How do you learn to be patient with an 84-year-old woman in perfect health, who acts like she is 2 years old? -

How do you learn to be patient with an 84-year-old woman in perfect health, who acts like she is 2 years old?


My mother-in-law lives with my husband and I in our home. We took her in 7 years ago as we thought she had Alzheimer's. Recently we had a huge amount of tests done due to the fact that after being a speciality nurse for Alzheimer patients she didn't seem to fit the mold. Well come to find out she has a REMARKABLE BRAIN! No signs of Dementia or Alzheimer's. We are at a complete loss as she acts like someone who is the last stage of Alzheimer's. Any suggestions are welcomed dearly.

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So what are these experts telling you?
Many years ago one of the children in my family went through a battery of tests to try to understand why he couldn't perform in school. The conclusion was congratulations!, it wasn't dyslexia or ADHD, and he was very intelligent. Uhm, thanks, but he still can't seem to get a grade above 50%. (sigh)

Just because they have ruled out ALZ or any other dementia shouldn't mean they can send you home with no answers. She is clearly impaired, if it isn't dementia then what is it, and how do you deal with it? Insist on an answer.
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GA, so, there are basics of grammar, syntax, spelling an punctuation, right? And if you are assessing someone for a change in cognition, you have to compare present assessments with previous level of functioning.

For a lot of people, writing a sentence and NOT putting a period at the end might not be a big deal. For someone like my mom, given the stringency of her early education and given the fact that she completed her BS at the age of 81, her clinical team had a pretty good idea of what they were comparing to--someone of average intelligence of better and someone who was used to paying attention to details.

For my mom, it was a subtle change in her "executive functioning" and ability to sequence a language task. It's also the sort of thing that is part of "things you do without thinking" track; to me, I knew that it meant that there were going to be findings, and that they were not going to be of the "oh, your brain is fine" sort.
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Being a nurse I have asked several questions...with little return..I finally after exausting efforts made them get a evaluation with a specialist for other underlining disorders, but of course the list is in the mean time we deal with someone who has all the characteristics of Narcissistic Personality Disorder. I hear you about your child..I went through the same with our son 27yrs ago...the same tests, extremely smart...finally took him to Albany Med to a pediatric specialist who's diagnosis was Asperger's....sigh...Amen.
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The 6 hours of paper and pencil testing is important. It's the test that my FIL, who shows signs of cognitive decline, refuses to complete. He's had CT scans, MRIs, and heart monitors, and has been in the ER and neurologists office ad nauseam and they find nothing. It's beyond frustrating. Does your husband have durable power of attorney covering both financial and medical? If yes, your husband can make the appointment for the full day of testing. If not, get DPOA done before it's too late.
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I SO agree with NYDIL that it's the paper and pencil testing that shows the decline.

I friend reminded me yesterday about a story I told her during my mom's workup for dementia.

The neurologist gave my mom all the basic tests; clock drawing, remembering three words, etc. He then asked her to write a sentence. My mom wrote a very coherent sentence, but I noticed that she didn't put a period at the end of it. A felt a frisson of dread at that moment; 12 years of Catholic School education and no period at the end told me what I needed to know, although EVERYONE else, including mom's regular doctors thought that she was "sharp as a tack".

The cognitive testing --6 hours with a neuropsychologist, testing intelligence, reasoning and sequencing, among other skills, showed that mom was no longer able to live on her own and manage her life. She was diagnosed at that point with Mild Cognitive Decline, which sometimes advances to dementia; in mom's case, she had stroke a year or two later, which caused Vascular Dementia.

I hope that you get your answers.
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Barb, thanks. I understand the change issue. I've seen that myself and it helps me gauge where my father is (and where I am!). And I can understand that it was a departure from your mother's normal pattern of writing.

Your mother is/was someone special - to complete a BS at age 81 - WOW!

And thanks for sharing the rationale behind this.
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So, what are the underlying disorders that she has?

How did they determine that she is not suffering from dementia?  Did they do brain imaging, basic neurological testing AND 6 hours of paper and pencil neuropsych testing?
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I could be wrong, but I don't think Narcissistic Personality Disorder comes on in old age -- I think it is pretty much a life-long disorder. What behaviors seem to fit this diagnosis?

Has she seen a geriatric psychiatrist?
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Yup, GA. She was totally awesome! My avatar is a picture of her waving to us at her graduation, Summa Cum Laude!

For everyone, she was reluctant to do the testing, initally. (Actually, she had been part of the norming group for this rehab center, 20 years earlier).

She said to me; " If they tell me I'm crazy, I won't believe it". I said , "mom, they are not going to tell you that; they just want to figure out what is going on in your brain right now"

That comment alone (about "not being "crazy") told me that she was no longer processing with a "full deck".

The good thing was that the testing demonstrated to Bro and SIL that what was going on with Mom was real and not "something she was doing to herself".

And kept me sane.
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BarbBrookyn makes some interesting points about the handwriting. I found a very amusing article on it and the brain. We can't post link here, but, I'm PMing to BarbBrookyn. I hope that's okay.

My LO has Vascular Dementia. It was revealed by MRI, but, I wasn't too surprised, because Primary had already diagnosed, AND I looked through my LO's recent checks and found one where her writing looked like a foreign language. It was odd letters mixed together and it didn't appear to be her writing, but, IT WAS. Pretty sad, but, revealing.
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