Expert: Michalene Peticca - 4/10/2007

Question

Is this a progression of her Alzheimer's or should we keep digging?

My mother is probably what you'd call a Stage 6 in her Alzheimer's disease.  She was diagnosed about six years ago.  Until a week ago, she walked fine, made it to the bathroom on her own most of the time, had a good appetite and a relatively good mood.  A week ago, my Dad found her in her bedroom pounding her fists on the bed, agitated.  She had to use the bed for support to stand.  He was sure she was in pain.  He took her to the ER.  X-rays showed nothing broken.  ER doctor diagnosed a possible muscle strain and sent her home.  Her family doctor wanted to run more tests.  He ran a CT and it showed nothing but I asked a surgeon who had done a hip replacement on her six months prior to check her out.  He said something was wrong with her knee or the area just below her knee because she had a cringe reaction and grabbed onto him when he was manipulating it.  The tests show nothing.  We were sent home again with Darvoset.  The second day home - she could stand a little and starting hobbling a little, even made it to the bathroom once on her own.  This morning, she can't stand at all.  It does appear to be just the one leg.  Now, her family doctor says it's the Alzheimer's.   Could this be right?   I think she's in pain, she's very aggressive and combative, hitting, pinching, very crabby.  I don't think the Darvocet is cutting it but it's hard to tell.  Can the walking problems start this way, in one leg, with the appearence of pain?  If it's that, I'm really worried.  I'm also worried that we aren't managing her pain.  I want to try another pain medicine but the doctor is reluctant.  

Answer
Hello Robin,
Thank you for writing.  It is wonderful that your family is so involved with your mother and are seeking several avenues of help for her.

What is typical about Alzheimer's disease is that is is so "atypical"...that is, each person that experiences the disease does so in a very individual way; although there are specific symptoms/characteristics that are specific to the disease.

Since Alzheimer's is a Brain disease, the brain is physically shrinking.  My thoughts have Always been that the individual MUST be having some pain as the disease progresses.   Therefore, Yes, i feel your mom truly is having pain.  However, it would be highly unusual (but not improbable) that her pain would be directly focused in her knee/leg area.

While it is true that the Alzheimer's person's brain deteriorates in sections (memory section, language section, etc.), i think you would notice an Overall motor skill deficit.  It would affect both legs, or one side of the body (like as if the person had a stroke), etc.

Please remember i am not a physician, but it would certainly be worth looking into checking your mother's Sciatic nerve or if she is having beginnings of Osteoporosis that would "mimic" or radiate to knee/leg pain.

I would be careful with the amount of pain medication as that can lead to delirium, which would exacerbate the Alzheimer's.   Please keep getting 3rd,4th,5th physican opinions as to the root of the cause and provide Tylenol as an additive with the Darvocet.

Best Regards and help for your Mom!,
Michalene Peticca M.A.