Nervous about my mom's upcoming neurology appointment, I know she's going to try and bluff the new doctor. What to do?

Dementia is NOT inevitable as one ages. There are many mentally intact elders. As for your mother "masking " her mental decline, a good neurologist should be able to discover her loss of capacity.

Is it possible to email the doc with your concerns ? Lots of hospitals have that ability these days.

My MIL has tried to fool them several times and insists she go in by herself. Each time they tell her the truth ... and the family is advised as her son was POA.
I had the same concerns and as the doctor told me...this wasn't his first Rodeo.
He was very kind to MIL too, gentle and good.
She is getting another round of testing as her confusion and memory is much worse now after 18 months.
She says she is sharp as a tack.
But she doesn't always know who I am.
They are right on it!
Have a bit of faith.

I wrote a letter documenting dates and incidents, as well as daily observations on my mother’s memory loss and hearing problems. I gave it to the doctor before her appointment, which helped him target questions and also tailor his approach to her based on how i told him she would respond and likely lie about her issues.
He was outstanding and i finally will be able to get her to do brain scan and sleep test to ascertain what the real issues are. Wish me luck, she has a terrible way of weaseling out of these things.

Contact the physician prior to her appointment. Write or call. Remember they can not release information to you unless She signs a release of information (roi)but you can tell them what you are seeing. Ask Dr to recommend ROI and POA then talk to your Mom about importance of both as she ages. Our dr. requires ROI be assigned annually. Once POA is activated the ROI is no longer required.
Remember to discuss driving issues with Dr if applicable. Some will advise DMV. They will also be the bad guy or gal and say no more driving taking the burden off you
 You are not the only person dealing with parents in denial, That I am 110% sure of. More often than not this occurs.
Educate yourself as much as you can on dementia. Lots of forms (110)
Watch Teepa Snow videos on YouTube. Shes an expert on working with dementia patients. I idolize her. Read the 36 hour Day. You need to know what's ahead.
Tell Mom they're could be other things going on besides dementia. Something as simple as vitamin deficiency can do strange things rp people.
Now go watch Teepa and best wishes.

Several issues:

1 - who has POA? if nobody then you'll have to do something - this could be the only reason to tell her she has dementia because while she has some ability to do this then hurry to help with this because sooner or later she won't legally be able to do this

2 - these drs & staff aren't fools or newbies - they have seen the showboating before & have ways to ferret out the truth - write out your concerns & quietly hand the envelope to the receptionist if you can't drop it off beforehand with your contact information in it - your mom may realize her problem & be embarrassed to talk about with you there OR you may be quite right that she plans to lie through her teeth but these plans often fail because she will have a hard time making a plan & carrying it through [because if she could then dementia wouldn't be an issue!]

3 - moving seems to show up dementia - as I understand dementia, it isn't caused by the move but rather surfaces when the familiar is removed then it is hard to re-adjust to the new place - the bathroom is in the 'wrong' place, light switches are moved, the kitchen has been rearranged - it takes a while for the damaged brain to re-adjust

4 - good luck & check out 'TEEPA'S GEMS' as Teepa Snow is a dementia whisperer & she has much usefully information

You need to go in with here whether she likes it or not. Just tell her when you get
there or when they call her get up and go. If she says anything to you just tell her you are going. Make sure you tell the nurse every thing that is going and your concerns. While you are in there, let the Dr know what is going on whether she likes it or not. Let her get mad, just tell her you are concerned, wanting to help her and you love her.

These pros have dealt with it all before.  My guess is they might do some cognitive testing and in fact might even give you some paper/pencil survey to identify behaviors/symptoms to get a full picture.  She's probably at an earlier stage of things and they can be quite clever.  Our wonderful family MD was totally unaware and shocked when I told him some things and then he did a mini mental exam mom did poorly on.  When an appointment with neurologist was set up they screwed up and sent info/survey materials to my mother as well as me.  The day of the appointment we'd waited 3 months for came and I learned SHE had called in 3 months prior and CANCELLED it.  Don't be afraid...you can't change much about this.  It was hard for me and in time it got easier to say "my mom has dementia" to explain certain things.  good luck and hold a good thought...support is out there for you.

EP, this is from a description of NHS 'memory clinics' and what happens on first referral - you will have a different system, of course, but I would expect the process to be broadly the same.

"Assessments are performed by mental health nurses, psychiatrists, occupational therapists and [clinical] psychologists. One fairly common tool of assessment is the Addenbrookes Cognitive Examination which tests specific areas of cognition including memory, attention, orientation, language, verbal fluency and visuospatial abilities. There is also the use of a semi structured interview which gathers information about an individual's experience of memory problems, and the onset and progression of any difficulties with cognitive functioning, activities of daily living and behaviour."

