Did she pass the cognitive test done by the neurologist?

We went through this with a good family friend two years ago. He always retold his stories/adventures, so that wasn't a real sign. For me an early sign was his inability to fix a door problem in their house. He was always a very handy person and totally missed what the real problem was. Another sign was his wife had an accident and was in the hospital for several days. He totally fell apart once his daily routine was no longer there. I was at the neurologist appointment and saw him fail part of the test. Heartbreaking.

Based on my experiences with the people closest to me as they’ve gone through aging, that’s not normal at all. Being forgetful and repeating stories, sure, but not to the extent you’re talking about. And not at 81.

Unfortunately I have a friend whose wife is going through this to a lesser but notable degree. And she’s just in her 50’s! I know they’ve been to doctors, but I’m not sure how aggressively they’ve pursued it. First I was hearing menopause, now he’s saying long covid. I asked if there’s been a formal diagnosis and he said no that’s just what he thinks. I think he’s in denial, gives her a cocktail of vitamins and pretends it’s getting better. I feel like I want to push them to more testing. She works at a school and at some point it’s going to become an issue. I’d imagine they’ll need a diagnosis if there’s opportunity for disability.

It’s a difficult topic to address, but I’d be looking for more answers for your MIL. If not for possible treatment, at minimum to set expectations and begin planning.

I'm not sure about the scale on the cognitive test. At her appointment in May, she had gone from 23 to 18. They changed meds, and at her appointment last week she was up one point. From what her daughter told me, the neurologist says she is not at the dementia stage, actually a long way from it.

Also, her daughter has been keeping a list of these incidents, and she discussed it with the doctor.

Can she see a gerontologist? Short term memory loss can be a real issue. Does she cook for herself? Risk of leaving burners on on the stove? Does she have pets she may forget to care for?

If she is on a toll road with no memory of it, that means she is wandering which could be dangerous on many levels. Friend of ours' father was in his 90s, went to drive to the store and ended up in another state. Eventually the police found him, were able to contact his son who was able to retrieve him.

MIL's dementia (not alzheimers) was noticed when she was wandering the halls of her living facility at 10pm looking for breakfast. Her sister ended up wandering at 11pm in NYC in November with no coat on looking for ice cream. The police found her and brought her home. Aunt with alzheimers...her husband put an alarm on the door so he would be alerted if the door opened and she tried to leave in the middle of the night.

Friend's mother is going through the same thing -- including getting conned out of tens of thousands of dollars, inappropriate buying of items, losing track of time and appointments, forgetting to take care of her cats -- very difficult situation for sure.

But it will always be easier to address sooner rather than later as her situation is only going to deteriorate and her need for care go up.

Also, her daughter has been keeping a list of these incidents, and she discussed it with the doctor.

It sounds as if this is being monitored appropriately and there is nothing you need to do.

Have they done scans on her brain to look for changes? My DH has been forgetful and not able to recall pertinent facts from the past, recent and longer ago. I went with him to his GP MD appt and discussed this with him. I had examples to give. The MD was concerned and ordered a brain scan and psychological testing much like is used to diagnose ADD or learning difficulties.

Fortunately/unfortunately my husbands testing did not show anything. Brain changes indicating dementia can be seen and there were none. The psychological test established a baseline for further testing down the road. My DH was an average student and his results were consistent with that, did well on some tasks, not so well on others.

The MD just feels that my DH is an inattentive male who doesn't listen to anyone and therefore doesn't remember any conversations that he isn't particularly vested in.

Some of this may be too late for your MIL, but may be beneficial if you are questioning someone else's capacity.

Whether to call it dementia or not is TBD, but these are concerning lapses and there are safety issues to be addressed including driving.

My own MIL’s dementia may have been precipitated by an untreated head injury and much of what we noticed was emotional. She alienated all friends including those she’d known for a lifetime.

She cooks some, although she has little interest to cook for one. She eats out a lot and has lots of leftovers.

She may have had a brain scan a couple of years ago. We finally convinced her that she had a problem (and FIL concurred.) That's when they started seeing the neurologist. She very regularly sees her GP, but I don't think he's specifically a gerentologist.

She does have a friend up the street, and they are together a lot. They check in by phone a couple of times per day, and see each other often. Mom tells her the plans for the day, including where she has to go. We're in the process of getting a medical alert device.

“The MD just feels that my DH is an inattentive male who doesn't listen to anyone and therefore doesn't remember any conversations that he isn't particularly vested in.”

Pretty sure I’ve observed that syndrome before!

Yes I didn't want to make light, but uhh...

Not normal aging. I do agree that doctor visits are brief and they can miss signs that the family is seeing.

