The People's Perspective on Medicine

Pain Reliever Awakens Alzheimer’s Patient From Dementia

Q. My 82-year-old mother has had Alzheimer’s for eight years. She sat all day and didn’t feed or bathe herself. Although she smiled pleasantly, she couldn’t retain working memory for more than two minutes. She repeated statements or questions over and over.

Last month she fell and broke two ribs. Her doctor put her on a narcotic pain reliever, hydrocodone (5 mg twice daily). A few days later she “woke up.”

She is talking, laughing and feeling quite sad to hear she has Alzheimer’s and that her close friend died three months ago. She is now dressing herself and putting on make-up for the first time in years. She told my sister, “What have you been doing to my hair? This is terrible and too light! I need a hair appointment tomorrow!”

Yesterday she opened up her phone directory and called three friends. She even supervised cooking dinner, though she hasn’t cooked for years. Have you ever heard of hydrocodone acting like this for Alzheimer’s disease?

A. What an amazing story! We could not locate any research testing narcotics such as hydrocodone for Alzheimer’s disease.

We heard a similar anecdote, however. A woman in the final stages of Alzheimer’s disease was put on Oxycontin (oxycodone) for pain relief her last two weeks of life. During that time she was lucid and capable of communicating for the first time in months.

A few weeks later we got this message from another reader:

Q. I read the letter about a reversal of symptoms in an Alzheimer’s patient who was put on the pain reliever hydrocodone. My dad is a 90-year-old Alzheimer’s patient in an assisted living facility. I myself am a pharmacist, and I felt compelled to write to you.

About two years ago my father fell and broke his hip. He was taken to the emergency room and given a shot of the narcotic Demerol to control the pain. When I got there, expecting him to be even more confused than usual, he was absolutely lucid and answered all the ER doctor’s questions accurately.

My sister and I were flabbergasted and figured his clarity would end when they took him to surgery, but he came out of surgery quite lucid, like his old self. This lasted several days but slowly he regressed back to his forgetful Alzheimer’s self.

As a pharmacist, I tried to make sense of it. I discounted the Demerol and thought it must have been a physiological reaction to adrenaline. I told everyone about it–his neurologist, internist, orthopedist, other physicians, fellow pharmacists, drug reps, researchers at meetings–but no one had any explanation and we all thought it was a fluke.

Six months later my father fell and broke the other hip. Bingo. Once again he was lucid and like his old self after being put on an analgesic, but then slowly regressed.

Your column is the first time I have ever seen any mention of this phenomenon linked to narcotic pain relievers. I would love to get to the bottom of this for both personal and professional satisfaction.

A. Yours is the fourth such amazing anecdote we have encountered. In each case, when an Alzheimer’s patient was given a narcotic analgesic, there was a significant, though temporary, improvement in the condition.

We have consulted some of the country’s leading experts on Alzheimer’s disease and they have no explanation. Although this may be a coincidence, we think it is so interesting that it ought to be studied scientifically.

Sadly, we have not discovered any research into these fascinating reports. Experts in the field discount the stories or just seem uninterested in following up. What a shame. It seems as if such anomalies deserve further study, even if the effect is temporary.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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When my 88 year old mom with dementia had a burst fracture at L1 and was put on Dilaudid, her memory, mood and sleep improved drastically. It was wonderful to see her old self emerge. She was playing games, and laughing. Her doctor is trying to take her off Dilaudid, so we have reduced the quantity from 5 pills a day to 1/2 pill every 8 hours with Tylenol. It has been over 2 weeks now, and we see a drastic decline in her short term memory. She is not sleeping well and is getting days and nights mixed up.

When she has a UTI, she shows no pain symptoms, and I think it is the same with her advanced arthritis and osteoporosis. When her pain is controlled her quality of life drastically improves. I don’t see any reason why a very elderly patient can’t have opioids indefinitely if it improves their quality of life.

Agree. My father had some memory problems but was still working at 72! Two years ago he fell in the shower sustaining 3rd degree burns on 6% and 2 dgree burns on 24% of his lower body. He was in the hospital for weeks where he recieved around the clock pain medicine. He came out of the hospital with an opiate rx and unable to recognize his grand children. A couple months later he’s having his diaper changed by homecare :( I HAVE NO DOUBT that the opiates exacerbated the disease. Please check with the octor before giving your loved one “Aunt Millie’s” gout meds.

