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A few have asked that I keep them updated on the progress of my Mom’s journey after having cognitive tests with a result of “Unspecified Major Neurocognitive Disorder” so I thought I’d share our experience we had at the neurologist yesterday. (For reference, here's my intitial post: https://www.agingcare.com/questions/mom-diagnosed-with-dementia-but-im-not-convinced-and-i-have-so-many-questions-472835.htm)



Firstly, we had an amazing Dr. He was very personable and took much more time listening to her and explaining than her NP ever has. So that immediately put both my Mom and me at ease. My Mom did all the talking but avoided any mention of memory concerns. When the Dr asked her what she was visiting for, she just said headache was her only issue (background: when I suggested we see neuro/go for MRI, I framed it in such a way to imply I was more concerned about the headaches - which is true, actually - and we could check for memory issues while at it. She fixated on headaches b/c I think she is both embarrassed and perhaps in ‘denial’ of there being memory issues). Finally the Dr probed about memory so she acknowledged it and then told him some of the issues she was having but that she wasn’t concerned. When it felt appropriate, I asked if I could add my input: I explained there had been concerns expressed around her memory (basically her husband constantly telling her about her “bad memory”, though I couldn’t say that b/c he was right there), however I expressed didn’t feel it was anything different of anyone else of her age and mentioned her stress and depression. He asked questions like: does she get up and walk around confused in the middle of the night, does she have to be reminded to shower, does she not remember what things are for - e.g. keys. (These were all a ‘no’) and then he went through some general tests with her (she didn’t do well on simple math and subtracting in her head, but she gets very nervous when doing any math, she only went to the 9th grade and has very low self-confidence with this and tests in general). After the questions were done, he went on to explain “pseudodementia”, not dementia but symptoms that mimic it and said since she scored highly on the PHQ-9 it’s could be that. Although I’m not sure if the Dr was just trying to soften the situation. He then also explained that MRI could show some changes in the brain and that some brain shrinkage is normal but he also added that he has seen patients with a very large brain that have major issues and others who have had significant brain shrinkage and they were sharp as a tack. So the message I got from that is that it’s not that straight-forward which I understand.



My gut feeling when I left yesterday was that she'll be okay. But today I woke up in a panic. I’m not sure if it’s just nerves but I am having all kinds of second thoughts. Should I have even started this process?? I know that if it turns out to be *actual* dementia of some sort, it can’t be treated so would this have all been an exercise (inadvertently) in making my Mom worried and potentially making a bad situation worse? Should we just have left well enough alone? Am I misunderstanding the whole process? The reason for going through with the initial cognitive tests was b/c Mom said she was tired of hearing her husband say how bad her memory is (he told me multiple times too) and I told her it wouldn’t hurt to have it checked out and anyway, it would likely “prove him wrong” and she would feel vindicated. I truly didn’t expect she would get the result she got from the cognitive tests. But I guess - to an extent - he got me subconsciously worried about it, too. And I would have felt I was being irresponsible if I ignored it altogether. The last thing I want is for Mom to feel like something is terribly “wrong” w/her and it make her progressively worse if there is something there.



So I guess what I’m asking is - if there’s nothing to truly treat dementia anyway, have I opened a can of worms?

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Heidi,
By coming back and updating, know that you are educating countless people at the beginnings of their journeys with dementia, even if it turns out to not be that.

Those of us, who involuntarily have been given a membership in this club, walked in, completely clueless as to the club’s prerequisites, rules, and how one proceeds into different levels of membership. One day we were on the outside, and the next, we were IN.

You’ve given insight and knowledge that so many of us wish that we would have had. I know that there are lurkers on this board, that never post. I just want to say thank you on their behalf. You will probably never know how much you’ve helped people by sharing your story.

Thank you, again.
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heidiann Mar 2022
Thanks so much for your message. I feel extremely humbled by these words. I really feel like I am just learning out loud and fumbling through this winding journey a lot of the time, but if it is resonating and helping others, that makes me feel really good. I will continue to share as often as possible. I’m beyond grateful to have found and to have been so warmly welcomed into this kind and supportive community. Thanks again!! With utmost gratitude…. 🙏🏼❤️
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When dealing with geriatric care, the end results of testing sometimes leave us with an answer of “no good choices”; whether you test or don’t test, or discuss or don’t discuss, or wait or move sooner, no choices emerge that really make things better.

