Answer: Dear OnCall+ user, it sounds like you are responsible for making the health care decisions for your mother. I am sure it must feel overwhelming at times. First and foremost I would suggest that you make sure your mother has a primary care doctor whom you feel comfortable with, who knows your mother and who is experienced in caring for elderly patients.
Because of your mother's behavioral problems, including her agitation and confusion at night (your refer to sundowning), your doctor will recommend that she have an evaluation to be sure she has no additional medical problems such as side effects from medications, thyroid problem or other underlying kidney or liver disease.
She should also have an evaluation to understand better what is the cause of her changes in behavior and whether or not she has dementia. I would not recommend she start any new medication(s) until she has had an expert physician review all the possible problems and talk with you about possible solutions.
Although I am not in a position to make a diagnosis, it sounds like your mother may have a type of dementia referred to as vascular dementia. I say this because of her history of both a TIA and later a stroke. We now understand that factors that effect the circulation to the heart also are important to the brain as well.
Ideally, your mother's blood pressure, her blood lipids or blood fats, and blood sugar should all be monitored and treated to make sure they are as close to the optimum as possible. Controlling these factors can help slow down the process of dementia. If there are no contraindications, a daily baby aspirin is often recommended.
Finally, your mother should be encouraged to walk and get as much regular physical activity as she can, which is often hard because of arthritis and other aging conditions.
Hopefully my thoughts will be of some help to you.
Warm regards, Dr. Marie (Marie Savard, M.D., ABC News Medical Contributor)
Question: My wife's short term memory has seemed to deterioate and she had problems following recipes or organizing her tasks. She fears she is developing alzheimers. We would like to get her diagnosed but don't know where to start.
Answer: We have tackled this question in our OnCall+ Alzheimer's section. Click here to get the answer. If you have additional questions about symptoms of Alzheimer's, you will find a long list of questions and answers on our index page. Take care.
Question: My wife died of early-onset Alzheimer's disease (in her 40s) on Dec. 5, 2008. (This was confirmed by autopsy.) Her uncle was diagnosed with senility in 50s. What is the risk of early-onset Alzheimer's disease, familial-type, for my four children?
Answer: While no one should determine the risk without a thorough family history and examination and review of the causes of dementia, the pattern of family history that is most likely to be highly heritable includes multiple cases of dementia within each generation.
Of note you have described only one case in each generation. If someone is seriously concerned they may benefit from a frank discussion with their own doctor, who may recommend additional evaluation by a dementia specialist or a genetic counselor
- Mary Sano, Ph.D., Director of the Alzheimer's Disease Research Center at Mount Sinai Medical Center