Have you been worried about an older person’s memory or thinking abilities?
Maybe your parent has seemed more confused recently. Or you may have noticed that your aging spouse is repeating herself, or struggling to do things that didn’t use to pose much of a problem.
These are very common concerns, and they often lead to questions such as:
- Is this normal aging or something more significant?
- What is wrong?
- Could this be Alzheimer’s? Or some other form of dementia?
- Can these memory problems be treated or reversed?
- What should we do about this??
The answer to the last question is this: if you are worried about memory or thinking, then you should seek out some kind of medical evaluation.
That’s because when families worry about an older person’s cognitive abilities, there often are some underlying health issues affecting the mind’s function.
Those need to be detected, and treated if at all possible. So, you’ll need to request help from a health professional, and in this article, I’ll explain what that initial help should consist of. This way you’ll know what to expect, and what the doctor might ask you about.
Technically, these kinds of problems are called “cognitive impairment.” This is a broad term that means some kind of problem or difficulty with one’s memory, thinking, concentration, and other functions of the conscious brain, beyond what might be expected due to normal “cognitive aging.”
(For more on “cognitive aging” and what types of changes are considered normal aging, see this article: 6 Ways that Memory & Thinking Change with Normal Aging, & What to Do About This.)
Cognitive impairment — which is also called “cognitive decline” — can come on suddenly or gradually, and can be temporary or more permanent. It may or may not keep getting slowly worse; it all depends on the underlying cause or causes.
In this article, I’ll share with you the more common causes of cognitive impairment in older adults.
I’ll then share a list of 10 things that should generally be done, during a preliminary medical evaluation for cognitive decline in an older adult.
You can also watch a subtitled video version of this information below.
Common causes of cognitive impairment in older adults
Cognitive impairment, like many problems in older adults, is often “multifactorial.” This means that the difficulties with memory, thinking, or other brain processes are often due to more than one cause.
Common causes of cognitive impairment in older adults include:
- Medication side-effects. Many medications interfere with proper brain function.
- Sedatives, tranquilizers, and anticholinergic medications are the most common culprits. For more information, see 4 Types of Medication to Avoid if You’re Worried About Memory.
- “Metabolic imbalances.” This term refers to abnormalities in one’s blood chemistry.
- Examples include abnormal levels of blood sodium, calcium, or glucose.
- Kidney or liver dysfunction can also cause certain types of metabolic imbalances, and these sometimes affect brain function.
- Problems with hormones, such as thyroid hormones.
- Imbalances in estrogen and other sex hormones may also affect cognitive function.
- Deficiencies in vitamins and other key nutrients.
- Brain function is especially known to be affected by low levels of vitamin B12, other B vitamins, and folate.
- Delirium. This is a state of worse-than-usual mental function that can be brought on by just about any type of serious illness.
- Delirium is very common in hospitalized older adults, and can also occur due to infection or other health problems in older people who are not hospitalized.
- Psychiatric illness. Most psychiatric conditions can cause problems with memory, thinking, or concentration. Psychiatric illnesses can also cause paranoia and other forms of late-life psychosis.
- Depression and anxiety are probably the most common psychiatric conditions in older adults.
- It is also possible for older adults to have bipolar disorder, schizophrenia, or other forms of major mental illness; these have often been diagnosed earlier in life.
- Substance abuse and/or substance withdrawal.
- Both acute intoxication and chronic overuse of certain substances (such as alcohol, illicit drugs, or even prescription drugs) can impair brain function.
- Damage to brain neurons, due to an injury.
- “Vascular” damage to neurons means damage caused by problems with the blood vessels, such as strokes or some form of cerebral small vessel disease.
- Head injuries are also associated with temporary or longer-lasting cognitive impairment.
- Damage to brain neurons, due to a neurodegenerative condition.
- Neurodegenerative conditions tend to slowly damage and kill neurons. This can cause mild cognitive impairment, and then eventually dementia.
