Expert: Paula Damgaard - 6/4/2005

Question
My brother has an A-typical Alzheimer's which started in the posterior part of the brain instead of the front and middle lobes.  It has affected all motor skills ie. he can't remember how to sit down or even find the door in a room.  He is 46yrs. old.  The problem is at night.  He wakes up 5-8 times/night.  We have tried everything from Trazadone to Ativan.  The Ativan worked for about the first week but no longer does.  I think one of the problems is he is unable to tell when he needs to urinate so every time he wakes up he thinks he has to go tho the bathroom which although it is only 3 steps away, he is unable to find, not to mention being able to get in or out of  bed alone.  My family is exhausted.  We are also taking care of his 3 children of which he has custody of.  I am an RN and the only thing I could think of is possibly a condom catheter at night might help.  Do you have any suggestions?  His physician refuses to prescribe him Ambian stating it doesn't work.  It works well on my patients so I don't get where he's coming from but my Mother totally trusts his advice because he is a "demintia speacilist".  Have you seen a medication that when all else has failed may possibly be effective in treating his insomnia?  We are depatrate.  He does not nap during the day.  He get up about 9:30 and goes to bed around 10:30 at night.  Any suggestions?

Thank You for your time,
Stacey James

Answer
Hi Stacey, yikes you guys sure have your hands full.  I am so sorry.  I am also sorry that is has taken me so long to answer your letter.  Somehow it got lost in the air space or something.

We don't prescribe Ambian either.  It tends to have the reverse affect.  God knows you don't need him up 24 hours!  what about other avenues?  Such as exercise programs you say that he is having trouble ambulating and your mother won't listen to any other doc - will he at least order PT?  You could work with the PT  person to get them to tire him out.  

I think your idea of a Texas cath is a fine idea.  I don't even know if they make them anymore (haven't been in a hospital floor setting in a long time) but if they do why not?  Anything at this point is worth a try.

Is he taking any other medications?  Perhaps some of them are causing him to be awake.   

Another thing we have done when we take a research patient into the hospital is to put paper foot prints made out of bright paper or reflective paper so that when he gets out of bed he would see the feet and hopefully find the bathroom.  Of course that doesn't help with the in and out of bed.  

I will ask at work tomorrow and see if anyone has any other ideas.  Have you considered respite care?  He could go somewhere that provides it for a night or two to allow you all to get a rest.

Anyway like I said I will ask at work.  So please respond to this with a comment or something so I can let you know what I find out if anything.  Paula