At what point do you start being seriously concerned about cognitive decline?

[IShouldNotCoco]

My mum is 78 and lately I’ve noticed that she’s very suddenly gone from being a good driver to one who drives in the middle of two lanes and seems unable to realise when it’s her right of way or not. Yesterday, she was waving her fists at another driver even though it was clearly their right of way - the give way line was on her side. She can’t reverse out of spaces now either - I had to take over and do it.

I think if I told her she should stop driving, she’d be aggressive towards me about it. She’s very upset atm because apparently she did an NHS cognition test which revealed she’s in the bottom 30% for her age.

She’s angry a lot of the time, lately as well. How concerned should I be about this? Any advice about how to handle it?

Write to the doctor. Let them take on the task of "inviting" her for a check up. Alternatively they may suggest said check up is a visit from the nurse to her home. She need never know you instigated this.

Why don’t you say you’re due an eye test and suggest you both book in together for check ups? That way she might feel less like you’re targeting her and more like you’re doing her a favour.

I sympathise, although thankfully a notifiable health issue meant that she had to give up her licence 18 months ago. I first realised there was a problem when she couldnt remember where the gears were and couldnt drive and put the screen de mist on at the same time.

I have notice in the last year or so a definite decline in her memory in general but she would go absolutely bananas if I mentioned it. It terrifies her as her mum had vascular dementia and her eldest sister is in a care home with advanced dementia. It really is her worst fear. I am at a loss what to do about it as she is still able to function its not at the dangerous stage where she could hurt herself, but there is obviously a problem. My father is also in denial.

My mum's first sign was being unable to count out the right cash at the supermarket where I used to take her shopping every week. Then she started buying batteries every week as she said the clock had stopped. It wasn't still she was spotted at the bus stop at 3 a.m. and a kind driver reported her to the police that her odd behaviour came out from all her friends and neighbours - who never said a dicky bird to me!!! She was referred to Adult Mental Health team and diagnosed with advanced dementia. And then came the task of finding a decent care home, funded by me selling her little house.

Strangely she sailed through the cognitive tests displaying remarkable knowledge and skills!

I was also an only child and can tell you that I felt like a gaoler and a bad daughter for taking away her independance but she actually settled well at the care home and we had some good conversations during my visits.

She didn't drive, so that wasn't an issue for me. Definitely get her eyes tested, and encourage aI paiddd hearing aid. Don't dismiss the NHS ones, some are better than others. I paid a small fortune for mine (I'm 74) and learnt afterwards that the same model was available on the NHS.

If she still drives erratically then you have to report her anonymously. It is very wrong not to.

Good luck with it all. What a good daughter you seem to be.

I would definitely contact her GP or DVLA. My mother stopped driving 2 days short of her 95th birthday (eek) in spite of me trying to talk her out of it when her previous car died a death 2 years earlier. What eventually stopped her was driving to church and back with a flat tyre when she then proceeded to bump along a row of parked cars causing thousands of pounds worth of damage. In the absence of parked cars it could have been pedestrians, as happened in Edinburgh when a toddler was killed by a 91 year old woman losing control and mounting the pavement.
I just lied through my teeth and said her insurer wouldn’t cover her any more. Although she didn’t have dementia she was definitely a danger to everyone. It was an absolute pain as I then had to ferry her everywhere but at least I could sleep at night.

it could be sadly be dementia - normal cognitive decline in aging is not as marked. Given the mood and behavioural issues could be fronto-temporal dementia which is more difficult to diagnose by non specialists and memory problems happen later jn the disease. Standard cognitive tests may not identify this early on. People with FTD may also not recognise that they have any problems at all - lack of insight. I work in the field of neuro degenerative disease and my mum has been diagnosed with FTD - we had noticed some minor issues with driving/parking but also personality changes which at the time we put down to aging/depression/stress but if you are noticing enough to be concerned my suspicion would be there is something else going on. Agree with previous poster you should outline concerns to GP.

