Neurologist

I don’t know how to get an appointment any sooner. If you believe she is in true danger you might see a lawyer about getting guardianship. I believe the court would order an evaluation. It’s my understanding this can be difficult to get and it would probably upset your sister and cause problems between you. If this isn’t an option, there might be some things you can do while you wait. Has your sister appointed a durable power of attorney? This is very important. Trying to convince her she has dementia and should get her affairs in order will probably not go well. It might be best to suggest that she do it as a precaution since she is “getting older”, maybe even tell her you are doing the same. I know this seems dishonest, but you are never going to convince her of anything using logic and reasoning. People with dementia often have anosognosia. This is the inability to recognize their symptoms or limitations. It can make things very difficult. To keep her safe you might find it is more productive to use work arounds. Instead of trying to convince her she shouldn’t drive, contact the dmv and report her as an unsafe driver, take her keys or disable her car (without her knowing you did it). Without the DPOA I’m not sure how much you can do to help her stay out of financial trouble. Look up the term therapeutic fib. I would also encourage you to learn all you can about dementia and how to be a caregiver. Do you have any plan for her care when you are able to act? If your thinking about assisted living or memory care you should keep in mind that there can be a waiting list. Dementia care is very expensive, if you think she may need Medicaid you may want to look at some of the basic requirements and what is covered in her state on line. I you can prepare for the appointment by making note of the symptoms you are seeing. I would give this list and concerns to the doctor just before the appointment. I have attached a few resources. If there is any reason at all to call 911 I would not hesitate. Explain the situation and tell them she is a harm to herself. If she might need to visit the emergency room (even if it’s a for a bad case of the flu) I would ask/demand a psychiatric evaluation. I hope you are able to figure something out.

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

Unfortunately, the reality is that long waiting lists are a reality for the neurologists and memory centers. The waiting time has also been exacerbated by the roll-out of the newer infusion medications as previously many PWD were seen and treated by their PCPs. When dad needed to be evaluated in 2016 the wait list was 6 months in his rural/resort community and about 4 in my more medically well-served area. When I wanted mom seen two years ago, the wait list for the university memory center where dad was seen was 6 waitlist to schedule an appointment 6-12 month after that.

Some thoughts—

If she hasn't been seen by her PCP for these symptoms, that should happen soon. A PCP can start the evaluation by doing some screening tests like MMSE, MoCA or SLUMS as well as ordering bloodwork and imaging to rule out other treatable causes that mimic dementia. In mom's case, she was treated for Lyme Disease and improved considerably with treatment for the infection.

You could try other practices as well as ask to be put on the cancellation list for UAB.

If her situation is unsafe, say she's living alone and shouldn't be, you could go through the courts to obtain emergency guardianship. When this is done, a judge will likely order a full neuropsych exam to determine her capacity before granting permanent guardianship. My aunt and a friend of mine both had to go this route for a LO. In many respects, the legal piece is every bit as critical as the medical one in the context of dementia.

If you are seeing a change of mental status with behavioral changes or agitation, admission to a geripsych unit via the ER may be an option.

I used the above option to get dad help. My mom fought me on having dad evaluated for a decade until there was a crisis. She'd left him alone to attend her sister's funeral during which time he came off the rails and had a psychotic episode. We drove him to the ER of hospital affiliated with the top memory center in my city where he was admitted to neurology and given a tentative diagnosis and treatment for his vitamin deficiency along with a follow-up appointment to complete the evaluation on an out patient basis.

With my mom, we started with the PCP who ordered the bloodwork and treated the Lyme Disease. She improved a lot, but I still see some changes in her. Since the wait to be seen was so long, we decided to participate in a study being done by the memory center that is aimed at developing an enhanced screening tool for PCPs. This was a virtual appointment that included interview testing and some physical tasks. She later received results by mail that indicated there were no concerns based on her testing.

Good luck.
HB