Expert: Michalene Peticca - 4/22/2010

Question
My mother was diagosed with alzheimers about 9 months ago at age 84.  She had a mri and the usual testing.  she enterted n assisted living and was put on the usual alzheimers drugs by her Dr.  At the assisted living she fell and had a head injury.  After this fall she started to act out towards staff and have agitation and hallucinations.  Her Dr. put her on risperdal which resulted in even more hallucinations and extreme agitation.  She was took off risperdal and the hallucnations subsided.  She is now in a skilled nursing facility and has severe muscle rigity and is unable to walk or talk.  She has swallowing problems as well as tounge twisting movements. Her blood pressure has been low after years of hypertension. She moans out loudly and does not seem to realize it but it is very disturing to hear.  Since she can't tell us what is wrong we don't know if she is in pain or just her way of communicaing. She was put on morphine at the assisted living but is now off it at the skilled facitity.  Her experience was not a good one at the assisted living.  She also moaned out while on morphine.  A psych evaluation is now ordered.  Is this common with lewy body and alzheimers?  She is in pnic mode all the time and it is very disturbing for ever one. She is curreetly on Lorazepam for the anxiety. We just want her anxiety to suside she sems to understand whay we say but can't verbalize but at times she can answer with yes or no. It has to be the wrost thing i have ever seen and I am a nurse. Help!

Answer
Hello Bonnie,

I am so very sorry for your mother's rapid decline in condition.  This must be very heart wrenching for you to watch.

Many times, severe muscle rigidity and repetitive motions, like tongue twisting are signs of over medication.   Tardive dyskenesia.  I strongly suggest you somehow convey to the psychiatrist that the rapid decline in your mother's health is Not a common occurrence with Alzheimer's disease.  However, she may have had a slight stroke, which caused her fall, which then precipitated the furtherance of pain.

Unfortunately, Alzheimer's disease is a true brain deterioration disease.  I can only imagine that shrinking of muscle tissues must indeed cause extreme pain.  

If this were my mother, i'd keep her as comfortable as possible with as much pain medication and yet, i'd suggest reviewing her psychotropics to see if you can significantly reduce their use and you may see more "regular" motor skills from your mother.

If i can help in any other way, don't hesitate to write.

My regards,
Michalene Peticca, MA