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Please forgive the long post. It's difficult to explain what's happening with my mother without telling something of her history.

My mother will turn 80 next month. I didn't know/understand this until about a year ago when I came across the definition for Borderline Personality Disorder, but she falls almost exactly into the Waif category. She has always been a "helpless" yet manipulative person, threatening suicide with classic signs of depression, heavy wine drinker, has never able to hold down a job, is stark-raving terrified of abandonment and is the least mentally-focused person I've ever known.

Twenty years ago a friend commented that my mother's way of communication was very "affected" and that she had a "charmingly childlike personality." He was right. I sometimes think of her as a teen who's trying to pretend she's an adult. Another thing that has always frustrated me is that she is unable to take in anything she doesn't want to hear (i.e. the need to go to a doctor when necessary, see someone for depression, a frank discussion of how her behavior effects me). Instead, she'll cry, say she's a terrible person who should just die, and then moments later it's like the conversation never happened.

She used to go through mood swings and crises from hour to hour or day to day. Nothing could ever be in the middle; it was either good or bad. She adopts extreme behaviors, solutions, diets, values, etc.

Beginning eight years ago, until last year, she used to insist she go everywhere I went. I couldn't go anywhere without her coming along. She told me that if I died in a car accident, she wanted to go at the same time. She wouldn't know how to survive or pay bills, and would put our pets to sleep and then kill herself if something happened to me.

I've worked at home for the last three years, but before that, she would freak out if I didn't come straight home from my job. If I stopped at the store to pick up some groceries, she'd be on the phone asking why I wasn't home yet, in a sweetsie, yet panicked manner.

That has calmed since I quit my job to work at home. If she has a problem or a complaint, I've learned to fix it as best and quickly as possible. I now make just enough to get the bills get paid, but couldn't support us both separately, so she knows I can't leave.

Okay, so that's the history, now the problem.

A year ago my mother took a hard fall and ended up in bed for months. She refused to go to the doctor, even though the pain made it impossible for her to get up or do everyday tasks. She healed enough to be able to walk around the house and occasionally go with me in the car, but she now is confined largely to home. She hasn't taken a both or shower since the accident and basins instead, because she can't lift her leg over the side of the tub.

She has diagnosed herself as having piriformis syndrome, basically sciatica to the 10th power. I've begged her to go to the doctor. She won't. She doesn't want a doctor to see her "ugly body naked." She doesn't want to end up hooked on painkillers. She doesn't want to have an MRI, other tests, or surgery, because she's read online that surgery is rarely successful and there's a good chance of paralysis.

Instead, she self-medicates with wine. I'll admit, I'm the enabler here, but without it the complaints and dramatic cries of pain would be multiple times worse than they are, and though this probably makes me a bad person, there is only so much I can handle. She needs to grab onto everything in order to move around or even keep from falling over. She tells me it's the sciatica that requires her to hold onto everything, but I honestly can't tell if it's that, or she's simply drunk. In the rare when she acts more clearly, she still walks with difficulty, but doesn't need handhold after handhold to propel her forward.

Lately, I've noticed that the "mental" component of her habitual helplessness is getting more pronounced. She repeats things often. She can't follow simple logical trains of thought. Her responses during conversations sometimes don't match what is being discussed.

My question is, how do I tell if her cognition problems are part of her way of interacting with the world, due to intoxication, normal aging, or the early onset of dementia?

Many of the indicators people list as signs of dementia are already a part of her and always have been. My mother has never been able to remember her own phone number or address (I've supplied them on forms for her since I was a teen). She makes up cutesy names for things she can't remember, but she's always done that. She has difficulty learning new things, even very simple things, but she's always been this way.

If anyone has suggestions, I'd appreciate it. I don't know if I can get her to go to a doctor, and she's definitely not so far gone that she's putting her toothbrush in the refrigerator, or forgetting who I am. She simply appears less and less "able" mentally.

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My mom has always been mentally ill. She is 90 now and taking Risperdal every day. It helps but she is still crazy. The OCD is unbelievable among many other weird things. No one understands unless they have grown up facing this craziness every day. My dad was a saint and I always wanted to be just like him. My mom.......not.
My wonderful husband died, my dear dad died, and so did my sweet brother. Now I am left with my crazy mom along with MIL with alzheimers.
Mental illness is a challenge...................a life-long challenge putting up with my mother. I could not put my mom in a nursing home - her reaction would be catastrophic. Trust me, she's been catatonic before. If you've experienced any of this, you know what I mean.
BTW, she started the Risperdal at 80 (thinks its for her heart). It took us that long to get her on meds. She has always been an academy award winning actress with doctors and hospitals etc. Anyway, I GET IT. Can't describe this issue unless you've lived it.
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FailingGrace, I have some very similar issues with my own mother. It is difficult that there are so many things which count as warning signs for dementia which have been a part of her life even while I was growing up. I think the key question is what is it that keeps you from taking a stronger stand about the aspects of this that really worry you? What is the part of this that you own? This is only something you can address for yourself but you might find it helpful. I've worked out what it is for me and while it gives some clarity I still haven't found solutions yet. One day I have to though.
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Thank you, Jeanne. I really hadn't thought about it in that way. I guess all I can do is accept things as they go. If I notice some alarming deficits, then she'll have to see a doctor, but until then, as you say, it doesn't make much difference how it is categorized. A very thoughtful answer that puts things in perspective.
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Unlike your mother, I believe in the value of modern medicine. I think it is useful to know (to the extent possible) the cause of pain or other problems, in order to treat them effectively. So I'd really like to see your mother evaluated and a treatment plan worked out.

