Fixation and melodrama...symptoms?

secondcor521

Hi all,

My Dad is nearing 88, has Alz/vascular, is definitely stage 5 Reisberg with some possible stage 6 symptoms. He lives in an AL facility nearby.

Last week his girlfriend of almost seven years was moved about two weeks ago by her family to be closer to them. She now lives about six hours away by car. She is almost 88 also and has some diminished mental capacity but is not yet as bad as my Dad is symptom-wise.

For the past seven years, my Dad's world has pretty much revolved around her. He says he is in love with her, wants to marry her, etc. I'm sure he has discussed marriage seriously with her on several occasions. She's not interested - she was already married to her first husband for 50 or 60 years. Although she cares for my Dad, I think she doesn't want to sign up to take care of him and there may be financial reasons for avoiding marriage. I find her position one that is wholly reasonable and I support it 100%.

Now that she's moved away, my Dad exhibits two traits: fixation and melodrama.

He is fixated in the sense that he mostly expresses little to zero interest in anything that is not about his girlfriend. Other residents, his family, activities at his place, are all mostly irrelevant. He is interested in news about his girlfriend, where she lives, will she call, can he call her, etc. He would (and does) gladly skip an activity that he might enjoy and wait by the phone in case she calls.

A week ago, she fell and broke her hip, underwent hip surgery, and is now in rehab. Unfortunate, of course. But it happens, and her family is doing a very good job of taking care of her as you would expect and hope - taking her to the ER, arranging the surgery, choosing a rehab place, visiting her, all that stuff.

The melodrama comes in that he wants to marry her or move to her city, or just fly there and surprise her, or visit her, or send her $500 worth of flowers, or shower her with other gifts, or hire a fleet of doctors to take care of her hip, etc. I would say it also shows up in him trying to call me 40+ times a day to see if I have new information about her ("No, not since you called 8 minutes ago, Dad.") Oh, and he threatened suicide because he missed her so much and his life was totally without meaning without her; we think it was bluster but we took away access to methods just to be on the safe side.

I get that he's mad at her family for "taking her away". It's understandable too that he's sad and misses her and is concerned about her health and well being. It's reasonable that he likes to talk with her on the phone and send her some flowers. But the degree of fixation borders on obsession and the melodrama seems over the top to everyone else around the situation.

So the question: Are these two aspects - fixation and melodrama - symptomatic of his dementia? If so, can you connect the dots for me between the listed Alz/dementia symptoms and his behavior (like it could be the personality and emotional changes mentioned in stage 6 Reisberg)? Or are these behaviors part of his personality and they're just intense now because of a rough situation? Or is it in between, where the situation plus his personality plus the disease results in this?

I ask because if I can understand the connection to the disease then it will help me be more sympathetic and understanding, and it also might give me clues how to address it better. Also, if it's part of stage 6 symptoms, that will help me know he's solidly in stage 6 instead of tentatively so, and it's helpful for all sorts of reasons to know where he stands disease-wise as I'm sure you can all understand.

Thanks for any insights!

SusanB-dil

Hi secondcor521 - so sorry you are dealing with that.

Obviously, she was so much a part of his life that the fixation is there more than it would be otherwise. Perhaps check with his doctor, because it also sounds like, at least part of it, is agitation.

Perhaps maybe, a 'joy-for-all' robotic pet - do you think that might help?

ButterflyWings

Hi @secondcor521 - Here is the link to another staging model and description of the behavior traits at each stage. Also a great explanation of the 7 As of dementia, plus the different things that can be affected depending on which part of the brain is damaged, when. Very complex what is happening to our LOs. And even non PWDs grieve a breakup of course, right? Probably especially if they had little notice and no control.

Tam-Cummings-LLC-Handouts.pdf

To answer your questions, In our experience the frontal lobe damage to a dying brain impacted judgement in pretty much all my DH's plans, ideas, expectations, etc. Also, delusional thinking is part of most of the dementias, so can contribute to his being unable to realize his instincts and thoughts of how to help her, are going way beyond what normal grieving responses might be.

Other than this, most people (even without dementia) suffer terribly if divorce, death, or dementia (in my case) causes the loss of a serious relationship or beloved person. Especially the sudden nature of this change and the importance of their relationship -- it is enough to rock anyone's world. An elderly dementia sufferer? omg, I think his reactions are completely understandable. In his view he sees her already as his mate, and likely at his age has lost many if not all friends to illness or the final goodbye. He must be devastated. I think you mustn't be dismissive. 7 years is a long time. Many marriages don't last that long.

