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Doctors' Answers to "Frequently Asked Questions" - Dementia
These comments are made for the purpose of discussion and should NOT be used as
recommendations for or against therapies or other treatments. An individual patient is
always advised to consult their own physician.
Elaborate Dementia and Medical
Problems [posted 11/18/98]
Question: My question is really more complicated than I am certain there is time to
ask here, but I'll try to be succinct. In February of 1996, my father, who is now 49, was
admitted to a hospital for what was believed to be dehydration and exhaustion. It turned
out he also needed his gall bladder removed. Following the operation, which healed nicely,
he and my family were informed that it was believed he was HIV+ and would die soon, as he
had an infection - pardon the spelling - called cryptosporidial meningitis. As it turns
out he is still living. Infectious disease specialists at Vanderbilt University in
Nashville, TN, told him that there was no way he could have been HIV+ and that the
hospital he was in used outmoded criteria to make their diagnosis. They also could not
find HIV in his bloodstream with repeated tests, even sophisticated ones. Regardless of
all this, my chief concern now is for his mental health. Since his illness and subsequent
hospitalization, he has behaved disturbingly. His personality, however you choose to
define that, is *drastically* different. He has a spitfire temper and a foul mouth. He
drives recklessly, has no patience with anyone in my family, and frequently lies to us
about his activities and where he has been. Moreover, he is also *very* confused, for lack
of a better word, about the details of his life, his family life, his early childhood, and
other key pieces of information it is not outside the realm of reason to expect him to
remember at his age. To top it all off, I am convinced, and have been for some time now,
that he is delusional. The list of evidence I have pointing me in this direction is long.
I'll just mention a few key things he's told me since his illness that lead me to
believe this. First, he believed shortly after he was released from the hospital that he
had the stigmata of Jesus Christ on his wrists and ankles. I examined them and noted some
discoloration but I just can't believe it wasn't due to his hospitalization for over 2
months. And for several years now, he has intimated that he *actually* believes he is the
secret member of the Romanov family in Russia. This particular belief has gone on for
probably 5 years now, and he still mentions it. Additionally, I believe that he fantasizes
about knowing famous/important people. He works (and does a good job) at a car
rental agency. In that time, he has told me and my mother in conversation that he knows
and is buddies with Rick Pitino (former U of Kentucky basketball coach), and that he
frequently has long conversations with William Shatner (i.e., Captain Kirk of Star Trek
Fame). He has also told my mother that William Shatner told him that he has AIDS and is
dying. For the most part, my father functions relatively effectively, and has held his job
for over a year now. He knows all of his family members' names and bathes and grooms
himself appropriately. However, these other behaviors I have mentioned are beginning to
overwhelm us. We are, to put it simply, concerned that he is a danger to himself and to
other people. And trying to confront him, even politely, about the inaccuracy of his
stories only leads to indignance and denial of any problem or deficiency on his part. He
also refuses to go to a physician of any sort, and jealously guards the medical
information we do have about him. This makes explaining the problem on a service like this
even more difficult, but nonetheless necessary. I am frankly beginning to wonder if he
needs to be institutionalized, and I don't mean at a nursing home. If so, I do not know
how to proceed. My family and I would really appreciate any advice, information, or
suggestions anyone could give. I have tried to research this on my own, but don't really
know what to look for in a library. His physician has told my family that he does not have
AIDS, so I can't really look at this as some form of AIDS-related dementia. Any response
at all will be appreciated. Thanks.
Answer: He certainly needs to be examined -sounds like a psychosis.
However, what were the results of the lumbar tap ? I can't believe that they would make
the meningitis diagnosis without some data. You need a neurologist and a psychiatrist,
maybe an infectious disease specialist. If your dad won't cooperate, most states have
committal laws for this circumstance. It usually requires 2 physicians, check with his
Dementia & Alzheimers Disease
Question: My father is 80 and has stroked induced dementia and some form of
alzheimers. He is on 20 mg of Aricept, this drug worked well until this past 6 months. His
gallbladder had to be removed and since then his memory, desire to live, bath or eat have
been lost. He also frequently wants his mother and father. I am at a loss, I am the only
child, and the only caregiver available. I am now afraid to leave him for longer than a
quick errand. I have not had a day off in over 3 months. He is a physically, an extremely
healthy man, yet, mentally he is regressing. Please, tell me what I need to do or where to
turn. Thank you.
Answer: Hard to know if it is a continuation of the Alzheimer's decline or
another problem superimposed on the previous dementia. I would vote the latter and check
with his physician for a complete evaluation. If it is the Alzheimer's there probably
won't be much improvement, so look for other causes. Even something as a small urinary
tract infection will tip these patients over.
Dementia caused by medications
Question: I am doing research for a book, and am curious to know if it is possible
to have Alzheimer's-type dementia with administration of benzodiazepines in a sufficient
dose? If not, is there any medication that would cause such symptoms? Is it possible to
receive a diagnosis of Alzheimer's incorrectly with something such as drug overdose the
culprit? Any information or references would be greatly appreciated.
Answer: Lots of drugs could mimic dementia, but not specifically
Alzheimers Variety. A good examination would detect this, a cursory examination
would not. Digoxin and seizure drugs would be high on the list. Other medical conditions
would be hypothyroidism, B12 deficiency, hypercalcemia, hyponatremia. These are all
rapidly reversible as opposed to many other types of dementia.
Question: Patient has dementia, cannot sleep longer than a few minutes at a time,
and wanders throughout the house. What would be the best sleeping medication to help?
Answer: This type of problem is chrefn with dementia. Usually we start with
haldol (haloperidol) for sedation and increase the dose until the right amount of sedation
is achieved. That is, start at 0.05 mg and increase 0.05 mg until a maximum of 5-6 mg
until sedation is reached. There is a newer sedative called risperidol which also works
better tolerated, but is very expensive. If this doesn't work klonopin is usually tried
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