BUT ... I am not your mother and she obviously has a different outlook. I'm not sure that in her case knowing what is wrong is so valuable, if she refuses to have or follow a treatment plan. Knowing she had a uti and assuming she has sciattica hasn't really done her much good, has it?

So I'm not really sure how valuable it would be to have a diagnosis of dementia. Would that change her willingness to follow medical advice? Would she take dementia pills? Would she reduce her wine usage?

Someone with dementia is not automatically considered incompetent. Dementia is a progressive disease and in the beginning and in some cases for many years the person is still able to make decisions on his or her own behalf. So getting a diagnosis of dementia would not necessarily give you more control over her medical decisions.

I doubt there are clear-cut ways to tell the difference between "more of same" and "new dementia added to the mix," at least at this point. Most doctors and tests would probably conclude dementia, without knowing what has been "normal" for her. You are probably in the best position to observe changes. You will be the first person to be pretty sure about dementia.

Years ago my mother had brain surgery following a seizure. The doctor was trying to get a sense of what was going on with her. Several of her children were being asked questions. Was she more forgetful lately? For example, did she start forgetting her grandchildren's names? In spite of the seriousness of the situation we looked at one another and burst out laughing. Mother never got OUR names straight. She has even called me by my brother's name! Forget the grandkids' names? Well of course she did ... that is just who she is. Similarly forgetting words and inserting substitutes can be a sign of dementia ... but that is just part of who your mother is.

Of course you love your mother and don't want her to have an undignified end. Of course. But I'm not sure how pinpointing exactly how much of your mother's cognitive issues are alcohol-related, just more of same intensified by old age, or early dementia will help with that goal.

I sincerely send you best wishes in helping your mother live in dignity, whatever the reasons behind her decline.
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When she made out her will about 15 years ago, she had the lawyer draw up a no extraordinary measures document, but even if that qualifies as medical POA, I'm not going to use that to force her to see a psychiatrist. I seriously doubt she's bipolar. She doesn't get manic, more like panicked. Depression and panic disorder run in our family. My siblings both have "issues" as well, in the case of one of them serious enough that I was told he was institutionalized at one point (we're estranged). If, as I suspect, my mother's main problem is borderline, she's not going to change. She'd have to want to change, and there's no desire on her part. Also, if she doesn't want to see a doctor for her back/nerve problems, that's her choice. If it worsens to the point where it becomes an emergency situation, I will definitely either rush her to the ER or call the paramedics, but until then, as long as she doesn't have dementia, it is her choice.

I'm not looking for a battle, just knowledge. My original question was how to tell the difference in cognition, given the factors involved. I'm praying this isn't the early signs of dementia, and rather just normal aging with too much wine thrown in.

For all her problems, and all the problems she's caused, she's my mom. I love her and don't want her to have an undignified end.
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Has she ever given you medical POA?
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Thanks for the suggestions. Yes, I agree she needs to be evaluated, but I've tried for decades to get her to see a psychiatrist. She doesn't believe she has any issues which need therapy or evaluation. She also hates the medical profession, and doesn't believe that doctors can help her with her physical issues.

As an example, two years ago she had an UTI. She refused to see a doctor about it. It got worse and worse until I had to drag her to the emergency room. She had a high fever and they took some blood. [OT: They put her in an ER cubicle and forgot us until the next morning when a nurse told us they had "temporarily" lost her chart and not realized she was there.] They told her she had a raging infection. My mother told the doctors she was fine and wanted to go home. They gave her some meds and discharged her, so I took her home where the fever continued another day until it broke, with her slipping in and out and babbling incoherently just like you see in the movies. My belief was anyone who is that ill belongs in the hospital, but she just didn't want to stay.
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I'm sure that you will be able to find a doctor who will make a house call, but I'm more certain that the Dept. of Aging might be willing to send a social worker over to assess the situation and make some recommendations.

Do you have medical and or durable POA for her?

While she does sound like a borderline waife, she might also have bipolar disorder as well. Anyhow, she needs to be evaluated by a doctor which I hope you can get her to one who specializes in elderly people.
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She may also have a mental illness such as Borderline Personality Disorder. I am no doctor but it can be anything listed. I would get a hold of the Dept. of aging and see if there is a way a doctor can make a house call. If you don't let her drink, you can see a little more of her cognitive thinking (No, I am not judging you.) and discuss it with her doctor. She really needs a doc to diagnose what it is that ails her. Sorry I can't be of any other help but there are a lot more wiser people on this site that maybe able to assist you.
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