Signs of dementia-not sure what to do in current situation

[flygirl767]

Hi my mum is 86 and has become increasingly forgetful over the last couple of years. She has had a stressful time as we lost my sister last year and she is on betablockers for the anxiety.

However, since lockdown, she has become very vague and repetitive. I have had 2 worrying phone calls, the first asking where everyone was and why she was on her own (she's a widow and lived alone for over 30 years) and then this morning, asking where her mother was (she died in the 1990's).

I know approaching the GP is the next step but can I do this or does she have to. Plus we have the issue of would they actually do anything in the way of testing at the moment due to COVID? Any help or advice appreciated, I am rather concerned.

Oh gosh that is so worrying for you. You can contact the GP to discuss your concerns, however there will be a limit to what they can discuss with you. It is worth considering she may have a urine infection though, this is a very common cause of confusion in elderly people.

Normally, if not a urine infection, they would ask her a series of questions & do blood tests to check if there were other reasons for the confusion as Vitamin D deficiency, B12 deficiency, thyroid issues for example can all cause memory issues/confusion. Blood tests are still being done but not sure re referrals to the memory team.
Are you seeing/caring for her at all? It would obviously be easier if the dr could do a telephone consultation with you at her house so she could give consent to discuss but if not then it would certainly be worth phoning them to voice your concerns and to have them rule out a urine infection.

HI thanks so much for your reply. Funny you should say that but she has been complaining of a swollen gland in her groin. I asked her if it could be a urine infection but she said that she felt fine otherwise. She doesn't drink nearly enough water, plenty of tea but it is a possibility it could be something like this as it is strange that it has come on so suddenly.

Yes I am seeing her, she needs jobs doing around the house as her home help can no longer come so as I have been self isolating as much as possible, I have been going over and keeping my distance (where possible as she can't quite get to grips with it and keeps following me into rooms!)

I think I will give her surgery a ring and see what they say is the best course of action.

Well I don't know what to think now. I spoke with the GP who asked me to bring her in. We went yesterday where she had a thorough check up. She passed the memory test with flying colours, no UTI so blood was taken as a precaution. Results today show all in normal range.

However, I had a delirious call last night, she thought there were people there in the house with her and again thought I lived with her. She still thought this was the case this morning and again in another confused call this afternoon, she was talking nonsense. Kept saying she was in someone else's home. GP wants me to keep in touch but says now that infection is ruled out, not sure where to go from here as the very sudden onset is not normal with dementia. He will refer her if this carries on for a few weeks.

I'm so worried, really not sure what to do and obviously due to CV we are limited in our options. Has anyone else experienced very sudden onset of dementia? Literally since last Tuesday, before then she was fine with just normal old age slight memory loss.

Could you try getting some vitamin B12 and Vitamin D supplements in her? Mum gets like this when either level drops low and is is a battle each time to get the GP to test for it.

I asked the GP about vitamin D as she had a deficiency last time she had bloods done but he said they don't test now. Actually she had stopped taking her supplements as she thought she didn't have to in the summer so I've told her to take them again. I will get her B12 too, won't do any harm, just need to get her to remember to take them! She was ok today, aware she had an episode the other night but worried why she went like it. Still not really aware of CV, keeps asking me when we can go out for lunch or to the garden centre and then is shocked and surprised when I tell her they are shut! I've friends with elderly relatives who are similar though, they just can't get to grips with this situation. Thanks for the advice

Oh OP that does sound worrying for you. I nursed my mum through dementia, so have walked this walk.

The best advice I had, from MN, early on, was to get power of attorney in place, whilst your mum is still able to sign the documents. You can download the forms from the internet - it 'only' costs £82 for Power of Attorney for Property and Finance and the same for Health and Welfare, if you download them directly from the dot gov site. You can then fill out the form, and just take it along for her to sign in a couple of places.

I cannot stress how much easier it made life, having this document in place. I 'sold' it to my parents by saying, rightly, that they were signing to say that I could help them, if they needed it later on, with their banking or with the doctor. It wasn't for now, but it could all take a while so it was good to do it now.

