Is It Dementia, Alzheimer’s, or Medication Side Effects? With Germaine Odenheimer, MD

A geriatric neurologist opines on public misinformation

These days there are too many people on social media proclaiming Trump has dementia when she says that all the facts are not available. In this interview, we didn’t focus on Donald Trump. This topic demands an expert knowing all the facts and doing her due diligence before tracking down a correct diagnosis.

Dementia misdiagnosis changes what happens to a person next: the medications they take, the independence they keep, and the care their family chooses. A woman in her sixties, a bank clerk, spent three or four years losing her thinking skills. She quit work and stopped driving. Her son prepared to move her into a nursing home, and her latest diagnosis was Alzheimer’s disease. He asked for one more opinion.

The second opinion came from my guest on Cults, Culture & Coercion, Germaine Odenheimer, M.D. Dr. Odenheimer is a geriatric neurologist and professor emeritus at the University of Oklahoma College of Medicine. She retired from academic medicine in 2017, keeps her medical license, and advocates for people with dementia and their caregivers. She also cared for her own mother, who had dementia. We first spoke in 2022 about her fight against a false Alzheimer’s cure, in our earlier conversation⁵. This time we talked about the dementia misdiagnosis problems she has seen across her career.

Why Dementia Misdiagnosis Belongs on a Podcast About Coercion

Dr. Odenheimer and I are colleagues in the Program in Psychiatry and the Law, a forensic think associated with Harvard Medical School. Like myself, she values truth telling and integrity. This commitment can get us both in conflict with others in our respective fields. In my practice, former members of high-control groups often arrive carrying a misdiagnosis of schizophrenia or bipolar disorder, when the symptoms trace back to undue influence. The DSM-5, the diagnostic manual of the American Psychiatric Association, even lists “identity disturbance due to prolonged and intense coercive persuasion”³.

My BITE Model of Authoritarian Control™ describes four categories of control a group exerts: Behavior, Information, Thought, and Emotions. A clinician who never asks about group involvement cannot see them. Medical care follows a similar pattern. A doctor treats a symptom, a label sticks, and nobody asks whether something else explains it.

Medical authority sits on the spectrum of influence like any other authority. Healthy influence explains its reasoning, invites questions, and welcomes a second opinion. Undue influence, the use of pressure or deception to override a person’s judgment, discourages questions. I am not comparing doctors to cult leaders. I am pointing to one shared habit worth watching: refusing to consider another explanation.

Delirium Looks Like Dementia

Delirium is a sudden state of confusion caused by a medical problem. Dr. Odenheimer says doctors often misdiagnose it, which makes it a frequent source of dementia misdiagnosis. Inattention separates it from dementia¹. She asks patients to repeat a string of unrelated numbers, and a person who cannot repeat at least five digits raises her suspicion of delirium. One patient with dementia and severe memory loss repeated nine.

Common causes include urinary tract infection, a medication, kidney failure, and dehydration, she explained. Dementia raises the risk of delirium, so a person with dementia is more vulnerable to it¹. She has watched this unfold in emergency rooms. A longtime patient arrives confused and agitated, and a doctor blames the dementia. “No, this isn’t their dementia,” she tells them. “This is delirium on top of their dementia.” In theory, treating the infection or stopping the medication reverses the delirium. The distinction matters, yet in her words, “people are not making it. Doctors are not making it.” 

I teach the mind-body connection, and I had not considered a urinary tract infection or constipation as a cause of cognitive change.

Ten Medications and a Wrong Diagnosis

Back to the bank clerk. Her slurred speech and unsteady gait did not fit Alzheimer’s disease. Dr. Odenheimer reviewed her medication list and found about ten psychotropic drugs, medications acting on the mind and affecting cognition. “I don’t know how she could even walk,” she told me. The patient’s psychiatrist insisted she needed everyone. Dr. Odenheimer found a second psychiatrist who worked with her to withdraw nearly all of them. Three months later, the woman “came back steady, stable, non-slurred speech, and normal cognition, completely normal.” Overmedication had produced a dementia misdiagnosis.

The woman’s medications had not changed in years, which puzzled Dr. Odenheimer at first. Delirium from a drug usually follows a new prescription, but this woman’s kidney function had declined, so her body no longer cleared the same drugs as before. “The more drugs you’re on, the more likely you’re going to have some cognitive impairment,” Dr. Odenheimer said.

The story did not end there. The woman later urged everyone she met to quit their medications, had a psychotic break, and returned to a psychiatric hospital. Dr. Odenheimer told her some of the stopped medications might have been necessary. The team settled on a low dose of one antipsychotic, and she lived independently for five more years. Do not stop a prescribed medication on your own. Work with a psychopharmacological psychiatrist, a psychiatrist who specializes in how psychiatric drugs affect the mind and body.

