Expert: Mary Gordon - 3/17/2010

Question
Dear Mary,
    I have a question about my mom. She has had A.D. for about 10 years now .She is in stage 7 . My question is her hands are staying real hot she has no fever and her face and legs are cool to the touch.Do you know what could cause this?

    I also have a question about my husband .He is 78 years old and he is showing what i think is A.D. He talks about things that happened when he was with his first wife . but he talks like it was stuff he and i done. I have noticed he gets really moody at night and when he goes to bed its not long till he gets up and he will ask me if its morning or night. We own a store and he still works but he is starting to mess up alot on the paper end of it .Some things he does just does not make any sence at all. I know he knows better or at least he use to. He also falls asleep in the middle of talking to me about something. Should i be worried or is it just his age? A few months ago we had to sign papers at the bank and he later said he didnt sign any papers. Its things like that . Maybe you can shine a light on it for me ( I HOPE )

      Thank you very much

           Sandy

Answer
Hi Sandy, you should talk to the doctor about your mother's hands if you think they are causing any discomfort (i.e. it's only really worth bothering about if you think it's causing her pain or other problems).  There are a few things that could cause it - but I won't speculate. Ask him or her about it.

I would be alarmed about your husband if I were you, and get him to a doctor. Write out what you are seeing in terms of symptoms and give it to the doctor. Better yet, after you write it out, I would mail or fax it to the doctor before your husband goes to the appointment. Don't trust your husband to tell the doctor about his challenges. If his mind is affected, he may not really understand what is happening to him, or be able to articulate it.  He may think he's fine, even when it is obvious that he is not. You know in your gut this is not just about age. Something is going on and you need to find out what it is. What you are describing could well be early Alzheimer's or other progressive dementia - but there are also many treatable health issues that can cause memory and other cognition problems. You will never forgive yourself if you found out later he had something treatable and could have been helped if it had been caught soon enough. The doctor will do some assessments, a physicall, various tests, and likely send him to a specialist for further investigations.

If this is Alzheimer's, there are some medications that can improve his cognition and slow down the progress in many people. It is also important to know what you are facing so you can make good plans for the future. If he has AD, you need to make sure his legal and financial affairs are in order, and you have consulted an estate lawyer about planning for his future care (i.e. learning about health insurance rules where you live, including medicare and medicaid). You will need a power of attorney for him for financial as well as personal care decisions and a release from him to allow you to talk directly to the doctor about his condition.

Below my signature, I have pasted the stages of dementia as defined by Dr. Reisberg - this is called the FAST scale. My guess from what you what you are describing, he is already in late Stage 3 or early Stage 4.

I would be worried. Get him to a doctor so you can find out what is going on.  

Mary Gordon

Stages of Alzheimers

In 1982 Dr. Barry Reisberg published what was to become the best and most widely accepted description of the stages of Alzheimer's disease. Even today, years later, when experts referto a person being in stage 5 or stage 6, they are referring to Dr. Reisberg's scale of seven stages.

Adapted from Reisberg, B., Ferris, S.H., Leon, J.J. & Crook, T. The global deterioration scale for the assessment of primary degenerative dementia. American Journal of Psychiatry, 1982

Level 1

No cognitive decline - (or Normal Adult). No subjective complaints of memory deficit. No memory deficit evident on clinical interviews.

Level 2
Very mild cognitive decline (forgetfulness or normal older adult). Subjective complaints of memory deficit, most frequently in the following area:
(a) forgetting where one has placed familiar objects;
(b) forgetting names on formerly knew well.
No objective evidence of memory deficit on clinical interview. No objective deficits in employment or social situations. Appropriate concern regarding symptoms.

Level 3
Mild cognitive decline (early confusional or Early AD). Earliest clear-cut deficits. Manifestations in more than one of the following areas:
(a) patient may have gotten lost when traveling to an unfamiliar location;
(b) co-workers become aware of patient's relatively low performance;
(c) word and name finding deficit becomes evident to intimates;
(d) patient may read a passage of a book and retain relatively little material;
(e) patient may demonstrate decreased facility in remembering names upon introduction to new people;
(f) patient may have lost or misplaced an object of value;
(g) concentration deficit may be evident on clinical testing.
Objective evidence of memory deficit obtained only with an intensive interview. Denial begins to become manifest in patient. Mild to moderate anxiety accompanies symptoms.Deficits noticed in demanding employment situations.

Level 4
Moderate cognitive decline (Late Confusional or Mild AD). Clear-cut deficit on careful clinical interview. Deficit manifest in following areas:
(a) decreased knowledge of current and recent events;
(b) may exhibit some deficit in memory of one's personal history;
(c) concentration deficit elicited on serial subtractions;
(d) decreased ability to travel, handle finances, etc.

Frequently no deficit in the following areas:
(a) orientation to time and person;
(b) recognition of familiar persons and faces;
(c) ability to travel to familiar locations.
Inability to perform complex tasks. Denial is dominant defense mechanism. Flattening of affect and withdrawal from challenging situations occur.

Level 5
Moderately severe cognitive decline (Early Dementia or moderate AD). Patient can no longer survive without some assistance. Patient is unable during interview to recall a major relevant aspect of their current lives, e.g., an address or telephone number of many years, the names of close family members (such as grandchildren), the name of the high school or college from which they graduated. Frequently some disorientation to time (date, day of week, season, etc.) or to place. An educated person may have difficulty counting back from 40 by 4s or from 20 by 2s. Persons at this stage retain knowledge of many major facts regarding themselves and others. They invariably know their own names and generally know their spouse's and children's names. They require no assistance with toileting and eating, but may have some difficulty choosing the proper clothing to wear.

Level 6
Severe cognitive decline (Middle Dementia or Moderately Severe AD). May occasionally forget the name of the spouse upon whom they are entirely dependent for survival. Will be largely unaware of all recent events and experiences in their lives. Retain some knowledge of their past lives but this is very sketchy. Generally unaware of their surroundings, the year, the season, etc. May have difficulty counting from 10, both backward and sometimes forward. Will require some assistance with activities of daily living, e.g., may become incontinent, will require travel assistance but occasionally will display ability to orient in familiar locations. Diurnal rhythm frequently disturbed. Almost always recall
their own name. Frequently continue to be able to distinguish familiar from unfamiliar persons in their environment. Personality and emotional changes occur. These are quite variable and include
(a) delusional behavior, e.g., patients may accuse their spouse of being an impostor, may talk to imaginary figures in the environment, or to their own reflection in the mirror;
(b) obsessive symptoms, e.g., person may continually repeat simple cleaning activities;
(c) anxiety symptoms, agitation, and even previously nonexistent violent behavior may occur;
(d) cognitive abulla, i.e., loss of willpower because an individual cannot carry a thought long enough to determine a purposeful course of
action.

6a - Requires Assistance dressing
6b - Requires Assistance bathing properly
6c - Requires Assistance with mechanics of toileting
6d - Urinary incontinence
6e - Fecal incontinence

Level 7
Very severe cognitive decline (Late Dementia or Severe AD). All verbal abilities are lost. Frequently there is no speech at all - only grunting. Incontinent of urine, requires assistance toileting and feeding. Lose basic psychomotor skills, e.g., ability to walk, sitting and head control.
The brain appears to no longer be able to tell the body what to do. Generalized and cortical neurologic signs and symptoms are frequently
present.

7a - Speech ability limited to about a half-dozen intelligible words
7b - Intelligible vocabulary limited to a single word
7c - Ambulatory ability lost
7d - Ability to sit up lost
7e - Ability to smile lost
7f - Ability to hold up head lost