What's causing my dad to act this way? What can I do to help him?
December 27, 2010 1:19 PM   Subscribe

For several years now, my father, in sporadic bursts, has been acting very strangely. I'm not sure what is causing him to act like that, and I'm not sure what to do about it, so I'm looking for advice.

First things first: I know none of you are my doctor (or my father's doctor), and I won't construe any of the comments below as medical advice.

My father is 71 years old and, overall, in pretty good health. For three or four years now, however, he sometimes goes into these "spells" where he'll act completely irrational.
By irrational, I mean laughing a lot at nothing, acting infantile (e.g., if he doesn't want to do something, he'll keep asking "why?" when asked, or he’ll pretend not to understand what you're saying), and making random observations with little or no provocation. He seems, in short, kind of punchy, and any conversation you hold with him will immediately make this apparent. He absolutely can’t be reasoned with at all, and both my mother and I get very frustrated talking to him. He'll also get very tired, sometimes sleeping for hours and hours, only to get up and sit on the couch staring at the TV, yawning loudly, complaining about how tired he is and fitfully napping.
Other signs he’s in this state are a redness in the face, looking terrible (puffy eyes, etc.), slurred speech, and a general lack of balance and coordination (the former of which, due to an old foot injury, isn’t great to begin with).
Now, I know what you’re thinking: he’s drinking. But he isn’t. (He had a drinking problem decades ago, and now only has a beer or a glass of wine on the odd occasion without incident) Sometimes these episodes have lasted three or four days, and I don’t see any way he could be sneaking drinks that long with such a sustained effect and with no side effects like a hangover.
Sometimes it seems like depression, such as when he slept for about 20 hours straight, despite numerous attempts on my and my mother’s part to wake him up, but in my mind (and I certainly could be wrong) such an explanation doesn’t jibe with this weird punchy behavior.
Now, it seems like this behavior most often comes on when he stays up very late and doesn’t get a lot of sleep, which is then reinforced when he stays up late after having slept most of the day. Trying to convince him, in this state, not to sleep during the day and to go to bed early so he’ll feel refreshed the next day are of no use. It’s like trying to argue with a willful child.
And here’s the odd thing: when it goes away it goes away suddenly, overnight, and the next day he feels fine and is totally back to normal. Oddly, he’s missed very little work because of this (maybe one or two days over the course of years), and these episodes tend to happen on weekends or on vacations.
As I said, he's in good health overall, and mentally he's 100% all the rest of the time. I don't think there's a history of dementia in his family, although I'm not totally sure.

So, those are the details. My mother is, understandably, concerned. She’s spoken to their mutual doctor about it, but because my father hasn’t complained of anything, she’s been told, there’s not much the doctor can do. My father, at my mother’s insistence, had a brain scan with apparently little result (sorry, I can’t recall exactly what the procedure was) and has spoken to a psychiatrist who has said, again, that since my father feels fine there’s nothing to do. My father, in fact, sees it all as my mother nagging him.

So, I suppose I’m asking two things: What could possibly be afflicting my father? And secondly, what can I (or my mother) do to help him? The paradox seems to be this: Taking him to the doctor is easy enough when he’s in a reasonable state, but it’s not particularly helpful since he’s not demonstrating any symptoms. On the other hand, it would be almost impossible to force him to go during an episode.

I should add, I live about eight hours away, although I’m home with my parents for the holidays now and a recent episode has gotten me worried enough to go on AskMe with it. I have setup a throwaway email address, whattodowithdad@gmail.com.

