Reaching the aggressive stage?

CatsWithHandsAreTrouble

Mom's been... off... since Wednesday last week. She spent most of Wednesday being distraught over something and for the most part wouldn't let me get near her, even for hugs. Always acted like I was actively hurting her. I chalked it up to her constipation as I've heard sometimes that causes PWD to be a little different. She had a BM Thursday night and Friday morning.

Sunday evening she was suddenly not fine after being okay all day. She was agitated and distraught over something, not sure on the details since I was out with my dad during then and my poor Younger Sister was left to deal with it until we got back and mom calmed down.

Monday morning she was a little off and was fine when our new aide came in. Then 9:30am came around and she just wasn't having it anymore. Lots of pacing, going up and down the stairs, went back to mostly not letting me near her. (She didn't pay much attention to the aide.) She tried to pass a stool around 11 which clued me in to her still being constipated as it was stuck in her rectum. Her agitation was worse after that and she started shoving me and yelling and grabbing me and threatened to hit me with an object. Then she was fine for lunch and we went on a walk and she tried to pass the stool and became agitated again. I had to stay in the other room pretty much all evening until dinner time because she was just hostile towards me. She was fine for dinner and afterwards. She got two stool softeners that day.

Tuesday morning she passed the stool around 4:30 and I saw her for a little as I checked in on dad. Mom was excited to see me. Sometime around 9 she had another BM. Older Sister was with mom all day and supposedly mom was fine all day. Then 5pm came and I took over for OS and mom was worked up again. We were doing some puzzles together and she was her normal anxiousness but then suddenly she started shoving everything away and trying to get up. She hadn't been to the bathroom since one so I thought she needed to go but while trying to get her upstairs to the bathroom, she became incredibly hostile to me and started grabbing and yelling at me again. Also tried to go out the front door numerous times; it was cold and dark and raining so I absolutely did not let her out which she fought me about. She calmed down a little for dinner but as soon as she had her last bite, she was up and ready to start again. Dad came home and she started telling him one thing or another and he took her upstairs and she calmed down and he put her to bed.

I don't know what exactly could be causing this sudden change. Is it the constipation? Is it the med change from middle October? Is this just our new reality? Things were going so well until she became constipated so it seems like it's that but who knows. Maybe it's another UTI?

I'm alone with mom all day today and I really hope things are better.

LaurenB

Good morning!  I could be constipation, UTI, excessively tired, new medication...It could also be the way she perceives everyone's approach.  When a PWD doesn't recognize a loved one and the loved one is wanting to offer affection, it could be similar to the reaction I would give if a total stranger at the grocery store came around and hugged me.  I'd fight them off.  "Why are you in my space?  Why are you touching me?  Who are you to tell me what to do?"  Consider that your loved one may not recognize you the way that you think that they do.  Maybe approach the as you would a stranger and ask them if it's ok to give them a hug, take them to the bathroom, etc...  Additionally, some PWD sundown at the end of the day or when the light is decreased.  Historically, I've noticed that as it gets darker earlier or on overcast days, my mom can think that it is the end of the day at 9:30 in the morning and thinks that she should be completing end of day routines when in fact she just woke up.

Dementia is such a moving target.  What will work for them one day may not work the next day.  

zauberflote

Constipation is AWFUL. That could certainly be part of it. My mom had a serious bout once, and the difference in her demeanor after she finally was cleaned out was very striking.  It's also well worth it to have her urine tested for UTI, with a culture, because that can also severely affect behavior.

CatsWithHandsAreTrouble

Thanks Zauberflote, always good to hear from you. I did bring up the possibility of another UTI to OS since she takes care of mom's medical stuff. I'm afraid she'd be reluctant to get one done. Last time we were suspecting UTI, she couldn't get a clean catch and mom got worked up for nothing but we did go through with the antibiotics anyhow to be on the safe side. 

Mom's had two BMs so far today and the stool were healthy so I'm hoping the Miralax is finally kicking in. She's been having a dose every day since Friday besides the few stool softeners.

Thanks Lauren for the reminders.

May flowers

It was always a puzzle as to what would set of my FIL, but I know constipation did in a major way. Eventually we had to keep him on a daily dose of Miralax (and some days a second dose in the evening) UTIs also agitated him, and he did have some back to back. There can be other issues too that they have a hard time communicating, like reflux, which we only realized because it was happening after meals and laying down.

Are her behaviors better now that she seems to becoming regular?

A new caregiver always sent my FIL into a tailspin, and sometimes it wasn’t new ones, but ones whose personalities grated on him. He couldn’t really communicate that, but we gauged on how restless he was after they left for the day.

I hope you get it figured out

jfkoc

Please do not think that there is an "aggressive" stage. Many people who have dementia are never aggressive so please so follow through on solving what the problem is.

mommyandme (m&m)

jfkoc,

I agree!  My mom hasn’t been aggressive, she’s been frustrated and worried at times, uncomfortable etc… we can usually find something to help pretty quickly.  I remember a “friend” mentioned early on, after I moved mom, about how angry they all get.  It’s just not true.  I wish that didn’t have to happen to anyone but it doesn’t happen to everyone.  

CatsWithHandsAreTrouble

My apologies if I made it seem like I wasn't taking my mom's feelings seriously and just passing it off as her acting up. I meant to only use terms that I know of as this is still new to me. 

I understand that she's trying her best to convey something is wrong and we're having a difficult time understanding each other. Everyone is looking into what she's trying to convey to us so she can be healthy and safe and not just slapping a label on her and saying "nothing we can do."

There's so much misunderstanding about dementia that a lot of "common knowledge" is actually a bunch of malarkey. It's taking a while for me to let go of those incorrect terminology for the proper ones. I'm pretty good with anosognosia so there's hope for me yet lol.

I think I meant "aggressive" as a catch-all term for multiple experiences happening all at once. Mom is such a sweetheart so her being violent towards me and thinking people are going to kill her had me very concerned. 

I'm not trying to make excuses, just trying to offer insight. 

CatsWithHandsAreTrouble

I think right now this is just a manifestation of the med change we made last month. We slowly halved her setraline dosage and got her on mirtazapine. The mirtazapine was supposed to be something like a "mood stabilizer" or something, for give me I'm very bad at remembering terminology. But apparently that has no effect on Alzheimer's according to a research done last year. 

We (mom's first neurologist) suspects she has Alzheimer's so with half the regular dose of setraline and the mirtazapine not "picking up the slack," that is probably why she's been overly anxious and "acting out." Her doctor gave us the go-ahead to give her the previous amount of setraline before the change. It's almost been a week so we'll see.

Mom's been regular in her BM and still was displaying the same "symptoms" so I think that it wasn't the constipation this time.