Expert: Mary Gordon - 2/27/2010

Question
hi i am my grans carer she is 92,and has ad, she sleeps loads,personal hygene bad, flat messy, the usuall things associated with ad.the last two days its like shes gone back to when she didnt have ad,cleaned flat,washed herself,dressed and held conversations and recalled the day before.while it is great to see this, it has totally freaked me out,is this how it goes? is this the last up before i loose her forever please help if you can. thanks

Answer
Hi Sarah,

Fluctuations are pretty common in people with dementia. Sometimes you will notice a change from day to day, or week to week - and you will certainly notice changes when they are more tired, stressed, hungry or upset. If you watch for patterns, you can sometimes time difficult activities to the point of the day when she seems to be at her best.  Any kind of illness, even a minor one, can really cause them to seem much more confused and impaired - for example, even a very minor infection can really knock them back mentally, and then they come back when they recover physically.   

I don't know how your gran was originally diagnosed with Alzheimer's in specific, but some of the common causes dementias have more dramatic fluctuations than others. Lewy Body dementia in particular is one that has major ups ad downs. As I know you are experiencing, any major ups and downs can really confuse caregivers - and give them either false hopes that the person is improving, or lead them to overestimate the person's capabilities (i.e She could do it yesterday, she should be able to do it today.) Worst of all, it can lead some caregivers to think the person must be doing it on purpose - just being difficult or stubborn when they suddenly can't seem to do something they could do a day or two before.

I would say enjoy every minute you have when she is more herself - because sadly, as time passes, these moments will be more and more infrequent.  You might also want to seize these days to accomplish things that are challenging on a "bad" day, like bathing or other personal care activities. A good day does not mean she is having a last bright moment before sliding down hill dramatically.

She is lucky to have you. She must have been a very special nanna to be so cherished.

Mary G.
Toronto