Has the neurologist done a brain MRI? Has the neurologist recommended a consultation with a geriatric psychiatrist so the two specialists can discuss their findings?

Consider a 2nd opinion.

Most importantly, keep an eye on MIL’s safety at home if she lives alone and while driving.

ETA - has your MIL seen her primary care physician recently? Untreated health issues like mini stroke, UTIs, diabetes onset, and low calcium levels can cause symptoms that present like dementia.

Agree on a gerontologist - we had a close family friend who was showing lots of signs for dementia, lost his wife and finally agreed to a continuing care facility - gerontologist there cleaned up his meds (lots that should not have been taken together) and the clouds lifted - totally different person after that - he had 7 fantastic years in the community with lots of friends, laughter etc

As a retired Home Health RN I can 2nd the importance of medication review. The rate of medication errors is horrific.

Be it in the home or direct from the pharmacy ( yes they make mistakes) in the hosptal ( yes there too) patient’s willful use of meds incorrectly ( so prevalent in the elderly that it is seen as an expected issue). Patients almost always have more than one physician. They get meds here and there . They RARELY report exactly what they are taking when they see the different Drs. Patients almost NEVER discard old drugs. They very often don’t complete the RX as prescribed….” I’m not taking ALL that antibiotic I might need it again”.

The issues are frightening in their scope and the attention paid to this problem when a patient has only 10-15 min at an MD appt, in many cases to review meds , symptoms , new issues etc is not sufficient.

I could tell you years worth of stories and the ONLY reason the issues were caught by me was because I was relentless in my pursuit of potential errors and spent 45min-1 hr at every visit. It is a problem that every family needs to be extremely determined to solve/ prevent. It requires dogged attention to every med taken or hoarded for later use. c

Given all that you've mentioned, I would definitely be concerned. Has the neurologist given her a cognitive assessment, PET scan, blood work? If not, I would make an appointment and have him/her order these tests. You can also get a second opinion with another neurologist.

As others have mentioned, so many things can come into play as far as medication, dehydration, blood sugar levels, kidney function.

Kudos to you for looking out for her and her safety. You are not overreacting.

The incidents you describe definitely point to cognitive impairment of some sort. One relative recently saw a decline his cognitive testing score. In-depth scans showed no evidence of dementia. A subsequent sleep study uncovered severe sleep apnea and prompted the use of a bipap device which has resolved the issue.

There are many possible reasons for cognitive impairment other than dementia like medication, sleep apnea and vascular blockages to name a few.

I'd be sure to get a consensus or at least affirmative acknowledgements (from all of the affected family members who are indifferent) before moving forward with your obviously concerned and caring plan.

An oldster who may be in decline or need changes of treatment can present a difficult and heavy burden to attend to. The difficulty pales in comparison to having to deal with outraged family members who suddenly become obstreperous adversaries.

A first step - does your mother in law have healthcare/end of life legal documents in place (like a medical power of attorney, HIPAA authorization, advance directive, etc.) ? If she does and you're not a named person granted the various authorities, or if nothing exists, you may encounter obstacles with your being involved with or even getting a second opinion. Getting these done may be a good thing to do before pursuing the actions you think are necessary.

Good luck. These situations are always hard.

Totally agree with Elmer’s suggestions. The fact that you are the Daughter-in-law and not a daughter makes this even more important. It would be a good thing if the two kids who are unconcerned about all the symptoms you describe at least don’t object to your husband and their other sister pursuing a reason and possible treatments for the symptoms. From personal experience I can say that some family members won’t object to any treatments in this specific arena as long as they aren’t expected to do any of the heavy lifting.

About repeating stories.... I have friends/family who repeated stories all the time. They all let somewhat isolated lives, not enough people in their daily lives. Yes, there were other people around, but these people were all somewhat introverted. Only one developed dementia, the others did not (or haven't so far).

One friend, when she visited us after we moved here, would simply not shut up, she went on and on and on. I love here dearly but was ready for her to leave. She's 90 now and still as sharp as can be. But she lives alone and when she visited, she just wanted to talk.

So the repetition can also be situational.

With at least two kids who appear to be on top of things, I’d avoid adding DIL as medical proxy or similar.

I missed this the first time I read the OP:

Her daughter takes her to doctors, and she agrees with me, as does my husband.

I think three of you is enough of a quorum to make this assessment that something seems off and you want her to see another neurologist. If you don't want to ask the current one for a referral, ask her GP. Her other loved ones can be informed but I would not ask their permission, especially if MIL herself is consenting to a second opinion. Plus at this stage it is just diagnostic.

