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My mother in law has poor memory and executive thinking, but she still has good basic ADL's including driving. Can't figure out how one area is so poor and the other so good. She doesn't know what year, month or day, it is
doesn't know my daughter is my daughter (but knows who she is as a person by name) , but told me I needed to turn the opener the other direction for it to work. I assume this comes from these are from two different parts of the brain. Any input?

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That is a great description Appaloosa and pretty much what I am going thru with my Mother. I am sure that she has had many undiagnosed strokes because she is 90 and that is what happens to our body as it ages. I totally understand about the confabulation. My Mom does that all the time. She just fills in the blanks. The problem is that when family or friends just see her for a short period of time they believe all the nonsense. I get it - she was a bright, intelligent woman at one point but not anymore. So sad.
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Appaloosa - Great description! It's not exactly like my husband, but the feeling of skills and deficits in unexpected places is so similar.
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Back to your original question, how can someone be functional in some ways and nonfunctional in others? I think it depends on which little pieces of brain have been damaged by whatever is going on. With a stroke, they can pinpoint the area of the brain with a CT scan and guess generally what will be broken, but can't always tell how it will be broken. With Alzheimer's and some other dementias, the bad proteins can be deposited anywhere in the brain, so little bits can be broken all over the brain. Plus, there are no tests to visualize the deposits in a live person, so you can't predict what's going to be broken.

My husband had one major stroke (big clot in right side) that took out cognitive functions but not memory. Later, he had a "shower" of smaller strokes from an infected heart valve. Those many little strokes damaged, among other things, language.

But not all language, just certain parts. He almost always gets left and right correct (he never had trouble before the stroke either, unlike me). But he can't retrieve nouns he wants out of his brain: people's names, the names of objects, colors, numbers. His gender pronouns (he/she, his/her) are usually, but not always, wrong. On the other hand, verbs are OK and the other parts of sentences (adjectives, adverbs, prepositions) come out close enough. He can speak a decent sentence as long as it doesn't have any nouns in it. He can describe the heck out of something to help me figure out what he means, although I have to be skeptical about the colors. One restaurant is the one he really likes but I don't, where they have the really crunchy things that you dip that are hard to eat without teeth. That's his favorite Tex-Mex restaurant.

He can't name things he sees in pictures but he can describe them. He can't think of names (etc) but he can describe them pretty well (without using nouns!). He can describe how we know the person he wants to remember the name of, but again, without nouns.

When he gets mad, words come out better, but I'm surprised by the number of angry sentences that don't have nouns in them:

I'm trying to help you.
That's how we've always done it.
I want to go home now.
If you don't stop that, I'm going to be very angry.
I want to report that guy and get him fired. (He said this about the driving assessment therapist who declined to sign off on his driver's license because he didn't pass the cognitive tests.)

He can copy and write out words that he sees, but not make up a sentence to write.

He can do arithmetic but not reliably say the numbers out loud. He can't count very well but can put number flash cards in order.

He can do a lot of complicated things he used to do (some complicated recipes, playing Hearts) as long as nothing goes wrong or he gets distracted. However, f the flow is interrupted, he can't start back up in the right place. In recipes, if he skips a step, he can't be redirected back to do them (I adjust a lot of recipes when his back is turned because, after all, I have to eat it too). Another example: when playing Hearts, you win big if you take all the points; otherwise, you don't want to get any points. If he thinks he's going to take all the points (which is hard and requires a complex strategy) but then someone else takes a point, he can't change his strategy to stop taking points and minimize the damage.

He studied French in high school but was never fluent and didn't use it for years afterwards. But he still remembers many of the rules of the language (gender, word order) but without nouns, he can't say much.

He can cook basic things and can find the temperature and time on a frozen package, but he doesn't concentrate enough to read the steps to learn whether to remove the plastic or cut a hole in it or whatever. For things he cooked before the stroke, he usually remembers the rules. But he can't (won't?) deal with new foods and things don't turn out so well when he needs to heat, remove the lid, stir, and keep heating--usually he eats it half cooked. He can set the oven timer but he doesn't always remember that he should wait until the timer goes off to take it out.

Luckily for me, he doesn't forget to turn off the oven or stove. If anything, he turns it off too soon. This means that most of the things he cooks aren't thoroughly heated but he never makes anything for himself that requires cooking for safety.

He has cognitive problems with "executive" functions, from the first, right-brain stroke. I finally figured out that many of them are manifestations of a broken sense of "enough". Enough to eat, enough time, enough water in the sink, enough liquid to wash down a pill, enough patience. His therapists describe some of them as problems with impulse control, but I see them as related to a shrunken sense of enough.

One thing that still freaks me out is "conflation." That's sort of like lying without intent. When the brain doesn't have enough facts (because of memory problems, when it hits a part that's broken, or when things happen too fast to process), it makes things up. So his memory of things can be very different from that of others at the same event. Different people were there, people said things that were never discussed, things that clearly can't be real happened. The "fantasy" memories are more likely in a situation that's outside his pre-stroke experience: I brought a plush cat toy to one of his rehab place to take the place of our cats. He remembers it as a real cat (we have one that looks like it), but couldn't decide whether it was a good kitty or not. On the good side, it didn't need a litter box, didn't wake him up meowing, and was always around. On the bad side, it wouldn't eat, so he was afraid it would starve to death, and it never purred.

