Dementia and Depression

MandyPonder

Hi, I'm Mandy (I'm 41 and I'm new here).

I'm struggling with my dad who has dementia and depression (he's 79).

He started showing dementia symptoms in Sept. of 2020. We're still trying to get a diagnosis because he kept cancelling the appointment with the neurologist. We've switched everything so his phone number isn't the one they call to confirm appointments.

My dad has pre-existing mobility issues and chronic pain (used a walker for awhile, but now struggles to even stand up or get to the toliet on his own). There's so much he can't do because he can't walk, and the little he can do, he doesn't seem to enjoy (playing cards, watching tv, games on the iPad).

He has lost his sense of taste and hunger, and the only thing we can get him to eat is vanilla ice cream. He claims everything else tastes bad or he feels like he's full all the time. If he doesn't eat, he doesn't have energy, and then he can't do any of his exercises from the physical therapist. I'm losing hope that he will be able to get to the toliet on his own ever again and he will be in diapers for the rest of his life.

He's currently in a skilled nursing rehab because he stopped eating and drinking totally and ended up dehydrated and experienced delirium/hallucinations. This has happened twice now.

I guess I'm just looking for advice from people who have experience with dementia when the patient can't be distracted by things that bring them joy because they are seemingly joyless.

Thanks for listening.

star26

Hi Mandy, What you are describing is not uncommon with dementia and the elderly. My Dad's geriatric psychiatrist prescribed Welbutrin (Buproprion) to treat his apathy and it helped. This made him more interested in everything including food and occasional walks. Doing physical therapy exercises was always a battle and usually didn't happen once the therapy visits were over. I just had to accept the consequences (decreased mobility) as bad as they were. I noticed that other medications also had an impact on his appetite: Dementia meds like Aricept reduced his appetite and also put him in a bad mood so we stopped those. I recommend a geriatric psychiatrist (MD not NP) over any other doctor for seeing if meds might help. The right caregivers can make some difference too. But keep your expectations in check - I've found that resiliency is poor in this population. I would be concerned with returning him to whatever caregiving environment allowed him to become so dehydrated. It's all related and creates a snowball effect. 

P.S. Rather than "joy", I'd shoot for engaged, occupied, and relatively content. Dementia causes interests to change so you might try different activities even if they are contrary to what your Dad has liked in the past. Ability level matters too. If card games are now too difficult, that's a good reason for him to reject them even though that likely won't be the reason he provides. You may be overestimating his current abilities. 

MandyPonder

Thanks for your response!

harshedbuzz

Hi Mandy and welcome to the best little club nobody wants to join.

You pretty much described my dad in the middle stages of the disease. What you are describing could also be the intersection of apathy and the cognitive shift that prevents former activities from being pleasurable.

It's very common for the palate to change with dementia with one's LO preferring sweets over anything else. You can buy protein powder to bulk up the nutrition in regular ice cream; there's even special meal replacement frozen treats and puddings. IMO, this isn't a battle to have- dad was terminally ill and needed calories in however we could do it. 

While dad did have some mood issues that were being treated mildly effectively by his PCP, the geriatric psychiatrist was much better at getting a handle on mood. Dad's geripsych tried Wellbutrin which didn't help with activating dad but it did cut down his drinking which was a problem.

I agree with star that "joy' may not be possible at this point. Safe, comfortable and engaged may be as good as it gets. That said, dad's MCF threw a Valentine's Day "wedding reception" for the residents and families with a DJ doing banter and playing songs from their era and dad had an absolute blast. Music remained the one thing in which he took pleasure. Maybe try that.