I am wondering if anyone can provide a bit of guidance for an issue that we are having with my 62-year-old mother. She has always been something of a hypochondriac and has, in the past, invented illnesses that had no basis in reality (i.e, told us that she had lupus ... diabetes ... cancer, etc when she hadn't been diagnosed). In the past few months, we've noticed some alarming things. Personality changes - extreme anxiety - repeating herself over and over again, a seeming inability to keep track of stories (she tells very different versions, sometimes in the same conversation with the same person). She seems to have a lot of trouble with remembering conversations. She has a lot of anxiety about missing appointments, and she will often call me several times in the same day and ask, over and over again, when her appointment is/what day/etc. She seems well orientated to time and place. She knows who we are, she's still living independently & paying her bills, driving, etc. However, she's recently had a few minor fender benders and narrowly missed accidents because she seems to have some difficulty with reverse/forward gears. She's been to a neurologist and to her primary physician. They are most concerned with her extreme levels of anxiety and have her on Ativan. They've also started her on Aricept. The neurologist has not done any extensive testing -- just the memory/cognitive test (which she failed). We frankly don't know what to believe, given our mother's history of being less than truthful and "sympathy shopping", as it were. We've asked the neurologist to do additional testing - he's recommended a spinal tap (???) and MRI's but my mother is resisting and at this point we can't force her to get testing. The overriding issue is her inability to keep track of conversations and some personality changes we've seen (she is very withdrawn, clearly quite anxious, and this is markedly different than how she always was). I am wondering ... is frequently telling the same stories over and over ... plus not being able to recall recent conversations ... early signs of alzheimers? She doesn't seem to have any other problems -- such as, misplacing things or unable to pay bills/shop for groceries, etc. I would appreciate any input. Thank you very much.

I believe Ativan can cause many of the symptoms you are describing especially if she if taking more than she should. I would have her get tested for Thyroid, B vitamin, and iron deficiency. I would also push her to get the spinal tap and MRI done. She could have a brain tumor. It is difficult to fail the Mini mental status test on purpose because the questions are common everyday ones that everyone knows the answers to unless they have dementia.
Good luck and Hugs,
Mariellen

I am wondering if anyone can provide a bit of guidance for an issue that we are having with my 62-year-old mother. She has always been something of a hypochondriac and has, in the past, invented illnesses that had no basis in reality (i.e, told us that she had lupus ... diabetes ... cancer, etc when she hadn't been diagnosed). In the past few months,

we've noticed some alarming things. Personality changes - extreme anxiety
--- Many people with alzheimers have problems with anxiety. It is quite unsettling to have trouble dealing with things that were once simple.

repeating herself over and over again, a seeming inability to keep track of stories (she tells very different versions, sometimes in the same conversation with the same person).
--- Repeating self in conversations is a common thing seen in emergent alzheimers. The most common early trait in alzheimers is making new memories and in this issue, she cannot remember whether she told you something just a few minutes ago. Confabulation, making up portions of stories, is done to cover holes in memory of events.

She seems to have a lot of trouble with remembering conversations. She has a lot of anxiety about missing appointments, and she will often call me several times in the same day and ask, over and over again, when her appointment is/what day/etc.
--- One thing that is not widely recognized is that early in Alzheimers, people have trouble with some things that are actually rather abstract (non-concrete) concepts. Things like the date, time, value of money. She is using you as a crutch in these concepts that she is having trouble with.

She seems well orientated to time and place. She knows who we are, she's still living independently & paying her bills, driving, etc. However, she's recently had a few minor fender benders and narrowly missed accidents because she seems to have some difficulty with reverse/forward gears. She's been to a neurologist and to her primary physician. They are most concerned with her extreme levels of anxiety and have her on Ativan.
--- Ativan is a bad medication for someone who has alzheimers. The anticholinergic properties causes increased levels of confusion. No dementia doctor would prescribe Ativan. Dementia doctors use antidepressant Zoloft for it’s anti-anxiety properties. Beyond Zoloft, they use Buspar because it does not affect cognition. You would do well to call the local alzheimers association and get names of dementia doctors in your area.

They've also started her on Aricept.
--- That is good. Make sure that she continues. Right now she is probably on an introductory dose, which will later be stepped up to full strength.

The neurologist has not done any extensive testing -- just the memory/cognitive test (which she failed). We frankly don't know what to believe, given our mother's history of being less than truthful and "sympathy shopping", as it were. We've asked the neurologist to do additional testing - he's recommended a spinal tap (???) and MRI's but my mother is resisting and at this point we can't force her to get testing. The overriding issue is her inability to keep track of conversations and some personality changes we've seen (she is very withdrawn,
--- Withdrawing from previous social situation is one of the warning signs of Alzheimers.

clearly quite anxious, and this is markedly different than how she always was). I am wondering ... is frequently telling the same stories over and over ... plus not being able to recall recent conversations ... early signs of alzheimers?
--- Absolutely

She doesn't seem to have any other problems -- such as, misplacing things or unable to pay bills/shop for groceries, etc. I would appreciate any input. Thank you very much.
---I bet that if you tagged along on a shopping trip, or watched her paying her bills, you would be surprised to see that she is having trouble with these issues. If she isn’t, she will within a year or so. Other things seen at this time, becoming disoriented while driving, trouble planning meals and shopping for meals, trouble dealing with mail, etc.


FAQ2 - ativan (Lorazepam)
http://www.prohealth.com/alzheimers/blog/boardDetail.cfm?id=22696#22748

FAQ4 - The Ten Warning Signs of Alzheimer's
http://www.prohealth.com/alzheimers/blog/boardDetail.cfm?id=28008#28008

FAQ7 - Behavior Changes in Alzheimer's Three Stages
http://www.prohealth.com/alzheimers/blog/boardDetail.cfm?id=34583#34583

FAQ8 - Anticholinergic drugs are bad for a person with dementia
http://www.prohealth.com/alzheimers/blog/boardDetail.cfm?id=36063#36063

FAQ36 - benzodiazepines including Ativan and Xanax
http://www.prohealth.com/alzheimers/blog/boardDetail.cfm?id=60920#60957


http://www.alznews.com/Library/InfoManage/Zoom.asp?InfoID=6771&RedirectPath=Add1&FolderID=1256&SessionID={2879EF60-DE93-4434-B805-03CA05B2ABE3}&InfoGroup=Main&InfoType=Article&SP=2
Alzheimers Daily News, Aug 25, 2009
Study Finds Risk in Off-Label Prescribing
a new survey of physicians has found that many might not even know when they are prescribing off label. Confusion was greatest with psychiatric drugs, the survey of some 600 doctors found. And one in three doctors who used lorazepam (often marketed as Ativan) to treat chronic anxiety thought it had been approved for this use; in fact, the FDA warning advises against using it for this purpose.



[This Message was Edited on 10/09/2009]