Expert: Mary Gordon - 8/1/2009

Question
My mother has AD and COPD. She is in the latter stage of COPD. This diease has brought the AD own at a rapid sped over the last few months. Doctors are saying it is time to cut the AD meds out? Other family members do not want to do this; what do you think, is there a time to do this?

Answer
Hi Diane, you probably know that COPD in and of itself often causes cognitive decline
http://www.gulfbend.org/poc/view_doc.php?type=news&id=120449&cn=231

COPD patients can suffer periods of low oxygen that can lead to brain abnormalities. The low oxygen can also aggravate Alzheimer's disease and other conditions that cause cognitive impairment. She may well have Alzheimer's disease itself - or she may just have dementia from the COPD, or she could have both. Alzheimer's medications do not stop the progress of dementia from other causes like COPD. They only slow down the progress of Alzheimer's itself, and only somewhat, in some people, and for a limited period of time. Those meds will not do anything for dementia from other causes of brain damage, like her low oxygen or strokes or other things that may be happening to affect her brain.  A lot of families opt to stop dementia meds at a certain point.

The question to ask yourself is if there is anything to be gained at this stage from Alzheimer's medications?  Are the meds doing anything for her in terms of making her more comfortable or happy ? If both her COPD and her dementia are advanced, you know her remaining time is limited. I know you want to ensure that she has as little pain and discomfort as possible, and is as happy and content as you can make her.

You know her best, and know what condition she is in, physically, mentally, emotionally. What would she want? What would be the kindest and most loving? What would keep her the most comfortable, the most peaceful and serene?  What do you want her last months to be like? Are there medical treatments or medications that no longer have a purpose in the bigger picture of where she is at?

Those are questions only you and your family, her doctors, and perhaps your faith community can answer. I know that contemplating the end of her life, whether in the next few months or a year from now, is devastating. It is also very hard to accept that it may be time to stop fighting the progress of the illness itself and change the focus onto preventing suffering. I suspect the doctors are trying to initiate dialogue about treatment decisions - particularly around formerly life-prolonging therapies that may no longer be in her best interest. It may be time to start to plan for end of life

You need to have a frank discussion with the doctors and with other family about what comes next. Would palliative care be the logical next step ? Palliative care teams can help to maximize care, relieve suffering and improve quality of life for her - and just as importantly - support your family through this difficult time. We opted for palliative care when my mother in law began to fail, and found it wonderfully compassionate and supportive for all of us.  

You want whatever you choose to have reasonable goals for her, and eliminate any unnecessary or non-productive medical interventions that may add to her distress or discomfort.  At this stage, it begins to be much more about quality of life than length of life.

Hope this helps. I know this is very distressing to watch, and be unsure what the right thing to do is. Don't think of stopping certain medications as withholding treatment from her. When "treatment" no longer buys less distress, and can't influence the outcome, it may be time to step back, and just concentrate on loving her and treasuring your time together.

Thinking of you.

M.