I had to speak to my mother about her driving as she was a danger on the road. Thankfully, she listened and gave up driving. My fear was she would kill a child or put somebody in a wheelchair for life. I couldn’t live with that. If she had refused to stop driving I would’ve absolutely reported her to the DVLA. If she’s a danger to others and won’t take responsibility then you have to. You’re not being disloyal or being a bad daughter as your actions are coming from a place of love.

In most areas if you're over ,60 you could arrange a home visit for a eye test and hearing test ...go online to see if you can get it.

I would (and have) written to or emailed the GP with my concerns and asked if they are able to assess them for cognition. The phrase you want is “because like you, we want to avoid a Hospital admission”.

What has happened in our experience is that the GP then gets them in on some pretext and assesses them.

Also agree with hearing loss and dementia being closely linked.

If she’s reluctant to get eyes or hearing checked have you tried “it’s time for your eye test Mum, do you want me to book it for you?”. One of my older relatives seems to respond better if they think it’s time for a thing rather than telling them to do it.

If she’s always been prickly with perceived criticism it might also be worth looking up PDA strategies.

Have you got POAs in place for both health and finance and is her will up to date? It’s important to get those sorted before diagnosis.

As for the car, can it go to the “garage” for a while to get fixed? You might need to sort her with a local taxi company and possibly food delivery whilst the car is out of action.

I found the Twilight Shepherd good for practical advice and Contented Dementia good for dealing with behaviour.

Around here ots only if you’re housebound.

This does sound very much like the onset of dementia. I have just witnessed my father's decline over the past 3 years so send you all my love.
Get her to the GP on some pretext. I messaged my father's GP and they called him in for a routine check up which started the ball rolling. I think you can also self refer to your local memory clinic.Good luck to you all.

This advice nails it 🎯
Some relatives just won’t listen to your caring concern - at least partly through fear - but will probably be flattered by a personal invitation from their GP.
Thank goodness you already have POA - for both health and finances I hope. If not her GP might collude with you on this too and ASAP.

Thank you all so much for your advice - I am taking everything on board.

In terms of the financial situation, it’s a total can of worms. I have had a difficult relationship with her over the years - she has, at times been emotionally abusive on and off towards me since I was a child.

As an only child, she often threatens me with disinheritance if I do anything in my personal life that she doesn’t agree with. However, in recent years she had settled on saying that she was going to leave the house to me. A few weeks ago, though, my 21 year old daughter approached me and said that my mum had told her she was to leave the house to her instead. My daughter told her she thinks she ought to tell me this and my mum turned on her about it.

In a way, this is all irrelevant and I don’t care who my mum leaves the house to. I love my children unconditionally no matter what. I don’t think my mum understands that some parents don’t actually resent their own children. But it does become more concerning in the light of my mums state of mind.

The main things that occur to me, though are if she does have dementia and would maybe need a care home in the future, what would happen to my dad because he cannot live independently, either? I’m assuming we would need to sell the house they have to pay for this but it does all sound quite complicated.

I would not be able to live with them because I have two autistic dependent children, still at home with me who need significant care of their own.

You do not need to sell their house to pay for your mother's care if your dad still lives there. In that circumstance, Social Services would pay the care home fees. So don't worry about that.

I agree reporting your mother to the DVLA is the best way forward regarding her driving.

I got my mother to see the GP by suggesting an over 65s check up (blood pressure etc), but that will only be helpful if she agrees to you going to the appointment with her. Otherwise even if the GP picks up on a memory issue, she won't engage with it or acknowledge/remember future memory clinic appointments, so you need to be in the loop. The GP will only include you with your mother's agreement. Fortunately my mother agreed.

But realistically even if she goes through the process of GP, memory clinic, MRI, and gets a confirmed diagnosis, little will change. There is little help available and your mother is likely to forget/reject the diagnosis anyway. So it is worth trying, but likely to be confirming what you already know.

Re your mother's assets, people with dementia say all sorts of things but don't necessarily follow them through. They change their mind from one day to the next, so I wouldn't take too much notice of that.

