Mom had her assessment with the geriatric psychatrist yesterday. The three of us spent a good 2 hours chatting.

His findings?

Pseudodementia. Even though she'll be undergoing the actual neurobiological evaluation in a couple of weeks, the doc thinks they won't find a true dementia like ALZ, MID, etc. As I've said before, she's just too articulate and "with it", but what about all the other symptoms she's been having?

The doc explained: Pseudodementia is a psychtriatric disorder in which the depression already present in someone over the age of 60 manifests itself into dementia-like symptoms. In Mom's case, her depression has been so longstanding and so severe that it's basically crippled every aspect of her life. Even her thought process is stymied. In the more severe cases, hallucinations, for example, are common (gee thanks *rolls eyes*)

The good news? It can be treated with meds and a lot of psychtherapy.

The bad? In Mom's case, because it's so longstanding and severe, it's going to take a lot of cooperation from her. She is clueless, of course. She's woven such a tapestry of denial that she can't even see the individual threads. She has no conception of how her action/inaction has crippled others, particularly me.

She has no desire to grow old gracefully. Her take on anything "elder" = six feet under. If she can't do what she's always done, she might as well be dead. She said that to the geriatric psych doc more than once.

She has the actual neuro evaluation in two weeks -- an all-day battery of tests to see if there's any sign of ALZ or another type of dementia. There's been a recent study I can't cite at the moment where people with longstanding pseudodementia eventually develop actual dementia because of how depression alters the neurons.

As for me? I'm torn between relief and wanting to pop her one because of the depression. Now, granted, in Mom's generation therapy was unheard of. I understand that. But why the hell hadn't any of her doctors before picked up on it?

*trying not to bang head against wall*

My Mom had long term depression that went untreated too. She now has Lewy Body disease which is described as dementia, hallucinations, Parkinson's like tremors and depression. I agree with the other ladies and gents here that you should wait for eval to be final but also do your own research. Docs are not always 100% correct on diagnosing these things since there is no simple blood test to determine the sources of the symptoms. Hope for the best, be prepared for the worst, take it day by day.

quote:

Originally posted by Moms_Buddy:
Anna, I wouldn't bank on this being your mom's condition because of her psychosis. The lack of "trying" is very common and it is not related to her "not trying" so much as not being ABLE to try... degenerative brain problems are maddening for caregivers because sometimes how things appear on the outside is so very different from what's going on INSIDE. I remember the first time my mom told me she didn't know HOW to try... that was a mind-blower. We take so much for granted, it's hard to get one's mind around something like "I don't know HOW to lift my leg" or "I don't know HOW to try."

Deperssion is also very common in elderly people but I am not sure which comes first - the chicken or the egg. I think depression is a stage of the disease process more than a causative thing... For example, bi-polar-like symptoms are very common, especially in early stages, but seem to diminish further on down the line...

Please don't spend a second looking over your shoulder - there is no cure for any of this stuff. Earlier diagnosis makes a difference in some conditions and can help people to be functional for a little longer, but there's nothing that "cures" this stuff, sadly.

Oh how right you are..... I need to move forward and work towards what I can do for her NOW. It's hard because all the time you want things to go back to the way it was. I have read many threads and think, that's my mom or gosh my mom isn't that bad because she functions well. The sad fact is there is no "cure" and her condition will eventually worsen. Thanks for keeping me focused.

quote:

Originally posted by AnnaS:
Oh wow, I just came accross this thread. This is so like my Mom. Long standing depression, except mine was so good at hiding it from her doctors. She had them hoodwinked until it caught up with her. Once my Mom could not work anymore, she just "gave" up. When she couldn't drive, she gave up. I mean, before her PD/Dementia diagnosis, she at least tried. Now, she doesn't unless I get after her.

Thanks for this thread, I wish I would have paid more attention to my Mom back when maybe it could have made a difference.

Anna, I wouldn't bank on this being your mom's condition because of her psychosis. The lack of "trying" is very common and it is not related to her "not trying" so much as not being ABLE to try... degenerative brain problems are maddening for caregivers because sometimes how things appear on the outside is so very different from what's going on INSIDE. I remember the first time my mom told me she didn't know HOW to try... that was a mind-blower. We take so much for granted, it's hard to get one's mind around something like "I don't know HOW to lift my leg" or "I don't know HOW to try."

Deperssion is also very common in elderly people but I am not sure which comes first - the chicken or the egg. I think depression is a stage of the disease process more than a causative thing... For example, bi-polar-like symptoms are very common, especially in early stages, but seem to diminish further on down the line...

Please don't spend a second looking over your shoulder - there is no cure for any of this stuff. Earlier diagnosis makes a difference in some conditions and can help people to be functional for a little longer, but there's nothing that "cures" this stuff, sadly.

