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

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.

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 long....so 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.

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?

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.

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.

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?

BarbBrooklyn: " 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, "

Wow, Barb. I noticed a few years ago that my mother wasn't making total sense in her written communications, and she is like your mother was -- Catholic school education and a stickler for spelling/grammar. I haven't seen much of her writing lately, but I'm sure it's worse.

My mother would never agree to any paper/pen testing. As long as she is deemed to be mentally competent, there will be none done. No consult with a geriatric psych, either, and no meds for her anxieties and obsessions. Sigh...

Barb, I'm not at all familiar with the significance of not adding a period at the end of the sentence. Could you explain? I'm really curious and interested.

I'm assuming this wouldn't be the same as someone with poor grammar who doesn't use periods at all, something like James Joyce's "stream of consciousness" style? How is the distinction made between someone with poor grammatical style and someone who doesn't use periods?

This is interesting.

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.

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.

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.

BarbB,

Thank you for your comment about your Mum forgetting something as little as proper punctuation being a red flag. I feel like I am tilting at windmills with my brother regarding our father. Bro does not see the little red flags, disregards them when I mention them.

Dad had a stroke and was involved in a remote post stroke program to check on cognitive changes, what improves/declines over the year after a stroke. Dad "passed" with flying colours, yet mixes up tomorrow and yesterday in normal conversation. He told me a long involved story about visiting a neighbour in hospital last winter and who also was there visiting. When I spoke with his neighbour, he told me the hospital stay had been 10 years ago.

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.

Find a good care facility for her and live your life.

It seems only her mental was tested. My mother has congestive heart failure. If not enough oxygen is in her blood she can talk elementary school level. Found out she had the blockage, then valve deterioration so long story short she now has a defibrillator with a monitor. The monitor alerts the cardiologist if there was activity within the last 24 hours. They have called for us to go to the ER. Without the portable monitor, we would have never known of the activity as it happened in our sleep. So much today, you never know.

Behavior changes can occur for a number of reasons.

You may want to have her tested for HE (Hepatic Encephalopathy). Ammonia can build up in the blood which effects the brain and cause many of the symptoms you described such as confusion, mood changes. This is a serious condition that can lead to coma and death if not treated. It's not commonly tested for unless there is known liver disease. See the American Liver Foundation's HE website to learn more: http://he123.liverfoundation.org

Hope this helps.

Cathy
PBC Patient & Advocate and Caregiver for our 85 yr old mom

So what exactly is she doing that acts like a 2 year old? Was she always a difficult person? Did she always show this behavior.

My mother in law was exhibiting bad behavior: accusing people of stealing, severe depression, moodiness, anger etc. My husband and I think she has dementia. Other family members do not, since she has a history of being mean and combative. Her sons call her the Prima Dona Drama Queen who enjoys being the center of attention. She has always been this way.

Who knows. Get her evaluated; when I was concerned about my mom, I had a geriatric assessment done at the local hospital. Try to find a doctor or facility that provides this service.

KellyEaton50: This is very much OT. I'm from the Capital District Area. I bet I know who you are talking about. At that time, there was no such thing as competent mental health professionals at Albany Med--and that includes the doc you took your son to. This isn't me speaking, this was the opinion of experts in Boston (Harvard profs) and NYC (Columbia prof) who interacted with the Capital District mental health community. Unless that DX was confirmed by someone who regularly works with highly gifted individuals and was done in either Boston or NYC, treat the report as toilet paper.

At the time, there were only a handful of large public schools (Guilderland, Colonie--especially Shaker High, ? Columbia, ? Schalmont, ? Burnt Hills-Ballston Lake, ? Bethlehem Central) that had a meaningful gifted and talented program and might be able to provide a proper education for a highly gifted student (the ones without ? marks are schools I know could, the ones with ? I suspected could). Gifted and talented programs were designed for students with IQs between 120/125 and 150--they generally do a poor job of accommodating students with IQs above 150. Many parents ended up sending their highly gifted student to private school (like Emma Willard School, St Agnes, Albany Academy / Albany Academy for Girls, Simon's Rock of Bard College, Miss Hall's School) because they did a better job by them. (I know Emma Willard School, St Agnes and Simon's Rock were good places for highly gifted students, the others I suspect are based on friends who went there).

