Dementia beginning, what are first steps?

[braumeister]

DW has a friend who seems to be in the beginning stage of some sort of dementia.
The servers at her favorite restaurant recently talked to her when she wrote a check and signed some strange, unknown name to it. That got her attention, and she started to realize that she is beginning to lose it.

She is in her mid 70s, and has recently failed the mini mental test twice. She has finally been persuaded to see a specialist (I don't know any more than that), and has an appointment set up for next month.

What should we tell her if she asks for advice?

 

[MichaelB]

That’s tough for the friend and she will need lots of support. Does she have family she can rely on for that?

With my mum I found a neurologist to be unhelpful after the initial diagnosis. It took a while but I found a geriatric psychiatrist who was much more helpful in developing a care plan, assessing the progress of the disease, and helping deal with the emotional impact.

 

[braumeister]

I think she has relatives, but don't really know. She is a retired nurse, so plenty of social contacts in the area. Thanks for the idea about the geriatric psych.

 

[RunningBum]

Have her see an estate attorney to get her POAs set up, and get the people who will have POA very acquainted with what she wants, and with all of her finances. She may even need to give up her access to most of her own money so she doesn't get scammed out of her money. With a mistake like signing a strange name to a check, sooner is better than later on this, while she is still competent to make these decisions.

She should start researching and visiting memory care places. Expect this to cost over $100K/yr, so if she'll run out of money she should try to find an acceptable one that accepts Medicaid. Many will want her to be able to pay a year or two on her own before starting Medicaid.

Does she have someone going to the specialist with her? Someone should, because she probably won't retain all of the information. The specialist should give guidance on when she probably need to go into memory care, etc. A lot will depend on if she has someone responsible living with her, or at least checking with her daily.

 

[SecondCor521]

My father was officially diagnosed with Alzheimer's/vascular dementia earlier this year by an internist. When that happened, the doctor provided us with a reference sheet to a lot of dementia resources. Some were local but many were national. Let me know if you want me to find it and PM it to you or post here.

There are a couple of prescription medications that might slow the progression of her disease. Her medical provider should know about these; as a nurse she might know of them as well. Mental and physical exercise and just generally good health care probably helps too.

Dementia is a collection of symptoms. The underlying diagnosis (i.e. the disease or cause) can vary widely. She may have MCI plus a UTI, Alzheimer's, vascular dementia, or other things. Some of these are more treatable and less scary; some are less so. It's probably wise of her to get whatever it is diagnosed first so (a) she can get the proper treatment, and (b) so she knows what she's dealing with. [ETA: Might not even be dementia - see post below.]

With my Dad, his kids (me and my siblings) are doing a lot of care coordination and legwork behind the scenes. I hope your DW's friend has kids or family or close friends who can step up to help.

...

On the POA stuff, if she does have dementia, she should probably get a durable power of attorney. "Durable" means it stays in effect if/when she is still alive but not legally competent, which is pretty likely if she has dementia.

It would be smart for her to also get her medical directives in order - POST, medical POA, living will, etc., whatever her state uses.

HTH.

 

[ivinsfan]

Don't assume the the worst something else could be going on. It could be med related as in medications side effects or dosage. Could be blood sugar...stuff happens.

 

[Piper20]

FIL had a few UTI’s when in his 80’s causing him to not make sense. Once meds cleared it up he was fine.

 

[copyright1997reloaded]

Have her see an estate attorney to get her POAs set up, and get the people who will have POA very acquainted with what she wants, and with all of her finances. She may even need to give up her access to most of her own money so she doesn't get scammed out of her money. With a mistake like signing a strange name to a check, sooner is better than later on this, while she is still competent to make these decisions.

This. She needs to get this done BEFORE an estate attorney can't/won't set up a POA because they don't think she is cognizant of the decision she is making.

 

[Octogirl]

Agree with other posts about getting a medical eval first.
I am an NP who worked with a geriatric psychiatrist for 10+ years.
Meds, UTI, cancer can mimic dementia so a full eval needs to rule them out.

Agree. See an estate attorney ASAP - because if her testing scores are too low, many attorneys will not do POA and she'll need guardianship.

Thank you for trying to help her.
Good Luck

 

[braumeister]

Thank you all for the good advice.
I have learned that she has no close relatives beyond one that she broke off contact with many years ago, and he is now incarcerated.

Nothing for now, we'll see how her physical exams go next month.

 

[Sojourner]

This. She needs to get this done BEFORE an estate attorney can't/won't set up a POA because they don't think she is cognizant of the decision she is making.

How would an attorney be able to make a medical diagnosis of incompetence in the absence of a qualified physician? Do they just "wing it" and decide whether the person is competent based on their own observations? Or do they use a standardized test of some sort? Just curious. Seems odd to me that an estate attorney would refuse to draw up a POA based on a non-medical, non-professional judgement of incompetence unless the person was clearly in the mid-to-late stages of dementia, which it seems like OP's acquaintance is not.

 

[RunningBum]

How would an attorney be able to make a medical diagnosis of incompetence in the absence of a qualified physician? Do they just "wing it" and decide whether the person is competent based on their own observations? Or do they use a standardized test of some sort? Just curious. Seems odd to me that an estate attorney would refuse to draw up a POA based on a non-medical, non-professional judgement of incompetence unless the person was clearly in the mid-to-late stages of dementia, which it seems like OP's acquaintance is not.

