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Mom's main problem is osteoporosis and arthritis. Lately she has started substituting words - "aisle" for "hallway", "truffle" for "toffee" - things like that, and she is WAY overdoing it on days she knows she has other things she wants to later on - which she has always been careful about conserving her energy for important events. Also, she has gotten irritable a couple of times, which in not like my sweet mother at all. Is this something I should be concerned about? How should I bring this up?

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If I remember right, she got a 25 both times. I'm not sure I would have scored as well. But then, I could be remembering it wrong. I keep telling Mom, between her and me, we don't have a brain cell left (I have fibromyalgia and epilepsy, for which I take topamax, which I like to refer to as dopamax, for it's dumbing down effect).
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I'm gonna chime in as a psychologist here; you don't "pass" cognitive tests, you get a score. The score may tell you that there is no dementia or decline going on, but once you have a baseline, you can measure from there. I like to tell folks that these tests pretend that you are a helium balloon, we want to see how high you can go; not like a test you study for and then get a passing grade or not.
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I think this is an important change and the neurologist needs to look in her head to see what is happening, then make sure the prescriptions match the problem. Usually the observed (from the outside) symptoms work well enough, but this involves at least one discreet area of her brain, or more. Might be time for a CAT scan or MRI. (I am not medical, so not sure which). Keep in mind that one illness or condition does not prevent another separate condition, they can both happen.
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She takes a LOT of calcium because of the osteoporosis, so I will have her blood checked for excess levels as well as UTI's. Thanks!
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Chiming in with the UTI.....has really weird symptoms!
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Bloodwork time.. Check her calcium level, I had this happen to me. I wasn't confused just had too much Calcium and that can cause mild seizures or blood clots hence strokes if untreated.
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There is a dementia type called semantic dementia that is difficulty with using the correct words and asking the name of something familiar. Does she ever ask what a bird is for instance? Not the type like sparrow, but actually does not know what something is called.
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Thank you all for your helpful suggestions. I hadn't thought of the silent strokes, or of it being a side effect of seizure activity. She does have a neurologist, and has another appointment fairly soon. She has had 2 previous cognitive tests (which she passed, no problems), so there is already a record of how she did in the past. Again, thanks so much.
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In looking up aphasia (which may be what your mom has with her substitution of words) I found that it can also be a side effect of seizure activity. So it sounds like it would be a good time to get her to a neurologist (or whoever is giving her the seizure meds) for a follow-up. If she isn't seeing a neurologist, it would be a good time to get her started with one. Good luck and keep us posted.
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I would think about taking her to see a neurologist who specializes in elders. She may be having small silent strokes. They might want to put her on a blood thinner if she's not already on one. You might want to get some baseline cognitive testing. If you don't have power of attorney, health care proxy and the like, now is the time to get them.
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Some background. I have been Mom's caregiver for 3 years. My husband and I live with Mom in her house. Mom gave up driving shortly after we moved in with her, because she had managed to mark up her new car in 3 of the 4 corners. Shortly after she quit driving she passed out at a friends house, and when she went to the doctors office, he wrote her up and she since received a revocation of her license by the DMV. The doctor put her on an anti-convulsant, even though she never had a seizure. He said her brain shows seizure like activity. She has severe pain issues after 3 back surgeries, has a spinal cord stimulator implanted and must take pain medications to control her pain. She is not addicted to pain medication, and that is one of her biggest fears - becoming an addict. I bought her a monthly medication pill box, and put all the pills in it for her once a month. It's a great tool, and even has daily reminders of when to take her pills. We also have a daily calendar for appointments that is shared for the 3 of us - all appointments for any of us go into that calendar, and Mom checks that at least 3 times daily, and still has trouble remembering what is coming up when.

I do the cooking, her bills are paid automatically, but she was unable to get her tax paperwork in order this year. She sent what she thought was required to her accountant, and was horrified when he sent back an exorbitant amount that she owed. I looked at it and told her what I thought she was missing. She called her accountant, he looked at her previous year, and that's what she was missing.

Mom reads constantly - newspapers, novels, whatever she can get her hands on. That has not changed.

Her medications have not changed lately. Her weight has not changed lately. I've noticed more swelling in her ankles, and we're going to get her in to see a cardiologist asap. She's had a quadruple bypass in the past, but a year ago a cardiologist told her her heart was "beautiful".

I will get her checked out for UTI's. Thanks for the idea.
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A change in status should always be noted. If your mom doesn't have dementia ask her if she's been feeling OK, if there's anything that's been bothering her lately. Gauge her reactions. I don't know what kind of relationship you have with your mom but if it feels right, share your concerns with her. Suggest that she see her Dr. for a check-up. Then explain to the Dr. what prompted the visit. I see no reason to sneak behind her back and try to trick her into seeing her Dr. As caregivers, we have to be able to have difficult talks with the people we're caring for (if their state of mind permits it).

If she's been irritable lately she may recognize that her memory isn't what it once was or she may have noticed a change lately as well.
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She knows she is in decline, that is why she is anxious and irritable. Make her MD aware of these changes and encourage Mom to get further testing. Keep an eye on her driving skills. When you see all four corners of the car scratched up, it is time to stop driving. Notice the small things: Did she stop reading novels? Cancel the paper? Buys too many groceries (hoarding)? Burns things in the oven/stove? Forgets recipes? Bills unpaid or paid twice?
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