Cerebral Amyloid Angiopathy and Death

Posted by sistertwo @sistertwo, Sep 28, 2019

To recap, my mom was diagnosed with CAA in 2008 when she was 71. When she was 77 she went into assisted living, moving three times. The first one was in her hometown, a small town where everyone knew her as a nurse and she felt she was taking care of them. The second one was near me and a big fancy facility with all the bells and whistles, but every time her dementia got worse she liked it less. The cost nearly doubled and they wanted to put her in the memory care wing, which we felt she didn't need quite then. Then I found an adult foster care home ran by a great family where there were just 5 residents. Once they had an opening, it was amazing how well she did there. No longer confined to one room, but she was a part of a family. They gave her the best care ever. They'd even take her out shopping! Their family became our family for one whole year. Of course, when I'd be there 2-3 times a week, we got to know one another very well. But, they gave me my own life back, because I didn't feel guilty when I wasn't with her anymore. She was in perfectly good hands!
During the past 6 months or so, she started having more small bleeds and then the past few months they were in the back of her head, affecting her more. Usually she needed some real good sleep for a few days and all would be back to her new normal. In May she was put on hospice. Mom never really knew she was going to die, because she had her wisdom teeth pulled 6 months earlier and couldn't get over the holes in the back of her mouth. I'd bring her to the dentist to assure her all was okay. When she had her appointment with her doctor to discuss hospice, she thought he was a dentist. I asked her if she understood what we were talking about and if she understood what hospice meant. Even though she was a nurse her whole life, she replied she understood everything, and that she would get used to the gaps in the back of her mouth and would be "good as new" after that. I guess there is something sweet about not knowing. That day when I dropped Mom and her caretaker off, she got real mad at me for not bringing her to her house (2 hours away). Her boyfriend (also a resident) and she would always talk about moving into either his house or hers and that day she really meant it! A week or two later she was doing better and there was talk of taking her off of hospice. In addition to doing better, apparently the insurance / medicare / whatever looks at CAA as a condition, not a life-threatening prognoses. Then she had some more "strokes" (reworded the orders) and it became obvious she was unlikely to get better. Some days she could walk. Some days she couldn't get out of bed. Some days she wanted to go shopping (we used a wheelchair), and some days she was really quite good. The last few days in July, although she wanted to get up, her brain couldn't tell her legs what to do anymore. Her three sisters all came to visit so John (her caretaker) carried her to the living room so they had more room. She enjoyed the reminiscing, but was virtually bedridden from then on. She would want to get up, but her brain was not able to tell her feet/legs how move. She fed herself some ice cream on July 31st, but she was so very weak and slept almost all the time. I asked her if she was ready to go see dad (he died in 2013). She could talk just enough to say, "Yes". I promised her I'd make sure she looked pretty for him. My sisters both came that day prepared to stay for weeks or however long it took. The following morning we held the phone next to her ear as each grandchild (10 of them) called to say their goodbyes. That night I checked her oxygen and pulse (little finger monitor) on and off all night, holding her hand from 3 am on. My sisters were talking, as I was still holding her hand, half sleeping, when she peacefully slept away at 7:47 A.M. on August 2nd. As I had promised, I put some lipstick on her before they took her away.
We watched our father suffer for 13 days from metastatic prostate cancer. My biggest regret with him was that we allowed Mom to control his meds and she refused to give him much (if any) morphine, claiming as a nurse it was her duty to keep him alive. Also, Mom didn't want people in her home and Dad could have and should have reaped the benefits of how great the hospice program really is. Not until he passed did we really understand how much her cognitive thinking was already off.
CAA is an interesting condition. The first year after Dad died, she managed to spend thousands of dollars on anything and everything. I think there are peddlers who prey on widows and when they came knocking, selling cleaning supplies, or removing trees, etc. she handed over big bucks. She also thought everyone was stealing from her. She misplaced everything and hid things in weird places. We'd have to take her Bose remote with us wherever we took her! We learned to keep her room as simple as possible. She constantly thought she needed new cell phones (never admitting it was operator errors). She was very good at masking her disability, talking mostly about things like the weather and other small talk. There is a lot of fabrication or denial that occurs with CAA patients. Later on she would repeat certain phrases that were etched in her memory making her come across as perfectly normal. She could fiddle for HOURS with jewelry, usually breaking it and then blaming someone else. There were times she was nasty, nasty. But, then a few hours later she would forget she was mad and all was good again. The biggest change we saw was that she went boy crazy. But, she met Dad when she was 16 and would rather been with virtually any man than by herself. What she wanted mostly from us girls was to take her and her latest boyfriend out to eat. Men liked her because she was beautiful, classy and witty. She was insistent she was going to marry each one of them and would gladly have turned everything (assets) over to any one of them. But, luckily her guy friends were good people and we would take them to concerts and out to eat with us.
We never sold the house that we grew up in, even though it was not lived in for 5 years. It gave Mom comfort knowing "when she got better, she could go home." There was no need to list the house with a realtor, as people have been wanting to buy it for years. By November it will be turned over to the new school superintendent and his children. Located right across from the city park & swimming pool, baseball/softball/football and track fields, it was the best place to grow up.
If anyone is still reading this long message, and either have CAA or a loved one with it, my advice is to embrace it. It is not a bad way to live and it is not at all a bad way to die. God bless you all.

