Is it dementia?
July 6, 2015 6:13 PM   Subscribe

My dad has been acting emotionally erratic and saying and doing inappropriate things in the last year. We lost my mom to ALS about 1.5 years ago, and he is understandably depressed. He's repeating stories or anecdotes two or three times in the same conversation. He's using very inappropriate language and subjects around my two young daughters. He also has been doing things like speaking loudly during quiet graduation and funeral services and having disproportionate emotional outbursts. Is this depression, or could it be dementia or Alzheimer's?

He's been on a quest to find a girlfriend, which he's doing by using He had a girlfriend for about 6 months, but it ended when she told him she thought he wanted a wife replacement. But now he's feeling rejected by the five or six dates he has had since, and calling the women awful things. He is self-pitying, but also can't seem to look outside himself at all.
posted by percor to Human Relations (21 answers total) 3 users marked this as a favorite
Response by poster: Forgot to mention that he's 70, in relatively good health otherwise, but keeps losing things like his TV remote, camera, and other things and says he thinks they've been stolen.
posted by percor at 6:15 PM on July 6, 2015

The behaviors you describe are not typical of depression, no. They are pretty textbook examples of cognitive decline.

If at all possible, get him in to his GP for a neurologist referral.
posted by Lyn Never at 6:16 PM on July 6, 2015 [27 favorites]

What you are describing sounds like Frontotemporal Dementia which my father suffered from. Quick onset, memory issues, and loss of self-control (e.g. inappropriate language) are all symptoms, as is the onset in the 70s. FTD is a cousin of Alzheimer's but is its own specific type of dementia. I would recommend having a neurologist check your father out to see if they can determine how afflicted he might be.

Best of luck to you. It's hard to watch and care for a parent as they go through this.
posted by jazon at 6:36 PM on July 6, 2015 [4 favorites]

Thirding that it sounds like dementia. My grandfather exhibited many of the same symptoms during his decline.
posted by bluloo at 6:39 PM on July 6, 2015 [1 favorite]

Sadly, I concur with the others. It sounds quite a bit like some form of dementia. This bit...
...but keeps losing things like his TV remote, camera, and other things and says he thinks they've been stolen. classic dementia. My mother started misplacing things and kept blaming "those kids" who stole them.

If you haven't already, I highly suggest you get your father's legal papers in-order now. This includes a POA. Dementia can accelerate frighteningly fast, and you really don't want to be in a position where your dad can no longer make decisions for himself, but there is no clear person designated to act in his stead.
posted by Thorzdad at 6:53 PM on July 6, 2015 [18 favorites]

I'm sorry, but I agree with everyone else. It sounds like some kind of dementia. As I understand it, the loss of routine that your mother's death created might have accelerated things -- she provided routine, stability, and a connection to the past. She grounded him.

I also strongly agree with @Thorzdad about your father's legal affairs. My father-in-law did not do this, and after he developed dementia, it was impossible to convince him to sign anything. He either thought his children were stealing from him, or he thought it wasn't necessary to provide them with directions (like in a medical directive) because they were smart and would figure things out. This has made certain things, like handling his remains, incredibly hard since his death.
posted by OrangeDisk at 7:06 PM on July 6, 2015 [2 favorites]

It does sound like dementia, but also get him tested for a urinary tract infection. Every time my mother would start acting like she had dementia it turned out she had a raging UTI.
posted by pushing paper and bottoming chairs at 7:22 PM on July 6, 2015 [20 favorites]

I work in geriatric psychiatry right now, and dementia is, unfortunately, my bread and butter. I would suggest either a neurologist who has geriatric experience or a psychologist who has experience testing (a neuropsychiatrist is the gold standard, but finding them is tricky.) Screens at memory centers will only pick up certain 'probably a form of dementia' in most cases, but occasionally you will find someone who is really good at distinguishing the types. A GP he trusts can run some of the tests to rule out, for example, a really abnormal thyroid or b12/folate deficiency.

There is not enough information here to make a clear distinction. nor would I suggest diagnosing via internet, In many people, depression, even bipolar I (manic-depression) can emerge (or become visible) later in life as well. Infection can also be superimposed on or mimic depression or mild dementia to even medical professionals who don't see the geriatric population often. There are dozens of potentially contributing factors, which is why a good history is important to assess if any treatment may be beneficial.

I second/third getting the financial/legal aspects of things in order ASAP. Make copies of any labs or workups he gets; communication between professionals in these fields can be spotty (in part because paper charts are still the default, at least around here.)

Finally, I am very sorry for the difficult situation, the difficult time. Please make sure you take care of yourself as well.
posted by cobaltnine at 7:37 PM on July 6, 2015 [13 favorites]

Seconding the UTI. I know it sounds strange, but it does cause confusion in the elderly, and it's quite common.
posted by islandeady at 3:06 AM on July 7, 2015 [1 favorite]

Just a reminder, double check all the medications he's taking (plus anything else--alcohol?). The elderly often end up with multiple doctors who don't communicate, and some medications or combinations of medications can make this stuff much worse.
posted by anaelith at 5:01 AM on July 7, 2015 [4 favorites]

Seconding to check his meds and get him to a neurologist. We're dealing with Alzheimer's right now and much of this sounds pretty textbook.

