My mother has Alzheimer’s disease, and has begun to have episodes of staggering and walking unsteadily. She looks like she is drunk and shakes badly. Are these symptoms common in Alzheimer’s disease? She reports feeling dizzy during these incidences, which are occurring more and more frequently, and seem to last from 20 to 40 minutes.
Vertigo caused by inner ear disturbances is very common in older adults, and can cause dizziness and an inability to walk steadily. However, vertigo is unlikely to cause shaking on its own. Also, because vertigo can be so disturbing to a person (probably even more so to a person with dementia), it could be causing anxiety attacks, which could lead to the shaking that your mother experiences.
Sometimes the medications that are commonly prescribed to treat Alzheimer's disease, such as memantine (Namenda®) or rivastigmine (Exelon®), can cause side effects such as dizziness (which would cause unsteadiness) and shaking or trembling of the hands or fingers. If your mother recently started taking one or both of these medications, you may want to revisit the dosages with her doctor.
It is also possible that your mother may have another neurological issue on top of Alzheimer's disease (AD). It is not uncommon, for example, to see AD patients with mild Parkinson's disease (PD)-like symptoms, and vice versa (PD patients with mild dementia). It really just depends on which area(s) of the brain are affected by the disease. Seizures can also cause shaking and loss of muscle control, and can occur as a result of AD. Because of the length of your mother's episodes (20 – 40 minutes), however, the shaking is probably not due to seizures, which typically will resolve themselves within 5-15 minutes or less. And it is also possible that you mother may be experiencing mini-strokes that are causing her to feel dizzy and unsteady. Therefore, it is important that your mother be properly diagnosed by her doctor to determine the cause of her dizziness and shaking so that, if necessary, she can receive the appropriate treatment.
My mother has Alzheimer’s disease, and I have been told that she is in stage six. She has been living in a facility and has full medical team support. She often just stares in to space, as if she is thinking. Yesterday, she was very alert, and her memory was just like it used to be a number of years ago. Before someone loses their memory completely, do they sometimes have episodes of remission?
Because of the nature of Alzheimer's disease, it is certainly possible for a patient to have brief moments of clarity interspersed amongst long periods of confusion and forgetfulness. Depending on the areas of the brain damaged by the disease, it is also possible for a patient to retain certain memories (recognition of specific people and events, for example) up through the final disease stages. While the disease in general follows a progressively degenerative course, the specific symptoms and their severity are typically unique for each patient.
Temporary periods of lucidity can therefore sometimes occur in Alzheimer's disease; however, it is unknown what these “remissions” might mean (if anything) as no formal studies have been undertaken to investigate this phenomena. One informal survey of the literature noted that a return of mental clarity can occur shortly before death, which they termed “terminal lucidity.” Of course, this was based on only a very small number of case reports, so it is not possible to draw any solid conclusions from this survey.
My 89-year-old mother is in the late stages of Alzheimer’s disease. She constantly wants to see her mother, who has been dead for almost 40 years. I have avoided telling her that my grandmother is dead, in an effort not to upset her; however, I wonder if she is “hanging on” just so that she can see her again. Maybe she would rest in peace if she knew that her mother has passed on.
Alzheimer's disease patients often confuse the past and the present, and may think that someone from their distant past is still among the living. Your mother's continued asking to see her mother might stem from an underlying fear of being alone, or being left behind by those that she loves. The next time she asks about her mother, take it as an opportunity to talk to her about these underlying emotions. Say to her "You miss your mother, don't you? Why don't you tell me about your mother and her favorite song, recipe, or holiday,” for example. Sometimes when you engage Alzheimer's patients in such topics, they become interested in telling you a story rather than repeatedly asking about their loved ones whereabouts. So if you keep her distracted by asking open-ended questions about her mother, then it may become unnecessary for you to directly answer about where her mother is.
However, like you suggested, it may also reasonable to tell your mother that your grandmother has passed away. Be gentle when you deliver such news because it may come as a shock to her—she truly does not remember or understand that her mother is gone. Make sure you provide your mother with plenty of reassurance that she is loved, valued, and will be well cared for. Also, don't be surprised if you have to repeat the whole conversation the next day (or even later the same day). Never yell at her because your mother likely has forgotten what you told her previously.
