Visuospatial deficit advice, please?
My sibling and I are in the process of having a full neurological work up for my 79 year old mother. So far she has had an MRI, bloodwork, EEG, carotid artery ultrasound, and neuropsychological evaluation.
From what I know so far, her bloodwork is normal, EEG is normal, MRI of her brain show mild to moderate subcortical microvascular disease? We met with the Neuropsychologist to review her cognitive evaluation and this doctor's findings are that my mom doesn't exactly have dementia, the MRI is not horrible and that mom did pass most of the cognitive testing (6 hours 3 hours each session) except for her low results in visuospatial perception. Does anyone here have knowledge or experience in this area? I'm still trying to wrap my head around what this all means. The Dr. also diagnosed her with severe depression. I always suspected depression since that is her personality. Mom is on an antidepressant and we will look into getting more psych help if she accepts it.
From what I see, my mom has a big issue with short term memory and cognitive decline. Could this all be just normal aging? For now she lives in the house I grew up and is refusing to leave. She does need help with cleaning, paying bills, food shopping etc. which my sibling and I help her do. It's getting harder to keeping traveling to her house 1 hr. each way and I am very worried about her living in this house alone. We have had the discussion of moving and she refuses along with allowing hiring outside help.
We have also noticed that she is having several bowel accidents (TMI but there is evidence of that in her bedroom and bathroom and I clean it up.) When I gently try to talk to her about it she denies there's a problem and blames her not potty trained dog (that’s whole other story) I know this is not from the dog.
We have a meeting with her Neurologist in 2 weeks to discuss all of the results. I am trying to prepare in the meantime that what I see in mom is not dementia even though my gut screams otherwise. I am off for the summer and will be returning to work soon and was hoping to have a plan in place. The more I read up on Visuospatial the more confused I become.
Willing to hear any suggestions and advice to help prepare for what's to come.
Thank you.
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1st column:
Mom used to (Insert ADL).
2nd column:
Now mom (Insert failure at ADL)
List everything you can think of.
Maybe seeing this all in a chart form would help the doc to make a diagnosis.
Get this chart to the doc well before the next appointment.
Do let us know how it all goes.
Towels-red
Bath mats-red--these were critical
toilet seats-red--these were critical
silverware, forks, spoons, knives--get red handled ones
I took to wearing red shirts and red sweaters
blanket on bed-red
bathtub--red sticky lobsters on perimeter
Mom was able to "see" red items. She could not see white and clear items.
If mom cannot do things for herself then she needs to be the one to change and make different living arrangements. Traveling back and forth to prop up moms illusion that she is still a woman that can take care of her household and her life will only make it so mom cannot see the truth and face the reality of her getting older.
It doesn't really matter what the neuro says, unless that diagnosis will get you to be able to declare mom incompetent and/or mom to admit she needs to either hire in home caregivers (if she can afford it) or sell the house and move into an assisted living facility (if she can afford it) or downsize into a smaller and more manageable place that can transition her to assisted living when she needs more help.
Edited to add: based on your post below about leaving mom on her own for 6 days and the results it is clear mom cannot live alone. Hopefully you can get the neuro to diagnosis mom properly so you can start making arrangements to move mom out of her house and closer to you in an AL or wherever she needs to be for her own safety and care and you and your sister's peace of mind.
I noticed years ago how his depth perception was distorted when driving.
I am trying to stay strong. I am still wiped out from my father's death on hospice last fall.
When things go down I am preparing myself for the change and for the roll of bad guy in her eyes. My job is to keep her safe, I understand.
I am not a medical professional but in my personal opinion, dementia = brain atrophy and we can’t predict exactly what areas will atrophy and exactly what functions those areas control. So the different types can give you some guide on symptoms, but the longer they have it, the more the forms blend into one another. Just my opinion.
He had problems “seeing” things right in front of him. Like he would be looking at a coffee cup on the table right in front of him but would say “where is the coffee cup?” We had his vision checked and his eyes were fine. His brain was not processing what his eyes saw. He would say “where is the cheese” standing by the open fridge. You could say “on the second shelf in the middle” and he would be staring right at it but feeling around like he was blind, not able to locate it. There was no treatment, no cure. Just deal with it.
His other symptoms including a lot of obsessive behaviors that were much more challenging to deal with than the vision thing.
He also started having incontinence issues toward the end and sometimes would not “see” or acknowledge them either. He fought wearing Depends a d he resisted having anyone clean him or help him with cleaning or most anything else.
