My mom has been in an ALF for three months. I guess she's stage 6. Last week she was suddenly worse. She couldn't seem to get her muscles to do what she wanted them to, so for example I would put a piece of food in her hand and she wouldn't be able to bring her hand to her mouth. She can walk, but she seems to get "stuck."

She got better for a few days and today she's like that again.

I'm wondering if it is a side effect of zyprexa because her dosage was increased twice recently (in August she was taking 5 mg, now she is taking 15).

I guess vitamin B-12 deficiency can also cause this symptom, and she has problems with B-12 because of an operation for colon cancer decades ago.

I also suppose it could be the progress of the disease. She's diagnosed with Alzheimers but it's possible she has some vascular stuff going on too.

I asked the ALF to call her doctor and I'll call the doctor tomorrow but I wonder what the collective insight of this group is.

I don't know about the medication she is on but when you talk with the dr. ask to have her checked for UTI. I know with my partner when she has a sudden decline mentally or physically it is usually UTI.

Also ask for a urine culture, sometimes it doesn't show with a urinalysis.

Hi Stef,

I don't know how to address the question of medication causing this side effect. My first thoughts are whether or not they staff has asked the doc to do a UA. Silent UTI's are an all too frequent culprit. Often no symptoms at all until a drastic change in behaviors, or abilities. Urinary retention can be an issue too. Is her fluid intake and output monitored by the staff? I am sure others will have some additional thoughts to share. Do let us know what you find out. Take care and we'll all be hoping for good outcome.

LOL, SJP. Great minds think alike. You were posting as I was still typing...plunk, plunk on the keyboard between throwing a toy for the pup.

Zyprexa does have some neuromuscular side effects, the increased dose could be a possiblity. Infection is another cause of sudden changes as well.
It's a really good idea that a doctor is going to evaluate your LO.

Could she have had a mini-stroke? When things seem amiss, I ask the nurse to check her vitals.

every body's reaction to meds is different...

My mother couldn't handle daily zyprexa --she would just sleep (her reaction to many meds) but then neuropsych said to just pay attention and give "as needed." I was to watch to see when the agitation recurred.

For her it turned out she needed 2.5 mg zyprexa twice a week. (Six months later he changed it to 5mg celexa twice a day instead ...)
My mother was 89 at the time and about 4'10" (and highly sensitive to meds...).

Besides UTI, constipation makes my mother suddenly drop levels.. (Constipation can also be a side effect of new drugs)

We have a similar issue with my mil. When the dr made the ALF put her on Namenda and Cerafolin, she too started acting really strange. She goes around holding her head and complaining of dizzyness and woozieness all the time. It was so bad the ALF ask us to take her to the ER one evening. Nothing was wrong of course. We knew that. Its that she weighs 98 and any meds full dose she can't tolerate. She's been on aricept for 4 years now with no problem. We are frustrated with this dr and are currently looking for a new replacement. Its hard finding one that will go to the ALF and will take new patients right now since there's a flu pandemic going on. Sometimes I wonder if there is such a thing as Patients Bill of Rights. We both have medical POA for her and we could get our lawyer on this, but we are just going to get another dr.

quote:

Originally posted by Always Learning More:
Could she have had a mini-stroke? When things seem amiss, I ask the nurse to check her vitals.

That was my thought. That's what was happening with Mom. She was, however, IMO, overmedicated when she first entered the NH. Atavan prn and I swear, everytime she peeped, they gave her atavan. I put a stop to it. She was like a zombie. She started having strokes after that.

Say something about the medication.

Stef, I'm not a doctor but a well-intentioned doctor suggested Zyprexa for me once because he thought I might be bi-polar. (I'm not and I also think he'd just returned from some fancy event sponsored by the manufacturer.) Anyway, I did take it for about 2 days. Strong stuff. My AD mother was also on it for a while. I can assure you that going from 5mg to 15 mg in 3 months is a pretty big step for fragile older people. Would've been for me and, of course, I'm not older . Definitely question the medicine.

My information lists the max target dose of Zyprexa (olanzapine) as between 10-20mg per day (in a divided dose) for dementia paitients. If it is interfering with movement, the dose is too high.

Example - Swallowing difficulties in demenia patients on a dose of antipsychotic that is too high - is a classic problem.

http://www.vac-acc.gc.ca/clien..._research/bgroulx_01

The "freezing" of walking you describe is called apraxia.

Thanks so much for the replies. Mom saw the doctor on Friday. He thought the freezing was a side effect of Zyprexa so he is taking her off it. He is increasing her Depakote and adding Seroquel for agitation. We shall see...

Update: Mom went off Zyprexa but had another episode of shaking/freezing a couple of days later. This one came on slowly and lasted for about 36 hours.

The doctor saw her in this state, finally. He seemed to think it wasn't a medication side effect. He mentioned UTI or dehydration. I can see why UTI would cause a decline but in between episodes she is pretty lucid for her. So maybe some kind of hydration/electrolyte imbalance makes more sense. I guess I will try to get her some Gatorade.

The day after the doctor saw her, she was more lucid than I've seen her in months.

quote:

Originally posted by Stef M:
Update: Mom went off Zyprexa but had another episode of shaking/freezing a couple of days later. This one came on slowly and lasted for about 36 hours.

The doctor saw her in this state, finally. He seemed to think it wasn't a medication side effect. He mentioned UTI or dehydration. I can see why UTI would cause a decline but in between episodes she is pretty lucid for her. So maybe some kind of hydration/electrolyte imbalance makes more sense.I guess I will try to get her some Gatorade.

The day after the doctor saw her, she was more lucid than I've seen her in months.

Be sure to get the "G" brand of gatorade, it has much less sugar, etc.

and Whole Foods and Trader Joe's have electrolyte water with no sugar...no additives..

I mix it with juices..

ps Is the doctor a neurologist? I think she needs to see one. Could the freezing/shaking be parkinson's symptoms?