Newbie Questions

Youngest bro just called. He recalled that PWD recently brought up the subject of carpooling again. He said he'll ask him today...re your carpooling conversation, how about we start this Monday?

A step in the right direction.

Some progress, went to office of PCP, got copy of report from original neurologist appt. "...patient's MMSE of 22/30 places the patient in category of mild-to-moderate dementia." OK now I have it in writing. I asked if the PCP had contacted DMV. The front desk person excused herself and went to ask PCP. Her answer was any communication they have with DMV has to be treated confidentially; I may want to ask DMV. I asked generically, not specific to bro, would "mild-to-moderate" trigger notification. Both women at the front desk didn't know the answer. I was ready with the next step for Yes or No. I hadn't figured on Maybe. I'll stay on hold for the MRI and EEG reports. Perhaps we'll know then from neurologist's office if that triggers them to contact DMV. Meantime youngest brother is to discuss carpooling to work (today), and I'll ask this weekend about SIL beginning to drive the truck.

Thank you M1, my thinking was that the MRI results will be discussed, and at the time of the discussion I would hope the Dr would discuss how this impacts him as a driver. It seems many here have advised that the best result would be the Dr making the decison, though we can not let that be the final word if he choses not to notify the DMV. I appreciate being pushed to do this (I'm not sure I worded that well). You and others gave me ammunition for the discussion with my siblings. I agree the DPOA and the other documents need to happen soon (within the next week, no longer).

Re family concensus, I agree. Oldest brother has agreed being out of state, he'll support anything decided here. With youngest brother, I've already informed him that the only way I'd agree to us each having POA is if he agreed it would be in heirarchy and that I was above him. We see the world differently, and I never want to be in the position of trying to convince him to see things my way. That was reinforced when I tried to go for concensus this morning. We just respectfully disagree on some points. Maybe I would have handled it differently if POA's we already signed.

Thank you again, I respect your advice.

I felt foolish. I had written a reply and later realized I didn't recognize agnosia for what it was. I had it confused with anosognosia. My little memory tool of thinking the one (of the A's) that kind of looked/sounded like nausea at the end was the sickness causing you not to know you have dementia. I didn't notice that rule would apply to two words in that set of A's. I need a new tool for remembering these. : )

Thanks. Definite food for thought. Alot has to do with the personalities we're dealing with. I'm not in their home. My instincts tell me with no license and no insurance he would obide by the do not drive. With only his up to now submissive wife being the enforcer of not him allowing him access to her keys...that feels more like a recipe for disaster.

I'll have to look at the POA situation and what's doable. I think the shared concept we have (perhaps erroneously) is any of us with the POA legally could act on his behalf. In use it is agreed:

a) Wife decides things unless she abidates on a specific decision per confidence of her understanding. (At her discresion an interpreter can be used, but there are other lesser matters where she may be in the frame of mind "you decide". This is in part in respect to the cultural differences where she has been taught to be defferential. As a sample, if we all get out of the car at the same time and she winds up walking ahead of me as soon as she becomes aware she'll stutter her steps until she is behind me, because I am older (>10 yrs). When she came in to the family I tried to encourage her to walk ahead of me, especially when her husband was ahead of us both. That just made her uncomfortable per her upbringing and respect for age. At her request, I bowed to her custom rather than making her feel I was disrespecting this behavior that felt natural to her. They've been married about 20 years, and this is still how she prefers it. She will have to make the major decisions. It's sometimes hard to recognize when she's defferential purely on understanding, and when culture is playing a role.

b) Next it would fall to me to act on his behalf, unless unavailable (out of state on vacation, or some other circumstate such as severe health issue on my part)

c) in the event the above two were not available, youngest brother would be fully empowered.

Youngest brother expressed it would be nice if we could get it all notarized at the same time, and not have to go through this again in the future. He would only step up to exercise authority on a situational basis as described above.

Iris,

The questions are welcome. I'm not sure I got your meaning, "This is why the members here are slanguage." I appreciate all that come by to offer their insights and advice. I think I went back and read about 25 pages of the most recent posts. There is so much shared experience here. I've read here, "you've met one PWD, you met one PWD." It's nice knowing we all have to adapt to our LO and our experiences, it not "wrong" to see someone else's solution not fitting your situatuion. I was talking to someone on my son's paternal side who had a loved one with AD. At one point in the coversation she was adamant that we could expect a certain behavior out of my bro. I was thankful I had read here about the variations, and not one size fits all.