That's why it takes so long! But it's broken up into different sections, and of course the team makes allowances for the age and health of the patients - you can't test someone properly if they're upset and tired out.

The "semi-structured interview" is the part I would expect you to be invited to sit in on, as well as the history of symptoms.

Take a good book because there is a lot of sitting around :)

Has anyone suggested doing an MRI or CT scan beforehand? You will also want to take any medical notes you have, and certainly her regular px.

Why are you affaid ? Ielieve, Is it not because you would like to convince her of what you believe so that she tells you that you are right ?
Your mother knows well what happens to her and is therefor i n the dienial, hoping that it will never happenbecause she is affadi of the consequencies. If your médical is an experienced professional,
In reality she will naturally try to fake, she has probably a lot of past expériences with success, but probably never with regard to démentia, why should she admit it to you her son. When the doctor discoure de fake answers, he knows exactly how to react
if by the first contact he has established a mutual confidence. The consultation cannot be one a bundle of tests and basta, no, it needs time and mutual confidence to by-pass her denial, as she is intimately convinced that notons is wrong, so does most of the persona starking a dementia.
At last dont be convinced that someting fil take place the way you think, most of the time it is the opposition, you mus stop telling your mum what you are affaid of, do trust her in order to be able to bring her to the réal professional doctor to be able to proof she has nothing because you are affadi that she really has something as you are probable certain she has. You must be diplomatie with her so that she starts to trust you and that takes a ± long time.
If you would like to start the diplomatie way, talk first with the physicien to develop astrategy as hour mother now knows your opinion and maybe thinks in hersent that you want her away what she will combat till the last minute.
In all thèse cases the denial is very presant and normal, what would you do if you were in the same situation as she is ?
Success and stengt is what I wish you.
Take the time that is needed as time does not forgivre what is not doyen with him.

Just to reassure you that the people giving the test will be understanding and will not make your poor mother think she's woken up in one of those school exam nightmares: this section shows how it's done -

**********
1. Place a pencil and a piece of paper in front of the subject. As a practice trial, ask the subject to “Pick up the pencil and then the paper.” If incorrect, score 0 and do not continue further. 

2. If the subject is correct on the practice trial, continue with the following three commands below. 
 Ask the subject to “Place the paper on top of the pencil” 
 Ask the subject to “Pick up the pencil but not the paper” 
 Ask the subject to “Pass me the pencil after touching the paper” 

Note: Place the pencil and paper in front of the subject before each command. 

**********

So: if your mother is struggling, they don't plough on regardless. You can also see that the tasks are deceptively simple. You could follow those commands without even consciously thinking about it. A person with dementia (past a certain point) can't.

The doc will not rely on the response to questions. The ‘test’ is about completing tasks, (draw the face of a clock and put the hands on 2 and 6). Or ‘Who is the President?’ She can’t fake that.

Best of luck.

My Father also insists upon going into the doctors alone and often does fool them, especially his primary doctor who is older and is convinced I am the wicked witch of the West. I have resorted to talking to the nurse directly when My sister and I have Concerns. I'm also trying to get them to see him in the afternoon when he gets tired and he shows his true colors. We did get my dad to agree to a reviews list so he doesn't forget things. This way we can fax it ahead to the doctor's office. My dad's primary told him he can still drive and doesn't lead it came that even my dad admitted he does need his cane, But insists on driving. He is fairly good at driving in the morning but I worry about his responses to other drivers since he is so hard-of-hearing and his reflexes are slow. Short of contacting the police, There is nothing more I can do right now. To himself or others, I will tell the police.

My mom has dementia but not Alzheimers. Regardless, she totally BSs the medical personnel. For 25 minutes or so during the meet-and-greet, she physically rallies--all perky and well-spoken and doing her 'cute' thing while not directly answering their questions--and the never lift their eyes, that are glued to the computer screen checking boxes (mom's responses). Also for 25 minutes, she can turn on the sharpness and charm. I go with her to all her doc appointments (luckily, she lost her DL), and both the primary, the freakin' neurologist and the hospital folks (she falls very frequently) seem to be totally unaware she may be BSing--and they all end up telling her how great she's doing, and they all gush and say "I hope I look as good as you do when I'm 90!" To boot, her organ are all in remarkably good condition, which further influence the doctors' appraisal of her.

And we go home and since I am living at her house now (watching her like a hawk), we might as well have not gone. Then we go back to the 24 hour cycle resumes.

