My mother is over 90, lives alone, cooks, cleans, writes checks, goes to church etc. - is "ok". In the last 6 months, she believes a crew comes in at night to work on things in the house (rearranges bricks in the fireplace, paints walls, etc.) and a woman steals her clothes, but replaces them with old ones. She wants to call the police to report it and make them stop. What should I do? (she's been tested recently for dementia by GB and neurologist and passes all the test just fine)
I'd talk to her doc about that.
Alprazolam (Xanax) is a benzodiazepine used for anxiety. You say she takes it in the morning so, theoretically, it should not be affecting her dreams. However, elders metabolize medicines more slowly than everyone else. So maybe it's having something to do with her perception of "the workers". The elderly are very sensitive to all meds and, if she still needs an anti-anxiety pill, may be changing to a different one that has a shorter "half life" (how long the effects last) would work better.
You haven't said if this occurs during her sleep, when she would be dreaming.
Is she awake when she thinks this is happening?
Does she "see" anyone doing work?
I think it would make a difference if this "work crew" was a DREAM, then she wakes up in the morning and tells you about it, as opposed to being awake and having "sightings" of imaginary people.
Either way her doctor should be informed.
Ask for a urine test with "culture and sensitivity". This is a more specific urine test (where they actually try to culture any bacteria) as opposed to the "dipstick" which relies on heavy concentrations of bacteria to show a reading.
Also, the "mini-mental" test for dementia is pretty basic. If you can remember how to write a sentence and draw a clock, you pass. I'd suggest the 100 question test with a geriatric neurologist. It will be much more accurate at predicting any dementias.
Have you read about "sundowners syndrome"?
Many times the person seems fine during the day but, as it gets dark, the confusion starts.
Good luck.
But as dementia processes begin, or even well-advanced 'normal aging', our pattern-recognition skills can betray us. When I can't remember where I put something, it's tempting to say 'I always put the keys on the table; they're not there; therefore Someone Must have TAKEN them.' Because the alternative is more like 'I always put the keys on the table, but this time I didn't. Oh rats!'
When I've given away a favorite sweater because it's too tight, I will often look for it again next winter. Nowadays it can take me a long moment to realize that I gave it away. It's only a short step from that to wondering 'who took it?' Especially if I've ever been victimized by theft before.
Reassuring her that she's safe may help. Taking her seriously may help. Also ... increasing the brightness of the light she uses in the daytime may help. And making sure she has a dark-enough bedroom to get good sleep, with a tiny nightlight on the way to the bathroom to prevent falling.
Good luck to you!
Since you indicated in follow up posts that you are getting some additional testing done, the best this to do is try to cope until those tests/results are done. As others noted, the simple test a PCP might administer will not really resolve anything. In the early stages of dementia, many can "pass" this test. Another thing is that a PCP or other doctors do not see mom on a regular basis, or for long during their exams. To really "see" the early onset, one needs to know what was "normal" before and how that has changed. Sometimes it can even be difficult for someone who lives with the person, because it is such a gradual change at that point - someone who has regular contact, but not all the time is more likely to spot the changes (my brothers did not see it until it became obvious - I called several times/week, visited multiple times in a month, so when the repetition and inability to recall recent information started, I took the time to lookup information on dementia and was therefore aware much sooner than they were (and more armed with what to expect and how to deal with some issues. They are still mostly clueless!)
Now, saying your mother is over 90, lives alone, cooks, cleans, writes checks, goes to church etc. - is "ok", really does not cut it. Our mother was also just over 90, lived alone, claimed to be cooking, cleaning, handling finances AND driving. The car/driving was the first issue to resolve (actually second, I mention finances below.) The accident prior to this becoming obvious was just chalked up to old age and being nervous, but having an expired inspection sticker, no clue how the back of the driver mirror disappeared and reporting a flat when it was a split tire with a ruined rim with no idea how it happened, with some other minor damage, we (mostly I) decided the car had to go. I took her for groceries, but had to clear out old freezer burned chicken and stop her from buying more as she had some that was still good in the freezer. Subsequent visits I would find the fresh veggies, etc all dried up or moldy in the fridge. Her mantra to anyone who tried to tell her she needed help or to move to AL was she was independent, could cook and take care of herself. In reality, she could no longer cook and was relying on frozen dinners and packaged foods. We had already arranged to move her to MC when she injured her leg, told no one but the neighbor (who reported a bruise on her leg) and could have died from this as it was really not a bruise, but cellulitis. So obviously she could NOT cook OR take care of herself. I had already taken over the finances because of errors, over-payments, under-payments, etc. So, unless you are monitoring these things carefully, she may just be pulling the wool over your eyes! Take a REALLY good look around the place (under beds, behind furniture, the freezer, cabinets, etc) and if possible check her mail/bill statements to see if they are over/underpaid or just plain overdue! Find a way to go over her financial statements for the last 3-6 months.
