Monday, October 20, 2014

Friday, February 15, 2013 mmurray358, Community Member, asks

Q: medication

My Mom has vascular dementia rapidly declining.  On exelon patch and respridrone since dec no  relief, very agitated especially at night.   Up roamng about in middle of night.   Any other medication that will keep her calm, help her sleep

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Answers (4)
Christine Kennard, Health Pro
2/16/13 4:35am

Hi

I am sorry to hear your Mom’s vascular dementia is getting worse. Agitation is very difficult to treat in older people with dementia. Medications such as Risperidone, although very effective in some people, do have some worrying side effects in this group of patients.

You need to get your Mom re-evaluated by her doctor. Her doctor will first exclude other diseases and conditions that may be the cause of her increased agitation, e.g. infection, medication side effects, kidney or liver problems. He/she will then see if treatments for vascular disease need to be adjusted to improve her circulatory system. This can help improve her confusion and her mental state. If the doctor does not feel there are any physical causes that he/she can treat then the antipsychotic medication may need to be changed or the dose adjusted.

Medications for agitation have to be carefully monitored and often there is no dramatic improvement straight away. Medications such as Risperidone do have an increased risk of death during treatment and older adults with dementia may also have a greater chance of having a stroke or mini-stroke during treatment. The FDA cautions doctors on the use of antipsychotics in the elderly.

Do get help urgently. It is exhausting for caregivers and home placements can break down very quickly if, as you are experiencing, the agitation increases at night. It is miserable for you, your family and, of course, your Mom. There are many different types of drugs available that can help, it is finding the right one that might take time.

 

I hope this helps

Christine

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mmurray358, Community Member
2/16/13 10:20pm

Thank you for your response.  SHe has been seen by both her primary and neurologist several times in  past 3 months.  They are not listening to the acuity of the situation.   I am a nurse pratctioner whose expertise in is woman's health, but I have researched the use of anti psychotics in the elderly.  THe serious side effects of respiridone are very concerning.  We are in late stages of vascular dementia  and really I just want her comfortable and calm.

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Christine Kennard, Health Pro
2/17/13 10:24am

Agitation is one of the most difficult behaviors for caregivers to cope with. As you will know agitation that results from brain damage caused by organic diseases, such as vascular dementia or Alzheimer’s, are difficult to treat. As you say what you want her is for her to feel calm so that her quality of life improves.

I wrote this sharepost on 10 ways to reduce agitation http://www.healthcentral.com/alzheimers/c/57548/153823/ways-alzheimer
that you may find helpful?

 

Sadly if your mother's condition does not improve and you cannot find medications that help her, you may have to consider nursing home placement. Doctors who have not experienced living with someone that is demented and agitated do not always understand just how urgent your need for help is. It can be frustrating for them, and for you, to find that there are limitations to our ability to treat some diseases and conditions.

 

Do go back to her health care providers and ask for a medication review.

 

All my best wishes,
Christine

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mmurray358, Community Member
2/17/13 10:14pm

Thank you again for your help.  Your article was very informative.  I knwo that long term care is a reality starign me in the face.  I am using respite care for when I am not home.  She requires 24/7 care and when i am away for conferences or for a needed break I am using  respite care.  

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NC, Community Member
2/16/13 1:44pm

I am sorry that your Mom has dementia. I think you need to talk to her doctor about other medications. But sometimes it is about caregiving. Is she staying at home? There is sundowning issue. At night, keep some night lamp on so she is not in total darkness. She is afraid of darkness. She also would not know day and night. Confused about timing and etc. Make sure she relaxes at sunset. You can give her early supper. Go out in the morning or early afternoon. She can have some daily acitivities that makes her tired after a day and yet she is not upset over sunset. If the house is dark after sunset, turn on the light to shine the room. Draw all the curtains at night so she sees no darkness outside. If needed, hire an overnight caregiver to calm her down if she wakes up in the middle of night. She may walk out even in the night so make sure someone is near her.

 

Regards,

NC

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mmurray358, Community Member
2/16/13 10:17pm

Thank you for your response we have been in constant contact with her neurologist and primary MD.  They are not listening to the acuity of the situation.  We  keep lights on all night long night:  light in her room, one in livingroom and hallway she is never in the dark.  Try to kepe her up as late at night as is possible so she  would sleep more over night.  Just a very difficult sitauon that is rapidly declining

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CJ, Community Member
2/17/13 9:04pm

Hello. I am the primary caregiver (with hired help) of my mother, who has Alzheimer's.  My father died of multi-infarct (now called vasular) dementia just over 20 years ago.

 

Sundown syndrome was our very *real* issue with my father.  He started getting agitated around 4 PM, and he didn't fall asleep till around 8 AM.  He would roam around the ranch-style house, bother all of us who were trying to catch night-time catnaps, and not have any sense of what he was doing. 