If you find you are dealing with some kind of dementia, I highly recommend reading The 36 Hour Day as soon as you possibly can.
posted by Sophie1 at 7:05 AM on July 7, 2015 [2 favorites]

I would also check if there's any B12 deficiency going on. We see that a lot in our 60 and older patients, and sometimes it can cause dementia like symptoms. Either way, get thee to a doctor, and take care of yourself as well.
posted by buttonedup at 8:19 AM on July 7, 2015 [3 favorites]

Sounds like my grandmother when her dementia started.
posted by Jacqueline at 8:35 AM on July 7, 2015 [1 favorite]

Here's another reason to be concerned/aware: The Biggest Threat To Your Retirement Portfolio: Mild Dementia

"People are able to make these disastrous investing decisions in the earliest stages of dementia because their loved ones, who assume dementia announces itself with forgetfulness, don't realize there are quite a few syndromes that develop into dementia whose first symptoms are not forgetfulness, but are instead loss of judgment, impulse control, and emotional balance."
posted by Short Attention Sp at 8:46 AM on July 7, 2015 [2 favorites]

Obviously, nobody should even attempt to diagnose this on the internet, but if you're looking for arguments to convince your dad to get to a doctor, there are a lot of conditions that might be causing this sort of thing. In addition to the ones already mentioned, there was some episode of Law & Order:SVU where Jerry Lewis played a guy who had some big depressive disorder that looked like dementia, and I have vague memories of there being some menopause like hormonal condition that old men sometimes get that makes them mean and forgetful. (I'm not even going to research these things, because I am an anonymous loser on the internet and my medical hypotheses are worthless.)

And even if it is some type of dementia, there are treatments available that can slow its progress, so that's not just a throw up your hands and wait for it to happen sort of thing, either.

The point being that a good, competent doctor should be able to do something to help him, regardless of the cause of his behavior changes.

And, you know, regardless of what if anything he's diagnosed with, it is probably a good idea to use this as a wake up call to have a plan in place legally if he doesn't have something already. You do not want to be in a position of trying to get power of attorney or anything over someone who has already lost the ability to plan and consent.
posted by ernielundquist at 9:31 AM on July 7, 2015 [1 favorite]

Talk to a lawyer or an accountant. You may want to consider ways in which your father voluntarily provides you with power of attorney over his finances. You can't really leave it until a formal diagnosis of dementia is made. The government may step in at that point.
posted by Nevin at 9:38 AM on July 7, 2015 [1 favorite]

I have a family member who gets like this when he is having cardiac issues and his brain isn't getting enough oxygen. Nthing getting him to a doctor.
posted by corey flood at 9:56 AM on July 7, 2015 [1 favorite]

Response by poster: Thanks so much for your responses. I'm going to try to talk with him about it, although he has been very defensive about anything he perceives as criticism and often blows up at me. Any suggestions on how to bring up the topic?
He does have some legal affairs taken care of- he began planning because of my mom's disease- but I don't yet have poa for him (did for my mom). I'm an only child and 5 hours away from him, so it's worrying me that things are worse each time I see him (1x/month).
posted by percor at 11:56 AM on July 7, 2015

You are going to need help, preferably from someone you can trust and that your father also respects. This could be your family doctor, or perhaps an accountant or lawyer, or a bank manager. But it should be someone impartial who will "do what's right", which is to persuade your father to provide you with power of attorney.

You also need to be vigilant about other people in your father's life who are not family. Once it is clear that your father is experiencing cognitive decline, existing friendship dynamics will change, especially if these friends are providing what they perceive as "help." They may feel entitled to a greater say in your father's affairs, and they also may feel entitled to be added to your father's estate. This is one of the reasons why it is important to nail down power of attorney. The other reason of course is that if the state steps in, the state will charge a heft administrative fee.

I speak from my own experience. A relative live about 4 hours away. She experienced cognitive decline, and relied on the help of a network of "friends" to do shopping and run basic errands.

Towards the end there was a lot of mischief happening. But we prevailed, mainly because of POA, and that was facilitated via the help of our GP.

Government, notably the social workers and the health system specialists who determine cognitive ability, is not an ally.

So finding that ally is going to be important.
posted by Nevin at 12:24 PM on July 7, 2015 [4 favorites]

Well, I'm not saying this will work, or that it's fair to gaslight your dad, but...make him an appointment with his doctor. And then take him to the doctor's appointment that he totally made himself and asked - nay, insisted - you take him to. There's a good chance that his "when confused, pretend to be in control" circuits will take it from there long enough to get compliance.

Understand that the doctor can't discuss anything specific with you without your father's permission, but there is a substantial amount of leeway in what you get to hear, and of course what you get to say and/or pantomime to the doctor, when you're in the room to take notes.

You can send a letter or fax or email to the doctor's office ahead of time as well, noting anything you want to note. They can't answer any questions, but they can certainly read what you have to say.
posted by Lyn Never at 12:28 PM on July 7, 2015 [2 favorites]

Any suggestions on how to bring up the topic?

This is going to sound super harsh and maybe too early, but if he is still driving, or making financial decisions, you are going to have to take things into your own hands for his safety. This may mean your dad gets really mad at you. Lyn Never's suggestion of taking him to "his appointment" is a good one. Ultimately, if it is dementia, you need to just take charge. He needs to see a neurologist ASAP and you definitely need to get POA. Is there a will or living trust in place? That may have the POA language in it already and it would take a doctor confirming in writing that he is non compos mentis to go forward.
posted by Sophie1 at 1:51 PM on July 7, 2015 [2 favorites]

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