Caregiving Questions

The symptoms you list, such as confusion, mood swings, and memory deficits, are all symptoms of Alzheimer's disease. But before you jump to the conclusion that your mother has Alzheimer's disease, please be aware that there are other medical conditions that could explain her recent behaviors. For example, early dementia symptoms such as confusion and memory problems can also sometimes also be caused by hypothyroidism (failure to produce sufficient thyroid hormones) or a vitamin B12 deficiency—both of which are common in the elderly and both of which are treatable. Confusion, mood swings and memory impairments can also be caused by stress, depression, brain injury, stroke, interactions between medications (or side effects from a new drug), and viral infections. A thorough physical and psychological examination can help to determine what may be causing the behaviors in your mother.

Your mother may be in denial, which may be why she gets angry when you talk about memory problems. It is very important that you get her to a doctor for a thorough examination. She will probably resist this idea, so make an appointment for her with her primary care physician and do what is necessary to make sure that she meets with the doctor. The sooner she has a medical evaluation, the sooner it may be possible to get therapy for her. If she does have Alzheimer’s disease, many of the Alzheimer's disease medications, when taken early on, may help to slow the progression of cognitive impairment.

Routines are definitely important to an Alzheimer’s patient, and a move to a new facility can be a disruption to this routine in and of itself. During this time, the patient may become stressed or agitated, and a familiar presence (such as yourself) in their new environment may help to ease the transition. You will have to take your cues from the patient and the staff. If possible, try visiting everyday before the move and then again for a few days after the move. In addition to your own observations, ask the staff about the patient’s behavior before and after your visits: does it seem to improve their mood or is there no noticeable change in attitude or behavior? Once the patient seems adjusted to the new facility, then you can gradually transition back to your regular visiting schedule.

Alzheimer's disease is dementia, one of the most common forms of dementia in fact. However, only after thorough physical and psychological examinations will a doctor will be able to tell whether their dementias are of the Alzheimer's type. Knowing whether or not the dementia is caused by Alzheimer's can be valuable in two ways. First, as part of the examination, the doctor will test for common causes of dementia in the elderly, such as hormone imbalances, vitamin deficiencies, viral infections, strokes, etc. Some of these causes of dementia are actually treatable.

However, the doctor may find that none of these conditions are the cause and that the dementia really is due to Alzheimer's disease. If this is the case, then an Alzheimer's diagnosis may be of value because it will allow your parents to be treated with the appropriate medical therapy. Many of the Alzheimer's disease medications, when taken early on, may help to slow the progression of cognitive impairment.

And depending on where your parents live, with an Alzheimer’s diagnosis, your parents would be eligible to participate in clinical research trials for new therapies, if they are so interested. If nothing else, sometimes just knowing the name of the disorder you are dealing with can be helpful, if only because you now can call it by something concrete.

And as your father’s destructive habit, you can try hanging signs on the trees reminding him to not snap the limbs off. You could also try wrapping the tree’s lower limbs with garden netting so that that the limbs are not as easily accessible. These approaches may help to deter your father, but will probably not stop the behavior. Unfortunately, the only way to prevent him from breaking limbs off the trees is to constantly watch him and, if you see him going for the trees, distract him with a new activity that will keep his hands busy. He may find the feel or the sound of the wood snapping soothing in some way, so try to think of different activities that incorporate these elements. Shelling peas or peanuts, sorting metal gadgets into bins, breaking up dead branches for kindling or compost, shredding paper, woodworking (if he is capable), or even drumming to music are some suggestions—be creative based upon your knowledge of his likes and dislikes.

Unfortunately, this is just the nature of Alzheimer's disease—patients must be constantly reminded of certain facts or events because their short-term memory is impaired. One thing you might try is to make a “shrine” to your mother somewhere highly visible in your father’s house. The shrine can include a picture of your mother with the words “In Remembrance” and the dates of her birth and death printed on the picture frame. A picture of her gravesite, funeral urn, or memorial plaque may also help, as might a clipped copy of her obituary or program from the funeral. A display such as this should help to provide a visual reminder to your father of his wife’s passing. You can also start a new routine by having your father help you select and place fresh flowers in a vase near the display for your mother and replacing them every few days or so.

