A typical Case of Motherly Dementia
Dealing with dementia symptoms in your own parent can stretch the limits of your sanity. Sometimes you may not even notice the first symptoms of dementia — the slow decline of your aging parent’s memory. Symptoms often continue until your aging parent starts exhibiting signs of other mental disorders, such as paranoia or delusions, which frequently piggyback on the effects of senile dementia. These symptoms often keep reappearing, until you are forced to take action.
My own mom taught school most of her life. She was highly organized and extremely independent. She read constantly and became quite adept at oil painting. At the age of 76 she moved closer to my sister and I, but her canvases and brushes never made it out of the moving boxes. I bought her a VCR one Christmas, but it was never turned on unless I happened to visit with a movie in hand. It became, like the microwave I had gotten her a year earlier, another piece of unused technology. It never dawned on me that my mom had stopped wanting to learn new things, or that this could mean that her aging mind was showing symptoms of dementia.
Soon Mom became suspicious and paranoid about her neighbors. She thought they could see into her windows, so she would keep the shades drawn tight with safety pins. She talked me into erecting a large barrier to block her neighbor’s view. Mom had always been a little paranoid. I figured it was her scar from having survived the Great Depression. I rationalized that if building a barrier would help her open the shades in those darkened rooms, it was worth the effort. I didn’t realize the obvious – that her dementia and her paranoia was growing.
My sister and I began a search for senior housing. We placed our hopes on a retirement community that offered a full-time social director to rescue mom from the depressed mood we were fighting. The retirement home helped her find new friends and subdued the paranoia, but only temporarily. Soon mom insisted her banks of stealing money from her safety deposit box. She also became absurdly paranoid about my brother-in-law, who she suspected, had a master key to her apartment. All missing items were blamed on this poor fellow. We never suspected that paranoia could be a symptom of dementia.
The amazing part of all this is that my sister and I continued right on with our lives, denying Mom’s odd behavior – while helping her change bank accounts and get new locks for her apartment. We never suspected dementia was taking her away from us.
Insidious Symptoms, Insidious Denial
Symptoms of dementia are insidious, because they start so slowly. Often they are mixed with periods of what appears to be normal behavior. So just when we thought she was showing symtoms of dementia, she’d return with what appeared to be complete clarity, asking us about our spouses and giving the usual motherly advice we had grown up with and trusted. Looking back, I can clearly see the progression of the disorder. But at the time, senile dementia sneaked in and stole Mom from us without a clue. Because of our busy schedules, hectic lives, and maybe a little denial, we didn’t see it until it was too late.
There was also a strong fear going on. I remember thinking that if my mother was showing symptoms of dementia, I must be showing symptoms of dementia too. She was so close to me that I had a lot of her same thinking patterns. She dictated reality to me when I was growing up. I worried about this a lot. I really wanted her to be “normal” so I could feel normal. I didn’t want anyone to find out my mom was acting crazy. I could just imagine everyone at work hearing the news and moving their fingers in circles around their ear saying “Ah ha! That explains it!”
So we took Mom to doctor after doctor trying to find a cure for her symptoms. Was it low iron, low zinc, or low potassium? They drew countless pints of blood trying to rule out what could be causing her behavior. But eventually, most of the doctors proved worthless in offering real help. Not one seemed to be able to tell us what was wrong. None of her five doctors could give us any advice that would help her. They all seemed to deny there was any problem. Fortunately, we met a geriatric counselor who advised us to take her to a local hospital for a geriatric evaluation. I wish we had done this evaluation five years earlier.
Identifying Dementia Symptoms and Other Mental Problems
At the current time there is no real cure for the wide range of mental conditions classified as dementia. But there are some ways to determine if dementia is taking over your parent’s life. If it is, there are steps you can take to slow its path, and keep your sanity in the process. Dementia opens the door for other mental conditions. Apparently, as the older brain compensates for the lack of memory, confusion, and other mental disorders: paranoia and delusion can move in. There are medications that can hold these disorders in check. But at this time, you can only slow the path of dementia symptoms. If your parent’s doctors won’t get involved, it may be up to you to notice that your parent is exhibiting symptoms of dementia and up to you to initiate action to treat their dementia. The checklist http://www.boomer-books.com/forms/warning-signs-of-dementia.pdf may help you identify any unusual behavior that may be warning signs of dementia or mental illness. Also there’s an excellent Website that may help: http://www.dementia.com
Types of Dementia
While Alzheimer’s disease accounts for the largest share of dementia cases (currently 50% – 60%), other forms of dementia also share in the battle for the mind. Lewey Bodies dementia is now in second place, accounting for 15% to 25% of all cases. Vascular dementia, otherwise known as multi-infarct dementia, ranks third.
You’ve probably already heard plenty about the dreaded Alzheimer’s disease, or maybe you know someone whose parents have developed Alzheimer’s. It is by far the most prevalent form of dementia, the most advertised, and usually presents the most severe symptoms. Most Alzheimer’s patients develop the disease after age 70. At this time, nobody really knows what causes Alzheimer’s disease.
Lewey Bodies dementia typically affects people between 60 to 80 years old. Males seem to be at the greatest risk. This disease comes on quickly, with episodes of delirium and prominent psychiatric episodes that include hallucinations. Sometimes there is difficulty with body movement, causing the patient to fall and lose consciousness. At one time, it was believed that this form of dementia was related to Parkinson’s disease since the symptoms were similar.
