Hard to know how to care. At dentist office for a routine cleaning we found three abscessed teeth with a lot of infection. She had not complained of any pain and when asked she denies pain. Had a total hip replacement and never took any meds. Experienced a very very bad U.T.I. never with any recognition of pain. I'm beginning to think that the part of the brain that feels pain has been compromised. Is this possible? Has anyone dealt with this problem. She is able to converse for short conversations most of the time. During her adult life she had a high pain tolerance but this is unbelievable. Thoughts?
As the disease progresses, the parietal lobes are eventually damaged and the result is an inability to feel and respond to pain correctly. Alzheimer's is considered a parietal lobe dementia due to the vast amount of damage occurring in these lobes. In some cases however, the opposite may be true. Sometimes persons with dementia may have extreme sensations of pain that gave no apparent causation.
Damage to the parietal lobes also means there is a craving for sweets or only the ability to taste sweets. They have an inability to properly regulate body temperature, hence persons with dementia have cooler body temperatures, but may not be aware of it. They also may not be aware or responsive to extreme weather changes. Tactile or touch sensation remains relatively intact, which is why touch and massage are activities used in late stages.
To determine pain you can refer to the dementia pain scale or watch for signs of pain. For example, if you witnessed a fall then assume there must be pain from the impact. If your loved one is protecting an arm or leg or winces when touched, that would be cause for investigation. If your loved one has a history of arthritis or broken bones, you can assume this causes pain. If there are weather changes, this can cause pain in the joints or at old fractures.
Breathing rapid short breaths, laying straight and stiff, or curled into a fetal position are all considered indicators of possible pain. Furrowed eyebrows or looking like one is in pain are signs and certainly crying out during movement indicate the presence of pain. Remember to treat the pain and be aware of the presence of pain, since your loved one may not be able to identify or alert others to his/her condition.
But about the joint replacement patients: I also often had many totally lucid and mentally normal patients with new joints, who required very little pain medication. Invariably these patients stated that their bad knees (or hip, or shoulder, whatever) had hurt them so badly prior to the surgery, and the post op pain was so much less by comparison, that even without the drugs, it was huge improvement for their experience. So don't assume that not needing pain meds after this kind of surgery is necesarily due to the Alzheimers.
BTW, for TamCummingsMS, What I found so helpful in this thread is the info you offered about the increased taste for sweets. I've noticed this in my dad. He still does some shopping on his own, but if he comes home with two bags of groceries, the vast majority of it will be sweets. If he didn't go to the senior center for their 1$ lunch every day, he'd eat nothing else but bakery and ice cream. He probably eats 6 to 8 packages of Entennman's in a week. I was blaming it on the part of his dementia that leads ignore all the "shoulds" of life and to do only what he wants, when he wants. You know the "shoulds". An person should take a bath, should wash their hair, should chew with their mouth closed, should eat healthy foods, etc. He doesn't follow any "shoulds" any more. But now often leaves the meals I bring by to spoil in the fridge, even foods that used to be his favorites. The taste for only sugar would explain that. Thanks