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Old 09-30-2012, 07:27 AM   #1
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what is this depression/dementia or alz. plz advise

i community, Please advise me for my mother.
Brief history: age 83, lost her walking and became bedridden as her knee could not be replaced due to weak muscles as per Surgeon, this was in 2010. Gradually her general health started going down. Appetite down, water intake down, urinary tract infection thrice, respiratory infection twice since then. She wanted some one at her bedside all the time and would complain " I am not feeling good". She would often ask to make her sit and make her sleep after some time. Now I come to turning point which occur on 16 th of august 2012. She was having problem passing out urine and was restless side by side. She asked to make her sit several times and tried to pass urine but in vain. Then she started shouting please make me sit. When we made her sit she continued shouting "please make me sit" I reminded her you are now sitting but she ignored me and continued shouting please make me sit and please do some thing to me. That day we took her to ER and she was continuously shouting please please make me sit regardless of whether she was sitting or sleeping. When I remind her that she is already sitting, then she would say make me sleep. They admitted for two days. Fixed catheter to pass out urine found minor infection in urinary tract, chest x ray clear. Pyschitarist prescribed seroquil, clonazepam, Zoloft in smallest doses as she has heart history. Released from hospital same problem continued. 15 days later went again to psychiatrist and he increased dose of Zoloft and seroquil. Nothing good came. Than took second opinion he changed medication to Zoloft 50 mg and xanax x3x.5 mg. During all this process there came no peace to my mothers mind. Gradualy she stopped eating stopped speaking she just nods her head to express yes or no may be weak to talk, but her restlessness continues. She can not talk but keep making notices as if small child crying. She just takes ensure 400 ml per day at the most, weight gone down extremly . Can any explain what is this or share their experience. Thanks

 
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Old 09-30-2012, 08:19 AM   #2
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Re: what is this depression/dementia or alz. plz advise

I'm not sure it is any of the above... or perhaps a combination of both. But what I tend to believe is that there is some underlying physical condition that is causing her distress. This creates emotional distress which makes the physical distress worse... and on and on.

It is typical for general health to decline if someone becomes bed ridden. Movement helps us maintain our general health. It can also cause mental distress because we lost our ability to be independent and accomplish task. The urinary and respiratory tract infections are common. Appetite decreases because she doesn't need as many calories as someone who is ambulatory.

A urinary tract infection (UTI) can cause the symptoms that you are seeing. The urinalysis needs to be cultured for proper identification of the bacteria causing the infection and the right antibiotic used to clear up the infection. It would help if Mom was put on a maintenance dosage of the antibiotic afterwards to prevent further infections. I have had such episodes with my Mom who has chronic recurrent UTIs.

Did your mom have any symptoms of dementia before she became bed ridden? Were there behavioral changes, loss of short term memory, inability to do task she had done before? If there were beginning signs of dementia, the UTI, and physical distress, along with the mental distress and pain, can make it worse more quickly. Physical and emotional pain are difficult to handle without dementia present but particularly so when dementia is present.

As for the depression, she may be depressed. The physical and emotional pain and stress she is under can lead to depression. But my guess is that the physical and emotional problems have led to the distress/depression. It's like a spiral downward with it all working together to cause the symptoms you are seeing.

It is hard to tell from what you have said here but physical conditions such as the UTI can lead to the emotional turmoil that you see. She may have dementia which will become worse with physical and emotional distress. She may have developed depression for the same reasons. But it appears from what you have said that the medical problems are also present and a large part of the problems.

Love, deb

 
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Old 09-30-2012, 09:31 AM   #3
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Re: what is this depression/dementia or alz. plz advise

Dear Deb, thanks for your input. Before this cycle of constant crying sort of thing she never had dementia. Her urine Dr shows infection so tomorrow I will give urine for culture, surprisingly she does not complain of urge and retention, may be because she is unable to speak. Mean while Dr has advised lassix for fluid removal and amino drips to give her energy. Thanks lord her creatinine is 1.0 so her kidney is fine. Her kidney and bladder ultra sound showed no problem in august 12. Your suggestion of maintenance sound valid because uti is recurrent, I will discuss with Dr this point. One main issue is to calm her down, have you used any pain killer etc for such problem. Sorry for typhos. Love Broke

 
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Old 09-30-2012, 10:24 AM   #4
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Re: what is this depression/dementia or alz. plz advise

If she had no signs of dementia before and has had no stroke or TIA, my bet is that it is not dementia. Strangely a UTI can cause symptoms such as you have seen. I needs to be treated aggressively. There could also be an underlying infection somewhere else that could be causing the distress. I would be searching for the source of her distress rather than treating psychological symptoms of distress. I keep wondering why her need to "sit".. or "sleep". Could letting her sit but her way of saying she needed help to urinate?

All of the psychiatric medications that you mentioned have side effects. Sever side effect of Seroquil include confusion as well as difficult or painful urination, agitation, inability to sit still, twitching, and weakness. These and other side effects are signals to stop the medication. Clonazepan side effects include confusion, unusual thoughts or behavior, painful or difficult urination, depression, anxiety, agitation, and hyperactivity both physical and mental. With the symptoms you described no wonder she was taken off these meds.

Zoloft side effects include anxiety; constipation; diarrhea; dizziness; drowsiness; dry mouth; increased sweating; loss of appetite; nausea; nervousness; stomach upset; tiredness; trouble sleeping; vomiting; weight loss. More urgent side effects include itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; bizarre behavior; black or bloody stools; chest pain; confusion; decreased bladder control; decreased concentration; decreased coordination; exaggerated reflexes; fainting; fast or irregular heartbeat; fever; hallucinations; memory loss; new or worsening agitation, panic attacks, aggressiveness, impulsiveness, irritability, hostility, exaggerated feeling of well-being, restlessness, or inability to sit still; severe or persistent anxiety or trouble sleeping; severe or persistent headache; stomach pain; suicidal thoughts or attempts; tremor; unusual bruising or bleeding; unusual or severe mental or mood changes; unusual weakness; vision changes; worsening of depression.

Xanax side effects include confusion and drowsiness, restlessness and weakness, and difficulty speaking. In the elderly there can be a revers effect. It is given to calm but in the elderly it can cause extreme agitation. I found this to be true with both my Mom and Dad.

Recently, a lady in Mom's unit showed a rapid decline with many of the same symptoms and it was a result of the medications she was taking including Seroquil. As I mentioned I have had experience with adverse reactions in my elderly parents from Xanax. So medication could be a problem.

The behavior problems created by the UTI will lead the medical profession to order psychiatric medications to fix a physical problem. These medications do have major side effect. There are some patients that do not tolerate them well. I would fix the infection, look for other physical/medical reasons for her distress, and try to do without the medications as much as possible.

Be sure to talk to her doctor about all the side effects you are seeing and all the symptoms you see. Try to find a good geriatric doctor that specializes in the elderly.....

Love, deb

 
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Old 09-30-2012, 10:47 AM   #5
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Re: what is this depression/dementia or alz. plz advise

sorry to hear about your mom. i know the urinary infection can cause so many unrelated symptoms. good luck and keep posting.

 
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