Mums anxiety and her 6 monthly check up

[Migwella]

Hi all,

My mum is 65 and has Dementia. She has suffered from it for about 5-6 years in total.

I live at home with both my Mum and Dad to help look after her.

She has been taking Aricept for the last 2 years. She is on 10mg per day.

She appears to be getting worse by the day. In the last few months she has noticeable declined.

Her next check up is 2 weeks away and I wanted to talk over some of the aspects on here to see if anyone has any thoughts or recommendations.


I have reread the post as it is quite lengthy and wanted to some up the problems here before you read on. She is very anxious, becoming more aggressive and has started to develop certain habits and repeating them (washing hands, teeth several times a day).


She has become more aggressive over the last few months. Particularly over what I would call trivial issues.

One of the reasons why I think she is so aggressive is because she is very anxious over the small insignificant things. The dog barking is one.

Another example if next door is in the garden, she gets very anxious. Next door is a loud chap and has a young child who he plays with in the garden. This creates a lot of anxiety for my Mum.

She also has a problem when any woman comes on tele, especially ones with long hair. She also gets anxious when my aunty comes to visit. As she doesn't know what day it is she will regularly ask me 'do we have any visitors today', meaning 'is today the once fortnightly visit by your auntie'.

She doesn't take as much care in her appearance. She wears some clothes that make her look like a 'bag lady', which she would never have worn in the pre-dementia days.

Despite that she also washes herself a lot. She will spend about an hour in the shower in the morning. She also washes her hands a lot. She will easily get through a bar of soap in a week just washing her hands. Toothpaste is the same. We bought a new toothbrush about a month ago. It is now on it's last legs and will need a new one.

She washes/brushes it several times a day. The most noticeable time is at night, usually 1am in the morning. She can easily be in the bathroom for an hour between 1 and 2am, washing her hands, brushing her teeth ... and then repeating the process.

She is always mentioning the fact she has a degree, which she achieved in her 50's. I think she is obviously proud about the degree, but she also uses it as a way of offsetting the fact she has Dementia. Almost as though she is saying 'ahhh I can't have Dementia, as I have a degree' I know it doesn't work that way, but she feels that it does.

I am sure there are other things that I have left out. I will be back to write them as I recall them.

Many thanks in advance for your replies.

Mike

[Vonny]

Hi Mike,

I think the consultant needs to be told exactly what you have told us.

Sounds like your mum has a touch of Obsessive Compulsive Disorder with the constant washing and tooth-brushing although that could be her way, along with mentioning the degree, of showing that she is in control. However, many dementia sufferers display some sort of repetitive behaviour so it could just be down to the illness.

The consultant needs to be aware of all this, they may be able to offer some medication for the anxiety and/or aggression.

It's pretty clear that your mum isn't going to go into her check up and say "I've got all these things wrong with me", so if you could attend with her you could hopefully have a private word with the consultant. If you aren't going, maybe you could write to the consultant prior to your mum's check up with a list of what is going on.

Vonny xx

[Margaret W]

Yes Vonny, I would agree. An hour in the bathroom washing hands and brushing teeth, and wearing out a toothbrush in a month, is definitely obsessive. It might be connected with AD, or it might be separate. Obsessive Compulsive Disorder is an illness itself, and has its own regime of treatment (about which I know nothing, I have to say).

So I agree that you have to alert mum's consultant to this behaviour, especially at 2 a.m.

Good Luck.

Margaret

[Migwella]

Vonny, Margaret

Many thanks for your replies.

I took your advice and printed off your replies and sent a letter expanding further on the issues.

I was very nervous going with her to the meeting yesterday as I knew that I would have to be upfront about things.

The meeting came and we saw a new consultant. As I walked in and sat down she gave me a nod and gentley waved the letter which was a great relief.

My mums memory test score had gone down by 2 points over 6 months. The first time it has decreased in the 18 months we have been going.

We discussed some of the issues and when my Mum tried to make out that there wasn't a problem, I did counter her. I did get daggers, but by the time we had left she was so relieved it was over that she had forgot what I had said. We went for a cup of tea and a slice of cake afterwards and she was upbeat as she had got through the meeting.

The consultant didn't expressly say my Mum had a problem such as OCD, but she has prescirbed Cipralex / Escitalopram (takes a lot of spelling that one does!!).

Any ideas on those new drugs?

Once again thanks to you both as your post helped me out.

Mike

[Sandy]

Hi Mike,

Sounds like you had a good session with the new consultant.

I don't have any experience of the drugs you've mentioned.

You say that your mum has dementia - has she been given a specific diagnosis? It's just that the diagnosis of younger people with dementia (YPWD) can be a bit more complex. The Alzheimer's Society has a good factsheet on YPWD:

http://www.alzheimers.org.uk/factsheet/440

Take care,

[jenniferpa]

Cipralex does appear from the literature to be a pretty effective, well tolerated drug for OCD and GAD (generalized anxiety disorder) so it seems a reasonable choice for your mother. It can take some time to become effective (up to a month). Be aware that any anti-depressant (which this is) can appear to increase the symptoms over the very short term. Obviously if you are concerned about anything call your doctor.

http://www.netdoctor.co.uk/medicines/100004710.html

[Vonny]

Hi Mike,

So glad you managed to get your concerns to the consultant and that all went well. I agree with Jennifer to give the medication time as the early days on new meds can seem to be either not working or exacerbating the symptoms. I think it can take between 4 & 6 weeks to bed in for most anti-depressants. Having said that, I went onto efexor anti-depressants and they were working within 3 days, probably the placebo effect!

Do keep us posted on how your mum is getting on

Vonny xx

[Migwella]

Hi all,

Thanks for taking the time to reply.

Just a quick update. I think these tablets are working already

She seems less anxious.

She no longer 'bitches' about any female within a 10 metre radius. This is a huge relief as it was particularly hard to deal with.

I am quitee hopeful about these tablets although it is early stages.

She is still washing her hands a lot. She did it 5 times in 20 minutes yessterday.

The consultant said that if these tablets didn't work, then we could up the doseage ... then if that doesn't work then they would look to use sedatives.

As mentioned in the original post this decision scares me but it is probably one I have to take at some point.

At what point would that likely to be?

I don't feel it is the case now and I would live with it for as long as I possibly could.

How sedate are sedatives?

Mike

[Vonny]

Hi Mike,

Good news that your mum's anxiety appears to be decreasing. I would imagine that if the cipralex doesn't work with the hand washing then a sedative would be gradually introduced. It would be something you'd need to discuss with the consultant but I can't foresee anything other than a mild dose would be given to start with.

Vonny xx

[Lynne]

Mike, overall you seem to have achieved an improvement. A low dosage of the sedative has improved matters, leaving leeway for a slightly higher dosage if necessary. Mum is less edgy and, I would imagine, so are you and your Dad.

The compulsive hand-washing? Well as you have probably read here, the other extreme is common too and possibly more difficult to deal with in that it can have serious health issues. But please don't think I am belittling the disruption such habits can cause. Often they are passing phases, disappearing as suddenly as they started (but may be replaced, unfortunately, with a different behaviour. I would suggest - if you haven't already - that you make sure the soap she uses is an olive oil based one (less drying) and encourage the use of hand cream if she will accept it.

Overall, positive progress this time round. Take things day by day - dementia is so unpredictable, you can't always plan ahead.

Best wishes