Diane,

It all sounds very familiar.

There is one tip that I almost forgot about.  It has to do with the
inappropriate dressing, etc.

My mother in law was always a pretty woman and a bit of a clothes horse and
she loved to try on clothes over and over.   I would do all the wash and
hang all the stuff in her closet and find she had them all pulled out in a
mess laying on the bed in a jumble.   It would drive me crazy.

Simplify.   One day when she is not looking, go through her entire wardrobe
and discard or put away anything that is inappropriate for the season, or
for her lifestyle anymore.   Keep only a few things in her closet, the kind
of things that are appropriate for the season and for what she does and
where she goes.   My mother in law would want to wear her best outfit every
day and her mink coat in the summer.    Too many choices will confuse her.

I ended up getting rid of almost her entire previous wardrobe.  So many
pieces were stained beyond redemption, or so out of style, or just
inappropriate for her life anymore (high heels, satin dresses).

I ended up buying her all new clothing, all new underwear, all new sweaters,
just everything.....which worked out well.   I bought nice looking matching
outfits that were easy to pair up and put on the same hanger.   I'd just
grab a hanger and it was a set for one day.

We found that quite early on somebody had to sit with her as she dressed.
She couldn't make decisions anymore what she needed to do next.   It was
like dressing a three year old.  You have to be there and be able to say
"not that way, it's backwards" or "now put on your shirt" or "here's your
socks"  or underwear or shoes, or whatever.

Back to the bathing....I cannot even begin to think how people manage with
only a tub.   Trust me when I say that the shower worked out best for us.
We have one bath with a shower and one bath with a tub.   We tried the tub,
but the shower worked out best.   It had a shower stool and the shower head
on a long hose, and enough room for someone to assist her.   They get
unsteady on their feet.  They tend to fall easily.  Getting in and out of a
tub can be very difficult.   That is why most of the nursing homes only use
showers.

Diane, have you considered using adult daycare by any chance?   It was a
lifesaver for us.   We put my mother in law in a local adult daycare center
and they picked her up by bus in the morning and dropped her off in the
afternoon.   We could sometimes rest, shop, sleep, or just enjoy the
respite.   They did all sorts of nice things, and I believe it preserved her
functioning somewhat.   That will be the subject of another posting, if you
like.

It sounds to me as though you are at the point where she is just now
beginning to need constant supervision with almost everything.... such as
bathing, dressing, etc.    You might need to resign yourself to that pretty
soon, you know.   Every person is different.   My mother in law never forgot
who we were, nor did she ever forget how to comb her hair, but she forgot
how to bathe and cook for herself as some of the very first symptoms.   Each
little loss needs to be dealt with.

Hi Diane, below my signature I've pasted the most commonly used set of
"stages" - these have become the standard descriptions. I'd say she's
late Stage 5 or early Stage 6 by the behaviours you are describing.
She's also likely more impaired than you realize and on more fronts.

Mary G.

Adapted from Reisberg, B., Ferris, S.H., Leon, J.J. & Crook, T. The
global deterioration scale for the assessment of primary degenerative
dementia. American Journal of Psychiatry, 1982.

Level 1

No cognitive decline - (or Normal Adult). No subjective complaints of
memory deficit. No memory deficit evident on clinical interviews.

Level 2
Very mild cognitive decline (forgetfulness or normal older adult).
Subjective complaints of memory deficit, most frequently in the
following  area:
(a) forgetting where one has placed familiar objects;
(b) forgetting names on formerly knew well.
No objective evidence of memory deficit on clinical interview. No
objective deficits in employment or social situations. Appropriate
concern regarding symptoms.

Level 3
Mild cognitive decline (early confusional or Early AD). Earliest clear-
cut deficits. Manifestations in more than one of the following areas:
(a) patient may have gotten lost when traveling to an unfamiliar
location;
(b) co-workers become aware of patient's relatively low performance;
(c) word and name finding deficit becomes evident to intimates;
(d) patient may read a passage of a book and retain relatively little
material;
(e) patient may demonstrate decreased facility in remembering names
upon introduction to new people; (f) patient may have lost or
misplaced an object of value; (g) concentration deficit may be evident
on clinical testing.
Objective evidence of memory deficit obtained only with an intensive
interview. Denial begins to become manifest in patient. Mild to
moderate anxiety accompanies symptoms. Deficits noticed in demanding
employment situations.

