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

7 answers | Last updated: Sep 28, 2016
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 Answers

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.

Community Answers

Debj1951 answered...

Thank you for your response. My brother was in the hospital 3 days, but within 13 days he punched a tree & fractured his hand. He spent another 4 days in the hospital. (There is a lady who lives in our jigh rise that brings out the worst of most people, always trying to cause problems etc)When my brother saw her he went balistic & that is when he punched the tree. Thank God he was with it enough to hit the tree (& not our resident "trouble maker." Not just my opinion, most can not stand her troublemaking ways) While in the hospital the phychiatrist said it is mostly yjhr dementia & secondly a nervous break down. The neurologist says just the oposite. (He has a great neurologist, but unfortunately he does not have hospital prividliges where his other doctors do. Brother is scheduled for a Physchiatric evaluation next month. I have noticed he is more careless with his money, he was always so tight with it, now he is more generous (to other people) I love him, will do what I can for him, but really get tired of repeating things, reminding him of people's names etc. I have a General POA, Plus a Medical POA. I take him to all of his appointments, go in with him because he can't remember the anwsers to the queastions he is asked, but I do give him the chance to answer on his own. I hate to see him as this progresses & I have no idea how I will be able to continue this regiment, & there is no way as long as he has any control that he will allow a stranger to come in to help - altough he does well on his own for now. I do have to talk to him sternly to"keep him in line" While in the hospital he was put on Seroquil. I will continue to follow the Neurologist's orders more than his PCP, but I do ask questions & add my input & opinion.

Jytte lokvig answered...

I agree with you that a neurologist or a psychiatrist is your practitioner of choice at this point. Your brother's behavior does not sound like "normal" dementia aggression. Have you done your research on Seroquel? Seroquel works really well for some folks and for others it can produce the opposite of the desired effect. My question to you would be: Did your brother exhibit this volatile behavior before Seroquel or only after?

In the meantime, if you have not already done so, I suggest that you help him protect his money by setting up automatic payments for all his regular obligations. Also establish a separate account for his "funny money" with a limitation on daily cash withdrawals. I suspect he's very vulnerable at this point and an easy mark for a ruthless con-artist.

Debj1951 answered...

WOW! I just feel over whelmed with all of this, but I do keepin mind that I am much more fortunate than many others. Steve's history was of agression, used to be a heavy drinker, but hasn't indulged in at least 10 years. Also he has a history of seizures - none for over 2 years (THank God) When he was drinking he would get in trouble with the law - was given a concussion by a billy club, plus fighting & having other head trauma. Frankkly at this point I am not sure if I have researched Seroquel. Normally I do a lot of research on anything pertaining to him. IE: Yesterday someone in this building had a van for sale. My son-in-law scraps out cars. Steve wanted SIL to come & check it out. Then the other two were discussing price, Steve went to his apartment to get a couple of chairs to give to SIL. This morning Steve & I were talking about it. He told me "Somebody came to talk to the man about buying the van, Then I left them alone to talk about it & I had to go do something" Well, Steve forgot the details. I tried to talk to him later about it & how does he feel his memory is, he admitted it is bad, but indicated he didn't want to talk about it. I know I am lengthy, but the one Support group I went to - I got nothing out of, plus it is on church night. I am just lost because he does manage (so far) on his own. I do handle his bills, & he gets a monthly allowance which he manages to make last all month, but I just feel maybe he walks to the stores & spends money for something to do.

Thanks for listening again. I so want some answers, but I know they aren't there. Also I know each person & case is different.

Jytte lokvig answered...

Steve is so lucky to have you. I totally understand how disturbing his memory loss is for you. But, as hard as it may be for you, the best you can do for Steve is not to beat yourself up over things over which you have no control. Do you want to call me directly sometime next week to brainstorm? Mornings are best on Monday or Tuesday. 505-466-8195

Debj1951 answered...

I will be so happy to speak to you, how thoughtful & fantastic of you to let me call. I live in Ohio, so don't know the difference in the time zones. It would be most helpful if you would give me a time frame in which I can call. Thank you so much & God Bless you for your help.

Jytte lokvig answered...

I'm about one hour behind you.