Hi All,

My Mom has been having some tremors lately. This last episode (Thurs eve) was more seizure-like instead of just shaking. Scared me to death! By the time the ambulance arrived, she checked out okay so instead of going to the ER we were able to see doctor Fri morning. She said since Mom didn't pass out completely, she ruled out a seizure, but with her falling over in the chair with a momentary stare it could have been a mini stroke. We go for an MRI and Doppler on Monday then see neuro on Friday.

She has been sleeping so much lately too, up to 14-16 hour nights and today she is going on a 2 hour nap already.

This is all new to me and Friday seems forever away. Any clue as to what's going on? Are the tremors and so much sleep just common in progression?

I could sure use some of your calming wisdom.

Many thanks.

Bill did the same thing for quite a while. Not actual tremors but he would be sitting and all of a sudden his whole body would jerk. There was only one time that he was shaking so bad that he couldn't direct a spoon to his mouth.

As for sleeping, he would go through phases where he slept for a couple of days and then he would wake up and return to normal sleep habits.

The two days before he passed he slept the entire time. But it was a different type of sleep. I could go in and wake him up and he would talk but then go right back to sleep. I could wake him but I couldn't keep him awake.

I'm not sure what stage your mothe is, but I would guess this is just another phase she is entering.

Hey SamesU, I don't recall what stage of AD your mom is in, but towards the very very end there is something called terminal drop where the AD individual will sleep long hours and throughout the day. If this is a new occurance, i.e., the long sleep hours, it could definitely be a medication effect. What meds is she currently on, and dosages? Also, how is her diet? This sounds like it could be 1 or 2 of three things. I was thinking perhaps a malnutrition issue with some sort of vitamin deficiency that can definitely be the cause of the tremors and the lathargy/fatigue. The second could be as a result of the medications, and therefore causing a neurological effect, hence the mini-seizure. Or thirdly, it could be an overlooked cardiac problem where she is actually hypotensive (low blood pressure) and therefore she can't perfuse enough oxygen to her head, leading to increased fatigue, and possibly the seizures during the times where those O2 levels fall drastically. Either way I think your mom needs a comprehensive workup of everything. If you are going to the GP or the neuro doc ask him/her all the possibilities, and ask what tests they can do to rule them out. This also helps so they don't get tunneled vision when you say "seizure activity" people usually think neurological, and order brain scans, etc. Let us know how things go.

I agree that you should let the doctor check out everything.

Helen didn't start the long sleeping until the final stage of this disease. She never had tremors but she did have little siezures near the end but was also totally out of it by then.

Hopefully this is something that the doctor can address.

Mom is Stage 6.

Yesterday, GP drew for complete bloodwork and I requested her thyroid and B-12 checked as well.

Back on the 2nd I suspected a UTI. Results by 5th showed "some" bacteria but the culture did NOT grow. Three-day antibiotic Cipro ordered anyway so took it Fri, Sat, Sun (6,7,8th). GP suspected Cipro could have caused this but said it should have been out of her system by four days later (which was the 12th when this happened). The only other meds change was at Christmas when the neuro put her on Nitrofur 50 mg FOR these recurring UTIs.

If you can believe this list, she's on:
Aricept 10 mg
Namenda 10 mg b.i.d
Zoloft 100 mg
Seroquel 25 mg
Synthroid 75 mcg
Norvasc 10 mg
Florinet 0.1 mg
Vytorin 10/40 mg
Aspirin 81 mg
Fortical Nasal Spray 200/act
Calcium chew w/Vit D
Geez, and all the doctors say she needs it all.

She usually eats a hearty breakfast. But as the day goes on, she eats less and less. I try to incorporate well balanced snacks since by dinnertime she will only eat a few bites, if that. Some meals she flat refuses and just wants a glass of milk. She'll eat a handful of Fig Newtons though. Her weight has maintained.

She has vomited in bed twice these past couple of weeks. I can't recall the first but the second was the same day she had another shaking spell. May be a fluke though since she didn't vomit this last time with the worst.

Her BP tends to run borderline high but her heart rate is usually low. She also has hypo-thyroid.

