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Alzheimer's, Dementia, and Parkinson's Disease

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Alzheimer's, Dementia, and Parkinson's Disease

Douglas Scharre, MD, is the Director of the Division of Cognitive Neurology and an Associate Professor of Neurology at the Ohio State University Medical Center in Columbus, where he serves as the Medical Director of their Neurobehavior and Memory Disorders Clinics. Dr. Scharre is also the author of Long-Term Management of Dementia (Neurological Disease and Therapy).
View Douglas's full Bio
Q:

My grandmother is 77 and has dementia. I take care of her 5 days a week. My question is why can't my grandmother tell the difference between something feeling cool and something being wet? I will hand her a pair of panties or a jacket that feel cool to the touch and she thinks it's soaking wet. Is this normal? 


Ashley from NC
A:

The normal functioning brain is able to differentiate cold from wet. However, both sensations can be similar. In the patient with dementia, there is damage to parts of the brain and this distinction may be harder to make for them. I would consider having her touch the clothes before putting them on so she can tell they are not wet. But warn her that they will feel cool or perhaps wet when she puts them on, but that she now knows they are not wet.  

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Q:

My stepmom is thinking about doing a few overnight stays with my dad who is getting ready to be moved to assisted living. My dad has dementia and I'm concerned that if these overnight stays have to be stopped it will confuse him even more. Is it best she not even start any overnight stays? 


Denise from NC
A:

It entirely depends on your father and his current understanding and behavior issues. If there would be safety issues with overnight stays with your stepmom for her or for your father, then it would not be a good idea. However, if he has significant memory loss, then he may forget after a short time that your stepmom had an overnight stay. Is it possible that he could continue to have overnight stays with your stepmom at her place even if he goes to assisted living? Perhaps the overnight stays have significant meaning to your stepmom and would be worth it. In general, I would not typically plan or not plan events just in case it may, in the future, confuse the patient. If there is a known history of a patient being greatly bothered by an event, then you can use this information to avoid similar circumstances in the future.  

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Q:

My father has been diagnosed with dementia and Parkinson's. He does not take medication for neither because he has angina and was told by the doctor that they cannot prescribe anything. Surely this is wrong. If only something to stop my father from shaking would he be able to carry out some day-to-day tasks. 


Jude
A:

There are many patients with Parkinson's disease and dementia who also have angina and are able to take medications for their memory loss or for their tremors. These medications can be very helpful in some individuals to help with their day-to-day functioning. I would suggest getting a second opinion from a neurologist.  

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Q:

My 83 year old mother-in-law recently was in the hospital for pneumonia. She has COPD and could walk well and was functioning quite well with a cane. She has had slight hand tremors for the past couple of years. When she came home from the hospital she fell going to the bathroom and hit her head and we do not know how long she was unconscious. When we arrived at the house that next day she was extremely confused, agitated and her shaking was remarkably worse. Her short term memory has gotten worse out of nowhere. She seems to be deteriorating at a fast rate. She lives with my brother-in-law and he did not think that we needed to take her to the ER and he blamed her actions on the recent hospital visit. If the fall did cause some type of brain bleed is it to late to go through the motions of a CAT scan etc since it has been wo weeks? I keep pushing to take her to a neurologist. 


Jack from NJ
A:

Normally if someone had a bleed or hemorrhage in their brain, they would not only be more confused, but often would have one-sided weakness or numbness, facial droop, gait issues, or something that was worse on one side of the body from before. You would be able to see any bleeding for weeks on a CT scan after an event in most cases. Medication changes are common causes of confusion, so be sure to check if the hospital changed any medications she is taking. Nevertheless, if you or others have noted a significant and sudden change in her behaviors or memory, she should see her physician ASAP. They can evaluate and let you know if a neurologist is required.  

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Q:

I take care of a patient with Parkinson's disease and muscular dementia. She is spitting out her food and medicine. I crush her meds and put them in applesauce. It worked for a while, but now she is spitting everything out after a bite or two. What can I do to help her continue to eat and receive meds?  


Terri from AL
A:

Patients with Parkinson's disease dementia or vascular dementia develop many problems with motor control. Sometimes this can extend to trouble figuring out how to chew or swallow at the end stage. If the patient is still able to swallow, then try placing the crushed medications in foods, puddings and ice cream, that have strong flavors that may camouflage the taste of the crushed pills. Some medications have liquid or solution formulations that can be switched to and then placed in liquids. There are medications that may help with appetite if she is losing weight. Nutritional supplements may keep the weight up as well.  

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Q:

My grandfather has had Parkinson's and Alzheimer's for many years and was fine until one night when he fell and banged his head. They cannot do an MRI because of his shaking. Now he is in a rehab center and barely eats and sleeps. He has extreme shaking in his body. He is 82. Is there anything we can do—anything?  


Mike from FL
A:

Individuals with Parkinsonism and progressive cognitive loss may have Alzheimer's disease plus Parkinson's disease or may have another neurodegenerative disorder like dementia with Lewy bodies. Head trauma can cause concussions or even bleeding in the brain (subdural hematoma, subarachnoid bleeding, or bleeding in the brain itself). A CT scan could usually diagnose any bleeding. A CT scan is not so much affected by someone shaking in the scanner like an MRI scan would be. There are many medications that may help sleeping issues (mirtazapine, trazodone, zolpidem, gabapentin, melatonin). Mirtazapine may improve appetite as well as help sleep. Valproate may help with sleep issues associated with excessive restlessness. Quetiapine may help with sleep issues if the individual also has false beliefs or suspiciousness symptoms. Megestrol, mirtazapine, or valproate may all help with appetite issues. In regards to his shaking, there may be treatments, depending on the cause. Other medications he is on may also cause shaking, appetite loss, and decreased sleep. His physicians can try to sort out the causes of his symptoms.  

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Q:

My 72 year old mother was diagnosed with Parkinson's 18 months ago after experiencing mobility issues and a fall. She is very mobile and has only a slight hand tremor. Her mental health, however, has significantly declined since the diagnosis. She is now often confused, can no longer do her own banking, has very little short-term memory and sometimes makes no sense when she speaks. She is confusing her medications and forgetting when and if she has eaten. She recently had a psychoneurological evaluation, which I was told was "inconclusive." I am now wondering if the Sinemet she is taking is somehow causing all the cognitive issues? 


Jennifer from TN
A:

Patients with Parkinsonism can have gradual cognitive decline due to a neurodegenerative condition. The most common ones are dementia with Lewy bodies or Parkinson's disease dementia. Since her hand tremors are slight, dementia with Lewy bodies may be more likely. Those individuals often may have issues with visual spatial processing, fluctuating symptoms, increasing sleepiness in the day or more closing their eyes, visual hallucinations and/or talking or thrashing out in their sleep. Cholinesterase inhibitors may help these individuals. As you point out, medications can cause cognitive issues. Sinemet may increase the likelihood for false beliefs, paranoia or hallucinations. If the Sinemet was never very helpful, it may be useful to lower the dose after a discussion with her doctor. Infections (urinary and others) strokes, and metabolic conditions may cause cognitive issues as well. These must be sorted out by her doctor.  

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Q:

My 86 year old father has Alzheimer's and is immobile. He's deaf, and he cannot feed himself or get out of a chair. He believes that he sleeps for a long time, but in actually, he sleeps around 5 minutes. The same thing happens when he's awake—after about five minutes, he believes he is awake for a long time. This happens repeatedly, so he is awake all night. With the sleeping pills he only sleeps a few hours. What should we do to help him? 


Lalita from NY
A:

There are many medications that may help sleeping issues (mirtazapine, trazodone, zolpidem, gabapentin, melatonin). Mirtazapine may improve appetite as well as help sleep. Valproate may help with sleep issues associated with excessive restlessness. Quetiapine may help with sleep issues if the individual also has false beliefs or suspiciousness symptoms. Also the use of good sleep hygiene is very important. That is, try to keep his rise times and sleep times the same every day, including naps. Try to increase activities if possible—perhaps watching slapstick comedy that he can see visually, review family pictures, picture books of topics that may interest him, crafts and more.  

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Q:

I recently had an MRI and the diagnosis was the beginning of memory loss or dementia. I am 66 years old. I walk two miles a day and am in good physical condition. I also ride horses. My mother and grandmother both had Alzheimer's. Is there anything I can do to slow down the memory loss and stay ahead of the game? I am also diagnosed with depression. The medications they put me on are Namenda 10 mg twice daily, escitalopram 20mg once daily and Lorazepam 0.5mg once daily. 


Rebecca from KS
A:

It is to your advantage that you are trying to be aggressive to keep your brain and body healthy. Physical and mental exercise seem to possibly slow down the cognitive decline with Alzheimer's disease. In addition to the Namenda for your cognitive loss, have your doctors consider the use of a cholinesterase inhibitor (such as donepezil, rivastigmine or galantamine). One of those medications works very well in combination with the Namenda. There is some literature that suggests vitamin E for its antioxidant effects can help slow down the course. I suggest 200 units daily. There are also many clinical trials looking at new potential treatments for Alzheimer's disease that you may qualify for. Most will have part of the study group be on a placebo and the others on the active treatment. Go to http://www.clinicaltrials.gov for a listing of current clinical trials. Note that there are some warnings about higher than 10 mg escitalopram if you are over age 60 related to heart concerns; these concerns do not seem to be seen with some other antidepressants like sertraline. Also, lorazepam can cause cognitive issues and so ask your doctor to see if you can avoid those types of medications.  

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Q:

My father was recently diagnosed mid-level Alzheimer's. He still exercises, is 88 years old and lives with me at our home. He does have trouble walking, but uses a walker. He is having trouble speaking at times, and his doctor is aware of his issues. But at night, usually after 8 pm, once it is time for him to get ready for bed, he starts getting totally confused. He forgets how to use the bathroom, he does not even know where it is. He is very confused and agitated. He is unsure how to get into bed, and I can tell he does not really know what is going on, but he knows me. His wife has been gone nearly 5 months in a rehab, and I know that is a factor. Should I play music or is it sundowner's syndrome? We hope to get him on some meds soon, and he is scheduled to get a scan on his brain soon. Please advise. 


Bill from TN
A:

He may have some elements of Sundowning syndrome, which is common in many dementia conditions. If some of his behaviors involve suspiciousness or false beliefs or paranoia, antipsychotic medication like quetiapine or ziprasidone may be helpful. If he is packing or wanting to leave and excessively restless, valproate may be helpful. If he is anxious or depressed, an antidepressant may help these symptoms. Sometimes a mild medication to help him sleep, like trazodone, may take the edge off. Any medication should be given at least 45 minutes prior to when his symptoms usually occur to try to prevent or reduce these symptoms. Please talk to his doctor to see what they recommend. Keeping the house lit with lights prior to bedtime may reduce sundowning. Music may help.  

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Q:

My mother, near 60, is suddenly having problems while drinking or eating. Whenever she tries to bring something to her mouth, her hand just gets disoriented and goes to the side. What could the reason be? 


Lubna
A:

If only one side (one hand) is involved, an MRI scan of her brain may be recommended by her physician to look for focal brain conditions or strokes. If she has normal strength and sensation in that hand, it may be a type of apraxia. Parkinsonian conditions like corticobasal degeneration can cause severe one-sided apraxia. Shoulder or neck issues could cause hand problems as well.  

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Q:

My father is 89 years old and sleeps constantly. I cannot get him to eat or drink anything. He is in the early stages of dementia, according to his doctor. I wake him up to take his pills and give him a glass of water to drink. He will only drink about half of it, and only twice a day. He will sometimes drink a High Protein Boost and will eat a half bagel with cream cheese occasionally, sometimes a little ice cream. He will not bathe, although he can still go to the bathroom by himself. I moved in with him a few months ago and he has seemed to go downhill rapidly since I did this. It seems like he has given up and is trying to die now that he has realized that he can no longer be alone. Any suggestions on how to get him to eat and bathe? 


Carole from PA
A:

You are doing the right thing in adding ice cream and Boost or similar supplements. Anything that he likes to eat that has high protein or high calories would be good. Milkshakes with protein powder and ice cream can be considered. Medications may help his appetite. Be sure to have his doctor look at his medications and get a metabolic panel on him to evaluate for other causes of poor appetite. An antidepressant should be considered if you feel his mood is low. Increasing pleasurable activities may also help.  

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Q:

My dad is 87. Two years ago he received a pacemaker, defibrillator and new valve. Recently he just sleeps. He eats a bit, doesn't like to go out and thinks 15 minutes is hours when he does go out. He's taken care of by my 85 year old mom. What can we do? 


A:

Make sure you tell his doctor about his sleeping and appetite. At age 87 he will metabolize all medications more slowly. Check for medications that can cause sleepiness. Is he depressed? An antidepressant may help. He may be bored. A senior center, daycare facility or just increasing pleasurable activities may help keep him interested and would tend to reduce his excessive sleepiness.  

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Q:

My Father, now 94, was severely injured in the Philippines during WWII. He was sent back to the US and was in hospitals for years. He still sets off metal detectors due to the shrapnel in his body and he is profoundly deaf. When the VA finally decided to test him for Alzheimer's, they discovered he had lost much of his frontal lobe way back in 1943. It explained a lot of his past behavior to our family. We've had Dad at home with my brother and my mother for years. It's a huge struggle and it's time to find a capable place where he would feel safe. Would an Alzheimer's unit be adequate or do we need something different considering the additional factors? I should say Dad is in outstanding health and until recently played 18 holes of golf three times a week and 36 on Saturdays. 


