My mother was diagnosed with dementia (MCI) about 5 years ago. She's been living in the Memory Care unit of a nice private pay assisted living facility near me for almost two years. Both her mother and older sister had Alzheimer's. Like it tends to do, the disease has progressed. She's been extremely combative with the staff over simple things like brushing her teeth and very basic hygiene. Within the past few months she's been making up more and more stories to fill the "gaps" in her mind. She's constantly talking about all the little kids in her unit and how they come in to her room and steal things and other harmless little stories and excuses like that.

Last week she pulled an aide's hair while she was helping my mom get ready in the morning. Then this morning she attempted to go after a staff member with a butter knife when going through her morning routine. For approximately six months now, I've had an Occupational Therapist and Speech Therapist seeing her on a regular basis. It's helped the staff identify her "triggers" but not much else. Her doctor is starting her on medication to help ease the dangerous outbursts.

For those with personal experience, have you found that having a geriatric or other specialist psychologist/psychiatrist was able to help at all? Everything I've found online seems to point to therapy helping patients cope with the anxiety and depression in earlier stages of the disease. I can't find much for the later stages.

My experience with therapy (cognitive behavioral therapy) is that it relies on the patient being open/honest and remembering things prior to meeting with the therapist then learning new behaviors. Obviously that traditional approach won't work with someone with significant cognitive impairment.

Thank you!

My Dad passed away at 92 from dementia-related complications four years ago. His symptoms started about five years prior.

First off: I am not a doctor. But I spent a lot of time with them as my Dad’s girlfriend and I slogged our way through the details of how to care for someone who is slowly going away.

We were told early on that any “memory enhancing/preserving” medications might have marginal benefits, but that’s about all. The doctors also said that psychological therapy generally doesn’t work because of the patient’s inability to understand and follow directions. Managing behavior/anger/lashing out in these patients is somewhat hit and miss, and that the best thing to do is control the physical environment (and the objects in there) and be consistent with the patient’s activities, schedule, and daily routine to give them as much consistency as possible.

This obviously requires a lot of teamwork between care staff and family members. What your Mom is going through is not unusual, unfortunately.

Good luck.

quote:

Originally posted by snoris:
My Dad passed away at 92 from dementia-related complications four years ago. His symptoms started about five years prior.

First off: I am not a doctor. But I spent a lot of time with them as my Dad’s girlfriend and I slogged our way through the details of how to care for someone who is slowly going away.

We were told early on that any “memory enhancing/preserving” medications might have marginal benefits, but that’s about all. The doctors also said that managing behavior/anger/lashing out in these patients is somewhat hit and miss, and that the best thing to do is control the physical environment (and the objects in there) and be consistent with the patient’s activities, schedule, and daily routine to give them as much consistency as possible.

This obviously requires a lot of teamwork between care staff and family members. What your Mom is going through is not unusual, unfortunately.

Good luck.

Thanks! And sorry to hear about your dad.

Totally agree that medication is lacking for this disease. She's been on one for a couple of years and it may have slowed the progression by a couple of months at best.

In short, no. A good neuropsych evaluation however is quite valuable as no two Dementia patients are the same. Therapy with the caregivers can be very helpful.

CBT is indicated for Cluster B personality disorders. It is not so much a traditional approach, rather something more recent that has been found to be effective for these disorders.

The traditional approach is Freudian psychoanalysis which is what is always depicted in movies and TV. In reality, Psychiatrists do not do psychoanalysis, they prescribe meds after 10-15 minutes exams. Then follow up a month or two later. Psychologists are the ones that do talk therapy, often concurrent with Psychiatric med therapy.

There isn't much you can do. My grandfather went through the bad suspicious combative phase between age 90 and his death at 94. I didn't see it directly but my uncle told me how it went.

Your only viable options are to medicate her with anti-psychotics and sedatives to temper the aggression.

My mom (82) has been in assisted living since March 2020. Yeah, since shtf. She survived covid and if she had her way, she would probably eat ice cream for every meal. Nutritional psychiatry is an emerging field. It would take a huge institutional shift to provide the most nutritionally based meals possible to residents. Perhaps you could get a doctor's order that prescribes a low carb meal plan. Even MCT oil and exogenous ketones are showing positive results. However, I mostly feel powerless and hold no illusions regard the path of this disease but there is hope for the future.

