DEAR DR. GOTT:
I read your column frequently and am always impressed with your responses as they shed light in areas that most other physicians are not aware of. I am hoping that you will be able to do the same for me.
My wife is 80 years old and we have been married for more than 50 years. Until four years ago she was outgoing, energetic and of sound mind, body and spirit. Since then she has become a shell of her former self. I remember this change was precipitated by her no longer wanting to drive. She came to me, out of the blue and said she no longer felt comfortable driving and wanted to see a neurologist. My wife is a very guarded person and is not fond of going to the doctor so I surmised that she had been experiencing some type of problem. She was diagnosed as having dementia and placed on Aricept, Namenda and (despite telling him she wasn’t depressed) Zoloft. She has since been removed from these medications because they were not helping her. She was switched to Lexapro (for depression I don’t believe she has) and Ibuprofen liquid (for acute pain).
From that point on she began a rapid deterioration, physically, emotionally and mentally. She started complaining of acute pain that radiated from the back of her thighs throughout her lower extremities. I took her to a total of six neurologist and countless other specialists but none could find the cause of her pain. She had had a host of tests including MRIs and CT scans but all they showed was normal aging. She hasn’t had any strokes or other brain damage.
Six months after all this started, she became totally incapacitated. She is no longer able to walk, sit upright (without assistance), move her arms and legs, speak (she does mumble), chew food or feed herself, or perform any routine activities of daily living. Her food has to be pureed and fed to her. She is incontinent and cannot move of her own volition. She remains in whatever position she was last placed in and has to be moved manually. Her vital signs and appetite, however, are excellent.
It has been four very difficult and frustrating years. I love my wife dearly and it greatly pains me to see her like this. I believe that she understands what is being said to her but is unable to respond or express herself. On rare occasions she will say something clearly (often someone’s name or will callout) but then retreats back into silence. She is also very rigid. She keeps her arms and legs tight as if she is tense and resistant to being moved. I see this as her being fearful of what is going on around her so she is guarded and trying to protect herself.
I have exhausted all of my alternatives to finding help for my wife. Can you please assist me?
DEAR READER:
You wife appears to have advanced Alzheimer’s disease, a progressive and fatal neurological disorder. The first stages often include minor memory loss and language problems. As it progresses, memory loss becomes severe with the patient often failing to remember names of loved ones, time, location, and more. Eventually walking, sitting, eating, daily activities, and personal hygiene become impossible without assistance. Finally, speech and the ability to respond are lost, as is all voluntary movement. Muscles become rigid, incontinence occurs and swallowing will be impaired. The body remains intact and in generally good health but the brain and its associated functions fail.
Unfortunately, Alzheimer’s disease is incurable and the treatments available can only slow the progression. Your wife appears to be in the last stages and, in my opinion, is no longer a candidate for treatment. The best thing you can do for your wife at this point is to place her in an assisted living facility or hire 24-hour nursing care for her. You may wish to start her on comfort only care. You also state that you believe that she understands what is going on and is simply unable to respond. However, with Alzheimer’s this is not the case. Patients’ memory and cognitive abilities often decline so much that they simply do not remember where they are, who is around them, and what is happening from one minute to the next. The prognosis is very grim and I am very sorry for you and every other family that has to go through this difficult process. However, research is on going and many breakthroughs have been made. I believe it is only a matter of time before the mechanisms of this disease are better understand and we learn ways to effectively diagnose, treat and even cure this horrendous condition.
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