Expert: Cindy Keith, RN, BS, Certified Dementia Practitioner - 11/3/2011

Question
My mom's dr. is cutting back on her mood stabilizer, I presume to help her stay awake more. She was diagnosed as a BPII just a couple of years ago. Her strong irritability, rages, etc seem to be lessening however she still switches from mood to mood to mood on a dime. My question is, can the BP symptoms or even the disorder itself take a backseat to the dementia as it reaches its severity? And is it common or necessary to keep treating the BP II for humane sake? Of course, meds can be re-introduced...we just want what's best for her physically, emotionally and mentally where it matters, so to speak.

Answer
Hello Beth:  I'm sorry to hear about your mother's dual diagnosis and the problems associated with it.  I'm sure it's been very challenging for all the family to deal with.  I think it says a lot for her physician that the bipolar disorder was even diagnosed when she already had dementia.  It's VERY challenging for any healthcare provider to figure out if the moods and behaviors are due to the BP, or the progression of the dementia, or possibly something new like an infection causing a delirium.  Her doctor may be cutting back on the medication for several reasons.  Many states mandate those types of drugs be "weaned" from the patient after a period of stabilization.  Also, he may wish to see just where she is with her BP in relation to the dementia and the medication is masking some of that.  He may also wish to consider switching to another medication for the BP and has to wean her from the current one.  It's really a guessing game as to how either disorder will play out in her damaged brain, and nobody can accurately predict which will be predominant.  If she is in the later stages of her dementia, then her comfort is of utmost importance and she should have whatever medication they can give her to keep her calm, happy and safe.  If that means giving her the mood stabilizers until her death, then so be it.  You do not want her to suffer with anxiety, anger, or restlessness she cannot describe to you if she can be given a medication to help control those feelings.  It is always a guessing game with any medication in people with dementia, and the BPII makes it much more challenging.  What has worked for the past 6 months may no longer work adequately as the damage in the brain progresses, so it makes sense to see if there are other answers.  Talk with the doctor to hear his thinking behind the decisions, and continue to remain an advocate for your mother as she moves through this last stage in her illnesses. Good luck to you Beth.  Cindy