Suppose I (related or not, take your pick) take her to an attorney to give me POA over her. The attorney is going to make sure she understands what she is signing. They won't just fill in the blanks on a form and push it over her to sign. And if she signs a different name, I'd bet the attorney won't do it. If another relative challenges it the attorney needs to be able to say that they understood what was going on at the time of the signing.

I'm not a lawyer and don't have personal experience with this, but I think an attorney will use some judgement, and perhaps require a competence test from an expert if they aren't sure.

 

[SecondCor521]

How would an attorney be able to make a medical diagnosis of incompetence in the absence of a qualified physician? Do they just "wing it" and decide whether the person is competent based on their own observations? Or do they use a standardized test of some sort? Just curious. Seems odd to me that an estate attorney would refuse to draw up a POA based on a non-medical, non-professional judgement of incompetence unless the person was clearly in the mid-to-late stages of dementia, which it seems like OP's acquaintance is not.

In the case of a POA (or a will), there is a legal standard, not a medical standard, that is applied. Presumably estate attorneys are taught the specifics of what that standard is and how to determine whether the person meets (or doesn't meet) the standard.

I think the legal standard is "in compos mentis", but IANAL.

ETA: A person's mental state can change over time. It depends on the exact specifics, but it is possible for a person to be in compos mentis on a given day and sign either a POA or a will and that would be valid as I understand these things even if the next day they're not OK. And the standard is a pretty low bar - a person basically just needs to know who they are, who the POA is or what the will says, and that they want that to happen when they're signing it.

 

[W2R]

If she's driving around to all these appointments with geriatric psychiatrists and estate attorneys and so on, I'm thinking maybe the most immediate help you can give her is to GO to these places with her so she doesn't get lost or forget where she is going or how to get home.

 

[Scuba]

This. She needs to get this done BEFORE an estate attorney can't/won't set up a POA because they don't think she is cognizant of the decision she is making.

Yes, this is absolutely critical!!

 

[Scuba]

Have her see an estate attorney to get her POAs set up, and get the people who will have POA very acquainted with what she wants, and with all of her finances. She may even need to give up her access to most of her own money so she doesn't get scammed out of her money. With a mistake like signing a strange name to a check, sooner is better than later on this, while she is still competent to make these decisions.

She should start researching and visiting memory care places. Expect this to cost over $100K/yr, so if she'll run out of money she should try to find an acceptable one that accepts Medicaid. Many will want her to be able to pay a year or two on her own before starting Medicaid.

Does she have someone going to the specialist with her? Someone should, because she probably won't retain all of the information. The specialist should give guidance on when she probably need to go into memory care, etc. A lot will depend on if she has someone responsible living with her, or at least checking with her daily.

Depends on where she lives. In CA, Medicaid doesn’t cover Memory Care, unfortunately. Varies by state.

 

[Katsmeow]

Depends on where she lives. In CA, Medicaid doesn’t cover Memory Care, unfortunately. Varies by state.

I'm confused. This didn't seem right so I went to multiple websites all of which said that California Medi-Cal covers memory care if medically necessary.

 

[kingkarmann]

As a caregiver for seven years I will say all the advice given thus far is spot on.
Your you and your DW must be great friends to take to time to investigate what is going to be an very difficult future for all involved.
I would suggest her finding Alzheimer's / Dementia support group as early as practical. It's a wonderful resource for those who have the disease and their loved ones.
I wish you nothing but the very best.

 

[MarieIG]

If she's driving around to all these appointments with geriatric psychiatrists and estate attorneys and so on, I'm thinking maybe the most immediate help you can give her is to GO to these places with her so she doesn't get lost or forget where she is going or how to get home.

+1

She also may be so distressed that she does not remember a great deal of what she is told at the appointments.

One thing may be to get together a support system for her. She is going to need it.

 

[KarenF]

That’s tough for the friend and she will need lots of support. Does she have family she can rely on for that?

With my mum I found a neurologist to be unhelpful after the initial diagnosis. It took a while but I found a geriatric psychiatrist who was much more helpful in developing a care plan, assessing the progress of the disease, and helping deal with the emotional impact.

I second a geriatric psychiatrist, but eventually all they could do for my Mom was to medicate her into "pleasant confusion" - an actual medical term. she had to be in a locked Memory care Unit eventually.

 

[Twolves]

If it is not too late, find LTC, or Long Term Care, or an alternative to long-term care for assisted living expenses. It will help the people who are caring for her and she will also be able to get better care without financial burden.

 

[KarenF]

If it is not too late, find LTC, or Long Term Care, or an alternative to long-term care for assisted living expenses. It will help the people who are caring for her and she will also be able to get better care without financial burden.

I would guess it is too late for LTC Insurance. My Mom had dementia, and when I applied for LTC I had to submit to a rather rigorous mental capacity test.

 

[braumeister]

Thanks to all for the helpful comments.
We are quietly backing out of the situation now, because the subject has become reconciled with an old companion who is now taking over the situation (and is quite capable of handling all these issues).

 

[ivinsfan]

Thanks to all for the helpful comments.
We are quietly backing out of the situation now, because the subject has become reconciled with an old companion who is now taking over the situation (and is quite capable of handling all these issues).

Well isn't that nice....best wishes to both of them.

 

[imnontrad]

Before she has an official diagnosis, have her designate someone to act on her behalf with
Medicare , Social Security and the IRS. They DO NOT recognize a general Power of Attorney and have their own forms. And once she has an official diagnosis, she cannot legally sign these. Each has their own forms and all can be downloaded.
But confusion can also result from something like a UTI.