yep, in my fathers case it was to enable my mother to retain her sanity for
a few more months

respectfully, I suggest it doesnt because his dad doesnt have the learning
capacity of a 3 year old, indeed he likely doesn't have any learning
capacity at all. certainly my dad hated every single minute of it, caused a
huge fuss when he went (more stress than was worth his absence), simply
because he couldnt understand that my mother needed some respite and that he
wasnt able to look after himself for more than 1 minute. He *never* got it,
ever, possibly because he was never someone that enjoyed 'joining in' in the
first place, and in the end stopped going, which was the trigger that ended
up with him going into care as my mother got no respite at all.

Now, some people will certainly acclimate, but I suggest that's usually
either because they are happier with the idea in the first place, or because
they show a marked decline and arent in a position to be able to complain,
or because the delusions fade as they get worse, or because of medication,
or some combination of these, rather than they get used to it and learn its
good for them.

Agreed

I agree the medication is the way to go, because IMHO someone who doesn't
like it is unlikely to change  to like it over time, **unless they are
declining fast**, (when time may act as the medicine), and if that doesn't
work, then either some respite care at home, or placement is needed.

Welcome, Sue,

Sounds as if you've been through some tough stuff. You don't sound
like a troll at all. BTW, when did the folks in W. Maine start with
"y'all"? <lol --  there are several of us here who were practically
born saying that>

Again, welcome,Sue!

one thing to keep in mind is that sometimes even people's reactions to a
particular medication.

My MIL did HORRIBLY the first time we tried her on Respiridol - was up all
night; caught her once at 4 a.m. putting on her coat to head outside to look
for 'the other dogs'   ...and was more agitated and difficult to deal with
than she had been without anything. Ended up on Zyprexa instead.

A couple of years later though, when the zyprexa was SO not working for her
any more, Rispiridol was again prescribed; this time it has made all the
difference.  She sleeps through the night now (has since last November when
she started on it), is content during the day, and the only imaginary people
she talks to now are friendly ones.

she's much happier and much much easier to deal with - have recently cut her
dosage in half and she's still doing great.

Dear Topedo,

It may in fact be a case of over medicating. Or it may simply be a
confluence of disease progression and the demographics of the patient
pool where you live. Sadly, as the various dementias progress, our
loved one's ability to respond to outside stimuli is reduced. They do
appear zombified.

Some patients with frontal lobe dementias have hallucinations from some
psychtropic medications. Don't remember which. My FIL didn't have that
reaction, despite a confirmed diagnosis of frontal lobe atrophy.

Frontal lobe dementia's, like Pick's Disease (and others, including
sometimes, vascular dementia), start with deterioration in the front of
the brain and move slowly towards the rear. They often show themselves
first through agitation, paranoia, difficulty finding the word one
wanted to use, compulsive behaviors, trouble with sequencing or
following directions and exagerrated emotional responses. It's a
slightly different progression from AD, which begins at the rear of the
brain and moves forward and tends to affect memory earlier in the
progression. The frontal lobes are where executive function is
governed. Like how well you can make your behavior conform to societal
expectations, how well you can govern emotions, how well you can go
through a sequencing process (like showering).

My FIL had some sort of frontal lobe dementia. He was always pretty
mild mannered - very formal. One could have a reasonable conversation
about one of his hobbies. When he couldn't find the right word, he'd
try to 'talk around it' ("you know, that thing you use to tighten
bolts..." or, "You know, that thing, um about this long,... well
whatever. Anyway..."). Then he would start talking about the people who
come in at night and hide his things, which is why all doors must be
locked at all times, even screen doors. He entered every sweepstakes
that came in through the door, including the 'send a dollar' scams - a
definite change from someone who prided himself on his Scottish
frugality. He was a woodworker who stopped doing projects because he
could no longer understand the directions for projects. But if you
tried to stop him from driving, he'd blow up at you and threaten
violence. If touched during a hallucination, fight or flight would
emerge and he'd get viloent.

A PET scan will show where the atropy has affected the brain, though it
won't differentiate between the different causes. Atrophy of the front
of the brain could be Pick's, could be dementia with Lewey Bodies,
vascular dementia, of something else. Dementia at the rear could be AD,
vascular dementia or hundreds of other causes. It will however give you
some insight into how the disease might progress for your father and
confirm atrophy of the brain as an umbrella diagnosis.

A good gerontologist is a gem. And if you can find a Neuro-psychiatrist
who specializes on dementias, you have hit rare pay dirt. They are
often more educated about the different medication options and
combinations which best keep our loved ones comfortable.

It's a fine line between emotionally even and overmedicated. But if you
can find the right balance, vague contentment wins over confused and
fearful agitation any day. In fact, as someone who has personally
experienced anxiety attacks, I might even choose zombified.

Adelle

It looks like zombification is one of the effects of Seroquel.
It makes people very drowsy.

