I'd be very interested in hearing from others on the use of this anti-seizure medication for behavioral problems in dementia. I've always believed my mother's to be more "frontotemporal" in nature than AD, per se (her symptoms were initially mood/behavior related; loss of memory came very late and is still not terrible; no decline in verbal skills at all, yet clearly there is brain damage -- probably multi-infarct/vascular in origin complicated by a head injury affecting the frontal-temporal regions bilaterally). The AD patients I see at the home are mostly quite tranquil and some even appear content -- not MY mother! We've tried other things to make and keep her happy -- Seroquel, Ativan, Remeron -- but this has been suggested now that she's seriously agitated and even somewhat combative in the SNH setting where, granted, it's very noisy, confusing, and I'm sure terrifying for a confused elderly person who's blind and also mostly deaf. I'm for just changing her "setting" to a home one, but am curious now about this. If anything will calm her down, that will be a boon not only for home caregivers and ME, but in the event of any future need to hospitalize/place in rehab.
I am sorry about this. But since she has the feeding tube, it may be her reason for being agitated. People with dementia hate tubes. When my FIL had this catheter on for 3 months back in 2010 spring, he was so agitated and pulled it out 3 times in a row. He was treated well at the end but he really hated the catheter. He slapped the nurse and he pulled it out behind the caregiver's back and etc. He begged his son to take it off but we couldn't until the treatment was over. He blamed everyone saying "nothing can be done!" But he just needed to wear it until everything was sort of recovered. He didn't understand why he has catheter and he does not know that he has problems and he said he was normal... (He had prostate issue and had microwave heat treatment.)
I am sorry to say this, but the tubes definitely is one factor. Maybe pain killer or some sedative can help her? She sounds miserable. You sure she wants to be fed now? Try to ask her if she is OK with it. It may be the reason.
My FIL is now taking both antidepressant and antipsychotic drugs. Check with the doctor to see what kind of sedative is good for her.
Nina has a point, feeding tubes are foreign and can be uncomfortable. Those with dementia will respond negatively to anything that causes them discomfort or seems foreign to them.
Both of my parents used Depakote. Mom is actually on a cocktail of medications to control her angst. She is taking Remeron, Depakote, Geodon, and Zoloft. She did spent 10 days in a Geriatric Behavioral Med Unit to find just the right medication levels for her. She went from manic angst and combativeness to contentment. That was three years ago and she remains content today. Dad had Vascular Dementia. At different times he took every medication you mentioned including Depakote and a few others. Some made him better but they were never able to control his occasional outburst.
It is trial and error that you use the right med or combination of medications that will benefit your Mom. Environmental changes are also important as well. Just know there is no magic bullet that works for everybody. So keep searching for what works for your Mom
Actually, she's been amazingly tolerant of the PEG tube (her agitation long preceeds that); never even notices it as long as it's kept taped to her belly (when they forced her to wear a BINDER over it, that was another story)... She did complain about the urinary catheter while she had one and is very sensitive to any physical discomfort. You can imagine: "touch" is about the only sense she has left (is blind, mostly deaf, can't taste or smell anymore)... Mom did well on Seroquel for two years, but then it seemed to "stop working" and even an increase only made things worse. Also did well on Remeron, but then her nephologist pulled her off it (it's "nephrotoxic," and she has Stage III kidney disease). Resperidol, for which I had high hopes, did nothing; nor did Geodon. I've often thought she should have a trial on an SSRI, but then I realize it can increase both wakefulness and diarrhea, and we don't need either of those. Fingers crossed for the Depakote. To tell you the truth, all of her complaints are perfectly valid; it's just that she's so LOUD about them. Makes her difficult to manage, home or "home."
Your experience sounds typical. A med works for a while and then the benefits wain. You go on to the next with hope and it may or may not work for who knows how long. Then you have all the other medical complications to consider. Not to mention the black box warning on the A- typical anti psychotics. It's not an easy mine field to traverse. Just know there are many options out there to try. It was a blessing when we hit the right combination for Mom that has held it's beneficial effects for so long. We never really hit the mark with Dad but we did get close. One thing to remember is that they do have legitimate emotional responses that need to be expressed... and they don't have the ability to express them logically and rationally as we do. I bet her touch is accentuated because of her other inabilities! It all combines to make her yell a little louder than we would... what else does she have! Hopefully you can find a happy medium between her need for expression and medication that will allow her comfort from her anxiety.
