Dementia, OCD and ‘normal’ aging behaviour - I need a reality check
January 7, 2023 1:03 PM Subscribe
I spent some time with an older relative over Christmas and came away concerned about their mental health. They do not come from a family or a community with any culture of talking about feelings or mental health beyond a joke (e.g. “I’m a bit OCD”), no one in their social circle has ever had therapy or been diagnosed (openly, at least) with a mental health disorder so this is extremely unfamiliar territory for them and I want to be careful how I approach it & sure of what I’m saying.
They presented what seemed to me obviously compulsive issues, but these are also on a clear spectrum with behaviour they’ve had and everyone has put up with, or laughed off, for their whole lives.
As examples – these aren’t the real thing, for anonymity, but are close enough.
X starts telling me the plot of a movie. I say “Oh, I saw that”. They continue to outline the plot. I say explicitly “I saw this TV show, you don’t need to tell me the plot” and they act embarrassed, pause, and then continue outlining the plot just as before. Sometimes they’ll acknowledge that I’ve asked them to stop, but find an excuse “yes, I know you saw it but the point is” and then continue just as before.
Or: we need to leave the house for a reason (something non-stressful they want to do) and they notice a cup hasn’t been washed up and go to clean it. In the past if we explicitly asked them “oh leave it, we’re in a rush” they would do so. Now they refuse, they have to do the thing, no amount of requests will stop them. They’ll acknowledge that we’re asking, and that they’re making us late, but find reasons why they have to do this urgently.
I just need a temperature check: this isn’t actually normal is it? Because the rest of the family are writing it off as “oh that’s just so and so, they were always a bit OCD” or "this is just how people are when they're older, be more patient" but I am genuinely concerned this might be a red flag for some form of dementia (this person is early 70s) that has pushed their instinctively obsessive behaviour into something they can no longer moderate or control.
They presented what seemed to me obviously compulsive issues, but these are also on a clear spectrum with behaviour they’ve had and everyone has put up with, or laughed off, for their whole lives.
As examples – these aren’t the real thing, for anonymity, but are close enough.
X starts telling me the plot of a movie. I say “Oh, I saw that”. They continue to outline the plot. I say explicitly “I saw this TV show, you don’t need to tell me the plot” and they act embarrassed, pause, and then continue outlining the plot just as before. Sometimes they’ll acknowledge that I’ve asked them to stop, but find an excuse “yes, I know you saw it but the point is” and then continue just as before.
Or: we need to leave the house for a reason (something non-stressful they want to do) and they notice a cup hasn’t been washed up and go to clean it. In the past if we explicitly asked them “oh leave it, we’re in a rush” they would do so. Now they refuse, they have to do the thing, no amount of requests will stop them. They’ll acknowledge that we’re asking, and that they’re making us late, but find reasons why they have to do this urgently.
I just need a temperature check: this isn’t actually normal is it? Because the rest of the family are writing it off as “oh that’s just so and so, they were always a bit OCD” or "this is just how people are when they're older, be more patient" but I am genuinely concerned this might be a red flag for some form of dementia (this person is early 70s) that has pushed their instinctively obsessive behaviour into something they can no longer moderate or control.
In my experience with old people who had mental issues all their lives (in those cases, childhood trauma), past 70 or so they tended to intensify in presentation and add extra anxiety where it wasn't present before. It makes sense that they no longer have the energy to mask, as well as less practice in masking after retirement so it's no longer automatic. (In several cases escitalopram from a GP helped lots.)
posted by I claim sanctuary at 1:26 PM on January 7, 2023 [4 favorites]
posted by I claim sanctuary at 1:26 PM on January 7, 2023 [4 favorites]
I know your examples are not the real thing, but if they really are close enough, they are so minor as to be of no concern whatsoever. The threshold to be concerned about a person's mental health is if the issues are causing distress or danger to the person themself (whether they cause annoyance to you is kind of irrelevant).