My 90-year-old mother has advanced dementia. She lives in an assisted living facility, and cannot live with any of her children because she can become violent, aggressive, and has the capacity to harm pets. She broke her hip eight weeks ago, and has been more violent than ever. Also, since her surgery, she should be using a catheter; however, she recently removed it, and becomes violent with anyone getting near her. My mother has a living will that requests no medical care if she becomes violent due to dementia or Alzheimer’s disease. The three children cannot agree upon what to do, and the assisted living facility wants to institute the Baker Act. What are our options?
You and your siblings would be best served consulting an attorney who specializes in elder issues, such as one that can be found through the Elder Law Answers Organization. Some legal advice can also be obtained through the Administration on Aging, which can be reached at (202) 619-0724 or at www.aoa.gov.
The assisted living facility where your mother lives may have rules governing the care of their residents who become violent, or pose a threat to themselves or staff, or are otherwise unmanageable. Residence at the facility may be contingent upon agreement to these rules. Instituting the Baker Act may allow the facility to proceed with treatment to manager her behavior so that they can provide her with the care she requires. However, because your mother has a living will requesting no medical intervention should her dementia become violent, then this document may supersede the rules of the assisted living facility. Because the exact requirements for enacting the Baker Act can vary by state, a lawyer in the state in which your mother resides would be best able to answer questions pertaining to your unique situation.
My grandma has Alzheimer's disease. My family is perplexed by her behaviors, which often appear inconsistent with this brain disease. For example, she remembers things, such as the date that my mother is to return from a trip, the time I'm supposed to pick her up for dinner (especially if I'm running late), and that my uncle recently got new puppies. However, she always reiterates that she has no memory. Sometimes, she pretends that she forgot something, and then admits later on that she did not forget. If confronted with this, she pretends she has no idea what I'm talking about. She calls me several times a day wanting to take me to dinner, and when I say that I can't see her until the weekend, she communicates her dissatisfaction with me. Although I'd like to see her more than once a week, she requires constant attention when she is over, and always wants me to sit down and "drink" with her. I’m perplexed, suspicious, and worn out. I welcome any advice.
As with any illness, there is certainly the possibility for a person to stretch the truth a little to garner more sympathy from others. After all, who doesn't like a little extra attention from loved ones when they're feeling sick? So yes, it is possible that your grandmother may exaggerate her symptoms from time to time in order to receive a bit more sympathy or attention from you. However, I also wouldn't doubt that she does have real lapses in memory. Your grandmother may be frightened or upset when she realizes she's forgotten something, and therefore seeks reassurance from you and your family.
Along with causing memory and cognition disturbances, Alzheimer's disease can also affect a person's personality, leading to mood swings and uncharacteristic behaviors. Patients who were once easy-going and sincere can become argumentative and even mean, for instance. There really is no way to predict how someone will be affected by the disease. Similarly, there is no way to know which of your grandmother's behaviors are deliberate and which are not. So for your own sanity (and your other family members' sanity), just assume that every uncharacteristic behavior she says or does are due to the disease, then plan your reaction accordingly. If you start with the mindset that her behavior is not deliberate, then you will be in a better position to determine how best you can help her. And don't feel guilty because it sounds like you are doing a very good job. You are being a responsible, considerate grandchild by visiting her regularly and trying to comfort and reassure her as best you can when she becomes upset.
When she starts badgering you to visit her more, remind her what a great time you had at your last visit and tell her how much you're looking forward to the next one (and remind her exactly when that will be). If she becomes insistent that you visit more, just say, “Oh grandma, I really wish I could spend every day with you, but my schedule just doesn't permit it.” Then ask her if there is anything special that she'd like to do during your next visit and try to honor her request as best as possible. Although at times you may feel like getting mad at her for acting up, try your best to remind yourself that her actions are not deliberate and that deep down she is probably just scared and needs reassurance. Getting mad isn't going to help her or yourself, and will just create feelings of resentment in the long run. As much as possible, enjoy this time you have with your grandmother, because there may very well come a stage in her disease when she is no longer able to coherently communicate with you.
In addition, sometimes you just need to remind an AD patient about what you have done together, and how much fun it was, in order for them to cease insisting that “you never visit.” For example, you can try keeping a small journal or photo album of your visits. It doesn't have to be elaborate or expertly designed; it could simply be things such as, “visited the garden today and saw the daffodils coming up,” followed by a snapshot of you with the flowers. This is a very tangible thing that your grandmother can hold and look through when she feels lonely or upset. Perhaps your mother, sister and other family members will want to participate in making something like this as well. Persons who visit your grandmother could write a short note for her to read after they leave, sort of like signing a guest book. Or they could bring something along (a joke, a photo, a poem, a pressed flower, a copy of a favorite family recipe, etc.) that could be pasted into the journal. Your grandmother may appreciate having something like this to keep her company when it is not possible for others to visit her.