The brain really is a funny thing and is remarkably compartmentalized. I find that pondering the oddities provides some black humor in what is otherwise a very bleak outlook. Everyone has to find their own way and that's mine--science and black humor. I hope my examples help you deal with your situation.
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My mother is able to take care of her own personal needs and may be able to do a bit more like helping to cook but we do it for her. Her memory however lasts maybe 10 minutes and other times it may be 20 seconds. I say this because she asks if the dog has been fed at least 30 times a day, some are back to back questions.

I too am thinking that perhaps you are dealing with vascular dementia in your MIL. The thing is you have to understand that she will get upset and consider anything you are doing to "help" as meddling in HER BUSINESS no matter how bad her dementia or Alzheimer's becomes. They will fight you at every turn and continue to say they are fine, and that you need to back off! You on the other hand cannot back off, as you are seeing that this person is becoming more and more incompetent.....BUT THEY DO NOT SEE IT!!!!

I walked in one day after being out of the room for 5 minutes and my mother was sitting at the table with all her medicine bottles and she had a handful of heart pills getting ready to pop them in her mouth. I gasped and grabbed her hand, saying "Oh no Mommy these pills were already taken, you don't take them again now." She was angry with me but I removed them from her hands and took the bottles and went to my room and locked them away. To this day she gets mad and wants to know where her medication is and she checks the cabinet. When I tell her they are locked up and why she calls me an out and out LIAR!!! She swears I am lying and that she has never done any such thing. I happen to know that is not the truth however.

When you know there is something wrong you can be as kind as you can be but you have to help them get medical attention and a diagnosis and you need to help them OVER any objections that they raise. If she gets upset, you may say, "Margaret I know you don't like going through all of this, and I don't blame you, but Pete and I love you so much, we want to make sure everything is okay." I find it is better when they are upset if you kind of agree with them in the beginning of your sentence that you totally understand where they are coming from, BUT we are doing these things because we love you, we are concerned for you, we only want the best for you, etc.

Best wishes and good luck, it is never easy and I have a feeling they will fight you til they die in many instances so don't get disheartened!
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ildlko61, when I went to the Medicaid office I asked about the program that we used to have here in Oregon. Apparently a couple years ago the state of OR stopped paying family for taking care of the elderly. Now, to have the state pay it requires that my mom be qualified for Medicaid and then I can be paid for taking care of her.
I would start with the Medicaid office or Department of Human Services for the Aging. I imagine that would be a good place to start.
You are lucky that PA still has the program. I wish OR did.
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Doctors are required to notify the state when someone is diagnosed with dementia or they can lose their medical license. She needs to have her driver's license revoked immediately because dementia affects her cognitive functions. If the doctor won't do it, you can notify the DMV.
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Just like JessyBelle, I have an elderly mother in law in the household. She is capable of taking care of herself, only she forgets to turn the water off, or the gas stove. I came home from work one day and the hole house smelled like gas. She tried to warm up soup but the flame never came on so she just left it without turning it off. That is when we decided that one of us has to quit their job to stay home with her so she doesn't blow up the house one day and hurt herself. I herd that there is a program funded by the state where you can get financial help to care for your elder parent. My question is anyone know how and where to apply for something like that in Pennsylvania. I know that only a few states are participating in this program, and I know PA is one of them. I just don't know where to start. Any suggestions?
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I'm in the same situation. My husband's stroke took out executive function. Before the second stroke damaged his language, he seemed fairly normal when you first meet him. I think that makes it even harder on the spouse because people will think he's OK based on limited social engagements and wonder why you are so stressed out about caring for him.

My husband can still beat us at the Hearts card game, although he can't learn any new games. It's surprising that someone who can't follow a one step instruction can plan and execute taking all the tricks, but he does.

A person with executive impairment or impulse control should NOT be driving. It might be hard to get her keys away from her but it's important. My husband is still mad at the occupational therapist who did his post stroke driving assessment and failed him. I was also unhappy about it because I had to take over driving as well as his other chores, which is a pain, but he's clearly not safe on the roads.
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I am trying to get my husband to do the daily cognitive brain-training games on lumosity. So far he has not, but I find them helpful although challenging. JessieBelle, if your mom doesn't like technology, this might not be an answer, but you might try. The games were designed by neurologists, and the site gives a chart of your daily progress. I have been impressed. About 6 weeks ago, my dog wrapped his leash around my legs and pulled me into a face-plant in the street. I'm still dealing with post-concussion syndrome. On the lumosity chart, you can clearly see when it happened and how it affected my performance. I highly recommend this site. 3 games a day are free; for all 5, you pay less than $5 a month.
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I thought about this question a good bit and realized that in her life my mother had not learned to do many things. She didn't drive. She had never learned to ride a bike or swim. She didn't like technology, so never learned how to operate anything electronic beyond a simple remote control. Her main thing was cooking, though she hated it, and walking. She spent a lot of time watching game shows like Jeopardy and working crossword puzzles.