Her sleeping change really has me worried because it's not a restful sleep as before. She talks in her sleep A LOT!!! Has bad dreams and sometimes will jump up and take off stumbling around. I will put her on the bedside commode if I feel she has talked a little longer than usual, which sometimes helps her really sleep, but sometimes she can't go. So it just gets her more confused.

I hope I answered everything. I tell you, I can't even think straight. If this is another part of AD we just have to accept, I'm just not ready for it. I've cried for days and just can't seem to get a grip.

That sounds like a lot of meds for someone in stage 6 of AD.

The sleeping always bothered me, too. But Bill always passed through that phase and was staying awake again.

He had a possible UTI the last week of Dec. and they started him on bactrim. and since he was agitated on ativan three times a day. He slept for a week. It was a very restless sleep and he would be kicking and moving in his sleep. Doctor said it was the ativan so they stopped it and then woke up and was fine for the next two weeks. Then one night he threw up old blood and was agitated so they started him on morphin again sleep for a week. Old blood in the stools. After a week of sleeping he woke and was good for about a month. Then after a real good day, he went to bed and didn't wake up for two days.

I'm sorry you and anyone else has to go through this. It's so hard to watch someone you love suffer and not be able to help them. Tears and prayers are the only thing we can do. The tears can't help our LOs but together they seem to help us.

I'll be thinking about you samesU

I have a couple more questions........

Is a 'comprehensive workup of everything' meaning the bloodwork? I told the doc we had eaten breakfast that morning but should we have fasted for truer results? She said it was ok, but is she checking for 'everything' I wonder? I really like this doctor I don't want to have to kill her.

About the MRI.......is the MRI what takes about 20 minutes or so? Oh, man, I can't keep Mom from fidgeting while I take her BP! How is this going to work? And I just checked the time, it's scheduled for 4 p.m.! No way! She'll be in Turbo Sundowning I just know it.

I'll see if I can reschedule the time but what about keeping her still? I'm afraid to introduce a med to make her groggy, especially if this turns out to be a meds screw up in the first place. Oh, what to do, what to do??????

Thank you all for your help.

Thank you, Joyce. We must have been posting at the same time.

I ask each doctor at every visit, "do we REALLY need all these meds?" It just makes me want to put her in detox!

I think of you Joyce and everyone else who has lost LOs. I just can't imagine your pain, but I am going to be there, it's inevitable, and there's not one thing I can do about it. It's just all so heartbreaking to feel so helpless when we care so much. My Mom has always been my best friend, truly. We were so close, did everything together. She was always so much fun. I miss her so much and she's still HERE! My God. Sometimes I just can't stand it.

Thank God we have each other.

A MRI is bad enough when you know what's going on. I don't know how someone with AD is supposed to be still unless they are sedated in some way.

I seem to disagree with Lori and Aitan on treatments. When Bill reached stage 6-7, I really didn't see any reason to do anymore than make him comfortable. During the time he was showing blood in the stools, it didn't make any difference where it was coming from as long as he was comfortable. I wasn't going to let them do any type of surgery so why?
I admit I would have liked to know but that was only my curiosity.
I spent over ten years asking why and never got an answer. I kept Bill comfortable and he knew I loved him, that's all I could do.

Sorry, sames u, I got off track. I do that a lot here lately.

Let us know what happens with the MRI.

You're never off track, Joyce. I appreciate everything you say.

...All of you!

Thanks sames u,
It's just a bad day.

How is your mother doing this morning?

She got up about 7:30, has been pacing around not knowing where she is, but easily distractable enough. Didn't even touch her coffee, but had a good BM. Now back to bed, talking and talking. I think I'll take her for a ride around the neighborhood, she always likes that, if I keep it in low gear

I'm sorry you're having a hard day. Do something special for yourself, if nothing else but have another good cry. You can do that, it's okay. Like you say, that's all we can do...and pray.

...or clean something

Hang in there, Dear.

