What medications or treatments can help control Alzheimer's anxiety?

Taura krise asked...

I know most of you are not doctors, and therefore, cannot legally give medical advice. I also know that all patients are different, and that what works for one could be disastrous for another! Keeping all of that in mind:

My 86-year old mom had dementia / beginning stage Alzheimer's, and I'm finding it REALLY difficult to find the right "medication cocktail" for her. I'm working with her doctor (an elder care specialist) to give her as high a quality of life as possible, while also trying to lessen the panic attacks/aggression/screaming that seems to be almost constant now. I would just LOVE for her to be able to sit in the living room with us all, peacefully.

We've changed her medications quite a lot lately (at my insistence) as, previously, she was sleeping, 24x7. I could barely feed her / give her water, so, that had to change quickly! Now, she's taking a combination of Ativan (on a schedule), Depakote Sprinkles (at bed time, for sleep) and Seroquel (as needed, for severe panic attacks). So far, we're not having very much luck!

As I type this, she's been yelling -- every 5 seconds, for almost 3 hours! -- for her mom, all 8 of her sisters, and for "Help!", over and over again, ad-infinitum. Of course, when I go in to try to calm her, she quiets down ... as long as I stay there and hold her hand. I did that for 2 hours this morning! But, as soon as I leave the room, even to go to the bathroom, the screaming continues, non-stop.

She's not in any pain or discomfort, she's completely bed-bound, and safely in a hospital bed, with padded rails (she often strikes out at people who aren't there, and kicks her legs around, etc). Just now, I closed her bedroom door, so that her screaming is muffled and I can make some phone calls. {sigh}

Obviously, this situation is not sustainable! Today, I've got a lot of work-related phone calls to make and the usual assortment of "stuff" to do around the house. If I want to get anything done, I have to find a way to ignore the screaming and just get. on. with. it. That's SO hard to do!

Is this type of behavior "normal" for someone with dementia / Alz?

If so, how do you all deal with the constant screaming?

Is medicating her MORE to keep her quiet "acceptable"? A failure? Giving up?

I love my mom, and I want her to be as happy as possible, even with this horrible disease. That said, I also know that other people share this home, and that OUR quality of life is suffering.

At this point, my care-giving options are: 1) TRULY constant hand-holding or 2) TRULY constant screaming

{sigh}

Experience? Advice? Medication Suggestions? Etc?

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.

There is no specific medication that would prevent the behavior that you describe. However, I would question using an antipsychotic, such as Seroquel on as needed basis. It would be better to find out which regular dose of an antipsychotic your mother tolerates without sleeping too much and add Ativan only as needed. You might also try less sedating antipsychotics, e.g., Abilify. Since your mother stops screaming if you hold her hand,it might be possible to try also some non-pharmacological approaches to manage her behavior. Does she have a favorite music that would calm her down? Some patients with dementia respond well to a Simulated Presence therapy. That involves making an audio tape asking questions about pleasant occasions in your mother past that she might remember. Leave a space on the tape for her to answer, something like a one sided telephone conversation. You may play it to her through headphones if she will tolerate them. The tape does not have to be long and if you use autoreverse tape player the tape may play over and over because she might forget that she heard it already. Another thing to try would be to give her a realistic looking stuffed animal to hold. Did she have a favorite pet? I hope this might help.