Do I just allow the loopy behavior?

waywardson

This may sound like a rhetorical question.

LO with middle stage dementia is currently obsessing all day long. Checking every drawer, every closet, pulling everything out of the closet, tearing apart her room, her drawers, all day long. She is sure that people are stealing her things. It starts innocently enough with her, then anxiety, then frustration, then fear, panic, hysteria, anger, boarder line violence.

I use to be able to distract. That doesn't work. Dr, has prescribed Olanzapine. That doesn't seem to be working (three weeks now).

My question is, do I just let this "nature" run it's course? Do I just accept that this is her world? This is what she will do? That this is her existence? I doesn't always end in hysteria. Once it's gone to far, it's gone to far. Obviously I don't want it to devolve into danger but when do I step in. She is on that train to hysteria from the moment she wakes until the moment I can get her to sleep.

jfkoc

Terrible for you and terrible for her. Please contact the neurologist asap. 

Please validate her fears before distracting. You might try music, dancing and by all means getting her out of the house for a walk or a drive.

Iris L.

This is not a rhetorical question.  Your mom has a devastating terminal illness and you need to learn as much as you can in order to help her.  Please don't hesitate to ask any question.  The members here are knowledgeable and willing to share!

Medications are often prescribed and may help.  Keep in mind that many meds prescribed for younger adults may have a paradoxical effect in older adults.  Also many meds may take days or weeks to see an effect.

Regarding olanzapine--the psychoactive drugs must be titrated to have the optimal result.  Close followup with the prescribing physician is necessary.  On the other hand, your mom may not be at all responsive to this drug.  Are you working with a geriatric psychiatrist?  They are specialists in these types of medications.

There are nondrug approaches to calming agitation.  Your mom forgets easily when things are not in her vision, so she accuses others of having stolen.  This is very common.  She seems to want to be active.  Have you thought of hiring a caregiver to keep her occupied?  PWDs eventually cannot self initiate constructive activity, meaning, you cannot leave her on her own much.

Iris L.

harshedbuzz

wayward-

It's a great question. My short answer would be to join them in their world but only after you've taken the steps to make it as positive a place as is possible. 

Sometimes that means validation of emotion, sometimes redirection is doable but sometimes medication is necessary to allow the PWD to respond to the former strategies.

If you aren't already seeing a geriatric psychiatrist, I would strongly urge you to. They are the specialists in the management of psychoactive medication and will have more experience with these meds than a neurologist or PCP. 

The medication you mentioned is an atypical antipsychotic that is generally prescribed at very low doses when used for PWD. Generally, a doctor will follow the 'start low/go slow' strategy when trialing such medications. It's possible she needs a slightly higher dose or perhaps would do better on something else or on a combination of meds which can work together to relieve anxiety and repetitive behavior without side effects or sedation. There is genetic testing which can be used to determine which meds might be most appropriate for her.

GeneSight DNA Test for Psychiatric & Depression Medication

One of the gentlemen in my mom's support group had a wife who spent her waking hours rifling through her closet and drawers- she'd been very into fashion pre-dementia and had a lot of clothing and accessories. His granddaughter came to their apartment one day and created a bunch of capsule wardrobes- a week's worth of tops, bottoms, church dress, nighties, undies and coordinating accessories that mixed well together if she spilled something or had a toileting accident and needed changing. She put one week's worth in the closet and drawers and stowed the rest in their nearby storage unit. He sent their laundry out, so weekly the dirty clothes went out and he brought in a new set. She still rifled through her stuff at times, but there was less clean up involved for him. 

HB