You need to have someone who is willing to sign as a witness to say that you are not pressurising your mum to sign it, but that can be done at a safe social distance.

Hope that helps. Best of luck

My Dad had a very rapid decline, over a matter of days, from being able to walk to the end of his road, catch a bus and take himself off to a chiropodist appointment then to bank and supermarket on the way home, to - unable to walk, and with delusions (a choir singing outside his neighbours house and keeping him awake). Almost certainly from missing his diuretic tablets. Once that was sorted he returned to normal-for-him - ie largely coherent and understanding the world around him, but with a few bees-in-his-bonnet.

Since them, any disruption to his routine, even as trivial as the carpets being replaced in his nursing home, have resulted in a loss of reality and relapse into an imaginary world filled with conspiracies. Covid has really upset him, on the one hand he's able to follow the news, and understand all the hygiene requirements, on the other, he's reverted to a WWII world of secrecy, is talking about preparing secret documents, and referring to places like his old home by code words.

All this is a very long winded way of saying - could your mother be suffering from the stress of Covid and the changes to her world?

There's more than one type of dementia - whilst Alzheimers may have a gradual onset, vascular dementia involves 'mini-strokes' which may cause more sudden changes (am not a doc, just had a father who suffered from both types of dementia). If I were you I'd ask your GP if they've considered this?

I was about to say that this sounds as though she's having mini-strokes. This happened to my FIL. He got in his car and discovered he'd forgotten how to drive. So he and my MIL walked home from the shops, as MIL turned to go up the path of their house, he asked why she was going to 'Jacks house' (Jack lives three doors down)

Three days later he had another and much more debilitating stroke. So you really do need to talk to your GP again as soon as possible

I spoke to the GP re mini strokes hes doesn't think this is the case as no other symptoms. I've now found out she's taken a whole month's worth of betablockers in just over a week! She can't remember taking them but I only got them last Friday and today there is 11 left out of 56. I will speak to the GP again tomorrow, she's still talking about these imaginary people even though she then says she knows there is no one else there. However other times she is totally ok again and aware that she is having these episodes. Thanks for everyone's advice.

Have you checked her pulse? Betablocker overdose can be dangerous due to slowing the heart rate to dangerously low levels.

Do you know what memory test the GP did? If he did something like the MMSE and your mum has a high level of education, it often doesn't pick up early dementia as it isn't good at testing the areas of memory most affected by dementia. So she may just have got away with it.

www.bgs.org.uk/sites/default/files/content/attachment/2018-07-05/mini-mental_state_exam.pdf

If the GP did something like the GPCOG then just on the informant test, there is obviously a problem - I very rarely see anyone who can draw a clock!

gpcog.com.au/

Then there are much more complex tests that the GP almost certainly didn't do but often reveal hidden problems.

If she has overdosed on beta blockers she needs emergency treatment in hospital and the rest of her tablets removed

The confusion could be a side effect of the tablets. She might benefit from a medication review and something safer like a dosset box

B12 and D3 etc have to be dangerously low before they show up as out of range. One reason that they don't routinely do D3 testing any more is because the the majority of people in Britain have low levels and this is worse in the elderly.

I would make sure she takes regular supplements of both. They are both things that can safely be double dosed, and D3 at least can be triple or quad dosed safely so you can keep them and give them to her when you visit to ensure her getting sufficient. It may (I think it will) or may not help depending on what's causing the issue but it won't do any harm.

Thanks again for the replies. Well it turns out she hadn't OD'd on Propanalol, she had put the box in her handbag and it was still full! The one we thought she had taken was an old one. So that is a relief. She is actually much better this week, still a bit vague but the confusion seems to have gone for now. I am keeping a close eye on her though and I am making sure she takes her vitamins every day. There is no doubt that the lockdown had affected her but not entirely sure there is not another issue causing it.

@AnnaMagnani the GP only did a very brief test, asking her dates, counting backwards, asking her to remember an address etc. I will take her back for a more comprehensive test if she deteriorates again.