DW going into rages

DoninNC

As my DW's Alzheimer's has progressed (late mid stage) we have seen more and more angry rages. At first she would just get upset and it would pass after a little while. The first serious one was also my first experience with sundowners as we when out before dark but were returning home after dark and she became disoriented, pointing to a building and saying I should turn in there because that was home and her dogs were there. I tried to assure her I was taking her home which was about 6 miles away. She kept giving me wrong directions and wanted me to drive through red lights. As we got within a mile of home she opened the car door door while we were still moving and tried to jump out.  I grabbed hold of her to keep her in the vehicle and managed to get the door closed but then she attacked me, trying to bite my arm, trying to grab the steering wheel, trying to shift the car into park. I pleaded with her to stop that we were almost home. As we're coming down our street she got the door open again and when I grabbed her she started screaming for help, which one neighbor heard. When we finally got in the driveway she jumped out and when she realized she couldn't get in the house she ran to our next door neighbor who thankfully is aware of her condition. I called 911 and sent out a sheriff's deputy. By the time he got here she had calmed down a bit and after they talked she "agreed" to let me come in the house. The next morning she asked me if something had happened the night before and had a man in dark clothes been there. At this time she was on Sertraline. There were a several more incidents at home after that but I found that if I just got out of sight for awhile they would dissipate. Then came the time we to have lunch with our son in law and as we were waiting to meet him in the parking lot she said to go home. After the last incident I wasn't going to hesitate so started heading home. When we stopped at a red light she opened the door and jumped out, ran across traffic and headed toward a supermarket. When I got into the parking lot we was talking with a Salvation Army bell ringer. When I pulled up beside her she shook her fist at me and ran into the supermarket. Within minutes the store manager came out and found me and I explained the situation to her. Eventually the police were called, they talked with me and her separately. She refused to leave with me but wanted her brother who I called and he took her home. She stayed away for about an hour and when I came back it was like nothing had happened. I contacted her neurologist who took her off the Sertraline and transitioned her to Citalopram. After that we continued to deal with rages here at home and her anger is always focused on me, her sole caregiver. Talking with her neurologist again and an office visit she transitioned from the Citalopram to Seroquel, starting last Friday. Now we are at daily rages, with her running to neighbors! Help! What do I do?

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VandyTor08

You can read my post about placing my wife (and the subsequent posts of mine in that stream), due to daily rages, and constant attempts to escape, in MC.  But I would also suggest you look into Zyprexa - this has really helped DW after switching from Seroquel, though I know different people respond differently to different medications.  I also think the socialization, change of context, and daily multiple activities have really combined with the Zyprexa to make a huge difference.

M1

So sorry for your troubles Don. It does sound like she needs admission to a geriatric psych unit. This must be extremely distressing to both of you and certainly not safe for either of you. Particularly if the seroquel is exacerbating things, sounds like inpatient care is warranted. Keep us posted.

aod326

I'm so sorry you're experiencing this Don. Even when we know the rages are a result of the illness, it's very wearing to constantly be the brunt of the rage, especially from someone with whom you have a normally loving relationship. I'm afraid I don't have advice to offer, but I wanted to let you know that I had similar experience with DH - he jumped out of the moving car twice.  I had been considering placing him in MC at "some point in the future"; when I was talking to our elder care lawyer about something else, she said "I think that time is here."   

We ended up placing him. His rages continued for a few more months, but have now passed.

Good luck - this is all very difficult and tiring.

shardy

Sorry you're going through this. It's rough no doubt. Multiple times I've had to grab Jim as he attempted jumping from the car.

The only thing we did differently is we didn't stop the citalopram, we just added the seroquel.

It did take around three weeks to show a difference. But the difference was big .I don't think I could handle him without it.

Ed1937

Don, I'm sorry you are dealing with this now. It sounds like a bad dream. I think the geri psych would be a good starting point. They might be able to get her meds straightened out to the point that those very bad behaviors cease. Placement might be in the near future.

I'm giving you a link to a video about sundowning. I have not seen it, but you might be able to pick up something from it to help. Best of luck to you. Dementia and Sundowning: Tips to help you manage sundowning  

jfkoc

You have had more than your share of frightening episodes....dangerous ones.

Since hospitalization is very  hard on people with dementia I would suggest trying some alternatives.

First of all I would stop taking her out side of the home except for a walk perhaps and even that I would stay on your block. At home I would stick to a routine as much as possible. It is hard for us to understand how easily even a little stimulation can cause enormous stress which can send a loved one over the cliff.

Next I would give the Seroquel a chance. Start very small and titrate up. When improvement stops you know you are at the correct dose. Like any drug you want to use the minimum.

It is a good idea to check all drugs given along with any OTC counter things taken....even vitamins. I use drugs.com but there are other sites online. Citalopram lists as side effects some of the behaviors your wife exhibited and may have been part of the problem.

