Expert: Mary Gordon - 2/21/2011

Question
My wife is in the late stage of ALZ and 8 days ago, she started having trouble walking, shaking, and at the same time she started sleeping up to 21 hours a day.  Is there a connection with her starting to  sleep so much and instability in her walking?

           Thank you for your time.

Answer
Hi Ennis, any kind of sudden change, rather than a gradual decline, is usually a sign that something other than her dementia has affected her cognition.

In people with advancing dementia, any kind of physical or mental stress can produce this - for example, nutritional issues like dehydation, vitamin deficiencies or electrolyte imbalances can do it. It can also be a sign of a minor stroke (very common and often without noticeable physical  symptoms), heart problems affecting oxygen levels or circulation. Minor infections can do it as well. The most common culprit is an undetected urinary tract infection. These often are silent in that they show no outward symptoms other than a sudden change in alertness and abilities.

I would take her to the doctor and get her checked out. If this is from something treatable, like an infection, this is a delirium and does not likely represent a permanent change. She will probably come back a ways mentally and physically if this is something simple to deal with.

As the disease itself progresses, she will be less and less alert and sleep more and more. The Alzheimer's also impairs her balance and muscular coordination, which as you know, will eventually stop her walking entirely. They also get tunnel vision and problems with depth perception, which can make being upright very frightening and increase their risk of dangerous falls. If you are wobbly and you can't tell how far away the floor is, much less make your feet do what you want, you can imagine walking gets to be a challenge.

That said, I doubt this is the Alzheimer's alone and I suspect something else has happened that the doctor will need to investigate.  

Hope this helps. You are absolutely right, the sleeping and the walking that represent sudden precipitous change are likely both  due to a factor other than Alzheimer's.

Mary