Newbie Questions
Hello,
I just started posting this weekend after having read for a few months.
My brother is a few years away from turning 65, and a few days away from his MRI. His wife speaks english as a second language, so they've asked me to be actively involved helping him through this.
One of the old discussions I read recently was advice about not discussing the diagnosis with the PWD. Is "Early Onset" an exception? It seems that would be true per implications for continuing to be able to work.
My brother has his "day job", but also had a side business working hours on nights and weekends. At his request, I helped him put a letter together for the last of his side clients stating he'd no longer be able to continue working for them.
I've seen here the advisability of consulting a CELA. I've mentioned this to my brother for adivce in handling his assets now to prepare for any LTC needs down the road. Some discussions I've read often advise to handle these things without including the PWD. Would it be true that this "Early Onset" situation is an exception? The concensus among our set of siblings is he would be at stage 4 in the Tam-Cummings scale. He has a definite word finding deficit in talking, and it also has a great impact on his ability to compose an email. But I'm still holding out hope that he can still follow a conversation - I think he can. How does one know when you've reached the stage where the PWD should no longer be included in such discussions?
Thanks in advance for any input.
Comments
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My wife 76 diagnosed 15 mo ago “ moderate on set of dimentia, she takes care of all personal needs, short memory loss and confusion at times. Mo driving and thinks she’s fine , times she tells me she’s not right. Hasn’t cook in yrs. Every case is different,
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Hi and welcome. Regarding the CELA (yes, do this ASAP), how many do this is by having an initial conversation without the PWD present and then bring him in to give input. Then, once things that he needs to sign are handled, again leave him out. You want and need his input on his advance directive. And of course he needs a sign his documents. But if he has anosognosia (inability to see his deficiencies) and has issues with reasoning and executive function, the discussions will most likely upset him and possibly make him resistant.
That being said, I took my husband with me to most appointments, until everything was signed. It was rough, but we got through. And our CELA knew how to explain things and direct the conversation so it didn't spin out of control (it also helped that there were two office dogs that my husband could focus on). And if he's truly able to reason and is aware of his issues, it's probably good to include him and give him that level of control.
All the best to you and your family as you navigate this important step.
PS you posted on the spouse/partner board. Not a problem, as there are many kind members who will be glad to help. But you may get more of a response and broader experience if you post on the general caregiver board.
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Hi Charley, thanks for responding. Sorry you're dealing with this. My sense is my brother won't be driving much longer. We'll know more soon. Yes, I've read every case is different. For my brother, I imagine he'll miss cooking. He has loved to cook for others. He has a smoker, and would often tell me what he planned to cook. I'd go in on the meat with him and he'd cook it up and then ask me to take my share to my MIL, who was in her 90's and didn't cook much. Perhaps six months ago he told me his smoker was no longer working. It was a few months after that his deficits became more noticeable. In hindsight, I wonder if the smoker stopped working, or if he no longer had the ability to use it.
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Welcome to the forum. The other consideration to address with an attorney asap is that with a diagnosis, he should qualify for short-term disability from his "day job"--this can be important, because you don't want him to be fired for cause and thereby lose out on any retirement benefits for which he may qualify. He then can also immediately apply for long-term disability, with expedited handling by Social Security. Once this is granted, he will be eligible for Medicare a year later. Some here have used different attorneys for the disability applications vs. the longer-term care concerns; I didn't have to go that route so I am not sure which is best.
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Aside from the excellent advice you’ve already received, I’d like to touch on the driving.
I think you are probably exactly correct that the smoker didn’t break, but your LO was no longer able to remember how to use it correctly. Dementia isn’t just memory loss. His ability to drive will be impacted. It may be that he gets lost driving in a familiar place, but, much more importantly, he may become incapable of reacting to sudden obstacles on the road, like a child running out to get a ball. With a dementia diagnosis, he will no longer have coverage in such a case and will be financially liable for any accidents or loss of life.
It is a hard obstacle to overcome and seems like a terrible thing to do to a person. Just remember it is the disease that is stealing some of his independence from him, not family. And you wouldn’t want him to kill someone, knowing you could have prevented it.
