Expert: Mary Gordon - 3/29/2010

Question
"Hi, My mom has been diagnosed with small vessel disease over a year ago. She suffers short term memory loss. Recently we put her in a very loving foster care type home. We really appreciate the loving cars she gets there.
last week her blood pressure went to 225. She was very calm, talking and seemed totally fine, the caregivers were nervous,(of course so were we) so we took her to emergency. It took them a long time and several meds to get it down, finally it did, after 3 days it came down. the doc suggeted physical therapy since her walking seemed a like she was slowing down. He also gave her an additional blood pressure med, Toprol. She was already on lisinopril, 10 mg. Now yesterday, she could barely walk, after awile, she started using a walker. We gave her gatorade and a bananna, I was thinking maybe these meds made her have problems with her electrolytes? Could these drugs do this to her?
thanks!
Love my Mom!"
(hi mary, my momis from canada also, living in mich., she is from Malartic,Quebec

Answer
Hi Anne,

Toprol is classed as a beta blocker, and yes, absolutely, it can cause what you are seeing. It can cause fatigue, dizziness, mental confusion, memory loss. It lowers blood pressure and can slow heart rate, which can lead to issues when exercising (i.e. your heart rate might not come up as high as it needs to, which can make you feel very weak).

If you layer those side effects on top of her small vessel disease (which causes vascular dementia, also known as multi-infarct dementia), and you've got a whammy. As you have probably observed with your mom, people with dementias are generally holding on with their fingernails to their cognitive and physical abilities. Any illness or change, any stressor or set back can result in a noticable decline in their abilities (i.e. increase confusion, decrease alertness etc.). Even something minor like a urinary tract infection or a head cold can really make them seem worse mentally and physically.

So, she's going to be more sensitive to side effects that healthy person. Beta blockers can certainly impact blood sugar if she is diabetic (it can cause low blood sugar), but I'd be thinking routine side effects of Toprol before I thought anything else. I doubt it is electrolytes.

You probably already know that as her illness progresses, her coordination and sense of balance will be impacted more and more, and she will find it harder and harder to walk. I don't know how much of that could be contributing to her slow down on the walking front.

Hope this helps. The only thing you can do is really keep an eye on her, and discuss what you are seeing with her doctor.

Mary G.