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Mom is 90, chf, labile bp and anxiety. She had a stroke July 1 which left her speech difficulties and some cognitive imoairments (she previously been dxed with mild cognitive decline due to a previous stroke). She is currently in subacute rehab, initially, they thought that she would fit into an AL setting, but now they are recommending SNF. Mom needs cueing with all ADLs, becomes suspicious, paranoid and delusional starting 3-4 pm for the past week or so. She is showing some regression in speech, motor and cognitive skills. Geriatric psych started a low dose of seroquel (she already takes klonopin and lexapro) which we are hoping will combat the disorded thinking. What are your thoughts on the appropriate level of care? Is this a predictably progressive thing, vasc dementia?

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My mom actually had severe muscle damage, not just aches and pains, from her statin, and it went into rhabdomyolysis and actually may have caused the fall that ended her independence. We had decided never to put her back on again, as it might have also contributed to her cognitive problems. Anyways, a new doc on the case apparently assumed it was just an inadvertent omission, since she had strong indications to be on one, and resumed...I find out only after she gets widely anxious all the time and check the meds, get her back off again, and the anxiety settled back down over the next several days. I realize this is controversial, but, there is some thought that the risk benefit ratio gets unfavorable for the very elderly, and some people do stop them; for actual rhabdomyolysis plus the number of risk factors for adverse effects my mom had, very few people would consider trying them again now for her at her age.
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hospice is sending someone to sit w dad nights and someone to be there during the day to assist mom and sis. he is not in in final, final stages so they are not sure how long this will go on. they are upping all his meds to help him be less agitated.
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Thanks to sll of you gor your helpful responses. Mom is alert, orinted to where dhe is snd why she is there. She has been on anti anxiety meds (first xanax, switched to klonopin when she stsrted to see a geriatrics pdychiatrist teo years ago). Her anxiety is debilitating, there is no way to reassure thst things will be okay. A couple of weeks into subavute rehab she started to think that people were ehidoering, thst we were sngry at her, thst she had to pay for help. She would cry piteoudly, have staff call my stalwart sister in law, but wasn't able to explain what was wrong. The low dose of seroquel seems to be calming her late afternoon paranoia for now. She's also on lissinopril, coreg, plavix and a statin. Any suggestions are appreciated.
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Vascular, frontotemporal, and Lewy body dementias are different from Alzheimer's but in their own way just as bad and progress like this. They can try preventives ike aspirin, clopridogel, or more modern meds that may work better to slow things down, but they will not totally stop additional strokes and degeneration. With Lewy body especially, antipsychtoics may actually make things worse, but everyone's mileage will vary. If antipsychotics are necessary and helpful, the low dose is a good thing, and they can also try a little Cogentin to combat motor side effects. I watched my mom have additional strokes despite being on optimal meds that she could tolerate, and we also had her on Sinemet that helped her motor function enough to at least feed herself, but she was also totally dependent otherwise; they did not even realize at first that she'd quit brushing her own teeth and needed help with that, and my hoeps that she would initiate or manage putting in her hearing aid were for naught. She lost vision due to the posterior brain circulation problems, and her aphasia responded only partially to speech therapy.
She also went from assistive living to skilled nursing level of care, but we were able to find a skilled nursing that was clean and bright and had a nice dining area and activities like an assisted living.

Lindipan, in Arkansas we have a residential hospice facility as well as in-home and possibly there could be something like that near you or ways to increase the support you are getting. If you end up needing to get on Medicaid for skilled nursing they typically are not generous but will leave the "community spouse" enough to live on and keep the home; details are worked out individually and depend on many things...it is complicated and might be worth inquiring about with your local Area Agency on Aging or equivalent, and/or hospice social worker...

Hugs to all in this sad, sorry boat.
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My dad with dementia with Lewy bodies and total body atrophy and incontinence is wheelchair bound is at the point where he is hallucinating more frequently. His speech is now at a point where he is not processing questions and responses. It is near impossible to have a limited conversation as simple as what did you have for breakfast. My sister and mom (who has early onset dementia) can not move him any more. Hospice comes in and does some assistance and a nurse comes to ck his vitals. We suspect he has been having mini strokes because speech, movement and cognitive abilities have declined so severely in such a short period of time. The nurse asked if we wanted to subject him to all the tests to verify. He is 83 and as mentioned less there and aware each day. Before there would be bad, good and better days...where they could actually get him out of the hse, (last week for example) now they can barely get him out of the bed, if at all. There is no money for a nursing home and even what little SS that comes in would leave mom (and sis who takes care of them 24/7 so has no income OR her own insurance for her own heart issues) homeless. What can we do, where do we turn, we have run out of resources and agencies to contact....
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My first thought when I looked at all these drugs and your mother's diagnosis was, what is this doctor thinking? I'm a nurse and all of these drugs are contraindicated with a patient with CHF, all make you very dizzy and sleepy, and all are trying to control the brain. I'm just speechless. If left on these drugs, your mother will be controlled, but at a cost. She will basically be sleeping her life away, but she won't be making trouble for staff. Is that what you want? Yes, any dementia is progressive and terminal. How one spends those last days are up to the people who care for them. I'm sorry your mother is experiencing her impairment, but all dementia patients have disordered thinking to varying degrees. You can either medicate her or let nature take its course. My husband has dementia, but I will not allow anyone to medicate him (although some have tried), and he has been stabilized for about 4 yrs.. There are outbursts, I deal with them, walk away, come back and he has forgotten what previously happened. This is a decision I have made with only my husband because I have medical knowledge. Each has to make their own decisions based on what they know. Give your mother a hug(s).
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