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Jeane C.,
Thank you for your imput, and the reminder there's another board to choose next time. We are fortunate that there's a retired lawyer in the family that has provided DPOA and other forms to be signed. My thoughts on the CELA are mostly around strategies with handling assets and applying for SSDI. We may get help with the expenses they are bound to incur if the VA approves his claim. But I see that as a big IF as may be necessary to prove his dementia now is related to being a nuclear engineer in his 20's. I guess I can picture him in a discussion of the need to do this stuff just right, but have his wife or sibling with POA actually execute the plan. A "good" complication is he works at the same place he has since he left the Navy and they are very willing to leave him on payroll as long as possible. But still, I imagine there are scenarios where it's just better if he goes on SSDI sooner rather than later.
M1, thank you for the welcome. I thought I read you must be on SSDI 24 months to qualify for Medicare. He'll hit 65 before that. But it seems I read a rule that says your SSDI amount would be equal to your full retirement age Social Security. I think he may "do it wrong" if he think he can stay on payroll til age 65 and then retire. (Having him carpool to work is lined up as needed.) I don't think that's in his long term best interest...but that's why we need the CELA to advise on that. I stopped by the office and picked up a few business cards. Her rates are $450 and hour, but can be well worth it to get this stuff right. For the record, his job has no pension or LTC or LTD insurance. The driving is a worry. What I've read of our DMV rules is that at 'Moderate' the doctor has his license revoked. If he comes up just short of that, I plan to use what leverage I have to have him go to DMV to be tested. I don't believe he would pass. I don't want it on my conscience that he would still be driving when he's not capable. The MRI is this week.
Phoenix1966,
I combined my responses re driving with my above comments to M1. I appreciate all the points you made. It seems you and I see eye to eye on this. Though I hope making it the Dr or DMV who makes the decision (re losing drivers liscense) that any displeasure will be focused there.
Thank you all for your input.
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Just one more comment-don't put too high expectations on the MRI being definitive, it probably won't be. the imaging tests are better at ruling out things (tumor, stroke, hydrocephalus) than at ruling them in. Neurocognitive testing is the functional test for dementia, but many never formally complete it.
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M1, thank you. I guess I've seen so many dramatic MRI's I hoped/feared it would be definitive, but perhaps that's a bit much at this stage. When discussing this with siblings I often reference "think horse, not zebra". But would an MRI tell us if we're dealing with a zebra - something else organic causing the symptoms? Re-reading your message, it seems it would show things such as a tumor.
The neuro-cognitive test, would that likely be the one he was given at the first appointment with the neurologist. That was where he was given 3 words to remember (failed most iterations of repeating that back), subtracting from 100 by 7's (only had one right in that sequence) and drawing two intersecting shapes similar to the outline of a house (the dr pointed out the original intersected at a box in the lower right, where brother's drawing intersected in the roof). That was scored 22 out of 30, mild to moderate dementia. It seems my expectation is to not have anything more precise than that, just potentially ruling out zebras.
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Sister, you’re a good sister. I get that you’re wanting to do the best for him and his wife. My best advice is to consider your brother’s personality and resiliency. In our case, My husband wanted to know everything. Others may not be able to handle it. You know him well. Maybe you just need to ask him how he feels about everything and how he wants you to proceed regarding information. It’s obvious he knows there’s a possibility, with the appointments and MRI coming up. You can never err with honesty.
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SSHarkey,
Thanks for your supportive message. Yes I know him well. Let me share a bit. As a kid he was designated a "mentally gifted minor" (as was our youngest brother). Always very smart. And he excelled at computers and all things tech. For decades he was my go to with tech questions, applying updates and buying/installing new hardware. And any tech device, I'd ask his input. He took great pride in finding a deal, then putting it on his credit card for me to get an extended warranty for free. When we as a family noticed his decline, I was chosen to be the go to to help him through this. I accepted without hesitation. He always sincerely thanks me - but I remind him that he's been pre-paying for my help for the last few decades - I'm glad to be of help to him.
So thinking though what I think he wants...I think he wants to be informed, until he can no longer process it, but I believe he wants someone he trusts to be making his decisions. Of course his wife is #1 decision maker, but it looks like in those cases where she doesn't feel confident (fear of not taking it all in per english as a second language), I'm next up. He plans to have the legal paper work signed in the next few days. He'll have one other brother named as POA, but we've all agreed in advance on the hierarchy so there will be no split decisions.
Side note, per his wife's request, brother and I set up going out for breakfast once each weekend, giving him an opportunity for a one on one with someone to listen to him as he goes through this.
