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Is It Just Me?

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As a reminder, I am not a physician.  You should not substitute my opinion for your own judgment.  But I do love these questions.  They clearly demonstrate that these issues are complex problems with shifting dynamics and no easy answer.  Yet for all their individual nuances, they are nearly universal.

My wonderful mother in law has been diagnosed with early stages of dementia. My husband and 7 year old twins have been living with her for the past month while we have renovations done on our home. We have noticed significant changes in her mental state; some alarming (leaving water on the stove to boil and going downstairs to visit with a neighbor). Prior to us moving in, we all noticed instances where she was forgettting things and she has since become good at not speaking when she is not sure – hiding it in my opinion. But she has not been able to do this while we are living with her. We have told her other children of our concerns and they insist that it is due to our being there and there being a change in her routine. I certainly agree that, as you discuss on your site, routines are important, but we have not disrupted her routines much. We are gone in the a.m. all day until around 8:00 at night usually. Her “routines” of eating, etc., are all the same. Is there disruption? Certainly. But we are concerned that this is more of a situation where we are there to see the extent of her problems and that they will not all go away once we leave. She lives alone and there have been two instances with the stove since we have been there that we were able to see. We are concerned about saftey more than anything. The other issues (not knowing it is Easter as we are opening easter baskets with the kids, not knowing it is a weekend and asking if the kids are going to school, not remembering I am in the house and scaring her, etc.) are not a safety concern and we roll with it – never call her on it, but gently answer the questions, etc. So, my question to you is, is this all due to our being there or is it more as we suspect? Thank you!

I think the fact that she already has a diagnosis of early stage dementia is where the answer to your question starts.  Here are some common symptoms:

  • Memory loss
  • Talking is better than problem solving
  • Denial is the dominant defense mechanism
  • Personality changes
  • Inability to carryout highly familiar tasks
  • Decreased abstract reasoning and executive function (judgment and insight)
  • Decreased temporal orientation (date, time, season)

Your presence in the home may or may not affect her cognitive abilities.  And the deficits you are now witnessing may or may not be new.  The point is, there is no way for me to tell you if the stress of your family moving in with her is the cause of her cognitive challenges, or if it’s the dementia at play.   I would consider having her evaluated by a professional (neurologist, psychologist, occupational therapist) and let the objective data support your findings. Discussions with family members always go more smoothly with the input of an outsider.  I would definitely consider putting FireStops over the stove.  I’d be on the lookout for financial and driving issues too.

Kudos to you, Marnie,  for your gentle, supportive approach in dealing with her errors.  Keep her safe and feeling validated, and hang in there!

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  1. I have been a Clinical Dementia Specialist for many years and can assure you that family input and support can only ever have a positive impact on someone living with dementia.

    Yes, routine is essential. However, familiarity and empathy are equally important.

    Family dynamics are complex at the best of times. If you can all get together and hold a family conference to discuss mum’s situation and the support she needs, only positive outcomes can result.

    Dr Dan.

    • I think it is more important to use the information that is being revealed to you to help you to support your Mum, rather than worrying about what is causing that behaviour. As DQ says, we may not really ever know ‘why’ something is happening – but we can certainly know ‘how’ something can be helped to not happen again. So for:
      1. Stove issues – consider Assistive technology devices that will either remind your Mum to turn them off or will turn off automatically
      2. Orientation to time issues – use reality orientation approaches of (a) calendars clearly marked off as each day passes and showing any key events such as birthdays, anniversaries, religious holidays and (b) regularly reinforce the day/event through natural inclusion in conversations.
      3. Awareness of others – give audible information of your presence before your mum sees you- talk to her as you approach, sing, hum etc..

      All these are possible solutions to the difficulties your mum has encountered. These difficulties may disappear when you all leave and she returns to her routine – but even if they do disappear, the solutions would still be helpful to someone without these difficulties.

  2. This is always such a tricky topic! When I meet families like this I always try to convince them to introduce some dementia management strategies now! The earlier you can implement new safety strategies, the better. And if it turns out the equipment, modifications or interventions weren’t necessary, no harm done! Follow DQ’s advice and seek professional assistance, not only for you and your mother, but for the rest of the family.

  3. I’m not a doctor, but I always recommend that someone see a doctor (first the GP, then a neurologist) because there are other treatable causes of dementia, such as an infection, B12 deficiency, Normal pressure hydrocephalus, depression, drug interaction (anti-depressants, anti-anxiety pills, even some antibiotics) and more. Please encourage your mom to see a doctor asap, and know that it’s actually fortuitous that you had the opportunity to live with your mom for an extended period of time in order to observe her actions. Many times symptoms of dementia are discovered or observed for the first time when extended family spends time with a loved one over the holidays. Good luck.

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