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When I asked my mother's doctor (privately) he said " Oh she does have a lot going on right now." (Decline in health recently) If or when I need to have him to sign she is capable or not, I need to have it in her medical chart a head of time. I know what to expect from what I have read by some posted here but when does it start? Mother is generally a peaceful lady, but of late, she can ask me the same question an hour later. She has no UTI or nothing off on her blood work. Thanks

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http://www.alz.org/alzheimers_disease_stages_of_alzheimers.asp
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Plus there are other forms of dementia, besides Alzheimers.

Dementia can creep up very, very slowly, doesn't follow a strict pattern and doesn't affect everyone the same way. But in general forgetting, repeating, personality changes, difficulty with sequencing of tasks (e.g. cooking a meal) are all signs of dementia. For the purposes of competency, a proper check by a medical professional is necessary. You should discuss her wishes with her and get her legal affairs in order now, while she is still able to discuss it.
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You would need a Dr. to diagnose her but I always found that personality changes are a red flag. Everyone has bad days and everyone gets crabby but if there's a subtle shift in personality I'd get to the Dr.
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AssandAche7 That is a good site.
Margaret What would be considered a medical professional of this specialty or would her family doctor do? I have asked her about her care, and she wants to stay with me. But realistically and reading different subjects on here, I need to know she understands I can not provide the best care for her. I am reading the Care directive and the Nurse is going over it with us soon. She doesn't want a POA ever again. Mom already put my name on her check book because she has trouble spelling her name, and writing a check. She opens her own mail then brings them to me. She can not cook a meal, she can't put a cap back on a tube, she sometimes asks what day of the week it is, or where I have been. She doesn't remember if it is time for medicines, I watch that and fix her pills. The RN who comes says she won't document anything of her concerns of dementia as mom signs her timesheet . This made me think about it strongly.
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PS We are on the tenth day of in home skilled care.
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If she is recovering from surgery or injury, it does take a long time, months, for them to resume full functionality. Mom had a stroke and had visiting nurses for months, from May to December. She made progress. Winter really set her back and she agreed to try an ALF this March. She really liked it. We knew she had dementia when she put potting soil on the steps instead of ice melt. We knew she had dementia when she was hiding bills and not paying them. We found ashes next to the stove with no explanation for them. Rotten food in the fridge is another hint. Overbuying groceries. A skin fungus from not bathing. Really screwing up medications. Lots of little things that are more than just forgetful. The final straw was when she turned on the gas cooktop during a power failure, expecting it to light a candle. Very scary.
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Pamstegman... Thank you. I noticed a lot of changes in mental state during the period before her heart attack (hence checking out NH's) 80% blockage in heart. Heart surgeon said she wasn't getting blood to her brain. I have seen great improvements in her thinking. She doesn't remember much 3-4 months before the heart attack but remembers everything else in bits and pieces since. She seems to remember Alabama life real good. Today is the day I approach her about the different paper work ...health directive, ROI and hopefully a new will. Pray prayers of positiveness.
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Personally, I would get a medical & durable POA on your mom.
So many have a cardiac blockage in their 20's. It's common.
IT STARTED....
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It is wise for everyone to have a POA. When you need it, it's too late if you don't already have it in place. That is the place where she can express her wishes to you regarding her care. Make sure she understand that the POA only kicks in when she is unable to make her own choices!

As to dementia, there can be many causes including hardening of the arteries and small transient strokes. Medicine is still learning about the causes and effects. Regardless of the cause, when someone becomes a danger to themselves, they need supervised care.

Good luck with this. It isn't easy.
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If you have notice changes or odd behavior, start documenting while it is fresh in your memory and send it to her dr ahead of time for him to review in advance. Then make appt and have dr do a mental exam --specifically ask him/her to complete a mental exam for cognitive impairment. Then take her in. That's what I did and he asked mom very specific questions related to some of the paranoia, socialization, current events, etc. and diagnosed her with early dementia. Then referred her to neurologist to confirm. Mom didn't accept the diagnosis --obviously scary for her...but it let me know what I was dealing with enough to prepare some and watch for other signs, help manage finances etc.

Mom continues to live on her own and for the most part is managing. It's been 2 yrs. they can prescribe medications that some have found to help. They didn't help my mom although she wasn't on them long enough to give a fair evaluation. Actually, she went off all her maintenance meds ...she's 91 and amazingly she is sharper now than she was for the last 3 yrs. I can't explain that except to say she likely shouldn't have been on some and secondly she likely wasn't managing her meds and taking them regularly as prescribed because of the dementia.