I encourage you to read the diagnostic criteria for OCD. For a persistent or recurrent thought or impulse to be obsessive, it must cause marked anxiety or distress, and the repetitive action is undertaken as an attempt by the person to neutralize the distressing thought. There is no indication in anything that you've written that this is the case for your relative.
posted by heatherlogan at 1:49 PM on January 7, 2023 [10 favorites]
I encourage you to read the diagnostic criteria for OCD. For a persistent or recurrent thought or impulse to be obsessive, it must cause marked anxiety or distress, and the repetitive action is undertaken as an attempt by the person to neutralize the distressing thought. There is no indication in anything that you've written that this is the case for your relative.
posted by heatherlogan at 1:49 PM on January 7, 2023 [10 favorites]
Response by poster: I don't mean to thread sit, but thinking about it: I am *not* primarily concerned about the "ocd like" behaviour per se, I'm concerned by the fact that it has rapidly (e.g. in less than 6 months, without any obvious external stress factor) become sigificantly more marked to the point of impacting on this person's ability to live a normal life (e.g. get to doctors appointments) or hold normal conversations. I'm worried it's indicative of some other underlying issue. Sorry if that wasn't clear.
posted by AFII at 1:58 PM on January 7, 2023 [2 favorites]
posted by AFII at 1:58 PM on January 7, 2023 [2 favorites]
Sounds fairly normal to me to be honest. Particularly the cup thing — I have noticed that tasks/problems become more “urgent” to the aged, and I think there are lots of reasons for that but it’s partly linked with reduced physical capability (I have to do this now, while I’m here, rather than later because coming back to do it takes more effort).
A certain bloody-minded determination in conversation also chimes with my experience of some people aging (often paired with less interest in what other people have to say). Difficulty following the conversation maybe? (Eg. due to deteriorating hearing).
I reckon both of these are often worse in people widowed, as the loss of the sounding board / sense check / engagement of the other partner leads to the person getting a bit cyclical in their thinking, and feeling more vulnerable (so wanting to control what they can).
This all based on my own experience with relatives and friends, not any kind of professional knowledge.
posted by breakfast burrito at 1:59 PM on January 7, 2023 [3 favorites]
A certain bloody-minded determination in conversation also chimes with my experience of some people aging (often paired with less interest in what other people have to say). Difficulty following the conversation maybe? (Eg. due to deteriorating hearing).
I reckon both of these are often worse in people widowed, as the loss of the sounding board / sense check / engagement of the other partner leads to the person getting a bit cyclical in their thinking, and feeling more vulnerable (so wanting to control what they can).
This all based on my own experience with relatives and friends, not any kind of professional knowledge.
posted by breakfast burrito at 1:59 PM on January 7, 2023 [3 favorites]
I know someone who was like this for awhile, and the family humored it in a similar way. Later their behavior intensified (e.g. washing up all the dishes from cooking Thanksgiving before serving the actual meal, which was then fully cold by that point, while strongly resisting others' efforts to serve the meal before the dishes were done). They did end up exhibiting more significant memory and task impairment as time went on.
posted by xo at 2:46 PM on January 7, 2023 [5 favorites]
posted by xo at 2:46 PM on January 7, 2023 [5 favorites]
Experiencing loved ones age is so hard!! Their behavior sounds totally fine to me: they’re self-aware that they’ve always been a bit different, people closer to them acknowledge it too, so really you’re the only one concerned here. It’s nice that you care but the best thing to do would be to butt out. As someone who does have an OCD diagnosis myself, I can tell you that OCD manifests itself in different ways but this is hardly of concern. And even as someone who is open and chill about my diagnosis, I’d be hella annoyed if someone I rarely saw felt the need to make unprofessional judgments based on a short visit over the holidays. Furthermore, we cannot force anyone to seek medical support, unless maybe it’s a life or death situation where the law gets involved. The good news is that this person has caring people close by and they’ll likely intervene if things get tricky. Otherwise occasional hellos are nice for everyone and usually extra nice for people who are older and don’t go out as much as before. I hope our responses provide some relief!
posted by smorgasbord at 2:49 PM on January 7, 2023
posted by smorgasbord at 2:49 PM on January 7, 2023
I never leave dirty dishes or used cups sitting around, nope, these are washed, usually when I am through with them. It is my routine in my home, I don't change my routines like this for visitors. But, if she is nervous, and older and poor, maybe she isn't getting enough high quality food to eat and vitamin deficiencies are influencing her presentation.
Part of the deal with visiting elderly relatives is listening, and letting them lead the conversation. They are in their home and they are your elder, and they are not on your schedule. If you don't enjoy this person, then don't visit. There are good handouts with regard to caring for and about the elderly, and how to allow them some limelight, and grace. Anxiously worrying about someone you rarely see, does not serve them. But people get rusty in the social skills department, the covid isolation has been particularly hard on the isolated elderly, and they need to converse and visit, a whole lot more than they have been. If you are up for spending more time, one of the suggestions is to schedule a weekly visit, something they can look forward to, be on time, do an activity they want to do, be led by their needs.