I'm beyond furious that these guys aren't paying attention or picking up on the numerous signs that mom's doing a song and dance for them.

I sit next to or behind, my mom shaking my head, but they either ignore me or say to me "let her answer".

I don't know if this is a 'doctor/patient privacy' issue, &/or that I'm not legally her guardian?

I love this forum--it's made a HUGE difference in my life!!!

Maybe you can make some videos of your mother with your phone. You could tell her the videos are to "prove" how well she functions day to day. Ask her to do things you know she struggles with--things like read a chart of numbers, circle the largest number, tell how much change she should get back from a $20 bill if she buys something for $6.50

I experienced this with my mom.
She kept looking to me for prompts when the doctor asked his questions. I felt bad and like I was throwing her to the wolves.

She did pretty good faking her way through it and the doctor finished with his questions but then he said. "I'm just going to give you a refill on your Tylenol 3's. My mom said " oh, I've never taken those before" But she had been for a while. Sometimes it's the little things like that that can trip them up. Hopefully your mom's doctor won't stick to the usual prepared script that your mom can fake her way through.

It's sad that we want them to fail in a way so we can get them the help they need but I guess it's one of those necessary evils of being a caregiver.

Oh yeah! This happened until she couldn’t cover up anymore. If it was a serious denial, I would tell it like it is. She has chf and used to tell the cardio that she exercised everyday with weights for her arms. I suspected she wasn’t capable of doing this anymore and in fact felt her chf had gotten worse. When I mentioned that I thought her symptoms were worse, the doctor did a blood test on her and sure enough her chf had gone into a new stage. So we are going to do some new testing on her to make her feel better with different meds.

I wonder why we even go to the doctor appointments like clock-work if honesty isn’t on the table? I told my mother how I felt and she’s a bit better now.

I am there too so I can interpret what the doctor says, as sometimes she doesn’t understand what it’s all about. It’s to help me too. I am her care-giver and have been for over 7 yrs now.

Yes I have been thru this with my mom also. She never wanted me to go in with her to see a doctor no matter what kind of doctor it was because she wanted to lie and deny anything and everything.
what I did was told her ok as long as mom, and myself will sit down together with the doctor so I could be updated on whats going on once the visit was complete.
I did give the nurse in the office a phone call and gave her a heads up to how sneaky my mom would be. I told her my concerns and questions they needed to ask her.
its the only way to handle them thinking they are getting there way and yet you are involved with the health issues also.
my mom after a few visits when she first got sick, gave up and let me in with her and things went fine from than on.
good luck.

Changing up doctors' appointment times from morning, when our cognitively impaired loved ones are better able to showtime, to afternoon, when they are approaching sundown or a bit fatigued, is a good way to demonstrate to doctors that our concerns are valid.

Four years ago I wrote a letter to my FIL's neurologist explaining my observations of my FIL in the morning versus afternoon, and my concerns that he was in cognitive decline. Many falls and ER visits later, this neurologist only recently determined that FIL has mild dementia. Very frustrating.

Looks like perhaos this appointment has passed but even if it has you could suggest to the doctor that she have a nuropsyc evaluation. It is more in depth and focuses particularly on her cognative abilities from many angles. It also takes a great deal of focus and work for the paitent so they can't continue a :rise to the occasion" throughout. It also has ways to tell when they are fudging it, if she is able to fool the test she is probably pretty solid cognativley. My mom does the exact same thing with doctors and she is both hard of hearing and has aphasia which actually makes it easier for her to fudge because they easily write stuff off to her hearing or soeach problem but she has become dependant on us to help her answer the questions because finding words can be so hard so we don't have quite the difficulty you do. The nuropsyc eval however requires most of it be done without us in the room, there is a part where they want to include family to get there opinions on questions but the testing is just the patient and the tester which is just fine. Her primary can order this too it doesn't have to be a neurologist.

Also I would suggest you find a way to get POA/MPOA/DPOA buttoned up quickly because if there is any question about her cognitive ability it might end up being too late...make sure she understands it only means you can act on her behalf not force her to do what you want.

So you're afraid that your mother will "showtime?" The appointment has no doubt come and gone, but you should be present with her physician. No question about that. You get to sit in!
My story - I lived in another state from my mom (her choice & I had to move in with her). Her doctor says - "So when is your daughter supposed to arrive?" Which meant that the doctor was going to act differently if my mother went to the doctor by herself! And it happened! A few days before I could arrive, my mom had a doctor appointment. I asked "did you get a resolution? My mother - "No." Me - "Why not?" My mother - "When she asked me what was wrong, I said nothing was wrong." So a wasted trip. I told her that she must speak up to her doctor!

