Went with my father to his doctor today, he passed memory test with flying colors! How can this be?

Wouldn’t the specialist’s diagnosis outweigh that of the GP?

The specialist has done much more extensive testing, I’m guessing? Much less easy to show-time his way through?

Maybe I’m not understanding the process?

Dementia is a process. Dad's living trust specified 2 doctors must declare that he cannot make informed decisions. He had several memory tests over the course of a year. Sometimes he did pretty good but other times he really couldn't remember important stuff. Additionally I was told by another doctor that, if someone is VERY intelligent (my dad is nearly a genius), they can pass these simple memory tests but have far more dementia than indicated. Eventually I got two doctors to agree and was able to take over as trustee etc. However, just a few months later, he took another test and did pretty darn well on it again, not normal but pretty well. He's good at math for one thing and many questions were number related. He is better in the late morning but if he's tired out he does worse. Changes in mood and paranoid accusations are certainly important to consider and won't show up on a memory test. I would take him to two neurologists... for one thing, these mood changes may be treatable with medication. It's a tough time... this "in-between time" before he can be "declared unable"... YOU know he's not to be driving etc, but you can do little without a doctor saying so except to let the DMV be aware and have him retested.

As far as AL is concerned, I would just start talking them up and getting him to visit and be honest that you think it would be best if he wasn't living with you. My dad stayed through Covid but I always told him it was temporary because once Covid was over I wanted to travel and have more freedom and he needed a livin cook and housekeeper and carer. My dad is also a social guy so he was looking forward to meeting new people. He went willingly. I think he was bored of our quiet household!
Good luck!

Can’t you get another opinion? I wouldn’t feel that your dad was doing well based on this one test. I would go by what his neurologist says.

You know that your dad’s behavior is off. So does your husband. So keep moving forward on this. Press for more testing to be done.

I think he’s memorized the answers to the same memory test they give all the time.

How did the neurologist conclude that your father has dementia?

If there is a CT or MRI report, or a written summary, send those to your father's doctor. There are many, many different types of dementia with myriad effects, and your father's behavioural changes wouldn't necessarily show up on a cognitive test.

The assessment of mental capacity as it relates to a person's ability to make a given decision is complex and fluid - your father's mental state can fluctuate according to circumstances and according to how well he is that day. In addition to that, issues such as keeping his food fresh and remembering medication can become difficult through fatigue and apathy as well as plain dementia - he doesn't check the dates because it's a faff and he can't be bothered.

But none of this means he can never move into a care home. While it's true that your father (for now at least) decides where he wants to live, he can't decide to live in someone else's (yours) home with someone else's support if that someone else doesn't agree!

"I’m way too sick to deal with this and my seizures, but I know it’s my fault I’m the one who wanted him to live in our guest home. Of course I didn’t have seizures then, but I really had no idea what I was getting into."

I briefly skimmed your previous posts to get a sense of your situation.

You can't keep doing caregiving, unless you want to die before your father. Do you know that up to 40% of caregivers die before the elder w/dementia? JUST because Sister Dearest doesn't want him in a care home AND refuses to take him in, does NOT mean that you have to!

In one of your previous posts, you said the next time your father falls, that you will put him in a care home. Will you follow through with this?

PCPs often don't want to get too deep into their patients' lives. In my mother's case, her PCP dismissed my concerns over my mother's increasing anxiety, lack of reasoning skills, etc. My hypothesis? She knew that my mother didn't drive, she knew I was local, and so therefore assumed I was going to be my mother's caregiver. (And the doctor grew up in Nepal, where families took care of elders.) And then it got to the point where my mother refused to let me come back to the doctor's examining room. So I didn't even know what went on from that point on (although I was always right there for the ER and specialist visits).

