Expert: Michalene Peticca - 5/23/2009

Question
I have a friend whose 87 year old father is in a nursing home after having stroke at the end of March 2009. Doctor outside of the nursing home diagnose him with alzheimer's. The nursing home (staff psychiatrist) diagnose him with vascular dementia. Don't know if any test were done. The staff psychiatrist said cannot tell the type of dementia until they are deceased and the brain is examined. Friend's opinion was voiced about the medication. 100mg seroquel at night, 25mg seroquel during the day, inderal 3 times a day, serax, and a patch for alzheimer's. Psychiatrist kept using comments that if friend was not happy, could move father, since they were the experts. Father gets agitated, confuses, and finally is too drowsy to do anything after taking the seroquel. A nurse also voiced her concerns about the seroquel. Friend does not know how to help her father. She is afraid the nursing home will take it out on her father if she continues to complain. Any advice would be much appreciated. Thank You.

Answer
Hi Barb,

You present a very common situation that happens in many nursing homes and i will try and help.

First, the medical profession is 99% accurate in diagnosing types of Dementia.  In the past, yes, we had to wait until an autopsy was complete to determine the exact cause.  An MRI could easily show Vascular dementia (caused by multiple strokes).  While it is less accurate on determining Alzheimer's disease, we can also build the bridge from the past to present and determine the onset and stage of the disease.

However, that said, we agree that your friend's father has Some type of Dementia.  Ok....and with his dementia, he is displaying some challenging behaviors. Now, are the medications that the doctors prescribing relevant for his needs.

Well, it depends on how you look at the situation.  From a physician standpoint, i would imagine they are attempting to extinguish the behaviors because it is interferring with staff giving him care.  Therefore, the physician may be under a lot of pressure from the staff to "help" them.   Thus, when he is drowsy, he cannot display behaviors and staff can care for him.

Yet, as an uninvolved medical professional, we do know that Seroquel or any other anti-anxiety medication is Not going to "fix" the behaviors.  The root cause of the behaviors are due to parts of the brain that have been destroyed by the Dementia disease.  And whether it is Vascular or Alzheimer's is irrelevant in this situation. We cannot change or 'bring back' what is already destroyed.  

So, is it ethical or acceptable to prescribe that amount of medication?  I'm not sure i can easily answer that.  I do know that your friend has valid concerns and if possible she might be more comfortable w/ her father being in a specialized unit that may provide calming, soothing ways to help take care of him.  

There are also many good training tools on the Alzheimer's Association's website for nursing staff to utilize.

While this phase of the disease is so challenging for families, and so undignified for the person, it will pass.  I cannot say if it will be 1 month or 1 year....but, it will definately pass and the need for all the medications will no longer exist.

Best Regards,

Michalene Peticca, MA