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Help - very dotty old dad has been told he hasn't got dementia...(41 Posts)
Well, thanks for that, unknown GP. Mind you, I'd seen this one coming, and I badly need the wisdom of MN to deal with it.
The main problem is that dad,75, has been showing signs of dementia - losing his way, forgetting daily skills, getting bad-tempered, repeating himself endlessly, since he was in his mid-60s. He drinks heavily in the evenings, which makes all the symptoms a lot worse. A lot worse - he monologues for 2 hours, loudly, and slaps anyone who tries to speak/go to the loo, f'r'instance.
But he presents brilliantly - he's practically a professional raconteur, charming, funny, well dressed and urbane. He's also way too young, still, to have Alzheimer's and he hasn't had a stroke ie no vascular dementia. He comes across normal to people who don't know him.
So I can see why the doc signed him off so blithely. The tests for dementia set the bar so low that a washing machine could pass most of them, grrr.
The issues remain, however:
1) how the hell do we find out what actually is wrong with him (I suspect alcohol has a lot to do with it)
2) how do we cope with his uncreasingly unpleasant behaviour. In the past ten years, he's done things, partic to me, that I wouldn't have tolerated if I hadn't given him the dementia disclaimer. Serious, taboo-busting stuff.
I am disappointed by them, and horrified. The inheritance thang was a vicious blow. I am beyond hurt, still.
Neither parent has been kind or supportive, indeed the thought of my parents being supportive actually made me snigger just now. You take all the laffs you can get, eh.
He needs to see a psychogeriatrician. Dementia is v complex, and cannot be diagnosed on the memory tests alone. His alcoholism is a co-morbidity that requires specialist attention.
Keep a diary of events. Stuff to look out for is confusion at the end of the day, waking in the night and being totally confused ( FIL used tomwake and think it was milking time; he hadn't milked for 30 years), visual and auditory hallucinations (FIL used to 'see' people in dim light), paranoia, aggression.
Always attend appts; you dad And your mum will play down his symptoms.
DO NOT let you GP prescribe sedatives or anti-psychotics. These should only be prescribed for very short periods of time by a psychogeriatrician.
The taboo stuff you mention may be sign of fronto-temporal dementia; itshallmark from what I remember is unsavoury sexual behaviour (masturbating in public etc!)
OP a one off spell of disorientation several years ago isn't really characteristic of dementia. A fronto-temporal dementia would very likely have a quicker course than that, although TBH so would an Alzheimer's pattern.
Alzheimer's would most likely have an insidious onset which it doesn't sound like from your description. It does sound a fairly complex picture with your dad, with potentially organic (brain) and/or personality factors. If he agreed to go to the GP with you before he might agree to go again whilst you request for specialist assessment.
It's hard to know at a distance but for me significant warnings would be forgetting (usually without any insight into it) and covering up (in a way different from 15 years ago), adding extra information in an uncharacteristic way (like filling in gaps to a story with inaccurate information), showing unusual behaviour, again in a way that is out of character.
I don't have any big alarm bells ringing about your dad and possible dementia, but if I was you I'd persevere on getting a fuller assessment. A specialist would possibly decide to do a brain scan. These don't give a definitive diagnosis of dementia but can rule in/out a mass such as a tumour or a stroke.
When my friend's DM was drinking and showing signs of dementia, they refused to assess her till she was off the drink. Thankfully she has given it up (it's banned in their house now), and although it turns out she does have dementia, she is much happier.
GPs don't diagnose dementia, it is done by referral to a specialist at a memory clinic, usually. Alcohol misuse, TIAs that have gone un noticed and rarer forms of dementia can mean that the diagnosis is a complex thing to do. Could you ask GP for a referral? I am surprised GP seems to have been taken in as one of the classic pieces of behaviour of those fairly early on in the dementia journey is to cover up the problem, often very plausibly. (I work in care)
GPs however won't refer someone for an assessment who has no signs of having dementia. Part of the problem here is obviously that your dad went by himself and doesn't think he has a problem. So GP could have been fed a load of misinformation. But you must be realistic about what a specialist opinion will do for him - it won't change his behaviour for starters.
