Husband issues / help me diagnose?

[anon98765]

(Please do not quote, reserving the right to delete later.)

Here goes... my husband's lack of common sense / executive skills is so extreme, I am wondering if there are deeper issues at play besides depression/anxiety/ADHD and possibly something physical. Putting this out here in case anyone has dealt with something similar and can help with any insights.

I should note that he has had neurological exams and everything came back normal.
He has been (and continues to be in) therapy for years, takes medication for depression and anxiety, but nothing is helping.
He tried ADD medications a few times and they did not help either.
Let me share some symptoms and examples.

Symptoms, which are all progressively getting worse
- terrible memory
- lack of anticipation / extreme impulsivity
- lack of observation
- not understanding simple things / asking for clarification when it is not needed
- no accountability / sense of responsibility
- lack of urgency
- extremely limited participation / curiosity of the life around him
- inability to learn from consequences of his actions
- extreme defensiveness and denial of the above problems

Some examples to illustrate the above.

- He smells gas and gets up to look at the stove. Does not see anything turned on, gives up looking, and decides it does not really smell like gas. Does not inform anyone. (What actually happened: one of the knobs was turned on, he claims "he did not see it.") This situation could have put him and his family in danger, but there was no anticipation of "something bad can happen if I don't alert others because I can't solve the problem". Instead, he convinced himself the problem did not exist in the first place. This issue manifests itself daily, from not finding a specific thing he wants and "deciding he didn't really want it" to something life threatening like the above example.

- Car makes a strange noise that is clearly not normal. He simply forgets about it. Does not mention anything until someone else discovers it and brings it up and then responds nonchalantly with no sense of danger that yeah, he heard that sound too. What actually happened? Brakes were failing.

- We take the kids skiing and the youngest keeps falling. It's difficult to get up on skis, especially when it's your first time. Husband is right there next to the kid and husband is NOT on skis. He does nothing until he is told to pick up the kid. This happens about 20 times in a row. Every single time, he needs to be told to help the kid up.

- We are driving on a narrow road where cars do not park. We need to stop in front of a house to get something, which requires getting out of the car. He decides it's ok to stop "real quick" because there is no one behind him at the moment. With zero anticipation for the fact that there may be (and will be) someone behind him a few seconds later. This keeps happening, despite him claiming (after the fact) that he understands why this creates a dangerous and inconsiderate situation.

- Similarly, he exits a hospital parking garage to pick up a patient waiting in the lobby and parks right in front of it, blocking the exit from the garage, while he gets out and goes inside the lobby. He is aware of this but decides it's ok because "he'll only be a minute" and there was no one behind him in that second. What actually happened? Cars could not exit the garage, a tow truck was called, and he got very lucky he got back before he got towed. Note that there are pickup spots specifically for this use case a couple of yards ahead of where he parked.

- He help the kids with the shower and leave the shower curtain wide open, not anticipating that water will go on the floor. The curtain does not need to be wide open. Water from the shower will form a huge puddle that he "does not see". He is shown the puddle, recognizes and agrees that needs to clean it up, and then immediately forgets. This happens repeatedly.

- He has a heavy pot in both hands that needs to go to the fridge. He does not anticipate needing to open the fridge to put in the pot. He walks over with both hands on the pot and tries to open the fridge while holding the pot (an impossible task).

- A few times, while driving the kids to school, he will drive by the school and keep going. The kids have to tell him he passed the school. He drives them every day.

- I ask him to bring me something. He grabs it and puts it in his pocket. Then comes over and stands by me. I ask why he is not giving me the item and he says because I did not tell him to take it out of his pocket!

- In terms of cognitive ability / lack of understanding - we will need to make a decision (say a simple thing like plan for the weekend), he will get distracted by a small detail, go off on a tangent, and never realize that we never actually closed the loop and made a decision. He also gets extremely confused with understanding simple things and is terrible at explaining things, skipping relevant information. And when he is told that he is not being clear, he just repeats the same thing and does not take steps to adjust.

- He does not do what he says he will. He either forgets or puts it off, but seems to be lacking a sense of responsibility / accountability because this is ongoing. The urgency of the matter / consequence if it does not get done has zero impact. 

Unfortunately, this is a small sampling of examples. There are a handful (or more) of these occurrences each day.
To make this worse, he is extremely defensive and cannot accept the reality that there is a pattern to his actions and deep, very general problems (as opposed to a specific one-off). He does not learn from consequences, regardless of how terrible they are.

Separately, he has no in-person friends, does not exercise, does not take care of his hygiene without being reminded. He initiates exactly zero. Any activity in his life besides work comes from the execution from other members of the family.

As I said, all evals have come back normal, including a brain MRI. Therapy and meds are not helping. I'm hoping someone can chime in with any insights / potential next steps, anything that could possibly help here.

