Can Alzheimer's suddenly get worse?

10 answers | Last updated: Mar 16, 2016
A fellow caregiver asked...

My mum has been living alone and taking mediciation for about 2 years for what was believed to be early signs of Alzheimers. Generally she just repeated herself at times and kept misplacing things. In a week she has had a dramatic change, becoming disoriented and believing people on TV could hear, see and speak to her. Her only companion has been the TV as I do not live in the same country. I call her once a week and she always seemed stable. She walked out the house 3 late evenings last week and was wandering down the street. She is now in hospital being assessed. The strange thing is that in her lucid moments she's the best she has been in years and there are not really any signs of anything being wrong. Other moments she will be totally confused and not make sense. I believe Alzheimers is gradual and progressive and does not usually have episodes such as my mum has. Could this be a a different type of dementia or chemical imbalancing? I would like to pin point the problem in order to seek an accurate therapy. Any advice will be appreciated.

Expert Answers

Lisa P. Gwyther, a social worker specializing in Alzheimer's services, is the author of The Alzheimer's Action Plan. An associate professor in the Duke University Medical Center Department of Psychiatry and Behavioral Sciences, she's also a past president of the Gerontological Society of America.

     Yes, Alzheimer's symptoms can and do worsen suddenly, once described by a man with Alzheimer's as the  "come and go" disease.  Although the progression of disability and memory loss in Alzheimer's is generally slow and insidious, people with Alzheimer's may have small strokes, episodes of delirium or acute confusion in response to another medical condition or a change in confusion, disorientation or behavior as a result of an event that gets stuck in their minds.  Some people develop delusions (fixed false beliefs) or hallucinations (seeing or hearing things) when they misinterpret what is happening on TV or they can't separate themselves from a fictional story.  It is frightening to believe the stories on TV are happening to her in the moment.  It may cause her to want to flee rather than rationally turning off the TV. 

Also, most people with moderate Alzheimer's become disoriented to time - she may awake at night, responding to a dream about the TV show and leave the house in search of something she thinks she must do for the people in the story.  She may be unable to take clues from the dark night that this isn't the time to leave the house. 

At some point, it becomes very risky to live alone, just because these episodes of confusion, especially at night, may happen unpredictably.  The hospital stay should provide an opportunity to check her for medical conditions like a silent infection that may cause delirium or a resolving small stroke, and to start a medication, if necessary, to reduce her hallucinations, especially if they are frequent and frightening episodes for her.

People with moderate stage Alzheimer's are at higher risk for delusions, hallucinations, delirium or acute confusional states in which they appear to go in and out of confusion.  However, lucid joyful or pleasant behavior may occur throughout the course of the illness.  Families describe good and bad days or even hours, often without an obvious trigger or precipitant like a sudden change in routine, lack of sleep, an illness or stress. 

It is probably more than one problem in addition to rather than instead of Alzheimer's causing her recent sudden changes.  A secure hospital environment may help her for the short term, but it is likely that she will need more supervision and reassurance in the moment, something that is difficult to arrange for someone living alone with family in another country. If travel for you is prohibitive, someone local may need to be your eyes, ears and the person to insure she gets the help she needs now.

SEE ALSO: Find Memory Care Near You

Community Answers

Supportgroupleader answered...

Rule out medical issues first. Potential UTI (urinary tract infection), mild stroke, TIA's, thyroid problems, delirums from being over-medicated. any serious infection.

Frena answered...

from my 20 years of working with people with alzheimer's and similar dementias, i have to respectfully disagree with Ms Gwyther.

dementia itself does NOT become suddenly much worse. it shows up as suddenly much worse when another different medical event is going on and requires expert medical investigation.

Mom's issue could be anything from overdosing on her meds, to a new med to which she is actually allergic, to all the usual other suspects -- UTI, stroke, oxygen deprivation, pneumonia and more and more and more.

any sudden severe worsening of dementia means "Get me to the doctor!"

Trying to cope w/az answered...

I found that when my mother would get worse all of a sudden, it was almost always a urinary tract infection. So, I would have a dr. check it out. From my experience with my Mom, it is a slow progress and when it became worse all of a sudden, it was a medical problem.

Ron. answered...

My father took a sudden dramatic downturn after several days in the hospital and never recovered. He was in the hospital for a relatively minor illness and was fine when we left late in the evening. The next morning he was a basket case. We found out that they had restrained him that night after we left because he was "aggitated". We will not send him to a hospital again except as last resort. Even major, well known and "respected" hospitals often seem to be clueless on how to handle people with Alzheimer's (or probably any other type of dementia). It is our firm belief that that the traumatizing actions of the hospital were directly responsible for his almost instant decline. If it is ever necessary to hospitalize him again we will not leave him without a family member present around the clock.

