A year ago, my dad died of lung cancer and he insisted I move in with her. Last summer, I let her be on her own. Moved in last fall to help, since I noticed a few things.

Many days my mom seems normal. Other days, her memory is bad. Today, we were working on the garden. We started on one part, then she wanted me to help one, place then another. At one point, she changed her mind 3 times in less than 30 minutes. This is not normal for my mom. Her gardens are her sanctuary.

Not sure how to approach the topic with her and my brother, who lives on the East Coast. My mom had a stroke over 3 years ago, and I had noticed memory issues. Few months ago, I spoke to Stroke Association and suggested it might be wise to check for vascular dementia based on the location of the stroke. How do you request that test for a family member?


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I wouldn't worry about brother at this point, because there could be any number of reasons for these changes. A thorough exam, including blood work and urine test (culture is best!) should be the starting point. If she's reluctant, a little fib that says Medicare requires a checkup might help. Before the appointment, contact the doctor office with notes about your observations - if there's a portal, post it there, otherwise it might be best to mail it or hand deliver it. Request they keep your reporting to themselves - it's to alert them and perhaps assist them in checking her, they shouldn't be telling her what you said, so as to avoid any recriminations.

Many doctors now give the short cognitive test to everyone over a certain age. When we changed docs, they tried with mom - not sure why, she had already been in MC for 2 years! She couldn't complete most of it and hearing was very bad (hearing aid had just gone through the laundry!) Anyway, at my checkup a few months later, then gave the test to me as well. Mostly it is for a baseline. You can tell her that you have to do this too, if she shows concern about it.

An alternative might be done at home. Before resorting to MC, I tried bringing in aides to keep mom in her condo longer (she thwarted that less than 2 months later, and it was only 1 hr/day, mainly to check on her.) Before they scheduled anyone, they sent a nurse who administered an even better test, right there in mom's place with 2 of us present (this was well before the doc visit.) Medicare does cover the cost. She was more comfortable being in her own place, so she didn't balk at anything. The doctor may be able to send someone to do this test. If not, you could inquire with aide agencies, to see if they have anyone who can do this. Tell them you're exploring care (you don't have to be) and would like to have an assessment.

But, I would highly recommend the checkup and blood/urine tests first, to rule out anything else. UTIs and other infections as well as imbalances in the blood can mimic dementia. Most conditions are treatable. If she seems better, then all is good. If not, cognitive testing might pinpoint something. Other tests (MRIs, CT, etc.) can be rather grueling, esp when one gets older.

If nothing else shows up, there's a good chance she might be in the early stages of vascular dementia, given she had a stroke before. Is she on BP meds? My mother was on BP meds for a LONG time. We don't know if she had a stroke or TIAs prior to dementia, but high BP, even treated, does predispose one to dementia or additional TIAs and strokes. Since mom lived on her own and I knew nothing about dementia, the very earliest signs were missed (recognized after the fact.) In those early stages, she will be okay with you, just learn all you can about dementia and understand that not everyone follows the same time line or has the same symptoms. Each person has their own "journey" but if we know what to expect and how to deal with it, things can be a little easier.

So, get that checkup scheduled and wait for the results. If it's something treatable, no worries! If nothing shows up, then move on to the next step, getting her tested/assessed for needs and start reading up on dementia.

FWIW if it is vascular dementia, my mother was 90 or 91 when I first noticed "issues", repetition, forgetting things she just said or asked about and having difficulty with finances. We couldn't get her into the MC unit until she was about 93. She remained in her own place until we could move her. We had to take the car away and help with necessities, but otherwise she managed. She lived in the MC for 4 years, stepping back in time to about 40 years ago, but otherwise relatively stable. It was a stroke around Labor Day that impacted her and then another in mid December that finished her. She was 97 at the time, so even if your mother is in the early stages, she could be okay for a number of years (you live with her, so no need to rush her in
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My husband who had a massive stroke in 1996 was diagnosed by his neurologist with vascular dementia in 2018. If your mom has had a stroke, I'm sure she has regular check ups with her neurologist, so perhaps you can get on the patient portal before her next appt. and let her Dr. know exactly what is going on with her, and let them take it from there. Best wishes.
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Did the Stroke Association have any recommendations about where to get a thorough evaluation?

My mom's longtime PCP saw nothing wrong with her increasingly anxious and weepy behavior. We moved mom out of her home to an Independent Living facility (using the coming bad winter weather as an excuse for this "temporary" relocation).

Her new geriatrics doc referred her to a geriatric psychiatrist after 2 visits. GeriPsych called me after one visit and told me that mom needed a complete cognitive workup. It was stunning just how quickly these two medical professionals analyzed mom's anxiety and loss of confidence with COGNITIVE, not emotional issues.

A thorough (6 hours over 2 days) neuropsych evaluation showed mom's memory to be intact but her judgement, executive functioning and decision making abilities to be at about the level of a 6 year old. And the MRI showed evidence of an old stroke.

I highly recommend this sort of diagnostic workup as a baseline from which you can ascertain current functioning and abilities and chart decline, if any.
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When was her last thorough medical checkup? If a while, schedule one.

Many folk even if they say "I'm fine" will go for a regular medical checkup if prompted. Doc can get a base line for for blood pressure amoung many other things. Wouldn't expect a Doctor to notice memory issues in a 15min appointment though (unless very severe). It is possible he/she can do a MMSE which is just a simple screening test - NOT a diagnosis. More thorough neuro exam will be suggested & needed before jumping to any dx. I think Vascular Dementia is tricky to diagnose as not always presents as memory problems. Sometimes family notice something off with judgement, reasoning or spacial awareness first. Can vary a lot - depending on many factors: stroke location, hidden strokes/TIAs, lack of O2, small vessels damage, heart issues. It is possible a CT or MRI may pick something up - but also maybe not. Problems may be stable for a long time or progressively get worse quicker. Again, varies widely.

I'd start with a thorough general medical. It may be a completely different reason for her new behaviour.

I'd adapt what I could at home to increase her safety, depending on what you are noticing.

I'd also have a good think about how long you want to live together. Was this a temporary fix or a long term plan on your side?
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Go to this site and follow direction for MMSE. ( Mini-Mental State Examination ) › clinical-update

Keep records of these "exams" for future use if they do not point to early stages of dementia.
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