Victoria from MO
A:

I would look for a place that you have visited and feels right, probably one that is not too far away from you so you can visit. He seems very active and so look carefully at the activities program to see if it would be a good fit. Activities would be very important for his quality of life. It will not matter so much that he has had brain injury from WWII and Alzheimer's disease as long as you choose a place that is comfortable with residents with behaviors associated with dementia.  

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Q:

I take care of my 91 year old mother who has advanced Lewy Body Dementia, where she is hallucinating days and nights and is quite delusional. She does not recognize me or where she is, and is very repetitive with basic questions. At night, usually all night, she yells and calls out my deceased family members' names very loudly, as well as reliving past episodes of her life like "Frankie, shut off the stove before the food burns!!" as well as the occasional "Police help!" and two-sided conversations with imaginary people. Her nighttime drug protocol now is Trazadone 37 mg, also Seroquel 25 mg and Namenda 2.5 mg at about 8 PM when we put her to bed and later melatonin 10 mg at 10 PM. The medicine is not really effective for any decent length of peaceful, restful sleep (six hours would be wonderful). Could there by any success with Galantamine for reduction of hallucinations or sleeping issues? She does not sleep during the day and has no other medical conditions besides glaucoma. 


Louis
A:

Is it possible she is talking in her sleep? Talk to her doctor about medication adjustments. I would consider changing only one medication at a time. Trazodone can often be used at 50 to 100 mg dose at night (even higher if helpful). Seroquel can often be increased to 50 or 75 mg at night. If that is not working, her doctor could consider very low dose 0.25 mg lorazepam. Other choices might include zolpidem or gabapentin. Galantamine is not known to cause sleep issues, but it would not typically get rid of them either.  

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Q:

My mom is in the mid stage of dementia. She has been living with my family (husband and 2 elementary age children) for a year and a half. Her condition has deteriorated enough that I can no longer provide a safe, secure environment for her, and keep my family sane as well. Because she will have to be on Medicaid very soon, our living options are very limited. We are considering a memory care facility (up to 80 residents) and I know she will fight like mad to avoid it. She has times where she is higher functioning. What is the best way to approach this? I don't know what to say to make it less scary to her and also to make sure she will move in there asap.  


Sara from WA
A:

Since I do not know your mother very well, this may be hard. Many times they will adapt very well after a honeymoon adjustment period. However, I would consider telling her that TEMPORARILY she will be staying at a new place where they will be providing activity therapy to help with her brain, that you will be coming to check in on her frequently and that you will be getting assessments of how the therapy is going. It may be helpful to ask her doctor if he/she would also recommend this place to your mother as a place than can help with her brain condition.  

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Q:

My father is 67 years old and had a quadruple bypass 6 years ago. He has had diabetes for 15 years and a recent amputation, as well as 6 small strokes. He has dementia—I’m not sure at what stage it is, but is recently hallucinating and saying weird things at night. He wants to get out of bed 10 times a night, then sleeps a lot during the day. He takes ambient and nortriptyline at night and has body tremors as well. My question is how can we know if he has Parkinson's or dementia? We aren’t sure how to care for him. My mother is in denial and says he can do more for himself than he does. 


Elaine from TX
A:

If he has cognitive changes and cannot perform his usual activities of daily living because of thinking problems, then he fits criteria for dementia. He may have vascular or stroke related dementia given his medical history. Parkinsonism, or tremors, stiffness and slowness, can be due to strokes. Parkinson’s disease and dementia with Lewy bodies are distinct neurodegenerative conditions that can also cause these same clinical features. His sleep disturbance may be related to REM sleep behavior disorder, often but not only seen in dementia with Lewy bodies. Parkinsonian conditions also often disrupt the circadian rhythm (sleep and wake cycles). Both nortriptyline and Ambien can cause confusion at times. Ramelteon (Rozerem) 8 mg nightly often helps the circadian sleep wake cycle dysfunction common in those with PDD. Over the counter melatonin is another choice. Trazodone nightly can safely be used for sleep issues. Seroquel at night might help both with sleep and hallucinations. If you wish further information regarding the best behavioral treatments for these conditions, you may wish to purchase my book, "Long-Term Management of Dementia" (Informa Press) through Amazon or click on the icon next to my picture.  

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Q:

I help my grandmother who is 83 years old and lives in a LLC facility in Maryland, where I live as well. My 67-year-old mother lives in Florida, and both of them have the same health issues and both of them ask me for help. I think my grandmother’s memory is getting worse, but my mother calls her to drive her crazy! What can I do to prevent this, but at the same time help them both? 


Kim from MD
A:

It is hard to answer your question without knowing more about the conditions they have. There are also possibly personality traits that are coming into play as well. Perhaps there are limits that can be placed on calls by the LLC from your mother to your grandmother. 

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Q:

I have been living with my grandmother for 15 years. She has always been an upbeat person. She has been under a lot of stress because her son (my uncle) is in the ICU. This morning she just was not herself. Her speech was impaired a little. I knew what she was trying to say, but she just was scrambling her words and all mixed up. Do you think it could be stress or should she be tested? 


Angel from IL
A:

Hopefully you took her to the emergency room right away. These symptoms could be a sign of a stroke. If it is a stroke, every minute you delay getting to the ER typically means more loss of brain function. If a stroke is ruled out than other causes can be evaluated including stress issues. 

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Q:

My dad is 87 years old. He has had Parkinson's disease since he was in his early 70s. The doctor told him that if he could tolerate PD medication it would be 15 years before it got bad. My mom passed away in April 2010. They were married 63 years. At the time dad's doctors said he would probably live only 6 months (according to statistics). He continued to live in his own home. We hired someone to stay with him during the day and my sister and I took turns staying at night. He was never alone. In January 2012 he fell and broke his hip. After surgery he was sent to a nursing home for therapy. He has been there ever since. His PD and his mind have gotten worse. Recently, he has been very agitated, does not sleep at all some nights and has been somewhat aggressive to the caregivers, which it not like him at all. We can't figure out if it's his medication, progression of his disease or something else. He was this way at home before he went to the nursing home, just not as often and it didn't last as long as it does now. We go see him every day and talk to doctors almost daily. I know it is common for people with PD dementia to be aggressive, but we just can't stand to see him like this. Is there anything you might suggest to help with this? They keep changing his medication but nothing seems to help. 


Panda
A:

Parkinson’s disease dementia (PDD) patients can develop agitation and sleep issues. It is common to give medication trials to see if he responds. Ramelteon (Rozerem) 8 mg nightly often helps the circadian sleep wake cycle dysfunction common in those with PDD. Over the counter melatonin is another choice. Trazodone nightly can safely be used for sleep issues. Seroquel at night might help both with sleep and agitation due to false beliefs. If you wish further information regarding the best behavioral treatments for these conditions, you may wish to purchase my book, "Long-Term Management of Dementia" (Informa Press) through Amazon or click on the icon next to my picture.  

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Q:

My father-in-law has dementia. He’s 89 years old and is bedridden— he can only get out of bed with help. He has caregivers during the day and evening. When they leave at night, they lock up the house. My worry is what could happen in case of a fire since he can't get up and get out. I think he needs to be put in a home where he can get 24-hour care. He could have that at home, but refuses for anyone to be in the house at night. We can’t make him understand that he needs someone there all the time for his safety. He has money, but he says he can't afford it. When we show him that he can afford it, he agrees, then changes his mind. What can we do? Can we be held responsible for his safety? 


Karen from IN
A:

He has physical problems, but it is unclear to me how severe his cognitive issues are. If his dementia is to the point that he is no longer able to make appropriate decisions, then if he has a Durable Power of Attorney (DPOA) for health care and finances set up, it should be put into effect and that individual(s) can decide for him and have someone stay the night or have him move to a facility. If he does not have a DPOA and is significantly demented, a guardian appointed by the court is the next step. Another way to approach his reluctance is to bargain with him and suggest that just temporarily, as a trial, for a week or two, you are having someone stay overnight. Tell him it is mostly for your own peace of mind and that it is affecting your health (if it is) because of worrying about him so much. After the trial period, you can reassess and maybe extend it temporarily if things are working out. 

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Q:

My mom is 88 and on hospice, diagnosed with dementia. She has had muscle spasms for about a month that affect her entire body nonstop. Her spasms keep her mouth opened and cannot swallow very well. Hospice doctors have her on Ativan (lorazepam) and just started Neurontin (gabapentin). But it is not working. It mainly just puts her to sleep, but she wakes up in a spasms. Is there anything else we can try to help her? 


Tina from FL
A:

I am not sure what type of spasm you are describing. Myoclonic jerks are quick, can be one side or whole body and may affect the jaw of mouth. They can occur frequently. These are best treated with divalproex sodium (Depakote). Muscle cramps, like a Charley horse can be related to electrolyte imbalances. Try tonic water or pedialyte like drink. Rarely, tetanus can occur from a wound infection and lead to facial and body spasms. 

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Q:

My mom is 80 and underwent a breast cancer operation. She also has Parkinson’s disease. My brothers are not taking care of her. She is always sulking when thinking of them. How can I bring happiness in her life and a smile on her face? 


A:

Depression is a common disorder in those with Parkinson’s disease. It is caused from environmental situations, but is contributed by her brain dysfunction from the areas damaged in those with Parkinson’s disease. Increase pleasurable activities for her and talk to her physician to see if an antidepressant is suggested. 

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Q:

Mom has a blockage in the back of her head and has been doing things that aren’t like her. She tried to adopt a 67-year-old woman and her son. And mom thinks I'm after her money and things. I don't want her stuff. I'm tired of people taking advantage of her. Could this be dementia? 


Joy from NC
A:

 She has issues with judgment and probably insight. If she is also having problems with memory, language, sense of direction, problem solving or performing activities of daily living, she is developing dementia. She needs to be evaluated by her physician to find the potential reasons and to get appropriate treatment to prevent further cognitive loss. The sooner, the better. Have her physician give her the SAGE test, a self-administered cognitive assessment tool. This is an excellent screening examination that can be downloaded free from the web at http://www.sagetest.osu.edu

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Q:

My father is 87 years old and has dementia. He is totally incontinent and is on coumadin for an irregular heartbeat. He lives in a very nice memory care facility. Lately his heart rate has been fluctuating. He wore a 24-hour monitor and his rate varied from 40 to 187. His cardiologist is recommending a pacemaker. We're leaning toward that because if he were to fall due to the low heart rate and become lightheaded, he might bleed out due to the coumadin. So Of course there's always the chance he could just fall just because of getting older. He still walks on his own. Wondered what your thoughts are on this. Pacemaker or not—I am torn and not sure what's the best thing to do. 


Carol from TX
A:

I would follow the advice of the cardiologist who knows your father’s medical condition the best. 

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Q:

My grandmother just turned 100 and was very active until around 8 months ago. Since then she has experienced multiple behavior changes. She is now in an assisted living facility. She has lost a great deal of weight, refuses to eat or take medication so they are not giving her anything. Just recently they started Ativan because they did not bathe her or change her clothes for two weeks because she would not let them or even me. What stage does she appear to be in and what does the assisted living have to do when a patient refuses meds, water, food, to change clothes or any real care? 


A:

The solutions to these questions would depend on the reason she is refusing care and nutrition. Sometimes when individuals get that old, they have decided they have lived long enough and wish to die. They may not tell loved ones their true intent for reasons of their own. Others that old may develop dementia and not understand the need for nutrition or care. In some cases, their organs are just shutting down after 100 years. In others, there may be some underlying depression or a mix of a lot of things. The goal at that stage is to provide quality of life and not force individuals to have to follow all the “rules.” 

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Q:

My mother in law fell on the 15th of November. The house we live in is safe—the bathroom, living room, her bedroom and the kitchen-dining room are all on one level with easy access. She has a walker and a personal toilet in her room for her convenience. When she fell she got a bruise right on the side of her right eye, she lost mobility and couldn't get around by herself so we took her to the hospital. The next day we went to go get her and she did not feel ready to come home—they took it that she was scared to come home and told us they wanted to put her in a home. It would be devastating to her to take her away from the family, and we want her around as long as possible to see her grandchildren grow up. There is always someone her with her and willing to get her food and help her. Two days later, she was ready to come home and they let her have a physical therapist come over and a nurse who looked at the house and thought it was great and safe. Today we took her to her doctor who asked her some questions and she said she has dementia without giving her a proper test. The doctor was very rude and said she wants mom in a home and is not capable of making her own medical decisions. She wants to take my mom away from us when we have done everything to make sure she was safe and happy. What do we do? 


Leslie & Cody from CO
A:

Even if your mother in law has a dementia condition, from your description, she is safe and well taken care of at your house. You have family that care of her and know her and so your home would be a great place for her to be. Anyone can fall, even if you are standing right next to them and try to prevent a fall. There is no reason you would need to place her into a nursing home unless Adult Protective Services (APS) for some reason felt she was not safe or well cared for at your home. You could ask APS to come to your home so they could verify that the home setting is appropriate. If your mother-in-law has the capacity to make decisions, she can designate a person as her Durable Power of Attorney (DPOA) for health care who would then be her surrogate to make decisions for her if she were no longer able to make decisions on her own. You can consider contacting the local chapter of the Alzheimer's Association to help you understand more about a DPOA. Other agencies or a lawyer skilled in elder law could be considered as well. Her dementia condition could be further evaluated with cognitive screening tests like the Self-Administered Gerocognitive Examination (SAGE), that is best taken at her doctor's office but that is also available on line at http://www.sagetest.osu.edu. 

