Could my mother's gag reflex to water be dementia related?
My 70 year old mother may be suffering from early/mid stage Alzheimer's. We are in the process of finalizing the diagnosis now. She is exhibiting a number of odd behaviors and physical "problems". One is that she says she can't swallow water because it makes her feel like she's going to gag. Could there be something mental about this related to the dementia? We are having a family appointment with a neuropsychologist tomorrow and will bring this up, but I'm really worried because she needs to drink more water but seems reluctant to do it. Any ideas?
Your mother's gag reflex to water could be related to her dementia, but difficulty swallowing thin liquids like water is usually a more common symptom of the moderate to severe stages of dementia. Regardless, it would helpful to have a swallowing study by a speech and language specialist. Swallowing problems may indicate another medical condition as well.
The swallowing study results should also suggest drink alternatives like thickened liquids or positioning changes like keeping her chin down near her chest when swallowing thin liquids. (Of course, she may not remember these instructions).
There are many ways to insure adequate fluid intake other than drinking water. Some older people have reduced thirst mechanisms or physical sensations which would remind them to drink, and some people never liked to drink water.
On the other hand, behavior changes or changes in physical problems or complaints, as you mention, are common in the moderate stages of dementia. People with memory disorders may get fixated on symptoms they believe are responsible for feeling "not like themselves" or symptoms which may have bothered them in the past. She may "perseverate" about a problem with gagging, getting the idea stuck in her head. Whenever anything bothers her, she may relate it to her gag reflex to water or to a physical symptom she had in the past which she recalls more easily than the present. For example, some people consistently complain about pain they may have had many years before. It may be more acceptable and less stigmatizing to complain about a physical problem than it is to complain about vague feelings of being lost or confused. However, that doesn't necessarily mean they aren't in pain right now.
Because there are so many possibilities, begin by assuming she is correct about her recent onset gag reflex, and start with a swallowing study. You want to give her every opportunity to insure adequate nutrition and fluid intake.
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My mother had this problem after she had her strokes.
You might trying using a straw if the person can remember the sucking process. I have heard people have had success with this.
Check the side effects of any medication she may be on.
My Mom was on 2 different anti-depressants, and when the dose was increased, she had the odd symptom of spewing a small amount of liquid after eating. I reduced (and later removed) the medication, and it went away.
At an earlier time, she also had the sensation that she had food or something in her throat that wouldn't go down. She was always pulling on her throat. She was checked by and ear nose and throat specialist (who found nothing), and also had her esophogus stretched (no improvement). Then I read where diabetics are frequently low on magnesium, and that could cause that symptom. I gave her 400mg magnesium (no results), then read diabetics need twice that amount, so I doubled it, and that feeling went away.
Along with all the other suggestions, I would carefully check each and every medication she is on. Many of them can even cause dementia or alheimer's like symptoms along with a host of other things. And don't just rely on your (or her) doctor for the side effects. Some will deny that the drugs can cause some of these symptoms. Ask your pharmacist for printout with both side effects, and interactions for all medications she may be on. Then do you homework on-line with something like WebMD. They have information on each drug, plus reviews from patients, and that is a really valuable resource.
Make sure they also to an X-ray or ultrasound or scope. My Dad had esophageal cancer that took 2 years to diagnose.
ask about the possibility of mini-strokes too, since that is an issue in swallowing problems. if it's a recent thing, figure out if she had a medication change recently.
many extra problems in elders are related to the medications they are taking. sandikat is totally right-on in that.
all caregivers should monitor any changes that happen after starting a new med and, no matter how much a doctor denies it is related, commonsense gives you the answer on that. then do the research on the internet. then go back and ask that the med be changed, reduced or discontinued.
as a caregiver, you are the gatekeeper keeping trouble away. you aren't the doctor but you are the doctor's monitor on behalf on someone who can't do that for themselves.
Taka, I sent you a personal note with a hug, but for the benefit of others, beyond the helpful answers the respondents have taken time to share, is a book entitled, Swallow Safely.
I don't know if we can post links to these messages but I reviewed the book and included highlights that may be helpful to you at: http://www.thecaregiversvoice.com/latest-news/tcv-book-review-swallow-safely/ If the link doesn't work, then visit TheCaregiversVoice.com and look under the Resources and Links tab for Product and Book reviews. You will find a detailed review of Lisa Gwynther's book here as well.
Alzheimer's can be associated with difficulty swallowing and all sources I've seen suggest that thicker fluids are easier to swallow. If your mother likes soft ice cream she may take that without a problem. Fruit smoothies are another liquid that may go down easily. I make them with milk , ice cream, banana and another fruit especially strawberries. And what about fruit nectars, and thick but homogeneous soups. A stick blender can turn any soup into one of these.
My better half has difficulty swallowing food,,,she's fine with liquids,,so I got some MUSCLE MILK from the healthfood store and do shakes with milk , blueberries and flaxseed...she loves them and I'm encouraged now to add a half banana...All your suggestions have been very helpful and I thank you plus A HAPPY THANKSGIVING.
If you want your mother to drink water, rather than some other liquid, there are unflavored thickeners at most pharmacies. This can be common in strokes, dementia, and parkinsons. It could be that your mother is further along in dementia than you think. I hope all this works out for you!
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