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Suggest Treatment For Dementia And ADD
Question: My husband has dementia and is ADD. His present mediations are Quetiapine 25mg tid, Zopiclone 3.75mg @bedtime, Mirtazapine 15mg @1700 and 30mg @ bedtime.To my eye he seems to be demonstrating many of the side effects of these meds. Should I ask to have him assessed by someone more versed in ADD?
Brief Answer:
He required further evaluation, no medicine for dementia is there currently
Detailed Answer:
Hello,
Thanks for writing to us.
I can understand your concern for your husband.
Quetiapine is for depression and sleep, zopiclone for sleep, mirtazapine for depression which also can cause sedation.Considering his age of 85 these much amount of medicines can cause excessive sedation and weakness. This may be reason for difficulty in walking.
In ADD(attention deficit disorder) , in my opinion, atomoxetine, armodafinil or methylphenidate would be more beneficial.
Risveratone might be rivastigmine- a medicine for dementia.It has been stopped due to side effects.
Another medicine donepezil should be added for dementia. Support of multivitamin,antioxidants as well as social care are also needed.
At this age he needs to be checked with MRI Brain for possibility of vascular dementia.
For specific diagnosis and treatment of ADD he must be evaluated by psychiatrist in detail.
Hope I have answered your query, I will be happy to help further.
Regards,
Dr.Chintan Solanki.
He required further evaluation, no medicine for dementia is there currently
Detailed Answer:
Hello,
Thanks for writing to us.
I can understand your concern for your husband.
Quetiapine is for depression and sleep, zopiclone for sleep, mirtazapine for depression which also can cause sedation.Considering his age of 85 these much amount of medicines can cause excessive sedation and weakness. This may be reason for difficulty in walking.
In ADD(attention deficit disorder) , in my opinion, atomoxetine, armodafinil or methylphenidate would be more beneficial.
Risveratone might be rivastigmine- a medicine for dementia.It has been stopped due to side effects.
Another medicine donepezil should be added for dementia. Support of multivitamin,antioxidants as well as social care are also needed.
At this age he needs to be checked with MRI Brain for possibility of vascular dementia.
For specific diagnosis and treatment of ADD he must be evaluated by psychiatrist in detail.
Hope I have answered your query, I will be happy to help further.
Regards,
Dr.Chintan Solanki.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you. Very helpful. I asked the doctor if an upper would be better to settle him but he is reluctant. It seems to me that the first sedative med did not work - he was up pacing the floor most of the night so it is increased instead of maybe the med being the cause of his restlessness. Is this rational thinking on my part? I have an appointment with his doctor tomorrow and would like to have some reason for my doubts.
Thank you. Very helpful. I did not make it clear that when he could not walk was 3 months ago. At that time he was given Risperidone and Seroquel to control his hallucinations which consisted of feeling that ants were biting his legs. He was at home and looked after by myself at that time until one night he had violent hallucination and landed in emerg and was restrained for two days. It was after this that he could not walk. I fought with the psychiatrist for over a week to get him of these meds. and then he was able to stand with the help of two nurses. From there, after six weeks in the hospital and being sedated heavily, he was admitted to permanent care. Now, with all this sedative medication he paces the floor all day and is up half the night. A couple of nights ago he fell and broke his nose. This has all happened since he first went on medication in October. All his life he has refused any kind of medication because they all work in the opposite way.
Thank you. Very helpful. I did not make it clear that when he could not walk was 3 months ago. At that time he was given Risperidone and Seroquel to control his hallucinations which consisted of feeling that ants were biting his legs. He was at home and looked after by myself at that time until one night he had violent hallucination and landed in emerg and was restrained for two days. It was after this that he could not walk. I fought with the psychiatrist for over a week to get him of these meds. and then he was able to stand with the help of two nurses. From there, after six weeks in the hospital and being sedated heavily, he was admitted to permanent care. Now, with all this sedative medication he paces the floor all day and is up half the night. A couple of nights ago he fell and broke his nose. This has all happened since he first went on medication in October. All his life he has refused any kind of medication because they all work in the opposite way.
Brief Answer:
Yes, medication may be the cause of restlessness
Detailed Answer:
Hello,
Thanks for more information. I have tried my best to understand your query.
He had hallucinations before 3 months.Hallucinations are generally symptoms of schizophrenia or suggest some infarcts in brain at this age.
Because of some antipsychotic medicines(like risperidone and quetiapine) in emergency he might had sedation and/or extrapyramidal symptoms which include dystonia. That might be responsible for his difficulty in walking.
After that those medicines were changed.
Current medicines cause sedation as a side effect.They are not sleeping pills except zopiclone. However zopiclone is not enough potent to induce and maintain enough sleep in patients with major psychiatric conditions. Benzodiazepine group of medicines like clonazepam or lorazepam would be more beneficial.
In his case seroquel and mirtazapine in day time are likely responsible for sedation. This may be causing difficulty in sleeping at night and restlessness.
From available history it is difficult for me to provide some comments on his diagnosis. I think his diagnosis is to be established first with proper history, examination and neuroimaging. Treatment should be done accordingly.
If by chance seroquel is indicated more dose should be given at night with sustain release preparation. Desvenlafaxine is an option in stead of mirtazapine in daytime as an antidepressant.
As you mentioned medications work in opposite way in his case, likely possibility is some problem in diagnosis.
With above information you just try to discuss about his diagnosis possibilities with doctor and treatment accordingly.
Hope this answer will be helpful. Feel free to ask if more queries.
http://bit.ly/drchintansolanki
Yes, medication may be the cause of restlessness
Detailed Answer:
Hello,
Thanks for more information. I have tried my best to understand your query.
He had hallucinations before 3 months.Hallucinations are generally symptoms of schizophrenia or suggest some infarcts in brain at this age.
Because of some antipsychotic medicines(like risperidone and quetiapine) in emergency he might had sedation and/or extrapyramidal symptoms which include dystonia. That might be responsible for his difficulty in walking.
After that those medicines were changed.
Current medicines cause sedation as a side effect.They are not sleeping pills except zopiclone. However zopiclone is not enough potent to induce and maintain enough sleep in patients with major psychiatric conditions. Benzodiazepine group of medicines like clonazepam or lorazepam would be more beneficial.
In his case seroquel and mirtazapine in day time are likely responsible for sedation. This may be causing difficulty in sleeping at night and restlessness.
From available history it is difficult for me to provide some comments on his diagnosis. I think his diagnosis is to be established first with proper history, examination and neuroimaging. Treatment should be done accordingly.
If by chance seroquel is indicated more dose should be given at night with sustain release preparation. Desvenlafaxine is an option in stead of mirtazapine in daytime as an antidepressant.
As you mentioned medications work in opposite way in his case, likely possibility is some problem in diagnosis.
With above information you just try to discuss about his diagnosis possibilities with doctor and treatment accordingly.
Hope this answer will be helpful. Feel free to ask if more queries.
http://bit.ly/drchintansolanki
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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