Vascular dementia is caused by tiny strokes in the brain called infarctions. The symptoms are similar to Alzheimer’s, but from what caregivers tell me, the symptoms aren’t as severe as Alzheimer’s. Afflicted patients have less of a tendency to wander than Alzheimer’s patients, and may have fewer personality changes than Alzheimer’s patients.
Many times dementia may be diagnosed as a combination of diseases. For instance my mom’s dementia was diagnosed as caused by infarctions, which was determined by a CAT scan, but she also showed some indications of Alzheimer’s disease. This diagnoses would imply that along with tiny strokes, there were plaques and tangles in her brain related to Alzheimer’s disease.
While no single test can diagnose Alzheimer’s disease, a trained physician can be 80-90% accurate. A clinical diagnosis of your parent’s condition is really important, as it will tell you if the dementia is caused by reversible conditions, such as drug reactions, tumors, infections, thyroid problems, or nutritional deficiencies. Even if the dementia is diagnosed as irreversible, the diagnosis may identify other treatable problems that may be compounding your parent’s dementia. And while there is no treatment today that can reverse dementia, you may be able to slow the deterioration it causes with drugs and vitamin supplements.
Why a Geriatric Evaluation is Essential
It’s very typical to resist taking your parent for a clinical evaluation. You can tell yourself it will be too demanding for your parent, or too much hassle for you and your family. There’s also the fear of knowing the worst. Knowing what takes place in the evaluation process at a geriatric evaluation clinic may help you overcome this anxiety. Also knowing that you are finally taking action to solve the festering problem may help bring you comfort as well.
The Geriatric Assessment Evaluation
If your aging parent is on Medicare, and showing symptoms of dementia, the test at the geriatric assessment center is free. You may find it important to get your family members involved before you take your parent for evaluation. Later, if guilt sets in for being the one to take action, you’ll have someone to share it with, and someone to remind you that you had no other choice. The hospital evaluation for dementia can be a real turning point in your aging parent’s life, and your life as well. Usually, your elderly parent will be required to spend several days in a hospital while undergoing physical and psychiatric tests, and evaluation by a medical and psychiatric team who specialize in geriatric disorders. The team will assess your parent’s condition, prescribe drugs, and help you plan for your aging parent’s future care.
The downside of the test is your aging parent may feel they are just fine and don’t need to go to any hospital for testing. They may also not want to face the fact that they’re losing their memory and their grip on life. Most elderly people enjoy their independence and don’t want to think about being mentally incompetent or dependent on another person for care. They may be very reluctant to find out the truth of their condition. Be gentle, and remind them that it’s what the doctor wants. A phrase that worked for me was “Let’s get it over with so you can feel better.” And “Let’s get a professional evaluation so you can feel better.”
Leaving your aging parent in a geriatric hospital for two days won’t be easy for you either. It wasn’t easy for me. If you’re not careful, guilt will begin to torment you. If you think it over carefully, you’ll realize that what you did, had to be done. Find someone you can talk to comfortably. Perhaps you can discuss it with a good friend of your aging parent – someone who can back you up and go with you and your parent to the evaluation center.
Pulling Your Family Together
Talk with your other family members also. This whole episode, though one of great pain and tribulation, is a great opportunity to get to know your family better. It can bring you all together and make your family stronger. Don’t cheat any family member out of the chance to share emotions or memories with you during this episode in your parent’s life. Turn this misfortune into an opportunity to bond with family members. If you have a family member who isn’t ready to help, move on to the next one. Don’t hate them if they’re unable to join in to help your parent. You don’t know everything going on in their life at this time, so try not to be judgeful. This is a painful part of your journey through life – an opportunity for understanding and love. If your family doesn’t have the love, time, or understanding within them to help your aging parent, forgive them and move on. Some day they’ll probably regret their decision, and you can talk about it then. But right now, you need allies, friends, and support.
The Actual Geriatric Evaluation Exam
While your parent is in the hospital they’ll be diagnosed by a trained staff of around five people, who will give them an interview, test, and physical examination that includes blood tests to rule out all curable causes for dementia. Then they’ll probably give your parent a neurological examination and laboratory tests such as an electroencephalogram to record activity in the brain, a CT scan to make an X-ray of the brain, or an MRI scan to produce a picture of the brain.
After these examinations, they’ll probably administer a series of psychiatric evaluations to make sure that your aging parent isn’t suffering from depression or another psychiatric ailment that mimics the symptoms of dementia. They’ll perform psychometric tests to determine your parent’s area of impairment and areas of remaining strength. They’ll also test your parent’s abilities to perform routine tasks necessary for taking care of themselves.
The staff will check the prescription and non-prescription drugs your parent is taking, especially the ones that can affect the central nervous system. Be sure and bring a list of the drugs your parent ingests. Eventually, the staff will have enough data to diagnose your parent.
If it’s found that your parent has controllable mental disorders, they’ll prescribe a cornucopia of psychotropic drugs in an attempt to achieve normalcy. These drugs should help your parent cope with the frustrations of losing their memory, and the side effects of memory loss, such as hallucinations and paranoia. This will help your parent enjoy more of the time they have left in their lives.
When the exam is over you may be put in charge of your parent’s life, because when your parent is released from the geriatric assessment center, you may become your parent’s advocate. They may be be relying on your care and judgment from this point on.
Bill Grote