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Q:

Our 87 year old father suffers from dementia and a significant eye disease and is noticeably declining. He lives in the family home with my younger sibling who works during the day. Currently, dad continues to drive short distances to the store and back, and is quick to let you know that his driver's license is legal for 3 more years. In anticipation that his driving days are numbered, we have hired an aide, three times a week for six hours each time, to do activities with him as well as drive him to the store. During Dad's recent visit with his PCP, I spoke to her privately. She absolutely noticed his deteriorating awareness and agreed it was time to stop driving. I requested she contact the eye specialist to ask him to tell Dad he needs to stop driving due to his eye condition and must have his license revoked. We felt it would be easier for him to accept that his sight is no longer safe for driving rather than that his faculties have reached a point unacceptable to retain his driver's license. We hope to keep his dignity intact as much as possible. Next week is Dad's appointment with this doctor. I anticipate he will not accept this well at all! How should I prepare for a possible inappropriate outburst of anger? What can I do to console him during the 45-minute ride home? What can we do to minimize the depression he will experience moving forward?  


Kathlyn from NH
A:

Driving issues are difficult for many. It is to your advantage that the eye doctor is willing to "be the bad guy" and tell him that it is now unsafe for him to drive. In this way you can say that it is not you but the doctors that are telling him not to drive. He will likely counter that he can see well enough to drive. In those cases, it may be wise for the doctor to refer him to a professional driver evaluation test or to his local motor vehicle department for paper and behind-the-wheel testing. If his cognitive issues are getting worse, it is likely he will fail those tests. Another technique may be to tell him that temporarily he needs to stop driving while x, y or z is being evaluated or because he is starting on a new therapy, if true. It is always easier to be accepting of something that is "temporary" rather than something permanent and stopping driving forever. Periodically, he could be re-evaluated and the doctor can declare that he still needs to temporarily hold off on the driving.  

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Q:

I am so confused. My mother was diagnosed 13 years ago with Parkinson’s. The past five years have demanded constant one-on-one care, but recently my mother has been acting very strange. She started complaining about headaches in the back of her head about a month ago. She was taken to the emergency room and had extremely high blood pressure, thought to be based on food she ate that day. She has started talking like a baby and saying things like "Me see you, you see me?" over and over. She has complete knowledge that she is doing this and makes a point of making sure we notice this—she says that it is due to a stroke and that she has read that your speech is affected after a stroke. She has been acting very childish, actually pulling a tantrum if we don’t pay attention to her and getting upset when I go college, even going as far as to call me and insist that I not go to college anymore. My first day of college was when she actually claimed she had a stroke and told me I needed to miss school and take her to the emergency room—doctors didn’t find any evidence of a stroke. Is she acting out or perhaps experiencing dementia? How can I approach this without causing resentment? 


TJ from TN
A:

High blood pressure can be a cause of headaches. High blood pressure can also cause strokes. However, if she had an MRI scan of her brain, strokes are very easily found, even if they are very small. If she had an MRI scan of her brain and no stroke was found, then she did not have a stroke. A CT of her head may not reveal small strokes. When strokes cause language deficits, they are usually very obvious to everyone and would not fluctuate with good and bad days. The person may not be able to comprehend well or may not be able to get words out well. Strokes affecting speech would cause slurred or strained speech patterns, which also would not fluctuate. Acting childish and having tantrums are not typically stroke behaviors. Perhaps she is afraid of you not being around. You can offer her ways to contact the emergency squad to take her to the hospital if you are not around (button around her neck to push, phone to call 911, etc). You can arrange for companions to come in to be with her while you are away. Senior centers or day care centers can be used to care for her during the day. Depression and anxiety symptoms, if present, can be treated with antidepressant medications. You need to sit down and tell her that you will be gong to college but that you can help arrange for her to be safe and protected while you are away.  

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Q:

My mother, 85, is taking medication for Parkinson's and has a level 6 Alzheimer's. She as been doing very well on the medication, but the other day she fell and hit her head and was knocked unconscious for a few minutes. She has been admitted to the hospital as a small spot of blood was found in her brain after a CT scan was done. The doctors are monitoring her and watching to see if the blood spot changes. I have a concern with her behavior now as she can answer your questions but then goes off in her own little world and talks about “golfing and it’s your turn.” She also gets up and goes to the table in her room and starts folding the bedding and towels, piles them neatly and then goes on to say it’s your turn play a card. She has never been this confused. Has the fall made this happen? Is there anything I can do to stop this? 


Paul from NY
A:

Head trauma with bleeding in the brain might cause confusion, depending on the degree and placement of the trauma and bleeding. Changes in environment such as being in a hospital can, in and by itself, cause confusion. Parkinson's medications can cause confusion and false beliefs. Any new medication could be a cause. Infections, like a urinary tract infection, are frequent causes of confusion. Her physicians can run some tests to determine if there are alternate causes for her confusion. During her confusional state, make sure she is very well supervised to prevent more falls or injuries.  

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Q:

My mother, 80, has been diabetic for 30 years and on insulin. She has dementia, too. Now she is showing unusual leg movements. What could be the reason for this? 


Thomas
A:

It would be hard to determine with such little information. Medications can cause unusual movements. Is she taking any new medications? Diabetes can cause renal disease in some cases. Chronic kidney disease can lead to abnormal movements. Restless leg syndrome is a condition where the person feels the need to move their legs as they feel uncomfortable. Sometimes that is due to low iron. There are treatments available. Her doctor may be able to evaluate for other potential causes.  

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Q:

My 95 year old father is in the late stages of dementia. He is combative when either his caregivers or I wash his diaper area—he screams very loudly and curses. My brother claims we are hurting him and I try to point out to him that dad is screaming because he does not want to be touched, but that we are not hurting him. His brother says dad doesn't yell at him, but he doesn't clean dad, he just changes the diaper or doesn’t clean him thoroughly. Dad was getting hospice care in our home and the nurses often complimented me on the care we are giving him, saying that he has the best skin in the diaper area and overall that they have ever seen in a person with severe dementia. The brother gets verbally aggressive toward me because he feels he needs to protect Dad from me. This is the same brother who lived with and oversaw dad not taking a bath for over 2 years while I worked to gain guardianship of him. By the way, I was a hospice care nurse and my daughter is a registered nurse who also advises me, so I really think we know what we are doing. Do you have any advice on how to convince my brother that screaming and cursing is not indicative of pain, but rather part of Dad's severe condition?  


Lilian from DE
A:

It may be difficult to convince your brother unless he experiences the same behaviors. However, you are correct that there are many causes of screaming and cursing that are not related to pain in severe dementia patients. Sometimes they just want to be left alone. They may feel threatened. They may think they will be hurt. The approach to your father will be most important in his behaviors. Distracting him with soft objects to hold, playing his favorite music, or adjusting the environment may help. If his screaming behaviors are occurring at other times than with care issues, behavioral medications may be useful.  

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Q:

My mother is 76 and has been diagnosed with Lewy Bodies Dementia. Her doctor put her on seroquel, which she has just decided she is no longer going to take. She said it has too many side effects and she already feels like she is losing her mind. Her doctor has yelled at me because I do not have her in a nursing home and I feel like I can’t talk to him about her issues. What should I do? 


Amy from FL
A:

Quetiapine (Seroquel) can often be helpful for the false beliefs, suspiciousness and visual hallucinations often seen with those with dementia with Lewy bodies (DLB). Very low doses (25 to 75 mg daily) are typically helpful. Seroquel can have side effects; the most common one is sleepiness. If she has clear side effects from the Seroquel, perhaps a lower dose would have less side effects. There are other medications in the same class of medication that could be tried if she has false beliefs, suspiciousness and/or visual hallucinations. Instead of Seroquel, ziprasidone (Geodon) may be tried (20 to 60 mg daily). In regards to communication issues with her doctor, you might try writing down your questions. You can ask if the doctor has a nurse practitioner or physician's assistant or nurse or social worker that you could talk to. They could summarize your questions and present to her doctor. Going to support groups like with the Alzheimer's Association or the Lewy Body Dementia Association may help provide you answers to questions and suggest improved ways to communicate with her doctor.
 

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Q:

My father 81 has Parkinsons, I’m sure. Shuffle, stoop and no arm swing. He now keeps his eyes closed most of the time. He has difficulty getting his legs to move and takes his clothes off and on all of the time. He can’t find the toilet in his own house and started seeing things. Examples are collecting imaginary apples off the carpet and seeing women in the room. When visitors are over, he walks better and can hold a relatively lucid conversation. But he won’t sit still for more than ten minutes, up and down like a yoyo. He is afraid of the dark and has been protecting his wallet and folding everything in sight. We have to wait four months for a specialist opinion. 


Del
A:

If he has memory or cognitive issues in addition to his motor issues, then dementia with Lewy bodies is possible. They typically do not have much in the way of tremors and often can have visual hallucinations. Most of these patients typically perform better when others are around. They tend to sleep more and more or keep their eyes closed more often. Carbidopa/levodopa and other anti-Parkinson's disease medications can also cause excessive restlessness and hallucinations. His physician could consider that these be tapered down if he is on them.  

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Q:

My dad is 93 and was doing very well for his age. About 10 months ago he was even driving, yet loved to walk. He would walk to the store one mile away and carry a package in each arm back to his home. He lived alone and maintained the place on his own, even the yard. Then he fell and cracked his pelvis and went to a nursing/rehab center for therapy. This is when dementia signs started. After 25 days he was walking pretty well. But the day before he was to come stay at my house, he got up in the middle of the night to go to the bathroom and slipped and broke his left femur in half. He went back to the hospital for two weeks and had a rod installed in the bone, then went back to the rehab center again where he broke his right femur. Back to the hospital for another two weeks then again back to the rehab center for 30 days of therapy. By this time the signs of dementia were much worse. He has since really pushed himself to walk with a cane. He has been doing pretty good, living with my wife and me. We are both retired now and enjoy taking care of my father. It is a hard, full-time job, but he is happy being around family. He came down with diarrhea on and off several months ago, but for the last several weeks he has become dehydrated from it and weak. When I took him to the ER, while waiting to be seen, he passed out. Going on the second week in the VA hospital they haven't been able to find the cause. They took him off any meds that can cause diarrhea and run every test they know of, yet no luck. I would really appreciate your input. 


Jerry from FL
A:

His passing out spell seems to more likely than not be related to his dehydration and diarrhea, perhaps causing his blood pressure to be too low. Review of medications and checking for infections are reasonable to look for causes of his diarrhea. I am not an expert on gastrointestinal problems. However, if he is on anti-dementia agents like donepezil or rivastigmine, or glantamine, they could be cause of his diarrhea. I would hold those medications as well. The Exelon patch has the least diarrhea potential of those anti-dementia agents. Drinking too many nutritional products (Ensure, Boost, Health Shakes, others) may cause diarrhea. Sometimes I have had luck with using probiotics over-the-counter to help with diarrhea. Also fiber may be useful.  

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Q:

My father is 80 years old. Over the last 4 years he has developed severe neurological problems. Initially his hands were continuously shaking. When talking, his tongue comes out. He is always tired and finds walking very difficult—even getting up from a chair has become difficult for him. Gradually he lost his control over urine and became irritable. Presently he continuously repeats the same thing, is very restless and talking incoherently, sometimes about suicide. My mother is almost 68 years old and feels absolutely helpless. My father has been getting treatment for Parkinson’s, but now nothing seems working for him. Is their any medical help for him? 


Kakoli from IN
A:

It is hard to understand his condition given the limited information. It sounds like he has dementia, behavioral changes, and movement abnormalities. Some movement issues can be related to medication use. Normal pressure hydrocephalus can cause gait and urine and thinking problems. Strokes, Parkinsonism, and other dementia conditions are all possible. A good diagnosis from a work-up that would include a brain scan, lab tests and cognitive assessments may suggest treatments that could be useful.

 

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Q:

My grandmother is 84 and just moved in with my mother and me. She is now saying I've been stealing from her and that she has seen me in her room, which never happened. She said I did it for “the trip I was taking.” I asked her what trip and she couldn't think of it, just kept saying she knew of my trip, like she was remembering a conversation that never happened. She accused her healthcare provider of stealing and of trying to poison her. She also hears voices and noises like someone knocking on her window, but no one is there. Even at the hospital she said someone was under her bed and that the nurses were trying to poison her and she heard them planning it. She has the shakes and nosebleeds all the time and at times hemorrhages when she goes to the restroom. She can remember things from the past, but makes up current things. Could this be dementia? She has high blood pressure, breathing/oxygen issues and high cholesterol and has blood clots. She's been hospitalized for the blood clots and had a bypass. She says she has Parkinson's, but the doctor said she doesn't though she does have the symptoms of shaking and a shaky voice. I'm just trying to help my mom get help from the doctors. Am I pointing her in the right direction? Please help. 


Jean from TX
A:

These false beliefs are very common in many dementia conditions. They are usually easy to treat with low doses of antipsychotics. Dementia conditions like Alzheimer's disease will present with significant memory deficits. Parkinsonism can be related to small strokes in the brain or may be due to a condition called dementia with lewy bodies. They tend to have more visual hallucinations. Voice tremors are usually caused by other conditions than Parkinson's disease and can occur with hand tremors. I would suggest your grandmother to see a neurologist who specializes in cognitive issues. Mental status testing can document if a dementia condition is present. Further work-up as required will help with diagnosis and then appropriate treatment and management can be applied.

