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Senior Health

Early dementia?

03/22/2005

Question:

I am currently staying with an 82 year old family member who is experiencing visual hallucinations at times and daily mood swings from anger to sadness. I am convinced there is a problem. I spoke with her Internist about the problem and he recommended, and referred me to a neurologist. He further said that based on the behavior I had described, that an early form of Dementia is possible. When I initiated the conversation with the family member regarding seeing a neurologist, she went into a 15 minute period of rage, periodically interrupted by crying. She repeatedly said that she was not crazy and did not need to see a neurologist (although I made no mention of her mental condition). She finally ended the conversation by telling me in a fit of anger and rage that she was not going to see a neurologist under any circumstances. I am at a loss for options. How do I get (or convince her to get)the proper diagnosis and treatment?

Answer:

There are a couple of options but the best one is to give the issue back to the primary care doctor. He/she should be able to make at least a preliminary diagnosis or, again try and have her see the neurologist. Dementia is only one of the possible explanations (although the most likely) for what you are describing. Depression, infection, and hypothyroidism could also cause these symptoms. Likely the patient will be more willing to talk about this with her regular doctor. It just depends on if he wants to tackle the issue. With HIPPA privacy issues he would be forbidden to talk to you unless the patient gives permission, however you could easily leave a message with his nurse explaining the problem. If she would allow, going with her to her next appointment would be very helpful to the doctor. Another option is to have other family members also meet with her to discuss these issues. It is usually best to have 2 or 3 trusted friends/relatives at the same time to have more of an impact. Your family member is experiencing anger, sadness and fear to varying degrees. Don't give up on her, she needs help at this time.

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Response by:

Elizabeth Joyner Gothelf, BSN, MAG Elizabeth Joyner Gothelf, BSN, MAG
Assistant Director
College of Medicine
University of Cincinnati

Steven Bartz, MD
Assistant Professor
College of Medicine
University of Cincinnati