My 83 year old husband diagnosed 8 years ago with dementia, had some oral surgery roads, he was given a prescription for oxycodone. We have had the loveliest evening, he is smiling, helping me with Christmas decorations. I was compelled to go to the Internet and now I see that it is a phenomenon.

My Dad is currently in the hospital with a broken rib – while he was on a lower dose of pain meds the first day after the break – he actually did seem far more with it. He knew my sister was visiting (which he forgets everything really a few seconds after he learns it now), and that he and Mom had been a hotel for awhile (their house is being renovated), he could understand me and follow what I was saying. He understood that he had a broken rib and that he was at the hospital. However, his pain progressed rapidly from different needs to move him in the bed, and he developed a wheeze and was asked to cough, which hurt – so his meds were upped – and the benefit was gone and delirium set in. But I was thinking – hey, does anyone know a little bit of narcotic might actually REVERSE Alzheimer’s? At least a little.

My mother who is 90 also has been suffering from dementia. Her neck pain was so severe (from degenerative issues) at one point that we had to move to Oxycodone for relief. Within just 20 minutes of taking only 1/2 pill she was almost her normal self without dementia. It happens every time. We can actually see the change happening. Why don’t they do a study on this? It seems it is very similar to some mentally ill who have to take pills to be able to function normally so how are those with dementia different?

IHave been taking. Oxycodone for a few years maybe like 3 years for seveare back pain because I have stomps and scoliosis kyphosies on my back and I can not stand the pain but I have been very concern about my lover and also sometimes I worry that I might get deminta or ALeihmers from take so many pain pills I only take them once a day but sometimes.

My mom is 93 and has dementia. She is in a memory care unit in a nursing home. She had been taking 5/500 hydrocodone for a few years. When she went to the nursing home, they took her off hydrocodone & put her on tramadol, which did nothing for pain. long story short, I convinced the doctor to put her back on hydrocodone, which now has been about 6 wks. I definetly see a difference in her memory, etc. She has been calling more people on her cell phone and just seems to be more alert to whats going on. But, she has become very agitated lately, wanting to fight the other residents etc! I’m really hoping she has a UTI and it is not a side effect to the hydrocodone.

Please put me on the list to receive notifications about this topic.

Opiate drugs do not always help cognition in the elderly! Sometimes they can cause symptoms that mimic Alzheimer’s Disease.
My mother had been using Hydrocodone (Vicodin) for many years for the pain from disintegrating back vertebrae. She didn’t have any cognitive or other problems (except constipation) from that drug, but around the time she turned 80, I was worried about the (then) significant amount of acetaminophen she was getting (while taking up to four of these pills a day) and its impact on her liver. So her doctor prescribed Oxycontin (while she still had some Vicodin tablets left).
Soon after getting the prescription for Oxycontin, she suddenly couldn’t understand what I was saying to her, and suddenly made no sense herself. I thought she’d had a stroke. My sister-in-law, a doctor, told me she’d been able to get me an immediate appointment at a good clinic — without telling me it specialized in Alzheimer’s Disease. My mother had had no symptoms of Alzheimer’s Disease before this (my sister-in-law doesn’t like my mother).
Five doctors at this clinic (colleagues of my sister-in-law), after giving my mother an expansive battery of tests of all kinds, diagnosed her with “atypical Alzhiemer’s Disease.” However, they’d never looked at her history of precription drugs. I got it and noticed the suden onset of symptoms had come soon after the Oxycontin. Sure enough, once she stopped taking that the symptoms went away.
Several years later, after a surgery, she was accidentally given Oycontin, and promptly hallucinated that she was in a dark forest while lying in a well-lit hospital room. The withdrew teh Oxycontin, and she returned to normal.
I have read several anecdotes of similar side effects of Oxycontin, and several nurses have said, oh, yes, Oxycontin can be problematic for patients, especially elderly patients.

For many months, my mother has been unable to remember what she had for lunch only 15 minutes earlier. She is often unable to remember the names of her children and grandchildren. When asked a question regarding the past, she states, “I don’t know that was too long ago.” However, since she has been in too much pain to participate in physical therapy, her doctor prescribed Lortab. When I arrived at the nursing home where she resides, I found a new mother. One who stated, “Well where did you come from?” She laughed, joked and sang familiar songs with the great grandchildren all day and into the night. Her sitter reported this morning that she talked about her childhood and siblings until late in the evening, not wanting to go to sleep. The sitter said she had never seen her so expressive and able to convey her thoughts as well. She told us of event which occurred over 90 years ago, when the day before, she was unable to name her uncle when asked. She enquired about several relatives we thought would have forgotten. One of her great granddaughters, smiled and stated, “Wow, I think Granny’s feeling better! She knows my name and that I like to ride horses!” Her family stood around the bed in amazement. I went to the nurses desk today ad asked if there had been a change of any kind in her medication and the only change was the addition of Lortab. Im so glad that I happened upon the article because now we know it’s not a fluke.