My 87-year-old father was diagnosed approximately 8 years ago with Alzheimer’s disease. He is now in a VA nursing center. He has decent cognition, but no short-term memory. Recently, he has started to chant very loudly, and sometimes it lasts for hours. He has been on several anti-psychotic medications that do not help with the chanting. He can be stopped from chanting, but only temporarily. What do you think about electroconvulsive therapy when medications no longer work?
Constant noise-making, such as whistling, humming, singing, chattering, or chanting, is not uncommon in patients suffering from Alzheimer's disease and other types of dementia. As the disease progresses, it is likely your father will eventually stop this behavior, possibly to be replaced by another such symptom. In the meantime, try to stay tolerant and remember that he would not constantly chant if he could control his behavior better. Although it may seem maddening to you now, there will come a time when you will appreciate your father's ability to “communicate”—even if it is only by ceaseless chanting.
Electroconvulsive treatment (ECT) has successfully been used as a treatment for patients with major depression who are non-responsive to conventional antidepressant drug therapy. In a few reported case studies, ECT was also successful in reducing verbal agitation (e.g., yelling, screaming, hollering obscenities, etc.) in elderly patients with dementia who did not respond effectively to behavioral treatment or therapy with numerous different antipsychotic or anti-anxiety medications. However, in another study in dementia patients having depression, though ECT was overall effective in improving symptoms of depression, it was also noted to cause short-term (1-3 days) delirium. Because these results are based only on a handful of case reports, it is difficult to say whether or not ECT would necessarily be beneficial in your father's case. Therefore, it is best to discuss this issue with you father's physician, or perhaps with more than one physician, before making any decisions.
My mom began stuttering and became increasingly forgetful, so we took her to see her family doctor, who ran many tests. At first, we were told that she had "small blood vessel disease," but as she rapidly became worse, the doctor changed the diagnosis to Alzheimer’s disease (AD). From what I'm reading, her case doesn’t fit the norm. She is angry most of the time, flies into fits of rage, lies, throws things, and insults people in public places. She has trouble remembering things, but appears to have no memory of her past at all. I have known other people with this disease who frequently talk about the past, but my mom is unable to do this. It’s been hard on my dad, who is her caregiver. She knows him, but often says she only pretended to marry him. She hardly sleeps and refuses to go to the doctor. Are these symptoms related to AD or are there other factors that could cause these cognitive and behavioral changes?
Most of the symptoms you mention do occur in Alzheimer's disease (AD). However, it is certainly possible that there could be another disease or condition, in addition to AD, causing your mother's behaviors. It is not uncommon, for example, for patients to have overlapping symptoms resulting from one or more different neurodegenerative conditions, often blurring the lines of diagnosis. You mentioned that you suspected that your mother's behaviors go back a long time, since you were a child even. It is therefore possible that your mother could, in addition to AD, have another pre-existing condition that continues to influence her behavior. Chronic severe depression or manic-depression (also called bipolar disorder) can each cause paranoia, irritability and mood swings, insomnia, and even memory lapses among other things. Your mother may have knowingly or unknowingly had one of these conditions before developing dementia.
Unfortunately, because the common repertoire of symptoms that accompany a diagnosis of AD include many of the behaviors you list (tantrums, aggression, memory impairments, speech impairments, mood swings, etc.), without a thorough examination by a doctor who specializes in dementia, it is difficult to say if another related condition or disease is causing these symptoms. Your mother's doctor should be able provide you with more information about the different aspects of AD. Out of concern, you may also consider discussing your mother's behaviors with her doctor—perhaps some of these are symptoms which the doctor is unaware of and should be informed of.
My husband has been incontinent for a couple years, and wears a pull up diaper. Hygiene is a huge problem because he forgets to change his diaper and take a shower. When I remind him about this he gets angry no matter what my tone of voice. I’m concerned about infection. He is also under treatment for bladder cancer and has to have a cystoscopy every 3 months. He does get bladder infections occasionally and I believe it is from not keeping himself clean. I’m willing to help him without making it a big deal, but he won't let me. Do you have any creative suggestions on how I can approach this issue to bring peace to us both? His short term memory is all but gone, but he responds to conversation, sings in church (still beautifully), and recognizes all of our children and grandchildren. I'm not ready for him to leave our house where everything is familiar to him.