- The more common neurodegenerative conditions include Alzheimer’s disease, Lewy-Body disease, Parkinson’s disease, and frontotemporal degeneration.
- Historically, this has not been as common in older adults as the other causes above, but certain chronic or acute infections can affect brain cells directly. (If cognitive impairment is caused by an infection outside the brain, such as pneumonia or a urinary tract infection, this would be considered delirium.) More recently, the COVID virus has become fairly prevalent; it does affect brain cells in some cases, and research is ongoing to learn more about this.
Toxins are another potential cause of cognitive impairment. Research is ongoing as to the cognitive effects of toxins people may be exposed to, such as heavy metals, air pollutants, contaminants in our drinking water, pesticides, and others.
Poor sleep and/or high levels of stress are two additional factors to consider, as the brain works less well under these conditions. (For more on sleep problems in aging, see here.)
Now that I’ve covered the most common causes of cognitive impairment in older adults, here’s what an initial medical evaluation should generally cover.
10 Things the Doctor Should Do When Evaluating Cognitive Impairment in an Older Adult
Here are ten specific things the clinician should ask about, check on, or do, as part of an initial evaluation for cognitive impairment in an older adult.
The following list reflects my own practice and that of most geriatricians. It is in line with most syntheses of guidelines and best practices, including the UpToDate.com chapter on this subject.
Most experts agree that these steps can be done by primary care clinicians.
1. Ask about and document the patient’s concerns about memory and thinking.
At a minimum, the clinician should ask an older person something like “So, have you noticed any changes in your memory or thinking abilities?”
Now, many older adults will either have noticed nothing or won’t want to talk about it. This is in of itself worth noting, especially if family or others have voiced concerns.
If the older person does have concerns or observations, these should be explored. It’s especially important to ask when the problems started, whether they seem to be getting worse, and how quickly things seem to be changing.
(Wondering how to talk to an older person about their memory loss? I explain how to do this here.)
2. Obtain or request information on memory or thinking difficulties from family members or other “informants.”
Older adults with cognitive impairment are often unaware of — or reluctant to reveal – the difficulties they are experiencing. For this reason, a health provider who has been alerted to the possibility of cognitive impairment should make an effort to get information from a family member or other knowledgeable informant.
The best is to ask a family member to complete a validated questionnaire, such as the AD-8 informant interview. (This questionnaire asks about 8 behaviors that may indicate a dementia such as Alzheimer’s disease.)
It’s sometimes necessary for the health provider to be diplomatic about requesting and getting information from family members, especially if the older person finds it upsetting. People may think that HIPAA doesn’t allow doctors to talk to family over an older person’s objections, but actually, clinicians do have some leeway in these situations. (See my HIPAA article here.)
Family members can facilitate this process by bringing in a written summary of what difficulties they’ve observed. Be sure to include information on when the problems started and whether they seem to be getting worse.
3. Ask about difficulties managing instrumental activities of daily living (IADLs) and activities of daily living (ADLs).
The ideal is for the health provider to ask both the patient and the family about this. Older adults with cognitive impairment are often not reliable reporters of what difficulties they’re having.
Instrumental activities of daily living (IADLs), in particular, are often affected by cognitive impairment. So it’s important to ask if the older person is having difficulty with problems with tasks such as:
- Driving and other forms of transportation
- Management of finances
- Grocery shopping and meal preparation
- Home maintenance
- Managing the telephone, the mail, and other forms of communication
- Medication management
The provider should also ask about ADLs, which are the more fundamental self-care tasks such as walking around, feeding oneself, getting dressed, managing continence, and so forth.
You can learn more about ADLs and IADLs here: What are Activities of Daily Living (ADLs) & Instrumental Activities of Daily Living (IADLs)?
Difficulties with IADLs and ADLs (which geriatricians refer to as “functional impairment”) are important to document. They offer a practical lens on how “severe” an older person’s cognitive impairment might be, and on what steps could be taken to support an older person while these cognitive issues are getting evaluated.