It's a drug approved for schizophrenia and bipolar disorder.
Like most drugs prescribed for elderly patients, it's being
prescribed off-label, which means that no clinical trials have
been done for this use and the FDA therefore has no
information about whether it works for this use or not.

There's a good wikipedia article on it at:

 http://en.wikipedia.org/wiki/Quetiapine

There's a link at the bottom of the article to reports by
patients taking the drug - mainly for schizophrenia or
bipolar disorder.  For some of those people, the drug
seems to be a lifesaver.  All however seem to report heavy
drowsiness and weight gain.

If you do decide to go the drug route, I recommend starting
with very low doses of whatever drug you try, and observing
your father very carefully.  Elderly patients often have lower
tolerances and worse side effects than young people.

Good luck.

   Alan

For about the last two years of my MIL's life, she was pretty much in a
stupor a lot of the time - either drowsing, or sort of just vacantly
sitting there. She used to sing to herself, and rant and rave in a
garble every now and there, but seemed barely aware of her surroundings
and the people around her - most of the time she wouldn't really react
to what was happening near her. Even her eyes looked dull. My husband
commented once that her eyes started reminding him of animal eyes in
that the spark of intelligence behind them had gone.

She wasn't on any medications at all when this happened - not a single
drug at all other than her B12 shots for her anemia - she died in 1999,
before Aricept was available here. The zombification was entirely a
function of the disease, which is awful to think.

I do know what you mean - when my MIL first moved into a locked AD
ward, she was relatively high functioning, and I was truly horrified by
the condition of other residents - I hadn't had much experience with
late stage AD, and was hauled up short by the reality - and the worst
of it was, before too long, the disease continued to progress, and she
was the same.

M.

and it's not due to the meds, it's due to the fact that they have
dementias more advanced than your father's.  i know that you find
it upsetting, because i suspect that deep down you are afraid
that your father will end up like that.

please don't think i'm cruel, but i'm trying to be realistic.
you can only expect things to get worse, never better, except for
the occasional moment when a few neurons will connect for a few
instants.  sorry, but it's going to happen, and denial is not a
river in egypt.

so think of it this way:  what good does it do for him to have
the full use of what little faculties he has left if it only
makes him agitated, upset, and paranoid?  

seroquel may not be the drug he needs, it could be something
milder or something stronger (it took strong risperdol doses for
a few days to calm my mother down, and then other meds after).
this is the time when a geriatric psychiatrist is what you need.
ask her doc for a referral.  ask her/him for the data sheets for
what's recommended, and if possible discuss it with her/him,
including plans for monitoring and increasing/decreasing dosage.

please tell us how you arrived at that conclusion.  there is a
vast difference between early and late stages.

Remarkable!!  With one look you were able to assess all those patients, know
there past history, know that that they were on drugs now, and know that the
drugs were the cause of the vacant behaviour, rather than, lets say, some
alternative cause, for example, it being a nautral consequence of late stage
Az. Absolutely oustanding, well done.

Hi Suzanne,

I respectfully beg to disagree with just a bit of what you said above.

Risperdol made my mother in law a happier person, and more comfortable in
her own skin.   She was one who was TORTURED by her delusions!   Risperdol
brought them under control.   It isn't a "bad" drug, but I admit that it
could be used incorrectly, or overdosed on.

By the time she was admitted to the nursing home in later stages, we
discontinued its use gradually because she needed it less.   I would explain
that there was a sort of a curve.   We started smaller dosage wise,
increased it, then slowly decreased it, based on her needs.

To be perfectly clear, I will admit that it would be awful for people to be
put on this drug without serious and careful observation and understanding
of the need for it, or the lack of need.   I am sure there ARE places and
persons that abuse these kinds of drugs.

For us, that drug was a godsend, and without it my mother in law would have
been in a facility way too early.  She would have missed a great deal of
life and we would have missed a great deal of her.

I am glad that people can see your opinion as well as mine, but in the
interest of the peace and fairness to the families dealing with these
ethical issues, I think the use of medications like this should be decided
between the doctor and the family according to individual necessity.   It
isn't a bad drug, but like any other, it can be used incorrectly.   Each
situation should be judged individually.

It is also important that people should realize that with or without drugs,
persons with alzheimers, will very often come to a place where they do get
very listless and sleepy and uninterested and unresponsive to much going on
around them.   In later stage they sleep almost all the time.

I am glad you were able to deal with your mom's difficulties without needing
anti-psychotic meds.  But then you didn't have to deal with the same person
we did.   We really had no other choice, excepting to maybe use some sort of
physical restraints, and that would have been really horrible in my opinion.

Suzanne, I live in Ontario, and when my MIL went through her journey
(in the 1990's), there were essentially no Alzheimer's drugs available
here, other than tranquilizers, which, thankfully, she only needed on
one or two occasions the entire way.

