what meds are you giving your loved one for severe agitation?

scarfire

My mother is 91 and was diagnosed 9 years ago with alzheimers dementia. She is advanced now and her agitation has been getting worse. I believe she might have undiagnosed PTSD from World War II (she was 10 on Pearl Harbor day) as she had two brothers who were shot down over Europe (both survived), She often goes into a manic rant about the war which eventually winds up with her screaming and F bombs flying and refusal to engage with her caregivers (I'm the primary caregiver). Usually the caregiver on hand (including me) will get an earful of verbal abuse when these rants happen.

She takes a 25 MG seroquel but that doesn't always work. I will be speaking with her neurologist this week but I'm curious what meds other caregivers are using for severe agitation.

Thanks for listening!

M1

There's a lot of potential to increase her seroquel dose, either by increasing the mg (say to 37.5 or 50) and by dosing it more than once a day. If she's tolerating it that might make sense before introducing yet another medication. When treating schizophrenia doses up to 800 mg per day are used, so 25 is just a whiff. Good to be conservative in the very elderly though.

Lorita

Hi Scarfire, Don't know if this will help or if your mother can take this - but, my sister who was in her 80s had alzheimers and when we had to place her in a memory care center for her own safety she was very agitated. She wouldn't take any of her medications so they used Ativan cream. When she'd get very agitated they would rub it on her arms and it calmed her. Finally she got more used to the place and the people and did settle down but they continued to give her Ativan by mouth. This kept her calm. You might ask your mother's doctor if this would be something that might help. Hope it does.

Elshack

My DH who is in memory care and under Hospice was given seroquel and ativan because he would roam the halls at night. They did away with the Seroquel as it made him too woozy but continued with a small dose of Ativan which helped to quell the nighttime roaming.

harshedbuzz

scarfire-

Did she have symptoms of PTSD prior to dementia? You'd typically see hypervigilance that would look like anxiety, poor sleep, vivid disturbing dreams, depression, iterability, avoidance behavior. I mention this, because the go-to medications could be different and a little trickier to titrate. If this sounds familiar, I would approach the prescriber of the Seroquel to increase that dose first and then revisit the idea of adding an SSRI to the mix if you think it might help. A geriatric psychiatrist is your best option for thie kind of medication management.

There was a man in my IRL support group whose DW had survived the horrors of WWII in Belgium. Her dad died in the war and the Jewish stepmom who had raised her as her own was taken away when she was not quite 14 leaving her to survive into adulthood alone. She'd had symptoms of PTSD even as a younger woman.

What often happens is that a PWD loses their more recent history and travels back in time. The man's wife did this. My own dad also did. We were fortunate that he revisited a very happy time in his life as he was challenging as a baseline. It sounds like your mom may be doing this as well.

Dad already had depression going into dementia, so he was already on Prozac (SSRI). His neurologist added Seroquel 25mg at dinner to that. We saw a geripsych to fine tune the meds. He had dad take the 25mg twice a day, increased the Prozac 10mg and added Wellbutrin. It worked well for him for the most part and made him more receptive to validation and redirection.

HB