How do I know if my mother-in-law's symptoms are related to her cancer or dementia/

A fellow caregiver asked...

My mother-in-law was diagnosed with Alzheimer's five years ago and the past 16 months she has required us to live in with her. She was also diagnosed with lung cancer eight months ago that has metastasized to her bone and also soft tissue.

My husband and I are having a lot of problems trying to separate the problems and symptoms we are seeing and know if they are from the dementia or from the cancer and where it could be spreading too. Other siblings choose to see only the cancer problems and not the dementia. As her live in caregiver, I see all the problems, some from the advancing dementia and some from the spreading cancer.

My mother-in-law is too far advanced in the dementia to be of much help in telling me problems she is having because she can not find the words to explain it. I just would like to know how to combine the care for each of these diagnoses. I am burned out on trying to be all things to her and no help.

Expert Answer

Helene Bergman, LMSW, is a certified geriatric care manager (C-ASWCM) and owner of Elder Care Alternatives, a professional geriatric care management business in New York City. She consults with nursing homes and daycare programs to develop specialized programs for Alzheimer's patients.

Caring for someone with dementia and another life threatening disease like cancer that has already metastasized can be very demanding. You try to give comfort and treatment but you are not sure it is what your mother-in-law wants or needs.

Often metastasized cancer can affect the brain and at this point she may be exhibiting confusion or other dementia symptoms from its spreading. Perhaps a brain MRI or scan might be helpful to assess this for further treatment.

As you probably are aware, if she is exhibiting behavioral pain (anxiety, anger, restlessness), it may not matter whether it is from the cancer or the dementia. You cannot separate the two and you would treat it the same way- with tolerance, reassurance, and assistance. If she is in pain and unable to express this, her behavior might be her way of expression and you can try different methods of pain relief from a massage to a warm bath to a sweet treat.

It sounds like it is hard for the family to understand and accept your mother-in-law's dementia and this makes it more challenging for you. Since you are providing the day-to-day care, maybe you need some respite if they would be willing to share the caregiving.