We learn here that It is not possible to reason with someone whose reasoner is broken aka a PWD. But expecting him to "man up" and just adjust is actually unreasonable on your part IMHO. I agree it may require some mood altering meds to help with depression or agitation, which dementia magnifies. My DH takes Sertraline daily in addition to Seroquel to help manage his various Alz symptoms. As caregivers, we find that managing our own "symptoms" is important too -- e.g. keep learning, posting, finding ways to ensure your self-care so that compassion and validation can come easily despite the stress of adapting to an LOs diseased brain and behavior.

Marta

Melodrama implies that your Dad is willfully behaving in this way. If he is indeed in stages 5/6 he has no control over his own thoughts and behaviors- his broken brain is the narrator of this drama.

Have you read “Understanding the Dementia Experience “? This essay gave me empathy and sympathy (and heartache) for what my husband was going through at age 59. All resentment melted away.

HollyBerry

Poor guy! That must be rough. It's so hard for people to make friends in AL because it's worse than summer camp or a college dorm - they're thrown together with people they'd probably never know otherwise, most of them have nothing really in common, not much to talk about other than the events of the moment, everyone is their own kind of socially awkward -- and when they actually make a friend (or more) it's the biggest and best thing ever. My mom never really made friends in 7 years of AL, and also had a Jr High sort of crush on a guy who reminded her of one of her old boyfriends. In a Jr High sort of way, she wanted his attention but was upset when she got it and upset when she didn't.

Anyway - my observation this week is that my partner (mid stage Alz?) is really suffering after we had to put our dog to sleep suddenly last week. It's as if she can only feel one emotion at a time, and since Thursday it's been sadness. She snaps out of it for short periods of time, a little longer each day, but her brain just loops and loops. I'm trying to be reassuring ("I'm sad, too. I really miss her.") and not make her feel bad for crying ("you have big emotions, that's just who you are") and reassuring again ("grief takes time. You were really sad when Katie died and after a while, you were able to think about the fun times and remember her that way."). Getting out of the house definitely helps, giving her something to do definitely helps, etc etc. If she isn't improving significantly in about a week, I'll probably call her geriatric psychiatrist and see if there's an adjustment to a med that might help. Can you call you dad's provider and see if there's a dose they can tweak, or anything that might give him some relief?

Edit to clarify: I don't expect her to be over it in a week! I do think that a week of being in big emotion turmoil is exhausting for anyone and she doesn't have the resources to make herself feel better without help.

jfkoc

I think when you connect the dots you will see a clear outline of tremendous grief. You father has suffered a terrible loss and that is what you need to help him with.

harshedbuzz

@secondcor521

I am so sorry for all parties in this scenario.

I think there are features of dementia to keep in mind when parsing behavior. The of the loss of social filter could mean that you are witnessing anguish that dad has felt before but not displayed in from of you or even others. The poor memory could mean that scab is ripped from the wound fresh as he is reminded of it. (knowing what I know now, I would have rolled this information out differently-- girlfriend went to visit family-- broke hip and needs to go to rehab there-- plans to return when docs say she can) And the loss of empathy and reasoning skills means he can't appreciate that what he wants might not be best for her or her family and that convincing him it is will not be possible.

That said, IME, personality does seem to remain quite intact until the very latest stages of the disease. My friend's mom stayed the snarky delight she'd always been with close friends until about 3 months before she died. My nasty Aunt N remained nasty as ever. Dad and I never got along. I knew that darker side of the man well but with the loss of social filter (inhibition) others found themselves dealing with his difficult personality. Dad remained capable of being willfully unpleasant; I recall dad in stage 5-6 telling me he was miserable not driving and not being in Florida which was my mom's fault and that he had "every intention of making her miserable too". (Dad's geri psych agreed with me that dad likely had some mental illness-- based on family history probably bi-polar disorder that likely developed in his teens. As dad regressed in the latest stages of dementia, that part of his personality was lost and he became warm and sweet in his demeanor)

My Aunt C remained sweet and helpful in her dementia. She resided in a lovely MCF for over 5 years. During that time, she formed very intense relationships with 2 different men. The first was around stage 5. The man was kind of obnoxious; He was loud, he had trouble not being first at meals, he swore at staff. My aunt befriended him as a kind of project, she would look out for him and calm him down with little jokes and defend him against the other residents who were unkind to him. There wasn't anything romantic in this, but when he died her loss was real. A few years later in stage 6 after she'd forgotten she was ever married (she'd had a uniquely wonderful marriage to a man who adored her) she entered a kind of MC-relationship that was more like a marriage with tenderness, advocacy, scaffolding and companionship. They died within a day of each other meaning neither had to go through what your dad is.