 

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Q:

Could having a caregiver help you cause a worsening Alzheimer’s in an 89 year old woman with the disease? She is totally dependent when the aide is around (11 hours a day). I know she can do some things for herself, but she demands help. I am her daughter. The rest of the family has deserted her. We have been living together for about 2 years and for 1 year in the same apartment building. She has had outbursts, delusions, and has been physically and mentally abusive toward me and the aides. These symptoms are less since her doctor ordered Risperadone, Aricept, and Lexapro, and other medications, but she has stopped reading her New York Times, her New Yorker, and Newsweek. I am with her during the night and have lost so much sleep because she is up most of the night saying "Hello, hello, hello" loudly. I work from home and just cannot stand the hellos, the agitation, the restlessness anymore. I promised her never a nursing home. I've searched for Assisted Living facilities, but they aren’t something she can afford. I am getting weary and sometimes just want to give up. I feel guilty that I can't rub her back and make her feel better. She is now incontinent during the night because she is so tired she cannot make it to the bathroom. I just know that she isn't happy and I am totally miserable. I keep my promises and have always told her that I would take care of her. But it's just too much. Any suggestions?  


Ellen from NY
A:

If her behavioral issues were better controlled, life for all caretakers would be easier. It sounds like her agitation and delusions are improved with Risperidone. Sleep issues can often be helped. Her dementia physician might consider trazodone, zolpidem, or others for sleep issues. Risperidone can cause weight gain. There are many other potential causes for weight gain. Quetiapine typically can help better with sleep than Risperidone and may be a replacement for risperidone for her agitation and delusions. Repetitive word speaking may suggest some obsessive compulsive symptoms. High doses of Lexapro or fluvoxamine (need to get to 200 or 300 mg daily) may be helpful for those symptoms. They may help depression issues. If patients are overly restless, we consider coming down on the Risperidone if it is at a high dose (more than 1 mg daily). Insomnia, feeling or acting hyper, eating a lot could suggest a hypomanic state, and the use of valproic acid or other mood stabilizers may be helpful. In regards to your predicament, the best way you can avoid burnout is to have some more respite. Consider daycare facilities, if available, in the day time so that you have more peace at home in the day. Have her "visit" and stay in a nursing home for a week so that you can get some respite periodically. You will be a much better caretaker if you can have time for yourself and have enough sleep.  

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Q:

My aunt is 90 and her diabetic son, 70, who has always lived with her, was taken to Johns Hopkins because he stopped taking his insulin for almost a year and became very lethargic. He has been in a nursing home for 4 weeks. Now, my aunt is “seeing” her son almost every night in her home. She knows he isn't there, but she tells me she talks to him a while, then he leaves. She also told me some girls came to her house and she served them cokes and potato chips, then when one of them glared at her, she went into the kitchen and called the police. When she returned to the living room, they were gone. When a policeman came to her door, she said she apologized for calling them, but the girl left and all was okay. They were very nice to her and said if she had anymore problems to call them. My aunt shuffles her feet when she walks and says sometimes she gets a little dizzy. She says she must be crazy for seeing these people. I live two states away from her and I don't know what to do. I told her to tell her doctor about this and I will keep reminding her up to the day of her appointment. Do you think she is under stress? 


Jeanie from NC
A:

Your aunt is having delusions or false beliefs. There are many potential causes. Some medications may cause them. They are seen commonly with infections, like urinary tract infections. Metabolic derangements or thyroid conditions might also cause these behaviors. Dementia is often associated with delusions. Stress is usually not a cause just by itself. She needs to be seen by her doctor who can evaluate her for potential causes. They can also evaluate her gait disturbance and for causes of dizziness.  

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Q:

I put my wife in a memory care facility this past Monday. She is 59 and has fronto-temporal dementia. This is her third day and when I call her all she says to me is "Come and take me home". She doesn't know why she is there and I can't reason with her. It is so painful knowing she wants me to take her home. I have always been there for her over the past couple of years and it is breaking my heart not being able to help her. How long can it take for her to adjust or transition? Is it possible that this is just not the right place for her? (The facility is the best I could find and has many great features as far as a memory care facility goes.) Please help. 


Tom from AZ
A:

You should feel good that you have your wife in a good place. Many patients require long-term care and it allows spouses to have quality time with their loved ones while getting help for their care. Some of the downsides to a change in environment is the natural reaction by the patients to want to go back to their comfort place, their previous home. Why would anyone with such impaired insight into their condition, as all frontotemporal patients have, want to leave their home and go to live somewhere else? They have no clue why they or their spouse would need any help in their care. Many times, as the patient gets use to their new home, these comments will decline. Exactly when these comments stop is different for each patient. It may help to not use terms like permanent or forever. It may be better to use terms such as temporary or trial period to get past these comments. Perhaps you can emphasize that the facility is helping to rehab or adjust medications to see how she does. Since you have done your homework in picking this place, stick with it and no regrets. 

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Q:

 My mum is 86, has dementia and doesn’t talk sense most of the time. She doesn't take medication and eats a lot, but seems to be losing weight.


Marion from UK
A:

I am not sure exactly what you’re asking. If she is supposed to take medications for her dementia or for other conditions and won’t, then crushing and placing them in her food would be advised. If she has a good appetite, giving her nutritional supplements would help her maintain her weight. These can be bought over the counter through Parentgiving, such as Ensure, Boost, Carnation Instant Breakfast and others.  

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Q:

My dad has dementia and has just recently moved in with my sister, who is also caring for a special needs granddaughter. When dad first moved in with her, I came by and took him to lunch once a week. She said he would do better if he never left the house, so I brought lunch in. When I called to see when the best time to see him would be, she said she was very busy that week. The following week she made the same excuse. As I probed into this more she said the reason she didn't want me coming to see dad was because when I came over she said he would have a bad night and she didn't want that happening anymore. I told her that, from what I have read, dad shouldn't be harbored and he should be around people who he is familiar with. She insists on not letting me see him till "he is ready." Do you agree with this type of care? I am frustrated that I don't get to see my own dad. 


Vaughn from NM
A:

Given that your sister has the duty of caring for your father, it is important to better understand his behaviors that cause her not to want you to see him at this time. What issues does he have at night after your visits? Perhaps there are treatments to make his nights better. In general, dementia patients enjoy being around familiar people. However at times, certain family members may make them more upset or irritable. Has she allowed you to talk to him on the phone? It is understandable you would be frustrated, but the focus should be on what is best for your father.  

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Q:

My mom has lived with me for 7 months. She is 91 and has dementia. At certain times she’s fine and then she can be totally confused and not even know who I am. My question is, would she be better off in an assisted living or is she happier here? She's never left alone and every day I take her to senior day care or a friend’s house and then they go to a senior center. I'm a single mom who has 17 year old and works full time as a realtor. Some days, I just don't know if I'm doing the best thing for my mom, me or my daughter. Any advice? 


Patti from NY
A:

Caregiving is very hard work. It sounds like you are doing a fantastic job. You are keeping her mind engaged with the day care and senior center activities. However, you also need to avoid burnout, which won't help you or your mom. You also have obligations to your daughter. If your mother has the money for assisted living and you can find one close by, you can still visit and have really quality time as often as you like with your mom and yet have more time for yourself and your daughter. If your mom often does not even know who you are, it may not be a big issue for her to move into another place. You could give it a trial run for a weekend or a week to see how she acclimates to a new place. It may be best for all. At assisted living facilities, they have many activities that should keep her mind active. They have more hands to help your mom around the clock. Other options could be to hire someone to come in to care for your mother to give you more time.  

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Q:

My husband survived a stroke May 2011 and was hospitalized in China, treated and released with no therapy. We have just now returned to the US and are going through initial tests and, I hope, the therapies he missed. Among other things, his short term memory is very bad, he builds up anger over time about me telling him or reminding him of what to do, and he has some long term memory loss. What is your advice? 


Linda from NV
A:

Strokes can cause cognitive impairment. His evaluation back in the US should investigate other causes of memory loss (through blood tests, cognitive tests, and neuroimaging). Frustration is normal when you are always telling him what to do. You can try to avoid telling him things and instead ask him—it will seem less like bossing him. Keep a calendar with reminders of what is planned for the day. Put up signs to remind him of certain duties so that he can do them without you reminding him. For things that you both need to do, perhaps like bathing, you can tell him that you are about to take your bath, but does he want to go first? In this way he may get less frustrated at always being told what to do.  

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Q:

My Momma is 91. She lives in a very beautiful large retirement village. She lives alone, but has access to nursing and has neighbors and friends very close by. She told me today about these frequent bad dreams that have been troubling her. She becomes very involved in her dreams and she’s very anxious. She awakens in the middle of the night, thinking it is time to get up, dress and start her chores, which is what she did today. Her older sister died several years ago from the effects of dementia. I am concerned she may be headed that way. (She lives in North Carolina and I live in British Columbia!) 


Joanne from BC
A:

Simple tests can determine if she has the beginning of a dementia condition. Her doctor can evaluate her for that. Let her doctor know of your concerns regarding her memory or thinking. Also let the physician know of her sleep issues. Make sure first she is not on medications that would increase bad dreams or insomnia. There are several safe medications that are not sleeping pills that can help with insomnia or bad dreams (e.g. trazodone and rozerem among others). Also, try good sleep hygiene habits may help, including keeping bedtime and rise time the same, avoiding caffeine or alcohol at night, and not drinking many fluids after dinner. 

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Q:

My grandmother-in-law is 94 years old. She has begun to hear people talking to her, telling her they are going to kill her. She is constantly worried, hides in closets, covers her head. She says they know everything we are saying and they are coming up through the floor. She has always been a very devoted Christian and we have tried numerous things. Is this dementia and will it get worse? She is starting to not recognize some of her family members. Is there anything we can do to help her? Thank you in advance for your help. 


Tracy from SC
A:

Your grandmother-in-law has psychosis (false beliefs). If she also has memory loss and perhaps trouble finding words, this is very likely a dementia condition. Be sure to check if she is on any new medications or increase in medications that can cause these symptoms. Urinary tract infection or other infections often cause similar symptoms. These can be treated. If no other cause is found, there are many medications that may help her psychotic symptoms, such as Seroquel at night or daily Geodon. Talk to her doctor to see if any treatment is right for her. She would likely only need a very small dose, given her age. Also if dementia is considered, treatment with cholinesterase inhibitors (donepezil, galantamine, or rivastigmine) may be in order to help her thinking and slow decline in her dementia symptoms.  

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Q:

I am a live-in caregiver for an 88 year old woman with Alzheimer’s (now at the mid-severe stage), mild cardiac arrythmia problems for years and, just recently, CHF. She is having lots of peripheral edema and her furosimide was increased. I also must say that this lady is the mom of my best friend from junior high school. I have been close to the family for years. I am also a practical nurse with many years of experience in geriatrics and dementia. I accompanied mom and daughter to her physician about 3 weeks ago to address the problem with the edema. She’d also been having increased incontinence and diarrhea for close to a month. The doctor increased the diuretics, came up with something to help with diarrhea and then requested the daughter to call in a week to report whether there had been any improvement in both areas. The increased diuretics have had no effect on the amount of fluid she is retaining. Yesterday I requested the daughter to call the doctor and report on the lack of improvement. She has still not called with a report. She has decided that her mom's whole problem is due to an extra 20 lb she’s carrying and told me I am to give her mom absolutely no sweets, bread, cookies, or candy of any kind and she will lose the weight, be able to exercise and ambulate around the block without difficulty. The poor woman is so fatigued due to her real health problems that she is totally unable tolerate the kind of activity her daughter is demanding that I force her to do. She becomes out of breath with just minimal activity. She is unable to walk even to the mail box. She prefers to sleep more than anything these days. She is failing, but I cannot convince the daughter that this is probably the way things will stay with her mom and that she should follow the doctor's instructions regarding what should be done in regard to cutting out foods she enjoys. I don't know what to do about these conflicts that clearly could be serious if not addressed yet I am told that I am overstepping my bounds whenever I question her or make suggestions regarding her mom's care. I don't know what to do. I am the caregiver after all.  


Karen from OR
A:

Increased edema is water weight and will definitely cause a lot of weight gain. It may also suggest increased problems with her congestive heart failure. Unless that issue can be addressed she would not be able to exercise or do any type of activities. Her quality of life depends on this. You sound like you are doing your best to convince the daughter. I would agree that it is best to let the doctor know the results of the intervention they suggested. You can let the daughter know that there may be other treatments to help her mother's edema and weight gain that the doctor can suggest. I suppose that it puts you in a difficult position, but keep in mind that anyone can call the doctor to give information without incurring any HIPPA violation.  

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Q:

My father has the first signs of dementia. He has become very addicted to his pain meds to the point that’s what his life revolves around. But it has come to the point where he doesn’t remember if he has taken his pills or not and won’t let any of us to control them for him. It’s not just with prescribed medications—even over-the-counter ones. Plus he’s our dad so when he tells us he’s hurting, we give in. We need professional help with this situation. Please let us know what we can do. 


Georgia from MO
A:

You say he is addicted and so I assume he is taking narcotic pain medications. Narcotics often increase cognitive issues, especially in someone who may have other causes of dementia. It is important to get his doctor involved in this situation. The physician needs to tell the patient that it is not safe for him to take his own medications due to their potential effects if he takes them incorrectly or in the wrong dose. The doctor could make it clear that, unless he allows a trusted family member to supervise the narcotics, it may be unsafe to prescribe them to him. 

