ASK DR. MINDY™
MINDY KIM-MILLER, MD, PhD
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My mother, now 82, was diagnosed with mild Alzheimer’s apparently about 3 years ago, but the family was not notified. Mother was given Aricept, which she told us was just simply to help her memory. Last July, she was diagnosed again, with family present, with mild to moderate Alzheimer’s, and given Namenda along with the Aricept. In just a very few months, she quit talking all together – and was diagnosed at that time with Degenerative Aphasia. We placed her in a nursing care home last January, where she got along well for several months, with many visits from us, her family and several times weekly trips out. She could not speak, but could well let us know what she needed. Then, in July, she began the wandering phase and we were told to find other care for her. She has been at a nursing center in Aiken, South Carolina since the middle of July. She has done pretty well there until the past 8 to 10 days. Suddenly, she has stopped swallowing her food and she moans as if she is in pain constantly. She is up and down many times to visit the bathroom, but does not even remove her clothes to use the toilet. Of course, she dresses in many layers of clothing and exhibits many other symptoms of nearing end stage.
My question is this. She has fallen several times recently since the non-swallowing came on. I know she is getting weak and malnourished and the pain seems to be constant. We talked with her doctor today and they agreed to put a pain patch on her and put her in a wheelchair, which I think is a good idea. My only question is that could something have caused the non-swallowing and falling, and could a disease such as myasthenia gravis be responsible for these changes in her. The doctors find no reasonable reason for the problem swallowing, it just came on very suddenly. Please let me hear from you so that I can begin to prepare myself for what is to come. Thank you.Paula
There may be several reasons why your mother is not swallowing and experiencing frequent falls. These two things are likely related and due to a combination of reasons that create an additive effect.
Alzheimer’s disease is commonly associated with decreased food intake and dysphagia (difficulty, discomfort, or pain when swallowing), particularly during the end-stage. People with end-stage Alzheimer’s may forget how to eat or suffer damage to brain cells that control the swallowing mechanisms. Some people with end-stage Alzheimer’s experience apathy and lose interest in eating altogether. There may be other reasons for a person’s resistance to eating. As Alzheimer’s progresses, there is also an increased risk for falls due to decreased strength, balance, mobility, and peripheral sensation. This is compounded by the fact that poor food intake leads to low energy and weakness, which adds to the risk of falls. At this stage of the Alzheimer’s, people are also at high risk for malnutrition, dehydration, choking, and aspiration pneumonia.
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