This is the first time I have heard about these stories. I, myself had a mother as an Alzeihmer’s disease patient for more than three years now. Two weeks ago she fell and hurt her left knees. My sister took her to the ER and the doctor prescribed her a 5 mg of hydrocodone. My sister gave it to my mom to take and she was sleeping all day. She went to she her primary doctor and he told her not to take it. If this narcotic drugs is working for some patients, I hope it would work the same to my mother. I’d like her to try for another 3-4 days to see if he Alzeihmer’s condition is improving. Thank you for the amazing story. God bless you all.

Being as stated ‘temporary’–Will we ever hear if the first lady with the broken ribs reverted as well? This is amazing. I was prescribed same drug [hydrocodone] for severe back pain of over a 2 month period as the only option for some relief.

1/2 helped right away, [I forget strength, just do not like RX, have taken few as possible, so am affected strongly]. Then a year later while traveling took the leap and took a whole one for expediency -made me terribly ill in the head and intestines. Took days for me to feel a semblance of ‘normal’.

But I must wonder ‘why’ temporary? Would it be possible for small dose everyday to keep the lucidity… Surely some geriatrician or other MD has witnessed this. And yet, no interest?
I am so interested to know if any have been long term results.
Thank you

I was a caregiver to my Mother for 11 years to her passing. She had many major health problems including Alzheimer’s. A year before she passed away we put her in Hospice care at home. Her physician started taking her off medications. She had taken Namenda for 11 years and while I credited it with the disease not progressing as much as other people in her circle with the same diagnosis, we had reached a point where it was necessary to choose her comfort over medications. The hospice plan introduced hydrocodone and morphine. I wondered why they was a positive turn around in her mental status making her lucid and engaged until the day she passed away.

All of this is so amazing to me. I’m thinking that why don’t doctors try this more for elderly? One of my husband’s grandmothers had horrible arthritis, actually several kinds of it, and was crippled up. Well, she had to take pain meds every day of the rest of her life. Her body all crippled up, but her mind as sharp as a tack. She was 80-something when she passed away in 1986, but still had all of her mind.
Well, like I said, she had to take pain meds to even keep her from screaming in agony. So the last few years of her life, the doctor had to change them and put her on Talwin. That’s a very strong narcotic. Doctor said that at her age and her pain levels, we don’t worry about becoming addicted to narcotics, which is how it should be. It’s the same as someone suffering from painful cancer having to take meds the rest of their time.
I’m wondering now if this use of pain meds helped her mind stay sharp. This is so strange. My husband’s other grandmother had dementia really bad and passed away at age 97. She had such a strong body, but her mind was pretty much gone. She never received any of the pain meds, I don’t think.

I am reminded of the recently-deceased Robin Williams and his 1990, “Awakenings” which IMDB blurbs on the movie, inspired by a true story, saying, “The victims of an encephalitis epidemic many years ago have been catatonic ever since, but now a new drug offers the prospect of reviving them.” While L. Dopa did bring the patients to a new lucid awakening, the effects were only temporary, despite even increasing the dosages as the improvements vanished.
One could also easily hypothesize other potential problems with narcotics and their already documented *diminishing returns* where more and more of a substance will become necessary to get the same results over time–if in fact they will still reproduce the same results (and the unintended side effects do not become the bigger issues)–because, let’s be honest–isn’t this already well-documented?
There may (or may not) be some room for a little more research in the areas–as most here are promoting, but let’s have some realistic hypotheses in both addressing potential researchers to look into this and in guiding the direction of research. They will be rightfully concerned about ethical, legal, and litigious ramifications in considering such research, in getting necessary approvals and assurances, and in setting up appropriate controls around these questions to answer what other researchers will want answered when the articles go for peer review in the journals and for afterward, when and if others get a chance to read it.
In other words, it sounds like a a long shot, and they may have good reasons for being dismissive with their third- party objectivity. Those close to someone with dementia will have a little more trouble remaining objective and approaching it from a standpoint of research and will have less interest in taking necessary precautions, perhaps erring on the side of wanting to use the substance to get the results (and without fully considering or examining the results).