Hello!

First off, I’m sorry for the issue you are facing with a loved one.

I’m a psychologist (PsyD) and a clinical social worker (LCSW). I’ve worked in my field for 32 years. I will tell you that memory is necessary for psychotherapy to be effective. Medications are the first line of intervention in your situation. Caregiver fatigue is a key to monitor, as those supporting the one with dementia can and often do burn out quickly. That person may need counseling. Also, please tap into home health services for the patient and for respite care.

Best of luck!

Jim

quote:

Originally posted by Lefty Sig:
CBT is indicated for Cluster B personality disorders. It is not so much a traditional approach, rather something more recent that has been found to be effective for these disorders.

The traditional approach is Freudian psychoanalysis which is what is always depicted in movies and TV. In reality, Psychiatrists do not do psychoanalysis, they prescribe meds after 10-15 minutes exams. Then follow up a month or two later. Psychologists are the ones that do talk therapy, often concurrent with Psychiatric med therapy.

I feel a professional obligation to respond to some of this. CBT is a recent development only if 60 years ago was recent. CBT has been applied to much more than personality disorders, as I'm sure the OP knows. It was originally developed for the treatment of depression and had been applied to everything from anxiety to insomnia.

While psychologists do practice talk therapy, so do some psychiatrists and, as per above, social workers.

Just needed to set the record straight.

To the OP, if there is no doubt as to the diagnosis, Jim's post is the most reliable in this thread. I'm sorry to hear about your mom.

Daniel

quote:

Originally posted by Lefty Sig:
In reality, Psychiatrists do not do psychoanalysis, they prescribe meds after 10-15 minutes exams. Then follow up a month or two later. Psychologists are the ones that do talk therapy, often concurrent with Psychiatric med therapy.

You are way off base.

Some psychiatrists only do meds, but many, many psychiatrists do talk therapy, including psychoanalysis and other styles

It's a common misconception, though. My guess is that it largely arises from the opposite being true - psychologists are not medical doctors, they have PhDs, so they cannot prescribe medication. They can only do talk therapy.

Between only being able to get meds from psychiatrists and some psychiatrists only doing meds, a lot of people seem to have the (incorrect) idea that all psychiatrists only do meds.

My mom’s Dad was and her brother is a psychiatrist. Psychiatrists went into practice wanting and intending to do talk therapy. It was insurance companies wanting to pay cheaper and lesser trained PHD psychologists to do talk therapy that made the shift. This forced psychiatrists into doing the drug prescribing for the less trained psychologists who couldn’t do it themselves since they are not MDs. My uncle psychiatrist still does talk therapy.

quote:

Originally posted by MelissaDallas:
My mom’s Dad was and her brother is a psychiatrist. Psychiatrists went into practice wanting and intending to do talk therapy. It was insurance companies wanting to pay cheaper and lesser trained PHD psychologists to do talk therapy that made the shift. This forced psychiatrists into doing the drug prescribing for the less trained psychologists who couldn’t do it themselves since they are not MDs. My uncle psychiatrist still does talk therapy.

As a matter of fact,he is head of children’s psychiatry at a major hospital.

I am not a doctor but I have experience with a relative with dementia.

No therapy or medication helped.

Over time she forgot things, them people and at the end was not even sure of her own name.

She would continually ask what time it was.

We bought a digital clock with large numbers when she asked we told her to look at the clock.
I am not sure when she did, she understood the numbers.

Dementia is different in everyone. Different parts of the brain are damaged in different ways.

She lived with us for several years before she died.

I didn't intend my comments to be universally applied or to imply that no psychiatrist does talk therapy anymore. If you are willing to foot the bill you can find a psychiatrist that still does.

My point is that the Dr. Melfi / Tony Soprano dynamic for the most part does not exist anymore. If your insurer is paying the bill, you will almost always be treated by a psychiatrist for meds in 15 minute sessions once a month or less frequently, and by a clinical psychologist or social worker for 45 minute sessions on a weekly or bi-weekly basis.

