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I am scheduling this appointment for the purpose of getting my 92-year old narcissistic Alzheimer's mom on appropriate meds for her anxiety and depression. I would also seek the doctor's opinion as to the appropriate level of care for her. Does the doctor administer tests or just interview the patient? Would I as the patient's caregiver and POA have an opportunity to discuss mom with the doctor?

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My narcissist mom was really good in her old age, the dear old girl, always up for a trip to wherever! We saw the neurologist who diagnosed probable Lewy Demenia , and she took a few simple tests in the office. ('who is the president? what day is today? can you tell me on this drawing of a clock the time, which is 2 p.m."). It took maybe 1/2 hour. She told the doctor about the 'people sleeping in her back bedroom', etc. She was about 85. He prescribed Namenda, which really didn't do much good. A few months later, we went back and she took those little tests again with that nice man (no idea even where we were!) and it was horrifiying to see how low she had fallen on the scale! Didn't know the day,where we were, the whole thing. (funny, though, Mom always knew me and the two or three visitors she had.)
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Murphclm I'm with you! I would think that the results of a 2-3 hour writtten test for a 90 year old would be questionable. There's no panacea!
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I took my husband who had Alzheimer's to a highly recommended doctor for the evaluation after it was recommended that meds might help his anxiety. It was a DISASTER! The doctor told us there was nothing wrong with him or his brain, only that he was lazy and wasn't using his brain. I stopped the appointment and unfortunately my husband was traumatized for days. Just remember, you are their advocate and must speak up when you think something is wrong or should or shouldn't be done, even to the doctors. Good luck!
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The doctor will interview you or should to get your full opinion of your mom's psychiatric condition, be very detailed and thorough, if they don't take the time for you, make them listen. Otherwise they'll likely hand you a big bill and just prescribe her some meds.
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Sorry, but Mom has Alzheimers so can't sign a HIPPA form. A medical POA is enough to talk to the Dr. I would take a copy with me for the Drs. records.
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It is a long process. I took my mom over 2 years to go to a so called Center for Healthy Aging and thought there would be a team a approach. No, my mom answering questions and either I would support or give my observations. The psychiatrist diagnosed her with Major Depressive episode. My father had passed away a year before. The whole family knew she had dementia/Alzheimer's . The next appoint six months later, the dr. diagnosed her with Alzheimer's(should I say Mild Cognitive impairment). The dr put her exelon to slow the progression with Zoloft to treat the depression. Two years later, she had been come agitated, anxious, hysterical, and disoriented especially at night. Finally after pleading my mom's case the dr. increased her exelon and added an anti-anxiety. The dr would not increase the Exelon previously because my mother only scored one point lower on a cognitive assessment. Really, I am her daughter do you not think I see my mom every day and know her ability/quality of life is declining? I am now trying to get the dr to decrease her Zoloft. It is a constant battle. In everything I have read the doctors need to treat the behaviors since their is FDA approval for treating Alzheimer's. I am in education and I have come to view it as treating children with ADHD. It is diagnosed by checklist and observations. Although, children can communicate how this drug or that drug makes them feels but an 86 year old cannot. I do have POA and my mother sign all the forms to have access to her medical her records.
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When Mom, in her late 80's, started having frequent UTIs and behaviors, we took her for psych evaluation, sleep apnea testing, lots of things to see what could be done. Sleep apnea turned up nothing; the psych evaluation was not something I even understood, she is also legally blind, a lot of things can be from that. something called Charles Bonnet Syndrome where you imagine things going on that aren't. Can't really add anything, just sympathize with all the uncertainty, busyness with doctor appointments, ER visits, etc. She now is pretty comfortable at home, is 91, I moved in with her for now. She had a hysterectomy last Fall, she just seems to keep going.
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There are no perfect solutions for disease and suffering. Mom is 91 with Alzheimer's, vascular dementia, and mental problems that won't quit; a fall risk with or without medications. If medications will ease her misery for she has left, I say bring them on.
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My mom back in 2008 (when she was in her 70s) had the lengthy cognitive testing and just refused to cooperate before it was over with. They wanted her to retake part of it but she just would not. I can't imaging putting somebody in their 90s through all of that. I would think it would be best just to try small amounts of medication and see what works rather than put them through the mill. She is now on a small amount of Depakote, her old antidepressant, plus Namzaric at the nursing home. No miracles have been observed, lol.
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Diagnosing something they can't treat other than doping them up. Psychiatrists make over a million dollars a year so it's big business.  If it's Alzheimer's, There is no cure for Alzheimer's..you put them on psych meds their risk of falling increases and falls usually kills Alzheimer's victims. I guess in that sense they are "cured". 
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It seems that 2 - 3 hours of written testing is a lot for an elderly patient. My mother is 91 and bipolar and is treated with seroquel and depacote. She still has manic episodes twice a year but they are milder than without meds. She was referred for a psych evaluation but won't go. At this point I've decided that changing her meds is no guarantee that there will be an improvement so things will remain the way they are.
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My mother needs a geriatric psych consultation because of her anxieties. She will never agree to go, though. I can't force the issue. But I can refuse to put up with her repetitive rantings about things.

Things will have to get a lot worse before they get better. She's in full control of everything. I'm not even allowed in on her doctor visits anymore (because she doesn't want them talking to me and not her; she's very sensitive about people thinking she isn't "all there"). Never mind that I don't think she even hears half (combined with not processing and then not remembering) of what is said to her.
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It does help, indeed. Have already made an appointment and preparing for it as well as I can. Thank goodness for this forum. You have all helped so much.
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I took my mom to a neuro psychologist who specializes in aging after her GP administered a mini mental status which she failed miserably . The neuro psychologist administered a 2 to 3 hour test which results indicated she had MCI with amnesiac features. He suggested she keep driving and working. (Part time job). She quit doing both with in 2 months. I do call her doctors office to discuss her symptoms. I have POA and the medical POA I didn't feel comfortable disputing her responses in front of her when she was being interviewed by either the GP or the neuro psychologist , so I had written my concerns and handed the paper to the receptionist before the appointments.  Hope this helps.
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Thank you for your answers! Gives me a better idea of what to expect.
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I should mention that my mom's cognitive issues were evaluated by a team consisting of a geriatric neurologist, a neuropsychologist and a psychiatric nurse practitioner. This eval was requested by the geriatric psychiatrist who was treating mom's anxiety.

Cognitive testing was three hours of pencil and paper testing which showed clearly mom's deficits in planning and reasoning abilities.
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Took my dementia mom to a neurologist who specializes in dementia and alzheimers. Haven't even met the doc yet, did two hours of cognitive tests and questions and answers. I sat beside and slightly behind Mom, and so I made some big GESTURES like nodding my head in agreement or not. I also put my two cents in, but I was very careful not to interrupt Mom and I tried really hard to be diplomatic. Next is the MRI....then we shall see what happens. I also handed them a folder with info in it so they could read it on their own time.
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Most psychiatrists, geriatric and otherwise, use interviews. My mom had a geripsych exam during a hospitalization and my brother and I were in the room to add information and to confirm stuff. ( Mom has extremely conservative political views and was holding forth on Sarah Palin....the psych turned to us and said "is this typical?" ( meaning, we're these new views or usual ones). My brother said " that's mom; slightly to the right to of Atilla the Hun").

But seriously, I would make up a bulleted list of your concerns and fax them into the office. Bring a copy the day of the appointment.

Mom will need to fill out a HIPAA form for you to get info from the doctor, but even if she won't, you can GIVE all information you want.

In general, I schedule a time to talk to mom's doctors AFTER the appointment, on the phone.
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