EDIT: He has always claimed "he's different at work". I don't have as much insight there, obviously, but there are examples where he acts similarly. For example, he's gotten feedback that he needs to do more of XYZ, which is like a pool of tasks that members of his group grab from. He would only go to do this task at the end of the day, where there was not much left. And he kept getting the same feedback that he needs to get his numbers up, but never fixed it by applying the simple fix of doing it at the start of the day. There are other instances like this, so I question about how different he actually is at work. We are at a point where I need to be involved in various work emails (such as negotiating something, writing a response to a certain situation, etc.)

[hermione]

He functions “normally” at work?

[anon98765]

Oct 20, 2024 22:04:33 GMT -5 hermione said:

He functions “normally” at work?

Good question. I updated with this information above.

[dexteroni]

Oh wow. Just reading that stressed me out. I’m so sorry. This would be impossibly stressful to deal with. Does he hold a job? Is he like this at work? I can’t imagine anyone keeping a job with the traits you’ve described. Does he do anything proactively around the house? Cook, clean, etc? I’m trying to gauge what life is like on a day to day basis.

I have no idea what could be causing this, but I’m astounded to hear that his neurological functioning is a-ok. Has he ever taken a cognitive test or an IQ test? I’m curious how he would perform in areas like reasoning, spatial functioning, memory, decision making, etc.

[maudefindlay]

Has he seen a neurosychologist? Has he had a PET scan? I'm so sorry you are dealing with this, it sounds very concerning.

[Deleted]

This is fascinating. A few things that you described sound like traits, like the absentmindedness, that I have with ADHD (though since I’ve started taking meds, I’m much better). A few sound like traits that my husband has exhibited since he had a stroke about 15 months ago. A few sound like my 10-year-old, who just doesn’t have any life experience to inform actions. And a few are completely different from anything I’ve ever observed in an adult.

Had he always been like this, or is this a change from how he was before? Has he had long-COVID? Does his family have any history of neurological disorders, or heart problems that could lead to stroke? Any head trauma or history of concussions? Has he had any clinical tests of his cognitive function? How does he feel about what’s going on? Does he notice any of these changes? I ask because my husband noticed some weird stuff post-stroke after he had COVID, and it was terrifying to him.

[trytobearunner34]

I am so sorry as that must be exhausting and so nerve wracking to handle daily. Has he always been like this or has it worsened over time?

[aprilsails]

I'm coming at this from the opposite direction where my STBXH is very OCD and controlling of his environment. However, this summer, he finally went on Wellbutrin after years of me saying he was depressed.

He hated it because he said it made him not care. Which is exactly what I wanted. I had one really decent month. Then things went to shit for other reasons but as of now I know he is off the anti-depressants which is not good.

I'm just wondering though if your DH's antidepressant and antianxiety meds are causing him to just not care so much that he doesn't notice things or can't action on them. Maybe at work everything is so routine that it doesn't impact him to the same extent, but it seems as though in new circumstances he's taking the path of least resistance (do nothing or do the bare minimum) and then let's it drop. He seems over medicated to me.

I think he might benefit from ADHD meds. However it is a complete and total crapshoot on which ones work and to be honest that process has actually ruined my life so I don't know if I recommend it, but the status quo does not seem tenable either.

[SusanBAnthony]

Your examples bring to mind an autistic child, with an intellectual disability.

[deadwing]

Has he always been like this?

Do you think he is safe to be alone with your children? The examples about the gas and brakes in particular raise that question for me.

You mentioned he's had some medical testing done that has come back normal. Did you go to any of the appointments with him? If not, do you have any concern that he didn't accurately represent the situation? If he can't take something out of his pocket without prompting, I wouldn't trust him to paint an accurate picture to his doctor.

This sounds like a very difficult way to live.

[rooster222]

My biggest question is if he has always been like this? Was there an incident or injury that led to these things?

Also, has he done a genesight test to see what meds are ideal for him?

[minzy]

How recent was the brain MRI?

[abs]

I’m so sorry. As others asked is this new?

Honestly all these examples sound like my FIL who has Alzheimer’s. I would follow up with a neurologist if you haven’t already.

[joy]

Will he allow you to speak to his doctors/attend appts? Do you see a therapist? You need someone with informed insight to help you understand. There’s a reason for all that you see whether it’s mental or physical and I hope you get to the bottom of it.

[stemmie]

I's so sorry. This must be difficult for you.

Could this be a post-COVID brain fog? During his many evaluations, was bloodwork done to look for vitamin or hormone deficiencies that can cause similar issues?

If you were describing this as new in someone in their 60s or 70s, my first thought would dementia of some kind. It's pretty rare for this to occur before the age of 50 but is sometimes seen as early as a person's 30s. People on the younger side often take years before they're diagnosed as imagining tends to look normal until well into the disease. People sometimes think of dementia only in terms of memory loss, but early on families might notice mood changes, poor executive function, lack of empathy, impulsivity, apathy as well.

