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

3 answers | Last updated: Oct 15, 2016
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 Answers

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.


Community Answers

Ron kauffman answered...

I'm sorry to hear that you're dealing with such a difficult situation as a caregiver. As I read your question, I noticed that you summarized with what you believe are your only two choices as a caregiver: 1) constant handholding or 2) mom's constant screaming.

I'd like to offer you some additional choices, because you stated that YOUR quality of life is suffering. You may not realize how accurate that statement really may be, especially since your home is shared by others, and there's no way any human being can be expected to actually comply with the two choices you listed.

As Dr. Volicer suggested, a change in her meds may help, as well as trying some of his behavioral suggestions. There are some other tactics and actions you might consider that have nothing to do with medicines. It's possible that your mother has learned a way to assure herself of getting your undivided attention, unfortunately, through the use of a negative behavior, her screaming.

Here are a few suggestions, and they include some tough love. First, if your mother responds to touch, you might try giving her a teddy bear or infant size baby doll to hold and nurture, which is similar to Dr. Volicer's suggestion. For some patients, that seems to have a calming effect. Another more unique approach might be to adopt a kitten or small breed puppy from the local animal shelter, and to allow your mother to hold and pet the animal on her lap.

Obviously, there are a lot of issues involved regarding adopting and caring for a pet, but rather than go into them "“ you probably know what they are "“ I think it might make some sense to consider the idea. For starters, you could conduct a test by checking in your local area to see if there are any service dogs that can be brought to your home to see how you mother reacts and responds. That would give you an excellent indication as to whether a pet of her own might have a calming effect. Remember, even if this idea works, and you decide to adopt, you and your family will inherit a lot of other obligations regarding the ownership and care for a pet.

Another idea is to bring in outside caregivers to sit with your mom several hours a day, to give her comfort and support while you do your work. If you can afford this, it's a way to wean your mother away from demanding 100% of your time, and it may open the door to the possibility of having your mom attend an adult daycare center a few times a week for outside socialization and stimulation. Both of these suggestions, if successful, will free up your time so you can work in peace and quiet.

If your mother is not a danger to herself and is not a wander or fall risk, you may go back to one of America's early experts in child rearing, Dr. Spock, for another idea. One of the things that he discussed was that when infants cry when they've been put to bed, mothers are often told is not pick up the baby every time the baby does cry, as that quickly teaches them how to get mom to pick them up.

Instead, assuming that the baby already gets plenty of love and attention at other times during the day, he suggested that mom check the baby and if there's no physical issue, pain, hunger, danger or the need for a diaper change, to leave the baby for as long as she can stand, so as not to teach the baby that a negative action earns a positive response.

Alzheimer's patients can often become very child-like in some of their behaviors, and while it sounds like a cruel and unusual punishment, your going for a 15-minute walk and letting your mother scream or cry herself out or to sleep, may be a way to initiate behavior modification. It's also a valuable way for you to get a short time out and a break.

Obviously, if there are safety or health concerns "“ screaming and crying is usually not a health concern "“ you have to weigh those carefully before you begin to teach her that by not screaming, she will receive positive attention and reinforcement from you and others in the household.

I'm sure there are other experts who can expand upon this short list of ideas, but from what you've described, the present situation is untenable and will in very short order create many more problems for you and the others in the house. Good luck, and let us at Caring.com know if any of these suggestions worked for you.


A fellow caregiver answered...

For my Combative Mother , the "perfect cocktail" is Cymbalta, Zanex, Namenda, and Temazepam. If she has always been on the mean side nothing can change that. I deal with it daily. Hang in there!