Expert: Mary Gordon - 3/26/2009

Question
Hello. My Mom was told by her primary physician that she has Alzheimer.  She's 73, and has symptoms of paranoia, delusional thoughts, hearing voices, very confrontational and easily agitated. He gave her meds of haldol then Thioridazine.  Haldol helped but it had a lot of bad side effects so he gave her Thioridazine.  She's been taking it for 9 months now.  The symptoms subsided but not 100%.  She still feels paranoid but not as much as before. My problem is now she's slipping back to her old self even though she's taking the meds. Does it loses it's effectiveness after 9 months? Also, my other concern is she had an episode with all the above symptoms 10 years ago. The doctor diagnosed her as schizophrenic.  She was on haldol for 1 year and stopped taking it altogether and life was normal again. 10 years later, the same symptoms reappeared. Can this be really be Alzheimer or something else. She doesn't want to go to a "real" doctor because in her mind, she is not sick. She only wants to see her primary. I realized that when she became paranoid etc the first time, she was depressed because my sister got preganant and ran away from home. After that incident, my Mom developed delusional thoughts etc.  Just last year, she purchased a home and is living on her own for the first time in her life. She was happy for the 1st 7 months, then she starts talking about how the neighbors are persuading the kids in the neighborhood to attack her etc. Can it be depression and not alzheimer?  Can stress cause her to react this way?  Thanks for your help

Answer
Kelly, it really is impossible to say if your mother has a progressive dementia such as Alzheimer's or if she has a recurrence of her previous mental illness.

Haldol is a major tranquilizer, and is also used for management of psychotic disorders - which does not include typical dementia). Thioridazine is a piperidine antipsychotic drug and in the past was previously widely used in the treatment of schizophrenia and psychosis. Again,  not a typical drug for Alzheimer's.

Your mother desperately needs to see a specialist - such as a neurologist, or a geriatric psychiatrist with a dementia speciality. Don't ask for her permission. Call the doctor's office, make the appointment and take her. Enlist the help of friends and family. Tell her white lies - tell her she needs to see this other doctor for insurance reasons. Bribe her with a nice lunch. Do whatever it takes to get her there. She needs to be properly assessed and diagnosed.

It may be something treatable, and you will never forgive yourself if later you find she could have been helped if she had gotten diagnosed in time.  

f it is a progressive dementia such as Alzheimer's, you need to know that they are relentless, incurable and fatal - and you need to know exactly what you are dealing with so you can make good plans. There are medications available that can slow down the progress in many people.

If she has AD, she will not be safe living alone for long, and you have to get legal items in place while she still is competent to sign wills, powers of attorney etc. You also need a lawyer with a good knowledge of local laws who can advise you on how to protect her assets to pay for her care, which can be extremely expensive.

You need some expert help. Think sneaky if you have to - she really needs to see an expert. A primary care physician - no matter how good - is not equipped to really sort out symptoms like hers.

Hope this helps

Mary G.