Expert: Mary Gordon - 10/22/2004

Question
Hi Mary I wrote to you a while ago about my aunt. She still has not been diagnosed as she refuses to be tested by any dr. One month ago she fell and fractured her sholder. The sholder is healing very well and she is in great health.But her mental condition has deteriated a lot since the fall. At first we thought it was the pain pills but she hasnt had any for 2 weeks. She is very confused and seems childlike and helpless.Could a fall make her condition  whatever it is so much worse in such a short time?She can still look after herself with my mums help but I dont think she can go ouy by her self anymore and her paranoia makes it very hard to help her at all. Thank-you Andrea

Answer
Yes, any kind of illness or injury will really set back someone with a progressive dementia like Alzheimers.

If you think about it, it does make sense. You and I have intact brains, and we also have a lot of extra capacity we don't use. With someone with AD, the damage starts long before you can see it from the person's behaviour, so in those early stages, the disease is working away, using up all the excess capacity until they have none left. They are just hanging in by their fingernails. Anything at all that puts them under stress is going to dramatically affect them.

Everyone gets fuzzy headed when they are sick, stressed, tired, or hurt, but because someone with AD has no extra buffer left, it is really noticable. Even a cold will make someone with AD seem like they have deteriorated.

My mother in law broke her hip early in the illness before she'd been diagnosed. Until she cracked the hip, she was really not doing too badly. She was living alone, coping okay, paying her bills - pretty normal. However, after the hip break and surgery to repair it, she was absolutely ga-ga for several weeks after - making no  sense, very forgetful, unsure where she was - just shockingly loopy. The hospital staff wouldn't believe us when we said she had been okay just a few days earlier. They even called a social worker since they thought she should be in a nursing home and that our idea that she would go home after rehab was crazy.

She did come back slowly, but never all the way. Since AD is  a relentless slide down a hill, even if you regain some ground you are never back up at the top again. Your aunt will likely get a bit better mentally over the coming weeks as she heals.

However, this is a glimpse into what is coming fast, and permanently. You really do need to find a way as a family to get her properly seen to by the doctor. Right now is the about best she will ever be mentally, and she has the most to preserve. If you can get her properly diagnosed, you can get her onto the newer medications like namenda that can slow down the illness and give her valuable time with a better quality of life. There are also medications that will reduce her emotional distress - her agitation, her paranoia, and the newer drugs do not turn them into zombies. Doctors can help in ways that will not only be good for her, but good for your family (i.e. she will be happier and less difficult to look after and assist). Now is the only time that matters, since later on in the illness, there may not be much left to save, and there won't seem to be a point to lowing down the progess. Don't wait for her to agree - she never will. Call the doctor, and take her in. Make up something about her shoulder if you have to.

Hope this helps

Mary G.