Hi Exhausted Piper,
I got home from work a little while ago and relieved the aide for mom.

The hospital neurologist prescribed:
Gabapentin (2 a day)
Resperidone (1 a day)
Escitalopram (1 a day)

Mom does have vascular dementia. I insisted on the neurologist giving her an MRI while at the hospital. Thank goodness I was in the hospital with her because I overheard him dismissing it. I approached him and said that if it was an issue of money, I would pay for it but that I wanted him to do it even if it was only for my sake. Thankfully, he complied because the cardiologist, whom asked for 2 EKGs for mom said that it was necessary as a baseline. The new neurologist that I took her to after the hospital stay said the same thing.

The EKGs revealed that the main valve to my mom's heart is also nearly completely sealed with calcium deposits. so, I could lose her to that or to dementia. It's a cruel thing when the mind starts dying before the body but that is pretty much where we're at right now.

As mentioned earlier, each case is as individual as the individual themselves. Mom is happy when I hug her, when I bring her little gifts like a solar bobble head to make her smile...silly little things. I don't consider it my job to make my mother happy or to create pleasant moments and care for her. I'm not saying that it's easy and, yes, it is exhausting and many times frustrating but I am able to do it at present and will continue to so for as long as I am able.

I've had Nest cameras installed in my apartment so that I can "check-in" from time during the day and make sure she is ok. It also keeps current and future aides on alert that I am keeping an eye on things.

When mom was admitted into the hospital, she removed her jewelry and handed it to me. I put it in a safety deposit box in the bank to keep things safe for everyone's sake. She wears very nice costume jewelry that I've given her more recently but things of more value are safely in the bank. I did this because I did not want her to accuse anyone of taking things from her. She does not remember even being in the hospital - let alone removing the jewelry herself and has made up fantastical stories about how it happened such as accusing my daughter (I have no children) or other long-deceased relatives.

I also disconnected the phones and decommissioned her cell phone after retrieving the contacts and calling her friends to explain what had transpired. I had to do this because she was calling them repeatedly asking where my father was. While in the hospital, she asked me where her husband was and I replied that, dad had passed away about a year ago." Her response to that was, not your father - I mean the man I'm married to now. He's very nice and he's your father now so you'd better get used to it.

The cardiologist found me by the elevator banks in the hospital crying one night and spoke to me. She told me not to lose heart because, based on what she'd seen on the test results, she believed that I may see a bit of what was my old mom before this happened and that I would need to let the new meds a chance to take effect. She further explained that it may take about a month for this to happen. She was right. Some days are still better than others even now and it's definitely a rollercoaster ride.

I spent a good part of 2017 flying to/from Florida, and watching my dad die slowly. My hotel room was either a hospital or a rehab center. Mom would not leave dad's side and it would give her some relief and time to sleep a little when I was there. I was thankful to be there with my mom when my father drew his last breath. It is my prayer that I can help my mom along on her journey and be there when she draws her last breath.

Hi EP,

Me again. The hospital psychiatrist and mom's general practitioner gave her quick eval questions that mom had already memorized (if you can believe it) before they walked into the room. She was trying to bluff her way through so as to get out of the hospital. Each time she realized they were making their rounds, she asked me certain questions and I very soon realized what she had done. One at least 3 instances, I excused myself to go to the restroom when I was really running out after the doctor to explain what had just happened. I asked the psychiatrist to come by at a different and to ask her different questions. He did so and realized what I was talking about.
I was lucky to get a healthcare proxy for mom while at the hospital. She very nearly refused to sign the document but the social worker asked her what she would want them to do if she was no longer able to breathe for herself etc. Mom replied that she did not want to make those decisions and then the social worker calmly said, that was fine and she did not have to. She then asked her who or whom she would like to make those decisions for her. Mom replied, her husband and her children. By default, that meant me and mom signed. Phew!

I was also able to get POA for mom during one of her more lucid moments after the meds took effect. I retained an attorney to provide me with proper forms for her and also to help me get Medicaid for her and also established a trust account for her for her own sake and mine. I'm still waiting for approval and aides are costing a fortune in the meantime. All prayers welcome that it gets approved soon!