Omfw… it was meant tongue in cheek. And i assume the daughter who now takes MIL has the requisite authority.

Thanks for all the insights. I'm going to forward this thread to the sister who manages the doctors. I absolutely agree that, as the DIL, I have no authority. Nor do I want it. She has all the proper paperwork and appointees in place. The brother who thinks it's no big deal has medical POA. Mom is definitely capable enough that POA wouldn't apply right now.

Mom is not resisting medical care. She is a bit freaked out by the possibility of dementia, and is open to medical options. She just saw her GP last week, and went for blood work yesterday. I don't know if there are tests that would be beyond the normal bloodwork. Good question.

I think some of us just feel that the neurologist is brushing aside these incidents and relying on test results. I will suggest to the sister that she ask the GP for another referral, and a meds check. She gets all of her meds from the same pharmacy, would they be able to do that, with Mom's authorization?

Do not forget to check for UTI. My neighbor about the same age had one and she did not even know it. UTI causes confusion. .

^^^^^^^*

Absolutely- please check for a UTI, check her medications and their interactions, and consult with a gerontologist-or at the least get a second opinion.

"The brother who thinks it's no big deal has medical POA"

We had a similar situation with my MIL for many years. That brother definitely shortened her life and made her last few years much worse than they ever should have been. He was the one who had the most to gain from making sure she spent the least of her money, and all his decisions were based on maximizing his inheritance.

Just want to underscore what Trail noted about checking medications, as well as Sherry's suggestion to check for a UTI. I have anecdotal experience with both, and they shouldn't be overlooked.

Good luck, Aok. I hope she gets a more complete evaluation.

I try to consider my posts carefully before making them and look them over before touching Submit. I willingly delete any comment and I'll mention having done that as you did, if I find or someone else points out that I made a mistake, am wrong or significantly misunderstood something.

I've tried to offer helpful comments in this thread and hope some are seen as such.

Edit to add - this post has been orphaned, it was in response to a comment by food asking me to delete a post. Which he seems to have deleted. Along with another

My first thought when I hear this is to please check for a UTI.

My second thought is medication. My 90 year old mom was diagnosed with heart failure and Afib last year. During that time period she was prescribed several meds in addition to meds she had been taking for other things. Within a week I noticed confusion, memory issues and the scariest of all, hallucinations. Her primary and cardiogist both said it is most likely the beginning of dementia and not at all related to the new meds. I continued to follow my gut because of the timeline of events. I met with 3 different pharmacists, spoke to my own primary and did a deep dive online. Found out it was caused by an interaction between her meds. Getting the doctors to change the prescriptions was another battle in itself. They are no longer her doctors. Mom was fine again after the meds were changed.

Hearing should also be checked. My mom has some interesting cognitive things happening and it all gets worse when her hearing aids need tweeking. It's a tough road to walk with these issues.

I missed the fracas. Legal and business terms are often borrowed in a casual speech meant humorously or at least not literally. The daughter who currently takes her mother to Dr.s appointments as a regular occurrence is totally within bounds to confer with her Mom about whether they should get a second opinion. Period.

If you want to spar for sparring's sake don't gum up a thread where the intent is to help a poster and reply to their request for opinions on a matter.

Of course, you will post again anyway if history is any guide. 🤦‍♀️

LMB, Elmer. I’ll tell you that means leave me be, but you might want to look it up just to be sure.

OMG, Elmer, Stop it, please.

Many excellent suggestions and observations in this thread.

I’d like to suggest having an assessment of your MIL’s mood You said that she lost her husband not yet 2 years ago. Depression is under-identified in seniors and may be related to her cognitive changes.

As said above, I would also suggest a Gerontologist assessment.

I’m sorry that your MIL and family are facing this. Its a complicated and painful journey for everyone involved.

Having gone through this with my mother, this subject is near and dear to my heart. My BFF is a professor of gerontology and we have had lots of discussions over the years. And tonight I have some thoughts. I’m not posting in order to argue or advise but to share my thoughts on dementia.

I wonder if a diagnosis is needed. Particularly since the MIL is freaked out at the idea. And then what does one do with the diagnosis? See more drs? Take more meds? My BFF says it’s best not to tell someone they have dementia. It can lead to depression because there is really not much you can do for it. And then you might have to remind them because. Dementia.

aww, Honu

Honu, Caroline I hope you don't remove your posts as there is much to consider in them for anyone walking this path - and the vast majority of us will walk it in one way or another. Arcy the reminder about hearing issues is important. It was a major issue with my FIL and whether it fed the dementia or was just along for the ride we'll never know but it certainly made things more difficult for him and for us.