My mother ended up being hospitalized for 17 days (this was pre-covid) for a gallbladder infection, then to rehab, then to a NH for long-term care. She'd been able to hide a LOT of her deficits for a long time, mostly because she was able to obsessively control her environment. One of her friends told me several times, "I hope I'm as sharp as your mother when I'm her age!" Yet I'd overheard conversations to this friend, and was surprised she'd said that. Once my mother was hospitalized, that seemed to tip my mother into obvious dementia. There were only a few days after that she seemed lucid.

I had been noticing issues with my mother for years. Even my brothers didn't notice for a while (they were all out-of-state). My mother did NOT live with me, she refused to hire any help (other than a cleaning service). She was having trouble climbing into and out of the bathtub (we installed grab bars, shower seat, handheld shower nozzle, non-slip rug, etc.). She had medical issues where she probably shouldn't have been living alone. I did NOT run over and be her personal hygiene attendant, as that was a line I drew and would not cross. I also got the POA brother to start paying for all the time I had to drive her around, be at the hospital when she had an infected gallbladder, then rehab, then NH, to the tune of $20/hour (the money was gifted to me, no taxes, since she would never qualify for Medicaid). My mother was verbally abusive to me. Since it was affecting my mental health, I found that getting paid made it just a job to me, and I was able to emotionally disentangle myself much more easily.

I'm sure many here would say I was a bad daughter because I wasn't willing to "put up, shut up, and offer it up," which is what most of society expects the daughters (in particular) to do.

So think about why you are willing to martyr yourself to the cause. Is there no way you can get your father out of your guest house? And is taking care of him causing you to lose money? Did you spend money on the guest house? Does he contribute to utilities, food?

What is his financial situation? Is he Medicaid-eligible?

Martz, I really feel for you as our boats are very similar. My mom lives 200 feet away, it may as well be a guesthouse. She too has vascular dementia, diagnosed after a neuro-psych eval by her neurologist. She too will "NEVER" go back there again. She also would NEVER consider moving to a AL MC as she plans to stay in her condo with me as her personal slave forever. And she can also showtime very well, especially with doctors. I could see my mom passing a memory test. It was the 6 hour neuro-psych eval that she could not fool. MRIs also back up the diagnosis.

So I really feel for you. Do you obsess about how to get out of this situation like I do? There seems to be no easy answer. In my state (FL) even with a diagnosis of dementia, and a report stating she should not live alone, and I have a DPoA, I still can not force her to move to ALF MC. A judge has to declare her incompetent before I can do anything.

BUT- what we can control is what we do. I'm pulling back more and more in an attempt to force my mom to accept some hired help (on her dime). Can you do that with your dad? Even a companion one day a week for 4 hours would be so beneficial for THEM, and it would take some pressure off of us.

If you are like me then you realize how truly difficult it is to have these conversations, but we must or our own health will get worse. I'm right there with you, so good luck and please post anything that works for you.

There are other non-dementia illnesses and conditions that can mimic dementia symptoms, like Lyme's disease, thyroid, vitamin and mineral deficiencies, dehydration, over- or under-medication, substance abuse, and more. Maybe you can convince your LO to go to the doctor so that it can be proven he DOESN'T have dementia but another condition? The only way to know is to discount the other possibilities.

https://www.dementiasociety.org/dementia-like-conditions

https://www.cbsnews.com/news/kris-kristofferson-misdiagnosed-alzheimers-has-lyme-disease

A PCPs screen for dementia is not meant to be a diagnosis and it is not. Although we use the word “diagnosis” to indicate someone may have dementia, it merely indicates the person shows symptoms of having some abnormal cognitive issues. PCPs aren't trained to go beyond their rudimentary test to find the cause of the dementia nor do they have time. Because dementia refers only to symptoms, further testing must be done to determine the cause of those symptoms. Being told your father has vascular dementia IS a diagnosis and, in the opinion of the neurologist, the cause of his dementia. I think the PCPs attitude is very flippant and dismissive.