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Ask about him taking short term disability leave of absence aka sick leave, pending completion of his medical and neurological evaluation. This is because sick leave usually requires only a doctor's note, and can begin immediately, whereas long term disability leave requires a significant amount of medical documentation and takes a lot of time. But with a dementia diagnosis, he is eligible for Compassionate Allowance for SSDI.
Regarding him continuing to work: you might discreetly ask to see his latest annual employee review to see if there have been verbal or written warnings of poor performance. If so, he is at risk for being let go. He might ask for reasonable work accommodations (see www.askjan.org). But this is not a guarantee. Discuss this with the attorney.
If he has been with the company a long time, it might be a good idea to arrange for a dignified "early retirement" for personal reasons. There is no need to disclose his actual diagnosis if he doesn't want to.
Iris
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Thanks Iris, I like your thinking on this.
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Hi. A couple of thoughts struck me. In random order because I haven't finished my tea yet.
Even though you are a sister, I suspect you may find this board the most useful for you most of the time. I was an adult child whose mom was initially in denial and then out of her depth as the result of birth order and temperament-- I found myself working with mom as a team. This board helped me navigate not just what dad was going through, but talking with these expert caregivers what were the best ways to support mom. Your situation seems similar.
A child who was identified as "gifted" would very likely have something called cognitive reserve which can allow them to "hide" their deficits a bit longer than without it. Sometimes this cognitive reserve can result in a better score on a quick in office exam like MMSE or MoCA than would be expected based on their ability to function in the larger world. Dad not only had cognitive reserve, speech that remained surprisingly intact, and he could showtime*, so it was hard to get a bead on where he was in terms of progression.
My dad took MoCA at his geripsych's office about 6-9 months before he died. He scored in the mid-20s; he could do serial subtraction faster than my mom who doesn't have dementia. The doctor assured him he was doing great and dad bragged all the back to the valet stand about being off the charts. While I was turning in our claim check, dad toddled off and got into some random little old lady's car.
Imagining studies don't tend to bring much to the table. A tumor is possible, but not likely. You might see some volume loss and perhaps evidence of past TIAs/stroke.
It's great that you and your SIL can work together. The language barrier must be challenging. We had something similar with my aunt. Her daughter, my cousin, was her only surviving child and was deaf from birth. While she did attend a so-called oral school where she learned English, she now communicates almost exclusively in ASL which made it difficult for her to give a history or report on life at home with nuance. What helped was getting the best interpreter possible. Most large metropolitan hospital systems do have interpreters available with notice-- this might be useful for your SIL.
So many people think of dementia in terms of memory loss. Just as important are changes in mood and losses in higher order reasoning, processing speed, and executive function. This will not only impact him in the workplace unless his job is a completely rote activity, but it will also impair his driving. Most insurance carriers will not insure someone who has a dementia diagnosis. Dad's policy was voided by such a diagnosis. If he's involved in an accident-- at fault or not-- his medical record that includes a MMSE or MoCA of 22 would be used as proof he wasn't fit to drive. If sued with no insurance, he could lose everything. His POAs could also be held liable for damages for allowing him to drive.
The other piece is that a lawsuit takes time to make its way to court and dementia is a progressive condition. My mom, who does not have dementia, was sued after an accident. The notice of the lawsuit came 6 months later and the depositions 5 months after that with a trial date set for 18 months after the actual accident-- a PWD would have progressed during that time and be a very different individual in front of a jury than the one who had the accident.
It's hard to weigh in on how much to engage your brother in decision making now and going forward. At some point, many PWD develop anosognosia. This is a condition in which a PWD is unable to recognize the ways in which and the degree to which they are impaired. They don't know what they don't know. With my dad, who was told he had dementia by his doctors for legitimate reasons, he could admit to forgetting things but not to losses around cognitive and reasoning skills. Trying to convince him otherwise felt like gaslighting to him and resulted in agitation.
*showtiming is when a PWD can temporarily get it together and function at a higher level than their typical baseline for a short time in certain settings-- like visits from family or a medical appointment.
