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Alzheimer's Disease

Assisting Someone with Progressive Dementia Problems

08/10/2000

Question:

My mother in law has lived with us for two years. Dementia, diabetes, Parkinson`s, ulcerative colitis, reflux, and low thyroid are the major problems. She is seeing an internist, GI specialist and neuro MD on a regular basis. When do I call or take her in before next schedule visit when they have told me to "go with the flow of change". Expect good/bad days, etc. We were able to be out ot town for a week (someone else checked in on Grannie). Upon returning we find that her speech is now very halted, can`t remember words she wants to use, told us she was giving up her checkbook. Worked over an hour trying to subtract one figure. When her granddaughter would call her on the phone while we were gone she said it seemed to confuse Grannie and that she could not carry on a conversation with her. Grannie does not want to be taken to the doctor. We don`t know whether or not to make her go since we have been told there is not anything that can be done. Is taking Artane for Parkinson`s. It is hard to just watch her worsen and stop going and doing things that used to interest her. Do I give up my career and stay at home with her? When do we worry or not worry over conditions? We have not traveled this road before. Appreciate your insight and sensitivity in reading this note and also reading between the lines.

Answer:

There is, of course, no way to answer all of your questions without examining Grannie. There are some things that it can be helpful to consider: 1) Any disruption in routine (like your travel) can be expected to have the effect of increased confusion in a person with dementia. 2) Mild dehydration and malnutrition are common when the affected person is left without their usual safety nets. Medications may be forgotten or doubled up unpredictably. Any of these factors will magnify confusion greatly. 3) Dementia does not generally progress noticeably overnight, or even in just a week. If you`ve seen this rapid worsening, and she is not rebounding after several days back in her usual routine, then a visit to the primary care doctor is warranted. You can express your concerns about possible dehydration or mismedication (because her usual supports were gone) and the physician will probably consider the problem much more seriously. Nonetheless, it is probably better to be scolded for overreacting than it is to face the guilt of letting a potentially serious problem go undiagnosed. 4) Should you give up a career to care for your mother-in-law? Only you can answer that question. In general, quitting will mean major stresses for you. You will have to assess whether the rewards you anticipate from that decision will offset the burden. If not, it is probably better to keep working and and use that income (which you are willing to give up anyway, if you are willing to quit) to pay for alternative care arrangements like daycare or in-home help. 5) By all means these are issues that you should be discussing with family, and probably a support group, to help you in making the right decision. You have obligations to those who are well (yourself, spouse, children, grandchildren, friends) as well as she who is ill(Grannie). Those obligations need to be kept in balance now, and in preparation for the time in the future when she passes, but the others in your life remain. Thank you very much for asking these very important questions. We hope that we were able to help. If you have any further questions, please don`t hesitate to contact us.

Related Resources:

Memory and Cognition Center
National Alzheimer's Association

For more information:

Go to the Alzheimer's Disease health topic, where you can:

Response by:

Jon Stuckey, PhD
Formerly
Case Western Reserve University

David   Geldmacher, MD David Geldmacher, MD
Formerly, Assistant Professor of Neurology
School of Medicine
Case Western Reserve University