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I'm taking my mom to see a geriatric specialist to see if their expertise can help with memory problems. She wants to be proactive about her memory. She sees some of the issues I see about her memory but others, only I see.


Some problematic behaviors are:


- using pens and pencils to clean out her ears


- going to bed really late. She says if she goes to bed early she then wakes up in the middle of the night and cant easily go back to sleep.


- not understanding that her primary care doctor wants her to taper off of Xanax and that she needs to do it slowly and carefully. She takes it before bed. As I explain to her the time to take it, she says she wants to wait until 1-2am so she can sleep deeply for the whole night. Sometimes when we talk about bit, she dismisses everything and thinks it is stupid to even take it at all. A few times, I have found the pill on her bedside table - a missed dose for the evening.


- When home health physical therapy was here, she would repeat herself a lot about pains and previous diagnoses from other doctors.


Wow, writing this out is just he tip of the iceberg and I feel overwhelmed. It's hard to document each thing that seems to be a little off and may be due to memory issues.


The clinic has a memory form that my mom filled out and I am filling out my own version because she can get defensive about what I observe, and I find it best to let it go rather than get into an argument over something that is impossible to reason out with her due to any possible cognitive decline.


I feel a bit stressed, I keep feeling my own sense of pressure to try to capture all of the issues I am seeing so that doctor can get the best picture of her memory. But that alone is overwhelming and difficult to pin point. Her memory is very good in general, but there are days when it is completely off and when her mood is difficult to deal with. She is usually a complete sweetheart, but at times she can pick on me and bully me. Generally, those times involve an ear infection or UTI or cold, etc.


Recently, her primary has put her on Zoloft and that already seems to be helping. Also, she has a referral for sleep apnea, which I very much believe she has based on her snoring and shallow breathing patterns.


Any advice or sharing of experience is very helpful. So far I have not been impressed with the mini mental exam, it has been easy for both of my parents to pass it, and my dad has been unable to pay the bills for three years. Obviously the test does not capture the depth or complexity of dementia. My dad has it and it is undiagnosed AND he's in denial. My mom at least wants to be proactive and protect her memory as best as she can.

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Xanax can cause all sorts of cognitive issues, as can depression and sleep apnea. Combine all 3 together, and you may find yourself believing your mom is suffering from dementia when she may not be. It's pretty hard to breeze through the mini mental exams if a person is really suffering dementia. I knew mom was mentally declining in 2016 and had her tested for dementia when she was hospitalized. She scored an 18 out of 30 on the mini exam and couldn't draw a clock, never mind show the time. She was diagnosed with progressive dementia at That time. She was doing ok though, functioning well, although incontinent and suffering insomnia in cycles. This past May, after a bout of pneumonia and a stint in rehab she scored a 10 on the MOCHA test and had to go from Assisted Living to Memory Care. She still has times of great lucidity, but very strange behavioral issues, angry outbursts and agitated verbal and physical activity. Dementia does not just involve memory.....it presents itself in many different ways. My father, for instance, did not suffer from dementia but could no longer handle the finances either. There can be a decline in mental function in the elderly without dementia being involved.

A real sign of dementia for most is when they have no concept of time. Mom is always off on what day of the week it is. She has no idea what time of day it is or that 6 pm means I'm eating dinner so she shouldn't call. Phones and remote controls become very confusing to use, thermostats are foreign, anything that has controls or buttons is problematic. Mom could work the DVD player in April and by May was clueless. I had to turn off the answering machine because she couldn't remember the password or how to listen to messages. It's getting more and more difficult for her to make phone calls or to remember to press the off button when done.

Repeating the same story or sentence is common as well. Having to repeat yourself is very common, sometimes 10x in one visit. My mother suddenly started introducing me as her mother one day. Yet she could carry on a conversation from pure muscle memory. The Hello How Are You type of chats that she'd had socially for decades were and are still intact. This is the dichotomy of dementia.

Don't feel like you have to tell the doctor every little thing they're doing or saying that may seem off. Its a good idea to keep a noebook of happenings so you can remember the incidents when at an appointment. The mini cognitive tests ARE accurate enough to establish a baseline and to measure decline from that point forward. The decline can be pretty slow......you may notice a step down at some point that seems pretty big....but it can take years to get there.

A UTI will notoriously make the old folks act unhinged, every time! As soon as my dad started acting the least bit off, I'd have him tested for a UTI and it would be positive. Like clockwork. Same with mom.

If your mom wants to preserve her memory, get her some crossword puzzle books and sudoku games, things like that which help keep the brain working. Cut down on sugar intake and keep active with exercise is also good. Alzheimer's is now being called Type 3 Diabetes and thought to be related to high sugar intake and insulin resistance. Who knows?