So moving forward, you, as a loving and concerned relative/caregiver, have to bear in mind that you may not be entirely wrong or entirely right about what you decide, but allow yourself to be reasonably confident (and comfortable) with taking what information you have, and choosing what is safest and most accessible and most reasonable for your LO.

Your LO may be unappreciative or frightened or hostile to your choices, but, although that’s obviously the hardest part of providing good care, you have to deal with your own reactions too.

What you’ve done is definitely not “wrong” and pretty unlikely to make her situation worse. Be at peace that you’re proceeding in a reasonable peaceful way.
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heidiann Mar 2022
Thank you so much. Your kind input is really reassuring. For a moment I really did feel like I was doing a bad thing.

But you’re right, there is never going to be a perfect decision in a complex situation such as this. Mom has been cooperative throughout the process as she understands its important to make sure all is okay with her and she also says she knows that I’m just looking out for her well-being so that’s what’s most important. 

I really do feel that she’ll be okay but I also know that I may not know for some time (if its early stages and the scan turns with no issues). So it’s a delicate dance emotionally.

Thanks again. Xx
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Heidiann, in the end, it doesn't matter all that much what label is put onto mom's disorder(s). Is it depression? Is it dementia? Is it ABCD or E? Who cares, really. Let her stay on the anti-depressants and see if you notice a change in her demeanor. THAT is likely your best bet. FWIW, my mother went down the dementia highway; I started noticing her behavior was 'off' about 2014; nothing serious, just a bit off. She'd always been a depressed woman who refused to treat it b/c 'mental illness' was a huge stigma in her time, and in her mind, more importantly. I personally believe that depressed people who are prone toward mental illness to BEGIN with in life, are also more prone to dementia/ALZ later on in life. Has that been empirically proven? I have no idea; just my personal beliefs based on what I've witnessed in my mother's family. So mom stayed on Wellbutrin from 2011 when I asked her doc to prescribe something for her, until she died in February of this year. Those meds DID help her; she went from hardly functional after a hospitalization to quite functional and social once again, so the change was dramatic.

So in 2016 during a hospitalization, I asked for mom to be evaluated for dementia b/c I KNEW something was off with her. She failed the MoCA test with an 18 out of 30, and the clock she drew was a blob with no resemblance to a clock at all, meaning her executive brain function was compromised. The EB function is like the conductor of the orchestra; if he's missing, the rest of the orchestra is lost & confused.

Even after she was diagnosed, mom was ok. She lived in AL and functioned fine; had friends, went to social events, meals in the dining room every day, etc, So she had dementia from 2014-2019 without any real limitations to her every day life. In 2019 she went into a wheelchair b/c of bad neuropathy & way too many falls; that's when she had to segue into Memory Care b/c of a combination of mobility issues AND dementia. Had she not had the mobility issues, she would not have been a candidate for MC until 2021. So, she would have been perfectly functional in AL from 2014-2021 WITH dementia at play, and taking no 'dementia meds'. I wanted to tell you our story to put your mind at ease to some degree. Oh, btw, mom was 87 years old in 2014 when I first suspected dementia, and 89 when she was formally diagnosed via the MoCA test.

Elders can live long lives even WITH dementia at play, before things get 'very bad' and they need full time care or to go into Memory Care. Some never need to at all.

My point, after this long winded story, is try not to work yourself up over 'labels' given by neurologists or doctors. Leave your mom alone to live her life. Her DH is probably adding to her mental stress which always adds to cognitive decline. So does AGE itself. I can't remember squat half the times and I'm not even 65 until July. God knows what I'd score on an exam myself. Don't put TOO MUCH stock into tests or anything. Just leave mom alone to be happy, and don't talk to her too much about ANY of this! I never once talked to my mom about 'dementia'; when the subject came up, I'd tell her she had 'memory issues' along with the rest of her age group in general. She was 95 when she died. She was still in better mental condition than a lot of the other residents in her MC.

