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sudden decline(1)
Posted: Sunday, January 29, 2023 3:06 PM
Joined: 6/26/2020
Posts: 73

Can someone with moderate-severe Alz suddenly go from reasonably cooperative to lashing out, getting in fights, and refusing to eat or take medicine? 

I'm accustomed to the steady decline of Alz, but this week it's like she fell off a cliff. She had to be taken to the ER on Friday and was admitted to the hospital over the weekend, mostly because her residential facility has fewer staff on the weekend and just can't handle the behavior she exhibited.

The other factor that may explain it is that her recent problems started early this week, when she began taking risperidone. Maybe she's having a bad reaction to it? I looked up the side effects, and it seems possible. I need to ask her doctors when they're back next week. 

Posted: Sunday, January 29, 2023 3:56 PM
Joined: 10/29/2020
Posts: 252

So sorry to hear about your loved one.  I’m sure that there are many possible options that can result in a sudden change in behavior.  New medication, stroke, lack of sleep, less than ideal communication breakdown, UTI…
Posted: Sunday, January 29, 2023 3:57 PM
Joined: 12/21/2018
Posts: 1442

In my experience, YES! someone can go from being cooperative to lashing out, getting in fights and refusing food and medication. 

I observed this with DH many times. When the behavior changes quickly there is sometimes a physical or medical cause such as fever, pain, infection such as UTI. Sometimes DH became frustrated in general with his decline, sometimes DH was triggered by my frustration or lack of patience. It became very important for me to remain calm and speak calmly as much as I could. 

Full disclosure and fair warning: more than once, during my caregiving journey I went from calm and cooperative to lashing out. Trust me when I tell you, it only made things worse when I lost me cool.

Posted: Sunday, January 29, 2023 4:53 PM
Joined: 4/2/2018
Posts: 7253

I think the two most likely would be medication interaction or UTI. Has she had problems with UTIs before? If you have her urine tested (please do), please ask for a culture. If there's an infection, that will tell them the best medication to use. Using the wrong medication could have minimal effect.

If you go to drugs.com, you can make a list of her medications, then check for interactions.

Posted: Sunday, January 29, 2023 5:20 PM
Joined: 6/26/2020
Posts: 73

Because she was in the hospital anyway, they gave her a full battery of tests - blood, urine, head CT scan. Everything normal or nearly so. Definitely no UTI. It’s been a challenge with both her internist and the memory program psychiatrist unavailable since Thursday. 

According to the most recent report, she knows who she is but has no idea where or why. At least she’s not acting like a rabid dinosaur right now.

Iris L.
Posted: Sunday, January 29, 2023 8:54 PM
Joined: 12/15/2011
Posts: 18692

Was she eating regularly? If they are understaffed, they may not have kept up eith her intake and she might have gotten temporarily hypoglycemic or dehydrated.  I say this because this happed to me a couple of years ago when I was eating one small meal a day.

Iris L.

Posted: Monday, January 30, 2023 5:43 AM
Joined: 1/11/2013
Posts: 280

If it were my relative, I'd get them to stop the risperidone. You say they've ruled out medical issues and it was the only recent change. My mother was once put on Seroquel and it caused delirium in a week. Also, if she was reasonably cooperative as you mentioned, why was she put on that med?

I'm sorry you are both going through this and hope this is resolved soon. Please keep us posted.

Posted: Tuesday, January 31, 2023 10:08 PM
Joined: 1/28/2023
Posts: 1

Oh my goodness, I can so relate. I try not to let him push my buttons but…
Posted: Wednesday, February 1, 2023 2:28 AM
Joined: 2/1/2023
Posts: 1

Totally get it and agree.
Posted: Wednesday, February 1, 2023 11:19 AM
Joined: 6/26/2020
Posts: 73

Well, the roller coaster ride continues...

My wife spent the weekend at the hospital, being very cooperative and taking her medicines. When the decision was made that she could return to her MC on Monday, she was delighted. That joy continued at the MC through Tuesday, but now she's telling the nurses that she wants to leave.
When she says that to me, as I know she will, what's the best way to respond? Telling her it wouldn't be safe or that she wouldn't do well without all the care she's getting -- that means nothing. So is it better to say something like "We'll see" or "Maybe sometime"?
When I talk to her, which may be on the phone tomorrow, I will probably get the strongest version of "take me out of here." So I need a reply that's ready to use.
Posted: Friday, February 3, 2023 3:33 PM
Joined: 8/5/2022
Posts: 57

We're trying, but you have to be good. Are you being good?  Did you eat your...  Did you do your... Have you had to...



Posted: Friday, February 3, 2023 3:44 PM
Joined: 6/26/2020
Posts: 73

I appreciate all the help here. It's like a safe harbor during a ferocious storm.

The MC just got approval from a doctor to cut my wife's Risperdone by half. So they'll see if that reduces her confusion or makes any difference at all. 

I"m still dealing with the "I'm leaving here by spring." She says it to staff, friends, relatives, and of course me. I'm starting to think differently about these things in two ways: 

That it really doesn't matter what I say because it will be ignored, forgotten, or distorted. 

That she's there, I'm here, and she's not going to change that. It would be horrible - maybe fatal - for both of us if she moved back here. So I need to stop getting palpitations whenever she repeats that idea.

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