Is it typical for Alzheimer's patients to experience rapid decline?

Debj1951 asked...

This is my brother's 3rd night in the Psychiatric ward. I took him with me tot he stock car races Saturday night. I went to the ladies room, coming out of the stal, I saw him coming out of one also. I joked ^ said "honey you made a wrong turn you are in the ladies room" It seemed to just go right over his head. Going back to our seats, he grabbed me & tried to kiss me. I called his name sharply & asked what he was doind, he said he was sorry, he didn't know what was happening, yet continued to say & do inappropriate things,(toward me) at the same time saying he was sorry, he didn't know what was happening. When he said he saw & heard the cars & the people, but just felt like he wasn't there We left & I took him to the hospital ER. Hous later (obviously, nothing in the ER goes fast) they decided to admit him to the Physc ward. He had been doing very well, would get short tempered at times in the store, but (we each live in the same high rise) he has always been so helpfful & everyone seems to think so much of him. He has been so tearful when I go to visit, not to sound selfish, but my heart breaks when I see him like this, he just doesn't normally cry, even when he lost his wife 30 months ago. I have had a cahnce to talk to his physchrist (SP?) yet, but I am so afraid he won't be coming home. Can an alzheiner's/Dementia patient go from being semi-normal to having to be placed in a short timr? Thank you for any insight you can give me.

Expert Answer

Jytte Lokvig, PhD, coaches families and professional caregivers and designs life-enrichment programs and activities for patients with Alzheimer's disease and related dementia. Her workshops and seminars help caregivers and families create a healthy environment based on dignity and humor. She is the author of Alzheimer's A to Z: A Quick-Reference Guide.

I gather that your brother had been experiencing some dementia but was still able have a pretty normal life, so the incident at the races was totally out of character. His sexual advances toward you would naturally raise great concern. You had no choice but to get him to the ER.

People with Alzheimer's and most other dementias typically decline in minor increments with plateaus in between. Physical or emotional trauma can cause sudden acceleration of confusion and exaggeration of dementia related behaviors: short-term memory loss and confusion. Your brother's demeanor during this singular incident does not sound like a normal trauma related dementia decline.

Your brother's episode would likely be classified as "delirium." While he was in the ER, hopefully he was given a complete check-up, including a CATscan, to look for physical triggers of this episode. Among other acute events, "Delirium" can be the result of a stroke, an infection, a drug-reaction, or an aneurism in the brain (blocked or enlarged artery.)

Regardless of the cause of his episode, you'll want him to see an Alzheimer's and dementia specialist, preferably a geriatric psychiatrist. If that's not possible, he should go to a neurologist. Be sure to verify that he had all the tests necessary to eliminate physical triggers of his episode. Also, insist on a thorough review of all his medications, before the episode and after his stay in the psych ward.

Hopefully your brother has a POA (power of attorney) in place, appointing you in charge of his healthcare, so you can be proactive on his behalf. In lieu of a POA, he can give you written consent to communicate with his doctors. We should all have POA in place, just in case. As you can attest, we never know when something extraordinary will happen.