Say you'll do this, and then you do that

concerned_sister · April 14

I'm not sure what to make of the following two behaviors.

The first, it seems I can chalk up to short term memory issues. We went out to breakfast yesterday. After we're seated, with menus in front of us, I asked if DB had any favorites at this restauraunt he suggested. He said it had been a couple of years since being here. He thought for a moment and said he was going to order french toast. A few moments later the waiter appears and DB points to an item on the menu and says he'll have…it may have been toast and eggs, I don't remember clearly, but it wasn't what he just told me. And then he pointed to an entirely different breakfast entree and said he'd have potatoes with his order. It was just "off".

This second one reminds me we have a potential fail point if DB still recieves the second factor verification code on transactions to be made on his behalf. Amyways, I think in another context I mentioned recently that with DB having SIL take over paying the bills, she needed to take care of their budget item to send me money for the shared family phone plan. DB had always preferred to do this quarterly paying in advance through paypal. I sent an email to them both asking her if she'd like to just pay monthly. Reply from him: just let me know what we owe. Reply from her: I'll ask DB to set it up monthly from the bank account. I reply to them both: you've agreed to do this monthly from your bank account. Is this a good opportunity for DB to show SIL how to set this up as an automatic payment so this is a skill she'll have in the future? I asked if they'd like to do this Sunday when I'm in there home so I'd watch as backup. This was two days ago.

Yesterday morning I see DB had sent a monthly payment through paypal on Friday night. No big deal, but this was saying one thing and doing another. Saturday evening SIL sends an email that DB sent the $ through paypal, but showed her how to do it. It got done, I got the $, perhaps I shouldn't sweat the small stuff, but this doesn't feel right. It seems he's having a harder time letting go than his words would suggest.

harshedbuzz · April 14

@concerned_sister

In dementia, working and short-term memory take a big hit early on. It could be the between the time the server came, he'd forgotten the French toast entirely. Or maybe he just changed his mind.

Question— you say he pointed to the menu. Was this a place like IHOP with pictures of the entrees or was it was standard written menu? If pictures, they may serve as scaffolding in the form of a visual prompt. If written, his reading skills may already be tanking given his language difficulties. Reading can be broken down into decoding and comprehension. Dad could decode and read words, but he didn't always connect them to context (like the name of a street he owned a business on) and couldn't hold onto information in the last paragraph long enough for anything to make sense.

I would think about paring them off the "Family Plan". It would be simpler for SIL if she was working directly with the carrier. She would not only be the authorized representative for the account she could arrange billing and service package that worked best for her.

On verification codes. There is often an option to have more than one. My investment broker allows me to use texted code to 2 phone lines, email or in-person call-back to log onto the accounts. My mom's (who is hopeless with all things web-related) email, gives the option to send verification to either of our cells or my email.

One thing about early middle stage dementia, is that sometimes it can look a bit like ADHD in terms of a lack of executive function and impulsivity. This make sense if you think about it— one of ADHD's primary deficits is in executive function which can be boiled down to if__, then___ thinking. Even if he could recall the newly agreed upon payment protocol, it's possible he decided to do something differently without considering how that might impact either of you down the road.

I would think your brother processing his evolving situation is going to be a marathon and not a sprint. As he progresses his anosognosia is probably going to worsen which means away from you actively attempting to reason and problem solve, he's going to feel like it's all overkill.

Personality is going to play into this. Obviously, your brother feels comfortable being "in charge". IME, that's hard to give up.

I may be projecting— My dad was the older and parentified sibling to his brother and sister while his folks were "busy". Calling the shots and controlling others is what felt right to him, and this carried over into his marriage. Dad chose someone who would not challenge him— not deliberately, I suppose, but mom's agreeableness and patience were appealing to him. I wonder if this could be what you're seeing. Despite being college educated and intelligent mom is loathe to be a decision-making adult. This worked great until he could no longer steer the ship. We were fortunate that dad was something of a misogynist around household chores which he considered beneath him. As he always had business finances and investments to manage mom took care of the household accounts, so this was the one piece she didn't need to pick up when dementia hit.

HB

concerned_sister · April 14

https://alzconnected.org/discussion/comment/205680#Comment_205680

"…and couldn't hold onto information in the last paragraph long enough for anything to make sense." When I was sitting there, that was the impression I had. Just too much information and he wasn't processing it all. In other settings with just a small amount of information….such as a text…he seems to read and respond appropriately. (though with difficulty, poorly constructed sentences etc.)

Re the phone bill, we have enough family members that the per person fee is very small. But it was an insight in to DB words not matching his actions.

Yes, we'll have to use one of the work arounds for the two-factor verifications. Ideally SIL will get to the point where she substitutes her phone number as primary.

Thanks for sharing your insights re his behavior and ADHD.

