Monday, February 13, 2006

Drugs and Dementia

The Health section in today's Los Angeles Times (2/13/06) features a helpful article, "Turmoil in life's final chapter," about the use of drugs in treating dementia-related disorders.
You can access it at,1,4337121.story?coll=la-headlines-health.
"It's not the grown child's name forgotten or the pill not taken or the suddenly lost sense of place that drives the elderly from homes to institutions, but the unmanageable aggression, the uncontrolled paranoia, the inappropriate sexual behavior that ultimately afflict 90% of those who suffer from dementia," the article by Marianne Szegedy-Mazak begins.

A sampling of statistics, which she takes from the Alzheimer's Association,
Dementia "affects one person in 20 over age 65 and one person in five over age 65."
Alzheimer's disease "accounts for 55% of all cases of dementia."
(Lewy Body Disease is not mentioned, but it has been estimated as the second leading cause of dementia.)
Seniors make up 13% of the population and account for 34% of all presciptions dispensed, according to Families USA, a consumer health organization.

The article discusses older antipsychotic medicines and their sometimes-serious side effects, contrasting them with the newer "atypical" antipsychotics.
In a side bar, the writer lists non-drug means of preventing or calming agitation, such as exercise, a distraction such as snacks or a video, or a soothing repetitive activity such as massage, hair brushing, or manicure.

Drugs that have not worked well with my mother include:
Ambien (zolpidem)--It was addictive and increased her confusion. In 2002 she was taking one at bedtime, one in the middle of the night, and one in the afternoon before we discovered and stopped it.
Restoril (temazepam, a benzodiazepine)--It's a sedative, given to her in May 2004, when she was hospitalized for ten days "for observation" after agitated behavior. It knocked her out. She was unrousable, could hardly sit up. There was no behavior left to observe. My sister and I had it discontinued as soon as we realized what was happening.
Ativan (lorazepam, a benzodiazepine)--This sedative was given to her in June 2005 when she was hospitalized after being without oxygen briefly because of angioedema (swelling) of the throat and tongue. It had her so sedated that she was unrousable and unresponsive--could not open her eyes or move her hand on command. Because of this medication, used partly to rest her brain and prevent seizures, she appeared to have more brain damage from the lack of oxygen than she actually did.

Drugs that seem okay so far:
Mom was also given Dilantin (phenytoin) , an anti-seizure medication, during this hospitalization because she had seizures when her brain was deprived of oxygen. Afterward she was given Keppra (levetiracetam), another anti-seizure medication, for six months. The Keppra made her sleepy, so her dose was reduced; otherwise she tolerated it pretty well.

She took Seroquel (an antipsychotic and antihallucinogen) briefly in June 2004 without any bad effects, as well as Desyrel (trazodone), an antidepressant and SSRI.
She took Celexa (citalopram), an SSRI, for almost two years before it was discontinued when she had the unexplained allergic reaction in June 2005.

Mom's neurologist, Dr. Claudia Kawas, said Lewy Body patients should avoid antipsychotics like Haldol and Rispirdal. Dr. K also discontinued the Darvocet (propoxyphene) Mom was taking as a painkiller when Dr. K first saw her in April 2004.
"The patient's apparent intolerance of antipsychotics could also point to Lewy body etiology... Given Mrs. Eggebroten's intolerance of neuroleptics, it might also be expected that she would have difficulty tolerating seizure medications as well" wrote Dr. K (1/5/05).
She suggested using tricyclic antidepressants (TCAs) because they suppress dreams as well as lifting depression.

Current medications:
Mom now takes Remeron (mirtazapine), a tetracyclic antidepressant; she also takes Exelon to slow the deterioration of her brain. She has also taken Namenda, similar to Exelon, in the past.
Currently her health is well stabilized by her various medications, which include Coumadin and others for ills unrelated to her brain.


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