The comprehensive workup would include blood work she needs to make a differential diagnosis, i.e., whether the tremors are metabolic or neurologic or cardiac in nature. Certain lab tests require fasting, but not necessarily the ones she will have ordered, so don't worry about the breakfast. I can tell you my grandmother has had 2 seizures already with unknown etiology, i.e., they didn't figure out why. It's tough to say with all the neurological atrophy that is going on in the AD patient anyway, but I think there may be a connection with the Seroquel. The first time she started on the drug she had a seizure. If you look at the manufacturer's website there is a big bold notice that the medication shouldn't be used in the treatment of Alzheimer's patients, yet it is the drug of choice for many psychotic symptoms in these patients. I would question the doctor as to why she has to stay on Namenda and Aricept at this late stage. There is no research that shows it's effective at this point, and I've actually read articles that say it increases agitation and aggression to keep the patient on these meds in late stages.
How long has mom been on the Seroquel? Being on psychotropic drugs for a long time can cause a condition called Tardive Dyskinesia which I've posted a thread about before. It's a potentially irreversible disorder, and causes repetitive movements such as tapping or lip smacking, and can cause a compulsive involuntary drive to move the body. This may be the tremors you are seeing, so bring that up with the doctor as well. If they catch it early enough and take her off the Seroquel then it will most likely alleviate on its own (assuming this is what is causing the tremors).

Here is an excerpt about Seroquel in elderly patients:

Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Analyses of seventeen placebo-controlled trials (modal duration of 10 weeks) largely in patients taking atypical antipsychotic drugs, revealed a risk of death in drug-treated patients of between 1.6 to 1.7 times the risk of death in placebo-treated patients. Over the course of a typical 10-week controlled trial, the rate of death in drug-treated patients was about 4.5%, compared to a rate of about 2.6% in the placebo group. Although the causes of death were varied, most of the deaths appeared to be either cardiovascular (eg, heart failure, sudden death) or infectious (eg, pneumonia) in nature. Observational studies suggest that, similar to atypical antipsychotic drugs, treatment with conventional antipsychotic drugs may increase mortality. The extent to which the findings of increased mortality in observational studies may be attributed to the antipsychotic drug as opposed to some characteristic(s) of the patients is not clear. SEROQUEL (quetiapine) is not approved for the treatment of patients with dementia-related psychosis

So much for use all having a Nice & Relaxing Week-End, Aitan! I don't think they exist anymore. We care about so many on the board, that there is bound to be one challenge, or Hospital visit, or even the end, like with Diana.

I am sure everyone appreciates, your professional insights, I know that I do!

Same U, I love the phrase (Maybe I shouldn't) "I hope this Doctor didn't do something stupid, cuz I really like her, and don't want to have to kill her!" I get that! I know you don't mean it, literally, but it can be so frustrating.

Oh, Aitan, I so greatly appreciate all of your information. I had forgotten about your relaxing weekend post. I even had you working overtime "with" me yesterday in the ER--in the form of a Kleenex in my pocket. I'd squeeze it trying to sound intelligent quoting you! Wish I could give you a raise!

Get this ER doctor...........

Doc: I think we're looking at advancements in the disease here.
Me: Well, I was hoping for a comprehensive workup of everything to rule things out. Maybe this is a blockage, vitamin deficiency, medications effect--(he interrupted, shrugged his shoulder)
Doc: Change her medications! As far as the tremors, sometimes an Alzheimer's patient can HEAR something that will make them shake.
Me: I've never heard THAT one before.
Doc: This disease is very complex. The brain is very complex. Blah, blah
Me: Yes, sir, I understand that, but maybe these changes are due to something we're overlooking.
Doc: I'm detecting some frustration here and that's not good for anybody.
Me: No, sir, I'm just trying to get to the bottom of this to see if--
Doc: You're just going to have to accept this disease gets worse. I suggest you look in to some kind of sitter. (The nurse interrupted with a call for him.) It sounds like you need a break.
Mom sits up: What's going on? (He left)

When he came back an hour later, I didn't say one word. Not one word. I just squeezed that Kleenex again and pictured myself holding his head--face first--in a bidet!

So, Aitan, you have helped in more ways than one! Thank you!