A visit with a neuropsychologist could be the definitive answer, but it doesn't sound like your dad would agree to this. I do think a serious, caring conversation is in order. Prepare a list of observations you have witnessed. Then have a respectful conversation with him about your concerns, what you've noticed (“Dad, we need to talk about your driving”.). I know that this will be difficult. Are there other family members besides your husband who could also participate in this discussion? Don't suggest that he is a bad driver, but that age can affect his reaction time, these are the things you've noticed, and his safety is your main concern. Suggest alternative transportation means. Losing his driver's license is losing his independence. How will he get around? You may even want to express how your worrying about his health is affecting your own. Going thru red lights and speeding 30 miles over the speed limit can only result in a catastrophic outcome.

And by the way, do not fault yourself for having him move into the guest house. You did what you thought was right at the time.

I understand you completely. I decided to take my parents in 5 months ago, and became to familiar with their inconsistent behavior. My husband has been witness also. I had a conversation with their doctor questioning why they were on a certain medication, Quetiapine, he said because they have early onset dementia. They were never officially tested. Now, after living with them for 5 months, (in the same house), I'm starting to doubt they have anything wrong with them.
I'm thinking they do it for attention, they love drama, chaos, and maybe they are not as nice as I thought :) haha

I'm really sorry for your experience, I think that if he is making you ill, as hard as it will be and unfortunate for him, you might have to seriously consider distancing yourself as much as possible. You should not have to get ill . He had a full life. This is your life. I say this with compassion for you. I know you have compassion for him, he is your dad. This is tough.

"I do feel an in-depth conversation is greatly needed (not sure if it would help due to inability to reason well but it’s worth a shot). I know he gets angry with me and does not respect me as caregiver (since I’m the daughter and he’s the parent) but I was thinking I can contact higher ups in his place of worship and perhaps he would listen to and respect them (unless the dementia is too advanced)"

That is my father to a T. You can talk and talk, it's never going to change his perspective.
When is enough enough?? You need to ask yourself that. Maybe it helps to write down how much you do for him and have done. When is enough enough?
How much more are you willing to do or can do? How far are you willing to go? You have seizures since you have been taking care of him? I think you have gone too far.

Why haven't you given up yet? I'm seriously curious, not trying to judge just trying to understand, since I'm in the same boat.

I wish you wellbeing, happiness, peace and strength.

See my reply to sjplegacy's post regarding the testing. That office test is so minimal it isn't worth much, esp since you already have extensive testing and a Dx from a neurologist. Perhaps the neurologist can refer you to another doc who specializes in dementia, but only IF you need a second "opinion." That neurologist report should be more than enough.

"I’m guessing he can never go into a care home if he refuses to go and he passes memory tests?"

This passing of memory tests negating care home is NOT true, esp not that PCP office test. What is true is that POAs are insufficient to "force" someone to move. Our EC atty told me this when I mentioned mom refused to consider moving anywhere (in home aides attempt failed when she refused to let them in.) Basically, everyone has rights, even those with dementia. He suggested getting guardianship, but 1) the facility chosen wouldn't take committals and 2) I don't believe she would have been deemed incompetent "enough" to get the guardianship. Even staff in the MC unit told me they can't force any resident to do something they are refusing, including bathing, medication, medical appts, etc. They have to coax the person, hopefully getting them to think it's their idea!

What we had to do was come up ruse to make the move happen. We did NOT have any medical paperwork to facilitate the move to MC. NONE. The assessment the nurse did never went to the facility. No real doctor Dx at that point or even since, but clearly she wasn't safe to remain at home. It can take some doing to get creative enough to get the move done, but once in MC, they should be locked down, so he can't leave. since you have a guest home he is in, perhaps some major work, renovation or pest control requires you relocate while this is done? IF no fib or ruse can facilitate the move, then the next step would be guardianship. It takes time and costs money, but if it gets him moved, it will be worth it! If you have to resort to this, you can try to get another opinion, but the court WILL order testing - just check to be sure it isn't the useless test that's used. EC atty would be a must. I would highly recommend consult with EC atty AND find a way to move that car!

