Our dementia care expert, Dr. Rita Jablonski-Jaudon, answers a reader question about a sudden drop in memory, and excessive sleeping.
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"Bob, thank you so much for your informative site. I have a question.
I know everyone is different, but my husband has made a dive downward in the last couple days. He is sleeping a lot more during the day.
Also his memory is pretty much gone as far as short term and reaching back . Is the sleeping issue normal for some.
I'm thinking of taking him off his medications for Alzheimer's. I know I will talk to Dr. Just wanted your valuable take on it."
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UTI was the first thing that popped into my head.
Any sudden dive raises my suspicions immediately. Also, something that few care providers think of, and family members may miss because the symptoms are slowly progressive--sinus infections. Here is the usual development.
The person with dementia gets a cold, caregiver treats the symptoms using over-the-counter remedies, which is appropriate, and the person with dementia seems to get better. Meanwhile, the goo in their sinuses is hosting a germ party and once the bacteria reach a critical mass--bam! Confusion, more sleeping, worsening memory, incontinence. So now, I also ask about recent colds (up to 4 weeks prior) when a family member calls with this issue.
DO NOT TAKE OFF ALZHEIMER MEDICATION WITHOUT SPEAKING TO THE DOCTOR !!!!!!!!!
Here is why. Donepezil works by increasing the amount of circulating acetycholine, a chemical necessary for nerve cells to make memories. The nerve cells in your brain constantly make chemicals, secrete enzymes to break down the freshly made chemicals, suck up the pieces, and remake the exact same chemicals. This cycle is like your central air fan--constantly sucking up the air, cooling it, and sending it back out. The reason for this cycle is to keep maximum fresh chemicals bathing your nerve cells at all times.
With Alzheimers (and some other dementias), the cells that make acetylcholine are dying off, so the level of available chemical is always directly related to the number of living cells. Donepezil (Aricept) slows down the breakdown of acetylcholine over time. So what is happening in your brain is the amount of acetycholine is higher than would be expected given the number of healthy neurons. The acetycholine does eventually breakdown on its own, which is why you see the symptoms plateau over time, and then start to creep up.
If the drug is abruptly stopped, there is the risk that the acetycholine levels plummet to the levels of the remaining healthy neurons. Once that happens, a new "normal" is made when the drug is resumed. The level of acetycholine can never exceed the level where it was when the drug was started.
This is a very simple lay-person friendly explanation of how donepezil works. It is the one I use all of the time with my family caregivers.
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Hope this helps.
Rita Jablonski-Jaudon, PhD, CRNP, FAAN is an internationally recognized researcher and expert on non-drug ways to handle dementia-related behaviors. She is an Associate Professor at the School of Nursing at the University of Alabama at Birmingham and a nurse practitioner in The Memory Disorders Clinic at the Kirklin Clinic, UABMC, Birmingham, Alabama. You can contact Rita or ask her a caregiver question at this email address - firstname.lastname@example.org
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