Post by norbert1 on Jun 25, 2006 10:33:44 GMT -5
In an earlier post, LindyLue also wrote -
"It has been getting bad lately mom who has ad she is 84 she has been with me for and year and half since my father passed away. My husband and I brought her home with us now this is the problem. She wants to go home. If I don't get in the car and drive her around until she gets tired, I will get punched and my hair will be pulled. She believes her mother is still alive and she wants to see her. She is not on any med for ad; she is on high blood pressure and diabetes meds.
I’ve put locks on the doors so she can't get out, but that only makes things worse. She becomes more violent. I really don't know what to do anymore. She goes back to see her doctor tomorrow. These episodes had been maybe once or twice a week; now they're almost every day. Please help. I don't know what to do anymore and I will not put her in a NH ,that is not an option for me. If anyone out there has any suggestions- please I'll try anything."
"I have talked with the doctor about medications for her. He said there isn't really much he do for her, just handle it figure out what works and go with it."
"No she is not any med for AD or dementia. He says there isn't anything that really help people and you just have to try and cope and go with what works. On Thursday last week we were out and she tried jumping out of the car because she thought she saw her mother's house and i just wouldn't stop. In that episode I got a bloody lip.
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LindyLue
First off, it appears you have a doctor problem. The fact that he will not treat the Alzheimers, and has refused to help with behavior meds in the past - tells me he is a family doctor and knows very little about Alzheimers. And prescribing ativan to a dementia patient is a real no-no. No knowledgeable dementia doctor would do that! Most family doctors are very unfamiliar with the meds needed to treat dementia behaviors. The best thing you can do is get your mother to a doctor who specializes in dementia. Your local Alzheimers association chapter can give you names of dementia specialists in your area.
Normally, when there is aggression, the doctors will first turn to an antipsychotic. Seroquel is the mildest and the best one to start with, unless things are really severe. Eventually the doc may go to a stronger antipsychotic, If they need a stronger antipsychotic, most doctors will use risperidal, a few prefer zyprexa. For strong agitation or aggression, they will add in a mood stabilizer like depakote if necessary.
Depakote is a seizure med, but it also functions as a mood stabilizer and it used for that purpose both in dementia and psychiatric/mental illness. Of all the seizure meds, depakote is better tolerated and easier to titrate. A new extended release version allows once a day dosing and produces a more even serum level, and therefore fewer side effects. This med makes the person less reactive to stimulation.
Actually, I don't know why they don't use the mood stabilizers more quickly.) Unfortunately, antipsychotics do tend to snow or zombfy the patient somewhat, but also takes the edge off the emotions that result in hitting. So you get the good with the bad when you have to resort to these meds.
A dementia expert is better able to sort out behaviors and decide if it is something that the drug will help. For instance, no med will help with wondering. Also, some emotions come from confusion thinking that her mother is still alive and you are preventing her from seeing her. Telling her that her mother is dead does not work. This was called reality orientation - you are attempting to tell her a truth that conflicts with her reality - based on the current state of memory. Obviously, medicine will not correct this false understanding of reality. The med will dull the emotional reaction. You may want to call the local Alzheimers association and discuss this situation. Communication and appropriate responses to a person with a faulty sense of reality is difficult. Using the appropriate responses that do not provoke reactions is very desirable, so you do not have to rely on medication as much.
For more information, go the upper left and do a "title" search on "FAQ13". Read the post on Validation.
By the way, the first thing a dementia expert will do is to prescribe Aricept. The boost to thinking is usually helpful to reduce the confusion, and the aggression that results. Even when an antipsychotic is needed, the use of Aricept will often allow a lower dose - which is very desirable.
Norbert
"It has been getting bad lately mom who has ad she is 84 she has been with me for and year and half since my father passed away. My husband and I brought her home with us now this is the problem. She wants to go home. If I don't get in the car and drive her around until she gets tired, I will get punched and my hair will be pulled. She believes her mother is still alive and she wants to see her. She is not on any med for ad; she is on high blood pressure and diabetes meds.
I’ve put locks on the doors so she can't get out, but that only makes things worse. She becomes more violent. I really don't know what to do anymore. She goes back to see her doctor tomorrow. These episodes had been maybe once or twice a week; now they're almost every day. Please help. I don't know what to do anymore and I will not put her in a NH ,that is not an option for me. If anyone out there has any suggestions- please I'll try anything."
"I have talked with the doctor about medications for her. He said there isn't really much he do for her, just handle it figure out what works and go with it."
"No she is not any med for AD or dementia. He says there isn't anything that really help people and you just have to try and cope and go with what works. On Thursday last week we were out and she tried jumping out of the car because she thought she saw her mother's house and i just wouldn't stop. In that episode I got a bloody lip.
------------------------------
LindyLue
First off, it appears you have a doctor problem. The fact that he will not treat the Alzheimers, and has refused to help with behavior meds in the past - tells me he is a family doctor and knows very little about Alzheimers. And prescribing ativan to a dementia patient is a real no-no. No knowledgeable dementia doctor would do that! Most family doctors are very unfamiliar with the meds needed to treat dementia behaviors. The best thing you can do is get your mother to a doctor who specializes in dementia. Your local Alzheimers association chapter can give you names of dementia specialists in your area.
Normally, when there is aggression, the doctors will first turn to an antipsychotic. Seroquel is the mildest and the best one to start with, unless things are really severe. Eventually the doc may go to a stronger antipsychotic, If they need a stronger antipsychotic, most doctors will use risperidal, a few prefer zyprexa. For strong agitation or aggression, they will add in a mood stabilizer like depakote if necessary.
Depakote is a seizure med, but it also functions as a mood stabilizer and it used for that purpose both in dementia and psychiatric/mental illness. Of all the seizure meds, depakote is better tolerated and easier to titrate. A new extended release version allows once a day dosing and produces a more even serum level, and therefore fewer side effects. This med makes the person less reactive to stimulation.
Actually, I don't know why they don't use the mood stabilizers more quickly.) Unfortunately, antipsychotics do tend to snow or zombfy the patient somewhat, but also takes the edge off the emotions that result in hitting. So you get the good with the bad when you have to resort to these meds.
A dementia expert is better able to sort out behaviors and decide if it is something that the drug will help. For instance, no med will help with wondering. Also, some emotions come from confusion thinking that her mother is still alive and you are preventing her from seeing her. Telling her that her mother is dead does not work. This was called reality orientation - you are attempting to tell her a truth that conflicts with her reality - based on the current state of memory. Obviously, medicine will not correct this false understanding of reality. The med will dull the emotional reaction. You may want to call the local Alzheimers association and discuss this situation. Communication and appropriate responses to a person with a faulty sense of reality is difficult. Using the appropriate responses that do not provoke reactions is very desirable, so you do not have to rely on medication as much.
For more information, go the upper left and do a "title" search on "FAQ13". Read the post on Validation.
By the way, the first thing a dementia expert will do is to prescribe Aricept. The boost to thinking is usually helpful to reduce the confusion, and the aggression that results. Even when an antipsychotic is needed, the use of Aricept will often allow a lower dose - which is very desirable.
Norbert