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Q:

My dad is 82. He was first diagnosed with Parkinson's disease about 5-6 years ago. He is on syndopa plus, amanterel, and urotone (he developed urinary incontinence quite quickly). He also has the other symptoms like falling, drooling, freezing, tremors, and mask-like face etc. He was in the hospital for aspiration pneumonia in May 2010. About a year ago, he developed fecal incontinence as well. So now he wears an adult diaper all the time. He can walk, though slowly, with a walker and has physiotherapy thrice a week. He is quite alert and has only mild memory loss. A neurologist to whom we took him last month to explore deep brain stimulation said he has Parkinson’s Plus and not Parkinson’s so it cannot be used. However now there are two problems: One, he cannot drink water because even a little starts off a severe coughing fit. Two, he puts his hand inside the diaper and removes the feces when he is in bed. Can anything be done to prevent aspiration of water and other thin liquids? I am afraid that he will again develop pneumonia. Please help.


Jayanthi
A:

There are many thickening agent products that are designed to help individuals with swallowing difficulties. These can be bought over the counter or internet. Parkinson's disease often causes dysphagia, leading to possible aspiration. Common signs of dysphagia include drooling, coughing and choking on liquids more than solids, and more difficulty talking after swallowing. The thinner the liquid (water, apple juice), the faster it can get to the back of the throat and the less likely the individual with Parkinson's disease with slow motor skills can close their wind pipe in time. If the liquid gets into the wind pipe, choking and coughing start and it may lead to aspiration of liquid or food into their lungs. That can cause a lung infection or pneumonia (aspiration pneumonia).  

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Q:

My father who is 74 years old is losing a great deal of weight. I recently took him to the emergency room and they took every test possible and everything came back normal. He is not bathing on a regular and he refuses to keep himself or his room clean. He will not let me clean his room and the smell is not good. I am waiting for his Medicaid card to come in the mail so that I can get him a family doctor, but in the meantime can you give me a brief summary of what you think is going on.  


Linda from NC
A:

Well, what you tell me is that your father is losing weight, refusing bathing, and not keeping his room clean. It sounds like he is not thinking as well and not making good judgments and this suggests a brain condition. Evaluation should include a good history, family history, social history, examination, lab tests, scan of his brain, and cognitive (pen and paper) tests of his thinking and memory. That information should help with making a diagnosis. In regards to his behaviors, close supervision, if not already present, may help. People tend to eat more and more regularly if they are eating with someone else. Nutritional supplements (Boost, Ensure, Health Shakes, Carnation Instant Breakfast, ice cream…) given regularly on a daily basis may help. Having a friend, family member, or health aide come in to bathe him may be needed. Perhaps bribing him with something he likes only if he takes a good long bath may work. At times it is easier to clean up if he is not around. Have someone take him out and then clean his room when he is away. If he is developing cognitive (memory or thinking) issues, having him appoint a Durable Power of Attorney for Health Care and Finances is critical prior to his losing the capacity to make decisions on his own. 

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Q:

Scenario: Father with dementia, Mother without dementia (but in denial, refusing to care for herself for fear of leaving her husband alone and refusing outside assistance). Considering this scenario, how should children approach the situation? The mother, in her 80's, has many health issues as well and needs knee surgery. She refuses to talk about her situation and just seems so angry when she speaks about her husband. The children are at a loss as to what they should do to help their parents. Can you offer any advice? 


Michelle from WA
A:

These situations are always difficult. Your mother needs some respite—time for herself. If children are close by, they can volunteer to take their Father for an outing to provide supervision for 4 hours or so to give her some time. Your mother can go with her husband to a Day Care Center if there is one close by so that he gets used to the staff and guests. After a few times he (and your mother) may be very comfortable to leave him under their supervision while she gets some things done for herself. If your mother needs surgery for her knee, one of the children or a respite care facility can watch and care for her husband. Your mother may also be helped by an antidepressant if indicated to help with mood and irritability issues.  

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Q:

My mother is 94 years old. She needs someone to come in and stay with her at least to cook two meals for her. She still doing some things for herself and lives with my sister who has to work. She trusts no one and thinks that people are coming into the house and stealing things. She does misplace things, forgetting where she put them, but it worries me that she thinks all these people are taking from her. Now she also does not want to eat. Is this dementia? 


Lilly from TX
A:

Your mother has false beliefs (delusions) and memory loss. This is probably a dementia condition, given her age. There are many causes for dementia including Alzheimer’s disease, medications, small strokes, B12 deficiency, low thyroid and many others. Her primary care physician should look for potential causes and treat accordingly. Sometimes treating the underlying cause (like replacing B12 in B12 deficient individuals) will also clear up the false beliefs. Sometimes the false beliefs require an additional medication specifically to help those symptoms, like quetiapine (Seroquel). 

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Q:

My mom is 93 years old and has been very healthy. Two weeks ago she developed a lot of anxiety over a huge family event and became very anxious and totally had a loss of appetite and weakness. She was diagnosed at the ER with a low sodium count and given 2 bags of IV fluids and discharged after being told that she needs to eat and drink more to bring her sodium level up! At her next blood draw her level was at 133. She is still very sick and weak and feels as though she is dying. Her memory is good. They did also put her on Ativan for her anxiety, but she has gotten worse, not better. I feel we are missing something here! Any thoughts of what is going on with my mom? 


Deborah from OH
A:

Sometimes using Ativan, especially at age 93, could cause more problems than it helps. For some individuals it can increase confusion, it can cause a lot of sleepiness, and is addictive. Often a trial of an antidepressant, such as escitalopram (Lexapro) or sertraline (Zoloft), can work very well for anxiety and has many less side effects. Low sodium issues can be responsible for confusion, anxiety, appetite issues and weakness. Her doctors, if they have not already, should identify the cause of the low sodium and try to correct the underlying cause. 

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Q:

My dad has Alzheimer's going on 5 years. It has got to where he takes his penis out of his diaper to urinate and doesn't put it back. Then he leaks urine in his pants, on the floor at night after he gets out of bed for some reason and in the bed. I have considered a catheter but fear he would just pull it out. Any idea to help with this? 


Michael from FL
A:

There is not a lot that can be done except increased supervision and reminders so he is correctly positioned in the diaper. Sometimes placing notes in the bathroom or bedroom to put pants on correctly may be helpful for some patients. Some men have an enlarged prostate or prostate cancer, which may cause dribbling. His primary care physician can diagnose this and there may be medications that could be helpful. If he is up a lot at night, then maybe a medication to help with sleep (like trazodone, which is very safe at low doses of 50 or 100 mg nightly) might be prescribed by his primary care physician. This may reduce his nighttime awakenings for random reasons, but would not keep him asleep if he really needed to use the toilet. Reducing or eliminating liquids after dinner and avoiding alcohol (which causes increased urination) may reduce nighttime urination needs. Use of a catheter, I agree, would cause more problems than it would solve. 

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Q:

Please let me know if there are any trial medicines for beginning stages of Alzheimer’s. 


Sue from CA
A:

There are many clinical trials for mild Alzheimer's disease and the precursor condition, Mild Cognitive Impairment. Many of these are testing experimental medications. The best place to look for trials in your area is to go to the website clinicaltrials.gov 

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Q:

My mum is 81 years old and has dementia. I moved her in and she has lived with my family and me since 2008. She is hard of hearing, forgets to eat, won't drink water (only soda) and makes up some bizarre stories. She has been more dizzy of late, and actually fell this morning in the bathroom. She hit her head. Quite a bit of blood. She managed to clean up most of the blood and crawl back into her bed. She initially didn't remember why she was bleeding and had slurred speech. An hour later, she was better with her speech. I am taking her to the doctor today. She won't take medicine due to her religion. The dizziness keeps getting worse, her appetite is down to very little (she’s 5’2", 115 pounds), and bleeds vaginally off and on. Not sure what to do to help ease her dizziness and help her eat more. 


Jul from CA
A:

Many medications can cause dizziness. However, since she is not on any medications, some blood and urine tests may be in order to rule out infection, electrolyte issues, low thyroid, B12 deficiency, or liver or kidney problems. For weight loss, nutritional supplements (Ensure, Boost, Carnation Instant Breakfast, among others) can help to provide a lot of calories with a small amount of liquid. There is a liquid medication, megestrol, that is often helpful as an appetite enhancer.  

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Q:

My husband has Parkinson’s/Alzheimer’s. He has become so restless, fidgeting constantly, tearing things up and breaking things. I give him things to occupy his hands, but it is getting worse. He is on Namenda, Carbidopa, Effexor, Exelon patch and Seroquel evening as well as a PRN. Any suggestions to help the constant fidgiting? The disease is worsening as just direction does not help much—he must be SHOWN how to do something, and he’s having more anger issues. 


Patti from MT
A:

With Alzheimer's or Parkinson's disease, restless behaviors and fidgeting are not uncommon. The medications he’s on that can cause increased restlessness are Carbidopa/levodopa (typical), Effexor at times and, if giving higher doses, Seroquel. Citalopram or Depakote may be more helpful than Seroquel and Effexor for these types of behaviors. If you wish further information regarding the best behavioral treatments for these conditions, you may purchase my book, "Long-Term Management of Dementia" (Informa Press) through Amazon or click on the icon next to my picture.  

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Q:

I have an 82 year old father who was diagnosed with dementia/possible Alzheimer's last year. Just prior to his diagnoses, he had gotten into a car accident, one for which he was responsible for causing. He was cited for not allowing enough distance between his and the other vehicle. His doctor adamantly opposed the idea of his driving and he told my dad so. I agreed with his decision, but my dad never totally accepted it. My dad lives on his own with some assistance. I pick him up and take him to my house after work to eat supper and to be with family. His neighbor also helps. I also pay his bills. Here is my issue. He rides his bike in places that are dangerous. I don't have a problem with him riding his bike in the small village where he lives. The problem I have is he tries to ride to my house, which takes him on a state route with busy traffic. I have warned him before. He doesn't listen. Do you have any thoughts? 


Thomas from OH
A:

Safety is obviously your main concern here. Independence is his wish. At some point he may not be using good judgment to ride a bicycle at all. However currently it seems that he is still capable with restrictions for safety to ride one. Our typical recommendations are to avoid riding at night, in inclement weather, or in unfamiliar areas. I would tell him that state routes are off limits at this time as you have. You could bribe him to not ride on the state route. You could suggest you take him to ride in places that are safe or ride with him on weekends. If all that fails and his actions are dangerous, you could have a police officer notified while he is riding on the state route to pick him up if he is showing dangerous riding techniques. This may reduce his desire to do those unsafe practices. If all else fails and he is in danger with his riding, removing his bike would be the last resort. Another idea is to follow him (perhaps ride a bike with him) and to observe if he is using good judgment or not with his riding. If he is not, watch once a month. Once he is noted to be using poor judgment, it is time to restrict his riding.  

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Q:

My 89 year old mother has been experiencing transient attacks of feeling like she is dying when she wakes in the morning. These spells pass and she is fine a few hours later. She has had extensive workups, which have all been negative. Today she called rescue and was taken to the ER and worked up again...all tests were again negative. She is "with it " and lives alone and still drives...Just do not know what to do next. 


Donna from NY
A:

It sounds like she has severe anxiety, maybe panic, attacks. Make sure she is not taking sleeping medications (especially over-the-counter ones) or hypnotics. Have her physician evaluate all her medications and remove all that are not needed. If blood pressure, oxygenation, low blood sugar, sleep apnea, thyroid problems, vitamin B12 levels are all normal, she could try something for anxiety. Benzodiazepines are not typically recommended for individuals her age. Antidepressants (escitalopram or sertraline) or buspirone may be the first ones tried due to low side effects.  

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Q:

I have an 81 year old mother who was diagnosed with Alzheimer’s two years ago. She has been in a care home for one year as she was no longer able to care for herself—wandering and not recognizing her own home. She was not able to tolerate carergivers in her own home, thinking they were intruders. She would not stay in my home and refused to wash. She was not eating properly to caring for herself. She is now in an excellent home where her health has improved, though her fixed delusions remain. She has some incontinence. She has no short-term memory and her ability to recognize familiar people is fading. I believe she is in the late middle stage of the disease. I am having to make complicated financial arrangements to pay for this very expensive home and would like to know what the chances are that she will live past 88. Her own mother had Alzheimer’s at the same age and lived to 88. Most of her siblings did not have Alzheimer’s and lived to around 87 years old. I realize there is no certainty, but is there any “rule of thumb” that could help in a difficult decision making process?


Lorraine
A:

It is hard to predict without more information about her other medical conditions and her current functional abilities. As you suggest, genetics can play a large part. If she is in the late middle stage as you suggest, 4-5 years more would be typical if she did not die of something else first.  

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Q:

In my search for answers to what happened to my 69 year old husband during routine gall bladder surgery I came across a question and your response. The doctors caring for my husband did indeed describe what happened as "rapid onset Alzheimer's.” This "diagnosis" came after several weeks of waiting for the anesthesia to "wear-off". I’ve always believed he may have had a serious adverse reaction to the anesthesia that accelerated a latent tendency toward dementia. Thoughts? 


Shari from VT
A:

As I mentioned in the prior question, I don't believe there is any such thing as rapid onset Alzheimer's. Dementia conditions occurring right after a surgery are almost always related to medications, infections, metabolic derangements, perhaps impaired blood flow to the brain or perhaps low oxygen to the brain during the surgery. However, other coincident causes of dementia need to be ruled out. If he had the start of a condition like Alzheimer's disease prior to the surgery then he will continue to decline very gradually with his memory, language and visuospatial problems after the surgery. However, this process is gradual (months to years) and not rapid (days to weeks).  