I would *strongly* recommend that you explore the web site sengifted.org. It is *extremely* common for people who are highly gifted to be misdiagnosed with Asperger's Syndrome. It's important for you to understand the personality characteristics of the highly gifted. Normally functioning highly gifted individuals share many personality characteristics with those who are autistic, it takes someone who specializes in working with the highly gifted to determine whether someone like your son has autism as well. 40% of highly gifted individuals also have learning disabilities (I have an IQ over 150 and am dyslexic), and yes, highly gifted individuals can be on the autistic spectrum, but the highly gifted are often misdiagnosed as autistic.
Article from Psychology Today blogger: https://www.psychologytoday.com/blog/saving-normal/201303/giftedness-should-not-be-confused-mental-disorder
Interview of Prof. James Webb about misdiagnosis of highly gifted individuals: http://www.gcgtc.com/services/projects/the-1st-gifted-awareness-week-germany-2013/june9/interview-with-prof-james-webb-usa/

Yes, it's commonplace for highly gifted students to do crappy in school--and flunk out. You'll read all about that on the sengifted.org web site.

This is not atypical of elders. They CAN and DO revert to what I call "their 2 year old self" when they don't get their way and/or want attention. My late mother did this. Tough call, but I did not engage in childlike behavior from her until she could be civil.

The only person qualified to tell u that is a Neurologist. Otherwise contact your local Alzheimer’s Association. They are qualified to give tests and it’s free.

Just to add; my husband, when we'd been married for 3 years or so, started to not "get" a lot of what I was telling him.

We drove to a family event; the directions were screwed up by construction. We stopped and asked and the folks said "drive about three miles down the road and look for the sign for the church".

DH drove three blocks and pulled to the side of the road. He said 'we're here". I asked "where are we?" He said "we're here; folks in the suburbs don't know about distance".

OOOOOkay. I encouraged him to drive the additional couple of miles, wondering what was going on.

The next day, he had a cardiologist appointment. He called me from the office.

To make a very long long story short, he had a nearly 6 MM aneurysm in his aorta and his aortic valve was leaking. Let me tell you, lack of O2 to the brain diminishes all kinds of thought processes!

I feel your frustration. Finding out the underlying cause for the unpleasant behavior is not going be of much help in getting you to be tolerant or patient towards her behavior. How do you treat bad behavior? If she behaves like a two-year old, then treat her like one. Put your foot down politely and refuse demands that don't make any sense. If the situation tends to boil over, be silent and remove yourself from the situation. Don't give in to her unreasonable demands. Don't take her slights or insults personal. It's difficult, but doable. Good Luck!

KellyEaton50: Your mother-in-law may be "actressing" to garner your attention. I assume you took her to get a psych eval?  My late mother often "acted" like a 2 year old. I chose not to engage in such childlike conversation.  Then she came back to reality.

I would think that if there is NO dementia or,alzheimers, then there must be some other mental health issues,just because she's elderly doesn't mean it has to be dementia it could be a brain tumor ,or Parkinson, it could be Bipolar ,physchtitophrenia, but..know you are great people to help her the way you do GOOD LUCK!

Could it be she is a manipulative narcissist? My mom is 88 and has great cognitive abilities, yet acts like a child in order to get her way. she lies to and manipulates those who are not on to her.

I am not sure know what the "last stage" of Alzheimer's is like. My mom is in stage 7, the last stage, of Alzheimer's. She can not walk, is double incontinent...I have to change her every 2-3 hours. She has little control of her hands...she can't help herself with anything. We have to hand feed her and offer her drinks. She is beginning to forget how to swallow. She rambles mostly because her ability to speak is so compromised by the disease. Her memory is totally gone... Not only does she not recognize or know any of her children and grandchildren, she doesn't even recognize her own reflection.

While I am sure you are frustrated with your situation, please understand that that is not the same as the last stage of Alzheimer's. I wish my mom could be her judgmental, self centered, arrogant self again.