Too involved? Waiting on crisis?

You received some excellent information from M1, so I'll just add a side note. I question her comment about how she "quit drinking." If she was a heavy drinker, quitting suddenly on her own is highly unlikely. Perhaps she was a light drinker, or isn't telling you the truth.

Also, is she driving?

@3rdfamily said: She has been drinking for years. And I've seen her sprint to a bottle of wine cause it was little past 5. Maybe she has Wernicke-Korsakoff Syndrome and doesnt want to tell me. That would be great, it's reversible if caught early.

Hi and welcome. I am sorry for your reason to be here but pleased you found this place.

I would suspect Wernicke-Korsakoff's given the history of drinking and the "no alcohol" notation on the bloodwork. Perhaps she's been diagnosed and doesn't want to share what is a stigmatizing diagnosis. I wouldn't expect traction with her PCP unless she becomes unable to communicate herself even if you are on the HIPAA forms.

My dad had WKS as well as garden variety Alzheimer's. M1 is spot on that you could be looking at mixed dementia. Early on, pre-diagnosis, dad's Alz symptoms were more prominent— the darker moods, the lack of empathy, no social filter and the apathy. But in the middle stages, as his WKS really kicked in, we saw more of the symptoms associated with that— conflated memories that came out as accusatory stories (I was often credited with terrible things my sister did), an unsteady reeling gait (falls), spatial processing issues (banged up and dented cars) and an intolerance to cold (setting the heat for 85F in July in coastal MD).

Often with WKS, there is a Wernicke episode which looks like a psychotic break. It's called a syndrome, but it's actually 2 distinct conditions. I was told if the Wernicke's psychosis was recognized, promptly treated and an abstinent lifestyle was maintained, that there was a good likelihood of a return to baseline. Unfortunately, if this is not addressed early on, the degree of improvement becomes more limited. Some people do maintain whatever level of function they land on, but some folks do progress. Dad was treated with IV Thiamine in the hospital and his clarity did seem to level off considerably until he started drinking. That said, this improved cognition left him in a stage where he needed mom and I to make major decisions as we planned for the progression of Alzheimer's which led to considerable agitation and even aggression.

That said, my mom— oh the irony— had a bout of autoimmune liver failure about 8 years ago. She did have considerable issues with confusion, memory and concentration for a time until she recovered. Dad's liver bloodwork was always within normal ranges by the time I moved him here around the psychotic episode that led to his diagnosis.

It's interesting you mention a significant number of family members with dementia. While alcohol is a neurotoxin, not everyone who drinks to excess seems to develop WKS. There seems to be a heritable component. My dad's family has a collective history of alcohol and substance use. The men who came before him behaved like poster boys for prohibition. Not only was dad diagnosed with WKS, it turns out his nephew was as well. Nephew was in his early 50s and seemed stable for a long time being looked after in an in-law apartment owned by his son. He may have relapsed, but he didn't live to see 60. My sister also likely had WKS in the end stages of her battle with HIV/AIDS in the days before effective treatments. It's possible one or more of your late family members could have had WKS.

HB

Based on what you have shared, dementia is already here, whatever type it is. I would get POA paperwork done with a lawyer asap so you don't have a total mess if/when she can't make decisions for herself. Without it you would have to pursue guardianship which is way more difficult and expensive. If she is resistant, maybe say you are doing your own legal paperwork and the attorney will do hers for free. "So I can see after you if you are hospitalized" kind of thing. Therapeutic fibs. Elder law attorneys are often good at finessing these situations. Once that is done you may have to wait for her to progress before intervening. If she is taking care of herself and most issues are related to personality changes and making odd choices, then you maybe just have to watch it unfold more. Watch out for kitchen safety. Burnt pans etc. That is probably the most likely to be a safety issue first. Can you get into her house and see if there are signs of alcohol? It would be unusual for a person with dementia to just quit easily and quickly. Is it possible she thinks she quit, or is telling you she did, but still using alcohol? Many PWD forget they need to abstain, or forget how many they have had and pile them on.