Thanks for your help.
posted by anonymous to Health & Fitness (19 answers total) 2 users marked this as a favorite
Does your mother have the means to videotape / digitally record one of these incidents? Because if your father is denying the significance of it, maybe it would help for him to be shown— when he's behaving normally— just how weird he is at these times. It sounds like you really need him to be onboard and concerned to get his doctors involved.
posted by mumkin at 1:25 PM on December 27, 2010 [4 favorites]

the quick answer, which may or may not be the problem is early dementia. a lot of people think it's not remembering where you live or what you were doing moments ago - but from watching many members in my family, it seems like the surliness and personality changes come first, the forgetful stuff comes later or that the forgetful had started and they hid it with the anger and erratic behavior.

your mom should ask her doctor "how do we know if this is dementia?"

keep in mind that he might also just feel like he's lived long enough to stay up all night if he feels like it. these things are hard to pinpoint. i wish you the best in finding some help and relief for your mother and father.
posted by nadawi at 1:26 PM on December 27, 2010 [1 favorite]

Additionally, your mother could show the doctor video of the episode. Target has simple low-end cameras in the $50-60 range.

Assuming your father hasn't had a full panel of bloodwork done lately, I would start there. It should include an A1C to see if his blood glucose has been erratic in the recent past.

You mom may also need to start logging his food and medications to see if there's a pattern - some combo of something that results in one of these episodes.
posted by Lyn Never at 1:30 PM on December 27, 2010 [1 favorite]

I am so not a doctor. But from the annals of weird medical things that have happened to my own father, is he on any medications? They can have side effects that you'd never imagine, and doctors might not warn you of. And older people (well, heck, all people) can be really slow to connect the dots on that. Oh, also does he ever forget to eat or drink? That can cause some weird symptoms too.
posted by DestinationUnknown at 1:31 PM on December 27, 2010 [1 favorite]

I'm sort of wondering what medications your Dad is taking since you feel confident ruling out alcohol.

It's the redness and puffy eyes that has me wondering... maybe there is some vitamin or OTC that periodically reacts adversely with his regular meds??
posted by jbenben at 1:32 PM on December 27, 2010

It is possible he has a source and is taking prescription medications other than his own recreationally, given the history of alcohol abuse and the timing of the episodes during weekends and vacations.
posted by rainbaby at 1:42 PM on December 27, 2010 [1 favorite]

He used to have a drinking problem - what you're describing sounds like a drinking problem - and drinking problems are incredibly common among the elderly. Honestly, I wouldn't write it off so fast.
posted by selfmedicating at 1:59 PM on December 27, 2010 [1 favorite]

My first thought isn't drugs or alcohol but rather a series of small/silent strokes.

I am not a doctor, merely someone who has known and worked with stroke survivors.
posted by lilnublet at 2:01 PM on December 27, 2010 [4 favorites]

There are other dementias besides Alzheimer's. I'm not suggesting that your father has this, but you might look into Frontotemporal Dementia (or FT Degeneration). One would hope that the brain scan would have shown this, but it is often mis-diagnosed and is not so common that all doctors think of it.
posted by jindc at 2:02 PM on December 27, 2010

I think selfmedicating is onto something. Especially considering "...these episodes tend to happen on weekends or on vacations..."

People with drinking problems are really good at hiding it sometimes. Is it possible he is drinking at work, and the issues you see ARE hangovers/mini-DTs?

But that's not to say that's the only answer. I think this is a possibility.

Maybe there is some transiently high or low blood pressure that spikes or drops and causes issues.
posted by gjc at 2:11 PM on December 27, 2010

Anecdotal: my late mother was sure my late father was suffering dementia or strokes, given his behaviour, but it turned out to be pretty serious alcoholism that had been hidden for years. When my mother was diagnosed with cancer, my father no longer made any attempt to hide the drinking.

Mind you, my mother was a heavy drinker, too, so part of the denial of his problem was likely denial of hers as well.
posted by Savannah at 4:38 PM on December 27, 2010

Some of the behavioral issues track with Frontotemporal Dementia, but that's usually progressive rather than transient or episodic. The physical symptoms you describe suggest to me something more along the lines of a dementia with a metabolic cause -- most commonly vascular dementia, in which a loss of balance or irregular gait are particular signs.

The history of alcoholism -- even if his drinking substantially stopped years earlier -- suggests the possibility of an alcohol-induced dementia such as Wernicke-Korsakoff Syndrome (there is less consensus about this diagnosis than with other dementias, fyi).