This bro and his wife have no children. SIL has just recently been more proactive about learning things, and acknowledging the need to plan ahead. Thanks for the tip on the Greater L.A. group being multi-cultural. I'll have to pass that on to her. I re-read your suggestion, "I suggest that you seek the telephone number and ask to speak with a Care Consultant from her background. That person can give you more guidance and perhaps have a person who speaks her language." I can put that on my todo for next week. It seems I should have that contact info ready to share with her by the time they call us in to discuss his EEG and MRI. I think it would be nice to give her someone she can talk to about it that will meet her where she's at culturally.

The neurologist asked the PCP for the most recent blood work. Brother tested after meeting with the neurologist and that was sent to him. (Rough timeline, family meeting mid Oct asking brother to follow up on these issues. Brother immediately took the action of writing to his PCP (who he had seen not long before), telling of the concern. The PCP missed how poorly the email was written etc. Bro offered he had been intentionally losing a lot of weight, and drank multiple cups of coffee a day. Bro suggested they might be the cause of the cognitive issues. Blood test was ordered early Nov. I was nominated offical Nag in the Oct. meeting. I kept reminding bro to make an appointment to talk about the cognitive issues. Excuses and delays on Bro's part. In Jan I had a need to switch PCP's so I started going to this guy. Finally (with Bro's permission) at my appointment I brought up the email the PCP had from bro and the family's concerns. This got the ball rolling. Dr scheduled an appointment with bro about a week later, which I attended. This was early Feb. Blood tests were ordered but Bro missed he was to go do that. After speaking with the Neurologist late we got the MMSE, EEG ordered, MRI ordered, and recent blood work ordered. The lack of Bro doing blood work in Feb was caught and he did that early Mar. MRI was last week, EEG the week before.)

I have his rx information, and none that I'm aware of or that the neurologist questioned as having cognitive affects.

Head trauma, it was mentioned in his 20's in his submarine days there was some falling down the stairs and minor head injury though Neurologist stated it was unlikely to be connected to what we are seeing now.

Let me know if there are other pieces of the puzzle that would be helpful.

Iris,

Thanks for your insights. Your words ring true. I now (as of January) go to/make his appointments. I now fill out his new patient forms. He and his wife always show their appreciation. In the early days, I didn't know my role yet. It seemed I was to "nag" him to do things. As you say, often the things he needed to do were outside his skill set. He needed help with his DAV paperwork. It was during that exercise that I truely saw how diminished he was in terms of doing a mulit-step process. I haven't hesitated to do for him since then. His wife has taken over handling the finances. I spent a few hours with him today as described previously. He's asked me to come back tomorrow to make sure we can log in to his bank and look at his accounts. He can log in on his phone with his fingerprint, but he currently is having issues logging in on a PC, and wants me to be able to look and advise. I can already imagine the advice that will come, as soon as the DPOA and other paperwork are signed, his access to his accounts needs to be taken away. It will be his wife only, and me as advisor.

As far as drinking so much coffee, he hadn't really stated why, only that perhaps that was why he was having issues. Clearly that's not the case, but he's down just to morning coffee and I believe he ordered decaf. After the family meeting in Oct he was convinced to quit dieting. His wife was concerned about him. As losing weight can be part of this disease, in hind sight I wonder how much of his weight loss in the last year were due to his intentions (he was dieting, and walking up to six miles), and how much was unrecognized disease process. I think he said his high was around 230 and he's down to around 180 on a 5'11" frame. Actually, I don't live far from him (within 30 minutes). His wife has asked me to meet him for breakfast every weekend. She mentioned it was to engage him in conversation. It seems she wants to keep his mind active, but there appears to be the twin motivation of having me observe him. I was with him from about 8:30 to noon today. I'll be over again for a few hours tomorrow.

Regarding your warnings about liquids, one of the things I did earlier this week was to email (to his wife and the other brothers) a set of PDF's found at this site among them was one about making the home safe. His wife acknowledged recieving them. I see brother at stage 4 on the Tam-Cummings chart. My perception is stage 5 is when he is no longer to be left alone. And over the comming weeks we need to be implementing the various safety suggestions. We (local brother, possibly my near 20 year old grandson) perhaps can all pitch in and help SIL get this accomplished.