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She takes no meds (even though lexapro was prescribed by a neurologist and primary doctor). She is focused solely on going home and won't engage in activities much. She doesn't know how to leave and it isn't safe for her to live at home. Home care is not safe or feasible. Is it time to take her to a neuropsychologist? She finally asked to see a counselor, but with moderate cognitive impairment, early dementia/alzheimers, she has fabricated all sorts of history as well as had delusions. I can take that she tells everyone that I'm mean and unbending, but I have to keep her safe. Two caregivers suggested memory care, but I don't think she's quite ready for that as her dementia is early/moderate and most people can't tell that she has a problem if they haven't known her or haven't spent long with her. I fear that guardianship may eventually be necessary. Just don't know how to help her through her grief and depression, especially when she has forgotten my character and no longer trusts me and her reasoning is shot. Any suggestions?

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I would say take her to both kinds of doctors until *hopefully* you can get her some help that relieves the stress you feel. From what you said about her past history, she may never be happy, but at least you'll know you've done everything you can. Sometimes that's enough to keep the guilt from creeping in for you. I hope you can find something that helps her and eases your mind. Hugs.
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A neuropsych exam is good evidence for guardianship, but a geriatric psychiatrist may actually be able to recommend treatment that will help. Why won't she take Lexapro? A geriatric psychiatrist might be able to explain the medical reasons for this kind of medication regimen in a way that she can accept. It sounds like it's worth a shot since nothing else is helping. On another note, it seems to me that if she no longer remembers that she can trust you, you may be dealing with one of the "interesting" dementias and would be well served by a specialized workup. So perhaps you need both kinds of specialists.
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She has been there for five months and is so determined, it seems, to prove that she'll never be happy. Mind you, she really has never been a happy or positive person, but she is taking it to new levels now that interfere with her well being. Pamstegman, I have discovered the truth/wisdom in your suggestion to avoid debate and not allow discussions to escalate into big conflicts that have no resolution. Just still wondering if a neuropsychologist would give support for her or me in any way. I've read that the neuropsych can help support guardianship, but I'm hoping to avoid that anyway. I just want her to begin to adjust. The caregivers just can't give her the kind of time she demands when she wants to talk about getting out of there (and other complaints).
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Sounds mean, but you stay away from the facility for two weeks while she settles in. SSRI's can take two months to really be effective. So limit your visits to an hour once a week and force her to refocus on activities there.
Arrive unannounced. We did that and "caught" mom having a good time. Once her Zoloft increased from 20mg to 25 mg, she saw the world in a better light.
Angry is a phase. Wanting to "go home" is actually a desire to return to her younger self. I just say "No" quietly and add "You are safe here". Don't attempt to debate with her delusions. Throw the guilt card away when she plays it. If she is not happy to see you, excuse yourself and go. Stay only as long as she is nice. She will catch on to this strategy.
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How long has your mother been living in assisted living? I heard it can take a few months for residents to become accustomed to the surroundings.
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Also, she is currently in assisted living (in case that wasn't clear).
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