I was very glad to get an official diagnosis because it helped us find medications that helped to control the worst behavioral symptoms, and it helped me activate my DPOA. With that and letters from his neurologist that he was unfit to drive and unfit to manage money, we were able to put in controls that were necessary. But in the end, it all comes down to symptom management. Neither FTD nor vascular dementia can be cured or slowed down at all. So again— symptom management is all we could do. Good luck and best wishes to you! It’s hard. My dad passed in May following several months in in-home hospice.
The occasional bowl incontinence is what is concerning and I know it won't get better. I was wondering if this is a sign of things getting worse. I know her bladder control is worse and she's still in denial about that.
One Doctor said to me (privately) "If it looks like a duck, swims like a duck, quacks like a duck...?"
Duck was a referrence to the D. word of dementia.
It has never been said by a medical person if front if my LO in my presence. However, mild cognitive impairement post stroke had been noted down. Other issues had been mentioned at various times.. brain shrinkage more than expected for age, small vessel disease, low oxygen levels, evidence of past TIAs, irregular heartbeat.
While *mild* was the word noted, it was not mild enough to live sucessfully or safely alone.
Started with dents in the car. Then emply cupboards as planning for a week's shop slipped away. Then more spacial problems with daily housework. Stroke arrived & left visual deficits. Eyes checked & eyes fine. Damage to visual processing part of brain.
Personal care slipped, showering refused, changing clothes refused.
Denial of growing incontinence.
Lack of insight to these issues.
I started researching & reading.
*Dementia is an umbrella term*
That has stayed with me & helped.
Alzheimer's Disease is one of the most commonly heard of types of dementia. Portrayed in films & books (some better than others). Often memory loss is the first symptom. Vascular dementia however, is another very common dementia but harder to diagnose & symptoms can be very 'patchy' depending on what atropies (as Suzy said below). Also as Suzy said, the obsessive behaviours have been the hardest to deal with.
I really hope things become clearer when you talk to the Neurologist.
Not able or wanting to shop in store.
Not showering
Likes to wear the same clothes over and over again but will buy new clothes at QVC or HSN ( apparently she has their store credit cards that I was not aware of, that is how she is paying without be catching on at first)
Denial and lack of self awareness.
I'm worried, sad and overwhelmed with her some days. Thank you. I really hope things become clearer after speaking with the Neurologist.
It might help if you write in more detail about what your M is doing that is a concern, and ask for ideas about how to deal with it. For a personal comparison, I have balance problems that could probably be called ‘visuospatial deficits’, I am waiting for a neurologist appointment to see if anything can be done about them (I’m getting less hopeful all the time), and I am now 77. I feel as though I have had every test under the sun, and I just need to cope. Not falling over is the biggest physical challenge, and my biggest goal is to hang onto my brain. Perhaps your mother is on the same path. If your mother is moving into fecal incontinence problems, you are coping with dementia symptoms that will take all your energy, no matter what happens about her visuospatial deficits. Good luck to all of you, Margaret.
I think results from labels vary enormously & also some dx take a long long time (& some are wrong!) but knowing is better than denial I guess.
"A person with dementia may also have 'visuospatial difficulties', when the brain has problems processing information about 3D objects. This can affect a person's spatial awareness or the ability to judge distances. They may have difficulties using stairs, parking a car or recognising objects."
Source: https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/how-dementia-changes-perception#:~:text=A%20person%20with%20dementia%20may,a%20car%20or%20recognising%20objects.
"The principal dementing disorder besides AD that is associated with visuospatial impairment is Dementia with Lewy bodies (DLB)."
Source: https://www.bu.edu/neuropsychology/files/2015/02/Cronin-Golomb-AD-chapter-Budson-2011.pdf
Usually, most dementia diagnosis are confirmed by discounting all other possibilities. Many do not have an imaging or test that difinitively "diagnoses" the disease. It can be helpful to know what kind of dementia one has, since the trajectory can include certain features. For example, Lewy Body dementia can include hallucinations, which many with other forms of dementia do not. Depression surely doesn't help if in the mix.
At 79, age-related dementia is certainly possible. If your Mom is taking prescription meds, I would now have someone reliable dispense them to her daily, just to make sure that over- or under-dosing is not something adding to her symptoms.
You don't ask an actual question, so if you can come back and clarify what it is you'd like help with, it would get you the best responses.
Vascular dementia is what makes the most sense to me. She did have a heart attack last year and pacemaker placement.
I set up her medications weekly in a pill box. My sister and I will call and remind her on days that we can't visit.
I guess my question ( my apologies for not being clear) was if anyone else has had a LO diagnosed with visuospatial deficit and did this lead to Lewy or vascular or another form of dementia?