We were very fortunate with her, as she did not undergo much in the way
of personality change. She just got vaguer and vaguer - she was always
very gentle and shy, and if anything, the Alzheimer's made her less
aggressive, if that was even possible - LOL! She did have some
delusions, but few of them were very distressing to her (i.e. she
thought people on TV could talk to her and see her). I've answered
Alzheimer's questions for allexperts.com for many years now - so I've
had conversations with more than 400 families who have loved ones with
AD and other dementias, and I know that we were just darned lucky on
the difficult behaviour front. She did lots of strange things, but
nothing that was really a huge problem in terms of her care, or safety
and distress for her or others.

A lot of families go through very, very difficult experiences with
their loved one with paranoia, anger, upsetting delusions,
hallucinations, agitation, sleeplessness, wandering, and physical
acting out that can include violence like throwing things, hitting,
pushing, yelling. Sometimes these behaviours can be managed without
drugs, sometimes NOT (i.e. loved ones and caregivers try everything
they can think of and nothing helps). We have family friends whose
formerly very gentle husband (a very large man) had to be placed in the
pre-respiridol days because of his anger and violence - this happened
at home with his wife who tried everything and was at her wit's end
with him. He became very unpredictable - kinda like a toddler who will
wallop at random. It was just plain dangerous for her and broke her
heart. I also recall the teeny Scottish school teacher (probably
weighed 80 lb) in my MIL's locked AD ward who used to scream swear
words, accuse staff of trying to poison her, and throw chairs and other
items at people (she was just wild when she got going, which would have
been funny if she hadn't been with a lot of frail people she had real
potential to hurt).

So if things are running smooth at your place, thank your lucky stars,
and have some compassion for others whose loved one is more
challenging. The point of the medications is to improve quality of life
- and for many people, no drugs results in earlier placements in
facilities because their families can't cope, or it means they get
kicked out of facilities because their violence or other issues can't
be dealt with safely.

When my MIL got to the point where she needed the locked facility, she
went to Chester Village in Toronto, which was then one of the few
places that had a specialized AD unit with activities designed just for
AD patients. It was great in terms of the care, the staff, and the
creative ideas for activities and programs they came up with.

Residents participated in many things, and those who were still higher
functioning did seem to enjoy themselves (and yes, music was something
many really participated in and seemed to get pleasure from). Very few
of them were on Alzheimer's or psychiatric drugs because there were
almost none available at the time. The unit almost never used
tranquilizers. My MIL got into a spin one time with agitation, and they
called us and asked for permission to give her a dose of something - no
one was routinely drugging anyone in there.

However, yes, many of them were very vacant. Its a function of the
disease. Its called "flattening of affect" - the range of emotions they
express becomes less and less in terms of happiness, interest etc. Some
of them also had Parkinson's issues and had "frozen" faces. Many of
them just didn't participate in anything - they just sat in the lounge,
ignoring the activities going on right in the same room, or shuffling
endlessly around the halls. Some of them ranted endlessly to no one,
some said nothing unless they were spoken to, and then only a yes or
no. My MIL lost her ability to talk two years before she died - those
last two years all you got from her was garble, with the odd
intelligible phrase thrown in, but she couldn't understand or answer
questions. She essentially withdrew inward, and stopped participating
in much of anything, no matter how interesting or stimulating what was
going on around her was. She just lost interest in everything -
although that doesn't adequately describe it. It wasn't just losing
interest - she just had no clue what was going on - she was just
disengaged from everything by brain damage. Just to give you an
example, we went to a special Christmas party with her, and we'd
brought a nice new robe for her in a wrapped box. She didn't know it
was Christmas. She didn't understand what was going on. She paid no
attention to the activities. When given the present, she didn't know
what it was or that she should unwrap it, or be excited or happy about
a gift (she'd formerly been a big fan of holidays). When we "helped"
her unwrap it, she showed no interest in the robe - she didn't know
what it was, that it was for her, or give any indication that it was
soft or a pretty colour or anything. Just pretty much vacant in terms
of reaction, engagement, interest, initiative etc.

When she stopped being able to walk, she finally had to go to the
nursing ward, and that floor was even more depressing - because the
entire population was pretty much end stage dementia patients who spent
their days sitting or propped up in bed, drowsing. Again, it was the
disease, not the way they were treated, and nothing to do with meds.

Mary

http://www.newstarget.com/004951.html

clipped

"Highlight:
An antipsychotic drug prescribed for almost half of all Alzheimer's
patients in Britain can actually worsen symptoms of the disease,
according to a study conducted by the Institute of Psychiatry.
...
An antipsychotic drug frequently given to Alzheimer's patients actually
worsens their illness, researchers say.

...
Patients given AstraZeneca Seroquel had a marked deterioration of
memory and other higher brain functions compared to those on placebo,
according to Professor Clive Ballard of the Institute of Psychiatry and
colleagues.

etc. etc.