Expert: Paula Damgaard - 10/16/2005

Question
Hi Pamela, I sure hope you can give us some direction on this.  My mother in law has been diagnoised for about 3 years with AD.  Up until about two weeks ago she had been calm and relaxed for the most part.  A couple weeks ago she started taking off walking, just needed to walk becasue she couldn't sit still. We started giving her Ativan .25 to .50.  She would relax. Something has changed she now has episodes when she is so nervous that when they pass she will comment 'Oh I feel better" She will get up in the morning walk unassisted to the bathroom, thirty minutes later it takes two people to get her on the potty chair.  She become to nervous that she just tightens up until she is in a knot. She wrings her hands and if she's not holding some of our hands. Mom was a young 70 when diagnoised and has been very agile and has remained continent.
She had a UT infection about 3 weeks ago, we got that cleared up but this has all started since then.  She had to have a catheter which stressed pretty bad. Some times the Ativan helps but sometimes I think it contributes to the problem. When she is having one of these episodes she complains of a headache and ohter places hurting that she says is fine when she's calm.
She is currently takeing Aricept 10mg, Namenda 10mg twice daily, Lexapro 20mg increased from 10mg 4 days ago,toprolxl 25mg, diovan169/2 160/25, Lorazepam 0.50 twice daily. Since the ativan hasn't been giving relief we have started giving her halperinol out of her comfort pak from Hospice.
This comes in waves.  We are worried that the Ativan may be making this worse.  I hope this is not just a jumbled up mess. But I am grasping at straw.  What do you think?  

Answer
Hi Sherry, What I think is tha tshe is on too many medicines!  If she is on Hospice then it is time to have someone go through her meds and remove some of them.

I am not sure what is causing her present symptoms but I think taking some of these meds away will reduce the chance that they are drug induced.  Haldol, or Haloperdol is not the drug of choice for any dementia patients.  We have discontinued using it in our clinic 15 years ago.  It causes the patients to become very rigid and takes over two weeks to leave the body after you stop giving it.  

I hope that you can find a good geriatrician and have him/her look at what your mom is on and remove some of the meds.  That could help her and you!

Good luck and let me know how it goes.  Paula