Bathing and personal hygiene are always difficult issues to deal with. It sounds as though you are really understanding and patient, which is commendable considering how frustrated I'm sure you must feel sometimes!
In general, motivating a patient with Alzheimer's disease to do something is more about gaining his cooperation rather than forcing him to do a task. Some techniques you may find helpful (if you haven't already tried them) include:
- Ask him to try to do something rather than tell him to do it.
- You can also make him feel like he has some control of the bathing situation by saying “The bath is ready for you whenever you are.”
- Keep instructions simple and clear. Avoid lengthy explanations.
- Bribe him with a favorite food or drink as a reward for changing his undergarment.
- Call the diaper an undergarment or underwear instead—he might be embarrassed by the word “diaper.”
- Offer simple choices. For example, ask him “Do you want to get changed by yourself or do you want me to help you?”
- You can also ask him to help you with the task. Everyone likes to feel needed, so if he thinks that he can be of assistance to you, you may find he is more willing to cooperate. Don't forget to praise him for his efforts.
- Maintain a pleasant and calm tone of voice. Sometimes how you say things is just as important as what you say. And don't forget to try to smile.
- Stick to a routine. For example, always try to get him to change his undergarment at least in the morning before he gets dressed.
- If all else fails, leave him alone and try again later using a different approach. It will give you an opportunity to calm down and reassess the situation if you are feeling frustrated. Also, his mood may change in the meantime, and he may be more amenable later. Don't continue to push him if the technique you are using is not working.
My mom is 86 years old and is considered to be ready for hospice. I have two questions. First of all, she can still read out loud, but can’t carry on a conversation, and only speaks in short sentences occasionally. Can she read aloud because that part of her brain is not affected by the disease yet? Secondly, she has been averaging one transient ischemic attack per week lately. Is this a sign that she may be headed for a major stroke?
In response to your first question, your hunch is correct. The area that is responsible for being able to read is distinct from the areas required for carrying out a conversation and formulating questions and answers. A conversation requires much more complex thought than simply reading out loud. For example, just because your mother reads out loud does not necessarily mean that she actually comprehends the text. In this sense, reading out loud is like being on “auto-pilot”—the recognition of words and how they are pronounced may still be intact, but their individual meaning, as well as the meaning of the text as a whole, may be lost.
Transient ischemic attacks, or TIAs, are an important risk factor in predicting if a stroke will occur. Most studies indicate that in a third to a half of all stroke cases, the stroke was preceded by a TIA. Because your mother has had a number of recent TIAs, there is high probability that she will suffer a stroke, most likely within the next year, if not sooner. Please talk to your mother's doctor, who will be able to provide you with more information that is specific to your mother's condition and answer any additional questions you may have.
I’m a family friend to someone with Alzheimer’s disease. For the last 3 years, I have helped to care for this woman. She lived in the same home for 50+ years. But, she had to move after the death of a family member. This has been a very upsetting change in her life! After an adjustment period, she has been comfortable living locally for the last 3 years with one of her daughters. Another daughter, who was out of the picture for many years, now wants custody of her mom for 6 months out of the year and to move her to yet another state. The mom does not want to go, and just wants to stay where she is living now. Unfortunately, the courts want to grant joint 6 month custody, even though the mom told the judge publicly in court that she does not want to go! Is there any way that I can prove that such a move would cause a detrimental effect on an elderly Alzheimer’s patient?
The laws pertaining to adult guardianship vary from state to state, and when the battle over the custody of an elderly parent crosses state boundaries, the case can become quite complicated. If the daughter in your state has not already done so, it would be best that she contacts an attorney who specializes in elder issues. Such attorneys can be found, for example, through the ElderLawAnswers organization and the Administration on Aging.
In my professional opinion, a living arrangement in which the residence of an Alzheimer's patient is changed every 6 months seems unnecessarily disruptive and could potentially increase the occurrence of anxiety, agitation, or other negative behavioral issues. If it is possible for your friend to present any evidence to the judge, then a signed statement by her mother's doctor indicating that such a living arrangement would not be in the mother's best medical interest could be influential in court.
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