Dehydration and Alzheimer's

When my friend Alan and I went to see Bob yesterday he was almost in the same state as he was in the clinic last Monday. He was in a deep semi conscious state. It felt like dehydration again so I put a little chocolate milk on his lips. He licked it off. I did more, he licked. Then I put about a quarter of a straw full right into his mouth and he swallowed. After a few more squirts I got him to actually suck the straw until he had finished it. 

This boxed drink was handy because I could squeeze it to get the milk to rise in the straw and into his mouth until he took over sucking.  The trick was to get it started for him because sometimes he doesn’t understand the instruction, “Suck, Bob.”

We also prepared bottles of half 100% juice, half water, and a sachet of electrolytes which he drank over the course of the day consuming at least 1.5 liters of liquid.  We’ve taken him off black tea because the caffeine is dehydrating.

I wrote to our doctor in Bangkok who always takes the time to e-mail me back with advice.  I told him the situation with Bob and he answered:

“Unfortunately, dehydration can be quite common since he has reached the point in his disease where he does not know what to do with the sensation of thirst.

I agree that offering water hourly during the day is a good idea. If he is unwilling to drink plain water, sometimes it helps to spritz it up with fruit juice for flavor.

Wayan and Bob

It is also a good idea to have him eat things with lots of fluids in them to prevent dehydration. For example, watermelon and soup (as long it is the clear type soup with not too much salt).

The nutritional supplement, like Ensure, does help. For putting on weight, eggs are actually pretty good since it gives muscle mass rather than fat. I have patients in whom we are trying to help gain weight and we use 2 eggs per meal (6 per day).

He may be experiencing the same problem with food as he is with water, in that if encouraged to eat, he will, but he has forgotten what to do with the feeling of hunger. This may sound bad, but we usually treat people like this the same way we treat a 3 year old we are trying to get to eat more. It helps to find out what they like and go with it until they change their taste. Just like a 3 year old may only want noodles every day for 2 weeks, and then suddenly change over to something else.” 

The results yesterday were so clear that Bob was dehydrated. He went from being in a deep sleep like state to talking and sitting up to gobbling up his lunch.

Just before we left, Alan was talking with Bob and pointed to me and said,  "I think she kinda likes you".  Bob said something incoherent.  Then Alan said, "She's kinda funny looking though".  Again Bob mumbled something incoherent.  "And I think she's a little crazy," Alan joked. Bob looked him straight in the eye and said in a clear and strong voice, "They all are!"

Yep! Bob’s still in there!