HB
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HB,
Thank you for taking the time to share your thoughts. I had read in the discussions here about cognitive reserve. I've been bracing myself that the MRI might show more deteriation than might be expected. Per the comments left yesterday, it seems that shouldn't be an issue. Though like your saying, he may not be a "true 22", based on the deficits he's showing with normal tasks. This is very apparent when trying to compose an email, or just carrying on a conversation. He'll often freeze up, and I have to try to smooth things out and keep going. Another sign of this from breakfast this past weekend was that he ordered an omelete, and I a breakfast burrito. I had to step away to get something out of the car. I returned and he was smiling telling me his food came. My burrito was in front of him. I reminded him he ordered an omelte. He looked down smiled, and said yeah. I encouraged him to set it aside while we waited for the other plate. The omelete came out and we each got our own meal. That was the first example I had of misnaming things, up to then it was word finding and freezing up.
Thank you for the reminder a translater might be available for my SIL. My hunch is the appointment to discuss the results of his EEG and MRI will be set on short notice, and in the DR's office. We might need to schedule some follow-up with an interpreter for her.
And thank you for emphasizing the driving risk. That breakfast example hit me...could he mistake a red light and a green light. We don't have anything in writing yet from his doctor. My expectation is he'll tell my brother to stop driving. (MRI is tomorrow) If not, my plan is to insist (by driving him there), that he go be tested at the DMV if the Dr doesn't do this as expected.
Re my brother losing his ability to reason. It will be sad, but I won't be surprised if that comes soon.
Again, thank you for offering your thoughts and helping me through this.
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He sounds exactly like my brother! Another techie nerd who worked for Dell in R&D. Kept us all updated and in working order for years! Also gifted. And like him, wants to be kept informed. He obviously trusts you. But it also seems that there is a mutual trust throughout the family. Savor that. Take advantage of the time. You won’t regret it.
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My advice: don't rely on imaging and doctor's reports to guide caregiving and planning. What you see are his deficits. Don't wait for an accident re: driving. Read a lot of threads and you will be able to be proactive.
Iris
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I agree re: cognitive reserve. My stepdad (PWD) is a retired doctor and scored a 29/30 somehow on the MOCA and showtimed for the RNs who evaluated him from the geriatric care management agency my mom hired for advice. They said he had mild dementia. This was 1-2 years after his MCI diagnosis by a neuropsychologist. Right after the 29/30 score, he walked to the bank, withdrew what he thought was a reasonable sum of cash to take 2 daughters to dinner, and walked home. Up on arrival home, he couldn’t find the money and it turned out he’d walked home with $2000 cash in his pocket. Luckily my family found the $ somewhere in the house.
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Another perspective on the entree mix-up would be poor short term memory loss. If I were guessing, I say he forgot what he ordered and accepted what was offered.
One thing I noticed fairly early on in dementia with my dad was that his palate changed. He not only had the common increased consumption of sweets and desserts, he started to eat completely different foods and often opted for something "hand-held". I almost fell out of my chair the first time my previously picky dad ordered chicken fingers at a steak house.
HB
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SSHarkey,
Congrats on having been blessed with a great brother. Our family is working well. My thing had been genealogy, and my prior employment used my research skills. So doing this research on behalf of my brother comes naturally. I've sent stuff on to my SIL, but I keep some stuff in reserve, as his primary care giver this will really hit her. The routine has been I'd look stuff up, put it in an email/text to the two other brothers and call them nearly daily to talk over the info and share recent observation about PWD. I am the PWD's go to. He has me contact his former employers, contact the DAV and other things. Yes we all trust each other...but on life in general we don't see eye to eye. I've made it clear if more than one sibling was given POA that a hierarchy had to be established, as we weren't going to have one sib trying to convince the other on a situation (one sib is out of state, so he wouldn't be a decision maker).
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Iris,
The MRI is today. I have told them (siblings) I want to take him down to DMV to be tested after we get his diagnosis. Yes, we were told, but we have nothing in writing. Perhaps I should call his PCP today (we have same doc) to see if he'd step in with DMV. My hunch is that even though we have nothing in writing, the neurologist may have sent a summary of our visit to the PCP. And though I'd like to blame the Dr's, I'd force the testing even if I don't have them interceding. From what I've read of our laws in Calif you can still have your license if you have mild dementia, but at moderate you lose it. We were told he's mild to moderate. I put him in stage 4 on the Tam-Cummings. Per "cognitive reserve" his 22 out of 30 maybe inflated. I agree with you, my observations have to trump the doctors. Even more so when possible showtiming is factored in. Luckily, there are two brothers at the same place of employment. Arranging car pooling should be a non issue...other than his pride.
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Housefinch,
I could totally see a similar circumstance. He blanks out in the middle of things.
