Does my husband have symptoms of dementia?

A fellow caregiver asked...

Does my husband have symptoms of dementia? My husband, 70 years of age, has lung cancer, and has been pink slipped by three hospitals over the last 3 years; his behavior is erratic and unpredictable, often happening rapidly from up to down. He has been tested twice and and seems to be able to fool the cognitive/mental tests; yet he is often confused, repeats questions over and over, forgets, changes mind, often within minutes and lies. Some days he seems to be able to function more normally, but I never know when he will change his mind or find out that his statements are untrue. He has made some very bad personal decisions, financial, relationships, acquisitions. Everyday living with his behavior is a nightmare. His brain MRI shows atrophy of frontal/temporal lobes, previous history of depression. I am not getting much information from any professionals. Any idea of what is happening to this man to cause his increasingly abberant behavior? Are these signs of dementia?

Expert Answer

Lisa P. Gwyther, a social worker specializing in Alzheimer's services, is the author of The Alzheimer's Action Plan. An associate professor in the Duke University Medical Center Department of Psychiatry and Behavioral Sciences, she's also a past president of the Gerontological Society of America.

Your husband has obvious dementia symptoms, somewhat consistent with one of the less common, younger onset dementias called frontal temporal dementia (FTD).  His ability "to fool" the testers is typical of people with FTD.  First, ask yourself if this is a significant change from the person he was (when he wasn't depressed). People with FTD initially have less noticeable memory complaints, and more prominent changes in personality, mood, behavior, insight, judgment and empathy (his ability to understand your feelings).  His MRI would suggest a frontal problem which could be an atypical depression, but regardless, it will affect his "executive function" or ability to plan and carry out wise personal or financial decisions.  He may have recent onset of addictive or compulsive behaviors or he may seem to have lost inhibition or his social censor which reminds him what is appropriate public behavior.  Perhaps his oncologist could encourage him to see a specialist in memory disorders?  Perhaps you could get him to see a specialist for a symptom that IS bothering him or which seems less stigmatizing or more familiar to him.? Could you suggest he may be depressed again, and there are successful treatments for depression?  The goal of adequate diagnosis and treatment justifies the means. Find a way to deliver a description of his symptoms to the specialist before the appointment or at least when your husband is not present.  If it is FTD, it is a very tough diagnosis and perhaps the toughest on families.  The unpredictable Jekyll and Hyde behavior and his lack of judgment pose real safety risks for both of you.  Don't give up on getting a diagnosis and finding a psychiatrist or memory disorders specialist who will work with you.   Remember, if he does have FTD or a dementia diagnosis, he is behaving in ways he wouldn't normally choose.  His statements are untrue not to spite you, but because he can't think, reason or control his behavior as he has in the past.  You will have to learn to work around him, rather than confront him and ask him to change.