Expert: Mary Gordon - 12/31/2007

Question
Mom was recently diagnosed with mci.  My sister and I are her care givers. We have many questions.  Right now the newest and crazy thing that started only 3 days ago is that she seems to have overnight forgot to walk upright.  She bends severely at the waist.  She says there is no pain and she seems surprised when we tell her that she is bent over and stands straight back up until she forgets again.  Mom is a very healthy 80 year old. Very active but going fast (to us) down hill mentally. But this bending over thing is amazing to us. Is it possible to forget to stand upright?

Answer
Hi Pam - I'd ask for an immediate referral to a neurologist.

"MCI" is a non-diagnosis because it doesn't tell you what the underlying cause is...and after all, you already knew she was mentally foggy or the doctor wouldn't have been consulted. The term "mild cognitive impairment" gets used to refer to benign age related confusion. However, this is clearly something more - so its not benign, it appears to be comprehensive and  progressive and it's being caused by SOMETHING, some deficiency, imbalance, some disease process. It's not just the "where did I leave those reading glasses" stuff that happens to most of us as we get older.

As you probably know, the most common cause of progressive dementia in the elderly is Alzheimer's disease. The second most common cause is from mini-strokes (multi-infarct dementia). There are many, many others - from Parkinson's, Lewy Body, Pick's disease, frontal lobe dementias, thryoid disorders, untreated diabetes, vitamin deficiencies, normal pressure hydrocephalus, and more. Some are incurable, but can be slowed down in their progress. A few can be stopped or reversed.

You probably know that balance and muscular coordination are controlled by the brain, and that the ability to walk is lost as global brain damage progresses - preceded by just the kind of thing you are describing - changes to gait, leaning etc. In other words, right now you are seeing evidence that her balance and muscular coordination are actively involved, not just memory - so its not MCI.

That is why it is absolutely crucial that she be seen by a neurologist or psychiatrist with a speciality in dementia in the elderly. You need to know what this really is - you need to understand what may happen next, what the options are, and what will happen with time so you can make appropriate plans for her care going forward (including the financial planning that is key if you are in the US).

She needs some comprehensive evaluation, which usually includes a full physical, assorted blood tests, review of history (including family history), review of medications, usually a brain scan such as an MRI. It should also include a proper cognitive assessment, that will look for impairments in reasoning, perception, coordination, reaction time etc. and not just memory.

Because this is happening quickly, it is even more alarming. Something is up - and when the alarm bells go off in your gut, listen to them. Get her back to the doctor and get a referral to a specialist (or if she already has one, tell them you need to see them ASAP).

Hope this helps - feel free to ask any questions you may have about behaviors at all.  I know this is frightening, but you will feel better when you know what you are dealing with. I would be very cautious about allowing her to walk on her own, since she will be at greater risk of falls if she is leaning.

Thinking of you and your sister.

Mary G