Functional impairments may correspond with safety issues that need to be addressed; if an older person is having difficulty with finances, it may be a good idea to check for signs of financial exploitation, or otherwise take steps to protect the person financially.
Last but not least, impairment in daily functioning is also a criterion that separates mild cognitive impairment (MCI) from more significant impairment (including dementia). In MCI, a person may be experiencing some cognitive impairment, but it should not be bad enough to significantly interfere with performing their usual daily life tasks.
4. Check for the presence of other behavioral, mood, and thinking symptoms that may be related to certain causes of cognitive impairment.
- Personality changes
- Apathy (losing motivation)
- Depression symptoms
- Anxiety symptoms
- Getting lost
- Confusion about visual-spatial tasks (e.g. having difficulty figuring out how to put on one’s shirt)
5. Ask about any new symptoms or changes in physical health.
It’s especially important to ask about symptoms related to neurological function, such as new difficulties with walking, balance, speech, and coordination. Checking for tremor and stiffness (both of which are associated with Parkinsonism) is also recommended.
The exact questions the clinician asks will depend on the person’s particular medical history, and the other signs and symptoms that have been brought up.
6. Ask about substance use and consider the possibility of substance abuse and/or withdrawal.
Excessive use of alcohol, certain prescription drugs (such as tranquilizers), or of illicit drugs can affect cognitive function. Health providers should inquire about an older person’s use of these substances.
Suddenly stopping or reducing the use of alcohol or other substances can also occasionally cause or worsen cognitive function.
7. Review all medications, with a focus on identifying those known to worsen cognitive function.
Certain types of medications tend to dampen brain function, and may cause a noticeable worsening in cognitive abilities. The health provider should especially ask about use of:
- Benzodiazepines, which are often prescribed for either insomnia or anxiety
- Commonly prescribed benzodiazepines include lorazepam, diazepam, temazepam, alprazolam (brand names Ativan, Valium, Restoril, and Xanax, respectively)
- Prescription sleeping pills, such as zolpidem (brand name Ambien)
- Anticholinergics, a broad category of medications which includes most over-the-counter sleeping aids, sedating antihistamines, drugs for overactive bladder, muscle relaxants, and others.
- For more information on the most common anticholinergics, see 7 Common Brain-Slowing Anticholinergic Drugs Older Adults Should Use With Caution.
For more on medications that affect brain function, see 4 Types of Medication to Avoid if You’re Worried About Memory.
8. Perform a physical examination.
At a minimum, the health provider should check vitals (blood pressure and pulse) and should also complete a basic neurological evaluation, including an observation of the person’s gait, balance, and coordination.
The purpose of the physical exam is to look for physical signs that may correspond to causes of cognitive impairment, or that may relate to other symptoms the patient or family brought up.
9. Assess the person’s orientation and perform some type of office-based cognitive test.
Assessing “orientation” means checking to see whether the patient knows things like the day, date, month, year, and where he or she is.
Some office-based testing should also be done, to check and document the older person’s memory and thinking abilities.
Probably the shortest well-validated test is the Mini-Cog, which involves a three-item recall and a clock draw.
A more detailed office-based cognitive test that can be done in primary care is the MOCA test (Montreal Cognitive Assessment Test). This takes 10-20 minutes to administer, so it often requires scheduling a separate visit.
There are some other “intermediate” length tests that can be done in the primary care office, such as the SLUMS (St. Louis University Mental Status Examination). The Mini-Mental State Exam is another option, although most experts (including myself) consider it less useful than the MOCA or SLUMS.
10. Order laboratory testing (unless recently done) and consider brain imaging.
In most cases, it will be appropriate for the health provider to order blood tests, to check for common health problems that can cause or worsen cognitive impairment.
Blood tests to consider include:
- A complete metabolic panel, which assesses electrolytes, kidney function, and liver function tests
- Vitamin B12
- Thyroid function tests
Additional tests, such as a complete blood count, may be ordered as well, depending on the person’s past medical history, current symptoms, and risk factors. For more on tests that are often ordered in older adults, see Understanding Laboratory Tests: 10 Commonly Used Blood Tests for Older Adults.