My mom is 90 and has been suffering from Parkinson’s for about 15 years. She fell and broke her hip a few years ago. We were with her in pre-op in the hospital. They gave her something strong and the change in her mental state was like magic.
Suddenly she was her old self, chatting normally with us and the nurses, talking about going to lunch and even flirting with the doctor (he was a handsome guy). We hadn’t seen her act like that in many years. It was like the dementia related to Parkinson’s just faded away and revealed the person we know and love.
Wish they could have sent her home with some of that stuff. We knew right away what caused the improvement because we watched the transition – it was that quick and impressive.
Too bad we didn’t know it was going to happen because we could have asked some important family questions that only she could answer.

I would like to see future comments

Amen!

Please stay after these responses to a horrible disease.

My 87 year old mother, who was diagnosed with dementia two years ago and now lives in a care home, recently fell and broke three ribs and her wrist. She was put on oxycontin and oxycodone for the pain. She was in severe pain (even with these drugs) and more confused for several weeks. But after two or three weeks, she began talking more and I noticed that her memory was better than before the fall!
Before, she could not retain something I said for 30 seconds. She’d ask the same question 10 or 20 times in a 30 minute conversation. Now, she has made several statements that show a much improved memory such as: when I went to see her and she had been to the beauty parlor that morning, I commented on how nice her hair looked. She said, “everyone who has been by today has said how good my hair looks! I’ll have to go see that hairdresser more often.” This is totally unlike her, who previously would have not remembered that she went to the hairdresser that day, much less that anyone else had complimented her.
Another example: the home took her (and others) out to lunch the other day to the Olive Garden. I said how much I like their food. She said, “Yes, it’s good, but they put too much food on the table.” I remembered how they bring the big bowl of salad, and bread, to your table, so you can have a much as you want. Again, a month ago, she would have said, “I didn’t go out to lunch.” Now, not only did she remember the outing, but she remembered the large servings of food!
So, I agree with the other comments here: why isn’t there any research on this topic??

Could it be that the initial injury / shock stimulated the body into overdrive and healing, and that the pain medication was not the reason for the recovery?

That is an interesting consideration……..

I just want to stay informed about this. Thank you. I have a brother who just passed away this afternoon who has had Alzheimer’s for several years & then had a malignant brain tumor. There have been quite a few cases in my mother’s family & it is definitely something to think about.

Hydrocodone (Vicodin) meds might be giving all this help to people. I take them occaionally for pain but they make me so drowzy that I avoid them at all costs. I don’t have dementia or anything like that (thank God) so I don’t notice any incognitive difference in me.
One 5 mg. tab makes me slightly drowzy but still able to function. When the pain requires that I take two tabs then I get very drowzy, almost “drunk”-like, & unable to stay awake. Two tabs help better with the pain but makes me unable to function properly, & if I lie down will fall asleep immediately.
Those are the side effects of this drug on me. I would love to take this drug when necessary without falling asleep. Do other people have the same reaction? My question is how can Alzheimer patients “wake up” & improve if & when this drug only puts them to sleep.?? That’s a mystery to me.

There was an article in 2011 about some similar sounding reactions.
http://www.nytimes.com/2011/12/04/magazine/can-ambien-wake-minimally-conscious.html?pagewanted=2&_r=0

The comments about dementia remind me that many of the symptoms of Alzheimer’s are similar to symptoms of B vitamin deficiency and iron deficiency. Has anyone ever thought about this??

Can you someway share this remarkable information with Mary Newport, MD whose husband has Alzheimer’s. She has been working with researchers as her husband has benefitted from his treatment with coconut oil. She had a problem getting anyone to listen to her work. I’m sure she would be very interested in these stories. She wrote a book about her research.

I would encourage your sister or her spouse to check on possible side effects of the statin drug she is receiving. Chances are there is little or no benefit and lots of dangers.
If they can bring on amnesia, who is to say they won’t increase dementia?

My compounding pharmacist suggested extra virgin coconut oil for me for other reasons not dementia. BUT he told me that taking 2 tablespoons per day of this.. by mouth or You can simply put in in food you are cooking like 1 TBS per meal. He said it helped an elderly person who could not function. The person is now dressing himself and helping with things around the house!!
amazing..

