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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. [ 04/28/11 ]

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? [ 04/27/11 ]

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? [ 04/26/11 ]

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. [ 04/05/11 ]

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? [ 04/04/11 ]

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? [ 04/04/11 ]

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.

I care for my mom at home, who is 83 years old and has dementia. Are Alzheimer’s disease and dementia the same thing? She says many very mean things about my family. I know we aren't supposed to argue with her, but she is unrelenting. If we react even a little bit, she gets even meaner. How do I respond to her verbal attacks? Can I ask her to please stop? Is it better to completely ignore her unless she says something nice? I just can't take her to the store or church anymore. I used to do this for years, but I am now worn out. She says that I keep her in “prison.” [ 03/16/11 ]

Dementia is a term that describes a condition of decline from previous cognitive functioning, not explainable by adverse medication effects or other simple reversible medical causes. In addition, it is characterized by memory problems and problems in one or more other areas such as recognition, ability to do learned tasks, use language, or to problem-solve. Alzheimer's disease is the most common dementia, and accounts for two thirds of the dementia cases among older adults in the United States.

The best approach to dealing with an argumentative or physically aggressive Alzheimer's disease patient (AD) is to try to change the subject or get the patient engaged in a new activity. You are doing the right thing by remaining calm and generally ignoring her comments. Arguing with an AD patient never accomplishes anything, and usually just serves to further agitate the patient.

Determine what your mother's favorite topics are and try to engage her in conversations concerning these subjects. It doesn't matter if she gets names, places or dates wrong—don't bother correcting her unless she asks—just let her talk. Or get her hands engaged in something that will take her mind off of her agitation, such as folding laundry, kneading dough, arranging flowers in a vase, drawing a picture, etc. These activities also can potentially serve to give her a sense of accomplishment and usefulness. Just remember to keep the tasks simple and clearly explain and/or demonstrate the steps involved.

Additionally, if you have not done so already, you may want to try keeping your mother on a fairly regular schedule each day. You can also try posting a large calendar or agenda on the wall that clearly lists the day's and week's activities. Post a schedule next to the clock with the times for each activity (e.g., listing mealtimes, different activities, bathroom breaks, bedtime, etc.) This can help to lessen anxiety about what's coming up next, which may aid in reducing aggressive outbursts.

Your mother may have moments of clarity in which she realizes that her cognition is deteriorating. She may not be able to remember a word or a face and this can be scary. It is also possible that she may be ashamed that she cannot remember the family member who just visited, and therefore becomes defensive when you insist otherwise. Even though this behavior is frustrating (to both you and her), it is all perfectly "normal" for Alzheimer's disease.

Most caregivers say that taking care of a loved one is one of the most difficult jobs they have ever done, and also one of the most rewarding. Every day can present new challenges, but you have to remember your mother's actions are no longer her own, as they are influenced – and sometimes completely governed—by the disease.

My mother, who lives in a care facility, is 95 years old and needs a wheelchair. She has, until recently, had full control of her faculties and a sharp mind. Now, I wonder if she has Alzheimer’s disease. Her memory is good, she is surprisingly alert to her surroundings and seems to understand the world news. However, she seems to be going through some form of mental torture and believes that she cannot trust anyone. She is very depressed, sleeps poorly, believes there are bugs in the bed, and believes that her family is “stabbing her in the back.” How can we help her? It is so distressing for us to see this progressing. [ 03/15/11 ]

Hallucinations, paranoia and depression seem to be your mother's chief symptoms, and can be caused by a number of different illnesses in the elderly, not just by Alzheimer's disease. In some instances these types of symptoms can be treated quite effectively. For example, sometimes certain vitamin deficiencies, drug interactions, or thyroid hormone imbalances can cause dementia-like symptoms in older patients, and are largely correctable. Therefore, it is important that your mother get evaluated by her physician to determine the cause of these symptoms so that any necessary treatment appropriate for her condition can be started. Alzheimer's disease is typically associated with memory impairments and cognitive problems, and because your mother's memory and cognition seem fairly intact, if your mother is indeed determined to have dementia, it is unlikely that it would be of the Alzheimer's type.