For years I went to breakfast once a week with my dad who had gone blind, and then his added his sister,who had been widowed. I count this as some of the most well spent time in my life. We always went to the same place, his best friend owned it, very old school cafe, it was always interesting. My dad schooled me on what the blind need, when eating out, and getting around in public. It was good for all involved.
posted by Oyéah at 2:51 PM on January 7, 2023 [11 favorites]
Part of the deal with visiting elderly relatives is listening, and letting them lead the conversation. They are in their home and they are your elder, and they are not on your schedule. If you don't enjoy this person, then don't visit. There are good handouts with regard to caring for and about the elderly, and how to allow them some limelight, and grace. Anxiously worrying about someone you rarely see, does not serve them. But people get rusty in the social skills department, the covid isolation has been particularly hard on the isolated elderly, and they need to converse and visit, a whole lot more than they have been. If you are up for spending more time, one of the suggestions is to schedule a weekly visit, something they can look forward to, be on time, do an activity they want to do, be led by their needs.
For years I went to breakfast once a week with my dad who had gone blind, and then his added his sister,who had been widowed. I count this as some of the most well spent time in my life. We always went to the same place, his best friend owned it, very old school cafe, it was always interesting. My dad schooled me on what the blind need, when eating out, and getting around in public. It was good for all involved.
posted by Oyéah at 2:51 PM on January 7, 2023 [11 favorites]
Best answer: That sounds like perseveration. The Wikipedia entry for it mentions associated conditions.
https://en.wikipedia.org/wiki/Perseveration
posted by cotton dress sock at 3:10 PM on January 7, 2023 [5 favorites]
https://en.wikipedia.org/wiki/Perseveration
posted by cotton dress sock at 3:10 PM on January 7, 2023 [5 favorites]
I will go against the grain, as a person with OCD, and say this does sound like it is now impacting their life more than it did before, and is somewhat concerning.
posted by tiny frying pan at 4:31 PM on January 7, 2023 [3 favorites]
posted by tiny frying pan at 4:31 PM on January 7, 2023 [3 favorites]
(But what is THEIR anxiety level about it? If the person isn't very distressed, I would worry less about it)
posted by tiny frying pan at 4:36 PM on January 7, 2023
posted by tiny frying pan at 4:36 PM on January 7, 2023
Best answer: A relative of mine died of one of the rarer variants of FTD. I am not a doctor or even an expert but I did do a lot of reading and just off the top of my head what you are describing does not sound like the typical behavioral changes associated with FTD. I'd expect something more like personality changes, flat out confusion/lack of ability to do tasks that were easy before or obvious language, speech or memory deficits, not an intensification of some kind of anxiety/OCD behavior.
My relative's onset symptoms were depression-like affect, handwriting changes and inability to do routine work tasks that had previously been easy, for instance. Really odd stuff, not just worsened forms of previous struggles.
It's possible that your relative had covid or some other illness that fatigued them and that this caused them to lose ground on masking/daily behavior. It's possible that they have a low grade infection of some kind. Talking to a doctor seems like a good idea, but if this were my relative I would be less worried about dementia than about just a general lessened quality of life that could be treated.
posted by Frowner at 5:00 PM on January 7, 2023 [1 favorite]
My relative's onset symptoms were depression-like affect, handwriting changes and inability to do routine work tasks that had previously been easy, for instance. Really odd stuff, not just worsened forms of previous struggles.
It's possible that your relative had covid or some other illness that fatigued them and that this caused them to lose ground on masking/daily behavior. It's possible that they have a low grade infection of some kind. Talking to a doctor seems like a good idea, but if this were my relative I would be less worried about dementia than about just a general lessened quality of life that could be treated.
posted by Frowner at 5:00 PM on January 7, 2023 [1 favorite]
Without a doctor, you cannot know.
Everyone declines cognitively as they age. Issues they previously had may indeed get worse. Stubbornness increases (and amount of fucks to give decreases, so that politely going along with other people may just lose its compelling forces).
But illness or disease can also do that, making it look exactly the same because the underlying factors are simply reducing resources for clearer cognition. Tumors, brain damage from injury or vascular event, infection anywhere in the body (but symptomless UTIs are a common cause that don't raise any other alarm but the cognitive symptoms; slowly worsening sepsis can also do this and only blood tests might turn it up until things suddenly get obvious and urgent), vitamin deficiencies, circulation problems, carbon monoxide, chronically low blood-oxygen post-COVID or because of COPD or environmental/workplace lung damage etc etc. You should get them to a doctor.
