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Medical Forum / Diseases and Disorders / Alzheimer's / August 2004

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pick's disease/FTD

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Spandau - 03 Aug 2004 01:25 GMT
Hello to everyone.

I hope that I am in the correct group; is this the proper place for
support/inquiries concerning FTD/Pick's Disease?
My father-in-law was recently diagnosed, and things are beginning to get
strange. I would like to be able to help support my mother-in-law, who
doesn't have net access.

Best,
Spandau
back to reading anything I can find about this illness
Howard Goldstein - 03 Aug 2004 01:41 GMT
:  I hope that I am in the correct group; is this the proper place for
:  support/inquiries concerning FTD/Pick's Disease?
:  My father-in-law was recently diagnosed, and things are beginning to get
:  strange. I would like to be able to help support my mother-in-law, who
:  doesn't have net access.

I believe this an appropriate (as well as a warm and caring) place for
discussing Pick's and other dementing illnesses that might be
diagnosed as Alzheimer's for lack of a more specific diagnosis.  

Just one person's opinion, one who's LO was diagnosed as probable AD
but with symptoms that appear to be more along the lines of Pick's
than classical Alzheimer's.
Spandau - 03 Aug 2004 17:49 GMT
Spandau again, this time posting from work.
Thanks, Howard, for the welcome. :-) Well met, although I certainly wish
the circumstances were not so sad.

I have a couple of questions:

1) when is a durable power of attorney necessary? My FIL has already
begun misplacing/losing cash, making double and/or extra payments on
things, and bought an eighteen-foot truck on the spur of the moment. (To
clarify, he's in the steel business.) The business will be sold by the
end of this year, and my MIL has control of the checkbook and the books,
but they have many investments and loans out to people, and only FIL
knows about all of them. FIL would have to sign a durable power of
attorney, wouldn't he? Therefore, he'd have to be legally competent?

2) How does one go about dissuading a person with dementia from driving
without making the person hate you for taking away his independence? My
FIL, like many FTD sufferers, tends to just drive off with no notice, or
obsessively go places (like the post office). He had a fender-bender
accident back in February, before he was diagnosed, that fortunately
only involved his truck and a guardrail. He doesn't get lost so much as
I think he forgets/gets distracted from where he is going. My MIL
worries that he will be involved in an accident.

Thank you so much for listening to me. These are very difficult
questions for me to have to ask.

Spandau

> :  I hope that I am in the correct group; is this the proper place for
> :  support/inquiries concerning FTD/Pick's Disease?
[quoted text clipped - 11 lines]
>
>  
Songbird - 03 Aug 2004 20:46 GMT
> Spandau again, this time posting from work.
> Thanks, Howard, for the welcome. :-) Well met, although I certainly wish
[quoted text clipped - 10 lines]
> knows about all of them. FIL would have to sign a durable power of
> attorney, wouldn't he? Therefore, he'd have to be legally competent?

*When* is it necessary? Now. (Heck, *I* have one and I am 44 and healthy!
Auto accidents are no respecters of age or health!) Get one as soon as
possible. Is he willing to sign one? If he is willing to, and he can make
that clear to the attorney that he knows what he is doing, he will probably
be considered legally competent -- and most attorneys are wise to how to ask
the questions in the way that helps the family but covers them ethically and
legally as well. If he's not willing to, you may have to wait until he is
incompetent and have a conservatorship put in place. But keep in mind that a
DPOA won't keep him from doing any of the things you mention -- it is
parallel authority, not a replacement one. (And while you're at it, get MIL
to sign one too just in case -- what if she is suddenly incapacitated at
this point? Who could access the checkbook? Complete sale of business?)

Also "debrief" him ASAP on who owes him money -- veil it in the vague "if
something were to happen (my expression is always "If you got hit by a bus
tomorrow") to you, we want to make sure Mom's getting what's coming to
her..." if necessary

> 2) How does one go about dissuading a person with dementia from driving
> without making the person hate you for taking away his independence? My
[quoted text clipped - 4 lines]
> I think he forgets/gets distracted from where he is going. My MIL
> worries that he will be involved in an accident.

You can't. But what worries you more -- his hating you, or the guilt knowing
he killed someone and you could have stopped him? "Break" the car if you
must. Pull the spark plug wires, hide the keys, install a kill switch that
only your MIL knows location of. For some people, having the doctor write a
"prescription" that says he can't drive any more works. In some places, a
diagnosis of FTD or any dementia is enough for doc to contact Dept. of Motor
Vehicles. They will either automatically cancel his license or call him in
for retesting. Fortunately, this was an easy one for me -- Mom always hated
driving and was glad to give it up. It was harder to convince my *Dad* she
needed to give it up. ("What if I am sick? Who's going to drive me?" An
ambulance, or a taxi, or me. Having others help -- foreign idea.)

> Thank you so much for listening to me. These are very difficult
> questions for me to have to ask.

Spandau, we have all been there, are there and will be there. No matter how
difficult, stupid, silly or odd you may think the question -- ask! It helps
all of us to help someone else through the muddle.

