Expert: Michalene Peticca - 2/7/2008

Question
Hello,
My Mom is 71, lives by herself and was recently diagnosed by her primary Dr as having AD. I understand I should get a second opinion and I will.  My problem is, my Mom refuses to go see a Dr. She feels she is not ill. For the past month, she displayed odd behavior..paranoia towards neighbors, hearing voices, constant non stop arguing with the voices but with incomplete thought patterns etc..her Dr gave her Haldol, she took it for 5 days and the symptoms decreased, but stopped taking them cause they made her feel horrible. Now its starting again and this time she is adamant about NOT going to see the Dr. She is very headstrong and stubborn. What options do I have? Also, with this disease she has..when we go shopping, she is fine..no outbursts, very quiet and does not hear voices.  Once she's home, she starts up with the yelling and talking nonsense. Could this be due to her being unhappy in her home environment? My concern now is to get her the help she needs. She will not take the meds to help her and will not go to the Dr for any reason. She is "normal" in the sense that she eats, bathes and do the evryday things around the house. She loved to garden, but now that she hears these voices..she wakes up early and starts arguing and talking for hours, she doesn't sleep at night..maybe only 3 hours..then wakes up in the middle of the night to argue with the voices again. She used to go out in the garden to plant etc everyday..now it's on the backburner. I need to get her help asap before more symptoms appear but don't know the best method to do this. Any advice?

Answer
Hello Kelly,

Thank you for writing.  I am sure this is a very challenging time for you and your mother.  

Because Alzheimer's disease is a degenerative brain disease, the destruction of neurotransmitters in the brain begin & progress differently for each person.  Your mom does fall into the "paranoia" and behaviorally changed Alzheimer's person that usually has frontal lobe deterioration.  It can be challenging as your experiencing.

My great concern is Haldol was given as a treatment for the "voices"?!!   Yikes....that is an antiquated medication that is a pure sedative and i am really glad your mother is Not still on it.  There are Much better medications out there....try asking for GEODON.   That has worked very well for the auditory hallucinations (which, yes, your mom actually Does hear) and will "level" out or extinguish her paranoia.  

However, that can only be accomplished if you are able to Get her to a doctor.  Which i see is a problem right now.  

Let's look at some ideas:
1.  Is anyone in your family Power of Attorney?  If so, it would easily be accepted if the POA took her to the emergency room of a hospital and requested a Mini-mental, diagnoses, treatment, etc.  She would Not be able to refuse treatment.    However, i'm sure you'd have a very angry mother.

2.  You can "fib" and say she is going to the dentist and she may or may not recognize the doctor's office of anything other than a dentist until she gets in the exam room.   Again, you'll have a very angry mother.

3.  You can make her life as safe as possible right now (take her car keys away, take any ATM cards, checks, unplug/turn off the stove, etc. )  and just keep close tabs on her.   What will eventually happen (and it is sad it does usually happen this way) is that she will have a "deconditioning" where she won't eat, she won't bathe, and possibly get sick so that you can take her to the hospital and have her admitted.   THEN, you can get the tests, med. changes, etc. while she is there.

I'm not saying let her go down that road, but i applaud you if you are up for a fight in the doctor's office to get her help.   That i will leave up to you.  Perhaps your mother can be convinced that there IS help out there for her but with another doctor.  I would strongly urge a second opinion...even if you have to take her to a neurologist.  Especially since she already has the AD diagnoses.

There are no easy solutions.   Please go to the Alzheimer's Foundation, Alzheimer's Association or the Johns Hopkins School of Medicine website for more info. and ideas.

I wish you strong patience!

Best Regards,
Michalene Peticca, M.A.