Many months prior, around the time we hired people to come check on her and ensure she took her meds (put them in a locked pill dispenser), one brother installed cameras at the front door (in and out) and the basement finished area. From this we witnessed HER version of sundowning - at night, just before bed, check the door lock, sidelights, something in the kitchen (camera view did not reach that far) and then the LR (light turned on then off would shine on the cabinets through the "pass through" window.) It was not until the other brother was up to "visit" and check out MC places that we found out the kitchen check was the dishwasher. This started out a few times/week with only a couple of iterations, and was somewhat amusing at first. But eventually this became a nightly marathon, running an hour to an hour and a half of checking these same things over and over and over... This would trip the camera every time she passed through!! I was getting 2 alerts every few minutes during that 1-1.5 hours! She also accused multiple people of taking items from her, when it reality she just had no clue what she did with the items. Except for a few times where she "snuck up" on the sidelights to look out (expecting the boogeyman?) and one time she seemed to trip on something, put her hand on the door to steady herself and then stared up at who knows what, we have no way to know if she was hallucinating. It is possible. Maybe she suspected someone was in the LR, resulting in that check. There was really no reason to check there (I can understand a lock check, but the rest? NO.)
She never reported anything to us, but she could have had some minor hallucinations. The cameras also allowed us to see that she was wearing the same clothing for up to 7-8 days!! I will wear something over again, no big deal. Mom however has more clothes than Marshalls or TJs (had no clue how much until we moved her out - OMG!!!) She always liked to "dress" for the day, so to see her wearing the same items over and over, even when they were "dribbled" on, was another clue. She also denied going to the basement area, but the cameras told us otherwise!
Although mom's condo also seemed to be "clean" and "well kept", she was not doing much to "dirty" it and after we moved her we find that although obvious minor cleaning was done (dishes, counter, sweep floor of kitchen), more intense cleaning was NOT getting done. Deep cleaning? Forget it. Sooo, unless someone stays there for a week or more, you really cannot be sure what is going on and what is/isn't getting done (including finances - does anyone help her balance the account each month, or ensure the bills are paid correctly?)
As for your brother, being unable to "cope" with her and "lashing out", this makes me suspect even more that she has some kind of dementia. People who are not informed about dementia and how to handle those who have it can often get frustrated, annoyed or angry with the behaviors they are seeing/dealing with. If mom is telling him these "stories" and he tries to contradict or correct her, mom is likely to get testy, which WILL frustrate your brother and can lead to "lashing out" in anger. This IS her reality and one needs to know how to "go along" with it, agree with whatever and make up how to handle it best as you encounter it. Offering to "check" on things, distracting her, changing focus when possible to something else, whatever works, just go along with her and agree.
"We did go to the police and they sent someone out to check the house, she said the policewoman didn't know anything." Of course the police do not know anything! If someone told our mom something she did not want to hear or agree with, they were labeled idiots (actually something else, but idiots works!) No one, and I do mean NO ONE is going to convince your mom that this is not going on. It IS her reality. Having the police aware of the issue is about the best you can do, so that if she does call them they can try their best to handle it (I'm sure dementia training is not included in all the training they have to go through, although some may be aware of it as they have friends or family dealing with this.)
So, again, getting that specialized assessment and possibly some medication that can alleviate the hallucinations or eliminating anything that might contribute to the hallucinations will be the first step. Meanwhile, learn all you can about dementia and educate the siblings as well. They may balk at this too - my older brother scoffed at a link I sent to him about sun-downing, because it was labeled "sleep disorders" on the website. READ IT, it has nothing to do with sleep really, but it CAN explain what we were seeing on the cameras! If she is deemed to have dementia of some kind, you and your siblings are going to have to start making some arrangements. It is good that at least one of you is checking on and helping her every day, but as this progresses, she will not be able to live alone. Someone will have to move in, have her move in with you, hire caregivers or consider AL/MC. I am pleased to see that you all three are working together to help mom!! THAT is a huge blessing for you!!!
She did grow out of it, and I am sorry that it won’t go that way with your mother. Perhaps it might help to say ‘I’m glad they didn’t do any damage, perhaps they are lonely and just curious, now the most important thing is for you to be glad for that and not worry’.
In some cases, it may be safer to prescribe Zyprexa for patients with dementia who exhibit hallucinations, anxiety, or delusions. As with any other antipsychotic medication, however, caution is warranted. At a minimum, genetic testing could be used to determine if your mother has the potential to have adverse reactions to medications in general, or to antipsychotics in particular.
My mother suffered from Neuroleptic Malignant Syndrome (NMS) after the administration of high doses of Haldol Decanoate (which they administered without my knowledge or consent). Be assured that NMS is a rare disease. You can be reassured that Zyprexa does not pose the same level of risk as Haldol Decanoate, which is just about the worst of the worst. My mother survived 3 years and 2 months with NMS; I cannot say that it was an unadulterated miracle. She lost all her muscle mass, suffered from neuropathy, and lived through 3 strokes. Hers was a miracle that extracted a very high cost.
If it were my mother, I would want to see the results of genetic testing to determine what, if any, medications pose medical risks to her. Please exercise due caution.
I'm sorry if my post was misconstrued... I only mentioned our story as it seemed similar ( scary thoughts.. scary images) I thought I was careful to say that all I did was tell the neurologist what my mom seemed to be experiencing. After he listened HE prescribed the medicine for a small dose to begin and see if it was a solution. In my mother's particular situation thank goodness it was the right thing. It's been 4 years and no bearded men and no purple monsters. I certainly did not walk in to her doctor office and state " I'd like some Zyprexa please"... most docs wouldn't handle that very well. I was just saying what worked for us.... certainly your mom's neurologist may say something completely different.
Blessings !!