Depression Learning

At What Point

Question:

…did you have your loved one with AD diagnosed?  How much do they have to go thru?  Also, how difficult is it to get power of attorney?  I have been putting alot of this off, and trying to kid myself that my mother will get better, but she’s not.  I just need some advice here, guys. Leslie

Response:

Leslie, Can she sign her name and will she if you ask her to? If so go to an attorney and do it  NOW.  Also do a Living Will. Now Please don’t put it off until she can’t participate. We never did get a diagnosis but he did give me a handful of AD literature. Bob

Response:

Leslie, I forgot to say it is easy. Bob

Response:

Diagnosing Alzheimer disease is a process of elimination which can take as long as six months.  Since there is no direct test to diagnose Alzheimer disease, other medical conditions (vitamin deficiencies, infections, glandular disorders, etc.) must be ruled out.  Usually the family doctor performs the preliminary tests and if no cause for the short-term memory impairment is found, he/she will refer the patient to a neurologist for more precise examinations (neuropsychological tests, cat scan, etc.).  Probable Alzheimer disease is diagnosed only when all other medical conditions are eliminated.  The diagnosis is probable and not definite since the only way to accurately diagnosis Alzheimer disease is by an autopsy of the brain after the person has passed away.  When physicians follow proper diagnostic procedures for Alzheimer disease, their rate of accuracy for diagnosing Alzheimer disease is between 85 and 90%.  I was also involved with a family where Alzheimer disease was assumed and the symptoms were later found to be the result of a vitamin B12 deficiency.  The symptoms disappeared after three vitamin B12 injections.  Although the majority of serious forgetfulness in older persons results from Alzheimer disease, it is not always so. Your mom may resist visiting her family doctor if she is aware it is for memory problems.  Most parents with Alzheimer disease are able to and actively hide their symptoms by developing creative ways to compensate for the forgetfulness.  The psychological tests employed such as the mini-mental or the Folstein involve asking the person very simple questions which can offend the person with Alzheimer disease.  The professional administering such tests should be sensitive to the self-esteem issues and not make your mother feel foolish replying to simple questions.  Having your mother diagnosed may be helpful since there are several drugs (Aricept, Exelon) which can be prescribed to in the early-moderate stages of Alzheimer disease.  They can sometimes improve memory or stop the decline temporarily. These drugs unfortunately do not stop the progression of the disease but other drugs are currently being tested.  Vitamin E supplements of between 400 and 800 IUs are also being prescribed to persons with Alzheimer disease which may have a protective effect on brain cells (if the person is not taking blood thinners). Power of attorney differs from country to country and I am aware only of the procedures involved in Quebec, Canada.  We must provide the lawyer with a valid medical certificate and psychosocial evaluation attesting to the incapacity of the family member with Alzheimer disease.  The lawyer forwards the documents with a drafted power of attorney for the court to probate. The procedure is less complicated if the person with Alzheimer disease completed a legal power of attorney in anticipation of incapacity.  Our power of attorney (called a mandate) involves a family member having the legal right to make decisions for the person with Alzheimer disease concerning both property and person.  It is important to have a power of attorney because you may have to make decisions which are in in the best interests of your mother which she may refuse to follow.  Without a power of attorney, your mother retains her legal right to decide even though her decisions may be detrimental to her health and safety. Be comforted that Alzheimer disease does not necessarly mean your mother will not have quality of life.  It may require some major changes in how others will have to interact with her and there are educational and support groups for family caregivers offered by Alzheimer associations and other community agencies which can provide counselling in how to make these adjustments.  Choosing professionals who are sensitive to issues of Alzheimer disease will also make life less frustrating for your mother. Howard Cossitt West Island Alzheimer Society Montreal, Quebec, Canada.

Response:

…did you have your loved one with AD diagnosed?  How much do they have to go thru?  Also, how difficult is it to get power of attorney?  I have been putting alot of this off, and trying to kid myself that my mother will get better, but she’s not.  I just need some advice here, guys. Leslie

Leslie, Howard Cossitt made some excellent points in his response to you. As you may know, my MIL recently died of AD and my husband is an only child…so we were IT in terms of family. I can’t tell you how important it is to get your mom properly assessed and diagnosed. There ARE treatable causes of dementia in the elderly. As I have said many times before, "senility" is NOT a normal part of aging and should always be checked out. It might be from a drug interaction, from a thyroid problem, from pernicious anemia (a B12 problem fairly common in older people and often overlooked) etc. You will never forgive yourself if you later find out she could have been helped. When my MIL was diagnosed, the first step was me having a talk with the family doctor about the kind of things we had been observing (forgetfulness, trouble getting to appointments on the right day, trouble handling her bank accounts etc.). He gave her some quick tests in his office, such as asking her questions about current events, to repeat number sequences, drawing clock faces etc. and quickly agreed with us that there was something wrong. He did a complete physical exam to rule out things like thyroid, B12 problems etc., reviewed all her medications to make sure nothing there could be to blame, and then set up an appointment with a geriatric psychiatrist who specialized in dementias. The psychiatrist examined her to rule out things like depression, and then also sent her for tests to try and rule out any other physical causes – i.e. his tests included a CAT scan to check for signs of strokes. His testing evaluated her deficits so we could get a clear picture of what was happening – in terms of what she was capable of. Her deficits were much more serious than we had expected – she was able to hide a lot from us. Knowing the full state of her disability was a wake up call for us, because she lived alone and needed much more help that we had realized or than she was able to understand or admit to. When everything else had been ruled out, and based on the pattern of her deficits and their progress, he diagnosed her as having AD. This really was not a big deal – it only involved a couple of appointments. The only part that bothered her was the interview with the psychiatrist because he asked her personal questions to try and determine if she was depressed, and she was a very private person who didn’t like talking about herself!! You should get a power of attorney right now. In Ontario, there are two kinds, one for financial decisions and one for personal care, and you need both to care for someone with AD. A living will is also a good idea (i.e. if your mother would not want to be rescusitated or kept alive artificially in the later stages, having her wishes in writing will help you with hard decisions and also will help you to deal with the nursing home/hospital/doctors etc.) You should not delay – see a lawyer right now. If she can sign something now, you will save yourself a world of trouble, because going to court to get someone declared incompetent is neither pretty nor easy. Much better to get her to sign something voluntarily while she can still understand what she is signing. You can present it to her not as something she needs right at this minute, but so you can help her down the road…which you will need to. Get your skates on. The lawyer and the doctor should be on this weeks "do" list. Mary G.

Response:

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