Physical ability versus cognitive decline

Discussion in 'Middle - later stages of dementia' started by Scotsfloat, Jan 22, 2017.

  1. Scotsfloat

    Scotsfloat Registered User

    Dec 28, 2015
    49
    Hello,

    It's been a year since I first came to this site in a state of desperation; my father had been rushed to hospital and at this point the extent of my mother's dementia was plain to see, as previously my father had tried his best to keep it from everyone else. He died in February 2016. My mum went into respite care and has stayed in the Care Home every since. She has moderate + Alzheimers and was assessed as having no capacity to make decisions. Physically, she is very able and gets around on her stick and rarely sits down for more than a few minutes. She is still able to climb the stairs at the Care Home, eats well and is still able to take herself off to the toilet when she needs to, although she does sometimes get up in the night and wee on her bedroom floor, but not all the time. She was getting up in the morning and having a wash in her room when she first went into the Home, but I gather this isn't happening so much now and she's also taken to sleeping in her clothes and staying up all night and sleeping in the day.She is very difficult when the carers try and help. Cognitively, it is really quite bad; in the last year she has forgotten who I am (or any of my siblings), she has to ask where the toilet is and tells me her mother visits her regularly (she died more than 40 years ago), her sentences are usually a jumble of words. So basically, physically she's not bad at all, but cognitively she is. I would like to ask if anyone could tell me if, as the cognitive side declines, the physical side of things will decline also as a direct result of this? I know everyone is different and this might sound like a daft question, but I guess I just want to feel prepared for any eventuality as she seems so capable, physically wise, at the moment. I've had too many bad surprises during the last year so don't want any more! She is 88. I would really appreciate hearing any similar experiences.
    Thank you
     
  2. marionq

    marionq Registered User

    Apr 24, 2013
    5,901
    Female
    Scotland
    Gosh. You need a crystal ball. Seriously, it is not possible with this illness to predict anything. You have so many imponderables. So many physical v mental outcomes. I would love to base decisions on what will happen next but I don't have a clue. My husband and his Alzheimers have taken over my life as well as his and I hope I get mine back at some point. Will I? Who knows.
     
  3. canary

    canary Registered User

    Feb 25, 2014
    10,786
    Female
    South coast
    Loss of mobility and incontinence are very definitely symptoms of dementia, but at what point people get them is impossible to predict. My mum is about the stage of your mum, but can no longer shuffle more than a few feet with a zimmer frame and spends most of her time in a chair or bed. A friend of mines mum has dementia, yet her mobility was one of the first things to go and has been bed bound for several years now. Other folk seem to stay mobile almost up to the end.
     
  4. Scotsfloat

    Scotsfloat Registered User

    Dec 28, 2015
    49
    Hi, I realise there are no clear cut answers at all; I should do with all the twists and turns that have happened to my mum so far, and yes it has taken over my life too and I have had to give up my job to sort things out. I wasn't looking for someone to be able to predict the future. What I was trying to find out was if there was a direct link between cognitive decline and physical ability from a medical perspective i.e. something that is recognised that can happen due to the connection between the brain sending messages to the body to carry out physical tasks.
     
  5. Scotsfloat

    Scotsfloat Registered User

    Dec 28, 2015
    49
    Hi, thank you for your response. I guess I was wondering about if messages from the brain are interfered with as the cognitive side declines, so physical things are harder to do as the 'brain messages' become less clear. I think I have been thinking about this as I'm in the middle of selling my mum's house and desperately need it to happen, not just for the Care Home fees, but also for my peace of mind. It is very stressful and can't but help think something is going to scupper it and after thinking the buyers would pull out etc, my mind strayed to 'what would I do if something happened to my mum'. I think part of me wants her to stay as she is, so I will have time to concentrate on her fully when the house is sold as it has been so distracting. Hence, I didn't want any nasty surprises, so started thinking of worse case scenarios :(
     
  6. canary

    canary Registered User

    Feb 25, 2014
    10,786
    Female
    South coast
    With dementia the brain cells are dying (sorry to be blunt) so the area that is degenerating doesnt work properly and it depends which part of the brain is affected as to what happens.