Level 4
Moderate cognitive decline (Late Confusional or Mild AD). Clear-cut
deficit on careful clinical interview. Deficit manifest in following
areas:
(a) decreased knowledge of current and recent events;
(b) may exhibit some deficit in memory of one's personal history;
(c) concentration deficit elicited on serial subtractions;
(d) decreased ability to travel, handle finances, etc.
Frequently no deficit in the following areas:
(a) orientation to time and person;
(b) recognition of familiar persons and faces;
(c) ability to travel to familiar locations.
Inability to perform complex tasks. Denial is dominant defense
mechanism. Flattening of affect and withdrawal from challenging
situations occur.

Level 5
Moderately severe cognitive decline (Early Dementia or moderate AD).
Patient can no longer survive without some assistance. Patient is
unable during interview to recall a major relevant aspect of their
current lives, e.g., an address or telephone number of many years, the
names of close family members (such as grandchildren), the name of the
high school or college from which they graduated. Frequently some
disorientation to time (date, day of week, season, etc.) or to place.
An educated person may have difficulty counting back from 40 by 4s or
from 20 by 2s. Persons at this stage retain knowledge of many major
facts regarding themselves and others. They invariably know their own
names and generally know their spouse's and children's names. They
require no assistance with toileting and eating, but may have some
difficulty choosing the proper clothing to wear.

Level 6
Severe cognitive decline (Middle Dementia or Moderately Severe AD).
May occasionally forget the name of the spouse upon whom they are
entirely dependent for survival. Will be largely unaware of all recent
events and experiences in their lives. Retain some knowledge of their
past lives but this is very sketchy. Generally unaware of their
surroundings, the year, the season, etc. May have difficulty counting
from 10, both backward and sometimes forward. Will require some
assistance with activities of daily living, e.g., may become
incontinent, will require travel assistance but occasionally will
display ability to orient in familiar locations. Diurnal rhythm
frequently disturbed. Almost always recall their own name. Frequently
continue to be able to distinguish familiar from unfamiliar persons in
their environment. Personality and emotional changes occur. These are
quite variable and include
(a) delusional behavior, e.g., patients may accuse their spouse of
being an impostor, may talk to imaginary figures in the environment,
or to their own reflection in the mirror;
(b) obsessive symptoms, e.g., person may continually repeat simple
cleaning activities;
(c) anxiety symptoms, agitation, and even previously nonexistent
violent behavior may occur;
(d) cognitive abulla, i.e., loss of willpower because an individual
cannot carry a thought long enough to determine a purposeful course of
action.

             6a - Requires Assistance dressing
             6b - Requires Assistance bathing properly
             6c - Requires Assistance with mechanics of toileting
             6d - Urinary incontinence
             6e - Fecal incontinence

Level 7
Very severe cognitive decline (Late Dementia or Severe AD). All verbal
abilities are lost. Frequently there is no speech at all - only
grunting. Incontinent of urine, requires assistance toileting and
feeding. Lose basic psychomotor skills, e.g., ability to walk, sitting
and head control. The brain appears to no longer be able to tell the
body what to do. Generalized and cortical neurologic signs and
symptoms are frequently present.

      7a - Speech ability limited to about a half-dozen intelligible
words
      7b - Intelligible vocabulary limited to a single word
      7c - Ambulatory ability lost
      7d - Ability to sit up lost
      7e - Ability to smile lost
      7f - Ability to hold up head lost

Diane,
My Mom is in one of the early stages, but was forgetting to bath
(actually she thinks she is doing it quite frequently, but we know
different). My sister-in-law started running her bathwater before she
gots dressed for the day and when Mother asked why she was doing that,
she would just say that she thought a nice bath would feel good and
relaxing. Mother didn't argue with that, so when I took over the
bathing, I told her the same and now she doesn't even question it. At
times she will say she just had a bath yesterday and that I don't need
to help her, I just say that I like doing that for her and she usually
just gets in the tub. We do have hand rails to help her get in and
out. So far that still works.
Sue