"I already wrote to motor vehicle and they did nothing."
and
"I tried to take his keys, but he has spares."

This is all too often an issue. Many docs won't get involved. Some DMVs have useless policy regarding this (MA = self-reporting dementia, seriously???) Please don't rely on either of these to resolve the driving issue. No matter who takes the license away, or how it is taken, for most this is NOT going to stop the driving!!!! When it was time to take mom's car, YB did all the talking and took the key. I was sure there was another, so I asked him to disable the car. Next day, she calls ME and accuses me of taking her key. Nope, don't have it. Day two, another nastier call demanding I get down there right now and fix whatever I did to her car. So, she HAD another key, she MANAGED to find it, and WOULD have driven the car! In both cases I could honestly say I didn't touch either one! I never bothered to cancel her license. We moved the car and then sold it. I just let the license expire - she had no means to find another car.

While pulling a battery cable can work for some, too often guys have worked on their cars and may figure this out. You've taken one set of keys. I would highly recommend using those keys to install either The Club or take it to get a kill switch installed. Moving the car to another location would be even better, using the excuse it needs work. If you can get it moved, and make sure your own car keys are secure ALL the time, that would stop the driving. You WILL have to put up with complaints, accusations, begging, pleading or whatever.

“He told me I can go to social security office and apply for long term care so he can have a caregiver.” ?????? That doctor CLEARLY doesn’t understand how “social security” works!

Martz, a doctor can't order a person to go to long term care.

They can suggest it, speak forcefully about it.

They CAN declare a person incompetent to make their own decisions which can be a trigger for the state to step in.

Has Dad had a needs assessment by the local Area Agency on Aging?

It's not just dementia that qualifies an elder for long term care! If he needs help with ADLs, then he qualifies. But a doctor cannot "order" placement, that's not how it works.

If you stop propping him up, he'll see that he needs help and then maybe he'll be agreeable to Assisted Living. He can get pretty bad with dementia before they make him go into Memory Care.

My mother is 94 and did poorly on her MoCa test in 2016, but was fine to stay in AL until 2019 when she got sick, scored a 10 (down from 19) and also went into a wheelchair after 40x falls. Then she had to transfer to memory care. She will tell you there's nothing wrong with her, she was "put" there with "the morons" for no reason. Meanwhile, she has moderately advanced dementia. But she can Showtime the heck out of a situation and fool people left and right. Muscle memory lets her chitchat and b.s. with others .....the " hi how are you, don't you look lovely todays" are in good working order, to the point where I've had folks ask me why she's in Memory Care. Ugh.

She has days of lucidity and days where she talks gibberish. Days where she'll tell me what she read in the paper, honest to God, and days where she's riding the bus from Colorado to NYC to visit Papa whose been dead since 1943.

I made it clear to her that I would not be caring for her in home because I am not qualified to do so, and because it's just "not an option". She's a very difficult woman, to put it mildly, and at 63 with my own health issues, she'd wind up killing me. When my dad fell and broke his hip in 2014, the rehab would not release him back to independent living so that's when I was able to place both of them in Assisted Living. Dad passed in 2015 and my mother just continued living there.

If your father hurts himself like mine did, you may be able to get him placed in AL the way I did. Otherwise, have him hire paid help and withdraw from doing it yourself. Don't become a statistic!

I'm really sorry you're going thru this, it's so hard. I want to send you a virtual hug and scream I GET IT. Wishing you good luck and Godspeed as I know there's no easy answer to the whole mess you're faced with.

It’s not your fault! You care.. I am kind of in the same situation! I pray God give us the strength to get through this. Btw how old is your dad? I was told by my dad psychiatrist that those test aren’t done once they are past a certain age.

My FIL was an auto mechanic and the only way to stop him from driving was to disable his car. Do whatever you have to do to make that happen. Saying he has spare keys is sticking your head in the sand. You have to be proactive if he is running red lights and driving 85MPH. Stop him before he kills someone else or himself.