Please keep in mind that often non-medical treatment is as effective as drugs and do what you can to simplify life for your wife. Looking back I realize that what I did, which by the way seemed like acting and living "normally", was not helpful.

Please let us know how the new med is doing and practice just listening and nodding. Explaining, reasoning etc are no longer tools.....you wife's world is real to her.

ElaineD

Dear Don,

I'm in NC, too.

What you are experiencing is frightening, and emotionally draining for you.  Of course the police had to take a great deal of time, and interview you both separately, because of their worries about domestic abuse/violence.   But that is all exhausting and draining.

I have read here that sometimes we, the caretakers, are 'triggers' for our LOs most difficult behaviors.

It seems strange that those who care most, and try hardest could trigger anger and violent behavior, but it seems to sometimes be the case.

I have also read that PWDs sometimes do much better in a (good) AL/ MC facility, where they have social interaction and constant attention from staff.

Elaine

DoninNC

How do I find your post?

DoninNC

Thank you, that gives me some hope.

VandyTor08

The post is titled "Placed DW in MC" on the first page

Jane Smith

Don, how very scary and stressful for you. I’m so sorry.

As far as the trying to get out of the car issue goes, while it’s not something I have personally dealt with, I’ve heard about it from several people in my various support groups. (One person had their family member with dementia actually get out of the car while it was moving on a very busy roadway and only narrowly avoided being run over.).  Advice in those situations included:

-person with dementia only rides in the back seat

-use the childproof door lock setting so they can’t open the door

-seat them not behind the driver so they cannot grab your head/neck

-consider a wider rear view mirror to give you a better view of the back seat

-I believe there are devices you can get to make it harder to unbuckle a seatbelt

-ideally have a third person in the car to keep the person with dementia distracted/occupied

-ask them to “help” you by holding onto something, but nothing they can harm you with

-or give them something soothing like a stuffed animal, something to fiddle with, a blanket or pillow, favorite snack

-favorite music if that helps, or sing together

As far as getting the meds straightened out, a stay in GeriPsych (some hospitals call it Senior Behavioral Health) may be needed. My mother spent almost two weeks in a GeriPsych unit and it was a huge help. They fixed her medications, gave her a thorough medical work up, did testing, diagnosed and treated some other problems I didn’t even know she had. She had great care and it was a very positive experience. 12 days of the right medications, hygiene, good sleep and nutrition made a massive improvement to her baseline health, not to mention finally getting testing and a diagnosis. She also went directly from the GeriPsych unit to a facility, which was the only way we were going to get her there.

This is so hard and I’m sorry.

I hope you’re able to get some help. Good luck. 

DebSch

My husband has a rare form of Alzheimer's called Posterior Cortical Atrophy(PCA) He has also had outbursts lately so I called his doctor and they added an anti-psychotic drug for him to take to control his mood swings BUT The drug made it so much worse instead of better, He starting taking off his clothes for no reason, and a lot of other strange things. Bottom line he had the re-verse reaction to these drugs and I will not put him back on them again. Not sure if there  is other drugs out there to help with my husband or not.

M4family

Don I know how those episodes can take a toll on you.  I've been experiencing them more often with DH who has early onset with a rare form at age 54.  We are currently working through increasing seroquel in hopes to find that special spot where there is a little relief.  And the video provided by Ed is helpful if not just to reaffirm we aren't alone in this awful journey.  For me, the hardest part is not knowing how long an episode may last and also how others react while watching it go on.  I feel for you having to call the police to help.  I try to do little field trips to places where I know my DH enjoyed going when he was still driving and had more freedom.  Unfortunately, I'm finding it is too much of a wild card to do these anymore as I cannot get him to leave when it is time; and unlike a toddler who doesn't want to leave the playground that you pick up and walk with, that cannot be done with a 200# man.  He does fine when others take him out so I've just decided to shift the field trips to the friends who still want to spend time with him.  Right now all he sees me for as his caregiver that takes care of his ADLs.  I'm adjusting to that slowly but am looking forward to not having to be the heavy outside of the house as well as in. I'm doing everything I can to keep him at hope, but these episodes are changing that thought. Hang in there!

DoninNC

Update: DW's neurologist increased dosage of Seroquel to 25mg twice a day one at lunch time and one at bedtime. It has helped but hasn't completely cleared the anger issue. Sometimes it feels like I'm dealing with 3 different personalities, the angry one, her normal self and the whisperer.  I had to deal with the angry one yesterday, not sure what set it off, but had to deal with verbal abuse for over an hour. I've learned to not reply to it as that just increases the intensity. She got on the phone with her brother and was telling him how I need to get out, what a terrible person I am, she would leave if she could. After being on the phone for quite awhile I noticed her tone softening almost like she was running out of stream. I got up and went out to get the mail. When I came back in I was greeted by the whisperer. She treated me like I was a different person. She was so glad I was there and had I seen that other man that had been there earlier. I just went with it and talked to her as if there had been someone else there and we had a good evening after that. Is it common to see this type of multiple personalities?