Did my uncle have a stroke?

August 1, 2007 2:25 PM

Did my uncle have a stroke?

I know you're not my doctor, or his. I know you want me to immediately abduct him and take him to an ER and/or you want me to know that I'm not the boss of him. I get it.

My uncle by a long-dissolved marriage is 60s, single, divorced for many years, no children, retired a few years ago. He's also an incredibly bright guy. Very verbal, very sharp, very sociable, very funny. An absolute joy to talk to.

Over the past five or six years, he's changed. At first he just became kind of dour and depressed. I attributed this to a man going through downshifting out of working life, and, being a bachelor with not much of a homelife, finding himself kind of socially isolated.

We don't live near each other, and don't talk as often as we should, so when I saw him recently, it came as a serious shock to me to see that he'd acquired a number of verbal tics I, as an ignorant layperson, associate with someone who'd had some kind of stroke: stuttering, repeating himself, constant fumbling for words and coming up with the wrong ones, dropping words from phrases entirely, going off on these long, vague tangents that didn't really go anywhere, making consistent mistakes in how he forms sentences.

That may not sound so shocking, but he is/was a brilliant, hyperverbal guy. His use of language has really been compromised. It's this way in writing, too, which is, given the fact that he was a journalist, really horrifying.

I know you can't diagnose a third party for me over the internet, but does that sound like he could possibly have had a stroke? It seems so to me, but again, ignorant layperson. I'd just like to have somewhere (even if it's wrong) to start bringing this up, and, hopefully, get him to a doctor.

But wait, there's more! I get the impression from awkward family gossip that he self-medicates with various anti-depressants (I know, I know), and I know that back in the hippie days he was quite the pot/acid/peyote-head, but as far as I know he doesn't currently use these drugs. Others in his family apparently attribute his language issues to his self-medicating.

As an added fun item, his father had some kind of dementia late in his life. However, I knew his dad semi well, and was around him when he started to show symptoms, and my uncle's stuff just doesn't seem the same.

I'm sort of at a loss here. He doesn't have a wife or kids to force him to see a doctor, and for all I know I'm being ridiculous. But my gut tells me something is wrong. Maybe it really is "just" the self-medicating, but even that seems less than ideal.

I guess I would like him to see a doctor about his language issues (even if it's just so the doctor can say "You don't have language issues, they're being ridiculous") but I don't even know how to bring this up with him. He's also semi-estranged from his one living sibling, so my family is kind of it for him. And we love him to death, but none of us are near him, in the Seattle area.

Thanks.

posted by anonymous to health & fitness (12 comments total)

Does one side of his body or face seem different than the other at all?
posted by miss lynnster at 2:33 PM on August 1, 2007

It's possible.

His symptoms sound a bit like vascular dementia - something that my father suffers from. Basically a series of small, but not debilitating, strokes. As a result my Dad, once a brilliant engineer who spoke three languages, can barely hold a conversation and has lost much of his coordination.

My mother has gone to great lengths to prevent his condition from worsening, and it's a full time commitment. What sucks is that there isn't much that can be done - there's no healing the damage.

The upshot, of course, is that your uncle should probably see a doctor whether he's suffering from dementia, the effects of a serious stroke, or whatever. The difficultly lies in the fact that he's not wholly incapacitated. He, like my father, will almost certainly protest.

So you have to make him go. It's not easy or possible to take matters into your own hands with an adult. But if you truly believe he needs medical attention you should definitely try.
posted by aladfar at 2:40 PM on August 1, 2007

Well, I think your concerns are definitely valid, and it sounds like you very much care for your uncle. I don't know that I would say that it sounds like a stroke or not (I am no expert), but there are certainly many issues that may cause a person, especially an older person, to start having language difficulties or to seem off their game.

As a family member who cares about him, I think really the best you can do is to have a frank talk with him. Say something like "I really do care about you, and I've noticed that you don't seem yourself recently in the way you talk and write. Have you seen anyone about this? Can I help you find someone to go get checked out by?"

If he doesn't want your help, then I don't know if there's much you can do. But by showing that you care and are willing to help, you are doing the right thing and providing your uncle with a resource he may not have known he could take advantage of. Even if you don't live near him, you can do the legwork by making calls and researching on the internet specialists in his area that he could see, or finding some sort of service (a social worker, maybe?) who can put him in touch with the right resources.
posted by tastybrains at 2:41 PM on August 1, 2007

It's possible to have a minor stroke and not be aware of it. For example, I've had two, but was only aware of the one. My rheumatologist suspected the other (based on subtle personality changes, which my husband had attributed to hormonal problems). My dad had a small stroke once, which we didn't discover until a year later when he had an MRI to check for something else. At the time, his only symptoms were temporary memory loss - he came in from outside and asked whose red car was out front (it was my brother's, and Dad had gone with him to buy it). Ten minutes later he was fine.