I think Depakote is considered quite safe and is specific for the kind of agitation she experiences -- the Resperidone and Seroquel do have warning about stroke in the elderly, and other drugs can cause tardive dyskinesia, etc. Anyone had experience?
Mom is on the medication. Gastrointestinal side effects are the most common. There is a blood test for Depakote levels in the blood that needs to be done periodically if she does stay on the medication. They also watch her liver function and blood cell count. I just make sure the necessary blood work is done every 6 months. One of the side effects you might appreciate is increased appetite and weight gain. Mom has been on it successfully for 3 years.
Oh, nooo. Tell me the GI side effect is NOT diarrhea! My mom's had that for two months and is just now getting over it... Since your mom's been on it for three years (at what dosage?), I assume it works; what symptoms did it relieve, if you don't mind sharing? Thank you for the feedback/input.
It can cause either diarrhea or constipation so you just have to watch. It is usually temporary if at all. Mom had an extended bout with diarrhea a few months back but it ended up being the Ensure that was the problem. It is such a hit and miss search for a cause since so many things can upset their gastrointestinal track!
Mom had manic attacks of anxiety and combativeness. She was completely out of control so I admitted her to a geriatric behavioral med unit for 10 days. One med did not do it for her. She had been on Zoloft which was increased to 150 mg twice a day and she stayed on that one. She was also on Remeron 30 mg once a day and they left her on that one. She was given Geodon in the ER and it seemed to help so they continued that and they added the Depakote 500 mg twice a day. So she has been on four different medications, each treating a different aspect of her behavioral issues, for three years and doing well.
Before she was combative, agitated, and aggressive on a daily basis. She would pack up everything within reach into any container she could find and haul it around while she screamed and cried. Much of it was thrown over the court yard fence or deposited by the office door. She refused to eat, kept Dad upset, and the words that came out of her mouth would make a sailor blush. She would throw things, and hit people when they tried to assist her. And she did not sleep. She would pace day and night only sleeping occasionally in a chair. She didn't want to sit and eat but would eat if you could get her to pick up a sandwich left on the table.
There was a period of time when she was "out of it" because of the effects of the medication but when she woke up she was a totally different person. I still see the characteristics that caused her anxiety but now she is content, can be distracted, and she is no longer in emotional overload. She still wants to go home. She will grab my hand and head off in a random direction but no longer with the angst of before. She still paces but it's not with agitation and you can get her to sit and eat or sleep. She is not longer striking out at people or anxious all the time. The periods of mild agitation are easy to control and most of the time she has a big smile. The tears have also stopped and she no longer screams or throws those southern hissy fits! That list of four meds gave me my sweet Mom back.
The psychiatrist that worked out Mom's meds is a psychiatrist that specializes in dementia behavior and runs the behavioral med unit Mom was in. I have shared that med list with a few and I do know that in at least two other cases of sever agitation it has worked as well as it did with Mom. But it is difficult for me to tell which med resolved which behavior since Mom went on all four at those dosages at the same time.
Dad was also on Depakote and I think it contributed to some of the diarrhea issues he had but it was not sever enough to stop the meds because it did help him as well. He had Vascular Dementia and was prone to hallucinations and delusions. It didn't fix all the agitation but it did help and he stayed on it for the last two years. It seemed to take the edge off the delusions and hallucination after effects
Hope that helped and I don't mind sharing my experiences at all!!
Thank you SO much! I've often wondered if an SSRI or even Trazadone wouldn't help her, too. It's hard for me right now to remember that she was like this BEFORE and that it's not just the result of being in the rehab; when she clutches desperately at me and begs to go home, I have to struggle to remember that she was just as agitated before her hospitalization (since last September, she would walk around on her walker for hours pitiously crying my name and begging me to come downstairs; since I had to get up and work the next morning, it got ugly at times). I'm sure she has brain damage that's vascular in nature and it really IS almost like having a low-grade seizure all the time, like her neurons are just firing out of control at the least aggravation. It's rather embarrassing since her roommate at the rehab is recovering from a terrible car accident and is laid up in bed at age 81 (her husband, 90, was also in there for the same reason) with two broken legs, a broken arm, a PEG tube, AND a ventilator and never complains while Mom will be screaming bloody murder about a crimped sheet or an itchy back! I pray it doesn't cause MORE diarrhea and does help. I DON'T want her in a geri-psych...