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@sistertwo Thank you so much for sharing this story of your mom's experience with CAA. My mom was diagnosed in 2020 after a couple of very obvious brain bleeds. She died on June 18, 2021, just about 7 months after being diagnosed and at only 64 years old. In hindsight, she had been having a lot of behavioral and personality changes leading up to the diagnosis. We wonder if the brain bleeding had been going on for 10 or more years, undetected. We'll never know. Funny that you say your mom became boy crazy - my mom did this too! She would also have bouts of anger - I remember in the hospital she was so mad at the doctors, at me, at everyone - it was like she was a totally different person. She also became very paranoid - she kept thinking that there were bugs in her house or on her skin so much that she would literally go crazy about it. There were no bugs. She also became very obsessed with conspiracy theories and religion. With each known brain bleed at the end she would decline and then bounce back a little less each time - each "new normal" having less cognitive ability than the last until finally she couldn't eat or walk and then she stopped talking. Thank you for allowing me to share my story.

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@bsfleck

@sistertwo Thank you so much for sharing this story of your mom's experience with CAA. My mom was diagnosed in 2020 after a couple of very obvious brain bleeds. She died on June 18, 2021, just about 7 months after being diagnosed and at only 64 years old. In hindsight, she had been having a lot of behavioral and personality changes leading up to the diagnosis. We wonder if the brain bleeding had been going on for 10 or more years, undetected. We'll never know. Funny that you say your mom became boy crazy - my mom did this too! She would also have bouts of anger - I remember in the hospital she was so mad at the doctors, at me, at everyone - it was like she was a totally different person. She also became very paranoid - she kept thinking that there were bugs in her house or on her skin so much that she would literally go crazy about it. There were no bugs. She also became very obsessed with conspiracy theories and religion. With each known brain bleed at the end she would decline and then bounce back a little less each time - each "new normal" having less cognitive ability than the last until finally she couldn't eat or walk and then she stopped talking. Thank you for allowing me to share my story.

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I am sorry to find out you also experienced CAA. It's amazing how many similarities we experienced. The details they'd share (about theft, bugs or whatever) are so vivid and real to them. We learned it was usually best to agree with her and let her share what she believed to be true. However, that eventually backfired when she got too smart and would say, "if you know people are stealing from me, why are you not stopping it. You do NOTHING!" But, she would also be very appreciative and thankful at times, too. I hope you had some of those moments.
You didn't have very long with your mom. She was really young. I'm that age. I do think you are right about her illness likely starting 10 years sooner. It is not an easy one to diagnose. For us the different cognitive thinking came on gradually. It's like over time we all became some form of codependent, masking the new behaviors. I know now that my dad did and us 3 girls were always covering in social events before we even knew we were doing it. Like, at a wedding or gathering, one of us was always near her to carry on the conversations. Her sisters actually got angry with us when we had to tell them the truth of what was going on. They didn't believe us. That's another story. We all lived a life of denial at times.
God bless you! And, cherish the good memories.

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Hi, thank you so much for this post. I found your post all the way from Belgium. My mom has been diagnosed the past week after having a cerebral hemorrhage. It was the second time for her having a cerebral hemorrhage. She is 65. The first time, after she got home, she was doing fine. Of course, she was struggling finding words et cetera, but furthermore she was doing fine. She could cook again, and she went for walks, to the supermarket,.. al good 🙂

But... a week ago she got a new hemorrhage. She was hospitalized, and diagnosed with CAA. Unfortunately, there is a big difference compared to her first hemorrhage. She simply cannot name objects anymore. For example fruit: if I point to an apple, she doesn't know it is called 'apple'. She forgot the name of her grandchildren, but she recognizes their faces. She forgets both short and long term (because she also does not recognize tv-shows anymore, while she used to watch them all the time before). Besides the memory, she is completely fine. She can walk (but is more tired compared to before), and physically everything is allright.

It is really scary for me, since the diagnose was just a week ago but the memory loss is immense. They did not give us a lot of information about CAA in the hospital. So I have a few questions for you. How long did your mother live from the moment there was severe memory loss? And how many hemorrhages did she get in total? They told us it is likely for her to get new hemorrhages but this is not sure. I am only 27 and I really am not ready for my mom to leave.

Hugs from Belgium
Fien

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Thank you, so very helpful. ❤️❤️❤️❤️

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