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Carers UK Forum • Does "mental decay"/dementia show on brain scans?
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Does "mental decay"/dementia show on brain scans?

Posted: Wed Apr 09, 2014 10:45 am
by jenny lucas
Hi - serious question. Does 'mental decay' and/or dementia show up on a brain scan?

I think I've read that dementia (some forms of?) can show up if the patient has a brain scan (MRI?), but I'm not sure if any other forms of what I am loosely calling 'mental decay' shows up.

For example, would my MIL's 'elderly confusion' show up at all? Or any other form of 'mental deficit' (sorry, really don't know what to call it when an elderly person basically ceases to be a 'responsible adult' any more,no longer capable of doing things, or learning how to do, things that we would regard a 'responsible adult' to be able to do, eg, change her electricity account, put appointments in diaries....even use the remote control on the telly)(not sure about the last one - as in, I find it tricky myself ha ha!).

I guess what I'm trying to find out is just how 'objective' any kind of assessment of mental capacity can be, or whether it only relies on tests given to the patient themselves. For example, I've asked my friend who is looking after her 'mentally frail' elderly father, what kind of tests were carried out, and she said one was that the GP give him a list of words, fairly random, and then he had to repeat them a short while later and see what he'd remembered. She was told that patients can often develop 'disguising' strategies when asked 'test questions' - for example, if they are asked 'what did you do when you were in your thirties' and they can't remember any more, they will disguise their inability to remember by saying something like 'oh, I never like to dwell on the past - I like to focus on the present'....that sort of thing.

Many thanks for any answers. I guess what I'm after really is to find out whether my MIL's current mental 'capacity' can be objectively measured in a way that will show what she is, and is not, capable of any more. I'm trying to work out when - and when not! - to 'encourage' her to remember or learn things. I know we tend to use the general phrase 'use it or lose it' but I don't want to 'plague' her by, say, going on and on at her and repeatedly showing her how to change chanells on the remote control ('Press 1 for BBC1,remember, Granny?'), if she is simply beyond learning now.

At the same time, if she CAN still learn or remember how to do things with encouragement, but "'won't" (ie, chooses not to)(even if it's a subconscious choice only!) because she wants ME to do them (because that's easier for her than having to do it herself), then I need to know the difference!

I remember a little while ago I said that surely if an elderly person 'won't' eat food delivered by Meals on Wheels, their carer shouldn't then 'give in' and make them dinner themselves, as the caree wanted. And I was told no, that can't be done, as the caree would simply starve themselves because they don't have 'hunger cues' any more to stimulate their appetite.

I'm trying to find the 'boundaries' between what my MIL can still do (with encouragement) and what she simply can't do any more (because her brain is beyond it now!). There's absolutely no point me 'beating my head against a wall' trying to teach her to use the remote, say, if she simply can't do it any more, plus it distresses her.

Summing it up, I'm trying to find the difference between "can and can't" and "will and won't"!!!

Thank you for any answers.

PS - could we possible keep this discussion 'neutral' in that we don't take off into a moral debate about whether carers "should or shouldn't " 'do everything' for their carees! I'll keep to that side of the bargain if everyone else will please! Many thanks! Image

Re: Does "mental decay"/dementia show on brain scans?

Posted: Wed Apr 09, 2014 11:32 am
by susieq
There are a few tests to determine Alzheimers - the MMSE test is the most common, consisting of questions from "what is the date today" to "spell the word World backwards", depending on the score an initial diagnosis can be made. This can then be followed by a CT brain scan - in the case of Alzheimers it is possible to see indications of shrinkage in the areas of the brain that control memory and, of course, Vascular Dementia will show small bleeds in the brain. Currently, though, the only way to get an absolute diagnosis of dementia is after death when the brain can be examined in detail.

'Senior Moments' are common for most older people (myself included !!) but do not necessarily indicate any form of dementia. Misplacing your keys, forgetting appointments are all common enough incidents and, again, do not necessarily indicate dementia. The time to be concerned is when someone fails to recognise family members or close friends; continually repeats the same questions (due to having been unable to process the answers given); 'forgets' to eat/drink etc. There is a lot of information on the Alzheimer's Organisation's website of what to look out for if you are worried about someone's mental state

http://alzheimers.org.uk/site/scripts/d ... yID=200341

Re: Does "mental decay"/dementia show on brain scans?