Beyond anything else, be sensitive to your father’s emotions. Perhaps a daily reminder that his wife is gone will be too much for him to tolerate. If he seems at all upset or agitated by a “shrine” or other visual reminders, then respect his feelings and remove the items. It is not worth it if it causes him to become greatly distressed. Alzheimer's patients often confuse the past and present, particularly when it comes to comprehending who is or is not still alive. Albeit disturbing to patient’s family, this is perfectly “normal” behavior for the patient. So if a visual reminder only serves to trouble your father, then all you can do is to gently remind him that your mother is gone and then change the subject so as not to cause him undue stress.

Not all dementia patients develop sleep disturbances such as roaming, so the fact that your husband has not developed this behavior is good but does negate a diagnosis of dementia. Doctors usually perform a battery of cognitive and physical tests to arrive at a dementia diagnosis, so again, it is unlikely that the absence of a potential symptom (nighttime wandering) rules out that a patient has dementia.

Normal Pressure Hydrocephalus (NPH) has symptoms very similar to Alzheimer's disease—such as progressive mental deterioration leading to dementia, difficulty with walking, and even incontinence—which is why NPH is oftentimes misdiagnosed for Alzheimer's disease. Another common symptom of NPH is an abnormal, shuffling-like gait or difficulty walking (similar to Parkinson’s disease). NPH is caused by the gradual build up of cerebrospinal fluid (CSF, the fluid that bathes and protects the brain and spinal cord) when the normal drainage or circulation of CSF is somehow blocked. Unlike Alzheimer’s disease, however, NPH is often treatable. If your husband displays a shuffling gait or has other problems associated with the control of his legs and lower extremities, you may want to contact his doctor to test for NPH.

Unfortunately, as an Alzheimer’s patient’s cognitive capacity declines, so do other regulatory brain controls, such as those regulating urinary and bowel functioning. First try to determine if there is any pattern to the incontinence: does it occur more frequently at a particular time of day or night? What is your father’s mental and emotional state during these occurrences? What types of foods and beverages were consumed that day? And so on. Relay this information to your father’s primary care physician, who may be able to determine if there is a medical reason (besides dementia) for your father’s fecal incontinence.

If your father is actually still aware of his bowel functions, then it may be beneficial to put him on a regular toilet schedule so that perhaps any accidents could be avoided or minimized. The aide can help with making sure your father uses the toilet at least once or twice during the visit. It may also be of benefit to arrange for an aide to stay with your father for a longer period of time while you are away at work.

Make sure that your father has easy access to a toilet and that the bathroom and toilet itself are visible and labeled if necessary. If your father has difficulty removing his clothing to use the toilet, then replacing difficult zippers and buttons with Velcro closures could help. If you choose to use adult diapers, you will need to fully explain to you father how they are used and what is to be done with them when they are soiled. Do not expect him to automatically know these things. Practice using them when you are present, so that he can become more comfortable with their use.

Finally, it could be of benefit to reassess his diet. Too much or too little fiber can cause frequent bowel movements or constipation, respectively, which can lead to other problems such as incontinence. Again, this is where assessing his toileting habits may be useful, as this information could provide some insight as to why the incontinence may be happening. Your father’s doctor may be able to provide you with information on potential treatment options should the problem be found to be medically related.

On average, patients with Alzheimer's disease live for 6 to 10 years following diagnosis, although some patients live as long as 20 years. So although it may seem unusually long since her diagnosis, the length of your wife’s disease is still within an average range. How long your wife will continue in long-term care is dependent upon her general health prior to being diagnosed, how quickly the disease has thus far progressed, and other complicating conditions or diseases she may have.

It is not uncommon for Alzheimer's patients to experience hallucinations. Reports indicate that just under half of patients diagnosed with Alzheimer's develop some hallucinations that are either visual and/or auditory in nature, and which generally occur in the mid- to later-stages of the disease. Alzheimer’s patients may report hearing the voices of loved ones or friends, which are generally not disturbing to the patient. In your mother’s case, the sounds or voices she may hear are obviously causing her to become agitated and distressed.

You may want to speak to your mother’s physician to determine if an anti-anxiety medication may be of value. It may help to reduce her agitation and allow her to sleep better. Anti-psychotic drugs are also often prescribed for reducing the occurrence of distressing hallucinations. However, anti-psychotic drugs do have real risks associated with their use in cognitively-impaired elderly patients, such as an increased risk of death in dementia patients. Therefore, you and her doctor should thoroughly discuss all possible behavioral treatments before resorting to anti-psychotic medications, and also whether the potential benefits to your mother’s well-being outweigh the risks of their use.