I live long distance and don't see her everyday, so I would visit and notice major changes. Paranoia, confusion, bad food in fridge, late bill notices, hallucinations were major flags.

Get HIPPA! DPOA for financial and medical current and in order and make sure you have copies in your possession. Start talking to her about what she wants and if she has plans when she can no longer manage. See if she will add you to her bank accounts. Visit some care facilities on your own, then narrow down to 1 or 2 and visit with mom well in advance of her needs so that she gets a feel for what she likes or wants in the future.
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There are two types of POA. There is a durable POA which is effective immediately. Then there is a springing POA which only takes effect when the person becomes incapable.
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For my husband I first noticed when he couldn't balance the checkbook and got "upset" about it. He was angry at first and then kind of defeated, almost cried because he couldn't do it. Also had a tough time making decisions about big things. …….like going on a vacation, or how to put something together, putting things off for a long while.
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With my mom it was inappropriate behavior.....she became obsessed with the UPS man, she would call the kid next door and insist that he get up! She stated that a neighborhood boy was in love with her. Hindsight is 20/20 I wish i had known the signs back then. also I have heard the phrase it is not where did i leave my keys? but more.....what are these keys for?
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Stargazer, "A Durable POA is exactly as the name says. It is durable which means that it becomes effective immediately upon you creating the document and survives and stays effective even if you were to become incapacitated. This is very useful when planning for incapacity. While you are healthy and of sound mind, you can chose any person that you trust to serve as your attorney-in-fact in the event that you become incapacitated (either a coma or vegetative state). A Springing POA on the other hand does not become effective when you create the document. Rather, it “springs” to life only upon a certain event that’s designated in the POA, most often, it is your incapacity. So in theory, if you were to be in a coma or in a vegetative state, your attorney-in-fact will then, and only then, have the power to speak and act on your behalf." (boston-estate-planning/power-of-attorney/durable-power-of-attorney-vs-springing-power-of-attorney/)

One of my siblings had a POA for many years & misused her authority with Dad's assets, including misappropriating assets that were entrusted to her, and ended up in her name.

As I've explained to Dad, giving someone a POA, especially a FULL (unlimited) is like turning over your wallet, credit/bank cards, all your assets and possessions to them.
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Have her doctor refer her to a psychologist they can test her and see where she is at. (Medicare should cover it). My dad had it done and I got a copy, diagnosing him with mild dementia and the Dr. opinion of what they are capable of, where they fall in their age group average and what care they need. Of course my dad, he doesn't agree with it !
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When you mention incapacitated and say coma or vegetable, what about Alzheimer's and Dementia ? Are they not incapacitated ? My dad was not taking his meds correctly or at all, couldn't cook for himself, so his diet was awful. Ended up really sick and almost died. Is that incapacitated ?
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Definitely get a POA ASAP. A durable POA is preferred because dementia is a slow decline and there will be many things your mom will be no longer able to do as the dementia progresses though, overall, she wouldn't be considered incapacitated. For example, my dad cannot make a logical decision about his cable plan (he signed up for internet even though he doesn't have a computer or know how to use one). I was able to change his plan to just TV and phone because I was POA (they wouldn't make the changes without that).
So, a durable POA is the most useful, but if a springing POA is all your mom will agree to, then it will do the job when it's most needed.
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Any hospital stay requiring pain medication or anesthesia can alter brain function (fog) and last for quite a while, sometimes several months.

Her General Practitioner doctor did not diagnose our 87 year old, we had the GP give us a referral (after they did a cat scan) to a neurologist (then to a neuro-psych) who then gave her a neuro-psych evaluation.

If their answers seem to general, like I ate left overs, means they are not remembering what they ate or likely did not eat, or weight loss from not eating...
Repeating themselves, asking for things over and over, in dementia the short term memory goes and boy does it go...(ex.) The baby shower yesterday is forgotten as soon as they walk through the door of their house, where have you been? I have been here all day with you...

Get a medical power of attorney, by all means...


