Expert: Mary Gordon - 8/5/2011

Question
Hello,

I read some of your answers on AD and decided to ask you for advice. I am originally from Georgia (not state, but country) and my Dad had AD for quite some time, but all the way up to two days ago he was walking smiling (he was not talking for quite some time, but making his own speech up), however three days ago he had a high blood pressure and high fever and since than he is in bad and not walking anymore. He is not eating well anymore either and all of this happened so quickly. My mom has been taking care of him all the time and now she is devastated and don't know what to do. We do not have good specialists on AD in Georgia and that why I am seeking for answers. Can you please advice how to feed him, because he is very weak and cannot swallow much. Maybe he needs some IV, or medications to keep him stronger? He means the world to me and I just don't want to let go yet.

Thank you in advance.

Answer
Hi Diana,

I think what you are seeing in your father is a delirium rather than a change in his actual dementia. Any time there is a sudden change, you have to play detective, as something has changed in terms of his physical health. A fever suggests infection - and if he is spiking a fever, that will really affect his cognition. When you or I become ill, we often get very muddle headed. We are sleepy and feel like we're in a fog and just can't think straight. Now imagine your poor Dad - when you layer illness on top of dementia, it's devestating. Even a minor illness, like a cold or a UTI, can have a dramatic impact on the person's ability to function.

I can remember going to visit my mother in law for a special tea for Mother's Day. At that point she was in mid Alzheimer's, and could still carry on a social conversation. She had a cold, and was totally out of it - practically in a stupor. It was very alarming because it came on very suddenly. When she recovered from the cold, she brightened up mentally.

If you are able to get medical treatment for his current illness (which may be an undetected infection), it's likely he will come around as he feels better. If he will eat and drink only small amounts, try to make every bite count. Make sure what he eats is full of nutrition and calories. You can add cream, butter, eggs to his food. Avoid juices, which are essentially just sugar water, and will kill his appetite for more substantial fare. Make sure what he eats is purreed, and of a soft thick texture. This makes it much easier to swallow. You can try fortified drinks like Boost, Gain, Ensure. Many pharmacies will carry these types of products. If he seems to be choking on liquids, I would try using a thickening agent, to make the liquid the texture of honey or thicker. Again, this makes it easier to swallow. There are many brands available - one brand is called Thick-it.

Hope this helps. I would get a doctor to assess his condition and potentially treat any infection, continue with the careful hand feeding, and watch and wait. As he recovers from whatever is causing the immediate crisis, he is likely to come back mentally.

Mary