Oh wow, I just came accross this thread. This is so like my Mom. Long standing depression, except mine was so good at hiding it from her doctors. She had them hoodwinked until it caught up with her. Once my Mom could not work anymore, she just "gave" up. When she couldn't drive, she gave up. I mean, before her PD/Dementia diagnosis, she at least tried. Now, she doesn't unless I get after her.

Thanks for this thread, I wish I would have paid more attention to my Mom back when maybe it could have made a difference.

quote:

Originally posted by Emad:
Hi,

We have the same problem as you.

How did you convince your mother to go to the evaluation? My mother does not trust any doctor. She will not take any medications prescribed by her regular doctor. She is in denial.

Seems we live in Mass. what is the dr. name?

Emad

I'd completely forgotten about this thread until I saw your PM, Emad. Two years later and my mom is now in early late-stage ALZ.

If I remember correctly, the neuro-bio workup definitely showed there was probable dementia somewhere underneath all her denial. Within a year Mom's accusations/denial disappeared and she suddenly turned into the sweetest "I'm a good girl" woman I'd never witnessed before.

I'll shoot an e-mail to you about the particulars.

Hi,

We have the same problem as you.

How did you convince your mother to go to the evaluation? My mother does not trust any doctor. She will not take any medications prescribed by her regular doctor. She is in denial.

Seems we live in Mass. what is the dr. name?

Emad

This message has been edited. Last edited by: Emad,

John Hopkins, very interesting observation.Sadly, many suffered with depression and it was labled something else.When a person sees all in life as negative it usualy comes with depression of some kind.Never addressed it affects those around them and they believe it is their normasl behavior and a certain wedge is drawn between them.

Depression used to be mistaken for dementia,20 or so years ago when the term was coined. Now it is rarely missed, especially when you get such a super work up-2 hours! After all is said and done, it sounds like you'll have a mother who can't/won't be emotionally healthy- does it matter whether it's can't or won't? Protect yourself from her pessimism-I suspect you've been exposed to it since you were a child. Ask someone about "axis II." It's where mental health people put personality traits in the diagnostic work up.

I had an entire post written up as a reply Saturday and it disappeared into HTTP Error land So I'll try again.

As long standing as it seems, I'm going to assume your Mom's depression is based on a chemical imbalance in her brain. That's as opposed to situational, she's not depressed in reaction to something that just happened. It is treatable. When depression is based on a chemical imbalance, it usually has to do with a fairly small number of chemicals. The goal of drug therapy is then targeted at those chemicals with a certain degree of trial and error. As long standing as her problem has been, she needs a doc that's really good at manipulating these meds. Ask around about the reputation of other's docs. Whether you think you know someone that suffers from chronic depression or not, you do. We're out there in the millions. Just ask. Important attributes are someone that it's easy to build a good rapport with, someone that's understanding and not dismissive. It may or may not be a psychiatrist. Mine is an internist. But because HE suffers from chronic depression and understands how painful it can be, he's made it his business to be very good at what he does when it comes to manipulating drugs. Another attribute, if a drug doesn't work, someone that switches to something else rather than just ADD something else. I would use any means necessary to get these meds into your Mom. If she's resistive, don't be beyond hiding them in her food. Many of the meds only need to be given daily or twice a day, not every 4 hours or something like that, which makes it easier. Some can be crushed, some can't. To get reliable information on that part, ask the pharmacist, not a tech, not the doc, but the pharmacist. Some meds may take effect right away, some may take 4 to 6 weeks to show what they're going to do. One thing I definitely would not do is let them wait on the results of whatever tests they're going to do before starting treatment for her depression. It seems that her depression is a known. I'd be getting it worked on aggressively now. Depression is the LEADING cause of disability in the United States. It's also the most untreated/undertreated condition there is. There's a post around somewhere where I listed many stats on depression. They're both extremely impressive as well as frightening. Just getting her depression adequately treated may make a really big difference in her condition. Another point, once people feel better, frequently they think "hey, I'm fine now" and quit their meds. NOT!!!!! Don't be alarmed if someone starts her on more than one med to start, maybe one is faster acting than the other. Don't be surprised to see her started at one dosage, and then have that dosage worked up higher over some weeks, common to do. Ask the plan so these won't be surprises.

As controversial as HRT (hormone replacement therapy) is these days, it, too, is a chemical that may effect someone with clinical depression. So if she's post-menopausal, I'd look into that as well. If she isn't already on it, maybe she could at least be given a trial of it and see how it effects her. Just something else to ask about.

As others have already said, I agree that you should just leave the DPOA type stuff as is. There are plenty of people that have those in place without having an illness.

NPH, Mom was diagnosed with it several years ago. At the time they did a high volume spinal tap to remove the excess fluid. She quit falling right away. That's what she'd been doing, just falling, no dizziness or anything, would just fall. Another sign of NPH is abrupt onset of incontinence. Those are kind of the 2 hallmarks of NPH. I was given the impression that the high volume tap was all that was needed, which was false. I fault myself for not looking into it more. Mom should have been shunted right then and wasn't. Now the effects of her NPH are irreversible. I tell that so others won't make the same mistake that I did.