My sister has been a dementia patient for about 8 years. She is capable of doing simple things and has not been on a significant decline for most of this time. She is in a independent living situation but has an aide who makes sure she follows personal cleanliness and eats at the appropriate times in the dining area and keeps her apartment in good order.
She does not initiate any conversation with me or anyone else but responds to questions. She was taken to the hospital last summer with breathing difficulties and remained 5 days. The only drugs given were albuterol inhalation and oxygen treatment along with her regular statin and lexapro.
She was released after 5 days. I picked her up and on the way home she was conversant and aware of everything going on outside the car. I would say that she was dementia-free for this short period of time. She soon degraded back to her dementia state. She is now on albuterol for breathing and on oxygen for about 8 hours a day but the dementia-reversal is not evident. What caused the abrupt but short-lived change with the hospital stay cannot be explained.
The examples cited in the Alzheimers awakening article and comment, as well as my sister’s story, all happened around a hospital stay. Is this significant?

I would like to be kept abreast of this. Experts? What have they ever done to help prevent or cure this condition? mm who are these so-called experts? Can they not be listed by name and asked why they choose to ignore these stories?

This sounds very similar to the plot in the movie “Awakenings” starring Robert DeNiro and the late Robin Williams. The drug in the movie discovered to have the same temporary effect was L-Dopa.

Temporary even if they kept the patient on hydrocodone? I had my first experience on the painkiller when I had my hip replaced earlier this year. The drug is stimulating and, although I found it bothered my nerves (I really hated the effect), I can see how the stimulation might be significant in the case of Alzheimer’s.
Good grief, surely keeping a patient on it for life would be justifiable if it allowed them to live free of that horrible disease. Not only justifiable, but criminal if it were NOT used.

As a caregiver for an increasingly affected spouse with Alzheimer’s, I think we should all be given hydrocodone. That would certainly improve everyone’s mood! What is the effect of narcotics in the brain of demented individuals? Perhaps this is a field for further research.

These “coincidences” should be made the subject for a research project!

When you say “temporary”, is the regression during the use of the analgesic or after the medication was terminated?

It IS a shame that so-called medical scientists are not interested in anything they didn’t think up themselves, and they discount patient experience as a fluke… this is similar to the anecdotal evidence that ambien improves Parkinson’s symptoms in a sub-group of people. I take the Canadian version, zopliclone, and seem to be in that sub-group, since when I tried to wean myself off it, my Parkinson’s symptoms got far worse, fast.
We need to take research back to the publicly funded universities and stop relying on the for-the-most-profit pharma corporations.
I am thankful your newsletter exits.

I had a similar experience with my 89 year old mother that, at the time, I attributed to her receiving oxygen and a transfusion. She had been diagnosed with pneumonia, and was hospitalized. After her treatment, she began calling my cell phone without help, and planning for her death and who should inherit her things. She was functioning at such a high level suddenly, that my sister and I were amazed.
None of the doctors seemed interested in pursuing this striking change in behavior, and Mom lapsed into her previous level of dementia after a few days. I am not certain whether or not she received a narcotic pain reliever.

Interesting and I want to be notified if anyone has experience with this.

I have lost at least two of my close relatives, first to Alzheimers and then to death… Had I known about his I assuredly would have found a way to slip them some “pain reliever” just to see if it would have this effect. It may not work for everyone but even if it works for just a % it would be a wonderful breakthrough.
I mean we’re not talking about people we need to be concerned about getting addicted here. Are we?
The fellow who’s father first broke one hip, then the other. The other lady who fell and broke ribs. Alzheimer’s does more than incapacitate mentally, it limits physical activity as well, which is a major factor in bone loss and consequent brittleness and breakage. It seems like a lot of illness and injury in Alzheimer’s patients, along with an alleviation of the hard work and emotional suffering of families caring for them, could be alleviated.
Only those “elder care” facilities might be harmed. Lucid older folks don’t need that intensive care and, in fact, can often live on their own and quite well too. Or live with and be part of their families again. If my aunt were still alive you can bet I’d be first lobbying for a short, test dose, of oxy-/hydrocodone and if I couldn’t get her doctor to prescribe I’d darn well find a way.
Nothing to lose, a human being to regain.

What happened to scientific inquiry? Please write more about these stories. The People’s Pharmacy already has great credibility and a growing following. Us regular folks are glad you are able to open this door. Thank you and please carry on with your good work.

This is amazing to hear that a pain killer could help memory so much. I wonder if this would be common in other pain killer including minor ones like over-the counter analgesics. Would this not be truly amazing.

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