Some Alzheimer's/dementia patients can have lucid periods. My LO's neurologist said that you should take the car keys away when you become scared being in the car with your father. Take the car away if you have to. If he has a diagnosis of a mental condition and continues to drive, the first accident may be encumbered by a law suit for damages knowing that he was ill. I assume you mean the cognitive test when you say 'memory test.' That only serves to provide a benchmark and must be given at intervals (say every 6 months) for it to begin to make sense. Patterns will begin to emerge over time. My wife did really well in the beginning, but now has extreme memory loss. She cannot draw a clock, count backwards from 100 by 7's (even using her fingers), cannot recall three words, did not know the date, day, season, state, city or facility she was in. She could go to places in distant past, but not recent. I know that it seems tough right now, but you are doing your best. Stress can take a toll on you, so you must find time for yourself. Find an agreeable counselor to speak with perhaps.

Dementia patients are best evaluated by neurologists that do extensive testing. Most clinicians do "quickie tests" to evaluate orientation to time, place, and person and don't really find the problems you listed. If you already have a diagnosis by a neurologist, go with that diagnosis.

Use the information from the neurologist for getting help for your father. As for his driving. arrange with DMV about giving him the paper test and a behind the wheel test. Also give them documentation about his dementia as well as a letter of your observations of his driving abilities. Most DMV will do the right thing and deny him a driver's license. He can get a state ID through DMV, but be aware that your dad may see this as a driver's license.

My father used to rehearse the answers. Count backwards in 7s. Get me to ask him questions around how many grandchildren he had and what year it was.
I helped him practise and we often fell about laughing.
Nobody was fooled by the rehearsals! The neurologist definitely out weighs the doctor and being able to count backwards one day, does not mean he would be able to the next.
Things become obvious over time. My advice is to take one step at a time and give yourself credit for what you have done and have tried to do. A lot of this is trial and error and adapting to change.
Good luck!

Wait - you can apply for long term care at the social security office? Is this doable in the U.S.?

I can empathize totally with many of your concerns. My Alzheimer's-ridden mom would accuse my husband of going through her purse in an attempt to steal its contents. I told her she had $5 in there and a lipstick; let him knock himself out. I even wrote a book about our travails called "My Mother has Alzheimer's and My Dog has Tapeworms: A Caregiver's Tale." I have a chapter entitled, "Steel Yourself for Stealing." Once she accused "someone" (no one in particular) of stealing her dental bridge. Do you know where it was? In her mouth! Regarding the car, Hubby said he'd disable it in the middle of the night, but luckily, the car stopped working on its own. My mom wanted to drive, but all she was doing was driving us crazy. There are so many written and unwritten rules of the road that require on-the-spot thinking, quick reactions, etc., that I too would be concerned with the driving issue. My mom would hide keys in her sweater sleeve, (since she forgot that the car wasn't working). Maybe you could tell your dad that there has been a recall of his car due to a safety issue. That could at least buy you some time. There are so many symptoms with Alzheimer's: judgment, behavior, cognition, agitation, memory, etc. I agree with other posters: maybe your dad needs a more complete work-up, with a geriatric psychiatrist or geriatric neurologist perhaps. I'm sorry for your health issues, too. I know that compounds things. You might want to contact the Alzheimer's Association: www.alz.org, for more information and guidance. Each state has a chapter, but if you go to that website, they can direct you further. Also, take care of yourself. I know that's a common suggestion, but important.

Get him tested by a specialist. Has for driving- Check out what you are able to do in your State. In MN you aren’t allowed to take the car keys even if their license was pulled. My Dad failed both written and driving test it cost $400 for him to take it. We ended up putting a lock on his his stirring wheel.