However I am still struggling to fit what you have described as dementia as it sounds more like many years of being a drunken arse.
I also think you really need to address what you hope a diagnosis to achieve? At the moment I actually think it would make things worse for you - increased pressure to look after your parents, not upset your dad as after all, he has dementia doesn't he, your mum waiting on him even more and essentially a get out of jail card for all his worst behaviour.
I think you should persevere on the assessment front but most importantly think about your relationships, boundaries with your parents as at the moment they seem to have carte blanche to hurt you.
Hmm - Dad's orientation has been permanently screwed since his mid 60s - he doesn't know where he is 10 min from the house they've lived in for 40 years.
He does confabulate - as an eg, he told me a brilliant story, wildly convincing, about one of his old interns who became famous, which he blithely confused with said intern's fraud trial 30 years on. I only realised when I read the court report in the paper later that day that he'd 'made it up', and, to boot, that the intern would have been aged 6 when Dad was accusing him of fraud (and being an intern in the first place).
The worry for me is the personality,er, deterioration. All his flaws have become the dominant, and virtually only, personality traits he has. His snobbery is, for want of a better word, insane. He genuinely doesn't give a shit about anyone else, and happily expresses that. He genuinely cares very deeply for himself and his own wellbeing and pleasure. It's out of character because it's his character distilled to its worst, non stop.
His old friends have fallen by the wayside. You can see people's eyes widen when he blithely comes out with some comedy remark about a neighbour 'being in trade' (Dad was, obviously) - and some dismiss him out loud.
Is that dementia? I bloody hope so, because otherwise I have to think again.
I know someone very well who got dementia at 65. That person certainly lost all inhibitions, and I was led to believe that was quite common. They did what they wanted and said what they wanted, without at all considering how it would be received, as they might previously have done.
I was also with this person when they were diagnosed, by an exert at hospital. The doctor wasnt fooled, BUT the patient would most certainly have denied to relatives that this was the diagnosis, as they did not want it to be true. I remember that no matter what the doctor said, the person just kept replying 'oh no, I'm fine, I'm fine.'
Surely that is a sign of dementia?
It does sound rather like fronto-temporal dementia (mentioned above) which is, I believe, a less common form and may not immediately be recognized by ordinary health professionals. You might care to loook this up - with reference in particular to Pick's disease.
Yes i think so too, but he's had it too long -unless picks progresses v slowly. Also, one symptom of pick's is silence - Dad talks for England.
It's a range of problems, Corygal - Pick's is only one but I mentioned it because it might steer you. The personality changes generally come first, I think.
fronto temporal dementia
But you need to get a clinical assessment in some way.
The very best of luck to the family.
The page I linked to has support group details. Maybe they would be best placed to advise you and you should contact them?
My DFIL had several mini-strokes, which while not noticable at the time, had a cumulative effect, in that he forgot how to take photos and how to drive, really, but retained his marbles otherwise, if I can phrase it somewhat indelicately. I imagine that the effect of mini-strokes varies according to where in the brain they happen. DMIL was v worried, but either she was afraid to broach the subject, or DFIL refused to believe anything was wrong. In the end, DBIL turned up on a visit, and immediately made GP appt and went down with DFIL.
They were quite near a specilist hospital (talking 15 years ago now though) so I think he had whatever tests were being done at that time. He was also on Warfarin to thin his blood, don't know if that was to prevent more mini-strokes or not.
Hope this may be of some use, if only to rule something out. Support group sounds like a good sourcce of info.
You are brilliant, thanks. Will have a crack today - a million thanks again.
Vascular dementia sounds plausible.
Given that you don't like them and have been disenherited, why do you intend to take on their care?
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