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Medical Forum / Diseases and Disorders / Alzheimer's / March 2006

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Downs and ups

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meg - 13 Mar 2006 17:23 GMT
My mother went to the ER on Friday.  Her memory care called us to say
she was not acting as usual, didn't want to get out of bed, had no
language and was unable to follow even simple directions.  ER diagnosed
a stroke, even though it didn't show up on the CT scan, after testing
for  a UTI,  etc.  I don't think anyone could imagine her recovering
significantly.  However, by Sunday evening she was just about back to
pre-incident levels, except for being exceptionally tired and having
decreased endurance.

I guess this is a good thing, but the ups and downs of this are very
stressful.  As I've written before, my mom is now a tortured soul and
very unhappy in memory care.  To be honest, a large part of me was
thinking this might be a blessing... to have her lose her an awareness
of her situation.  Now she's back and as aggitated and unhappy as ever.
It's so wearing.

By the way, she has been quite constipated for several days.  The ER
doc and med aid said constipation would not cause such a drastic change
in her abilities.  Has anyone had any experience with constipation's
effects on dementia.  My sibblings have mentioned a stroke can be
caused from strain.  She's on coumadin to decrease her chances of
strokes.
Mary_Gordon@tvo.org - 13 Mar 2006 18:15 GMT
Well, if you run some searches, you will find that constipation
certainly can make confusion worse in someone with dementia.

Here is a fairly typical comment I found:
6. Constipation.A common condition in the elderly, it can be
minimised by a good diet, plenty of fluids and exercise. Mild aperients
may be needed. In a patient with dementia, constipation can lead to
urinary incontinence, faecal incontinence and a worsening of confusion
often with irritability or aggression as well. This is thought to occur
due to the pain and discomfort of the constipation.

Mary
meg - 13 Mar 2006 18:42 GMT
Posting on top:

Ugh.  I just called the med. aid at my mother's memory care to let her
know about a doctor's appointment and mentioned my mom's amazing
recovery from Friday's incident.  She said "I think your Mom is a very
good actor.".  At first I thought she was referring to my Mom's ability
to hide her level of her dementia, but then realized she was referring
to Friday when Mom couldn't, talk, couldn't follow simple 1-step
directions, couldn't walk without assist. couldn't take her medicine
etc.

This was one of my favorite people at Mom's memory care, she always
seemed so caring, gentle, and loving.  Now I hate her.  How ignorant
can someone be to think that someone with dementia could maintain that
level of disability for over 24 hours as a way to get attention.

More upset!

> My mother went to the ER on Friday.  Her memory care called us to say
> she was not acting as usual, didn't want to get out of bed, had no
[quoted text clipped - 18 lines]
> caused from strain.  She's on coumadin to decrease her chances of
> strokes.
Dennis P. Harris - 14 Mar 2006 04:33 GMT
> This was one of my favorite people at Mom's memory care, she always
> seemed so caring, gentle, and loving.  Now I hate her.  How ignorant
> can someone be to think that someone with dementia could maintain that
> level of disability for over 24 hours as a way to get attention.

i suggest talking to the person's supervisor;  it sounds like she
needs additional training in 1) sensitivity to the feelings of
family members and 2) strokes and how they affect patients.
Dancing Queen - 14 Mar 2006 12:32 GMT
> Posting on top:
>
[quoted text clipped - 13 lines]
>
> More upset!

what an awful thing to say.  all her good work undone with one comment, her
true colours have been shown.

:(

>> My mother went to the ER on Friday.  Her memory care called us to say
>> she was not acting as usual, didn't want to get out of bed, had no
[quoted text clipped - 18 lines]
>> caused from strain.  She's on coumadin to decrease her chances of
>> strokes.
Dennis P. Harris - 14 Mar 2006 04:40 GMT
> By the way, she has been quite constipated for several days.  The ER
> doc and med aid said constipation would not cause such a drastic change
> in her abilities.  Has anyone had any experience with constipation's
> effects on dementia.  My sibblings have mentioned a stroke can be
> caused from strain.  She's on coumadin to decrease her chances of
> strokes.

i would suspect possible dehydration as part of the culprit for
the stroke (less fluid intake = thicker blood) and of the
constipation.  

many AD folks don't drink enough liquids (the brain sometimes can
no longer properly interpret the body's thirst signals) and they
may have to be prompted to drink enough water every day.  

you should ask the staff at the facility to monitor her intake of
liquids and insist that she drink the amount of liquids that her
doc recommends.  if she's incontinent, they may have reduced her
liquid intake so that they won't have to change her depends so
often, or deal so often with toileting.
meg - 14 Mar 2006 14:44 GMT
Thanks Dennis,

No signs of dehydration and they do monitor her fluid intake.  We also
did have to cut down on her fluid intake because of the incontince
issue.  She was exhausting herself with bathrooming.  Her constipation
is caused by a medication change while we try to manage her colitus.
She's usually got the opposite problem.
 
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