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Wednesday, September 30, 2020

Bag: The diagnosis of dementia begins with the elimination of reversible factors

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Dear Carol: I’m worried about my 78-year-old mother-in-law who has become so forgetful that she can no longer put together a simple dinner without the main ingredients being left-handed or misused. She was an exceptional cook, so this is even more distressing. My father-in-law diligently eats everything he does without complaining, privately apologizing as to why a particular meal was so strange. Plus, even before the COVID-19 isolation, he was getting lost on his way to or from his neighborhood grocery store, even though he said it was “for fun.”

I pressured my husband to talk to his dad and tell him mom needs to be evaluated for Alzheimer’s. So far, it has blown away my concern. What can I do to convince the family to take her to a doctor? – HK.

Dear HK: Denial of the symptoms of cognitive decline is common, but it doesn’t help anyone. I’m sorry you’re in the middle.

You’re right that your mother-in-law should see her doctor, but I suggest you don’t jump to the conclusion that she has developed Alzheimer’s. This is what most of us think when we see symptoms like the ones you describe, but let your doctors decide.

You might go further with your goal if instead of saying that she needs to be tested for Alzheimer’s, you say she should probably see her doctor for something they would consider non-threatening such a drug check, which is true. So once she sees the doctor, she should be tested for any number of things that can cause memory problems and / or confusion.

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His medications should be carefully evaluated for potential side effects. This includes over-the-counter medications and supplements, as well as prescriptions. Many frequently prescribed medications are anticholinergics, which in layman terms mean bad for brain function, especially for the elderly. Accumulation of these drugs can cause dementia symptoms.

Additionally, some vitamin deficiencies can cause cognitive problems, most commonly B12 because it is often poorly absorbed by older bodies. Hence, it is necessary to look for any type of infection such as urinary tract infection which can have a profound effect on older people.

If your mother-in-law has a full physical exam and everything is fine, she will likely benefit from a cognitive assessment. Dementia has no cure, and while there are drugs that help some people maintain their cognitive abilities a little longer, they don’t help everyone. Therefore, the idea behind a diagnosis at his age is more often to eliminate other problems that may be causing his symptoms and to plan his treatment rather than cure the disease.

At this point we can hope that your mother-in-law’s symptoms are reversible. Otherwise? Remember that people living with dementia perform better with proper family support. This often means educating yourself about the disease and treatment methods, which would be worthwhile. Your local Alzheimer’s organization is a good place to start.

ARCHIVE: Read more of Carol Bradley Bursack’s Minding Our Elders columns

Carol Bradley Bursack is a veteran caregiver and established columnist. She is also a blogger and author of “Minding Our Elders: Caregivers Share Their Personal Stories”. Bradley Bursack hosts a website to support healthcare professionals and the elderly at www.mindingourelders.com. She can be reached via the contact form on her website.

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