Hope some of this info was helpful. Good luck!
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TaylorUK Aug 2, 2019
I agree with puzzles,colouring and other activities that help keep the memory active. I totally disagree with your comment "the mini cognitive tests are accurate enough to establish a baseline". My mother sails through these every time I ask for them to be done because they are too simple and factual, ask her to reason or explain anything which mini tests don't do and she varies from day to day between totally capable and totally incapable. She has been living with us for three years and is just about to have a third Op for the same problem, the other evening she told my husband she moved in just before Christmas, had never heard of the consultant, hadn't had any previous operations and had no idea where she was going the next day - but she passes all mini cognitive tests - so personally I think they are as much use as a chocolate tea pot. Getting someone outside to see her decline is very very difficult because she can usually hold a normal conversation for the short 15 minutes or less they stay, only our friends who drop in at random slowly managed to put the picture together, and NO she doesn't have the go to UTI.
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Document all the behaviours you see and have it delivered to the specialist marked in big letters to be read before appointment with Mrs x. He/she will then have some background and be able to work relevant questions in.
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jjmummert Aug 5, 2019
Spot on. I kept a record of my mom's behaviors on my computer and it was invaluable to her primary care doctor and for the neurophychologist who did her tests. In fact,, the final evaluation contained a lot of my written observations and concerns. I have POA, but anyone can send written concerns to a doctor even though he/she is limited to whom they can share information.
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When I take her to the doctors office. After we are called into the room. While we are waiting for the doctor to come I excuse my self saying I have to go to the bathroom.
I leave the room, and I go talk to the nurse or doctor and explain that you would like to tell them what you have observed. Explain to the nurse that if you say these things in front of your parent they either deny it or gets upset that you told them.
then just go back into the room sit with your parent or wait for the doctor to come in.
And cross your fingers and pray you do not have to use a bathroom since you have already been!!!!!
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Your mom needs to be seen by a neuropsychologist and have a completely battery of tests.  Depending on where she lives, determines available professionals.  If you want to email me, I will reach out to my colleagues across the US and try to find some recommendations.
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I took Mom to a geriatric Neurologist, and although their tests seemed simple, it really helped us discover where she is with her Alzheimer’s. That way you know what you’re dealing with. My Mom refuses medication for depression or Alzheimer’s, so I try to respect that it is her personal choice. It’s too difficult to babysit her with regards to things she should be taking or doing. If Mom is eating everyday, not falling, and is safe, I could consider it a good day!
My mom has the opposite sleep problem, she goes to bed at 7pm, so she’s up in the middle of the night wanting breakfast! Hard when you’re in an assisted living facility..
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gdaughter Aug 5, 2019
Do not regret the no pills route, I don't, and the best neurologist in our city with years of experience was not opposed and basically in agreement with me considering mom's level of functioning and age at 90+. The risk of sign effects vs. likely low benefit just didn't make it make sense, not to mention the expense...and mom being her age...many years back when they went on medicare never signed up for the drug plan. SO although there is an emergency sort of appeal process, right now they would look back all those years times all those months...and there is a penalty for each month...it would be outrageous. So we're just letting it be for now.
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I always type out a scenario of all of the concerns that I think the doctors need to know. My father in law lies directly to the Doctor and is so convincing that it makes me think I'm the crazy one. When I have the notes with me, I give it to the nurse and ask that they have the doctor look it over before he or she steps into the room. So far, I have had nothing but positive response from the physicians and my father in law's real needs are being met.
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Reply to cindic0911
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This is going to be a marathon, not a sprint so make sure you include self-care in your daily routine. I realize your life now is full of medical appointments and changes and not sure if your parents live with you or vice versa, but there are important things you should work on little by little while their memories are reasonable. As AlvaDeer suggested, make sure someone local, responsible and trustworthy is assigned their Durable Power of Attorney (someone younger than them). Also, Medical Directive, will, etc. I'm assuming your mom (and dad) signed the HIPAA waiver at the doc's office so that staff can legally discuss your parent's medical info with you. Also:

- the financial PoA should know their banking info; what investments they have and where the paperwork is; insurance papers; pre-paid funeral paperwork etc. Their sensitive information needs to be locked down so that it is protected against abuse and scammers.

- go through their photos with them, for fun and to write down names, dates, places

Your plate is full so that's enough for now. Many are in your same shoes. Wishing you peace.
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Reply to Geaton777
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When you speak of taking your mother to a geriatric specialist , do you mean a physician whose speciality is treating older adults? The reason for the inquiry is that an avenue to pursue with your mother is an evaluation by a geriatric psychiatrist or a neuropsychologist. These individuals have extensive training in the administration of various cognitive tests and will allow for more time with your mother as opposed to a regular office visit with a physician for medical needs.
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I’d ask first who is her primary caregiver and second who has POA. Discussing these issues in front of her may not be the best plan. Write out you’re observations and mail to dr(please keep it short and to the point) before her next appointment. You’ll see a difference in some ways, they are working blind without info from family.
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Reply to AT1234
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The mini test is exactly that - mini. It might not catch dementia or another cause for the symptoms observed.

Getting a good thorough exam is the best place to start. Observations are good to bring along. There are many medical issues that can present as some form of dementia and many of these are treatable. Reviewing medication would be a good idea as well. If it is early stages of dementia, many people can "fudge" their way through an exam or even the tests.

Before our mother exhibited signs of dementia, I happened to stop by her place on my way to work. She was in a miserable state and clearly confused/befuddled. In her case (we went to the ER and she spent the night in the hospital), it was most likely OVER-hydration. Often people consider under hydration, but drinking too many fluids can wash out the electrolytes in your system (keep in mind that the 8-8oz glasses of fluids suggested should include fluids you get from FOOD as well!) One of the symptoms of low potassium is "Abnormal psychological behavior: depression, psychosis, delirium, confusion, or hallucinations." She was drinking too many fluids. Once her system was properly restored (drip bags), she returned to her normal nasty self!

As for the mini-test: we recently changed doctors (it was planned anyway, but just in time as PCP retired!) Mom was given the mini-test (she is in year 3 MC) and couldn't pass it. Back when this started, she might have been able to squeak by. They gave me the same test when I had my checkup a few weeks later. Mini is the word! When I suspected dementia for what I observed, we contacted an aide agency so we could start with minimal (1hr min) sanity and med check . Before scheduling anything, they sent a nurse who did a pretty comprehensive test (covered by Medicare.) She made recommendations for a locked/timed med dispenser and other suggestions to get us started. The plan was to increase aide days/times as needed, but after a few weeks she refused to let them in.

So, be sure to have a full thorough exam to ensure this is not some treatable medical issue. Some of what you have described could be attributable to dementia, but could also be some other underlying issue. Just testing her cognitive ability may miss any other treatable condition.
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