    The temporal lobe (at the side) is used for speech and some short-term memory. The occipital lobes (at the back) are used for spacial awareness and to interpret what is seen. The frontal lobes at the front) are used for making decisions, emotions and social awareness (the bit that stops us saying "look at the a**e on that woman!" very loudly - like mum did!) and also stores the long-term memory. The bit in the middle is used for movements.

    This is a very big simplification, but you get the general idea. Its not that the cognition affects the physical side, but that both the cognitive loss and the physical symptoms come from the loss of brain cells.
     
  7. canary

    canary Registered User

    Feb 25, 2014
    10,786
    Female
    South coast
    I think our posts keep crossing :rolleyes:

    I wondered "what if" when I was selling mums home too - I think its natural.
    Dont worry too much. It will get sorted. I found it a huge relief once mums home was sold.
     
  8. Scotsfloat

    Scotsfloat Registered User

    Dec 28, 2015
    49
    Hi, thank you for this and please don't apologise for being blunt; I prefer to hear things as they are! This has given me something to think about and makes total sense, so many thanks. Re your mother's comments ' look at the a**e on that', I can totally relate to, as when I have visited my mum in the past, she always used to say VERY loudly ''Just look at how fat she is, how can she even walk?'' - this was about the Care Home Manager, who was usually standing in front of her when she said it! :/
     
  9. Scotsfloat

    Scotsfloat Registered User

    Dec 28, 2015
    49
    I seem to have become completely pre-occupied with it to be honest, which has knocked on to obsessing about my mum's cognitive decline. The house has been empty for a year and after accepting an offer, the buyer's survey has been done and hopefully I should get a completion date soon. I SO need it to be done and dusted as it feels like my life is completely on hold. I keep imagining the buyers pulling out and having to start the whole process again. ''shudder''.
     
  10. jakiflora

    jakiflora Registered User

    Sep 26, 2014
    35
    My Mum entered a carehome due to wandering. She could walk for miles trying to 'go home'. Two years on she has become physically frail but still walks unsupported. She is unable to speak coherently, is doubly incontinent and finds it difficult to feed herself, due to stiffness in her arms. She is completely reliant on care home staff to anticipate all her needs due to lack of cognition and speech.
    I would say that Mum is one of the most severely affected mentally of the Alzheimers patients in her home, but physically she is one of the strongest. It appears each patient experiences Alzheimers in different ways.
     
  11. Shedrech

    Shedrech Volunteer Moderator

    Dec 15, 2012
    8,088
    Yorkshire
    hi Scotsfloat
    I know what you mean about the house sale - dad's house finally sold a few weeks ago after one buyer had pulled out months ago, so I was on tenterhooks and couldn't let myself think it would happen until the day of completion - I just carried on with blinkers on - and I was jittery about dad, as though worrying about him meant I didn't have to think about the house .... just daft; even though we are rational, the psychological/emotional effort to keep everything running smoothly tales its toll - it was a major relief receiving the phone call to say all had gone through - didn't quite sink in until I saw the bank balance ;)
    won't jinx anything by saying any more except
    best wishes :)
     
  12. Scotsfloat

    Scotsfloat Registered User

    Dec 28, 2015
    49
    Thank you for your reply and I can only imagine how difficult this must be for you. I somehow got it into my head that because my mum was so physically able it would stand her in good stead, but then I started wondering if her cognitive decline would take this advantage away. Canary has clarified this for me in a previous post. It's truly an horrific illness. I wish you all the very best.
     
  13. LadyA

    LadyA Registered User

    Oct 19, 2009
    13,539
    Ireland
    My husband was diagnosed in 2008 by his GP, but I knew he had dementia at least a couple of years before that. He finally had to go to full time care in 2014. He remained fully mobile until he got aspiration pneumonia and spent a week in hospital, in the Summer of 2015. After that, he could not even stand without support and spent his remaining couple of months either in a mobility chair or, in his last few days, in bed, before his death in August 2015. But until that final illness, although his cognitive abilities were gone to minimal, he couldn't hold any sort of conversation, couldn't read, - he was still walking well independently.
     