Trazadon is good. That is a medication that has been used very successfully in the facility I worked in. I had a long conversation with my old boss about this very medication when Mom was in distress and he highly recommended it (and I trust his recommendations).
Nobody wants Mom is a geri psych! I surely didn't. I was the one that didn't want to use any psych meds. With my experience I though I could handle it... whatever it was. I also thought I could fly wearing spandex and look good LOL But I learned different quickly! Putting Mom in the geri psych unit was the hardest thing I have ever had to do. I think the psychiatrist worked as much with me as he did with Mom. Now I understand better the need for treatment of the emotional well being along with the treatment of the physical well being. They are both important in the total treatment of this disease. Even with excellent physical care, the emotional distress can be detrimental to their well being. I now understand that I would hospitalize and approve of medication for emotional pain just like I would for physical pain. I had to get past my own emotional hang ups about geri psych care in order to get Mom the help she needed... and I have absolutely no regrets that I did it. We have had three wonderful years since then. In my honest opinion, with the extend of Mom's emotional distress, I truly do not believe she would still be alive today if she had not spent those 10 days in intensive treatment for her emotional distress.
Very true; if you Google "hospital delirium," you'll see that it's associated with a high mortality rate, not only at the time or within a month of the event, but in the ensuing YEAR. Of course any suffering needs to be relieved; if this doesn't work, I'll strongly suggest we try the Trazadone; it may kill two birds with one stone, since it's sedating and she can take it at bedtime (we've had to resort to Ativan once again for that)...
My issue with GP is that ours are all VERY far away (at least 50 miles) and also greatly limit visiting hours; they also require participation in "group therapy" and, frankly, that would just upset Mom further since she can't see and can barely hear. We also had a very bad experience with one GP (pulled her out quickly); if they ever insisted on that, I would just take her home instead and deal with things as best I could, so wish us luck!
As common as agitation/combativeness/verbal expression is, staff seems rather clueless?
You are right about the hospital delirium. Any other delirium follows suit.
And yep the Trazadone given at night will knock out two problem... sleeping and agitation. I am not a fan of Xanax or Ativan because of the short half life of these meds. They also tend to give anxiety hang overs after they wear off... or at least did for Mom and Dad. I took both of them off this medication and refuse to even let it be a PRN. It sedated but by the time they woke up it was wearing off and they seemed to be more agitated than they were before. Mom was better with nothing than these And I had a very bad experience with the Ativan in the hospital with Dad. I checked him out at daybreak and it took me days to get him back to normal after he returned to the facility.
I was lucky to find the psychiatrist that we used. He was not that far and available more than most. He started this little unit (only 10 beds) and was there all the time! He also understood that "talk therapy" or "group therapy" was not beneficial for the elderly patient with dementia. Everything he did was one on with with the resident but he did insist on family involvement so we could understand.
I will say most rehabs are no cued in to dementia related complications. That would be the one thing that would cause me to pull Mom out. In your other post you indicated it was going well so I had hoped that they were dealing with her dementia and other impairments as well as her physical rebound. Just be watchful and your head will tell you when it's time to go. In the mean time try to renew yourself for the long haul!
I said she was making progress; that's not the same as saying she's in a good mood! She seems to have good days and bad days. I, too, don't like her getting boat-load of Ativan, but that was actually MY suggestion when nothing else seemed to work. They were reluctant to prescribe it. If we get no benefit from the Dekapote, I'll definitely request Trazadone, and I may even suggest Benedryl at night instead of the Ativan...
It seems to me the vascular dementias are much more prone to these "emotional" symptoms; I see little old people with AD there who seem much more peaceful (but not necessarily drugged or sedated)... Just rather vacant and quiet. Not MY mother...