Expert: Michalene Peticca - 3/13/2008

Question
QUESTION: Hello. Mom was diagnosed with (FTD)dementia due her "personality" changes. She had hallucinations, paranoia and was very delusional. She is taking 1MG of Haldol for 3 1/2 weeks now and has stopped hearing voices and is less delusional. I thought haldol was helping her until I witnessed her cursing at some kids in her neighborhood. They were just riding their bikes on the street past her house yelling out loud at each other and as they pass her in the garden..she takes her hat off, put her hands on her hips and yelled real loud "f***".  I asked her why, and she said 2 of the boys "wants her". Please know when she moved to this neighborhood 1 year ago, these boys 12-14 years old, mowed her grass for her. A simple look from them will cause her to react in this odd way and I'm not sure if she needs a different medication and if so any suggestion. Also, she loves to garden and is always outside and the kids are always outside as well, so I'm having to leave work early just to be there so nothing happens to her. Kids can be very cruel and not understand she's ill. They already threw things at her window and ring her doorbell and run away so I can see why she would be angry at them. Her english is poor so the only mean of yelling back is to curse at them. If this new medication works...will she still be able to recall what the kids did to upset her..or will she forget why she is upset at them to begin with? I want to be able to go to work and know she is safe. Thanks so much for your time.

ANSWER: Hello Kelly,

Thank you for writing.  I know this is a Big challenge for you with your mother.  And, as you know and have seen, frontal and temporal lobe dementias are the most challenging dementias. Due to the brain tissue deterioration in these specific areas we see a dramatic personality and behavior change in our loved ones.  There is no cure, and as your experiencing, we can only "mask" the behaviors.

Although i am not a physician, I would strongly get a second opinion about the medication your mom is using.  Haldol is an "old" medication and was the "child" of the Valium days.

Geodon is a much better medication and after being taken for a couple weeks, i think you will see significant improvement in your mother's cursing and paranoia.  It is also very effective for the hallucinations.   But, i would strongly urge that once you see an improvement, DO NOT let your mother stop taking the medication, she will decline back, if not further into behavior/emotional challenges.

I suppose it is a blessing, with regards to negative interactions, that most dementia individuals do not "remember" what has been said to them in the most recent future.  However, i do believe that dementia folks are like any individuals that lose a sense (ex, hearing) and become much more "intuitive" and focus on the more "non-communication" in a relationship.   That means, your mother will "reflect" other people's emotions much more rapidly.    And, she may have some uneasiness or upsetness as she looks at the other children, but may not know why.  

Hope this helps.  Best Regards,

Michalene Peticca, M.A.

---------- FOLLOW-UP ----------

QUESTION: Hi Michalene...Thanks for your feedback. Went to the Primary today and suggested Geodon instead of Haldol and he refused saying the newer meds are too "toxic" and since my Mom is 72 and very petite, Geodon will cause many side effects. I'm very conflicted since I have my Mom's best interst at heart and he being the Dr should aw well. Any thoughts as to why he may feel this way about Geodon? My situation is unique in that English is a second language for my Mom and this particular Dr is the only Dr she will go to since she is able to talk to him. Since she's taking only 1MG of Haldol for 3 1/2 weeks..would it be wise to up it to 2 MG? Thanks.

Answer
Hi Kelly,

Well, i can only say that the physician and i disagree.  However, i'm not a physican, nor your mother's physician, but, i would have hoped he'd base the non-usage of Geodon on a specific reason (like kidney problems) other than "toxicity".  Yes, it is a medication that has to be watched and monitored.   It is NOT a medication that "dulls the nerves" like Haldol.  It is a brain chemical modification that controls the "signals" and "perceptions" of the brain.   It is a medication that can increase liver enzymes and you must drink enough water while taking the medication.   However, i still feel it is best to try in your mother's situation.   

But, i suppose in good time.  Certainly 1 mg of Haldol is not going to cause any great problems for your mother....although some sleepiness after she takes it.  And i would NOT recommend any stronger dosage if your mother is as "petite" as you say.

I think you'll find that it will calm her, but does not solve her paranoia and cursing.  Stay the course for now...but keep that doctor's number handy for about 1 month from now.

Keep in touch!

Best Regards,

Michalene Peticca, M.A.