Exhausted Piper,
I forgot to mention that mom can still shower herself, and gets around with a walker and cane. she needs someone to be with her or nearby because her balance is a little off. I took control of her meds because she cannot remember a lot of things and I thought it best to take care of that for her. I keep her allotted medications in a case and refill each slot on a weekly basis.
Sundown or Sunset dementia is definitely interesting so rather than give her a sedative like Alazopram (i.e., Xanax) when she has more anxious moments, I have the aide give her two melatonin gummies with her last pills of the day, which are given with her dinner. I checked with her cardiologist first and also had her general practitioner evaluate all of her meds in addition to the dementia ones.
Mom takes Levothyroxine as her first pill of the day because she had her thyroid removed a few years ago. Other pills are for sugar, cholesterol, heart, stomach...
When I had her current doctor evaluate them, he reduced her pills by nearly half.
Her Cardiologist is the one whom advised me to give her melatonin instead of Alazopram whenever possible because, in combination with all other pills, it knocks her for a loop.
I also try to keep mom to a structured schedule so that she gets accustomed to new routines. I tried to bring her to a senior center after checking out a few in our neighborhood but she did not respond well to it at all and started to shut down. The doctors advised me not to force the issue. I therefore bought puzzles, a keyboard, memory games, adult coloring books and lots of movies in addition to having an Amazon Prime membership and Netflix so that she always has something to watch when she wants to. The aide also takes her for walks whenever possible and, when the weather is bad, they go up and down the hall a few times for exercise. Every day has its own challenge but I try to do my best.
And, in case you were wondering, yes, I've had the occasional melt down and that is when I reach out to the Alzheimer's association. They have 24/7 counselors available on the phone so, even if I have to go into a stairwell to speak to one of them, I do that when the aide is here. When not, I wait for her to take a snooze and then call someone. This site is also very helpful.

Me again EP,
Sorry for the book I'm writing here - lol! I also have the aide take mom to mass on Sundays and then to a movie but make sure I check the movies out before I tell the aide which ones are more appropriate.
Once in a while, like on holidays, I take mom, the aide and a friend out to dinner so that celebrations are not eliminated.
I have animated toys that play songs and items that light up, which make her smile and laugh. One toy is a plush kangaroo that plays the song, "Despacito" as it shakes a set of maracas - lol! When I hear that song in the morning, I know that mom is making her bed. Yes, she still likes to make the bed.

I strategically switched bedrooms with mom because mine was the master bedroom I shared with my late husband. We have a junior four apartment and I turned a smaller room next to the kitchen into a room with a daybed. That is where I sleep now. It's cozy and it's just fine. I'll soon have to put locks on the doors for it though because mom has lately been searching for her missing jewelry or money or phone...the list goes on. Best advise that I have learned in those instances is to distract and redirect. For instance, if she starts asking for a cell phone, jewelry, etc., I say, I'll be right back - I have to go to the bathroom or, I had a really bad day at school or work and I just need a hug. I've also learned that therapeutic fibs are necessary and kind in many instances to protect them from themselves and others.

PS I keep my own cell phone on vibrate and do not let her see me using a phone. Visual queues can be important. And, the Nest camera system also works with an app that I have on my phone, which enables me to check on things from my phone as well as my laptop. Each time there is movement in mom's new bedroom (my former), my cell phone, which I keep under my pillow, vibrates. This alerts me to check on things. Most times she is simply going to the bathroom but, I guide her back to bed when she is done and pretend that I am up because I also had to go to the bathroom.

Hi Piper -
Feel your pain and anxiety. Hubby with Parkinson's has been Oscar material for snowing the neurologist and the kids into thinking that he is doing good. Of course the kids only want to see the good stuff. The neurologist just wants his share of the Medicare payment. Hubby is a showtimer - a term I got from this site. He can fake total normalcy, but it only lasts a short time. Key is to keep him engaged as long as possible so that his true condition comes out. Kids are starting to get it, and I think the Dr. should already know it. The tests they give them are hard to deny. Simple questions/requests that they will answer with varying degrees of correctness, scaled on 1-30 points (MMRSE I think is the name of one of the tests). You will experience some relief when you see the results. Good luck to you, and like another poster said, stay in the corner and only respond to the doctor if he/she looks to you for confirmation or denial. Prayers, 'cause it ain't easy

First of all get DPOA ASAP! You can download forms from the internet and have notarized. Or...for a more detailed document, get an attorney to draw paperwork up ASAP!

We went through that with my dad. I contacted the doctor before the appointment and brought my brother that was in denial as well. When we arrived at the appointment my dad did his typical “show timing “. However, this time, the doctor asked my dad to draw a clock and asked him several questions. Needless to say, my dad failed miserably. I knew it was bad, but I didn’t realize it was that bad. It was all I could do to hold back the tears.

My mother does show time for her dr but I write a letter to the dr to update him and hand it off to the nurse for each visit. They copy it into her record.
When she went to the Neuro dr they are experienced with “ show time “ and she could not fool them.
The dr reminds her she was diagnosed with dementia and she tells him she does not.