As for brain imaging, some expert guidelines recommend it for everyone and other guidelines suggest it be used “selectively.”
(In most cases, brain imaging reveals non-specific findings such as signs of cerebral small vessel disease and perhaps some mild atrophy of the brain. These are common findings in many older adults and tend to have a variable correlation with symptoms. Most causes of cognitive impairment cannot be definitely ruled in or ruled out by brain imaging.)
Overall, an initial medical evaluation should result in these four key things happening:
- Documentation of the patient’s and family’s cognitive concerns.
- This means documenting what the patient and family have noticed, in terms of difficulties and changes in memory, thinking, behavior, or personality.
- Documentation of any functional impairment the older person is experiencing.
- This means documenting what the patient and family have noticed, in terms of difficulties managing life tasks (IADLs and ADLs).
- An objective assessment of the older person’s memory and thinking skills.
- This best done through some form of short standardized office-based test, such as the Mini-Cog.
- Clinicians can also document their impressions and observations based on talking to the older person. (Did the person seem confused? Paranoid? Repetitive? Tangential? Was the person able to answer detailed questions?)
- An evaluation for common medical causes and contributors of cognitive impairment.
- This means checking for those common problems that can cause or worsen cognitive impairment.
Generally, it will take at least two primary care visits to complete an evaluation for cognitive impairment.
The second visit is often used to do a cognitive test such as the MOCA, and can enable the clinician to follow up on laboratory tests that were initially ordered.
And then what?
Well, what happens next depends on several things, such as:
- Whether the health provider was able to draw conclusions about what is likely causing the cognitive impairment
- Whether treatable conditions were identified
- How the patient and family feel about the evaluation
- Whether the older person is willing and able to cooperate
- Whether the clinician feels that referral to a specialist is necessary
- Whether the clinician is willing and able to help the older person and the family (or refer them for help) addressing any functional impairment or safety issues
You may be wondering: should you expect a diagnosis or “an answer” after this evaluation?
I’ll be honest here: probably not. Even with an adequate initial evaluation, cognitive impairment may take a few months (or even longer) to completely evaluate and diagnose. For instance, it’s often necessary to try treating one or more potential causes, to see if the cognitive problems improve or not.
Other causes of cognitive decline — notably neurodegenerative conditions such as Alzheimer’s and some of the other dementias — can take a while to diagnose because clinicians are first supposed to exclude the other potential causes, and that can take a while. (For more on the diagnosis of dementia, see “How We Diagnose Dementia: The Practical Basics to Know.)
What to expect from an initial evaluation for cognitive decline
It may not be realistic to expect definite answers. But that doesn’t mean you can’t expect some explanations.
Your health provider should be able to explain:
- How substantial the cognitive impairment appears to be, based on the office-based testing and the evaluation so far,
- What was checked for, and what has been ruled out (or deemed unlikely) as a cause for the problems you’ve been worried about,
- Whether any of the medications might be making memory or thinking worse, and what the options are for stopping or reducing those medications,
- What the healthcare team proposes to do next, to further evaluate the issues or follow up on the problems.
So if you’ve been worried about memory or thinking problems, ask for that medical evaluation. If your health provider skips any of the steps I listed, don’t be shy and ask about it. (Either it’s an oversight or they should be able to explain why it’s not necessary.)
You probably won’t get all the answers and certainty that you’re hoping for, but you’ll have gotten started and that’s vitally important.
Of course, you may well be facing the problem of not being able to get your older loved one to go to the doctor. That’s a very common issue, but it’s too complicated to cover in an article. (So I’ve written a book! You can find it here.)
In the meantime, especially if it’s a challenge to see the doctor for some reason, then it’s all the more important to the most out of your medical evaluation when you do manage to get there.
