Expert: Mary Gordon - 8/10/2006

Question
Mary, clearly you are very educated on Alzheimers.  Have you ever
heard of an AD patient in the late stages losing his ability to feel
physical pain? It seems that my father who has recently broken
bones etc feels no pain. The nurses in his home don't understand
how why he isn't in pain. It is very odd to us.  It is great that he
doesn't, but it makes a very curious.

Answer
Hi Sara,

Given the degree of accumulated brain damage that your poor father has at this stage, we probably shouldn't be surprised if loss of sensation is among his deficits. If you could see a scan of his poor injured brain you would see large areas of shrinkage where there is nothing left but fluid.

It might also be that he doesn't express pain in expectable ways, or feels something and doesn't know what it is. A lot of the experience of pain in a normal person involves anxiety over how long it will go on, and what it could mean - and he can't be tortured by thoughts like that -so he may feel something but just have no clue what it it is or that he should be much bothered by it. I've also known of people with AD who give signs of feeling pain in a particular location, when their injury is elsewhere entirely - almost as though they couldn't figure out where the sensation is coming from. So many of them are almost in a stupor during their waking hours, they may just be so detatched they are barely aware of their bodies and any sensations.

As you know, people in later AD are far from normal neurologically - they don't feel hunger or thirst the same way a "normal" person does, they are often barely semi-conscious, their coordination and reflexes have changed - so other sensations and functions may also be blunted. He may also have had small strokes that cause loss of awareness of portions of the body, or numbness. As you probably know, the second most common cause of progressive dementia is called "multi-infarct" and its caused by a series of teeny strokes that may happen without visible symptoms other than cognitive decline. Your father can have this going on as well as his Alzheimer's - its not uncommon.

It is a puzzle and so frustrating for the caregivers. I know you want to make sure he's comfortable and not suffering and its very hard to know what the right thing to do is when he can't tell you how he feels. All you can do is go by the external signs. If he's eating and sleeping and not agitated, he's likely as comfortable as he can be, and pain killers would only make him sleepy.

My mother in law hurt herself a couple of times mysteriously - we were never able to figure out what she had managed to do to herself, but she seemed oblivious to what looked like very painful bruising.  Its a small blessing, I suppose, but a sign of them slipping even further away from us.

Hope this helps - I don't think there is a perfect answer as to what he can experience at this stage. Hang in - he's lucky you are there and concerned about his comfort and wellbeing.

Mary