  14. Scotsfloat

    Scotsfloat Registered User

    Dec 28, 2015
    49
    I'm doing exactly the same; blinkers firmly fixed in position and creating other things to obsess about to distract me from the house! The sale of the house is huge and it feels like I will finally be able to move on when it has been completed. Hopefully in a few weeks, I shall be in the same position as you. Fingers crossed! Thanks for your supportive words xx
     
  15. Scotsfloat

    Scotsfloat Registered User

    Dec 28, 2015
    49
    Thank you for your response and I'm sorry for your loss. I guess there really isn't any rhyme or reason to it all; perhaps I was grasping at straws trying to make some sort of sense of it at a time when I am dealing with a lot of stress.
     
  16. Trini

    Trini Registered User

    Dec 7, 2015
    39
    I always remember somebody posting once to say once you have met one person with dementia you have met one person with dementia! It is so true. There is no pattern. I continue to be amazed that MIL with VD is totally incapable of doing anything physically but can still sit up yet still recognises OH and knows who he is. Very few words and totally dependent on her live on carer, yet seems to be hanging on to one particular bit of brain function. When OH sees her each week she still asks "how's my car?"
     
  17. Hill Man

    Hill Man Registered User

    Apr 10, 2016
    61
    Mid Wales
    I think the best way to think about it is that both cognitive ability and physical ability are the product of a healthy brain. When bits of the brain are damaged either one or the other or sometimes both of them will be affected. However humans are wonderfully compartmentalized - I think of us as like one of those Swiss cheeses full of holes - sometimes there will be a hole and the PWD will have lost something sometimes its solid cheese and they will appear fine. Since we have little idea of how the healthy brain works we have truly no idea how the holes will interact. At the end of the day perhaps the most useful advice is "just be ready to accept change"
     
  18. Witzend

    Witzend Registered User

    Aug 29, 2007
    4,289
    SW London
    My mother was much the same - far better physically than mentally. By the time she went into the care home at 89 she could no longer even make herself a cup of tea, and her short term memory was practically zero, yet she could still easily manage stairs, and for the first few years in the CH she would spend much of the day (and often half the night, too) wandering about. Luckily the CH was designed with this in mind and nobody ever turned a hair - it was 'normal'.
     
  19. lemonjuice

    lemonjuice Registered User

    Jun 15, 2016
    1,535
    England
    My mother has been at roughly stage 7d, doubly incontinent, completely able to weight-bear or move herself let alone walk, unable to recognise food or feed or drink herself, doesn't speak and only rarely responds to her environment (eye movement), yet phsically the Dr says she is incredibly healthy. Her brain has just 'forgotten' how to process those actions. But heart, lungs/ breathing, kidneys etc. no problems and the Dr reckons if it weren't for the brain deterioration, she would be 'fit' enough to still be carrying on her normal life independently and still be bowling twice a week.
    So sad, but just goes to show how the physical is impacted by the mental deterioration whilst possibly still being 'physically healthy'.
     
  20. Scotsfloat

    Scotsfloat Registered User

    Dec 28, 2015
    49
    Thank you all for all your comments and details of personal experiences; it has really helped me get a better perspective of it all :)

    My mum had an assessment on Monday by the local dementia team and I was reassured to hear the fact that because she is so active, the assessor was impressed by her physical ability. Mum is always 'busy'! One thing that came up though was that the Trazodone she has been taking for about a year is far less effective now and she is more agitated, but it was unlikely they would increase the dosage as the Care Home manage her very well and allow her to just get on with it. I really like her little homely Care Home and feel they do a very good job looking after my very challenging mum! The assessor also said an increase in the dosage may lead to falls. Has anyone had any experience of a PWD with Trazodone and how effective it is?
    Thank you.
     

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