Dear Carol: I’m worried about my mother-in-law, age 78, who has become so forgetful that she can no longer put together a simple supper without major ingredients missing or misused. She used to be a superb cook, so this is extra distressing. My father-in-law dutifully eats anything she makes without complaint, making excuses in private about why a particular meal was so strange. Also, even before the COVID-19 isolation, she was getting lost on the way to or from her longtime neighborhood grocery store, though she said it was "for fun."
I’ve been pressuring my husband to talk with his dad and tell him that Mom needs to be evaluated for Alzheimer’s. So far, he brushes off my concern. What can I do to convince the family to take her to a doctor? — HK.
Dear HK: Denial of the symptoms of cognitive decline is common, but it helps no one. I’m sorry that you are in the middle.
You’re right that your mother-in-law should see her doctor, but I’d suggest that you don’t jump to the conclusion that she has developed Alzheimer’s. This is what most of us think when we see symptoms such as you describe, but let her physicians make the determination.
You may get further with your goal if rather than saying that she needs to be tested for Alzheimer’s, you say that she probably should see her doctor for something that she’d see as non-threatening such a medication check, which is true. Then, once she sees the doctor, she should be tested for any number of things that can cause memory issues and/or confusion.
RELATED COLUMNS: Respecting older parents' autonomy is more productive than demanding change | Nursing home changed Mom’s medications without telling me | Caregiver needs to protect herself from mother’s misplaced anger | Caregiver waiting to hear 'thank you' may need to adjust thinking | 86-year-old mom refuses to accept in-home caregivers
Her medications should be carefully evaluated for potential side effects. This includes over-the-counter drugs and supplements as well as prescriptions. Many frequently prescribed drugs are anticholinergic, which in lay terms means detrimental to brain function, especially for older adults. The accumulation of these drugs can cause dementialike symptoms.
Also, some vitamin deficiencies can cause cognitive issues, most commonly B12 because it’s often poorly absorbed by older bodies. Then, there is a need to look for any type of infection such as one of the urinary tract that can have a profound effect on older people.
If your mother-in-law has a complete physical exam and everything checks out fine, she will likely benefit from a cognitive assessment. Dementia has no cure, and while there are drugs that help some people maintain their cognitive ability a little longer, they don’t help everyone. Therefore, the idea behind a diagnosis at her age is more often to eliminate other problems that could be causing her symptoms and to plan for her care than it is about curing the disease.
We can hope at this point that your mother-in-law’s symptoms are reversible. If not? Remember that people living with dementia do far better with proper support from families. That often means educating themselves about the disease and methods of care, which would be well worth the time. Your local Alzheimer’s organization is a good place to start.
Carol Bradley Bursack is a veteran caregiver and an established columnist. She is also a blogger, and the author of “Minding Our Elders: Caregivers Share Their Personal Stories.” Bradley Bursack hosts a website supporting caregivers and elders at www.mindingourelders.com. She can be reached through the contact form on her website.