In hydrocephalus, the problem is excess spinal fluid in the ventricles of the brain. For one reason or another, it isn't being recirculated as it should be. In kids born with it, they have increased intracranial pressure, high pressure inside the brain. That's easily seen by their enlarged heads. In shunting, the idea is to drain off or divert this excess fluid. One end of the shunt tubing is placed in the ventricle of the brain, the tubing is tunneled under the skin down to the abdomen, where the excess spinal fluid drains off and is reabsorbed in the system, eventually being excreted mostly by the kidneys in urine.

I hope some of that helps

And I hope this post makes it to the board

Cathy

Another thought, ask for samples. My doc ALWAYS has them. A lot of psych meds are expensive. So having samples may avoid wasting money on a script she may not be able to take for one reason or another.

This message has been edited. Last edited by: ces,

Before changing anything wait till the full exame is done. Unless the full thing is done you can't have a complete diagnoses/cause. I would not give everything back just yet. Wait for treatment to begin and enough recovery is done to SLOWLY allow her to do more and more for herself. Even if it is what he says that does not mean she is ready to act or function normally.

embersom, I would not change anything, at this time.You never know what changes may occur.No harm done with you having the DUPO.JUST CONCERN YOUR SELF WITH YOUR WELL BEING AND WORKING TO GET AFFLICTED AS CLOSE TO NORMAL AS POSSIBLE.You know haste may make waste

quote:

---

Originally posted by may:
emberson , that is a very interesting diagnosis.This doctor is good as he did not put a quick, by the books, label on her problems.I tried for years to get a true diagnosis as I knew mothers problems were not AD related but due to depression after so many losses of loved ones.At least you have an answer , that is great.Thank you for sharing.I am ging to research this as I never heard it before

---

You know what gets me? For the past couple of years I've been treating Mom as if she has a dementia -- my DPOA went into effect, etc. -- and now I'm not sure what to do. Do I give everything back to her because she's considered competent? I'm really not sure.

quote:

---

Originally posted by caolson:
To add my two cents worth....

When we began our journey to diagnosis for Roger, the neurologist first diagnosed Roger with pseudodementia. I came away from that appointment relieved, yet I knew we hadn't gotten to the bottom of the problem. Before reaching the final diagnosis of frontotemporal dementia, Roger was diagnosed with moderate sleep apnea as well as normal pressure hydrocephalus. Yes, he was fitted with a CPAP and also had surgery for a shunt to help with the NPH symptoms, but even then I knew that we hadn't gotten to the bottom of things yet. I'm not trying to contradict your doctor's diagnosis, but sometimes a patient hasn't reached the place where a doctor can say anything bigger, so they suggest pseudodementia. Just my spin....

Love, Chris

---

True. Believe me, I'm not parading around with glee (I'm too much a realist) -- there's the neurobiological tests to consider. She might have something else going on, according to the doc, and if that's the case, the pseudodementia/depression's going to only compound it, if it hasn't already.

One thing I've learned, though: Medicine isn't as cut-and-dried as we tend to believe, especially when it comes to the brain.

Good morning May,

From what I've learned along the way, hydrocephalus is the infantile form and normal pressure hydrocephalus is the adult form. Yes, you most typically think of hydrocephalus when you think of a newborn, but it can and does happen later in life as well. Often infantile hydrocephalus goes hand in hand with spina bifida, so you may have heard of it in that regard as well.

Gotta go....I need to attend a care conference for Roger today and the roads are not going to be great. UGH

Love, Chris

Caolson, thank you for adding to the information.The condition you speak of uuuuusualy begins in the fetus, right.I am not familiar with it but had heard another speak of it..Thank you.

To add my two cents worth....

When we began our journey to diagnosis for Roger, the neurologist first diagnosed Roger with pseudodementia. I came away from that appointment relieved, yet I knew we hadn't gotten to the bottom of the problem. Before reaching the final diagnosis of frontotemporal dementia, Roger was diagnosed with moderate sleep apnea as well as normal pressure hydrocephalus. Yes, he was fitted with a CPAP and also had surgery for a shunt to help with the NPH symptoms, but even then I knew that we hadn't gotten to the bottom of things yet. I'm not trying to contradict your doctor's diagnosis, but sometimes a patient hasn't reached the place where a doctor can say anything bigger, so they suggest pseudodementia. Just my spin....

Love, Chris

emberson , that is a very interesting diagnosis.This doctor is good as he did not put a quick, by the books, label on her problems.I tried for years to get a true diagnosis as I knew mothers problems were not AD related but due to depression after so many losses of loved ones.At least you have an answer , that is great.Thank you for sharing.I am ging to research this as I never heard it before