Posted: Wed Apr 09, 2014 1:38 pm
by Scally
I will rise to the bait concerning: "a moral debate about whether carers "should or shouldn't " 'do everything' for their carees!" and add that there are many good practical and caring reasons why we shouldn't infantilise or do everything for people with disabilities including Alzheimers, mainly because it increases their dependency and rate of functional deterioration.

Re: Does "mental decay"/dementia show on brain scans?

Posted: Wed Apr 09, 2014 3:27 pm
by jenny lucas
Oh Scally, jeepers creepers, I wasn't TRYING to bait anyone!

I was trying, hard, NOT to get into a moral debate about how much carers should do for their carees from a MORAL point of view (ie, doing things for our carees because if we don't we are being horrible, cruel mean and nasty!)

BUT, if the point you are making is that it is not in our caree's interests to infantilise them, as it simply 'encourages' them to deterioriate even further into dependency, then that is a very very valid point indeed.

It is, however, I would say, different from the one I'm asking, which is 'what things CAN an elderly person still do' (with kind encouragement etc etc) and what is now 'beyond them'. For example, I could try and teach my cat to use the remote control, but it ain't gonna happen! It's just not within his mental capabilities (I think!)

I neither want to 'waste my time' nor 'pressure and plague' nor 'distress' my MIL trying to get her to do more for herself, eg change channels on the remote to something she likes to watch after the channel she was watching happily has come on with a new programme she doesn't like! - if, that is, her brain just cannot learn how to do it now.

Susieq - I don't think my MIL could spell the word world forwards, let alone backwards....

Re: Does "mental decay"/dementia show on brain scans?

Posted: Wed Apr 09, 2014 3:52 pm
by b.r.wade
totally agree Jenny

Re: Does "mental decay"/dementia show on brain scans?

Posted: Wed Apr 09, 2014 4:12 pm
by Koala
Jenny, my mother has not been officially diagnosed, but my feeling is that any test based on questions is probably seriously flawed. When my mother was in hospital a few months ago, one of the doctors asked her what day it was and she answered, "Wednesday" whereupon he said, "Only one day off." I had to try very hard not to laugh as it was basically impossible for Mum to know the day when I usually only know myself when I click on the date on the PC. I can also give examples of the medical people believing that Mum was incapable of certain things when they are actually well within her scope.

Mum would no doubt be content for me to do a lot of things for her, but our daily routine revolves around me getting her to do as much as is possible. Every now and then I am stunned when she does something that I actually thought was beyond her. I had a conversation recently with a medical person regarding the possibility that Mum can still learn new things. The answer seemed to be that no one really knows. All I can say is that it appears to me that she can.

I hope this helps.

Re: Does "mental decay"/dementia show on brain scans?

Posted: Wed Apr 09, 2014 4:20 pm
by Anne001
I will avoid rising to the bait (although I am biting my tongue hard ....).

I can only refer to my mum's diagnosis where the usual memory tests plus a brain scan was used. The brain scan showed signs of atrophy (alzheimers) plus evidence of vascular dementia. However, dementia is not like other diseases with broadly similar symptoms. So I am not sure that this helps you. Some dementia payments can use a microwave / TV remote etc (at least in the early / mid stages), some cannot. Some old people cannot use a TV remote and have no signs of dementia. Sadly, there is no hard and fast rule.

Re: Does "mental decay"/dementia show on brain scans?

Posted: Wed Apr 09, 2014 5:02 pm
by JHR57
My Mums GP diagnosed Vascular Dementia many years ago using just the memory tests, she has since had a brain scan and very detailed heart tests, GP said all the tests would only show what he already knew and indeed he was correct..... His advice to me was to let Mum do as much as she can on her own otherwise she would get completely dependent upon me and lose all confidence in the daily routines.... he even "told me off" for offering her my arm when we were leaving he surgery he said although she's a tad doddery she was perfectly capable of walking unaided .... I follow his advice to the letter and obviously do the things that would put her in danger but things like hanging a bit of washing out whilst I am there and pushing her push along carpet sweeper over the carpets and making a cuppa I am quite happy to let her do .......... Must admit I do almost everything else finances she just wouldnt have a clue and meals she can do but forgets to eat them so I go back just to make sure she's remembered to eat xxx

Re: Does "mental decay"/dementia show on brain scans?