Frena answered...

oh Ron, i'm so sorry to hear that. alas, it's not unusual at all. the worst possible thing for the average person with dementia is to go to the hospital -- even though this is sometimes unavoidable, of course. medical staff often have no idea how to treat people with dementia, who often end up being over-medicated, tied down and just traumatized beyond recovery. one thing caregivers need to do, if at all possible, is to either be there themselves or to arrange for someone to be there. if money is an issue, often you'll find that family friends will help out with this by sitting watch. or church members or neighbors sometimes. that can provide the essential reassurance and presence that elders with dementia need. don't be shy to ask around folks! you'll be surprised how much people may respond to an emergency need. if at all possible, families need to negotiate medical help without hospitalization, not leave their person just for "observation" (great fees for doing little that a family could not do at home), not agree to elective medical procedures that won't help a person with dementia (hip replacement -- a disaster for the person who can't be part of their own rehab, not accept hospitalization for a minor illness if it could be dealt with by daytime visit. I encourage families to make important medical decisions for their elders by weighing everything and asking themselves, would this really help? medical decision making needs to be different for a person with dementia. there really is no bottom-line same treatment for everyone rule.

A fellow caregiver answered...

As a MCI patient, with several close relatives who are suffering from ALZ,. or died as a final result of this terrible disease, I was determined to find out all I could. Though few was no Alzheimer's Association nationally active, their is now. I am extremely impressed with the answers I learned, prompting me to start using Aircept for the past ten years and Namenda for two years. I have been doing fairly well, until this year. I feel like I am now approaching the slipery slope to ALZ and my family realizes it more and more. I have some members who are interested and dearly care and I have arranged for a caretaker. Any one with a older FRIEND OR FAMILY member who shows symptoms should get their possible ALZ patient to competent nuerologist who specializes in ALZ to be evaluated. There are also University Clinics, such as UCSD Shiley Marcos in San Diego which are excellent and will evaluate as part of their ongoing research programs,at little or no charge, or publicity. Originally,I had an excellent young nueroligist who immediately put me on Aircept, which was very expensive for me, but it was worth, it wasn't covered by Medicare or other insurance. but I am, still driving and just got my new drivers license, on a yearly evaluation basis. My had the same synptioms, but her small town physician didn't believe in the medication was worth the expenseit d She is also diagnosed now, after I took her to a nuerologist two years ago. She is in much worse shape than I am and is 15 momths my junior at 81. With my familial experience watching my mother and father's sister deteriorate for ten years to their deaths made me decide to make sure I did the research and everything in my power to keep current on everythinbg I could do over the past ten years to slow down my decline. I participated in blind research studies, including Alzmed, which was not marketed, but learned a lot about research studies and their importsance, if properly run by a legitatemat research facility. I have also used John Hopkins Hospital News letters for their up-to-date and outstanding research. I will be 83 in August, am in good health and hope I have made all the right decisions, so far. I know that I did not make the wrong decision to keep educated on the subject of dementia, as my sister does not WANT TO KNOW WHAT IS CAUSING HER MEMORY PROBLEMS. but also is an ALZ patient in much worse shape than I am because of her lmmediate familiy's indifference and primary physician's lack of knowledge. I don't know how much time I have left, but knowledge has allowed me make my Trust and plan for the enevitable future. Families should realize how serious and prevelant this disease is and the much younger aged adults are being affected. It is worse for everyone and needs to be planned for! EDUCATE YOURSELF and help financialy in the ex[ensive reasearch to find a cure as soon as possivble

Maky answered...

To the anonymous caregiver, I'm the caregiver to my husband, I agree that education is a key, I read everything I can get my hands on, and have learned so much. Thank you for sharing, you are an inspiration to all of us caregivers. You are the must energetic 83 old and also very smart in taking control and being proactive. Thank You and God Bless You

Deeanne2 answered...

My husband, who is 83 and in the mid stages of Alzheimers, was doing very well, but after he had a bout of shingles he was fatigued most of the time, slept 12 hours or more at night and was very disoriented in the morning, not being able to find his way to the toilet. It has been three months since the shingles and he has improved somewhat but is far from his pre-shingles state.

A fellow caregiver answered...

deeanne2 I so sorry to hear about your husband having shingles. I had a bout at the beginning of February and it was the worse pain I've ever experienced. Through a friend of a friend I found a cream that helped me tremendously and you may want to try it. I ordered it from