My mom was diagnosed with Alzheimer's disease. Her speech sometimes is not understandable and she cannot walk on her own because she loses her balance and falls. She also does not want to eat much and prefers only certain foods. Also, she leans sideways when she sits in a car or on the couch. Recently, it has become difficult to give her medicine. She sucks on it like candy. It's also hard to check her mouth to see if she has swallowed the pill because she does like us to do that. We were crushing the medicine up and putting it in certain foods like peanut butter or mashed potatoes, but that isn't working well now because she is not eating very much. Are these symptoms are normal. Is there anything that can help her to eat more? Does the winter season make her symptoms worse? [ 02/25/11 ]

Of course it is terribly difficult to witness a loved one succumb to this disease, but you can take some comfort in knowing that you are providing her with very good care. Regarding your mother's loss of balance and sideways leaning, it is possible that she is suffering from vertigo, which can affect elderly individuals regardless of whether or not they have Alzheimer's disease. Your mother's physician can test for vertigo and possibly even correct it depending on its cause.

It is fairly common for AD patients to have decreased appetites and lose weight as a result. A decreased appetite may be due to a loss of interest in food, decreased or altered sense of taste, decreased energy expenditure (therefore requiring a lower caloric intake), or a loss of the feeling of pleasure or satisfaction normally derived from eating (referred to as anhedonia). Because she is eating less, what she does eat therefore matters more. Your job is thus to make sure her food is nutrient rich so that every bite counts. If nothing else, you can try using liquid meal supplements to provide her with additional calories and essential nutrients. Some additional caregiver tips for encouraging AD patients to eat are provided by the Alzheimer's Disease Education and Referral Center (ADEAR) through the National Institute on Aging (NIA).

Finally, the long and often sunless winter months experienced in more northerly climates can sometimes lead to a condition called Seasonal Affective Disorder (SAD). Although no study has formally tested this, since Alzheimer's patients are more prone to develop apathy or depression than non-AD persons, dreary winters might affect the mood of these patients and increase the risk for depression. Regular exposure to sunlight can help to improve an Alzheimer's patient's overall mood and—when combined with calming, dim lighting in the evening—can help to keep a patient's circadian clock on track. This internal clock frequently becomes disrupted in Alzheimer's patients, such that they end up being awake at night and sleeping during the day.

My mother sleeps on the couch during the daytime. If she gets up, it is usually because she wants something to eat; however, very rarely does she complete her meal. She gets up several times during the night to watch TV and eat. When her exercise therapist, speech therapist and nurse stop by, she does what they ask, but she does not listen as well to her family's requests. What should be our expectations? [ 02/23/11 ]

As Alzheimer's disease (AD) robs a person of memory and logic, it also affects the portions of the brain involved in emotional responses. Alzheimer patients therefore often have blunted emotions, and may appear apathetic or depressed. They appear to lose interest in their surroundings and can become withdrawn. Because depression is also commonly observed in patients with AD, particularly in the early stages of the disease, it can be difficult to determine whether a patient's blunted emotions are due to depression or simply a symptom of the disease. It may therefore be warranted to have your mother evaluated by her physician to specifically test for depression, because antidepressants might be helpful if she is confirmed to have depression.

In general, remember to stay calm and positive when speaking to your mother or asking her to do something. Sometimes it is all in the way of how you ask her rather than what it is you want her to do. For example, if you ask for her help in accomplishing a task, you are more likely to get a positive response then if you just tell her what to do. Because the therapists and nurse probably work with many dementia patients, they have learned good techniques for getting patients to work with them. So don't be afraid to ask these professionals for any specific suggestions about how to best work with your mother.

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

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