As far as dementia/Alzheimer's goes, I'm no expert, but I do have several friends and family members suffering from it. Your uncle's symptoms don't sound like anything they've exhibited. I would definitely take him to a doctor, using whatever pretense you find necessary. Perhaps you can talk to your own doctor ahead of time, tell him your concerns, and then take unk to him. Doctor can at least evaluate the meds your uncle is taking and see if they're too much or contra-indicating with one another.

Best of luck!
posted by Oriole Adams at 2:42 PM on August 1, 2007

Eeesh. Anytime there's significant speech/language changes in an elderly person, it's cause for concern. Even if the root is in his self-medication, he could be doing permanent neurological damage.

If he were my uncle, I'd make him go. I'd take him there. I'd sit with him if he wanted me to. I know you can't force and adult to do anything, but you can try your hardest to persuade him.
posted by christinetheslp at 3:00 PM on August 1, 2007

Without knowing more about the health of your uncle, even an educated guess is difficult to make. He needs a proper diagnosis from a qualified doctor.

That said, have you noticed any other signs of impairment apart from the dysphasia? Is he apraxic as well (an indication of a possible CVA or a lesion on the left hemisphere of the cerebral cortex)? Does he have trouble understanding you when you speak or display obvious recent debilitation of memory? Does he have a history of poor cardiac health?

Vascular dementia does seem to be a good candidate. However, it should be clear that any type of stroke, even a transient ischemic attack (due to the likelihood that it foreshadows future CVAs) or multi-infarct dementia lesions, presents a real medical emergency requiring rapid diagnosis and treatment. Time is brain tissue and the best thing you can do for your Uncle is take him to a specialist who can give him a CT scan and an MRI and figure out precisely what's going on.
posted by inoculatedcities at 3:04 PM on August 1, 2007

No way to tell from here, anonymous. Stroke, dementia, pseudodementia of depression, and medication side effects are all in the list of possibilities.

Certainly a doctor is the person to sort this out, not you or me or the anonymous internet.
posted by ikkyu2 at 3:31 PM on August 1, 2007

Since you might have trouble persuading him to actually see a specialist if he is referred to one, start with a neurologist.
posted by yohko at 3:57 PM on August 1, 2007

Yes, it is possible. Behavior and/or personality changes are often a symptom.

A woman's adult children took her to a new doctor because they were concerned about the possibility that she had had a stroke. They told him that she had had significant personality changes. After speaking with her, the doctor went back to the children and reported that they should not have any concerns. Their mother, he advised them, was outgoing, friendly and delightful.

"That's what bothers us," they replied. "For the last twenty years, she's been grumpy and miserable."
posted by megatherium at 4:24 PM on August 1, 2007

Stroke is absolutely an option. So is Dementia, and Parkinson's. And lots of other neurological issues.

The important thing here is that he's undergone a significant change in personality, that appears to be getting worse. No matter how difficult it might be, you need to get his ducks in a row now, because it's not going to get easier later on.

That means dealing with a will, and power of attorney, and health insurance, and most importantly getting him diagnosed properly and cared for as quickly as possible.

Good luck.
posted by davejay at 5:43 PM on August 1, 2007

It might be early signs of alzheimer's or parkinson's. The American Stroke Association has info that might be helpful too. Alcoholism is also surprisingly prevalent among the elderly.

Whatever it is - you're right, it's not normal. It's worth seeing a doctor about. There are treatments available to slow the progression of parkinson's and alzheimer's, and the sooner he starts, the better. If it was a stroke, then he's at risk for further strokes, and preventing them may be as simple as taking 1 baby aspirin a day.

I'm also curious about the antidepressants he self-medicates with. Are the prescription? What are they and where is he getting them? (And what's wrong with self-medicating, anyway?? Huh? Huh??)
posted by selfmedicating at 7:23 PM on August 1, 2007

I would start by calling him much more regularly. Be interested in how his life is going. At some point, it will be appropriate to comment on the tics and other changes, ask if anyone else has commented on this. You need him to admit that there is a problem. Then you can start the discussion about seeing a doctor.

At the same time, talk to him about his life and see what other resources, especially people, that he has. At some point you will need to think about how much you want to get involved in this man's life, if there is no one else to step up to the job. Are you willing to make phone calls. Fly into to help with doctor's visits or other things?
posted by metahawk at 9:52 PM on August 1, 2007