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    Old 10-13-2003, 05:29 PM   #1
    biosol
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    Question Mom's started falling

    Hello,
    My mother who is in the middle/maybe late middle stages has started falling. We've had 4 incidences in the last couple weeks. We are trying to figure what causing this.

    Briefly, either the Zoloft or Aricept was increased by the family doc 2-3.5 weeks ago, the first incidence was while she was sitting at the kitchen table, her head dropped and she slumped forward for a short time. About a week later she was standing behind a counter in the kitchen and fell down backward hitting her head hard on the floor. She was taken to the ER where they did a neck x-ray, CT scan, blood, urine, and another test. Everything came back negative, so she went back home. The next day is the 3rd incidence where during a shower she apparently turned off the water and fell/leaned back against the shower wall and slid down. The family doc requested a Heart Rate harness of some kind to record information for 24 hours. The device was returned the next day, and then the following day she was outside watching me and my father and then said she needed "to go inside" and grabbed my arm. We started to walk toward the house and then she paused and closed her eyes. I asked if she had a headache and she said her head really hurt (which she doesn't really remember telling me). First her right leg, and then her left started to either twitch or give out and then her whole body started to waver. Then she started to fall backward. My dad who had been following us caught her upper body as her bottom hit first. After only a minute or two she kind of came back to and we assisted her walking into the house and up the stairs to her bed where she slept for about 30 minutes and then was up sitting at the kitchen table and close to being back to normal.

    We heard today, that the heart recording device showed something and a Cardiologist would call to make an appointment.

    Oh, I forgot, the medicine that had been increased was stopped the day she went to the ER, so maybe it was the anti-depressent?

    Has anyone had/heard of anything similar, and would you be able to provide and information as to what your experience was?

    Thanks.

    [This message has been edited by biosol (edited 10-13-2003).]

     
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    Old 10-13-2003, 08:09 PM   #2
    BarbaraH
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    Hi,

    This sounds just like my widowed 87 year old mother. A year ago, she fell 4 times over a period of 3 months. She lives in a nursing home, having forgotten her home, church, my name, and a few million other things. She also fell over backwards and we went to the ER each time (all CAT scans were normal). At that time, she'd used a walker for about 6 months and her gait was already unsteady. At that stage of her Alzheimer's, her concerns were whether she'd be late for school and if her mother knew where she was.

    By Christmas, she leaned backward as she moved forward while using her walker (with my arm around her so she could not fall backwards!). I asked her doctor to request a physical therapy evaluation for Mom. I was concerned she'd break a hip if she continued to fall, but also didn't want her in a wheelchair unless absolutely necessary. A physical therapist worked with her for 3 weeks and concluded she needed to be in a wheelchair because she seemed to have forgotten how to walk. Mom has been in a wheelchair ever since.

    When all this happened, Mom's medicines were unchanged and her doctors and I thought she'd just gone farther down the slippery slope of Alzheimers.

    We are on a most unwelcome path with our loved ones. It's good to have a place like this to share the journey.

    I wish you well - Barbara
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    Old 10-13-2003, 09:58 PM   #3
    camachinist
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    Welcome.....

    either the Zoloft or Aricept was increased by the family doc 2-3.5 weeks ago

    Find out which one and what the dosage change was.

    We started to walk toward the house and then she paused and closed her eyes. I asked if she had a headache and she said her head really hurt (which she doesn't really remember telling me). First her right leg, and then her left started to either twitch or give out and then her whole body started to waver.

    Could be extraneous brain electrical activity, similar to an epileptic seizure (sounded a lot like the complex partial seizures a good female friend of mine has had), or possibly a TIA (transient ischemic attack or mini-stroke). My mom had a splitting headache, collapsed and ended up in neurosurgery. If she hadn't collapsed in the doctors office, likely I'd have buried her last year. She had a hypertensive stroke, bleeding into the brain spaces. She did have a couple of incidents similar to what you describe when beginning treatment with Aricept earlier this year. I was tapering her off buspirone at the same time. The effects were transitory and I haven't noted any since.

    the medicine that had been increased was stopped the day she went to the ER, so maybe it was the anti-depressent?

    What other meds is your mom taking, other than Zoloft and Aricept? Normally, no brain chemistry medication is stopped cold-turkey, unless a serious health condition arises from it.

    the heart recording device showed something and a Cardiologist would call to make an appointment

    If atrial fibrillation has shown up on the recorder, perhaps your mom has been having TIA's. A-fib,depending on severity, can throw clots. Is mom on an aspirin or Coumadin therapy for preventing clotting strokes? My mom is taking aspirin for blood thinning, as she has chronic a-fib, controlled by atenolol. We have to balance the risk for further brain bleeds with that of the possibility of clotting from the a-fib.

    As a disclaimer, I'm not a health care professional but have had extensive experience working with the doctors handling my mothers case, as well as the researchers at the AD center which dx'd her vascular dementia and the physical and cognitive therapists who have worked her case. The internet is an amazing information source too, yes?

    Best wishes!

    Pat

    Edited for clarification of blood thinning therapy.

    [This message has been edited by camachinist (edited 10-14-2003).]