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HB,
Thanks for your thoughts. This was a recongition thing. I asked him, your ordered an omelete right? He agreed looked down at the buritto and smiled (communicating I got mine). I was pretty convinced he didn't recognize what was infront of him as a burrito. We've gone out to breakfast the last couple of weekends. Breakfast has many sweet offerings, but so far he's stayed away from those.
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A person who "blanks out in the middle of things" should not be driving.
Iris
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Please don't let yourself get bogged down by minutia, such as remembering breakfast options. I am frequently thinking about the little things that I don't remember, as a person with memory loss. But I don't let myself get stuck on these things. There used to be a book recommended, "Moments of Joy" by Jolene Brackey. There are so many upsets, for lack of a better word, in the world of dementia. We cannot focus on every little thing. We have to have some peace and some joy in our lives.
Iris
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Iris,
I love that you're on my case. I appreciate this. I actually called the PCP's office Tuesday to see if there was anything in writing. I had to leave a message. The neurologist did not give us any notes when we were in his office; he said he'd have something typed up. From a co-worker of my bro's I heard that bro had his speakerphone up loud today and it was overheard that the PCP's office called bro and said they got a copy of "the report". Hmmm, my first hunch was it was a follow-up to the message I left. This happened a few weeks back when I left a message with the PCP and they called bro with the answer (that he did not understand). OR, this was PCP letting bro know they got a copy of bro's MRI report. I half expected bro to call tonight, but I didn't hear from him. My plan is to wait until 10:30 a.m. and to call in to the PCP if I don't get a call from one of them by then.
This is to let me know if the Dr has handled it with DMV or if I need to initiate the action.
Thanks again.
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Iris,
To me it wasn't a "remembering" issue, as much as a recognition issue. It actually underscored for me the driving risk - what if he mistook a red light for a green light. I'm treating this as a priority.
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A couple thoughts-
Are you cleared to speak on brother's behalf about medical issues? Do they have a signed HIPAA document on file with your name? If not, you will not be able to have a 2-way conversation with the doctor outside of an appointment you attend escorting your brother. Even if you have it signed, the doctor may convey the information to his patient absent documented incapacity.
About the driving. I know you're sick of hearing about this onerous responsibility-- the losses in dementia are about more than memory. In the early days of the disease progression, memory isn't the most critical loss. There can be losses in executive functioning, delays in processing information, glitches in spatial skills and reasoning, and changes in mood/personality that could lead to poor decision making. Proof of these kinds of losses can often be seen on a PWD's car-- scrapes from guardrails, dents from backing into poles, dings and scrapes. Dad's late model car looked as if it had been in a demolition derby. My mom's neighbor mistook his gas pedal for the brake and drove through the back wall of his garage into the laundry room a few weeks ago.
I sincerely hope the doctor will tell your DB he can no longer drive, but at the end of the day it's on family to police this anyway. If there's any doubt, there are specially trained OT's who can test for fitness to drive. The obvious limitation to this is that the results are only really a snapshot of a single day in a progressive condition.
HB
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HB,
I'm grateful for the insistance (for lack of a better word) on the driving. Knowing how serious you all with experience take this helps steel my resolve to take this in my own hands.
Re speaking for my brother medically:
I share PCP's with this brother. I went with the brother to his appointment where we discussed his decline. We asked for a HIPPA form to sign, and the doctor responded since bro was physically there telling PCP it's ok, PCP didn't need bro to sign the form, PCP just made note of it. (I wish he had done it anyways. This might have prevented his staff calling back bro when I call in with a question.) Bro "butt dialed" me this morning. I asked if he had spoken to his Dr. He said he checked for his results, and they hadn't been released yet.
I do have a HIPPA release form signed specific to the DAV where I can communicate on Bro's behalf.
We have signed HIPPA with the neurologist office.
We have HIPPA signed with the MRI place, I'm to be emailed the report and digital images when they are sent to bro.
Regarding bro's truck - It's about 3 years old and no signs of damage. This can change in an instant, but at this point everything is intact. As agreed to, we'll be doing breakfast again Saturday. I was here composing the next sentence, "I hope I hear from the doctor's office today...", scratch that, I'll go down to the doctor's office today. I need to see what we have in writing, if they've started the process with the DMV, or if I'll have to take the initiative. Hmmm, maybe I'm at a point of leverage here. He agreed he would sign the DPOA, and other legal forms after the MRI which we accomplished Wed, though he may push back and say he meant when we had the results of the MRI. Thinking this out, I can call brothers and get them on board that we insist that he do the DMV test before we take on responsibilities for him. One of the brothers would be his car pool buddy (they've done this in the past), so we can make this happen. I'm confident I'd have full cooperation of his wife. I guess I have to start this rolling today by going down to the doctor's office.
