Rapid Decline or Delirium

I agree with re-doing the tests for a UTI if a culture wasn't done. My mom's PCP always orders a lab culture with any in-office test; yours might have as well. My mom doesn't have dementia, but at 86 she goes absolutely off-the-rails with a UTI. She's paranoid, aggressive, uncooperative and her BP is all over the place (202/110 at noon and then 98/67 at dinnertime). Having been through dementia with dad, my sister and 2 of her sisters it's terrifying.

It sounds like your wife's disease may be progressing if it's not a UTI. It's said that EO dementia tends to progress more rapidly than when a person first has symptoms after age 70. It could be she has mixed dementia with Vascular being one part (this is thought by some to be more common than having only Alzheimer's). VD tends to progress in the manner you are describing-- a kind of plateau baseline that is maintained for a time before a sudden shift to greater impairment. My aunt and my dad both had dementia at the same time. His was mixed Alz and WKS and resulted in a fairly typical gradual loss of cognition over time until the end when it sped up. Hers was primarily a slowly progressing Vascular type. She clearly had symptoms when her husband died in 2003 per her PCP, but she was able to remain independent in her home for a good five years before things went sideways. After she went into MC, she continued to stay at a baseline for a year or so before an obvious drop in abilities. Since she lived 300 miles away, I didn't get to see her often but there were times when she was pretty much the same in October as she'd been when I saw her last in March. She passed in 2018 which is a little on the longer side of the life expectancy for VD.

HB

@mickenny

My dad had multisensory hallucinations. In the mid-stages, he started with auditory ones and complained about "the kids" not settling down after their bedtime. It wasn't ever clear who "the kids" were; his irritability and need to control around it seemed to suggest he'd time traveled to when my sister and I were young or perhaps when they had custody of my nieces for a time but it could have been randos. He would never answer my mom when she tried to figure it out. She generally managed this by leaving the room for a bit and returning claiming that she'd told "the kids" to knock it off. He also went through a phase around this time where he misidentified people in the reflection of windows at night or in scale portraits.

In the later stages he started to have visual hallucinations and would sometimes converse with them, so I would assume he was hearing and seeing things. With the exception of the "small people who walk through walls to use his bathroom", the visual hallucinations tended to be pleasant for him-- often old friends stopping by. I was once told sharply not to sit in a chair where one of his golf buddies was already sitting.

He took 25mg of Seroquel morning and night. Regular Seroquel can be crushed but the extended release can not be. Your pharmacist can tell you which you have.

@Sherry LD

I'm sorry things are going badly. Perhaps it's time for you to start a thread of your own to share about that or even just vent.

FTR, my father took Seroquel successfully with considerable alcohol consumption. His original prescriber was a neurologist who diagnosed him and was aware of his alcohol use. His geri psych took over his meds about 6 months later and was OK with continuing to prescribe it.

HB

@mickenny

For dad? No, the hallucinations never went away. But as I said, his hallucinations didn't trouble him all that much and responded to us shooing away the ones that irked him.

That said, it can be really hard to parse exactly what you are seeing behaviorally because often it's a mix of things.

Early on, dad reported "seeing" people. The first time he was in the midst of a psychotic episode that was due to his alcohol-related dementia. This was more of a visual processing error than seeing what wasn't there. He was home alone in his home on the golf course which has no window treatments covering the glass in the open dining/living area and also a large 2 story gallery wall of art-- some large portraits and prints framed with reflective glass. The "bad guy" he was seeing was either a painting of a person or his own reflection in the glass. This isn't all that uncommon is often a trigger for PWD who won't cooperate around showers or bedtime until mirrors are covered. You can buy sticky panels that can temporarily cover mirrors online of at big box home improvement stores.

Dad also has a lot of paranoia and delusions in the middle stages of dementia. Delusions are false beliefs. He didn't actually see or experience these things he talked about, but he knew these things, and as a result they were his reality. This can be frustrating behavior to manage. Sometimes a PWD will fixate on a specific family member or fellow resident in their MCF and accuse them of all manner of crimes. He accused mom of having sex with men in the parking lot of the local Rite Aid and me of selling his house on the golf course for $360K less than it was worth. Other folks here have reported their LO fixated on some person at their MCF accusing them of stealing things or talking trash about them.

Somewhat related to false beliefs are conflated memories. This is when a PWD recalls the gist of something that did happen but is hazy on the details of the who-what-when-how of the event. Dad's ARD is known for this being a common behavior. Initially this felt like dad was rewriting history but these stories all had a commonality in that they were deeply upsetting to him and in ruminating on them, he backfilled the antagonist of the tale as me because I was the person in front of him. One story centered around him having to collect his sister's and my sister's kids at a bar when their mom had gone off with some guy they'd just met. They were troubled women and categorically terrible parents-- both of them. His version, shared with my DH and teenaged son, put me in the leading role as the woman who abandoned her kids for a good time. FTR, I only have the one and at the time dad was kind of iffy around the pair of them. He referred to my husband of 35 years as "the guy Harshed is shacking up with" and mistook his Japanese-American urologist for my son who looks more like Ed Sheeran. After he died and I did a deep dive into his investments, I discovered that the "missing $360K I stole" were losses from bad day-trading decisions before he forgot how to use his laptop. He couldn't accept responsibility for his actions, so he put it on me.

You mention her tendency to aggressive and violent talk. We saw that with dad in the last year of his life. I'd visit him and he'd tell me all about having been thrown in the trunk of a car and then murdered the night before by the bad guys. Other times we'd be sitting in the living room and he would report on the blizzard or hurricane outside when he could see out the window that it was perfectly sunny outside. This kind of made no sense at first until I noticed the horrible crimes were more or less the plots of the previous evening's Law & Order: SUV or one of mom's other crime dramas. Since these absolutely terrified him, she only watched them on her small kitchen TV alone. I put parental controls on his set-top box which kept him off all-news channels, TWC and the channels that carried a lot of the crime dramas. Once we restricted his viewing to nature, old sitcoms, golf and football, and the auto auction the crazy violent talk stopped. I noticed once he went to MC that they heavily monitored TV viewing to avoid this; their 5 TVs had sports, games shows, TCM, old sit comes and Hallmark Channel.

HB