My dad was the same way. He had little a little notebook he would keep in his pocket with a pencil to write things down. As for the driving. Check your states driving laws. In my state from 70 on you have to renew in person every year and bring a doctor's certificate that you are mentally and physically able to drive. I ended up having to get that certificate from his neurologist because like you he had a good game face with the primary care dr. He was not happy about it but he had started getting into fender benders on a weekly basis and telling me someone hit him at the grocery store while he was inside shopping. He eventually adjusted to using the elderbus through the senior center to get to appointments and shopping if he could not wait for me to get there after work or the weekend so I could take him. Plus we could go out for coffee and spend time just talking or playing cards more :) I think it took a lot of stress off for both of us.

It’s easy to put the cart before the horse. With good intentions, sometimes we try to implement changes on our parents too soon. It doesn’t sound like he’s that advanced so at this point I’d only be concerned about safety. Maybe unplug the oven & get him a toaster oven. Offer to take him on errands & appointments until eventually he just agrees to sell the car so he can make some money, save on taxes/insurance & gas. I’d be grateful if I were you because once it advances, there’s no denying it & that’s when he is really going to need your help.

Beware of the 10 minute (or less) little standard test that a doctor gives someone to make a determination on their mental state, I.e., dementia, Alzheimer’s, etc. Please do your self a favor and listen to Teepa Snow on YouTube as she gives many presentations on the 70 to 90 different types of dementia. (That’s right 70 to 90 is what she said.). She is a professional in this area and she has stated that the short test a doctor gives for the purpose of determining one’s state of “dementia” is no test at all and cannot determine one’s stage of dementia or dementia at all! Doctors are very uneducated when it comes to dementia.

In the UK these tests are useless because they test a) long term memory - which is the last thing that goes, short term is much more of a problem
and b) because memory doesn't = ability to reason.
So my mother keeps passing the same wretched tests because she can make a decision, but has absolutely no idea why she made it or what the consequences are. The only useful determinant of someone's metal abilities is a long meeting with specialists in elder memory issues and dementia. Drs simple question tests are a complete waste of time.

Did he have the comprehensive neuro-psych exam by a neurologist or just the short in-office MMSE exam? My husband was the opposite. Failed the MMSE in both this family doctor's office and his initial neurology exam but passed his neuro-psych exam with a diagnosis of "sluggish cognitive tempo." The doctor said it took him FOREVER to answer each question and complete each task but that his end results were all correct. Not completely sure I agree with this diagnosis but I am glad we had the evaluation done. BTW...the one thing my husband still excels at is driving. I swear that he sees "trouble" coming before it even happens and his reaction time is super fast. But he has been a driver of MANY different cars, campers, trucks, snow plows all his life so that will probably stay with him (according to his neuro) even after other things...like his short term memory...get worse.

Look up "showboating" and dementia. That may help you see what he may have done. (Also, in my experience, doctors don't care.)

Your father is 'showtiming' for the doctor. Which means he can keep it together well enough for a short period of time and appear coherent and rational. I'm surprised he was able to get one over on his doctor.
What you have to do now is speak privately with his doctor and tell him about how he can't reason very well and the accusing your husband of stealing all the time. Then ask the doctor to assess him again, but ask him to mention what his son-in-law stole from him and when it happened. The doctor will be able to see through the showtiming then. Make sure to tell the doctor about the driving too. If your father is getting approved for homecare services it's because he can't manage on his own anymore. If he can't manage his own basic needs and needs a homecare worker, he can't manage driving a car anymore.
Go back to his doctor and make him understand.
I know all too well the situation you're in the middle of and how others will think you're nuts. You are not.

OMG, this happened to me. The doctor was annoyed with me! My husband got a 95!

But my husband was having memory issues. Two years later he was diagnosed with dementia.

He could have been on the correct meds all that time!

The problem is with the test. This is the same test that told us that our former president was in fine fettle. Remember that? He told us he'd gotten an A+. Well, this is the test he got an A+ on.

Hilarious, if it were not tragic.