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My 73-year-old mother has multiple physical issues and a diagnosis of early cognitive disorder. She has a history of RX abuse, medicating herself to the point that she forgets medicating herself and is adversely affected by too much medication. She refuses to accept that she needs assistance with her medication management, as well as in home assistance for cleaning, laundry and personal care. None of the doctors she sees will say she is not competent to direct her own health care. Multiple doctors continue to give her medications that contribute to her stumbling, slurring words and cognitive disability. What kind of assistance is available to help her so that she does not mismanage her medications and go without homemaking and personal care? We have medical powers of attorney only if she is unable to make decisions for herself. No doctor will step up so that we can improve her situation. Help.

I'm not aware of a medical diagnosis called Early Cognitive Disorder. If the diagnosis is Mild Cognitive Impairment (MCI) then the patient must have been evaluated by a neuro-psychologist who administered extensive neuro-psychological performance tests and analyzed the results. There is an amnestic MCI and a Multidomain MCI variant with different implications for the rate of progression to dementia. Most patients of MCI are competent to make their own decision for various matters.

This patient should be evaluated at a formal memory disorder center for her possible MCI and should also choose a geriatrician to be her PCP (Primary Care Physician) to simplify her drug treatment regimen and avoid drugs interaction and toxicity side effects.

P Liem

I totally agree with Dr. Liem's words, "This patient should be evaluated at a formal memory disorder center for her possible MCI and should also choose a geriatrician to be her PCP to simplify her drug treatment regimen and avoid drugs interaction and toxicity side effects."

If it is difficult to get her to the center, call our office, Alzheimer's Arkansas (800-689-6090) for some brain-storming about the best means to get her there.

If that fails, there are also several geriatric-psychiatric units around the state. These in-patient units, while not appropriate for everyone, can evaluate the medications and prescribe appropriately. Involuntary commitment is possible.

In the meantime, it sounds as though Mom should not be living alone. If she won't accept any assistance, then as a last resort, Adult Protective Services (800482-8049 for Randolph County) can be called to evaluate her living conditions.

Phyllis Watkins

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