Good luck. My dad's strange behavior over a period of years became hellish for the family to deal with, until we latched onto FTD via a list of symptoms one day. We figured it wasn't Alzheimer's or vascular, but FTD has six major areas of symptoms, and he clearly had a significant presentation in each of these areas. The journey to pinning down his diagnosis then involved a neuropsychological examination (which he took the liberty of cancelling at first!). In any case, in my experience, the brain scan is much less useful as a diagnostic tool and more as a confirmation of an existing diagnosis.

My advice to you is twofold. Pursue a diagnosis, and do some forward planning. You will want to have assets moved to a trust, because Medicare has a look-back of five years. If you are still able to obtain private long-term care insurance, do so (the brain scan in his medical record, however, would be a concern and may make him ineligible). It will be worth its weight in gold. Protect your mother's and family's assets in advance, with his cooperation when possible. Put in place a durable power of attorney including your mother and you or a sibling, and a health care power of attorney. These will actually be more useful than a guardianship should that become necessary and are much easier to use as there is no court supervision or third-party trustee.

nadawi: there are numerous forms dementia can take. Alzheimer's can seem almost benign in the beginning, but lead to personality changes later; other types can manifest first as a personality change. The key is that each dementia looks different in the early stages, but they almost always converge toward the end.
posted by dhartung at 4:44 PM on December 27, 2010 [8 favorites]

nadawi: there are numerous forms dementia can take.

yeah - that was my point. very nice write up.
posted by nadawi at 5:04 PM on December 27, 2010

I would find a different doctor for him. By saying both of your parents have the same doctor I am assuming it is a family doctor of many years? Sometimes even doctors see odd behaviour in the elderly as just part of "getting old" and tend not to take it as seriously as they should. From your description, it could be one, two, or all of the things listed above: alcoholism, med issues, mini strokes, dementia, etc. He needs a serious exam to pinpoint what the problem may be and the doctor needs to take the family's concerns seriously because the family are the people who are with the patient all the time so they can easily see when behaviour makes a drastic change.
posted by MsKim at 6:10 PM on December 27, 2010

My grandmother started acting sporadically weird like that for about a decade before it became obvious that she was developing dementia.

Since I believe there are now some forms of treatment that can slow the process down, you should get him seen by a specialist ASAP.
posted by Jacqueline at 6:30 PM on December 27, 2010

My father has bipolar disorder, and the combination of long sleeping and laughing at nothing, acting "punchy" etc sounds like him when he is off his medication. Episodes for him (and frequently for people with bipolar in general) can be triggered by messed up sleeping patterns - e.g. jetlag, missing sleep, etc. He also tends to look physically wrecked when he is in one of these states (the red face, puffiness, etc, and not quite making normal eye contact).

Can you get your dad to see a psychiatrist? I'm not trying to diagnose him: just saying that what you report could be consistent with mental illness rather than something purely physical.

Of course Occam's Razor suggests that drinking is the more likely cause in your father's case. Don't underestimate how good alcoholics can be at sneaking drinks and staying on multi-day binges.
posted by lollusc at 6:32 PM on December 27, 2010 [1 favorite]

Silent ischemias?
posted by orthogonality at 8:34 PM on December 27, 2010

My thoughts were very likely urinary tract infections or much, much, much less likely epilepsy.

Google urinary tract infection and confusion. I"m nobody... just did some psych and brain physiology at university.

This is serious enough to get properly investigated. His prostate might need a look at.

I'd have money on it being a urinary tract infection. (The dementia-like confusion is profound.... they really seem quite off base... and then it goes...and may come back) Best of luck, possum.
posted by taff at 11:11 PM on December 27, 2010

Does he snore? Perhaps he has intermittent sleep apnea, and when he's acting weird it's because he hasn't been getting any proper sleep.
posted by Joe in Australia at 2:02 AM on December 28, 2010

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