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Q:

I have a father with dementia that has advanced after a pretty serious illness. He is in a wheelchair much of the time, but can use a walker for short periods of time. He has severe back pain and needs help with daily living activities. He is currently at home with 24-hour care, but is starting to not trust the people caring for him. Would he be a candidate for memory care, or do his health issues create a problem for that? 


Kelly from CA
A:

Many people with dementia can develop false beliefs or suspiciousness. Sometimes it is caused by other medications like narcotics, carbidopa/levodopa or many others. First have his doctor review what he is taking. The caregivers might be able to reduce some of these suspicions by changing the way they approach him. They can try to empathize with his concerns and redirect to another topic if these false beliefs come up. There are some very effective medications (antipsychotics), if used in low doses, that often greatly help these types of symptoms. Whether his behavioral issues correct or not, it is likely that most nursing homes with memory care would be able to take care of all his health issues. However, the best way to find out is to visit them and explain his situation.  

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Q:

Does mild dementia indicate that a parent has to be put away and can not reside with a daughter? She is such a joy to have and she attends an adult day care. She knits, plays cards, etc.  


Allison from PA
A:

Absolutely not! As long as the parent is safe and needs met, they can live where it works best for them. The only reason to consider assisted living or nursing home is usually because the person is no longer safe at home or the caregiver(s) can no longer adequately care for them. Another advantage of senior living, assisted living or a nursing home is the activities and socialization provided, which help keep the person's brain stimulated, which is thought to help brain functioning. However, your parent goes to adult day care and it sounds like she is getting a lot of good brain stimulation.  

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Q:

My almost 87 year old aunt has been recently diagnosed with mild dementia. She has only recently in the last three weeks been given Aricept. After her knee replacement surgery, we decided to move her to an independent living facility and provide additional caregiver assistance. This was over her objection, but there was no longer any way for her to live at home by herself. She has been at the facility for about 3 weeks and still is not adjusting well. She refuses overtures from other residents. She insists she will not be staying there long. I am at a loss what to do to help her adjust being 1000 miles away. This is all costing a lot of money and I am worried we have made the wrong decision. Any thoughts or ideas?  


Judith from TX
A:

There are no easy choices. If she is not safe at home or no longer able to care for her needs appropriately at home, she either needs the safety net of an independent living facility or in-home assistance for supervision, help with daily activities and safety needs. Many times there is a honeymoon period of adjustment when moving into a new place. For some this is short and for others it may be much longer. It is costly either way, but depends on the amount of in-home supervision required. She should continue the Aricept and make sure she increases the dose to 10 mg after one month. If there is some evidence of depression, irritability or anxiety, an antidepressant (such as sertraline or escitalopram) at a low dose may be helpful for the adjustment period. Ask her doctor if any of those are appropriate for her.  

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Q:

My mom is 67. She first started saying someone was taking her things two or maybe three years ago. In the last two months she hit her head and was fine—except now she is saying the devil is after her and people are trying to have sex with her. She’s saying "Jesus" constantly, eating less, goes out and walks until she is weak and won’t go in basement. She wants lights on and won't go back to her apartment saying, "They having sex with me through the wall," that they have a detector to find her and she only feels safe under the dining room table or outside. Are these signs of Alzheimer’s/or schizophrenia? What do I do? She says “Ain’t nothing wrong with me,” “You don’t believe me” and “The devil is real.” 


Pat from OH
A:

Your mother has symptoms of delusions, which are false beliefs where no amount of logic or persuasion will change her mind. Typically, trying to interject reality will cause anger and disbelief on her part. Empathizing with her concerns (it would be terrible that strangers are having sex with her) will allow her not to get too angry at others. Some medications can cause these symptoms. Check for any new medication she is taking. Infections like urinary tract infections can cause such symptoms. Significant liver of kidney disease, electrolyte imbalance or endocrine conditions as well as other conditions can also contribute to these types of symptoms. If the delusions are longstanding, it may be due to a dementia condition like Alzheimer's disease. If she had dementia she would also have significant short-term memory loss. It would be unlikely schizophrenia, as that condition starts much younger as a general rule. There are many choices of medications that help delusions called antipsychotics. Her doctor should be able to decide if she is a candidate for any of those treatment choices.  

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Q:

Who decides what time a dementia client goes to bed?


Doris from GA
A:

Normally the individual should decide what time they wish to go to bed. Keeping good sleep hygiene (maintaing routines for sleep and wake times and turning off distracting lights or noise at bedtime) is very important to a dementia person's functioning and for good sleep habits. If the individual is attempting to go to bed very early and then is waking up in the middle of the night causing disruption to others, we would suggest increasing pleasurable activities to keep them up to a more suitable bed time. If the individual is tending to go to bed too late, avoiding naps in the day, eliminating TV or other distractors at normal bed times or if needed, giving medications to get their sleep/wake cycle under better control may be helpful.  

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Q:

My grandfather is 85 years old and has dementia and Alzheimer's. He was put on Aricept tablets by the doctors at the memory clinic and my mum managed to look after him at home for about 3 years until things got too bad. The worst thing of all was the bowel incontinence. He is now in an EMI unit at a local nursing home. The problem that is concerning me is that he opens his bowels up to 7 times a day and doesn't know that he has done it. He is an extremely good eater and remains so. In fact he doesn't know when he has had enough, but he has lost an awful amount of weight. He has had investigations at the hospital and all his bloods have come back normal. Is this just part of the disease? 


Kelly
A:

Aricept (donepezil) in a small proportion of patients can cause loose stools or bowels and weight loss. If no other cause is found, donepezil may be the cause. Adding fiber to the diet daily may be helpful. Rivastigmine (Exelon) patch in some individuals will produce less gastrointestinal issues since it is a patch and not a pill and circumvents the stomach. It can be given in place of donepezil. Adding nutritional supplements to his diet may also help with weight since he has a good appetite.  

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Q:

My dad has dementia and is not eating food well anymore. What should I do? 


Melanie from VT
A:

If his appetite is low, consider supplementing his food intake with nutritional supplements such as Ensure, Boost, Health Shakes and others. They pack a lot of calories in a small amount of liquid. There are also medications that may help with appetite (mirtazapine, megestrol) that you can talk to his doctor about. If he is having trouble with chewing or swallowing, the only solution is to make his food softer to make it easier to swallow. If he is choking on liquids or food he should see his doctor. There are also products to thicken the consistency of liquids to make them not cause choking as much.  

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Q:

I am with my wheelchair bound hubby @ assisted living. This Community has Azheimer’s and dementia residents. They are never hungry, but given food will eat usually—not always. When should the family be made aware of this and/or depression? 


Krys from OR
A:

 Alzheimer's patients often get to a point that they do not know how to look for or seek out food. They may lose language abilities that they can not express their desires that they are hungry. Depression should always be looked for. Crying spells, “wish I were dead” comments and apathy are all signs to watch out for.

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Q:

My Dad just went into a Memory Card facility six days ago. The facility staff wanted no family contact for at least two days to get him "acclimated". On the third day they said he is still too anxious and did not want my mother or me to visit. I decided to go anyway and found dad to be very agitated, thinking mom had left him, thinking it had been two or three weeks rather than two or three days since anyone has seen him and he cried in front of me for the first time since his mother passed away 25 years ago. Thus, I have told my mom to go ahead and visit him daily. However, his agitation really has not got any better. He keeps wanting to leave, still thinks mom has left him, and so I don't know what to think. Do we leave him alone for several days to "adjust" or do we still keep seeing him and reassuring him, even though this makes him anxious when we leave and he can't go with us? Looking for some advice. 


Mike from TX
A:

Many demented patients have a tough transition when moved to another environment, especially when familiar people or things are not present anymore. Often over time (and that varies with the individual) they acclimate to their new home as they get accustomed to the staff, other residents and their environment. Depending on the stage of their disease and the degree of comprehension of their environment, that can take a long time in some cases. Some patients do better if the family visits often and others seem to do better if out of sight, out of mind. It depends on how he reacts to family to determine if that is more anxiety-producing than not. Anxiety and depression can be treated very well during the adjustment period and I would talk to his doctor for consideration of starting a medication to help.  

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Q:

My mother-in-law is 73 and is having serious issues with her memory and paranoia. Most of the time she appears to be normal, or just maybe hiding it very well. She lives in a 4-bedroom house by herself, which she manages to keep clean and maintain. She also drives and does her own shopping. Every so often she will insist that the neighbors are moving the property markers and are moving fences and driveways onto her property. Most recently she took a 2 week trip to Florida and upon returning insists that someone has broken into her house and has replaced all the furnishings with items that are not hers. She has even called the police to tell them that her car has been replaced with another car.  


Dorothy from NJ
A:

Evaluation is needed to find the cause of her false beliefs including memory screening and assessments. Please see the answer below for more details. 

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Q:

On December 11th 2010, my dad had a heart attack, then kidney failure along with sever COPD. Due his illness he was placed in a rehab facility to recover. Over the past year his health has gone up and down, but lately he has been making up stories that no one comes and sees him, or that he has gone somewhere (like when his friends visit he drives their car and other stuff). I will follow up and none of this is true. He will tell me that he's not getting his meds etc. Seems like a lot of stories—none of it's true but he believes it. It's almost like lying! I will ask him something and won't tell me the truth. My dad has visitors all the time, but will then say the next day no one comes by, but his memory of the majority of his is still there. I guess what I'm asking is, is making up stuff to the point he believes it part of dementia? 


Yvonne from CA
A:

What you are describing, false beliefs can be caused by many conditions. Certainly people with dementia (Alzheimer's disease, Lewy body dementia, Parkinsonian dementia and others) can have false beliefs due to their dementia. However, certain medications in some people may also cause false beliefs (steroids, anticholinergics, antihistamines, pain medications, amiodarone, mexiletine, antiarrhythmics, many antibiotics, sleeping pills, anticonvulsants, some antihypertensives, anti-Parkinson agents, and others) in some individuals. Toxins like alcohol can cause false beliefs. Lack of oxygen to the brain (hypoxia) from sleep apnea, COPD, poor heart function can cause false beliefs in some individuals. Significant liver or kidney disease can cause this. Low B12 or thyroid abnormalities can cause this in some people. In short, just because here are false beliefs does not mean the person has dementia. A careful and complete evaluation should be done to find the specific cause. There are medications that can reduce false beliefs (antipsychotics) that may be considered by their physician.  

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Q:

My mother died last year and since then my dad, who is 88, has moved in with my husband and me. He has dementia, can't feed himself and is given his medicine. He spends a lot of time in his bed. Also has to use a bedside commode. Any advice or ideas? 


Karen from LA
A:

The usual goals of care would include safety and quality of life. Increasing pleasurable activities and using day care centers to increase brain stimulation may help quality of life. Look at all his medications to make sure they are not sedating him. Make sure that all caregivers get enough respite so that they can increase the amount of quality time with him. Consider a companion to get him out of the house.  

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Q:

Do you think that "memory care" as marketed by Assisted Living facilities is in essence a scam of sorts? I am coming to this conclusion for two reasons: A) There is no regulation whatsoever of this area, or enforced standards as to what works and what doesn't and B) Needless to say, "Memory Care" costs more money. My mother has Alzheimer’s and I have been looking into a new AL facility for her. I think anyone with Alzheimer’s or Dementia benefits from one on one attention and love, but to market it as "memory care" seems false to me. What say you? 


Cheryl from LA
A:

There is great variation of care provided in Assisted Living facilities. For some "memory care" is just having a locked unit where the dementia residents stay so that the Assisted Living facility can advertise they have a special place for dementia residents. The best places not only have secured units, but also have extensive training in the care of dementia residents. They have dementia specific activities based on the individual resident's level of functioning. They have more, rather than less, activities that are resident specific. They have environmental cues and stable nursing staff to help provide routine and stable environments for those with memory loss. They have training regarding behavioral modification techniques and ways to improve communication to those with dementia. They have training with ways to approach and care for those with fear, suspicions, anxiety, intrusiveness, and agitation other than always using chemical or physical restraints. They have expertise with their physician staff who know when and with what medication (behavioral stabilization and cognitive enhancers) using the appropriate dosing will lead to improved quality of life for a specific resident. They communicate routinely and often between each other and with their physicians to notice issues early and to take appropriate actions early. In looking for an assisted living facility you can ask about the topics I mentioned above. You can also ask how often they have to send a resident out to the hospital for behavioral or dementia issues or how often they give someone a 30 day notice to leave due to the resident's behavior or dementia issues. The best facilities rarely have to send the residents out or away as they have great staff and the training to appropriately care for the resident in place. Good luck on your search. 

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Q:

My father is 73 years old and has a shunt from normal pressure hydrocephalus and now they are saying he is in full-blown dementia and on his death bed. Could you please tell me if this can happen like this? It all happened in a matter of a few days. He is combative, spitting and yelling. 


Renetta from LA
A:

If the shunt that was placed malfunctions or is clogged, it can cause acute hydrocephalus leading to severe headaches and lethargy leading to unresponsiveness. If there is an infection of the shunt in the brain, that can lead to sudden and severe cognitive impairments. A bleed in the brain related or not to the shunt (subdural hematoma, cerebral hemorrhage) can cause rapid deterioration. Degenerative dementias never progress in a matter of days. A CT head of his head or a shuntogram can help with diagnosis of the problem.  