[mcppalmbeach]

Has this always been the case or are these new behaviors?

I’m sorry because this sounds incredibly hard to live with on a daily basis.

[lucybrown]

Oct 21, 2024 5:48:58 GMT -5 SusanBAnthony said:

Your examples bring to mind an autistic child, with an intellectual disability.

I’m here. Without more information, it sounds like autism and he has developed the ability to mask at work.

[waverly]

Since we are all getting older in this board I was going to say dementia.

It sounds like he always had this but it’s getting worse which could indicate autism or intellectual ability. Did he ever have a psych eval for the ADHD? Did they find autism or ADHD during the eval?

[underwaterrhymes]

I agree with the above.

An MRI might show signs of Alzheimer’s in later stages, but not necessarily other forms of dementia nor Alzheimer’s in the early stages.

I would make an appointment ASAP with neurologist. This level of poor executive functioning is highly concerning.

[ssmjlm]

My mind initially also went to being on the spectrum (I believe that's the correct phrase, but apologies if I'm wrong) or early onset dementia.

I would probably take what you've written above and get him into a neurologist as soon as you can. You can use the log to point out patterns and provide examples that are also safety focus like the gas leak.

[midwestmama]

I think getting a consult with a neurologist is the next best step. Make sure you go to the appointment with him. Some of the behaviors you mentioned are similar/the same as what we have experienced with MIL, who has symptoms of dementia (but no official dementia diagnosis that DH and I are aware of). For example, she recently had to call DH because she couldn't remember how to get to the HS where DS's football game was being played...and it was a home game, a mile and half from MIL's apartment, and DH went to this same HS. But when DH talked with her about how concerning it was that she forgot where the HS was, she brushed it off by saying her brain was having a "moment."

[Bad Dingo]

I'm going to basically mirror what others have been saying.  This sounds incredibly hard and concerning.

1. Has he always been like this?
2. Has he been mildly like this but it's increasing in frequency/escalating in severity?
3. Are you attending doctor appointments with him to make sure that he's accurately portraying what is happening and seeing the results of tests?
4. Has he had a basic cognition test?
5. When he does something like, putting an object in his pocket to bring to you, is he actively waiting for you to ask for it or did he actually forget that he has it?
6. You say he's tried ADHD meds so does he have a diagnosis of ADHD and has he tried the various options available?

I'd be pressing for a full medical workup, and if he's already seeing a neurologist, I'd see a different one. Some things to consider - Long covid, stroke, dementia, reactions to medications that he's currently taking.

[Bad Dingo]

As a personal anecdote, cancer treatment left me with a lot of these issues and particularly the maintenance meds I was taking. The issues kept getting worse and worse so that I felt like I was drunk all of the time and losing my mind. I went to a neurologist, had tests run, he insisted it sounded like I was having seizures. I finally decided to take a break from my meds and the symptoms decreased dramatically.

[jennistarr1]

My biggest question...how much of this is a change for him. Any anecdotes from when he was a child that was like this? Or are they emerging as an adult and worsening

[nicolewi]

I am so sorry. I agree that this is not normal and it’s extremely concerning. I have the same question as several others… Is this new? Did he used to be a lot different? When did changes start? And you say it’s getting worse?

Does he have siblings, parents, etc.? Any family history of anything or any weird symptoms in relatives?

[Velar Fricative]

If the onset is sudden I feel like this might be more physical versus developmental, IMO.

I would have never guessed this could be the result of a stroke until my good friend’s husband was hospitalized for something and during the battery of tests the doctors found he had had mini strokes well before his hospitalization for the current issue. Her husband said he definitely felt off and just didn’t bother to go get checked. He also had untreated diabetes. I believe some examples listed in the OP are the kinds of things he dealt with but not every example fits. Just tossing some possibilities out there, I really hope you get answers soon. This sounds really alarming and way beyond normal brain fog.

[shauni27]

this would be so fully overwhelming. I have no advice, just sending internet hugs because that sounds incredibly challenging.

[Bad Dingo]

I just re-read the OP and it kind of sounds like this has been his personality for as long as you've been together, so maybe the question is, has something changed that you don't want to put up with it anymore? That's ok too.

[missva]

I'd also suggest he talk to his doctor about his meds. My husband gets extremely spacey when his meds are off. He may need an adjustment there.

[wanderingback]

Since none of this sounds new since you say he’s had a bunch of tests and whatnot I would go next for a neuropsych eval and psychiatric eval. Autism or personality disorder should be considered. Some of the things on that list I do but definitely all of them all at once is overwhelming and concerning. I hope you get answers and some helpful next steps.