See what activities you can get mom involved in that keep her OUT of the house and occupied. I'd like to say she is very lucky to have a daughter like you as her advocate and caregiver. You did the right thing on her behalf and didn't open a can of worms; you can always have THIS baseline to go by, forever more.

Wishing you the best of luck just letting mom live her life now, w/o getting any more advice from doctors about dementia.
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heidiann Mar 2022
Thank you so much for sharing your Mom’s story. This is so very helpful for me. Especially seeing the timeline and also hearing that she went for a very long time without many limitations. That’s encouraging. I want to keep Mom active and social for as long as possible. It’s been a struggle b/c of her depression the last 2 years but I am seeing a lot of improvement in her since last year already….Plus the pandemic has played a major role in her stress b/c of the social isolation. And yes I am careful never to use the word “dementia” and try not to talk about memory at all. When with her Drs I am very careful to refer to it as “memory issues” instead and was also sure to follow it up with, “no different from any other normal person in this age group”. Thanks again for sharing and I’m glad you were able to spend so many quality years with your Mom after and in spite of the diagnosis. Goes to show that our elders don’t have to be defined by this disease. ❤️
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If she has dementia or not is not up to you. You did the right thing by bringing her to the doctor. Early dementia is difficult to diagnose. It may not be much different from the normal moderate cognitive decline that everybody experiences in old age. Dementia can not be diagnosed with an MRI, but it will rule out a brain tumor or an old stroke. The best way to diagnose an incipient dementia is by a neuropsychological test performed by a neuropsychologist. Even without any tests, dementia will emerge with all its characteristics within a couple of years. Dementia is a progressive and incurable disease. Once it begins, nothing will stop it. Some medications used at the beginnings might slow down the progression of the dementia a little bit, but it won't cure it.
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heidiann Mar 2022
Thank so much for your input. It’s really helpful as I try to navigate and educate myself on this very complex and nuanced topic. Mom already did go through the cognitive tests but the diagnosis was characterized as “unspecified”, plus the testing was interrupted - which meant the Neurosych had to put a disclaimer in about accuracy of the results. He also suggested further evaluation to see if there was a reversible cause. I guess that’s where the memory meds came in. It was me who requested an MRI - my thinking was that we could maybe see if there was evidence of stroke (she was also having headaches which concerned me - her mother died from a blood clot in her brain). But I am now starting to understand that if it’s early, it will be difficult to diagnose. So if nothing obvious comes up in the scan, then I now know we just have to wait it out. Xx
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So if I am correct you are not yet finished, and haven't yet had the final read out of all testing by the doctor? You still have the MRI to go.
Heidi, I well remember you, your Mom, and your direct and intelligent route with this whole thing and I have often thought of you and wondered how it is going. Thank you for this update.
Number one this question is more for your Mom. "Would you WANT to know. Would you want us all to know, no matter how unpredictable the disease is, the course, would you want to know." For my brother the answer, after the incidental finding of his Lewy's when he had had a car accident was "yes". He said that while he was very sad about what he likely had, while he was afraid where it would take him, he was relieved to know why he was having all the symptoms he had and why he saw the world differently than we "normal folk" did, different than he used to see it.
There is nothing, to my mind, worse than not knowing.
With all the research you have surely done by now you know what you can know, cannot know, might know, might not.
The husband, no matter his rather brutal approach, has been worried. Likely your Mom has. You have. Now you have what answers there are.
And with a FINE DOCTOR, and how often does THAT happen.
So you are on a journey to know if there are any signs. Or not. You can be more relaxed in knowing either way and can set up your lives to adapt.
Have you seen the series This Is Us. Follow a whole family from birth through death with flash backs and with three children, triplets. So much to say about family, about who we are by genes and who we are by being raised. In the last two seasons the aging Mom gets diagnosed with early Alzheimer's and it follows her journey from perspective of her family's reaction and of her own. I suggest it for you.
I would want to know if this were me. I wouldn't take medications; none are proven. I would simply want to know the reasons things were "happening" to me and the reasons I was seeing what I was seeing. I would also want to know if it was ruled out and I was simply reacting in a bizarre way to a rather cruel husband and the vagaries of aging. I would want to know.
Ask your Mom. Do you want to know? Or do you want us to GUESS every single time a word comes out wrong, every time your balance is off. Would you rather we guess?
To me there isn't a single nanosecond that I would second guess this one, but that's me and I can't stop your second guessing. I can tell you I think it is a waste of precious time, and sad you would do that to yourself.
You have a wonderful doctor. There art thou happy, as the priest says to Romeo.
You have a whole family approaching this difficulty together as a united force, all there. THERE art thou happy?
You will be able with what medicine can offer today to set in place if need be the things that must best be set in place. There art thou happy?
Please let us know: Is all testing now done with both MD and MRI? Is there a final diagnosis and is it that this is all at present uncertain? Or is there more to go.
And again, thank you for taking us on this journey of one family facing what may or may not be at the very beginning. Thank you for your very intelligent reaction and response and support of your family.
I think you are all just great.
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heidiann Mar 2022
Hi Alva, as always - thank you so much for your kind thoughts and your concern. 🙏🏼