Posted: Wed Apr 09, 2014 6:46 pm
by jenny lucas
JHR57 - that sounds encouraging! The situation I have, though, is different in that it isn't about my MIl trying to do things she might not be able to do, but simply not trying at all!

I've just now this moment been downstairs for three minutes as she called up to me 'are you there' and I gave my dutiful answer 'is it G&T time?' and she called back 'yes'....so down I went and fixed her G&T. There was no attempt whatsoever by her - nor has been, ever since she went 'dependent' on me in the autumn - to go into the kitchen to do her own G&T (Which she does perfectly well in her own flat still!). She just 'wants' me to do it for her. She'll actually come all the way upstairs to 'get' me if I dont' go down, and would rather trek slowly and effortfully up a flight of stairs, rather than go into the kitchen and get the lemon, tonic and gin out of the fridge herself.....

As for the remote - if her programme ends, and I'm not around to change channels to get the next programme she likes, when I go in she's watching a programme she doesn't like, because it came on after the previous one, rather than try changing the channel (she won't press any buttons at all, except the on off one).(A few visits back I used to try and show her how to change the channels, and 'made her do it herself', but she just reverted to not bothering afterwards, so I've given up!)

This is what I mean about 'has she lost the ability to do these things' or is she just 'getting me to do them becuase that's what she likes'! I sometimes think she likes getting me to do things for her not just (if at all?) because she's 'lazy' and it's easier for her if I do them than her (though, as I say, she's prepared to walk effortfully upstairs rather than make her own G&T), but because when I do things for her it reassures her that I am looking after her.....I think she may see it as 'proof' and reasurance that she is not being left to do things on her own...it's part of her comfort zone that I wait on her hand and foot at Hotel Granny....

And maybe, too, if I come in and see the TV is on a programme she obviously isn't keen on, and I sit down and fix it for her, she knows that she gets my company for five minutes extra as well (it doesn't dawn on her I'm doing 'other things'!) (nothing else in the world exists except doing things for her, she is 'Granny-centric' just about completely - unless I point 'other things' out to her.).

I suspect that when I do things for her I'm paying her attention, and she likes that, and it reassures her.....

(It could also be that, hey, she's a Leo - so 'homage' is part of the 'duty' that lesser mortals should be paying her!!!!!!)(sadly for her, I'm a Virgo, and so am both programmed to serve - BUT programmed to criticise as well!) (Her own MIL was a Virgo I've just discovered - and they never got on either!) (For anyone not into astrology, Virgo-Leo is a terribly incompatible combo!)

The other problem, of course, is that EVEN IF I take the line of 'get her to do more things on her own' GETTING her to do it - going over and over how to use the remote - is SO damn effortful, that I jsut do it myself! It's like getting kids to tidy up - takes so long to nag them that most mums just tidy up after them as it's faster!

As for mental decay overall, I appreciate that VD and Alzheimers are particular neurological conditions, with particular neurological defects and damage in the brain, but is 'old age confusion/senility/whatever it's called' actually a medical condition that is associated with a particular presentation in the brain at all? For example, when MIL is 'confused' about something or 'can't learn how to do the remote', would a brain scan show 'that bit' (whatever that bit is!) of her brain 'not working'?????

Re: Does "mental decay"/dementia show on brain scans?

Posted: Wed Apr 09, 2014 7:06 pm
by bowlingbun
As the mum of someone with brain damage, I know there are some "black holes"in his ability, he cannot do ANY maths, not even 2 plus two. There are, however a number of areas which are variable, and I've come to accept these. So maybe sometimes mum can do the hanset, sometimes not. But driving a 12 ton steam roller is no problem for my son.. He learned to swim, ride a bike and make a cup of tea before his normal brother. I can't expla in it, but I know it is true.The brain is very complex and we don't fully understand it yet. Learning to live with this sort of problem is difficult for me, but even more difficult for him. Have you ever asked Mil why she can't do her own drink?