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Q:

My Dad has had three different cognitive tests and has failed each one. The last test was in August 2011. He was told he would have to stop driving. Each time the doctor prescribed medication for Alzheimer's, but my mother would not administer the meds. She said it affected him too much in negative ways and never let him have those meds for more than 2 days. She also let him to continue to drive. I told the doctor that he was still driving and they contacted the state and had his license revoked. How do I deal with a second parent who has dementia also, but has all control? 


Tony from MS
A:

I am sorry that you and your family have had to go through all of this turmoil. I am not sure of your question. Do both parents have dementia? Is it your mother or father that has all control? If your father continues to drive, is not using good judgment in his driving and is not safe, then disabling the car or removing it may be potential options. If your mother is overly controlling, you need to discuss with her that her husband's dementia syndrome will decline more slowly in the future by getting and staying on Alzheimer's medication if that is what his doctor is recommending. The longer the husband stays functional and able to take care of day-to-day activities, the less work it is for the wife. If it is the husband that is controlling, the family must try to do what they can to keep him safe. His doctor needs to bargain with him to just try the medication temporarily to see if he likes it or if it seems to have benefit. For a fair trial, make sure he gets up to the best dose. After a couple of months, the medication may be more routine and he will not complain about taking the medication or the doctor can suggest to keep on it a little while longer to see how it does.  

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Q:

My 80 year old aunt who was diagnosed with dementia has suddently started hallucinating. I’m very concerned about her meds and dosages. Could these meds be contributing to problems (Namenda 5mg morning and 5mg night, Seroquel 25mg morning and 50 mg at night, Razadynde 12 mg at night, Prazosin 1mg night and Meloxican morning and night). Or maybe her meds are not strong enough? 


Anne from LA
A:

 Medications can often cause hallucinations. Of the ones you listed, meloxicam might cause issues in some individuals, but it is not common. The other medications do not typically cause these issues. If any of these medications were started just before these behavioral symptoms started, then talk to her doctor about coming off that medication if possible. It is possible that she is having false beliefs or delusions and not specifically seeing or hearing things (hallucinations) that others do not see or hear. Seroquel is a medication specifically for these false beliefs. Perhaps she was started on it for that reason. The usual does range for Seroquel is 50 mg to 150 mg total dose daily in dementia individuals. Since there are many causes of these behaviors, including infections (urinary tract infection), metabolic disturbances, environmental considerations, among others, it is best to get her back in to her physician so they can make sure she does not have an infection and to check for other causes to treat.

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Q:

My Mother has dementia. She has a husband, but my siblings and I feel he is not taking care of her. We thought about guardianship, but not sure where to start. The husband does not follow the doctors’ orders and most of the time does what he thinks is best (regarding medicine, etc.). She is losing weight because of not eating properly. I have medical POA, but have been told it would not work if we decide to try and place her somewhere. I guess he can override that. 


Diana from NC
A:

If you have a Durable Power of Attorney (DPOA) for healthcare and your mother no longer had the capacity to make these decisions on her own and your father and siblings are all agreeable to place her, then there is no need for guardianship and you can make the arrangements to place her in a long-term care facility. If there is disagreement between family members, this becomes harder to do and then a guardianship may be the best option. To get a guardianship, you will need her physician to fill out paperwork obtained from the courts to provide information on her capacity. The courts then decide if a guardianship is appropriate and who the guardian will be. They may choose a non-family member. Another option is to contact Adult Protective Services to come into the home and evaluate the situation, particularly if you feel that her husband is not taking care of her properly. They can help as well in getting the process started for a guardianship if they feel that is needed.  

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Q:

How do I get my mother-in-law Barb from acting out around my daughter when we are not home? We live with Barb and my daughter gets her off the bus from daycare before we get home and Barb treats her just horrible, yelling, cussing, throwing—it is just awful. This never happens when we are home, but we have heard this over the phone several times and the neighbors have told us. Please help.  


Sherry from AZ
A:

There are many potential reasons for her behaviors and so it will be hard to be very specific. In general if your daughter can bribe her with something she likes to eat or do, this may help. In other words increasing pleasurable activities usually helps. Perhaps you calling Barb just after she arrives home may ease the irritability. If none of that helps, you could talk to Barb's doctor about medications, like antidepressants that may help calm her a bit more.  

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Q:

If the research shows that UTI can cause dementia-like symptoms, is there a treatment with prophylactic antibiotics to prevent the infections from establishing themselves? 


Janet from AZ
A:

 Yes. In some individuals who have frequent urinary tract infections, physicians at times prescribe daily low toxicity antibiotics to help prevent them from occurring.

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Q:

My grandmother of 92 had a episode the other night where she said that she saw a man in her closet and a little girl was sitting on her bed. Could this be a result of a UTI? 


Kirsten from IA
A:

Many things may cause false beliefs or hallucinations in elderly people. An infection such as a urinary tract infection or pneumonia could cause this. New medications or overdose on medications is another common cause. Metabolic conditions or liver problems may cause these symptoms. If they are recurrent and especially if they are associated with fevers, confusion or other new symptoms, your grandmother should be seen by her physician.  

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Q:

I have a mother with dementia. She paces back and forth, requires frequent attention and lately has been getting quite agitated, yelling irrationally at times. She lives with my 85 year old father in their long time home. He's getting to the point of exhaustion, but is worried that she will react very negatively if she is put into a nursing home or memory care, separated from my father. What would be your advice? Second, are there ways to search for places that have nursing homes AND regular assisted living on the same premises? Memory care without Medicaid is not affordable for us. 


Anjon from DC
A:

Behavioral issues are common in those with dementia. They are due to loss of brain cells and due to neurotransmitter changes in the brain related to the brain damage. Environmental or behavioral modification techniques can be helpful to reduce unwanted behaviors. However, they are often not enough and medication supplementation is often required to help even out the neurotransmitter impairments. Agitation, irritability, false beliefs and mood issues can often be relieved dramatically with appropriate pharmacotherapy. If your mother has fewer of these behaviors, it is much easier to care for her. Your father may also benefit from more respite. You could have your mother go to day care, have a paid caregiver come in or take her out or have family watch her while your dad gets some time to himself. Regular respite is invaluable and reduces burnout for caregivers. To evaluate how negatively she would respond to a nursing facility or assisted living facility, she could be taken there for a weekend or a trial period and see how she reacts. Many facilities have all levels of care in the same campus (independent living, assisted living and nursing home). A husband could be very close even if a wife has to move to the nursing facility when more care is required. Your local Alzheimer's Association chapter or Area Agency on Aging could give you a list of facilities that have those choices. My edited book, "Long-Term Management of Dementia" (Informa Publishers) has great information about all these management issues and much more (see the link next to my expert column at Parentgiving). 

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Q:

 What are the symptoms of Parkinson’s disease. I am a man of 60 years of age. My hands shake and I am unable to hold a cup of water without spilling it. The shaking is throughout my entire body and shaky in bed as well as in my sleep. I’ve been dealing with this for many years after Desert Storm. They called it Desert Storm Syndrome. Recently I had my gallbladder removed—my blood pressure went up and I now have anxiety attacks. I am taking meds for it, but the shaking is still there and has affected my writing. I feel like falling backwards at times. Please help.


James from FL
A:

Parkinson's disease usually starts with tremors/shaking on one side much more than the other. The shaking is worse when the hand is at rest and much less when the hand is moving such as when drinking from a cup. Other features are stiffness, lack of facial expression, slowness of movements and trouble with balance. When the shaking or tremors affect both sides of the body or head or jaw and are worse when trying to write or move, Parkinson's is less likely. Essential tremor, medication or toxin-induced tremors or familial tremors are more often the causes. Individuals with restless leg syndrome have a desire to move the legs or sometimes the arms and a feeling of not being comfortable. It often keeps them up at night. Medications for anxiety can also at times increase tremors as can other medications like those for asthma or breathing issues. My suggestion is to seek out a neurologist for a complete evaluation of potential causes and treatments.  

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Q:

I just heard that music therapy can be helpful with Dementia patients. What are your thoughts on this? Would it be beneficial for us to try it?  


Frank from OH
A:

 Any activity that helps stimulate the brain is helpful for dementia patients…in moderation. Too much stimulation of anything can cause anxiety and confusion. A variety of stimulating activities at different times is better than only one activity. Music therapy can be very helpful to calm a person and stimulate certain parts of their brain. As with any activity, if the patient responds to it, it is worthwhile to continue. If their response is more anxiety or distress, then it is worthwhile to discontinue it.

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Q:

My divorced father is 79 and has been diagnosed with dementia. He is at the stage of being unable to pay bills, care for the house and remember recent events such as doctor appointments. He insists on living at home and has an unmarried couple and her two teenage daughters renting the basement who help me with his care. My father seems to like the boyfriend, who is of good character and looks out for him like a son. Recently, my father has begun to make up allegations that the man is molesting his girlfriend's daughters. Both my knowledge of the people involved, and the fact that my father cannot remember details such as how many daughters there are, leaves no question in my mind that he is making it up. He also shows an inappropriate interest in sex and likes to embarrass people with his talk. I have been aware of my father's accusations for a few months and refused to give him an audience, but he recently confronted the boyfriend with some “friendly advice.” The boyfriend is now rightfully scared. A close friend of my father's has also confided that my father brought the accusations up to him as well. Would a psychological exam as a demonstration of his mental incompetence help, should this ever become a legal issue? Or is a retirement home the safest way to protect others from his accusations? 


Kimberly from WA
A:

About 70 percent of individuals with dementia, particularly with Alzheimer's disease, develop false beliefs. Only 3 percent develop hypersexuality with physical sexual aggressiveness. However, more commonly we see frequent verbal sexual comments. Typically, one can first try to use logic to dissuade the patient of their false belief or try to ignore the behaviors if they are not harmful. However, many times these techniques do not work due to the nature of the condition. When the behavior issues get to a point where they are causing significant problems for the patient or others, it is time to consider medications. Due to the potential seriousness of the accusations, use of an atypical antipsychotic (like quetiapine or ziprasidone or risperidone) to help reduce the false beliefs may be something his doctor may consider. There are also medications that may help with hypersexual behaviors, particularly antidepressants like selective serotonin reuptake inhibitors. Chapter 4 in my edited book, “Long-Term Management of Dementia” (Informa) goes into detail about dealing with problem behaviors if interested (see the link next to my expert column). It is also important that these concerns get documented by his primary care physician or dementia specialist. Evaluation and management of these problems by his physician, including a clear diagnosis of his dementia will help in case there are any legal issues that arise. If the behaviors are not treated, it may not matter where he lives as he may have the same accusations everywhere he goes. This is more typically the case than not. 

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Q:

My 86 year old mother has just lost 15 lbs in 10 days. What is going on? (Yes, she is eating.) 


Marianne from PA
A:

You can lose a lot of weight quickly if the weight is from water or fluid loss. Some patients are on diuretics that will cause them to urinate out excess fluids that may be building up in their legs or elsewhere. I would have her seen by her primary care doctor to look for reasons. 

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Q:

My mom has been diagnosed with dementia for three years now. She is 80 years old. My brother took care of her for three years, then in July 2011 he felt he could no longer take care of her. Not one of her nine children offered to take Mom except me. When Mom first came to love with me, she weighed 65 lbs. She eats very well and I can see she is gaining. She was admitted to the hospital 2 days ago for a bladder infection—they weighed her and she is still at 65 lbs. How can this be? Was she not weighed right? 


Marie from CA
A:

I suppose it is possible they weighed her incorrectly. However, in general, patients with this low a weight who have dementia have a very hard time gaining weight. Also, a person can become dehydrated and lose a lot of weight if they are not drinking or eating much for two days. It is possible after her bladder infection is corrected, she will gain weight again. Continue supplements with or between meals and eat with her to help with weight gain. There are some medications that can also improve appetite (mirtazapine and megestrol), but they also may have significant side effects to watch for. 

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Q:

My father is 67 years old, and Alzheimer’s was diagnosed last year. Mostly he has cognitive deficit, and I am very concerned because the neurologists in our region tell me that we can do nothing. He takes Exelon 9.5 mg each day and he has had cerebrolysin infusion/30 ml for 20 days. Please tell me, what else could I do for him? What do you think about vaccination, and which one: passive or active? Thank you! 


Karin
A:

Exelon at 9.5 mg/24hour patch is an effective dose for individuals with Alzheimer's disease. This medication is often combined with memantine titrated up to 10 mg twice a day. I have no experience with the use of cerebrolysin as it is not often used in the United States. More studies are needed for that agent in regards to how long it can remain effective for patients. Vitamin E 200 units daily can be helpful as an antioxidant in Alzheimer's disease patients. There have been encouraging signs from the monoclonal antibody "vaccine" against amyloid in human studies. More research is required to see how well it works. The same is true for the other passive and active approaches. If he is eligible and willing to participate in a clinical trial and there is a center close by doing these trials, I would be very supportive of getting involved. Altruistic patients with Alzheimer's disease wiling to participate in research will help to speed up the discovery of new therapies for them and others. 

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Q:

My father in law has dementia and sundowners. He also just broke his hip so the trauma has made him much worse. What kind of doctor should he be seeing? Is a neurologist that specializes in management of dementia the best bet? How about a psychiatrist that specializes in dementia/Alzheimer’s? Just trying to get him the best and correct kind of doctor. 