So just to clarify - we haven’t had the MRI yet (that’s this coming Friday) this was the first new patient consultation with the Neurologist. I know it didn’t really produce any definitive conclusion but thought it might be useful to share the experience. Especially since I hadn’t heard of “pseudodementia” (I guess in theory, I must have known it was a “thing” when I’d originally speculated that Mom’s symptoms could be depression-related). And also to share what a great Dr we had. He even offered to call me on Saturday to give me the results b/c he knew that he would be leaving on vacation for a month the following week and didn’t want make us wait. He went above and beyond.

Thank you also for sharing more valuable insights from your brother’s experience. What you’ve said really puts it all into very clear perspective for me. It obvious that there is no way I could have pursued it any differently and nor should I want to. I always will want to know everything. And yes I think Mom will want to know but I think if we can confirm it’s early stages, I’ll tread lightly and keep an eye on it and just try to keep her in a positive headspace. 

Re: her husband. Hmm….Yes, maybe he’s worried but his behaviour lately has been confusing and frustrating at best. And I now think he’s partly the reason for my questioning myself about all this. Last week, he told Mom that I’m “poking around to find something wrong” (when he knows full well it was HIM that stirred up the concerns by constantly telling me and her that her memory was getting “really bad”). And a real doozy: at the Neuro yesterday he sat quietly though the whole consult, asking no questions and as we all stood up to leave, he said to Dr : “can I have 5 mins with you alone?” Mom was mortified and Dr tried to tell him he had other patients but he persisted. He then refused to tell us what he talked to the Dr about. Later telling Mom that he just wanted the Dr to know that it was me and not him that “arranged all of this”. I have no idea what the purpose of this was. Perhaps deflecting from the issue of him gaslighting her and putting a strain on her mental health? Or trying to make himself look good and me bad? Or maybe thats not what he said. Maybe he wanted to play the concerned partner. I don’t really know. But I do know that move undermined Mom. It’s one of his go to toxic traits. “I knew he was going to do that”, she said when we walked out of the clinic. It upset her so much, she was stressed for the rest of the day. He’s got a really clever way of making us both feel really bad. Oh also, he’s not attending the scan. He felt it was more important to visit his brother two states away (who, to be fair, has just been diagnosed with cancer) - he didn’t really see being there as support for my Mom during this scan as something that was necessary since he “can’t go in anyway”. And oh he also doesn’t know when he’ll be back. 🤷‍♀️

Thank you for the film suggestion. I have not seen this and it sounds great - just the thing I need right now! I will watch it this weekend. And I will also be back to give you another update after we get Mom’s results. 