This article was originally published in 2018, and was last reviewed by Dr. Kernisan in Dec 2022.
Robyn VW says
My mom is in her mid-70’s and has had several health issues. She does have Parkinson’s and resulting dementia. My dad and I have noticed over the last year that whenever she sees her brother and his wife, she has noticeable cognitive decline immediately after. This has happened 3 times, the last being just a short 10 minute or so visit when they ran into each other at the doctor’s office. We don’t want to say family can’t visit her as she and her brother were fairly close but we don’t understand why this happens and it very frustrating to see her go so far backwards in a day. It takes several weeks for her to bounce back.
Nicole Didyk, MD says
That’s an unusual story and I’m not sure what’s causing your mom’s decline. It could be that something else is the cause, such as an infection or environmental change.
If it’s not just a coincidence, it may be that seeing her brother is a psychological trigger of some kind. If you’re able to ask your mom, or her brother about it, you may get some insight. I can understand your dilemma about whether to limit visits if you’re noticing this change.
Laurence Alter says
Question-asking is an Art. If you ask open-ended questions or (shock, shock) leading and presumptuous questions, you’ll get an answer that is normally hidden.
An innocent example: “Are you feeling fine?” vs. “How are you feeling?” vs. “How (bad)(good) are you feeling?” Now, of the three styles of questions, what one is more likely to get a candid answer?
Your own medical question, above: “Have you noticed any changes in your …… (mental ability)?” is an easy question to dodge or keep an answer hidden. Better to PRESUME a deficiency and ask: “What changes have you noticed….?” or even “How has you mind ‘acted up’ on you, lately?” [by saying ‘acted up,’ you are being casual and colloquial, making it easier to admit to some mental failure or mental ‘fault’).
I have been reading a lot about sleep and the relationship to cognitive decline. I have also read about using sleep aids that also cause issues with the brain especially with the elderly. We are definitely concerned about our cognitive decline. We have been using over the years generic benadryl OTC meds to help fall asleep. Refer to one of your other articles. https://betterhealthwhileaging.net/medications-to-avoid-if-worried-about-memory/
Recently we have switched over to low dose Melatonin and CBD oil as sleep aids. We are using very low doses to start with 1.5mg melatonin and 15mg CBD oil. We are still waking up in the middle of the night and wonder if we can increase either one. We would like to know your opinion on using both of these seemingly harmless OTC sleep aids and their effect on cognitive decline. One of us is currently taking 30mg of prozac and are slowly reducing to 10mg or even stopping completely because of the REM sleep disorder and replacing with herbs and CBD oil.
Thank you very much for your website.
Nicole Didyk, MD says
I’m so glad you’re learning more about sleep and sleep medications here!
Definitely agree with stopping the Benadryl. I don’t prescribe cannabis, although it is legal here in Canada. Most of my patients on CBD or THC oils are followed at a specialty clinic. If that’s the case with you, your prescriber may be able to advise if a higher dose would be helpful.
Studies of melatonin for sleep have used doses ranging from less than 1 mg to 10 or more mg, but there doesn’t seem to be benefit to higher doses compared to lower ones.
Most sleep medications help with falling asleep rather than maintaining sleep all night. In addition to adjusting medications, I would review your “sleep hygiene” practices to get a better night’s sleep.
Gem Butterfield says
What are your thoughts regarding pandemic and isolation dementia? My mother has seriously declined since the pandemic. We don’t know what to do.
Nicole Didyk, MD says
I haven’t heard the term: “Isolation Dementia” but there are definitely negative effects of isolation on those with cognitive impairment. I found this article that reviewed the effects of social isolation and how they can be reduced: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8504102/
In my practice, I have noticed some of my patients living with dementia become more withdrawn, less active, weaker and with more low mood symptoms. As the restrictions are lifting, there’s more programming for social and physical activity opening up which is great! Gently getting back into going out and being with others is what I’m recommending to those patients and families.
Every little bit can make a big difference.