Linda from OH
A:

There is no question that he would be best served by a physician who specializes in dementia. It would not matter if they are a neurologist or psychiatrist as long as they specialize in dementia. 

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Q:

My dad lives in Florida with his wife. He is 80 years old and has had Parkinson’s for about 5 years. Now they are saying he has dementia. He’s in a hospital, but has to go to a rehab center tomorrow for three weeks. I am really worried about him. Is there any surgery or other things that can be done for him? 


Mitch from NY
A:

There are many potential reasons for dementia and most are treatable. His physician can assess for potential treatable causes and start appropriate treatment to help the condition. Some causes of dementia are treated by surgery like those with hydrocephalus. There are also some cases of Parkinson's disease where the symptoms can best be treated with deep brain stimulation or surgery. Potential candidates must be evaluated at specialized centers that offer these treatments. His neurologist would be able to let you know if he would be a potential candidate. 

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Q:

My mother, age 91, seems to be healthy physically (she has not seen a doctor since my brother was born 57 years ago), but mentally, has memory loss. She will only talk about her childhood and cannot carry on a conversation about anything else. She refuses to leave her home, since my dad died 6 years ago. My husband and I bring her food, clean the house and do the laundry. She refuses to have anyone come in to help her and refuses to move to an assisted living facility. I know she does not eat well, appears to be losing weight. Recently she has become agitated and is very negative toward my husband, saying that he hates her and that he has shoved her and yelled at her. This happened after we made her go have her hair washed as she is not taking care of personal hygiene. I have offered to wash her hair and trim her nails—she refuses. Since she sees no one but my husband and myself, I have no one to ask for help. She refuses to let my children or grandchildren in the house. I feel like I am neglecting her care, but don't know how to get her to agree to any help. I know she is depressed, she refuses to see a doctor and without just physically removing her from her home, yelling and screaming, I don't see another solution. I have called adult protective services and they said, "Just because she chooses to live differently from what you would like, doesn't mean she is wrong." 


Marge from IN
A:

Sorry to hear about the situation. It sounds like she may be suffering from a progressive degenerative condition. However, there may be treatable issues if she would allow an evaluation. This may not be possible until she gets so ill or gets an infection that she has to go to the hospital. She also sounds like she is a bit suspicious and maybe paranoid. Many times medications will help her behaviors enough that she would be more amenable to increased supervision, a shower, food, and an evaluation. Since no physician will prescribe without seeing her, it may be possible to get a visiting physician to come to her house when you are coming out to see her. They may assess the situation as dangerous to her and Adult Protective Services may have to come out. They may be able to get enough of a flavor of her behaviors that they may be willing to prescribe a medication. Some medications like risperidal come in liquid formulation and can be placed in something she drinks if she refuses to take any pills. You may have to visit daily to make sure she drinks her drink with the medication in it. This may help her suspiciousness and increase her willingness to allow more supervision and evaluations. Best of luck. 

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Q:

My father who is 81 years old just had back surgery to repair 3 herniated lumbar disks. He entered the hospital coherent and without any problem that was remarkable. After surgery he is now in full blown dementia. We have taken him to a neurologist who believes he has Alzheimer's, but this is post surgery. How can a man who showed no signs now be properly diagnosed with this? Could this be due to anesthesia, medication, post operative brain dysfunction or what? We cannot seem to get anyone to help us. Would appreciate your opinion. 


Susan from TX
A:

Many times if there is a sudden change after surgery, it suggests that he is suffering from an acute confusional state. There may be many causes. The most common causes include medication effects, infection or strokes. Metabolic issues like impaired liver or kidney function can play a role. Not getting enough oxygen (short of breath) can be a cause. A scan of his head would rule out a stroke. Infection from the surgery or other causes (urinary tract infection) can lead to confusion. Often after surgery people are placed on pain medications and many of these can cause confusion. The faster he can get off these medications the better for his confusion. Anesthesia should wear off and would not cause long lasting impairment. Those individuals with underlying dementia would have less cognitive reserve and so will be much more sensitive to having medications, infections or other conditions cause a confusional state. They will recover most of the time completely, but it may just take a few weeks. Alzheimer's disease is a gradual progressive condition and there is no such thing as rapid onset Alzheimer's disease. If there is a sudden change in cognition there is always something else (maybe in combination with a mild dementia) as the main cause of the issues. 

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Q:

My 81 year old mother in the late middle stages of Alzheimer’s. She is waking in the middle of the night. The physician has my dad giving her a sleeping pill. My dad contacted the physician again and was told to give her two pills. My dad says this is the sundowner’s syndrome, but I thought that was occurred late afternoon early evening. Do you have suggestions to help my mom sleep through the night?  


Margaret from CA
A:

There are many ways to help with sleep. First, try to make sure she does not nap in the day. Avoid alcohol and caffeine. Keep on a strict sleep schedule, go to bed and wake up the same times each day. As far as sleep aides, the least toxic for Alzheimer's disease is trazodone, maybe 50 to 150 mg nightly. Avoid all over the counter sleep aids as they can make her confusion worse. Other that can be tried include mirtazapine, zolpidem, gabapentin, and others. My book, Long-Term Management of Dementia (see information to the right of my column on Parentgiving) has other choices listed. 

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Q:

My dad is 87 and doesn't get around well, so doesn't get a lot of exercise. He doesn't have much of an appetite, so doesn't eat well. I am going to offer a supplement drink, but I am wondering. Is there something he can take, or eat or drink, that will give him more of an appetite? 


Kim from FL
A:

Supplements are the first best choice. Ensure, health shakes, Carnation instant breakfast, Boost and others are all pretty good. Start with one can a day. However also make sure that someone eats with him as this will usually increase food intake. There are medications that can stimulate appetite like mirtazapine or megestrol. These can work very well in situations where there is severe appetite loss. However both can have side effects that are best avoided if supplements will work. 

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Q:

My grandfather is in hospice care and recently aspirated and contracted pneumonia. No treatment of the pneumonia has been given and a steady diet of morphine and ativan with no food and limited water has been the staple for the last few days. He is in the middle stages of dementia. Is this typical treatment? 


Annaq from GA
A:

Hospice care usually means end of life care to keep someone comfortable just prior to death. However, the amount of treatments given while in hospice care is usually left up to the doctor and family. Some families will treat infections, like pneumonia with antibiotics. Some families will not treat and just provide comfort care. Morphine is often given to help with pain issues and anxiety symptoms to make the patient comfortable. Ativan can be used for sedation or anxiety. Just prior to death, no food and limited water makes the patient more comfortable. Too much fluid may build up in their lungs giving a sense of drowning. Fairly soon the patient cannot drink anymore and death ensues quickly and comfortably. Often the patient may have made a Living Will that instructed family members that he would not wish to live if certain irreversible conditions became so unbearable that it made his life not worth living anymore. Exactly what medical issues or combination of medical issues occur that lead to that conclusion is very variable for different patients and different families. 

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Q:

My 87 year old mother has been in an assisted living facility for a little over a year now. She cannot remember things from maybe five minutes ago. Other times, she can't remember something that happened many years ago. Is this dementia or Alzheimer's? Other than memory, she seems to be okay. My brother lives in the same city as the assisted living facility location. I live several states away. Can you give me some insight and suggestions as to how to cope from a distance. Thanks, Mom's Daughter 


Barbara from NE
A:

Anyone age 87 with progressive memory or thinking problems is very likely to have a degenerative condition like Alzheimer's disease. Her doctor should have run some lab tests and a scan of her brain to look for reasons for her memory loss. Dementia is a non-specific symptom, meaning someone is having trouble thinking and doing day to day activities. One cause of dementia is Alzheimer's disease, which is due to an abnormal accumulation of toxic proteins that accumulate in the brain and kill some of the brain cells, particularly in the memory areas. Dementia can also be caused by head trauma, having many strokes, low thyroid, vitamin deficiencies, kidney or liver problems or drugs, to mention a few other conditions. Many causes of dementia can be treated including Alzheimer's disease. I would ask her physicians what type of dementia they think she has. Then get more information about that condition. Visit the Alzheimer's Association for information and think about going to a support group meeting where you live. Inform the assisted living facility of the types of activities your mother would enjoy so that they can direct her to those types of activities. 

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Q:

My mother is 86 years old and was diagnosed with dementia in the past few months. I noticed all the changes that the doctor told me as far as her physical and mental state of mind. My question to you is she keeps asking to go back home (to another state hundreds of miles away) and wants to see my dad, who passed away 36 years ago, wants to have lunch with him and then go to the garden and see God which she wants to see my dad in the cemetery. Is this another wave of mental thoughts and do I tell her and remind her that dad has passed away or change the subject? I go and spend dinner time with her and have some giggle moments with her. I also get out some of the old pictures and she gets somewhat happy with that too. 


Maureen from GA
A:

It is alright to reorient your mother to reality if it does not cause her significant grief and anxiety. If reminding her that her husband has died many years ago causes her much distress or disbelief, then it may be better to change the subject. You might agree that it would be nice to visit with him (her husband) and that it may be something to think about later. 

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Q:

I care for my mother-in-law and my aunt who both have very different forms of dementia. My mother-in-law has diabetes, congestive heart failure and kidney failure that fluctuates between stage 3 and 4. I noticed her having trouble with her memory about 5 years ago and took her to the doctor. They evaluated her and told me to do memory games with her. Later they put her on aracept, which seems to help. Well, you can tell when she has forgotten to take it anyway. She has trouble with numbers and remembering birthdays and spelling and has quite a bit of confusion, but I have not noticed any suspicious behavior and only a few times has she had hallucinations. Could her dementia be caused by her kidney failure? And if so, does this kind of dementia cause brain damage and is it reversible?

My aunt is 86 years old and has had dementia for many years. She does have suspicious behavior and hallucinations. She was never evaluated that I know of and her doctor does not seem to think it is necessary at this time. She has never been on medication. She did have a UTI, which could explain some of the hallucinations, but not all of them because she does it to a lesser extent when she does not have a UTI. It is strange because one day I can hold a normal conversation with her and the next she is out of it. She is now becoming incontinent and just recently having trouble controlling her bowels. It will be bad for a few days with constant accidents and then she will be fine for a little while and then it will start up again. What kind of progression can I expect next? It is hard not knowing what to expect next. If I had some kind of Idea maybe I could prepare myself to deal with it.
 


Sheree from MI
A:

In regards to your mother-in-law, yes, significant kidney dysfunction can cause dementia. Toxins in the blood that the kidneys normally would remove may not be removed as well and so more get into the brain and effect its functioning. However, many conditions that affect the kidney (e.g. diabetes) can also affect the brain as well. If the dementia is only from the kidney dysfunction, it can be partially reversed by correcting the kidney problem or giving dialysis. If the brain dysfunction is due to several conditions then reversibility is less likely.

In regards to your aunt, given her long history of progressive decline, a degenerative brain condition is most likely. Those conditions, like Alzheimer's disease or dementia with Lewy bodies have a fairly predictable course. Patients lose more and more abilities to do day to day activities. The rate of decline is usually fairly stable and the speed that she has declined can help predict how fast she will continue to decline. Obviously UTIs, intercurrent illness, diet issues and other conditions can cause fluctuations in her bowels, incontinence, thinking and moods. Her physician can help with these intercurrent illness or conditions. Another excellent source of support and information about prognosis may be obtained at Alzheimer's disease support groups where families going through similar issues can share their experiences.
 

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Q:

My Dad has a lot of medical things going on: Parkinson’s, Alzheimer’s, copd, acute renal failure, a blood clot in his chest. He’s on dialysis, he also has high blood pressure, diabetes, and cholesterol. My question is it safe to put my dad on a medication called trazodone to make him get sleep? He doesn’t sleep at all—he’s up around the clock. He’s 74 years old and has fallen and even has a history of strokes and a bleed in the brain, which has resolved thankfully. What can be done so that my dad can get some rest?? Thank you! 


Lisette from NJ
A:

In general, trazodone is a very safe medication and often helpful for sleep issues. It is best taken every night to promote sleep. I use it often in dementia patients. It can be titrated to effect, usually helping with dosages from 50 to 100 mg nightly. In specifics for your father, it would be important to talk to his physician so that they can review his medical issues and other medications to make sure that he would not have problems taking trazodone. None of the conditions you mention that your father has would necessarily be contradictory to taking trazodone. It would most likely work fine, but his physician would have to review his case prior to prescribing it. 

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Q:

Lately I've noticed changes in both my 81 year old mom-in-law and her sister who’s 84 years old. My mom-in-law who was already experiencing memory difficulty at night (she called me two days in a row and had the same exact conversation with me twice), now asks the same questions over and over at night (about new info). My neighbor called it looping. I'm concerned because she still drives and lives on her own. Our aunt (her sister), who has always been sharp, was really fuzzy the last time the family was together and said "I don't know who half of these people are." They were all family that she knew this summer. She lives at an assisted living center because of back problems and mild Parkinson’s. Our mom and aunt had a sister who died last year of sudden severe dementia at 86. Please tell me what you think we should do? 


Bonnie from OH
A:

There are many potential causes of cognitive problems including medications, thyroid issues and vitamin B12 deficiencies that are completely reversible. Other causes including degenerative conditions like Parkinson's disease dementia or Alzheimer's disease are very treatable and those medications help to slow down the cognitive decline. Both family members need to be evaluated by their primary care doctor for causes of their impairments. Also family can ride with the mother-in-law to ensure she is still using good judgment with her driving. If there are questions regarding her driving skills, driver evaluation centers can be contacted for professional evaluations. 

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