She lost her ability to do complex tasks, such as cooking. She can still cook things in a toaster oven and make her iced tea. She has spinal stenosis, so walking is painful. She is still pretty sharp with the word games on TV, e.g. Chain Reaction and Lingo. She outperforms me on them. So even as her memory and executive skills head south, her verbal skills are still strong. She also still does the essential feeding and toileting, which is a huge relief for me.
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My husband, Lewy Body Dementia, retained most ADLs throughout his ten year journey with the disease. He could feed himself just fine ... but he couldn't remember if he'd eaten. His doctor reported him to DMV as soon as he was diagnosed and his license was revoked. This was extremely upsetting to him, for at least a year, but it was absolutely essential for public safety.

My mother, type of dementia unknown, has mobility problems but otherwise her ADLs are pretty good. She could not safely live on her own. She has never driven, so that is not an issue, but even if she'd been driving until recently she certainly could not drive now.

The brain is amazingly complex. Being able to perform ADLs is wonderful, and makes caregiving easier, but it is not related to cognitive performance in other areas.

Driving involves the muscle memories similar to riding a bike, but it also involves judgment, cognitive memory, and executive function. It is not enough to remember HOW to brake ... one also must be able to judge WHEN to brake, and to have fast enough reactions to apply the brakes quickly.

I am sorry, truly sorry, but your poor mom should not be driving.
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I am in the same situation. My mother is 90 and in pretty much perfect health but cannot remember who came to the door 5 minutes ago. She can do her own ADL's (activities of daily living) but has no short term memory. She is very good at tricking people who do not talk to her more than 5 minutes. The drivers license has to go. How would you feel if she ran down a 5 year old? Just yesterday an 80 year old driver in my county ran thru a store because he did not remember the gas pedal from the brake. This has to stop. We reported my Mother to the DMV and got her license revoked until she takes a driving test which she cannot do because she will never pass. It was not pleasant and still is not because she bitches about it a lot and I have to drive her everywhere but so what- we do not allow 5 year olds to drive cars so why are our demented elders out there on the streets?
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My mother is the same way. We stopped her from driving a few years ago when she got into an accident.
But, overall she scored a 19 out of 30 on the Cognitive test which shows she is of poor mind. She doesn’t know what state she is in. She can’t remember my husband’s name one minute after telling her. But if you ask her what her phone number was a couple years ago she can spit it out so fast.
To me it is such a strange disease. My mom can still shower, eat, and dress herself, for now. But, she wanders, repeats, forgets that I was just sitting at the table, and talks about pets she had 20 years ago as though they are there in front of her.
So, YES, bizarre how the brain works or doesn’t.
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My husband's uncle has vascular dementia which started out with many small strokes which caused brain damage. It had a very subtle effect on him and was undetectable by many of his friends. We lived with him and were able to notice discrepancies in his behavior. He did drive but was having small accidents that he hid from us. His brand new car had all these dings on it... He also compensated for his shortcomings pretty well.

Recently he had a major stroke, but again his body had no paralysis or weakness. The only effects were cognitive, spatial and the like. He likes to gesture to his body and says, "THIS is OK!" Meaning that since he doesn't have the usual problems that a stroke victim has, he must be ok all over. In any case, he can easily care for himself - he can eat, brush his teeth, get around, etc. To many people he appeared to be "fine", until you really talk to him and see that his words don't make sense. Brain injuries and dementia are very unusual and complicated. They effect everyone differently and may affect several different parts of the brain. Although the uncle was basically high-functioning he had damage to five different areas of his brain!
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I've just learned that procedural learning is the last to go. This involves things that you do physically that become "hardwired" into the brain. Like you don't forget how to ride a bike. I guess when these things start to go it is really an advanced disease. The doctor has said if she does not voluntarily reqlinquish her license before winter, he will make the call. Anything anyone tries to do to help is consider interference with her life and she's not having it.
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My husband, who has Parkinson's, does well during the day but "sundowns" at night. Does this occur more in the evenings? Exelon patches have helped him. I would suggest consulting someone who specializes in balancing medications. It has surely helped us.
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The situation you describe is not completely unusual early in Alzheimer's Disease (AD). Has your MIL been to the doctor recently? Does she have a diagnosis of something in particular? If not, this might be a good place to start.

DriveAble is a program which tests people's ability to drive using a computer-driven test and a practical driving test. That might be helpful as well. Just because someone has been able to drive to and from the store without an accident does not mean that he/she is a "good" driver or "should" be driving.

A physician is able in my state to send a letter to the state and request a driver's license to be revoked, even if the person disagrees.
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I took Psychology at university/college and found that every part of the brain (and there are a lot of parts) have specific functions. Sometimes when one part becomes damaged or disconnected (somehow) the other parts remains intact. I found a great website which might help you. It specifically relates to alzheimer's and the brain as well as behaviour. Hope that helps! You can always search on google as well. There's tons of information on alzheimer's/dementia and how it impacts the brain.
http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=114
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