A Second Opinion When Experts Double Down

A mother in Greece once contacted me about her son, who had belonged to an Indian guru cult. He was found in his apartment naked, meditating, and refusing food and water. Hospitals had held him  for years, misdiagnosing schizo-affective disorder. I flew over. He was so heavily medicated that I was unable to hold a conversation. I met his two eminent psychiatrists, and both insisted they had made no mistake. I had no authority to change his treatment.

Back in the United States, I described the case to Dr. Louis Jolyon West, who founded and directed the UCLA Neuropsychiatric Institute and studied Chinese Communist coercive persuasion⁶. He examined the young man, agreed he was overmedicated, and arranged a transfer to McLean Hospital in Massachusetts. Doctors there lowered his medication under supervision to test whether cult involvement explained his condition. I held an intervention with former members on the hospital grounds. He came off all of his medication and returned to Greece to a life of his own.

I do not ask anyone to distrust doctors. Fourth Generation psychological warfare psychological warfare methods push anti-expert and anti-science, anti-democratic institutions to demoralize a population. I reject this wholeheartedly. I want to research top doctors with credentials and experience, who have open minds, are willing to consider alternate hypotheses based on facts, and a commitment to do no harm.

Stay in Your Lane

Dr. Odenheimer fought the same narrowness inside her own clinic. Doctors referred patients with diabetes or thyroid disease to the dementia clinic only after those patients failed to follow instructions, and the clinic’s director replied with a rule: referring doctors should get patients to follow directions first. She disagreed. “The reason they’re not following the directions is because they’re having cognitive impairment.” Colleagues told her to stay in her lane. “I’ve never stayed in my lane, and I’ve frequently been in trouble.”

Questions Families Should Ask

If you doubt a diagnosis for someone you love, start with questions. Ask whether anyone checked for infection, dehydration, kidney problems, and medication effects before attributing the confusion to dementia. Ask for a medication list and the reason for each drug. Ask for a second opinion. Dr. Odenheimer also urges caregivers to join a support group, and the Alzheimer’s Association lists groups by location⁴. She notes some groups are not good, yet members of the groups she joins on Zoom tell her the groups saved their lives. 

We also returned to the supplement scams targeting desperate families, which I covered in our 2022 conversation⁵. Both topics share one lesson. When a person or an institution asks you to stop asking questions, ask more of them. What would change in your family if you treated every label as a hypothesis worth testing? 

---

Resources:

Alzheimer’s, Dementia and on Being Wise Consumers: A Conversation with Germaine Odenheimer, M.D. Dr. Odenheimer describes the dinner-talk scam she investigated and explains the difference between dementia and Alzheimer’s disease. 

Mental Health Diagnoses and QAnon: A Complicated Issue. I explain why clinicians who skip a history of group involvement misdiagnose and overmedicate. 

Synanon and Enthusiastic Sobriety: Cults Disguised as Drug Treatment. Two cults posed as drug treatment, and the post lists red flags to check before choosing a program. 

An Expert on Addiction and Critic of 12-Step Programs: A Conversation with Lance Dodes M.D. Dr. Dodes explains what his research and clinical work say about addiction and its treatment. 

Multi-Level Marketing Groups Defraud Consumers! I describe how deception in multi-level marketing recruitment hurts consumers.

References 

1. Adsule K, Mohanaselvan A, Schoo C. Differentiating Delirium Versus Dementia in Older Adults. StatPearls. NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/sites/books/NBK570594/ 

2. Dementia Officially Replaced by Major Neurocognitive Disorder, per DSM-5. Neurology Reviews. 2014;22(5):43-47. https://www.mdedge.com/neurologyreviews/article/81892/alzheimers-cognition/dementia-officially-replaced-major 

3. Hassan S. Mental Health Diagnoses and QAnon: A Complicated Issue. Cults, Culture & Coercion with Dr. Steve Hassan. https://stevenhassan.freedomofmind.com/p/qanon-mental-health 

4. Alzheimer’s Association. Support Groups. https://www.alz.org/help-support/community/support-groups 

5. Hassan S. Alzheimer’s, Dementia and on Being Wise Consumers: A Conversation with Germaine Odenheimer, M.D. Cults, Culture & Coercion with Dr. Steve Hassan. August 11, 2022. https://stevenhassan.freedomofmind.com/p/alzheimers-dementia-and-on-being-wise-consumers-a-conversation-with-germaine-odenheimer-m-d 

6. Louis Jolyon West papers, 1890-1998. Online Archive of California, UCLA Library Special Collections. https://oac.cdlib.org/findaid/ark:/13030/c84j0hcd