Expert: Margot RN BScN GNC - 9/16/2009

Question
My mother is 72 and in the last 2-3 months we have noticed that she seems to be confused.  It is like she is drunk or on high on something.  She has some memory loss but nothing that she doesn't recall later.  She may forget what she had for lunch but as you keep talking she will remember.  We took her to her doctor and he gave her a memory test, asked her some questions and had her draw a clock.  Her score was 19, he said thathe was surprised that she scored so low.  So he put her on aExelon patch and he did a MRI that showed she had had a previous stroke how old we don't know.  I was wandering if maybe whe could be having a reaction to her medication.  This confusion seemed almost to happen overnight.  She takes Metoprolol Tartarte 50 twice a day.  Triamterene-htcz one a day, Alendronate once a week, and Lipitor one a day.  She takes 2 os-cals and one centrum.   Could all of these be having a side?

Answer
Hi Sandra and thanks for writing,

It’s a bit challenging to guess without knowing your Mother’s full medical history and her current test results, but I can share some general information.

Usually when we see someone older start to get confused we look for treatable causes and don’t right away write it off as ‘Dementia’; I hope her doctor ruled out common treatable causes of confusion before he ordered the Exelon Patch.

The most common cause in older people is a Urinary Tract Infection (UTI) due to decreased fluid intake, dehydrating medications (like the Triamterene she is taking) and of course the female anatomy works against us, especially if we’re incontinent.  I would ask her GP to do a simple Urinalysis to rule this out.

Of course many other medications can also cause confusion or delusions, especially if your Mother doesn’t eat or drink much which will allow the medication to build up in her system as it’s not flushed out fast enough. Confusion can be a sign of medication toxicity which can easily be detected with a simple blood test to show serum levels. I would ask him to look into the Metoprolol Tartrate  levels as it certainly can cause confusion.

Those are the two most common causes of treatable delusions in the elderly. Another very common but obviously not treatable cause of behavioural changes is CVAs (Strokes) and TIAs (Mini-strokes) which can not be detected without a CT Scan – but even if we confirm a stroke with a scan, we can’t treat them, we simply then know a possible cause of the confusion, but in all honestly, I don’t think this is the case with your Mother from how you describe it.

So my advice is to talk to the doctor about looking for treatable causes of the confusion, if her doctor won’t help (sadly, not all doctors are that interested in our elders), speak to your doctor or ask for a referral to a Gerontologist.

Hope this helps, all the best,

Margot