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Caregiving Questions

Latest Questions and Answers
My husband was diagnosed with Alzheimer’s disease 6 years ago. He has just started exhibiting an unusual behavior that baffles me and seems to agitate him greatly. When he sees his reflection in a mirror, he becomes angry and insists that "that man" get out of our house. I have covered the mirrors and have even taken down the mirror in our bedroom. This did not help because he just pulls the coverings down. Is this a common symptom? Is he suffering from hallucinations, delusions or both? Thank you. [ 02/12/10 ]

It is not uncommon for Alzheimer's patients to report seeing strangers in reflective objects, when in fact it is their own image they see. This phenomenon is referred to alternatively as self-misidentification, mirror sign or mirror delusions, and it is basically the inability to recognize one's own reflected image. This behavior is often more disturbing for the caregiver than it is for the patient, although as you indicated, the patient can certainly become agitated over the “intruder” in the reflection.

If cloth coverings have not worked, the only real recourse is to remove the reflective objects from the home altogether. If the mirrors are permanent structures or too difficult to remove, it may be possible to apply a self-adhesive vinyl covering (which is non-permanent and can later be removed) or, if you do not mind a permanent change, spray paint the mirrors with a frost finish designed for glass surfaces. Check with your local hardware or design store for more options.

Is it normal for an Alzheimer’s patient to be completely helpless just like a baby? My mother was able to walk, go shopping and take a bath by herself 3 weeks ago; however, after a week-long hospital stay, she cannot talk, walk, lift an arm, open her eyes or focus in the morning. She is unable to function normally until around 1 p.m. and the cycle begins again the next morning. Could you explain why this happens? [ 02/01/10 ]

If your mother received anesthesia while in the hospital (such as for an operation or other procedure requiring her to be sedated) it is possible, though not proven, that this could have made the Alzheimer's disease (AD) worse. Similar instances have been reported for other AD patients who were relatively fine prior to an operation, and then were reported to have more severe symptoms following a procedure requiring anesthesia. Scientific studies have had mixed conclusions as to whether anesthesia can affect the disease or disease course, so it is not clear whether this could be the cause of your mother's recent behavior if she did have anesthesia.

Even if your mother did not have any anesthesia while in the hospital, AD on its own can in some cases cause a patient to experience a very sudden decline in their functioning. It really depends upon the area and extent of the brain affected by the disease. Please talk to your mother's physician about the recent changes in her condition, emphasizing that this deterioration has only happened within the last few weeks. There may be another medical reason for this, but her doctor would have to perform an examination to determine other such causes.

It is also possible that your mother is depressed, which is not uncommon for AD patients. This may explain why it takes her so long to “wake up” in the morning. Or perhaps your mother is not sleeping well at night, which may be why she wakes up disoriented and unable to function properly for some time. Again, her doctor should be consulted about this new behavior, as there could be a medical explanation apart from AD that is causing her to behave in this manner.

My dad was diagnosed with Alzheimer’s disease 8 years ago, and is taking Aricept and Namenda. He has started humming randomly (no tune, just a constant monotone). Is this behavior associated with final stages of Alzheimer’s disease? [ 01/30/10 ]

Constant humming (or singing, chattering, muttering, or other noise-making) has been reported in patients suffering from Alzheimer's disease and other types of dementia, but this behavior has not been formerly associated with any particular stage of the disease. Typically, patients who display this behavior are recognized as being at least in the second stage of Alzheimer's.

My mother has advanced dementia and for the past few months she has been moving and jerking continually. She does "pelvic thrusts" while sitting or lying down. What is the cause of these movements? [ 01/28/10 ]

About a third of Alzheimer's patients have been reported to develop a condition called myoclonus, which is similar to the sudden involuntary jerks and muscle twitches you may experience when falling asleep. The muscle spasms themselves are not painful, and if your mother already requires constant care, then they probably are not as debilitating as they would be to someone who is still mobile (i.e., muscle spasms can interfere with activities of daily living or could cause a person to fall and injure herself). Even though there are medications that can help reduce muscle spasms, there are always side effects to consider when introducing any new drug. Please consult with your mother's physician for further advice.

I am concerned that my 84-year-old mother-in-law may be showing early signs of Alzheimer’s disease. She never seems to remember anything that I tell her, appears depressed, does not want to do much of anything of late, appears confused about what day it is, has a vacant look and can drop off to sleep easily during the day (but says that she cannot sleep at night). I am not sure if these symptoms are related to old age or if they are related to something more serious. Any advice would be helpful. [ 01/26/10 ]

As people age, their memory may decline, but this is completely normal. However, normal aging does not necessarily explain the confusion, apathy, depression, and sleep problems you noted your mother-in-law to have. It is therefore possible that the symptoms you list are indicative of another condition.

For that reason, it would be wise to get your mother-in-law examined by a physician who can help to diagnose what the cause of her symptoms may be. Your mother-in-law may be depressed, for instance, which alone can lead to memory impairments, confusion, apathy, difficulty concentrating, and sleep disturbances. Or the diagnosis may be something more serious, such as dementia. Besides Alzheimer's disease, there are several causes of dementia in the elderly that can be treated and even reversed. For example, memory impairments and confusion consistent with dementia can be the result of hormonal imbalances (thyroid hormones in particular), vitamin deficiency (such as vitamin B12), or infections of the brain (such as meningitis)—all of which can be treated. So a doctor's evaluation and diagnosis can be particularly helpful to help figure out the cause of her symptoms and possibly even treat them.

