Decline stopped. Is this the new normal?

@DotBern amen to the comparison to hell.

I am sorry you are at this place. My aunt did a similar thing in terms of spiraling down to a point where she was no longer taking anything by mouth. Her sister guardian would alert us all of the changing situation and then after about a week, my aunt would start eating and being more alert. Rinse and repeat. Three times before the final decline. The geriatrician at the facility felt the rebounds were likely a function of recovering from a mild viral infection. As glad as we were to have her back to her baseline, the emotional rollercoaster was hard for those who loved her.

You said:

Now I'm wondering if we should decrease her Zyprexa dosage in order to help with the word salad. I find anytime we have upped the dosage, it helps with her agitation but increases her word salad. Having a conversation is now almost impossible. She talks non stop but doesn't make a bit of sense. The facility believes the medication helps her more than hurts her however I am inclined to decrease the medication in order to have her make some sense when with her. Her neurologist tells me it's all a fine balancing act and tends to agree with me most often to make a change. Any one else have issues with Zyprexa causing total word salad? Any thoughts or suggestions on this new phase? I just want what's best for her. I think the facility enjoys her less agitated and I fear we've caused her more disruption in her cognitive abilities by increasing the drug.

Any of the atypical antipsychotics have the potential to dull cognition a bit at the higher doses prescribed for schizophrenia and even bi-polar disorder, less so for the very low doses most often prescribed for agitation in dementia. That said, by the time a PWD enters hospice, the loss of cognition and impact on expressive speech will likely be considerable. I agree with her neurologist that medication is a delicate balancing act. Sometimes there is no perfect regimen, and a trade-off is made along the lines of ceding some alertness for distress. Only her team on the group can make that call.

In defense of the facility, behavior is communication. If she's agitated it's because she's distressed in some way and doesn't have the cognition to work through whatever it is upsetting her. The use of medication to dial back feelings she can no longer process is about more than her being an easier resident, it's also about reducing suffering. I would talk with her doctor and the DON about trialing a lower dose of the Zyprexa. With disease progression, she may be OK with less medication. If not, it can be added back in. IME with Seroquel (same class of medication) the impact at a low dose had more impact on dad's alertness than his speech which was freakishly intact. In the first 2 weeks of starting, it made him sleepy but less so after.

I hope you can work this out.

HB

mom is on hospice. She declined really quickly once she got on it. She was prescribed an additional anti anxiety medication and a pain pill. I thought those might be responsible for part of the decline. So we took them away. After several days without then, it was obvious she was only declining further. So we put her back on the medication Monday, although the lorazepam was changed to Valium yesterday. We felt she could tolerate that better - she was too too itchy and fidgety on the lorazepam. She’s had Valium before.

I had similar experiences with my mother, who had VD and was in NH. Sometimes she would stop eating and taking medications, but I could tempt her with food she loved but didn't get at NH, like a fried fish sandwich, and she would rebound for a time. It worked until it didn't, probably because she didn't know me anymore in those last weeks.

My wife with AD takes a very small dose of Zyprexa. It helps her agitation, and I see no difference with cognition. Cognition varies from day to day and is on the decline as is typical of the disease. On Zyprexa, she no longer sits weeping for hours on end. I would give it to her even if it did affect cognition, I think.