Expert: Michalene Peticca - 9/14/2008

Question
QUESTION: I am beginning to strongly suspect my mother (81) has AD. She will not see a doctor. I need to plan for her care. After studying the 7 stages, and studying AD in general on the Internet, I would guess her to maybe be in stage 3 or 4. She constantly complains of short term memory loss, and her behavior indicates she is getting worse. She can still cook, clean, and make clothes and dress herself.She can make a list and follow it, to move or just to buy groceries. Has trouble finding car in lot.She can do routine things, but cant learn someting new like how to use a cell phone.She is aware of current events, and knows who Obama and McCain are. She recently lost her checkbook, swore it was stolen, and had me take her to the bank and close the acct. 3 weeks later, I pull up to the drive thru with her,(she never drove in her life, and always had my dad handle banking before) and she hands me the old checkbook, and the teller says that acct is closed.(we are at the drive up bank, not the bank she went in to close acct 3 weeks prior.) She went in and denied closing it, but remembered when I got her out to the car and reminded her of the events to jog her memory. Anyway, I was wondering what you think about how long she has before she needs assisted living, nursing home, etc. I'll care for her as long as I can, and she will not be eligible for medicaid for 5 years.


ANSWER: Hello David,

Thank you for writing. I am glad you asked about your mother, because many times, folks Do think their loved one's have Alzheimer's disease and are maybe too quick to "jump" to a diagnosis.

So...that said, let's talk about your mom.  MOST people develop AD PRIOR to age 75.  You would have seen these same "symptoms" in your mother when she was in her 60's if she truly has AD.  I probably defer from some physicians on this...but, having seen thousands of cases of true AD, i'm confident to say that.   

So, no, i do not think your mother has AD.  But, she certainly does have some minor memory lapses & is having difficulty with daily functioning.  Is this abnormal? Well,...let's think about life 40 years ago...when your mother was 41.  Cell phones? Microwaves? Remote TV? Satelites? Internet?  Stop and think...would you say Life & society are simplier or more complex now?  Let's imagine we are 80 years old....how much would YOU & I want to know and learn about new technology?  Personally, i have no desire to learn an I-pod or Blackberry...does that mean i have AD?

OK...so we are on the same track?  What i think is going on with your mother is most likely depression and/or anxiety.  Both of these may cause memory loses, inabilities to do daily functionings and overall emotional imbalances at times.   Quite "normal" in today's society & certainly quite "normal" for an 81 year old who has to feel like they have to "keep up" with all that is around them.

I would strongly suggest taking your mother to her physician and looking at either Effexor or Zoloft as a routine medication.  I think you will find this will help her tremendously.  

As for AL admission.  That is between you both....if you feel she would Benefit from being in a structured, social environment, then yes, AL is a viable option.   But, i would strongly suggest medication and wait a month and re-evaulate how she is doing.

Best Regards,

Michalene Peticca, MA



---------- FOLLOW-UP ----------

QUESTION: Thank you Michaline. I hope you are right! My letter to you was for a "second opinion." I like your comments much better, but am I kidding myself? My first letter (same as the one I sent to you) was sent to ask the lady expert in Canada on this same board. her answer was completely different and terrifying. She said my mother is already in stage 4, and based on her experience with her AD patient and family member, my mother is on a rapid decline that will undoutably have her totally incapacitated by 1 year from now. Scared the hell out of me. She proceeded to say if I  don't have LTC insurance (which is hard to get for an 81 year old) I will be wiped out. Her patient went from the symptoms I described now, to incontinent and unable to walk in 1 year. She said they get bad VERY fast after stage 4. I suspect her experiences are based on 1 person. My mom DID start complaining of short term memory loss to me and the hospice nurse that was taking care of my dad 6 years ago. My dad died 6 years ago from ALS, and my mom waited on him thru the end. The hospice nurse said her sudden short term memory loss was grief, and my mom WAS very lonely for him, and still is; combined with living alone for the next 6 years in the county in their old house. She said the silence and lonliness was killing her, so I have moved her next door to me this month, and am selling her house, which she gifted to me. She has gotten worse this last month, and I wonder if the moving confuses her. The bank incident I told you of was the worst memory lapse I have seen, and that happened 2 weeks ago, during the move. I must also tell you that she will not see a doctor, and meds are out of the question. She is sensitive to food allergies and chemical allergies, and the doctor that brought her back to health 40 years ago when she was dying of being allergic to her foods and the chemical in non organic food, and not knowing it, has her convinced for life that all meds like the ones you described are bad for her. (BTW- switching to organic food and spring water instead of tap water completely cured me of spastic colon immediately; I belive in it too) I also must mention that since she gifted the house to me, our atty says we are not eligible for medicaid for 5 years look back period. If disaster strikes in that 5 year time frame where I can no longer handle her, my only other options are self pay. I will care for her as long as I am capable. I see her daily now, and she never drove anyway, so I do all that. Another noteworthy comment is that she was a 1950's style housewife to begin with, and never even HAD a checkbook or paid bills till my dad died, and she had to learn ALL that 6  years ago! She was slow to learn then, but she learned. If I can master this "copy and paste" I will attempt to send you the letter I got from the other person that has had me up all night worrying. I trust you have seen a lot more AD patients than her.

Answer
Hello David,

My goodness!  Well, i can't say for 100% certainty that it isn't AD, but i am willing to bet 23 years of Long term care experience and thousands of folks that i've looked after, that it is something OTHER THAN Alzheimer's disease.  

Without your mom going to the doctor and getting medication, i think you do need to watch her diet and will she take vitamins??  

Funny, i too am very allergic to foods and go "organic" from meats to veggies...i have been very healthy because of it..but, i do watch balancing my diet.   Perhaps your mother is not drinking enough water as well.  Dehydration, low iron, etc. can all "exacerbate" memory loss and delirium type symptoms.   

Type in "Delrium" for the WebMD website and see what you think in regards to your mother.

Yes, that is true about the Medicaid look back. But, also, in 5 years who knows where Medicaid will be??   New President, new system?  It's really challenging in the Long term care "world" with funding..so i expect to see some big changes anyway.

Now, get some rest..focus on one day at a time....your mom is going to need you to really watch and care for her.

Best Regards,

Michalene Peticca, MA