Songbird
Mary Gordon - 04 Aug 2004 01:44 GMT
Hi Spandau,

Get your skates on and see a lawyer, STAT. Someone in the family
absolutely MUST have a power of attorney for both financial and
medical decisions for both your FIL and MIL - in some places they are
a single document, and in some places two, so make sure both are
covered off. Having powers of attorney signed and ready doesn't mean
you need to invoke it until you have to, but its important to have
them in place. If you don't, the family will end up in court to get
the authority to manage the affairs of both parents (i.e. if your MIL
becomes ill, no one will be able to look after either your FIL OR her
without going to court - which is a lot of very expensive and
frustrating bother. You should also make sure your FIL has a valid
will that has been reviewed in recent years to ensure its still up to
date and appropriate per his wishes. Many people write a will and
never change it, despite the fact that their life circumstances have
changed making the terms inappropriate. Also, check all his insurance
policies, pensions etc. to see if the beneficiaries listed are as per
his wishes (i.e. I mention this because my father's insurance had my
mother listed as beneficiary, and she'd been dead for 17 years, and
this created a lot of problems for me which could have been avoided if
he'd updated the policy information after she died - check and make
sure he's got current names on his policies etc. He may be still able
to sign things, but don't delay for another week - get this stuff
organized and in place.

A lawyer should also be consulted to assist with structuring finances
to protect your inlaw's assets and estate as much as possible - your
father in law is likely to need very expensive care shortly, and there
are things that can be done to help preserve funds for your mother in
laws use in later years - and since the rules are very complex and
vary from place to place, even within a single country, you need some
expert advice to help navigate! Your MIL must also spend time trying
to get your father in laws affairs in order, so she knows whats what -
she will be managing the whole thing in short order, with whatever
support she will accept from family or hired experts. Time also to
quiz your father in law to find out what she can about loans - she
should write down what she can find out, so even if she hasn't got all
the details, she has somewhere to start.

I'd work on the legal and financial stuff first, just to make sure
that everything is in place ASAP (like yesterday). On the driving
front, depending on where you live, the doctor may have a legal
responsibility to report him to the licensing authority, and if he or
she has not done so, the subject should be broached with the doctor.
Failing that, YOU can report him as potentially incapable of driving
safely by writing the licensing authority  a letter describing the
diagnosis (they won't tell your FIL who "finked him out"). What
usually follows is a request for the person to complete either a
special assessment of their ability to drive, or actual road and
written tests. Keep in mind that dementias like Alzheimer's and Pick's
don't just affect memory, but the ability to reason, focus attention,
muscular coordination and reaction times, depth perception, emotional
control, judgement etc. etc. - all things you need in order to be able
to drive a car safely. You have a duty to him, but also an overriding
duty to help protect others he may be endangering, so don't hesitate.
Driving is not a right, but a priviledge based on the person having
the ability to do so safely, so don't feel guilty, and go with your
gut. He's already had a fender bender, and this disease will progress
rapidly.

Mary G.
Tumbleweed - 04 Aug 2004 07:56 GMT
<snip>

> 2) How does one go about dissuading a person with dementia from driving
> without making the person hate you for taking away his independence? My
[quoted text clipped - 4 lines]
> I think he forgets/gets distracted from where he is going. My MIL
> worries that he will be involved in an accident.

Do it via the doctor or a letter to the DMV. IF you write your doctor then
he'll also have to report your FIL because of the potential legal
cosnequences if he doesnt. As others have posted you'll also have to have
something 'happen' to the car because otherwise he'll probably forget he's
been banned (assuming Picks is like Az)

Signature

Tumbleweed

email replies not necessary but to contact use;
tumbleweednews at hotmail dot com

Dennis P. Harris - 05 Aug 2004 07:31 GMT
> 2) How does one go about dissuading a person with dementia from driving
> without making the person hate you for taking away his independence? My
[quoted text clipped - 4 lines]
> I think he forgets/gets distracted from where he is going. My MIL
> worries that he will be involved in an accident.

If he's been diagnosed, his doctor SHOULD already have written
the DMV to have his license cancelled!  If not, ask doc if she/he
wants to be liable if your FIL kills someone.  Have the doctor be
the bad guy.  If he continues to drive after losing his license,
tell your local police department, giving them a description of
his vehicle and its license number.
Spandau - 05 Aug 2004 12:31 GMT
This is a general thank-you to all the people who responded. Just the
knowledge that there are others who have been there, done that makes me
feel a lot better. Thank you all.

I spoke to MIL last night, and she's dealing with the legal/financial
matters. I also spoke with her about the driving issue, and I think she
understands what a serious matter it is. Ironically, my FIL has
succeeded in losing *all* the keys to his truck, so at least he can't
drive it, but he's now begun asking my MIL for the keys to *her* car. <sigh>

Thanks for the info about the DMV. My worry is that he won't give a damn
about having a valid license, but will just try to drive as long as he
can get keys to a vehicle. He's not a nasty person, but he is very
stubborn.

Best,
Spandau

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