     
    Old 10-13-2003, 10:36 PM   #4
    biosol
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    Barbara & Pat,
    thank you for the information. the occurance seems closer to what Pat described happen with his mother. my mom is going to turn 69 next month and has not yet used a walker, still remebers all of us kids, and responses pretty normally (just having trouble finding or remembering certain words or finishing some sentences).

    i found an aricept side effects site that mentioned atrial fibrillation as an "other" adverse side effect. she goes in to see the GP tomorrow and hopefully the Cardiologist either tomorrow or the next day, so we'll see what they say. i'll report back when i know more.

    thanks again for your consideration.


     
    Old 10-14-2003, 08:14 AM   #5
    camachinist
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    i found an aricept side effects site that mentioned atrial fibrillation as an "other" adverse side effect. she goes in to see the GP tomorrow and hopefully the Cardiologist either tomorrow or the next day, so we'll see what they say.

    Interesting....hadn't seen that in the literature before. Thanks. I know my mom had a-fib before Aricept because I have EKG's from the time of her neurosurgery. But I don't know if the Aricept has made it harder to control. Will check into that.

    If your mom has the minor deficits you report, she's still very high functioning. As treatments are ramping up in this area at a rapid pace, she likely will reap the benefits. Also, her relatively young age is an asset. She's likely in fairly good health and not as fragile to the mistakes which can happen with this disease.

    Keep us posted!

    Pat

     
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    Old 10-14-2003, 08:23 AM   #6
    biosol
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    For all here is the link to the side effects page I found. [url="http://www.rxlist.com/cgi/generic/donepezil_ad.htm"]http://www.rxlist.com/cgi/generic/donepezil_ad.htm[/url]

    Also, wanted to ask in your experience are there neuro specialists who are Alzheimer's specialists, or do they consider all neuro specialist be equally knowledgeable about it? We are trying to move up from the GP level to someone more specialized.

    Also, I forgot to mention that when she fell when I was there and I asked if he had a headache, she not only said that her head really hurt, but her stomach also. After her nap, when we asked about that she identified the low part of the stomach to just below (gut?) area.

    Thanks again.

     
    Old 11-04-2003, 02:11 PM   #7
    HannahR
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    Parkinsons?

    My Dad had Parkinsons, and he would fall often, and when he did walk with a walker (one of those four pronged walking sticks), he sometimes would just stand there, almost like he could not take a step, or couldn't remember how.
    It can become quite debilitating, yet I know someone who manages to keep his symptoms at bay with medications. The important thing is that proper care is given, and that requires a proper diagnosis, which only a doctor can make.
    Best of everything to you. I really mean it.
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    Old 11-05-2003, 09:36 PM   #8
    camachinist
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    Quote:
    Originally Posted by biosol
    Also, wanted to ask in your experience are there neuro specialists who are Alzheimer's specialists, or do they consider all neuro specialist be equally knowledgeable about it? We are trying to move up from the GP level to someone more specialized.
    IME, the best neurologists for the task are those working in or in concert with an AD research center. I found the research center neurologist, neuropsychiatrist and neuropsychometrist to be far more familar with and comfortable with working with a dementia patient than any of the other doctors we've seen, regardless of specialty.

    I would heartily suggest having anyone suspected of having AD or dementia related diseases evaluated by an AD research center. The one we used was staffed and operated by the UC San Franscisco medical school. Great bunch of folks. They'll be following my mom for a number of years. We have a follow-up meeting next Monday and mom will go in for her yearly evaluation in February 2004.

    BTW, the ache in the abdomen might have been caused by the blow to the head when falling. I've had friends fall and become nauseous or vomit from the head trauma. Nerves run everywhere and when something gums up the works like a head trauma, one can get all kinds of weird occurances.

    Pat

     
    Old 11-19-2003, 04:33 PM   #9
    biosol
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    Thanks for all the info.

    Here's an update. Apparently, the cardiologist, the neurologist, and the research project at Stanford University, couldn't find anything wrong (related to their areas). So, they have/are going to switch from Aricep to another/the other medicine. Since she's stopped the Aricep, the falling episodes have tappered off and she hasn't come close to falling recently. It does seem the she has progressed however, to maybe a higher level. It had just been problem with specific words or finishing sentences, but now she seems to be having trouble with bigger concepts, like calling the drive-in, the place they show movies. She still knows and recognizes all of us kids, but is starting to (seemingly) stare blankly from time to time, although I'm not sure if she's thinking/remember something or not.

     
    Old 11-19-2003, 06:43 PM   #10
    camachinist
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    With discontinuance or starting of any therapy, there are trade-offs. Evidently your mother didn't respond well to Aricept, in the sense that the side effects outweighed any benefit she was getting. You may be seeing the effect of the enzyme balance returning to its natural state, kind of like the rubber band effect. I'd monitor her behaviors and journal significant issues, looking for some stabilization before instituting the next regimen. Remember, she's not going to die tomorrow if she doesn't start on a new medication right away.

    The important thing is to monitor her physical health and keep her safe. IME, the interplay of these two factors is where the dementia bites people.

    Pat

     
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