Dementia - When Good Days Go Bad
My 88 year old mother has been living in an assisted living community for just over eight months. During that period of time, her mental state has declined substantially. It was surprising to witness just how rapidly her condition changed. Efforts to address her delusions and behavioral problems were only recently introduced. There has been some success with these efforts.
Risperidone has been providing some calmness and much needed, organization of thought for my mother. I have been very impressed with these results because my mother's confusion, delusion and paranoia had been making her continued residency in an assisted living community questionable. Unlike some assisted living communities, hers does not provide a specialized dementia care unit. They can deal with dementia affected residents on a somewhat limited basis.
While atypical anti-psychotic drugs can help a person with dementia to think more clearly and reduce or eliminate delusions, they are not a cure and are not a permanent solution to the undesirable dementia symptoms. A particular drug may be helpful for days, weeks, months, or longer. Some are not well tolerated and are simply not suited for certain individuals.
It's wonderful when the drug therapy produces the desired results and a genuine improvement is observed. Sometimes, a slight improvement is all that is needed to make the dementia afflicted person conform to a facility's expectations for continuing their contract. They do have to consider the safety of the resident as well as other residents and staff, particularly if aggressive behavior develops.
After a period of time, setbacks may develop. The effectiveness of the drug may be changing for any number of reasons. A setback may be a temporary isolated problem that lasts for a few hours, days, or even longer. A "setback" defined here, would be a decidedly negative change in behavior, rational thinking, or judgment. A delusional or hallucinatory condition may be an additional component of a setback that would need to be addressed.
It is very challenging to deal with this sometimes roller-coaster aspect of the mental condition. After a number of very good days, a sudden and unexpected change in thinking and behavior can catch you off guard. It is a disappointment when the confusion and other difficult symptoms return. It could just be a bad day. Things may improve the following day. If they do not improve, the medications will need to be revisited.
In the beginning of late stage dementia, it is a very difficult time for the person with dementia and their caregivers. Stability can be achieved for indefinite periods of time. There will be good days, perhaps many in succession. There will also be bad days when setbacks develop. It's sad that these circumstances cannot be controlled better. The good news is that drug therapy can bring about some very good days that might otherwise not occur at all. While drug therapies may have some mortality risks associated with their use, the benefit is an improved quality of life that seems more beneficial than longevity in a highly distressed condition.
I would recommend discussing the use of drug therapies with your loved one while they are still capable of making their own informed choice about it. Due to the increased risk of death, the decision is best left to the person impacted by their choice. It's likely that they would want to have a better life rather than a longer one, but that's still a personal decision. I should also point out that use of these drugs, while not without risk, doesn't guarantee a premature death.