Why does mom know neighbors and friends but insists she doesn't know me?

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Mom has undiagnosed dementia - NP believes it is vascular dementia, visiting nurse thinks her behavior is more like alzheimers, PCP thinks it could be latent bipolar disease since it happened pretty quickly. In any case, there is some psychosis going on for some reason. We are in the process of getting a psych referral but not sure that Mom will cooperate. Well last night was the worst yet. Mom had a pretty good day. I actually carried on conversations with her most of the day. Then something snapped and she didnt know who I was. This has happened before where she thinks I and my sisters all have imposters. Mom went into the hall in her apartment building and starting banging the walls and screaming to call the police. Two neighbors came out and tried to calm her. I also called a friend and asked her to come over. Mom recognized and responded to all three of them but insisted she had no idea who I was and I was certainly not her daughter. Can anyone shed light on how she can relate/respond to mere acquaintances but doesn't know me? I have been by her side and helping her for the last 10 years. One minute it's what would I do without you and the next she claims I'm not her daughter. We got her settled and into bed last night. This morning she has not uttered a single word and just stares into space it glares at me. I'm at my wits end.

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Weary....your feelings are absolutely normal. Yes..she is scared and this situation is extremely difficult for everyone, especially you. You're doing a great job given your situation. It's likely time that she is placed in more suitable care....whether in home or in a community. Her personality sounds a bit like my mom who has moderate vascular dementia and is very independent, emotionally a wreck as she copes with dad who is in skilled nursing with Alzheimer's, scared of the changes she experiences, delusional and quick to lash out. I'm doing what I can to manage their care from 400 miles away and visit every 5 weeks or so....but my bottom line is it's her or me. She is 90. I'm 69 with a son, grandchildren, and a posse of great friends where I live. I'm trying to help mom live as independently as possible for as long as possible...and she knows that. We do what we can with all good intentions...but I am part of those who have determined not to sacrifice ourselves to this disease. Sorry to ramble...but by now i think you know you have big shoulders here to lean on.
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Mom does hallucinate. Not only does she see things but she has elaborate stories about what she is seeing. Trains coming on her porch to let people off, machines that move full grown trees from one side of the road to the other. She also hears music constantly, mostly opera.

There is a social worker coming Monday to discuss living options for her.

I woke up this morning dreading the fact that I to go over there for the next 2,days.

I feel so guilty for not wanting to be with her but I'm not sure how much more I can take. I also can't even imagine how scared she is and that, too bothers me more than I can say.
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This phenomenon is not extremely common, but it is common enough to have a name, and to be written up widely. It is called capgras syndrome. The patient suddenly believes that certain loved ones have been replaced with identical-looking impostors. This belief applied to certain people -- a wife might be seen as an impostor but a neighbor is seen as himself.

According to an article in PubMed, "Capgras syndrome is more commonly associated with neurodegenerative diseases, especially Lewy body disease, where visual hallucinations always coexist. In the absence of a neurodegenerative disease, the onset of Capgras syndrome occurs at a significantly younger age and can be associated with psychiatric disease, cerebrovascular events, and illicit drug use"

I belong to a support group of carers for people with Lewy Body disease, and several of our members have dealt with this.

It would really, really be useful if your mom would have a complete workup. Knowing more about what you are dealing with would be useful. Do look up capgras and at least you'll know that you are not alone. Also ask her geriatrician if her other symptoms seem consistent with Lewy Body.

Has Mom been acting out her dreams -- running in bed, waving her arms, etc?

Has Mom lost her sense of smell?

Is she now unsteady on her feet?

Does she seem to have problems with depth perception -- taking a big step over a door jam, or having trouble getting into bed or a chair?

Does she seem to see things that aren't there?
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Weary, Sounds like you did everything right, and this is getting harder for you and your Mom .
Keep coming here, keep posting, keep talking this out with your caregiving friends on AC.
I know there is medicine that may allow her to know you for a time, depending on the stage of dementia or alzheimers she is in. Sorry, but I don't know the names of those meds anymore.
Please be brave.
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Thank you all. It has been a rough few days. Mom has been screened for infections, has been to ER and had a brain CT scan - all negative. Mom refused to be admitted for a neuro/psych work up.

Mom has been diagnosed with CHF and Pulmonary Hypertension. I suppose that's why the NP is presuming that she has vascular dementia. Her PCP is a geriatrician and not convinced. The visiting nurse is there to treat pressure wounds.

As always, appreciate this forum and the input you all offer.
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Sorry that your Mom doesn't know you.
Addressing only the psychosis, (and, I realize there is limited information), this 'case' screams "under-served by the medical community". A NP, visiting nurse,
PCP thinks....all undiagnosed-are they just guessing? How long has this been going on, and how did the patient receive a visiting nurse with no actual diagnosis???

In my opinion, and I am not an expert, not a doctor: Follow the advice to get an expert diagnostician consult. A geriatric psychiatrist, a neuropsychiatrist, an emergency room visit-the fastest route to referral, imo.

I agree that it could be anything, such as a urinary tract infection, or even a side effect of the wrong medication given for the wrong diagnosis.

Start with a diagnosis, have the medications reviewed S.T.A.T.
That means right away-even if it is the 911 call you could have made when Mom was 'upset'. You say that you have been caring for her for ten years. In alzheimers or dementia, this behavior could be a turn for the worse-find out. I don't know, but understand this is way hard on you.
Others will come and give support on how to cope and also how to manage and predict these outbursts. Keep checking back, write more....how is she today?
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I think I'd take her to a neurologist first, psych second. Wouldn't it be a good idea to rule out organic/mechanical causes? Has her PCP taken bloods to screen for reactions to infection?
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Have you Mom checked for an urinary tract infection... that in itself can cause strange reactions in the elderly.
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I'd try to get an EMERGENCY psych referral ASAP. I'd call your hospital for help. Most have places they refer you to. I would treat it as an emergency.
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I wonder if she remembers you all when you were younger?
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