During dementia the brain shrinks...
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Have her tested by a pyc-neroligest who specializes in Dementia. Then you will have the documentation you need. Medicare pays for it.
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That website is very helpful. It helps me understand where Mom is at in this process. I would say she's firmly in stage 4, headed towards stage 5. She no longer uses the phone unless I give her the number or dial the number for her - and she much prefers if I dial it - because she can't remember the numbers for family members who have had the same number for decades. She will ask me what day it is in order to take her pills and wants me to fill the pillbox each week now, because she forgets what to put where, and reading all the labels confuses her. (She recently accused me of giving her too many pills, saying she *always* took only 4 pills in the a.m., when the labels clearly indicate she should be taking 2 of one pill and 1 each of three others - so 5 pills total - which makes me wonder if she's been under-dosing all this time, or if she just doesn't remember how many she took before.) She won't touch the checkbook or finances, because she's afraid she'll mess them up because she forgets to enter things in the checkbook or if she's paid a bill. She forgets to change her incontience pad and drizzles her way to the bathroom because she's soaked it through.

This is so hard...and so sad.
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My mom lived with me and seemed perfectly fine until she got the Shingles and was in so much pain they put her on the drug GABAPENTIN. Between the pain and the drug she literally "lost her mind" in matter of days. Within one week she went from (what we thought) normal to not being able to be left alone. With both my husband and I working full time I scrambled to get her into an adult day program, arrange transit to and from the program, and finding a wifi camera system so I could leave for work and watch her on my phone to make sure she was okay for the hour she had to wait alone for her ride. (Mind you this was in the very beginning - she can never be left alone now). Looking back now I realize there were a few signs that something was up that we just missed. For example, when doing a thorough cleaning of her room when she was away for a weekend, I found numerous copies of lists with the same info on all of them. Contact numbers for family members and friends, relatives names and how they were related (including sons and daughter) etc. maybe 20 of these lists all over her room. When she returned she was upset that I had cleaned and reorganized her room so she put her stuff "back where it belongs" with pens and forks together with tweezers and combs. All this was going on before the week that it all fell apart. So now I realize that things were already happening and the Shingles/Medicene just progressed into warp speed something that otherwise would have most likely taken months or even years to advance to that stage.
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How to tell if there is a problem? Someone once told me that forgetting where you put your keys is a sign of forgetfulness.. Forgetting what you do with your keys is a sign of a mental disorder.
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I would think poor hygiene would be one of the first signs.
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In addition to dementia, it could be the early stages of a UTI. Most drug stores sell at home test kits for UTI infections. Also, D-Mannose is great for bladder infections. You can do research about it on-line.
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MYTHREESONS... when we had the DPOA drawn up, the lawyer had me leave the room while he talked to mom. He made sure she was comfortable with naming me. There's been a lot of confusion about when the DPOA should kick in in our state... I was told that a doctor needed to sign off on it. Regardless, I have been handling mom's business for years now and haven't abused my power, but used it to do the best I can for her and take care of all her business so she can be peaceful. I agree, you need to trust the person you assign, and it's a shame if you can't trust your own child : (
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With my mom. There was normal age related forgetfulness, then she started getting info confused. When she got info confused, I knew she definitely had dementia. The forgetfulness started in 2008 and by Dec 2009, she was having confusion with forgetfulness.
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What about headaches? Have any of your loved ones with Alzheimers experience severe headaches?

There is a possibility that Namenda is causing the headaches. I have now started giving my husband a new Namenda, which is taken only once a day and is time released. I haven't really had enough days to diagnose if this new medication will help, for I suspect the Namenda given twice a day could have caused the severe headaches. marymember
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marym~My mother nor my father complained of headaches. However, I do believe the disease can cause them to focus on something that is a result of the disease playing havoc with their brains. My mother complains that her vision is blurred, she refuses to wear her glasses but does admit when she does wear them, her vision is improved. Is high blood pressure an issue, if so, maybe an increased dosage may help with the headaches. Something to think about. Hugs to you!!
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my mother also complained for 2 years about pressure in her ears. The ENH specialist suggested a procedure for sinus' ....sinuplasty. During this procedure, he removed a polyp on the left tube that connects to mom's left ear which was the ear that was giving her the most problems. He also corrected a deviated septum. My mother continued to complain about pressure in her ears for 1-1/2 years after the procedure. In June of last year, her focus switched to her vision. Mom is mentally incapacitated, and her vision could be helped by a procedure to one eye that has tinny tiny bumps on the cornea from irritations that cause blurry vision. Since the procedure would require mom to wear an eye patch for 7 days, we decided against it. She would not wear it, and would be rubbing her eye causing further problems since she would not understand.
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The question is almost unanswerable, because no one really knows when it starts. We know when we begin to notice it. Then there are things we look back on and say, that was it too. I agree with others, if your mother will sign a power of attorney to someone, have her do it now. Get her medications evaluated, that can affect her mind. If she wants a Living Will, do it now.
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