she had lived in for years, she couldn't hide things as well. 

Plan for whatever her worst moments are. That's a peek into what's really going on. 

dah2731

Hi Jennifer,

I have the same issues! My Mom was diagnosed in 2020 with MCI and is on donepezil daily. I sometimes question if I should have gotten a second opinion. I am always wondering if I am handling this the best way. 

Sometimes we have conversations that seem totally fine, she's aware and knows whats going on. Then later will come, the losing of words, days of the week etc.  She does have trouble with numbers, I pay her bills, and keeping things in sequence. Also, she has a terrible time with the computer and TV remotes. Omg, I go to her house several times a week to fix the TV. We can actually laugh about some of this. She always wants me to explain to her what I've done. Ok, I get a little testy with this one, since I've explained it and showed her, lets see, every time. I've written down step by step instructions. They are right on the table. She says she used them but it didn't work. I think this is where "don't argue with them comes in". The same with the computer, it's all written down but she can't follow step by step instructions. But then, we carry on our daily things and she is just fine, mostly. Losing words is very frustrating for her and happens often but mostly she seems fine. 

I hate to complain when I know others have it much worse and I'm terrified for the day that she too will be much worse but right now some days are just such a struggle.

Thanks for letting me vent and you are not alone with this. It's helpful to know someone else has the same type of issue.

harshedbuzz

Dah-

OMG yes. The TV phase. I had almost forgotten all that.

Understanding of technology disappeared in the middle stages- dad could no longer reliably use his computer and replaced several muttering something about them "not making them like they used to" (after he died, we discovered he'd had no less than half a dozen individual security subscriptions on auto-renew and was spending close to $2K from the grave protecting laptops he'd disposed of a decade earlier), he struggled with his flip phone after returning to it after struggling with a voice activated model (This was fun, sometimes my phone would ring when he was talking about me and I'd hear him talking smack about me and another time I sat amused as mom's phone rang everytime he called out her name to order a snack or drink causing her to be redirected to answering it only to have no one on the line), sometimes he tried to answer the remote to the ceiling fan or change channels with it.

But his antics with the TV turned my hair white. FTR, my mother is a technophobe; she's convinced she will never understand things and does not even try. Dad went through a stage where he futzed with the TV constantly. Sometimes he'd hit a button on one of his many remotes and the TV wouldn't respond causing him to assume the cable box needed "fixing" and other times he'd just disconnect everything because he didn't like the look of the wires. (He told me "Everything is wireless these days")

I'd moved them closer to me, but it was still a 20 minute drive to troubleshoot the TV get it back on. I hear you.

HB

Kitchen_Cat

Morning, 

Our regular doctor told a story about his mom suddenly speaking Yiddish in her last moments. Nobody knew she could ever speak it, because her mother, that did speak it, passed when this woman was very young, under 5. Aren't our minds are amazing complicated and beautiful. Wishing you peace and strength and many more interesting conversations with ur ma. (((Take care)))

alicestevens

Wow! that is really an amazing story.

King Boo

I found very detailed coherent notes predicting the demise of GM in 2008, written by my LO a day before everything tanked.

Really tanked.  Couldn't recognize a medical crisis, a mouse infestation or get tax documents together to file a tax return, or keep food in the house to cook, or grocery shop - but could write the warning signs and the SELL!!!! warning.

I wish I hadn't been so swept up in the ensuing care crisis so I had been able to pay attention to this.  Caught plenty of garbage from the sibs that" my failure to recognize that I should act cost them a few thousand in their inheritance." But really, who juggles the stock market whilst spending the night in the ER with a probably not going to make it theme going?

Charming it was not.  

I found that note when cleaning out the house.  

Really rattled me  until I could correlate what was actually going on at the time in my dayplanner.

Iris L.

These are because the nature of dementia is that signs fluctuate and that the appearance of signs is piecemeal--all due to biochemical or other manifestations in the brain.  Also, dementia is progressive--symptoms and signs will change over time.  

Iris

Michael Ellenbogen

All I can say is don’t under estimate on what she is unless you can proof it is not true.  Things don’t always appear as what they are. Many times it not the person with dementia that is wrong but the other party in some way. Become a detective.

Rebeck

I wept when I read this, and all the answers. I joined today and I have already learned that our experience is the norm. We are not alone! Thank you, everyone for being willing to share.

toolbeltexpert

Rebeck wrote:

Welcome Rebeck to the forum that no one want to join. Sorry about your father. Everyone here is in a different place and your situation sounds really difficult, having family that's not on the same page makes for a tough start. And getting all the other stuff together takes time.  But we are all here to listen whenever you need to vent.  Keep reading and posting there's lots of folks here who have lots of insight. 

Holly H

I understand what you are saying, but I have the deed. She's just paranoid.

Holly H

I understand what you are saying. However, my brother and I are very close. We know where the deed is and we have each shown her when we are there but she goes right back to the same story after we leave.

abc123

The human brain is truly amazing, even damaged! The book The 36 Hour Day has a section that explains how the brain will actually misfire and work well for a brief time or moment. Each dementia patient is different. I’m sorry about your mom.