Emotion remains intact well into the disease process. His pain is real. He may also be suffering from the loss of scaffolding and support she offered him. He might fare better in a higher acuity facility if his current one is more of a hospitality model AL. Dad's MCF was good at engaging PWD in distress, and they had an affiliated geri psych who could add or tweak medications to help him cope with this turn of events. Dad might respond well to validation from you. Perhaps picking out flowers for her (FTD has a nice website/app) that you promise to order (and either do or don't). Or perhaps he could write a card to send her. Given her age and the hip fracture/surgery situation, one might expect her not to do well cognitively, so I wouldn't expect acknowledgment if he does try to contact her in some way. My nasty aunt broke a hip in stage 5 and came out of the hospital in an agitated stage 7.

secondcor521

Thanks to all for the replies. I read them all and ruminated on them.

I think the situation (which has improved since my original post BTW) is a consequence of a combination of the situation, reasonable grief, and his disease. That was the thrust of my questioning, and I am satisfied I understand well enough now.

Part of what made the behavior surprising was that he was previously not as histrionic - not even when my Mom - his wife of 50+ years - died. What I understand now is that my Dad, for most of his life, repressed/suppressed/hid his emotional responses and now, due to his disease, he is less able to do so.

I do think that her departure and subsequent broken hip and the associated stress on my Dad has made his disease process progress. Although it could also be coincidence and there's no way of knowing for sure.

Replies to comments:

SusanB-dil, he is somewhat agitated, and I think antidepressants would help, but he thus far has refused them. I don't think a robotic pet would help - I think it would confuse and possibly scare him at this point. Thanks for the suggestion though.

ButterflyWings, he had been told several times in the months before her departure that she was moving, but my sense is that it was too traumatic so he blocked it out or forgot about it. So when she actually did move, it certainly seemed sudden to him. And since he is very selective in his friends (he maintains very few), her departure was a big part of his world. Thanks for helping me see it.

To be clear on one thing, I didn't expect or ask him to "man up". I observed his behavior, and it surprised me and was challenging to be around, so I wanted to understand it. But it's also true that I was stressed out and was having some caregiver burnout at the same time.

I read the document you posted and there were several of the "A's" that applied to him and his behavior recently, so that was helpful as well.

Marta, I haven't read that, but your reminder that it isn't willful was additionally helpful. It's very hard to remember sometimes, especially since he is quite intelligent and several areas of his brain still work well - it can be confusing. Thanks.

HollyBerry, thanks. As mentioned above, he has declined medication. We're kind of in a gray zone where sometimes I make medical decisions for him but more often I don't. It seems to depend on the provider and the situation. Anyway, at this point his PCP has discussed/suggested medications several times and each time he has declined. I suspect either he thinks he doesn't need them or doesn't think they would work well or doesn't think he "deserves" them (which of course he does, but that's part of his personality now).

jfkoc, agreed. It's hard to figure out how to help. As a male engineer, I sometimes am not the empathetic type. Plus the "on repeat" emotion due to dementia has been hard on me. But harder on him of course.

harshedbuzz, you got it pretty well. As far as rolling the information out, that was a combined effort between his girlfriend and her family and me. I didn't bring it up much before hand for various reasons.

What you say about emotions remaining intact is a trend I've very much noticed. Again, my Dad was pretty cerebral most of his life, so now he's sort of a different person, and I find better results if I tend to the underlying emotion rather than the factual question at hand. I'm not great at this but I'm learning.

I am debating a different facility, but need to consider a lot of factors and discuss with my sisters in a few weeks when they're in town. Where he is now attends well to his physical needs (medications, showers, food, dressing/undressing, transfers, etc.) but I don't think the frontline staff has much MC training although some of them are very kind and thoughtful people and try to help him.

He's bored and his mind is "blank" most days now. But he's not hallucinating or violent or aggressive or wandering or sexually inappropriate. He doesn't seem to be interested in any activities, but that's not for a lack of trying on their part - there are a wide plethora of things he could do if he chose to. He's just a sad, lonely, old guy mostly.

He did write her a Valentine's card which I sent for him, and I sent him flowers for her, and the two are seeming to be able to connect on the phone every day.

You're also right in that she has declined markedly since she broke her hip. I spoke with her on the phone a few times and the interactions were very very puzzling to me. She wasn't making much sense. And a few weeks ago before she left she was much better.

Thanks again for all the thoughtful replies. They were very helpful!