I’m 78 years old, live alone, manage all my own stuff w careful intentional decisions, feel daily impact of “loosing marbles”.
I’ve been troubled for many year about housing construction restrictions on lighting. Fewer, dimmer lights than in decades past. I suppose to “save energy”.
However, recently I read articles indicating brighter lighting can improve brain/mental health functions.
I totally agree w this anecdotally.
I wonder if you have any thoughts about this. Not just what it is doing to older adults…literally dimming us down before our time. but what it is doing to children/younger adults.
Nicole Didyk, MD says
That’s an interesting idea, Joy and I haven’t found any scientific information about that. There is a lot of data suggesting that avoiding screens (laptops, tablets, phones) for one hour before bed promotes better sleep, but I’m not sure about dim light in general.
Time outdoors in natural light is definitely healthy, as long as one wears sunscreen!
Howard Kirsch says
I didn’t see a mention of poor sleep as a possible cause of cognitive decline. You did mention sleep medications, but not the quality of sleep itself.
There are multiple studies that have linked poor sleep with longer-term cognitive decline, including the development of dementia and Alzheimer’s Disease.
Nicole Didyk, MD says
Thank you for mentioning sleep, as there does seem to be some association between sleep disturbance and dementia. I found this article, a systematic review of over 12,000 papers: https://www.sciencedirect.com/science/article/abs/pii/S1087079217300114?via%3Dihub. One of the difficulties that authors point out is that many sleep disturbances are self-reported and thus hard to standardize.
We definitely see REM sleep disorder as a harbinger of dementia with Lewy bodies.
Jessica Johns says
Hi my 66 year old mom had a rapid decline psychically and mentally over 1-2mths. I tried to get help from pcp and they recommended talking therapy before they would try medication. (She did have similar symptoms in 2014 where she was found to be depressed/anxiety and with therapy and Ciltapram she was fully recovered in 3 mths and after 1 year got of the meds.)
So now with over a month with weekly appointments with therapist she continued to decline. She stopped driving, lost 10 pounds in 2 weeks, difficulty doing daily task like cooking, bathing, whispering to her self etc. I took her to ER for a acute mental distress and was admitted to a adult acute psych ward/lock down. She was there for over 3 weeks where they put her on antipsychotic Zyprexa and Remeron for appetite/mood/sleep. The did a Slums test shortly after admit. They said it showed early dementia but said mental illness could be the cause of her score. They diagnosed her with major depressive disorder and anxiety but cant rule out dementia of some kind. She was treated for a UTI which she had no symptoms of. CT head no contrast was normal. Lab normal. After just 1.5 weeks of being in hospital while on the antipsychotic they said she was medication resistant and needed ECT. I refused ECT.
She is discharged but due to self care deficit she is going to assisted living. Before discharge they changed her med to Risperdone (she has worse symptoms while on this) and melatonin for sleep, remeron and trazodone/hydroxizine for prn. I cant get her in till 10/15 to see psychiatrist (med management) and therapist to talk to weekly started this week. She is scheduled soonest i could get her in for memory testing is DEC for evaluation with a psychologist.
What kind of testing can be done to confirm dementia? What type of Dr. or medical person can tell the difference and diagnosis. Best imaging? She had a CT without contrast. Is without contrast best in checking? Im concerned with is this delirum, mental illness or dementia or combination.
Nicole Didyk, MD says
I’m sorry that you mom has experienced these changes and been in hospital, how stressful! It also sounds like there have been a few medication changes in the past while.
I can understand wanting to get a diagnosis of dementia sorted out as quickly as possible, but sometimes, waiting a while can be better. Delirium can take weeks or even longer to improve and evaluating someone’s cognition while they’re delirious could give a false impression.
A CT scan is useful to rule out conditions that can mimic dementia, but it is usually not abnormal in most cases of dementia. A CT with contrast can be helpful to detect tumours so we sometimes do one in a person with a history of a type of cancer that can spread to the brain (like breast cancer or lung cancer).