Any age really if you’re noticing changes. Cognitive decline shouldn’t just be inevitable as we get older. My mother in law was diagnosed with young onset dementia in her early sixties x

My children and I have noticed that she cracks jokes much more than is usual for her - quite funny jokes.

My older dd has noticed that she has started talking about her mother and her childhood a lot. She unfortunately had a very abusive childhood and fractured relationships with her siblings as a result which is sad. At this point, none of them speak to each other.

Do you guys think it definitely is dementia then?

She definitely is worried enough to have started trying to do large jigsaws every day. So she must have noticed a change.

In regards to the GP, on a good day she’s likely to agree that I can come with her and be included.

Last year, she had some chronic problems with her physical health which led to her being hospitalised and that traumatised her a lot and I had to step in and do a lot for her during that time but then she had her gallbladder removed and has felt better since Christmas. I’m not sure if that episode has also contributed to the decline.

Please get her off the road before she seriously injures herself or someone else.
My father had 3 incidents in his car before he would agree to stop driving. One resulted in injuries to a father & daughter when he crashed into the back of their car & they received a 40k insurance payout.
set her up with a taxi account so she can still get out and about.

I can so relate to a lot of what you’re saying, thankfully my mum can’t drive but she’s an immovable object when it comes to trying to get her to do things like see a Doctor. You might find her anger is more frustration with aging, we’ve been thinking my Mum might have the start of Dementia for about 6 years, but that’s more to do with getting angry, she now swears which she never did and she can be a nightmare when you take her out speaking to everyone she meets. However she still looks after my Dad (she’s his carer) and leads a very independent life. It’s just hard when you don’t have a Sweet Compliant mum where you can tell them what to do which others seem to have 🤣🤣

She refuses to go in a taxi. What I can do is hide the car keys as she tends to rely on me to get things for her as is.

Absolutely this. Please act responsibly and follow this advice to stop her from driving. Sudden aggressive behaviour can certainly be an indication of brain problems so definitely needs checking. I have known several eldeely people who would just not give up driving despite being unsafe, kept hitting other cars, reversing over people at supermarket it took a few incidents to get them to stop. It is very weird, in other countries health checks are mandatory and after a certain age more frequent in order to be able to drive. Unfortunately it is in human nature to have very little self awareness and when you add in the mix cognitive decline it is tough.

She has always had a tendency towards being aggressive if she’s in a bad mood. But yeah, shes in total denial that her driving isn’t what it was.

In reply to your question, you said she scored badly in an NHS cognition test. That, combined with the deterioration in driving skills, plus the anger, sounds like dementia or other neurological problem. Good luck with getting her to see the doctor.

I totally understand. My father was as belligerent as they come. But I’m so glad we succeeded in getting him off the road. I dread to think what could have happened. Luckily he was happy enough to get the bus & I helped with groceries etc.

FIL had Alzheimer's and was in denial after he was diagnosed, enabled by MIL. She left him to fill out the form for the renewal of his driving license which I was furious about because I know he wouldn't disclose his full medical information. I eventually refused to get in the car with him and wouldn't let him drive my DDs around. The last time I was in the car with him, was after a concert DD1 had been performing in and PIL offered us and DM a lift home (we had used public transport to get there). The whole way home MIL sat telling him where to go and to stop at red lights/go at green lights; it was a terrifying experience.
PIL had 2 cars even after he stopped driving (we eventually took one of them away because MIL was stressing herself so much at keeping the two cars running). While they still had two cars, if MIL went out she would regularly come home to find that he had packed the car with random items ready to go home; they had lived in the same house for over 25 years. I eventually put my foot down and insisted that he couldn't have access to car keys because I was so concerned that he might actually get behind the wheel and try to go "home".

OP, you mention that your DM is 78; when is her birthday? If she has renewed her licence on time since she turned 70, she will be due another renewal before her next birthday. Could you "help" her with that?

Please don't worry about being an only child. Your decisions carry weight. This is a new path gor mum and for you. Do what you think is right.
Another only child here.