What would be causing restlessness with dementia?

5andstrong asked...

Thanks for taking a moment to read this. I am consumed with the unknown and trying my very best to educate myself in an effort to help my mom, 76, who has advanced dementia. She no longer eats solids, is incontinent, drinks Ensure because she is essentially 'forced' to not because she asks. Recently she became extremely agitated and restless. Hospice doctor ordered Lorazipam ATC and added Seroquel. Ever since she started the Seroquel she has become angry and suddenly speaks incoherently, cries and yells. My father is her primary caregiver with the help of a home aide. I'm seeing my dad suffering just as much as my mom. The confusion is why she suddenly became so restless.

We had bloodwork was done and found her potassium levels to be high. She was treated for that succesfully. However, the restlessness continues with the added outburts of screams and yells. She sees her mother that passed away when she was 4 and calls out for her brothers and sisters that she hasn't seen in years. The Hospice doctor visited with her yesterday and suggested she may be constipated therefore causing discomfort (ie. restlessness) and ordered an increase in the Seroquel and taking her off the Lorazapen. Are we overlooking something? Can they confirm she is at the end? What phase is she in? What can we do to help??

Expert Answer

Ladislav Volicer, M.D., Ph.D., is recognized as an international expert on advanced dementia care. He is a courtesy full professor at the School of Aging Studies, University of South Florida, Tampa, and visiting professor at the Third Medical Faculty, Charles University, Prague, Czech Republic. Twenty-five years ago, he established one of the first dementia special care units.

Every medication may cause adverse effects and from your description it seems that Seroquel is not good medication for your mother. It may be useful to try another medication for treatment of her delusions and hallucination - Risperdal or Abilify have good effects. Lorazepam should not be used on a long-term basis. I do not understand the issue of constipation and increased dose of Seroquel. Is she really constipated? Seroquel is certainly not a good medication for treatment of constipation. Behavioral symptoms are not good predictors of length of survival. The most common cause of death are intercurrent infections (mostly pneumonia) and it is very difficult to predict when they happen.