Expert: Michalene Peticca - 5/3/2008

Question
My mom is 87 and living in a nursing home under hospice care.  She seems to have signs of both moderate and severe alzheimers, I know that everyone has symptoms at different times but my confusion is why does her symptoms come and go at times? Some of her symptoms are: daily crying, refusing to eat (when she does its only 1-2 bites ) she says it tastes bad no matter what it is,can't do basically anything by herself,constantly looking for her dead parents and my dad (who died 3 yrs ago the same way), mummbling and not making sence, watches tv and thinks that is part of her life (she either puts herself there or the charachters come to life,accuses people of being mean (which I always check out),has little or no control of bodily functions,constant UTI, sleeps alot and there are many other symptoms. Although everyone is different the family is wondering how can this all be happening when all her vitals are good and shows no signs of things shutting down.
We are so confused that we went ahead and did prearrangements for her funeral and tried to get all her affairs in order.  Do you think we are jumping the gun or do you think her time could be very near? I know no one can know for sure but we need to know as soon as we can so we can get her immed. family together (we have 67 people in just immed. family)

Answer
Hello Phyllis,

Thank you for writing and bringing up some excellent questions and points about Alzheimer's disease.  

Your mom is truly a "classic" case of Alzheimer's disease and hopefully, i'll be able to make this understandable in simplistic terms.

Alzheimer's diease is a physiological, brain disease. That is, it deteriorates the brain through plagues & tangles (ameyloid proteins)that grown on brain recpetors and eventually squeeze receptors, or break them, so the the "electricity" can't pass through the brain.  I always use the analogies:  like ice on telephone wires or poison oak growing up a tree.  The Alzheimer's brain looks just like that.

Because the brain controls so much of our bodily function, when it is "misfiring" or making confusing signals to the rest of an Alzheimer's individual's body, they certainly will have days of tearfulness,not eating, thinking others have been mean, etc. etc.  ALL VERY REAL to them.  Additionally, hallucinating (about your father/her parents, TV people with her)  ABSOLUTELY REAL to her..that is, YES, she does see them, and yes, they are right in the room with her.   It's a whole spatial/ability to differentiate reality from not thing that is lost in the brain.  

Don't forget, we were TAUGHT what TV is....if you lose the understanding of what it is...why wouldn't you think people in the TV were really just small people right in front of you ??   Alzheimer's is truly is a mind bending disease and mind bending for us to understand it.

So, understanding that the brain controls most of bodily functions, when those parts of the brain shut down, parts of the body shut down...the problem is, most Alzheimer's individuals are very healthy PHYSICALLY and so there is this constant back & forth from the brain to the body.  

We never see Alzheimer's disease on a death certificate as the main cause of death; because, a person dies from COMPLICATIONS of Alzheimer's disease:  deterioration, renal failure, pneumonia, infections, etc.    

I am a big proponent of pre-planning for a funeral, your not speeding up the disease.  Also, with most Alzheimer's individuals (if her health is otherwise good)....they "fade away" slowly in their last few days and you'll know when the time is near.    But, don't hold me to that, so HE doesn't prove me wrong!

The best visits you can have with your mom at this point Phyllis are quality, positive visits.  Sing, laugh, hold hands, smell flowers, smell perfumes, look at pretty pictures, go for a wheel outside for fresh air, pet an animal, listen to music, feel soft stuffed animals, give Lots of hugs & kisses!!  Etc, Etc.     Don't worry about the rest...

Best Regards,

Michalene Peticca, M.A.