This is typically what is covered. Yes, there are exceptions, but I'm talking about what is going to be the case >80% of the time. Some employers have Employee Assistance Plans that provide a set number of visits to an approved counselor for each issue per year, free of charge.

The reason DBT is indicated for Cluster-B personality disorders is because they are behavioral and not neurochemical and thus do not react to medications, which can make things worse if the are misapplied. Clinical Depression, Bipolar Disorder, and many other disorders are neurochemical in nature and can react very well to the right medication for the specific individual.

Yes talk therapy can help people who do not have clinical disorders and just need someone to talk to - minor depression caused by life events, stress related to work/family, etc. It can also help with clinical disorders in teaching the patient how to manage their care and accept that things are different for them and they have to take concrete steps to achieve and maintain recovery. DBT can be useful for other diagnoses that are behavioral in nature as well. But the fact is that psychoanalysis and DBT have their roots in an understanding of psychiatric illnesses that predates modern knowledge of neurochemistry and the vast array of medications that are available today. We don't treat other physiological ailments using methods developed 50-100 years ago do we?

The reason for the shift is this:

All the psychoanalysis in the world, delving into parents and childhood and everything else that may have contributed to your current state doesn't really fix anything. Knowing root causes is nice, but knowing them doesn't fix the current problem. In the movies there is always the "eureka" moment when the tormented patient finally understands the cause of their problems, after being dutifully challenged by the therapist and guided to the revelation. After that they generally get better. This is not reality and it is tiring to see it over and over in entertainment.

Dementia is caused by a physiological breakdown in the functioning of the brain over time. There is not a whole lot that can be done except meds that sedate or otherwise reduce angry outbursts. Perhaps stem cells might help repair the brain the future but that is a long way away.

quote:

All the psychoanalysis in the world, delving into parents and childhood and everything else that may have contributed to your current state doesn't really fix anything. Knowing root causes is nice, but knowing them doesn't fix the current problem. In the movies there is always the "eureka" moment when the tormented patient finally understands the cause of their problems, after being dutifully challenged by the therapist and guided to the revelation. After that they generally get better. This is not reality and it is tiring to see it over and over in entertainment.

Awareness alone is not the fix. Psychodynamics also takes advantage of corrective emotional experiences. The transference reaction is a goal in such modalities. I think your understanding of the theory is a bit shallow.

The point that the system wants the most expensive resource to see as many people as possible, removing a large segment of psychiatrists from the therapy pool, is fair. Add to that the fact that fewer psychiatrists (and doctors in general) are interested in striking out on their own where they can determine their own treatment methods and the large swing towards biological models of psychiatric illness (as alluded to) and you get what we now have. When I was training a number of my fellow trainees didn't even accept the possibility of the unconscious. They could not tolerate the idea that their own motivations were hidden from them.

I enjoy therapy. I'm a better provider for it.

Daniel, MD

I'm not a medical person so this is just an opinion. Since Alzheimer's is a degeneration of the brain cells I don't see how psychotherapy would be much of an answer. This doesn't seem to be a correctable emotional or behavioral problem, it's basically continuous brain damage.
The caregivers could probably do with some consultation in many cases as it seems to be very hard on them during the long process.

I have seen the effects of dementia on both loved ones and caregivers. Nuh uh - not happening - I will not live that or put loved ones through it to care for me. A plan is in place.

Very sorry for what you are dealing with. I have no answers. But as a biologist, it seems to me that memory to recall and apply learned behavior would be necessary.

My MIL is 86 and was diagnosed with Alzheminers in 2007--14 years ago. Her decline has been S L O W. She went throguh and argumentative phase and got semi/slightly violent, though that phase was thankfully brief and not too bad. When we moved 1.5 miles away in 2006, it seemed like a great idea. Double-edged sword quickly. But my wife and SIL have devoted maybe 1000 hours helping since the diagnosis. My FIL died very quickly in late 2019.

My MIL is in a memory care facility but she's almost catotonic most of the time, and sleeps like 18 hours a day. Needs help (and that's being generous) for everything. Not a good existence in any way, and not cheap. Thankfully my FIL provided well for her care... Best of luck to you.