"I would think your brother processing his evolving situation is going to be a marathon and not a sprint. As he progresses his anosognosia is probably going to worsen which means away from you actively attempting to reason and problem solve, he's going to feel like it's all overkill." Except for the anosognosia part, this almost sounds like observations of YDB.

Re being in charge, I think you're right on target. It's no accident that his wife's cultural background was appealing to him. But I don't see it in the same way per his childhood household. We came from a pretty messed up situation. But that's a whole 'nother conversation.

MN Chickadee · April 14

My mom had a hard time ordering in restaurants early on in the disease. Something about it was just really challenging. She would end up with something too spicy or something she didn't like. We learned to confer about what she wanted and she would hold her finger over it until the server came. Eventually we just took over ordering for her or else it would be a waste of money.

Regarding two factor, is he on an iPhone? If so you may be able to log in his apple ID to another device (old discarded iphone, or an ipad) and still receive those messages if it is on wifi. My dad receives his text messages on both his phone and iPad. Otherwise you may need to change the # those texts go to.

concerned_sister · April 14

We're an android family. But that is a thought to see if the code can go to a pad the house when it is sent to his phone. Ultimately this needs to be migrated to hers, but we'll take these next couple of steps one at a time.

Hope5757 · April 14

With MIL, even in very early middle stages, making decisions between two familiar objects was tremendously difficult.

So, when we went to a store and she needed mascara, we spent over an hour looking at mascaras. When we went to an office supply store for a binder and sheet protectors, she was so overwhelmed, I finally just picked items after it was obvious she was anxious and becoming upset.

As the disease has progressed, she shows increasing inability to make any decisions.

JJ401 · April 14

If brother is displaying these difficulties to you, my concern is that there are others that you are not seeing. DH here was fine until he wasn't and I realized there were bills that he just stopped paying. He no longer does the bills.

" Ideally SIL will get to the point where she substitutes her phone number as primary." The time for that may be now.

Restaurant confusion is common. Too many choices. At restaurants, I usually tell him that he has liked x and y when we have been here in the past. Usually he'll pick one of those. But, often when his order arrives he'll ask me if he ordered that.

If you are seeing confusion on a visit, it may be worse when you are not there. He may be holding it more together while you are there.

H1235 · April 14

Ordering off a menu was hard early on for both my mil and now my mother. We know/knew their likes and dislikes and would often make suggestions in the beginning. Even something subtle like “oh did you see they have… I know that’s one of your favorites “. I found both would just take the suggestion. It allowed them some independence in not having someone help them navigate the menu line by line. But by the time the food got to the table it was a surprise anyway, since she would have forgotten what she ordered. My mom usually asks what I’m having and just orders that. Eventually we ended up just ordering for my mil and I imagine we will end up doing the same with my mom. So many little things you just do think about being a problem until they are.

housefinch · April 14

I suspect you’re seeing the tip of the iceberg of what he’s already lost. I am guessing he may need to have all his finances taken over and just allowed $20 cash a week for himself or whatever. I’m sorry. I don’t envy your family in handling this situation.

concerned_sister · April 14

Hope57,

Thanks for sharing your experience. I'll try to keep in mind decision making is becoming more difficult. I remember in seeing some of the online videos that offering the PWD a choice of two usually works best. I had hoped there was a favorite that led him to suggest this restauraunt. Maybe after a pre-waiter discussion with DB, I need to suggest, "if you don't mind, I'll order for you".

JJ401, you're right, this has had a financial impact on them. That is being addressed. Once we talk to the CELA, unless she suggests a reason not to, they will pay off all their credit cards. I've discuss with them using just one of thier cards and retiring the others. (Not necessarily closing them per impact on credit score.) Perhaps shredding is the solution. YDB suggested getting DB a "capitalized" credit card, Basically you deposit a fixed amount and the spending is capped at that amount.

I hadn't considered he may be "showtiming" me.

Chug,

Thanks, I'll have to make a mental note of what his favorites are. We're not likely to hear, "I'll have what she's having." I'm notorious in the family for being a picky eater. The others are more into spicy food and the condiments.

Hello Housefinch, you're in tune with younger brother's suggestion of a capitalized credit card. His problem has been more of the nature of not paying bills rather than spending extravagently. But when reading the experiences of others, I can easlily imagine DB falling into the category of buying X on amazon, forgetting and buying it again, and again. I do see challenges ahead as SIL will have to enforce limits with DB. And I know I need to start giving them space, with inevitable trial and error, after we get to the other side of the CELA appointment. My next goal will be to help him get in to the VA medical system, so that down the road they'll be there for him as his needs increase. That I see as far less time consuming that prepping for the CELA appointment. Today I've sent him things to print out for the appointment. He called to ask me if I ever sleep. I've put a lot together, thanks in large part to the help I've been given here.

Say you'll do this, and then you do that

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