Should we ask about dementia?

[skinnyjeansbigboots]

My MIL (mid 70s) is very unwell at the moment. She is extremely anxious, depressed (says she wants to die), paranoid (at one point she thought even FIL was trying to hurt her). She is alternately constipated and incontinent and now refuses to eat. Her sleep is very disturbed. She wanders around a lot and at one point left the house and was found in a field, very confused. Medication had an initial effect, but she is definitely worsening.

Basic diagnostic tests (bloods, CT scan etc) have shown nothing untoward, so they are treating her illness as Psychotic depression. However I have some limited knowledge of dementia (not medically trained though)and feel that her symptoms may be indicative of Lewy Body Dementia. I have tentatively mentioned my concerns but, understandably, the family are clinging to the depression diagnosis and are convinced she will recover soon.

My question is how far should I push this - bearing in mind that some medication used to treat psychotic symptoms is contra indicated in LBD? Of course I hope I am wrong, and I don't want the family to see me as a harbinger of doom, but if it is dementia earlier treatment could really help MIL. I am also concerned that the psychiatrist has said that all of her physical symptoms are hypochondria brought on by her anxiety, when in fact problems such as constipation are common in LBD.

Any opinions would be gratefully received.

[Pleasemrstweedie]

From what you've said, it sounds as if you should, if only to rule it out.

[NK346f2849X127d8bca260]

I have a relative who has suffered psychosis with severe depression and a MIL with dementia and what you describe sounds more like some form of dementia to me.

[Brontebiscuits]

She is likely to have also had a memory test as part of her assessment, can you ask for the results of that too? (although having said that, severe depression can cause some temporary cognitive impairment and that still may be what's going on). is she in a inpatient unit?

[BumDNC]

She's had a CT head? This could have shown changes and would be what the psych will use for a diagnosis but ask for another opinion on this along with a full memory test although severe anxiety can have quite an impact on the results of something such as ACE-R or ACE-III. I think treating her anxiety should still be the priority because then you can see if this has caused her cognitive difficulties

Please also ask them to rule out any infections or pain - both can cause cognitive decline

[KatsutheChristmasOctopus]

Thank you for your replies. I did wonder about infection as she had a fall/leg injury which took ages to heal just prior to getting really ill but I believe this has been looked into. She had a head CT to rule out stroke etc but I will ask them if it was reviewed with other things in mind.
She is not an inpatient at the moment, but was initally. I'll say to DH about the memory test as he is there this weekend and can find out more.
I really appreciate the advice. It is shocking how quickly she has become so unwell.

[BumDNC]

A CT or MRI would show changes to the brain structure, if this was the case with dementia.

I have worked in this area for some time and untreated pain can result in a lot of confusion, anxiety etc
Are they treating her constipation? Because instead of telling her it's her over thinking it they should treat it.

Psychotic depression is awful I do feel for you all, has she not shown any improvement with treatment for this?

[KatsutheChristmasOctopus]

Sorry just noticed name change fail!
She showed some improvement to begin with for about 2 weeks, but has become progressively worse, with anxiety being more pronounced. I do agree about treating her physical symptoms - I worry that following advice to "be firm " about them could make things worse. Even if they are objectively minor, they are clearly causing her distress.

[BumDNC]

What kind of ward is she on?

[BumDNC]

In some ways I think this could be staff having a poor understanding of her issues. Is a psychologist working with her? If not, why on earth not? Her feelings can be validated, not dismissed and also use distraction onto other subjects but IMO being in hospital is ripe for these things to be worse because what on earth else do you think about or do all day? So although it's annoying for nursing staff to deal with her anxiety, treating her other concerns will help.
I wonder if you could look into getting your mum a health advocate/friend to visit or at worst, ask for a transfer to somewhere you feel she may flourish. I don't know the circumstances but I think getting firmer with staff could help you get some more clear answers. Why isn't her treatment working? Does she need a medication review? What's the plan? Why no psychological input if this isn't medical issue? Have all of her medical issues been addressed
Make a list and speak out at her next review... is she on section?

[BumDNC]

Oh god sorry I see she isn't now!
Didn't read it properly

Ok so she's in the community?
Demand a review with CPN present
Ask for urgent psychology input

[KatsutheChristmasOctopus]

I think what you've said about her having little else to think about is valid for home as well - she is too agitated to settle to anything which then makes things worse because there's nothing to distract her. We tried jigsaws and adult colouring but she's shown little interest.
She had a session of counselling but other than that is under the GP with psychiatrist review every 6 weeks. I will see if we can get more input as you've suggested.
Thank you for your help- it is appreciated.