All the best to you xx
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Barb in Brooklyn has a very good suggestion....and maybe you can also locate a senior center where your mom could attend activities and have a meal a couple of days weekly, to help her be around people and give her and her husband some space. Doesn't have to be a therapeutic program. Just the local senior center or one in a nearby community that has interesting programs. You dont have to live in a town to attend that senior center.
I think the medical systems tries hard NOT to diagnose dementia until it is pretty well advanced. Once that diagnosis is in place, the patient is not allowed to make decisions and the health care proxy must make decisions. That makes situations messier and take longer to figure out what to do next. And we all know, for the business of health care, speed is of the essence to ensure maximum profits.
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You can't cure congestive heart failure or arthritis, or deafness, or myriad other ailments that go along with getting old, but you don't just cover your ears and go "lalalalala" in an attempt to make them go away. You treat them. With CHF you use medication, with arthritis, you use medication and a walker or another assistive aid, and with deafness, you get hearing aids. With dementia, you learn how to cope with it using various techniques.

Information is power. Why would you not want to know what's going on?
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heidiann Mar 2022
Yes, I fully agree that information is power. This is main reason why I initiated this whole process. I wanted to be as proactive as possible. So it’s not that I DON’T want to know, or that I dont want Mom to know at all, but it’s about whether Mom needed to know *all* the details *at this point* if we’re not sure of if it’s still in early stages*. I maybe should have clarified that. 

We also don’t have an exact diagnosis - it’s “Unspecified” - and her NP didn’t really do anymore to investigate, just prescribed meds (I took the initiative to order the MRI, not her NP) so I was questioning whether it was something that needed more investigation at this stage (other than medication and wait and see) I just don’t know what was the right thing to do….. I’m trying to navigate this on my own and learning as I go.

What I do know is I want is for Mom’s health to be cared for in every way possible way while also trying to protect her mental health as and not let her worry every day that there’s something wrong with her (she worries constantly already and I fear it will make any condition worse).

It’s a delicate balance to strike in a very precarious situation.
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Heidi, you've done not one but 3 very useful and loving things:

1. You did what your mom asked and arranged testing.

2. You sought to rule out what other conditions might be causing her low cognitive scores.

3. You followed up with the doctor who says that BECAUSE of her score on the depression evaluation, this may well be pseudodementia, not actual dementia. Depression IS treatable.

Dones the depression medication seem to be making a difference?

In your shoes, I would have mom seen by a geriatric psychiatrist for medication management and evaluation for PTSD-- perhaps some sessions with a psychiatric social worker can help mom on her struggles with her husband.
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AlvaDeer Mar 2022
I kind of agree with the extra information on the amount of gaslighting we are seeing with hubby. It is pretty major I think given her answer to me below. He sounds a bit of a manipulative monster, actually, after all that. I told Heidi below that I myself (at 80) would rather be in a nice ALF with nice adults my brother was with, playing bingo, having ice cream socials and the rare wine hour, having games and going to movies on the bus, Homes of the Stars tours on the bus, watch a bit of TV and read in bed. The last thing I would want now is to deal with some manipulative Charles Boyer gaslighting me in my last years.
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heidiann I think you did the right thing. If you had not taken your mom in for evaluation you most likely would be second guessing that decision as well.

Rest your mind.
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Heidiann; I just saw your reply to me about getting mom to see a geripsych for medication management and a psychiatric social worker for talk therapy to learn how to deal with her DH's gaslighting (which actually sounds more like HIS cognitive decline talking).

Please tell your mom from me that I resisted going to therapy years ago because my crazy ex-DH would say (and he did) "See, YOU'RE the crazy one. It's not me, it's you!). I found out later that when we went to couples counseling, the therapist regularly would excuse him from coming any longer after a few sessions because he was "unfixable"--i.e., had personality disorder. I got the therapy to help me deal with him.

I learned in therapy that it's us sane folks who go to therapy to learn to deal with the crazy people we live with.

It sounds to me like mom has always lacked self-confidence and assumes that others are correct in their assessment of her as "lacking". Therapy can go a long way toward re-framing this habit of mind.

Please give her a hug from me.
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Gingerroot2 Mar 2022
Gosh it was nice to read your post!
“We go to therapy to live with the crazy people around us”.
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