None of this requires all this big tiptoeing around "mental health". These are all neurological issues, including compulsive and perseverative behaviors (we don't know the cause in any greatly useful way, but it's not just trauma or bad parenting or whatever, it appears to affect the parts of the brain that are supposed to handle those things in more efficient ways, including impulse control). Dementia is not mental health, it's slow organ failure. You can't talk-therapy away the neurological disorders of old age any more than you can heart disease.
It can't all be fixed, though, is something you should brace yourself for. Neurologists in particular can be unpleasantly frank about this, in a "yeah, getting old sucks *shrug*" kind of way, or "I can't fix mean/eccentric/uncooperative" but...getting old does indeed suck. But any time a change strikes you as abrupt, that's absolutely a good reason to get followup and most doctors do sit up straighter when you say so. Because some things CAN be fixed, and they're likely to come on faster than normal decline.
posted by Lyn Never at 5:16 PM on January 7, 2023
Everyone declines cognitively as they age. Issues they previously had may indeed get worse. Stubbornness increases (and amount of fucks to give decreases, so that politely going along with other people may just lose its compelling forces).
But illness or disease can also do that, making it look exactly the same because the underlying factors are simply reducing resources for clearer cognition. Tumors, brain damage from injury or vascular event, infection anywhere in the body (but symptomless UTIs are a common cause that don't raise any other alarm but the cognitive symptoms; slowly worsening sepsis can also do this and only blood tests might turn it up until things suddenly get obvious and urgent), vitamin deficiencies, circulation problems, carbon monoxide, chronically low blood-oxygen post-COVID or because of COPD or environmental/workplace lung damage etc etc. You should get them to a doctor.
None of this requires all this big tiptoeing around "mental health". These are all neurological issues, including compulsive and perseverative behaviors (we don't know the cause in any greatly useful way, but it's not just trauma or bad parenting or whatever, it appears to affect the parts of the brain that are supposed to handle those things in more efficient ways, including impulse control). Dementia is not mental health, it's slow organ failure. You can't talk-therapy away the neurological disorders of old age any more than you can heart disease.
It can't all be fixed, though, is something you should brace yourself for. Neurologists in particular can be unpleasantly frank about this, in a "yeah, getting old sucks *shrug*" kind of way, or "I can't fix mean/eccentric/uncooperative" but...getting old does indeed suck. But any time a change strikes you as abrupt, that's absolutely a good reason to get followup and most doctors do sit up straighter when you say so. Because some things CAN be fixed, and they're likely to come on faster than normal decline.
posted by Lyn Never at 5:16 PM on January 7, 2023
Those don’t sound medically concerning to me, especially if they’ve always kind of been like that. People tend to lose their filters as they get older. Perhaps they weren’t good examples, since your followup about suddenly missing doctors’ appointments sounds potentially more concerning than either of those examples.
I just don’t think it’s that unusual for an older person to want to talk more than usual about the plot of a movie you’ve already seen or feel compelled to wash a dish before leaving the house.
posted by wondermouse at 6:42 PM on January 7, 2023
I just don’t think it’s that unusual for an older person to want to talk more than usual about the plot of a movie you’ve already seen or feel compelled to wash a dish before leaving the house.
posted by wondermouse at 6:42 PM on January 7, 2023
Because of the rapid change and that it's making their life more difficult, I would be concerned and and encourage them to talk to their doctor about it.
posted by The corpse in the library at 8:24 PM on January 7, 2023
posted by The corpse in the library at 8:24 PM on January 7, 2023
Response by poster: Massive thanks here to Cotton Dress Sock - I've read a bunch of stuff about Perseverence now and it's absolutely spot on, and much closer than the very loose and lazy way I've used OCD - and it flags up what's different about their behaviour now compared to before; they're exhibiting so many behaviours in the diagnosis that they never had before (e.g. obsession over ideas, repeating words and so on) which I didn't mention in the post.
Their life partner has brought up the behaviour changes a couple of time, expressing frustration about it, so I think I'll talk to them and see if X can be encouraged to go to their GP just to check that nothing's wrong. They have experienced both covid and a head injury recently so there are potential things that shoudl be considered given the answers here.
posted by AFII at 1:42 AM on January 8, 2023 [3 favorites]
Their life partner has brought up the behaviour changes a couple of time, expressing frustration about it, so I think I'll talk to them and see if X can be encouraged to go to their GP just to check that nothing's wrong. They have experienced both covid and a head injury recently so there are potential things that shoudl be considered given the answers here.
posted by AFII at 1:42 AM on January 8, 2023 [3 favorites]
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