Personality change calls for medical consultation

Aging column by Dr. Michael Gordon (08-17-2001)
Reprinted with permission from the Toronto Star

The mother called her daughter and asked when she was coming over. "I told you this morning that I’ll be over at noon," replied the daughter.

"Oh yes, see you then," said the mother.

On another occasion, the daughter arrived to take her mother to a hairdresser’s appointment. She found her still in her nightgown even though she had called an hour and a half earlier to remind her. When they returned from the hairdresser, the daughter went into her mother’s kitchen and found a pot with burned soup on the bottom.

"When did you burn the pot?" asked the daughter. "I didn’t burn the pot, what are you talking about?" replied the mother.

Then came the doctor’s visit. The mother usually went alone, but this time the daughter accompanied her. The doctor asked the mother, "So how are you tolerating the new medication for your knee pain?"

The daughter looked at her mother curiously, "You didn’t tell me you had knee pain and that the doctor prescribed medication." The mother appeared puzzled. The daughter turned to the doctor and asked, "Have you noticed anything wrong with my mother?"

"No," said the doctor, but she had seen the mother only once or twice a year and nothing seemed to have changed. She assumed that the patient was still taking her blood pressure medication and the pills for her hiatus hernia-related heartburn. The daughter recounted the episodes of forgetfulness. The doctor arranged for a full assessment.

When the daughter took her mother home, she went into the bathroom and looked at the medications. The bottles were almost full even though they had been refilled two months previously. Something was wrong.

In my experience I’ve found that the person closest to the individual in question may not notice the subtle changes for quite a while and simply attribute the problems to age or hearing loss. The spouse or child may be so used to directing activities that they don’t realize the other person is participating in decision-making less and less.

Sometimes it’s a visit from an out-of-town family member that brings the problem to the surface. "I can’t believe how much she has changed," is a phrase that I’ve often heard in my office when children accompany a parent to a visit to evaluate loss of memory and changes in personality. The children will then recount different events that in hindsight clearly signalled the beginning of a problem. An out-of-town daughter remarked to me how her mother became lost in her neighbourhood at the last visit even though she had been to her house many times before.

How do you know when it’s time to seek medical advice about a subtle change in a loved one’s memory or personality? It usually requires a number of repeated events for a pattern to develop. Since there is a natural decline in some elements of mental function with aging, many people attribute these changes to the aging process and therefore do not worry. Some people complain about problems with remembering names for example, but in fact had that problem all their lives. That is usually less worrisome than when the people are not aware they are having any problems with memory or that they can no longer do things that they excelled at in the past. A former accountant who can no longer add figures and is not aware that there is a problem is of greater concern than someone who could never balance a cheque book and still can’t.

When a problem is suspected, it should be brought to the attention of the family physician. Keep in mind that not every event of memory loss or personality change is due to a dementia such as Alzheimer’s disease. Many medical conditions can cause such changes including the effects of medication (both prescribed and over-the-counter), alcohol, underlying illnesses, depression and other types of dementia. A careful medical review, which may entail various tests, is necessary to put the pieces together. At times the family physician may request assistance from a specialist such as a geriatrician, neurologist or psychiatrist.

The biggest challenge for a family member is to recognize that an important change has occurred and to seek a doctor’s advice. There may be medical interventions that can change the course of the problem.

Dr. Michael Gordon is Vice-President of Medical Service at Baycrest, a professor of Medicine at the University of Toronto, and a member of the National Advisory Council on Aging.

These columns appeared in The Toronto Star in 2001 and 2002 and are reprinted with permission.