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Here's what I've looked up:
When someone is diagnosed with dementia in California, the Department of Motor Vehicles (DMV) takes specific actions to ensure road safety. Here’s what happens:
- Driver Medical Evaluation: If the DMV receives a report about a driver with dementia, they follow up by sending the reported driver for a driver medical evaluation. However, DMV does not take action without information from the driver’s doctor. Dementia refers to a group of degenerative brain disorders that affect memory, language, reasoning, and problem-solving skills. These disorders are generally progressive, meaning they worsen over time and significantly impact a person’s ability to drive safely1.
- Moderate and Severe Dementia: People with moderate or severe dementia cannot safely operate a motor vehicle due to the following deteriorations:Consciousness: Inability to respond rationally to the environment, leading to serious accidents.
- Cognitive Processing: Difficulty remembering destinations, inattention to external stimuli (such as pedestrians or oncoming traffic), and poor judgment in traffic situations.
- Strength and Coordination: Weak muscle control and slow reflexes, making it unsafe to react appropriately to traffic situations or hazards.
- Driver’s License Reexamination:Drivers diagnosed with dementia must attend a reexamination and take a driver safety knowledge test.
- If the driver passes the test, they may be asked to take a special driving test or a Supplemental Driver Performance Evaluation.
- DMV schedules a reexamination within 6-12 months to reassess the progression of dementia because mild dementia can rapidly progress to moderate or severe, even if the driver is unaware of it.
- If faculties are significantly impaired or if the driver is mentally and physically incapacitated, DMV may take action such as revoking the driver’s license1.
Remember, road safety is paramount, and these measures are in place to protect both the individual and others on the road.
0 - Driver Medical Evaluation: If the DMV receives a report about a driver with dementia, they follow up by sending the reported driver for a driver medical evaluation. However, DMV does not take action without information from the driver’s doctor. Dementia refers to a group of degenerative brain disorders that affect memory, language, reasoning, and problem-solving skills. These disorders are generally progressive, meaning they worsen over time and significantly impact a person’s ability to drive safely1.
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I had a 3 way call with the the two bros (only one missing of bros was PWD). They are in agreement with the plan that I go down to the Dr's office today and get the copy of report from original meeting with neurologist. Check if communication with DMV has begun. If it's in process - good.
If it's not in process, see if I can get a moment of the Dr's time, perhaps a word with him can start the process.
If not able to speak with him or he disagrees, I have to have conversation with PWD tomorrow at breakfast. I had to concede some points to bros to reach concensus. I need to discuss with him the reasons to stop driving per protecting their assets etc. (I kept making the point about reasoning with a person with a broken reasoner.) They agreed with me, that I wouldn't present it as a choice - I need to inform him this is about to happen, and over the next week he needs to talk with his wife and carpool buddy.
Though I held strong on this is the time to stop, they held out for tell him this is happening, and you have a week to talk to your wife about this and we'll talk again in a week. They agreed not to waiver if we gave him a week to adjust.
We discussed if we need to provide him additional information (I kept making the point we won't be persuading him, I'm adamant we can't let him feel like he has a choice, and then turn around and overrule his choice) we could talk about our not wanting to accept the risk his driving would have for us in becoming his POA.
Though I did talk to my SIL during the MRI about her needing to take over the driving, we didn't time frame it. I'll be needing to talk to her again now. I've mentioned the SIL has english as a second language. She comes from a country where the female is always in the submissive role within the family. It has not been unusual on days when bro was not working he would drop her off at work and pick her up. From her not driving herself if it wasn't necessary, to her being the only driver in the family will be a shift for them, but it's one they've already been talking about.
Thanks to all who have prompted me to treat this with urgency. Time to get my day started and head out to the Dr's office.
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Commonly Used Abbreviations
DH = Dear Husband
DW= Dear Wife, Darling Wife
LO = Loved One
ES = Early Stage
EO = Early Onset
FTD = Frontotemporal Dementia
VD = Vascular Dementia
MC = Memory Care
AL = Assisted Living
POA = Power of Attorney
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