Mother (91) is lucid some days, other days not. Her "doctor" of the last two decades can't answer this. Dementia or Alzheimer's? -

Mother (91) is lucid some days, other days not. Her "doctor" of the last two decades can't answer this. Dementia or Alzheimer's?


She can't remember how old...How old I am (I am her first of two and the eldest), nor what year I was born! Is this dimentia or Alzheimers? Or both? There are pills for everyting these days. Is there a pill for this or are we on the slop to the end now? We are changing doctors, by the way.

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so you just trying to figure out if it's Alzheimer's?
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Yes to all who ask has she been diagnosed with dementia (mild as of April, 2015)...Thank you for chiming in!
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cwillie, I tend to agree with you in most circumstances. My mother is 95. She has had dementia for a few years and it is getting worse. It clearly is not LBD and is not Alzheimer's. But none in the family want to put her through more tests (or put the system through more expense) to find out exactly what she has. It would not change her care plan. We feel she is getting excellent care with simply the knowledge she has dementia.

BUT if she had any symptoms of LBD I would want that evaluated. There are some aspects of LBD that require/respond to treatments not common in other dementia forms.

I was at an LBD caregiver support group meeting tonight. A new person was there because she had happened upon an article about LBD and the light went on -- aha! this sounds like what my mother has! She described some sleeping issues her mom was having and we all nodded vigorously. That is RBD, it is strongly associated with LBD AND it is very easily treated once you have the diagnosis.

In the case of Lewy Body Dementia I think it is worthwhile getting a specific (if tentative) diagnosis even for people in their 90s for the sake of some treatments available, some drug cautions about what should never be used, and some idea of what to expect. If as a caregiver you are trying to follow the "7 stages" descriptions you will simply be very confused. LBD does not progress in the same way tha AZ does. Good to know that.

So I think it very worthwhile to have an evaluation that can give a preliminary diagnosis of "dementia." Whether it is worth going for more detail than that depends not only on the person's age but also on the nature of the symptoms. Any thing vaguely suggesting LBD deserves further testing, in my opinion.
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The cognitive evaluation is a good idea, but personally I wouldn't bother sending a 91 year old for a lot of tests just to pinpoint what kind of dementia she may have if any. If she was 71 or even 81 it may be worth pursuing, but I am doubtful there is much that couldn't be learned from her medical history and her present behaviour.
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Do what Jeanne said. Make sure the doctor is an aging specialist - a geriatrician. They are trained on aging issues, just like a pediatrician is trained on children under age 12.
That doctor might want your mom to see a neurologist and have imaging done.

There can be lots of reasons why someone that old may act peculiar. They might have a urinary tract infection. They might be dehydrated. Their medication is conflicting, or it's not being taken correctly. They could be in pain and unable to explain it. Or, they could be experiencing a period of cognitive decline for real.

Ask the doctor to do a cognitive evaluation. There are lots of versions of tests, but essentially they ask the person to do things like write a check to pay a bill, draw hands on a clock for ten minutes to 11:00, remember 3 words in a story, explain the instructions on a pill bottle, judge if shapes are similar or different in size. There's a more involved version my mom did, where she had to attempt to boil water and stir in oatmeal on a stove, count change, and some other practical tasks you should be able to do to live alone safely. She scored pretty low, and was told she can't live alone again. And she didn't.
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There have been times in the past 10 years when I've had to do the math to figure out how old I was. Likewise to figure out how old my sisters and brothers are, and even (dare I admit this publicly?) how old my sons are. Some people just don't retain those "important" details well.

If you mean you are 60 and your mother seems to think you are a teenager, that may indicate a problem. If you mean she isn't sure whether you are 58 or 62, that may not be so significant.

Has your mom been diagnosed with dementia? When you go to this new doctor, bring a list of behaviors or occurrences that seem "not lucid" or unusual to you. Forgetting ages is not by itself very conclusive.

Frankly, I don't hold out a lot of hope for pills to help mom remember when you were born. There are some pills for dementia that a doctor might want to try.

If she does have dementia, then the question is what kind of dementia? There are about 50 types. Alzheimer's is the most common (~60%). It may not be possible for the doctor to pinpoint what type it is.
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