Our mom was diagnosed with Mild Cognitive Impairment around 80. Her concierge MD felt it was very mild and stressed that not all MCI progresses to dementia. As we began to see increasing issues with memory and executive functioning, the family decided it was in our collective best interest to move our mom closer to one of us.

She moved closer to me and into a lovely independent living apartment where she did well for almost two years. But it became clear her cognition issues were progressing despite being on Aricept/Namenda. Her primary MD was now a gerontologist who continued to order routine medical screenings but did not refer her to a neurologist until we formally requested it. Not sure what we hoped to learn but the neurologist said something important to me at the first visit. He confirmed the dementia diagnosis with the clinical protocol but recommended our mom have a full neurological work-up - MRI, blood tests, etc. He said "Your mom deserves it." And she did. If this were some other type of disease, we would not hesitate to confirm the diagnosis regardless of the prognosis.

Testing revealed a diagnosis of Alzheimer's type disease with contributing vascular dementia. This diagnosis helped us understand what to expect and how to prepare our mom and ourselves for her future. We moved forward with a more palliative care mindset. Our mom had no other underlying health issues and moved through the nine stages of Alzheimer's Disease as predicted. It was heartbreaking but we understood what was happening.

So all of that oversharing is to say, listen to your collective instincts, advocate for her as if she had cancer, heart disease or any other condition. From what you have shared, you and your family have reason to be concerned. And my guess would be your MIL is also anxious about the changes she is experiencing.

Wishing you and your family the best as you navigate the care of your MIL. None of this is easy.

This place is such a vast collection of knowledge and experience, it's amazing.

We'll continue to keep an eye on Mom, and implement some of the suggestions here. She has lapses in memory, but I don't think she's a danger to herself. She functions fine, and if I were to introduce her to you, you wouldn't know there are issues. You have to attend Thanksgiving dinner for that!😄

Thanks again.

I don't think I can add anything that hasn't already been said, other than wondering how someone who is 81 could be experiencing 'early' dementia?

I deleted an earlier post since the post i was responding to had been deleted. thank you, Mtnrdx for your empathy

When I wrote "early", I was thinking early stages, not early in life. She is definitely well along on her path.

i dealt with this for my grandmother. During that time period, my mom was diagnosed with terminal cancer. We hired caregivers that were there overnight with the 2 of them. But there cane a time when we gad to focus on mom and moved my grandmother to assisted living. It broke my heart. She was diagnosed with Alzheimers and on Airicept. It did not help her situation, but it did slow progression. my sister and i were devastated the day we took her to AL. she told us dhe would have never believed we would do that to her. 🥲

However, within a few weeks she was handling it pretty well and as time went on it became her secure place. They were wonderful to her. One thing I will mention is that I went to court for ”conservatorship” in order to make decisions, handle her finances. i was already doing the finances per her request. She would have never signed herself into AL. You might want to talk to a lawyer and see if there any documents you might need.

We're in the process of getting a medical alert device.

Consider an Apple Watch. It looks cooler than one of those gizmos that would hang around her neck. Plus it works wherever she is, not just within range of the base. An Apple Watch has a fall monitor that will call for help and, if set up to do so, will allow you to track her whereabouts. After DH fell in the bathroom and subsequently died, I bought an Apple Watch. It gave me a lot of peace of mind.

We've looked at Medical Guardian, and they offer a smart watch. Perfect for her, because she always wears one, she's accustomed to charging it, and it MG one does all the things she wants.

“I wonder if a diagnosis is needed. Particularly since the MIL is freaked out at the idea. And then what does one do with the diagnosis? See more drs? Take more meds? My BFF says it’s best not to tell someone they have dementia. It can lead to depression because there is really not much you can do for it. And then you might have to remind them because. Dementia.”

Could not disagree with this more, for so many reasons. More doctors Yes, if that’s what’s needed. More /different medications? Yes, if that’s what’s needed. In many cases there is a lot that can be done to treat the disease (slow it down in many cases). You can help the patient with the changes that are happening (right up to the point at which you can’t), prepare their environment (rearranging furniture, reorganizing needed items so they won’t be missed, etc) so ADLs are easier.… Unless the person cannot understand anything that’s being said, infantilizing them by withholding a diagnosis because you’ve decided it will lead to depression is just wrong.

i can see both sides and have found the sharing here very helpful.

However, with both sets of parents gone as of a year ago, it occurs to me I am not the target audience. I need to print this out and hang it on the fridge. 😬

There are over 100 types of dementia With different symptoms and, more importantly, trajectory. A diagnosis can be very helpful in both understanding the present and planning for the future