A Geriatrician would definitely be helpful in sorting out whether there’s a delirium, dementia, or something else.
Steven P Richter says
I Just discovered this website. Can’t express how helpful some of the information I have been reading over, has been for me, relative to my own situation with an 88-year old mother and her care since my father passed away 4+ years ago. I would welcome any and all information that could be sent to me via email, as I will list below, From what I have seen thus far, this is the most valuable resource I have come across, to date, in my attempts to understand and make plans for the future, whatever shape it may take. Sincerely, many thanks and praise for this.
Nicole Didyk, MD says
I’m so happy that you found the website too!
If you’re interested in resources, the best thing to do is check out the links and list of resources at the end of the articles. You can also print the articles (scroll to the very bottom of the article and on the left hand side, there’s a little icon of a printer. Click on that to go to a printer-friendly version of the article).
You might also be interested in my YouTube channel and website The Wrinkle (http://www.TheWrinkle.ca), where I have many articles and videos about cognition and the the aging brain.
Thanks for taking the time to comment and please keep visiting the site!
I took my 78 y/o mother to her regular doctor for an assessment. He found “little wrong with her cognitively”. I pressed for a neuro consult and the neurologist performed an extensive physical assessment and asked us both several questions. He diagnosed her with dementia and symptoms of Parkinson’s Disease. This doctor has now left town, and when I tell my mother’s doctor that Mom is having frequent losses of memory, inability to figure out how to turn off the oven, hallucinations, trips “to see my father out of town”…. My father is dead. None of these things seemed to phase her regular doctor and I fear for her safety. She consistently refuses assisted living and wants me to come and live with her. This is something I cannot do. She has an appointment with a Geriatrician in August, to which I will be accompanying her. Any suggestions on where I should go from here?
Nicole Didyk, MD says
Firstly, your mom is very lucky to have such an involved and helpful child. It sounds like you’re dong a great job of advocating and sharing relevant information with your mom’s health care providers, which is a good first step. It’s very frustrating to have to tell your story all over again to a new doctor, but seeing a Geriatrician is sure to be helpful.
I would start by trying to get a sense of what the most pressing safety concerns there are, and how best to approach your mom about mitigating the risks.
Dr. Kernisan and Paula Spencer Scott have just published a book called When Your Aging Parent Needs Help: a geriatrician’s step-by-step guide to memory loss, resistance, safety worries, and more. It has practical advice about how to assess the situation with your parent, and communicate with your mom and her health providers in the most effective way. I highly recommend getting a copy and there are also online tools available when you get the electronic version of the book.
As a result of COVID, my mother (84) came to live with us. She reads a lot, socialises, follows the news. She can count backwards, and now the actual date, in those kinds of things she does right. Everything seems fine until you live with her and you notice these “little” changes: she accuses you of stealing from her, forgets things, is very indifferent and cold at times being able to cast aspersions and make cruel comments as “small talk”, has neglected her grooming, makes very categorical judgements about people, obsessively watches videos of pimple popping; she doesn’t follow any COVID protocol because it’s a disease for “old people”. She denies any kind of deterioration. She accused me of kidnapping her when I asked her to isolate herself. The moment a visitor comes or we go to the doctor, it’s as if she pushes a button and switches into a “lovely” mode. I have not been able to be in private with a doctor to tell him about this. I tried one and he indicated that it is unethical. Should I wait until she is completely deteriorated and interdicted to seek professional help for her? I am very distressed.
Nicole Didyk, MD says
It sounds like you’re having a tough time, and I’m sorry to hear about your distress. In a situation like the one you describe, the behaviours could be part of a person’s personality or could be a response to the stress of a new living arrangement, but may also be related to the onset of dementia. Dr. Kernisan has a good article about this, which you may want to check out.
In most regions, it’s legal to share information with a doctor (although they may not be able to share information with someone who isn’t the patient), so I often suggest sending a letter to an older parent’s doctor if you see changes that you think they should be aware of.