General med questions.

LaneyG

Hi all. First thanks for all the support and ideas. Struggling with something. How can you tell if LO behavior and affect is related to med regimens vs. typical progress of the disease. My husbands meds were adjusted recently. Only seems to becoming more agitated and delusional. And before he had mma y more happy moments of you want to call it that. Now even when he is not worked up about something he seems very out of it.

Also…Are we going to have to make trade offs along the way between managing his behavior and having him be more content, present, less out of it?

thx!

Marta

You can’t tell. However, if a med change is followed by worsening symptoms, you would want to notify the prescriber.

The second part of your question: will there be a trade off? This is very individual. This is why ideally your loved one is seen by a geriatric psychiatrist who can best balance these outcomes.

Marta

Ed1937

Please let the doctor know about that. Some meds should not be used with certain dementias.

harshedbuzz

@LaneyG

This is not an easy question to answer.

There are so many moving pieces to this. Firstly, prescribing psychoactive medications is an art at best. Prescribing them for a person whose brain is dying complicates it further; PWD are a moving target in terms of prescribing. This is one of the reasons I agree with @Marta that psychoactive meds are best managed by psychiatrist in general and geri-psych's in the case of the elderly and/or PWD.

Besides the possibility of him having been prescribed something contraindicated for his kind of dementia as @Ed1937 mentioned, there can be genetic differences which make a specific medication a better fit for a person than a different one from the same class. Often doctors make these choices by trial and error which can take time because some meds take 4-6 weeks before you get a sense of how they will work for your LO. There is a test available called GeneSight that can supposedly determine which medications within a class are most likely to be a good fit. This is now covered by Medicare. I have never used this myself.

https://genesight.com/

Sometimes a medication can be very well tolerated up to a certain dose, but if you increase it, the medication can activate the person and make their behavior/symptoms worse than they were before. Or the side effects can be intolerable. Dad had this with Prozac (this was not uncommon with SSRIs among the folks in my ASD support group), we backed him down to the originate dose and then added a small dose of Seroquel. Sometimes prescribing several meds at lower dose is the best way to avoid side effects. DS and my mom do OK on low doses of Ritalin, but to take the amount they need to function makes her mean and him an emotional basket case. For DS, it made more sense to try a completely different stimulant (Vyvanse). Mom's psychiatrist didn't feel she could safely continue any stimulant in her 80s and switched her to a new and expensive SSRI that is used off-label for ADHD. It doesn't work as well, but it's safer given her age and heart health.

If you suspect a new medication or dosage level of one that's been previously well tolerated, you could remove it/reduce the dose (with his doctor's permission-- some medications need to be gradually decreased) to the previous level and see if your DH returns to his previous baseline. If he does, it's more likely the medication/dose was the problem rather than the disease progression. If he doesn't improve or is more symptomatic, it's likely the disease progression. You can test similarly if you suspect drug interactions (with the blessing of his doctor(s)) but removing what can be safely and then adding back the other meds one at a time over a period of 2-4 weeks.

HB

Vitruvius

It’s not just psychoactive medications that can cause changes in behavior obviously. In the case of my DW, during Stage 6 she was having noticeable intermittent drops in her coordination and balance, and this caused falls. The neurologist suspected silent seizures. She tried two different anti seizure medications. Both almost immediately caused significant negative behaviors. In the end we decided that it would be best for her to remain pleasant and calm, even if it meant allowing the seizures to take their toll.

I really feel this was the best decision but it was hard to have to make this trade off.