Isadora, sorry but I believe you are asking for something impossible, [from
your description of her as suffering from "delirium and dementia"], if you
are expecting her to be able to cogently tell you whats wrong and how to
stop the screaming...and thats if there is something wrong, it may just be
the dementia.   You cannot talk to someone with dementia and have a
reasonable conversation, that is almost the definition of the condition.

IMHO, if she is screaming because of pain, zonk her out, thats the kind
thing to do, thats what I'd want if I was unable to say where the pain was.
.......I presume you have had this sort of 'conversation' with her and she
has been unable to tell you? (or even understand what you mean?).

If she is screaming because thats what the dementia or the delerium does and
that distresses her, zonk her out, again that must be the kind thing to do.

This discussion has arisen here before, when people have complained about
their LO's being 'over medicated' (aka tranquilised) , or is that the
ethical thing to do, but OTOH if they are agitated and causing distress to
others (and others are causing distress to them), then everyone ends up
worse off.

Dorie,

I just read Tumbleweed's response to you and it is excellent, so I just
wanted to add my endorsement to what he said.

In our case my mother in law began having very disturbing delusions.   She
was extremely uncomfortable with them, and "overmedicating" her was
necessary at that time.   That may be the case with your mom.   If she is
screaming and upsetting herself and everyone around her, she may honestly
need to be medicated to control it.   If I were you, I would go with the
professionals and what they see and recommend for her, even if it seems a
bit much to you or I.

The most important thing to understand is that alzheimers goes through
stages, and what might be necessary medication at one point, might turn out
to be overmedication later on.   My mother in law, for instance, is no
longer on anything but the minimal amount of meds.   Her disease has
advanced to the degree that it is no longer necessary to use strong
medication to control her comfort level.   You have to be very watchful and
know the person very well to be able to adapt when it is appropriate to do
so.

Isadora,  Has she been treated at all for pain?  It sounds to me like
the basis might very well be pain and she is unable to cope.  Sitting in
a wheelchair-or any kind of chair for any length of time can become
uncomfortable and she is unable to either judge, interpret, or
communicate any other way.  Postural pain in very common in the elderly,
nevermind actual and likely pathology(osteoporosis, arthritis, etc.).  I
recently discovered this pain assessment tool that might give you some
insight.  Hopefully, the staff would be receptive to rethinking things.

http://www.greatseminarsandbooks.com/Tips/Entries/DiscomfortScale.htm

(Sorry, couldn't get it to come up as a link.  You'll need to copy and
paste the URL into your browser).

Beth- Physical Therapist

Here are a couple of articles about screaming

http://www.aafp.org/afp/20030601/2335.html

This next one has some good suggestions for things to consider and
rule out.

www.stacommunications.com/customcomm/
Back-issue_pages/AD_Review/adPDFs/january2004/11.pdf

These two are about a medication called quetiapine that has recently
been used for agitation with Alzheimer's patients with some success
(its in the respiridone family)

http://www.scienceblog.com/community/article3365.html
http://www.ahaf.org/whatsnew/AD_Medication_July_2004.

I've also read that background music can reduce screaming. At this
point, probably worth a try!

Mary G.

I think you should consider more how *she* feels when she is
screaming.
Sedation is NOT just to make your mother less annoying to others - it
is also to make HER less aware of her own mental pain.

There is a risk in keeping her sedated;  but I'm sure doing so
seems better _to her_ than needing to scream.

That said, I hope you can still find some medication that gives her
comfort without knocking her out entirely.

Isadora, I really feel for you.  My Mom, who passed away a few months ago
was a screamer.  In her case it was that she needed a lot of attention and
had an attention span of about 20-30 seconds.  Yes, she would yell for
help when she was in pain, hungry, or when she wanted to go to the toilet,
but she would also yell for attention.  When you would go talk to her, she
would respond and stop yelling, often she could not remember what she
had been yelling for.  When I would take her in her wheelchair out for
a "walk" if I didn't keep talking she would start yelling again because
she couldn't see me.

She was on varying amounts of Zyprexa, which helped.
Depakote had no effect.
Xanax was very successful, compared to no Xanax.  She still
yelled, but not as much as with no Xanax.  She was taking
Xanax pills in a smaller amount 4 times a day because the
larger amounts a couple of times a day left lots of the day
with lots of screaming.  She was also on the Zyprexa.

I think the Xanax helped because Mom had always been
anxious and tense.  With the mental confusion I don't
think she could bear it without constant distraction so
the anti-anxiety effects of Xanax were, I think, what
helped.

It was just awful.  Her roommate hated her and would
want to tell me how bad she was whenever I visited.
Some of the more clueless attendants wanted "the
family" (me) to "tell her to be quiet" or "come and
sit with her".  The great majority of the staff
was great, but it put a lot of stress on everyone.
I began to fear that they would toss her out, even
though they wouldn't have and couldn't legally have.
My nerves were shot.

I kept repeating that I preferred that she be
knocked out as opposed to agitated and upset
if there had to be a choice.

She wasn't happy and when she died I think
she "escaped".

Joan