 

We suffered with watching his demise between December and February.  He died after only a short bout with the serious dementia.  The doctor eventually shifted him to Haldol.  When I read about Haldol, I was quite upset that my father had been put on it.  But he was only on it for about a week.  His heart just gave out.

 

I am very sorry this is happening to you.  I know what it is like, and it is not easy.  I'm not sure that medications can help.  Are you in a position to afford assistance in your home?  It is too much for any one person to shoulder such a burden.

 

Good wishes to you,

CJ

 

 

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mmurray358, Community Member
2/17/13 10:17pm

Appreciate your insight and past experience.  It is a very difficult disease for all.   We have help in daytime while I at work but rest of time care is my sole repsonsibility.   Doing best we can taking it day by day.   

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CJ, Community Member
2/17/13 10:44pm

Hello again. Is there any way you could get assistance maybe twice per week for an overnight?  You need respite.  We used to "spell" each other when dealing with my father's sundown syndrome and his vascular dementia.  I used to take the weekends (Fri thru Sun) and two of my other sisters took the other days.  This worked okay for us.  My mother was run ragged by it.

 

It seems to me if the situation is going downhill rapidly, you might not have too many more months left.  What happened in my father's case is that he finally fell during one of his night-time walks (he just didn't get any sleep). We had to get him hospitalized, and he went downhill from there, all in a matter of days.

 

My heart goes out to you. Many of us have been where you are.

 

Good wishes to you and yours,

CJ

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AFA Social Services, Health Guide
2/25/13 9:11am

It is advisable to first consult your mother’s primary care physician about any questions or concerns regarding her medications. Since her doctor would be familiar with her full medical picture and plan of care, he/she can review which prescription medications would work best in decreasing her symptoms of anxiety. 

 

Since you inquired about risperidone , I would like to provide you with some information on this medication. It is an antipsychotic medication that works by changing the actions of chemicals in the brain.  Risperidone is usually prescribed to individuals that have schizophrenia and bipolar disorder.  In some extreme cases doctors may prescribe risperidone to individuals with Alzheimer’s disease with severe behavioral problems.  To learn more about risperidone, please visit its official Web site at www.risperdalconsta.com.

 

There is controversy regarding the usage of antipsychotics amongst individuals with Alzheimer’s disease. Individuals with psychiatric symptoms tend to exhibit more behavioral problems than those without these symptoms. Treatment may include carefully-supervised use of medications and behavioral interventions. Use of antipsychotic drugs for dementia has been controversial, and the U.S. Food and Drug Administration in recent years have required drug labels to carry so-called “black box” warnings regarding them. Current research shows that antipsychotic drugs are associated with increased mortality rates in individuals with dementia. For complete information on this issue, go to www.bpac.org.nz/a4d/resources/guide/guide.asp?page=6.

 

In addition to any medications your mother’s doctor might prescribe, you might want to also explore behavioral interventions.  Often individuals with Alzheimer’s disease have Sundowner’s Syndrome—which refers to increased agitation, anxiety, confusion and hyperactivity that begins in the late afternoon and builds throughout the evening. There are a few tactics that you can utilize to help ease her symptoms. Try to put your mother to bed as late as possible, and keep all stimulating activities reserved for the earlier part of the following day. Make sure that your mother doesn’t take any naps throughout the day, as this may be fulfilling her need to rest and can inhibit her desire to sleep at night. Also, avoid giving your mother any caffeine such as coffee, tea, or soda. In the later part of the evening, when the sun begins to set, turn on all the lights around the house and keep noise and other forms of stimulation to a minimum. It is a good idea to create a relaxing environment that will prepare her for bed. This could help her sleep better at night.

                

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mmurray358, Community Member
2/25/13 4:15pm

thank you for you  advice.  Have cut back her caffeine intake. She is not a good ater drinkier takes tea mostly so I only use decaf products and have asked the ladies who care for her when I work to reduce the amount of tea she gets.    We do keep lights on all over house.  She does not sleep during day actually she is just wound up all day long going room to room.   Can get tired watching her .   I try to keep her up as long as  she can handle it but by 8:45 she is edgy just like a baby crying to go to bed.   We have  had a rough few days with her trying to leave house.     I am a nurse practitioner this is nto my field of expertise geriatrics but there has to be some medication to  keep her calm.  I really do not feel that exelon patch or the respiridrone are  helpful in her case at all.  Have voiced these concerns to both neurologist and primary md who difer to each other in planning care. All I have gotten is adjustments in timing of the respiridrone.  It is all very frustrating.   

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By mmurray358, Community Member— Last Modified: 04/01/14, First Published: 02/15/13