Even if your mother-in-law were to be diagnosed with mild cognitive impairment (MCI) or probable Alzheimer's disease (AD), this diagnosis can be useful too. Taken early, the medications currently available for the treatment of AD can help to slow the debilitating effects of the disease. A proper diagnosis, whatever it may be, can also help to prepare your mother-in-law and your family for deciding which course of action to take for the future; particularly should your mother-in-law be found to have Alzheimer's dementia or another such degenerative disease.

My mother has a mild form of dyslexia, and due to family circumstances this problem is getting worse. I notice that she is having more difficulty finding the right words, not finishing her sentences, and becoming absent minded and confused. She gets frustrated and angry when people don't understand her. The symptoms have become worse during this past year and I wonder if it is possible that these changes are signs of Alzheimer’s and not dyslexia? [ 01/19/10 ]

It sounds as if your mother may have dysphasia (also referred to as aphasia), which is an impairment of the ability to comprehend or produce spoken or written language, as opposed to dyslexia, which is a learning disability affecting a person's ability to read and spell. Regardless, this symptom coupled with mild confusion, forgetfulness, and behavioral changes all indicate that something is wrong, but only your mother's doctor can determine what may be causing these issues. It is true that these things are symptoms of Alzheimer's disease, but they are also symptoms of numerous other conditions. For example, head injury, mild stroke, viral infection of the brain or nervous system, brain tumors, chronic depression, hormonal imbalances, certain vitamin deficiencies, and chronic sleep deprivation, to name but a few, can all cause mild confusion, forgetfulness and behavioral changes. Therefore, it is best that your mother sees her primary care physician as soon as possible for a thorough examination and diagnosis, because many of these conditions can actually be treated and even reversed with proper medical care.

My grandfather’s doctor believes my grandfather has developed Alzheimer’s disease. I don’t like going to his house because all he does is scream at me. He never used to be like this. Is this a symptom of Alzheimer’s disease or could there be something else causing him to behave this way? Also, is there anything that can help control these outbursts? [ 01/17/10 ]

Alzheimer's disease can cause dramatic changes in a person's behavior, which can lead to emotional outbursts and yelling. Even under the best of circumstances, visiting a dementia patient has its challenges—and screaming certainly adds to the difficulty. But for your grandfather's sake, please continue to visit him. He may not seem like he appreciates your visit, but the social interaction—and the knowledge that people care enough about him to visit—are definitely good for his moral overall.

There are medications that can help reduce aggressive behaviors in Alzheimer's patients, but this is something your grandfather's physician and primary caregiver need to discuss. You can mention it to his caregiver, but the decision of whether or not to use such medications ultimately rests with your grandfather and his caregiver.

However, you may be able to help the situation just based on the way you interact with your grandfather. When you visit, try to avoid agitating him in any way. Talk to his primary caregiver beforehand for advice, and ask about anything in particular that might trigger these outbursts. Be aware of what you say and do—both words and/or actions could be potential landmines (such as bringing up a topic he dislikes or sitting in his favorite chair). It may be difficult to know what will set him off, and these things may even change on a daily basis. So it is best to try to stay calm at all times, even if he is yelling at you. When you talk to him, look directly at him and speak clearly using uncomplicated language—sometimes Alzheimer's disease patients become agitated simply because they cannot understand what someone is trying to tell them. If he starts yelling, try shifting his attention to a new topic or activity, or if possible just leave the room until he has calmed down. Allow your grandfather to guide the conversation whenever possible, even if it means hearing the same story over and over again. And finally, do not try to engage him in a yelling match as this will only serve to upset him more.

My grandma is in the last stage of Alzheimer’s disease. I'm just really confused on how to handle this situation. She has meant so much to me and I feel like no one truly understands how I feel. [ 01/15/10 ]

Dealing with the complex emotions that come with witnessing a loved one succumb to this terrible disease can be overwhelming, so it is good that you are trying to understand and work through these emotions. And it is not unusual that you feel isolated in your situation, but you are definitely not alone. There are others who understand what you are going through; you just need to find them. Your best bet is to locate an Alzheimer's disease support group in your area. Many of the individuals in these groups have been where you are, and you can talk to them and help sort out your feelings. If this option does not appeal to you, try talking to someone who can offer some unbiased support, such as a counselor, therapist, clergy or other spiritual advisor, or anyone else that you feel comfortable talking to. And do not discount that fact that other family members may be just as upset by your grandmother's disease as you are; they just may have different ways of coping with their emotions. So I would also encourage you to talk to your other family members, as you may find out (once you actually get them to talk about their feelings) that they are actually right there with you.

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Disclaimer: The information provided here is a public service of the BrightFocus Foundation and should not in any way substitute for the advice of a qualified healthcare professional; it is not intended to constitute medical advice. Please consult your physician for personalized medical advice. BrightFocus Foundation does not endorse any medical product or therapy. All medications and supplements should only be taken under medical supervision. Also, although we make every effort to keep the medical information on our website updated, we cannot guarantee that the posted information reflects the most up-to-date research.

Some of the content in this section is adapted from other sources, which are clearly identified within each individual item of information.

Last Review: 04/29/13

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