What are some signs that PWD is progressing to another stage?

abc123

What type of behavioral have you experienced with your LO? Is it often a uti? I need to know what others have experienced.

Thank you.

Salsam

My dad's worst behavior began with a UTI.  That was the stressor that led me to get him admitted to a MC facility. 

I didn't know it was a UTI, and it happened over Christmas...that meant additional days to get medication started, and never got pain meds. 

He threw over furniture and threw himself on the floor.  He had NEVER done this.

It was a caregiver who said to me, "He's in pain."

The UTI diagnosis was done over the phone by Hospice nurse...by the time I took him to primary care doctor the infection was clear. 

The "Stages" are NOT clearcut....before the UTI my dad had trouble with constipation, and was very difficult to help...he panicked, forgot to use toilet paper, and other times, if the diet was better and we added some fiber it was better.

Sleeping has never been consistent with him...my mom has Dimentia too, goes in loops but seemed somewhat with it until we needed the MC facility. However, at home she rarely had any sleeping problems. 

It is just difficult.  I am grieving not having them live with me anymore...and it seemed that they declined faster in the facility but I think it just shows up more because I see them a bit separated from me .

A doctor helped me when I took my mom there and started to cry...because my mom was half asleep that morning --she said,  just remember she is still here and you can give her a hug. 

So I try to comfort myself by thinking when they are gone I will feel grief and relief. 

I have cared for my aunt who died of cancer...and she had physical pain, and my parents have emotional pain.  And me, too, because I am connected to them, but it is one day at a time, and there are golden moments. 

MrsAnnabelLee

If you see a sharp and sudden change in behavior it's always smart to rule out a UTI. As far as shifting from one stage to the next, it's usually somewhat gradual and there may be some back and forth for a bit. The specific signs vary depending on what stage you estimate your LO to be in currently. I'd explain our shift from 4 to 5 as a change in the awareness of the disease. My mom was very aware of all that was happening to her in stage 4 and experienced a lot of anxiety and agitation as a result. In 5 she was more attune to the present moment, and not as aware of those things. Then, from stage 5 to 6 the hallmark difference is the PWD's ability to attend to their own ADLs (bathing, toileting, eating, etc.) without help in stage 5. My mom is beginning to shift into stage 6 now and she is needing some help washing her hair.

May flowers

I also have this question. As I am talking to the MC my FIL will be moving to soon, I have told them that he can still handle toileting, grooming, bathing right now but that I don’t know what will happen after the move. For bathing we have to set out his clothes, towel, and put everything in his pockets on his nightstand. He can do the rest for now. But showering really takes it out of him - he is  exhausted and a bit agitated afterwards. 

Anytime he visits a new place, and when he first moved here, he has peed in odd places - mostly because he is disoriented to where the bathroom is. Once he settles in, it is not a problem, but I don’t know if a move to MC will put him in the next stage as he seems on the verge now. Any change really exacerbates his confusion.

He has had some rough days here lately as well and he just had a urine culture which was negative. His blood work showed some slight kidney issues (high creatinine and bun, and  low eGFR). I wonder if kidney issues can cause the same cognitive problems a UTI can. The neurologist hasn’t said anything about the test to us, just posted the results online. 

Marta

May flowers:  chronic kidney disease is typically silent (no symptoms) until the eGFR drops below @ 30 ml per minute.  At that point a number of issues arise, such as anemia, bone loss, disturbances in electrolytes. Cognitive changes do not typically occur from the kidney decline until toxins accumulate and the patient requires dialysis. 

For now, encourage more water intake to boost the GFR. 

M1

Hi abc, I agree this is a hard question.  When I joined the forum last summer I would have put my partner in a solid stage 4.  But now, things are coming along that weren't there before; confabulating, not recognizing or remembering close friends and family, much more word finding difficulty.  So I think we're into five at this point.  But I agree it's hard to know sometimes, especially if you're dealing with someone who had a lot of cognitive reserve to start with.  Things I haven't seen yet:  no dressing problems, toileting problems, hygiene issues.  But:  she has her own bedroom and bathroom, so I'm not in there watching to be sure she's brushing her teeth, etc.  I may need to be a fly on the wall a bit more to pick these things up.

GothicGremlin

Hey abc123  - I haven't noticed changes in progression due to a uti. It seems like the changes are gradual, and sometimes easy to dismiss, although with a early more dramatic harbinger of things to come.  I've seen it twice now, when my sister went from stage 4 to 5, and now 5 to 6.  From 5 to 6, she had one or two instances of incontinence spaced far apart (what I'm calling the harbinger), but that now is a regular occurrence. Confusion/brain fog has been like that too for her - a one-off experience (or two) a year ago, but that now is common.

May flowers

Marta, thanks for the feedback about kidney issues. His GFR is 44, and we have started encouraging him to drink more water.

Ledbets

My mother sort of foreshadows what was coming. She wore strange color combinations. Then put things on backwards. She had accidents which became closer and closer together. She fell once every two months. Then every five weeks. Today she could walk with help. Yesterday she couldn’t walk at all in the morning, but could do well with help that afternoon. It is like a lightbulb burning out. It flickers first. Then it’s gone. Most of her progression has been like that. I used the stages to prepare for what was coming. Things are by no means steady, but I recorded things in my journal. I could look back and start seeing a bit of a pattern.

abc123

Thank you to everyone who replied and shared! My Moms Alzheimer’s has presented itself very differently from most PWD, even from the early stages. Recently I am seeing a lot more behavioral issues and she is also incontinent now. She is easily agitated by new surroundings and becomes angry and uncooperative tohe point of not eating and not getting out of bed. I was trying to explain to Dad that these changes might indicate a progression in her disease. He is acting like he is in denial all of a sudden. He does not want to place her even though I think it would be the best thing for her. I think I may have to settle back and let it hit the fan. Perhaps then he would be more accepting of what’s coming next.

M1

That's hard to do abc, takes a lot of control to not intervene sometimes when you know it's not going to go well. Sorry you're facing that.