Physically Fit

ESkayP · June 25

When my mother went to the ER twice this spring for syncope (fainting spells), both doctors looked at her test results and marveled at how physically fit she is in spite of the dementia. She limps a little bit due to a troublesome hip, but she's strong. Her posture is good. She takes BP medication and Seroquel for anxiety, but otherwise, her drug list is short. Cognitively, she suffers a severe lack of communication. Her words are nonsensical. She gets agitated easily. She fidgets at mealtimes. She doesn't sleep through the night. Her memory loss is extensive. I'm the only one she seems to recognize, but even then she knows only that I am her person. She wouldn't be able to say, this is my daughter or call me by name. She has to be told her own name which she does still respond to when addressed. When I try to talk to her, she usually nods or laughs softly, but rarely is there any sign of comprehension. She's gone. She doesn't even say, I love you back to me when I leave. I wonder how long she can physically survive like this. I can't help but feel she is simply a hollow wandering shell of a person. Is Alzheimer's still terminal in a person with her level of physical fitness? Do the stages of the disease still apply? Are there any others experiencing this combination of bodily strength with mental weakness in their LO? She's only 79. Sometimes I worry that she could outlive me.

psg712 · June 25

My mom is physically in much better shape than she is cognitively. Similar usual reaction to me as you experience - there is recognition but she cannot verbally identify me. If someone asks her, "is this your daughter?", about half the time she will say yes. The other half of the time she just stares at the questioner without responding. There are rare moments when she can access facts from the past - I just posted an example on another thread here - but that is very unusual now.

psg712 · June 25

Yes, Alzheimers is still ultimately terminal. I think thatbthe stages still apply, but of course every person is an individual and there are variations. I relate to your concern about her longevity vs. mine.

harshedbuzz · June 25

Alzheimer's is always terminal. It's also hard to predict a timeline for progression— that can be all over the place. Sometimes people progress very slowly and the accelerate through stages 6 and 7 in less than a year; my dad did this. My aunt was midstage— forgetful but still quite verbal, able to be prompted through her ADLs and continent— she broke her hip, came out of surgery in stage 7 and passed within 3 months. Sometimes some other condition that isn't on your radar will be an exit ramp before dementia progresses to its end stage; a friend's 90-year-old mom developed breast cancer and died from that although she seemed to be progressing at a fairly rapid rate.

HB

ESkayP · June 25

https://alzconnected.org/discussion/comment/246671#Comment_246671

One of the nurses said that a surgery can escalate dementia quite rapidly due to the anesthesia. My Mom broke her right hip exactly five years ago, and although she recovered, that is when things relating to dementia started to become undeniable. I've been concerned that her left hip will give out. It bothers her now. I remember my grandparents talking about friends who passed away swiftly after hip breaks. It's just too much stress on them. I don't know what to do with this feeling of vulnerability. Life is so fragile.

harshedbuzz · June 26

@ESkayP

Boy, oh boy, does the fragility of life resonate. That, along with the awesome responsibility of providing care decisions for a parent, is why I'm up at 4:30 this lovely morning. Oddly, things seemed clearer parsing care for dad with dementia vs mom who is described by her pulmo as "the healthiest sick person in my practice".

What your grandparents observed is common. The risk of death in the year following a hip fracture in older adults (50+) is 5-8x the risk for their peers. Often pneumonia, CAD or CHF are the cause of death in these patients.

I wonder sometimes if it's a chicken or the egg situation, in some cases the fall is often the result of a change physical healthy— the shuffling gait seen early in Parkinson's and in mid-stage dementia, cardiovascular issues, visual issues including poor processing, balance issues, muscle weakness (elderly folks sometimes seem fit but have weak core and hip muscles which can impact their stability).

That said, you might want to look at whether the BP medication is still appropriate. Dad's BP ran high from middle age on but in mid-stage dementia, it started to drop for some reason. (Unmedicated, it was borderline) He hadn't started to lose weight and wasn't making healthy choices (completely sedentary on a diet of ice cream, chips, cookies and Chardonnay). His PCP reduced the does and finally eliminated it entirely. It didn't eliminate his falls, but the incidence didn't increase which is amazing given his general deconditioning, shuffling gait and vision issues (poor spatial reasoning and no depth perception).

It may be that the risk of a fall related to low BP is greater than the risk of a cardiovascular event. That became the case with dad; ongoing ADT for a recurrence of prostate cancer left him with significant bone loss. You might want to run this by her PCP.

HB

ESkayP · June 26

@harshedbuzz

Mom's PCP did decide to cut back on her BP dosage, so that may make a difference. She added to Mom's chart the stipulation of allowing high blood pressure under certain conditions so the MC staff would understand. I had forgotten about the shuffling gait as a sign of mid-stage ALZ. I thought Mom's hip must be hurting, but the subtle "limping" really could be another symptom of her condition.

Sorry you were up so early this morning. I hope you can catch up on your rest soon.

Physically Fit

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