Help! Thoughts?

kawfire1817

Hi everyone,

First time posting for me. My dad has been having memory issues since about the beginning of 2023, he denied he had any issues and only went to a neurologist once his PCP sent him in the June of 2023. Of course it took time to get the appointment. We did testing in December and he started to get worse after the new year. He had really repetitive behaviors of checking car doors or house doors or asking my mom if the doors were locked. He was started on Escitalopram in February with minor changes. We received the definitive diagnosis in June and he was started on Donepizil. Around that same time he started having delusions that he had another house and family, my mom wasn’t his wife and he needed the car key. That led to him getting angry and slamming doors and yelling. We were able for a few weeks to use distraction or I would drive him to his “house”. That stopped working about a month ago. We started he on as needed Seroquel and then once a day and then twice a day and then 3 times a day with some good days but with the bad days being very bad and PD and FD having to be called out. Finally this past Monday he was over the top and since I worry about a stroke since he has been on blood thinners for 35+ years and already had a brain bleed in 2017 we took him to the hospital and had him admitted to geriatric psych. He is not doing well there, he wants to come home, because he needs to go to Michigan. he has no problems. He is big time anosnosia. And if you say he has dementia he gets very angry, we had started saying his brain needed some medicine. That only worked for awhile , they stopped the all of the original meds and started him on Depakote, yesterday the had to give him Ativan and started respiridone. Today they just called and that isn’t working , he ranted and raved and slammed doors for a couple of hours this afternoon after being told he couldn’t leave,he needs to get back to Michigan so he doesn’t lose his job, (he hasnt worked in 15 years @;- the steel mill he did work at is a vacant lot) until he finally settled. They are starting him on Thorazine. I am a paramedic and been around dementia patients and have done my research on all of the drugs options associated with dementia care and all f the no pharmacological things as well.

Anyone have any experience with medications not working or something to try that might be out of the ordinary.

I had been reading these discussions and they have been helpful.

Not sure what we are going to do with him if, he keeps having these outbursts. He can’t come home, my mom has been his caregiver with me assisting. But these angry moods with aggressive behavior put my mom in harms way because she has COPD. We have discussed taking him back to Michigan but that poses a whole lot of other problems including finding doctors for both of the, and then no support.

​fesk

I am sorry your family is going through this. It's difficult to tell from your post, but are they giving the medications time to work and/or get out of his system? Over what course of time have all these changes been made? Those are a lot of changes. It takes time (weeks) for these medications to work. When stopped, most need to be tapered - not stopped abruptly. Depending how long someone is on the medicine, they may have withdrawals or rebound symptoms. Are you able to speak with the doctors to be sure they are giving the medicine enough time? I recommend to start at low doses and adjust up slowly.

kawfire1817

Hi Fesk,

He was only on the Donepizil for 2 months, the seroqueal only for a week everyday and it made his outbursts and anger worse and him more aggressive. He is now inpatient at Geriatric psych. I know the meds take time and will be following up with the doctor. Our problem is that we need to get his angry outbursts under control so we can move him to memory care. He has gone for as long as 3 hours demanding the car key he needed to go home and he just cont8nues to escalate anytime you tell him no.

M1

welcome to the forum. Sounds like he is in the right place to get his meds adjusted, but it will take time, likely a matter of weeks not days, and don’t let them rush you or pressure you about discharge. Dosing can take time to adjust. It doesn’t sound like they gave either the Seroquel or risperidone very much time to work. Thorazine can be effective short term but has way more long term side effects. I’d ask for a face to face meeting with the psychiatrist of record. I went through a similar hospitalization before my partner went to memory care, so have been in your shoes.

Don’t even think about taking him to Michigan. That’s the broken brain talking. Just say you’re working on it.

howdoidothis

https://alzconnected.org/discussion/comment/224107#Comment_224107

I have read several posts about outbursts precluding memory care. I’m not sure I understand. If memory care is intended for dementia patients and behaviors are a part of the disease, how can they not accept or kick out people in need of services?

M1

howdoIdothis, it’s because they have to consider the safety of their employees and other residents. They can handle mild behaviors but not violent or aggressive ones. It’s hard enough getting people to do the work without threats to their own safety.

​fesk

kawfire1817, Seroquel caused delirium for my mother in about the same time. Looking back, I do think the doctor was too aggressive increasing the dose. Again, it can take weeks to see an improvement. Switching the medications quickly can escalate the issues and create more outbursts.

I've been through this with my mother (not in geripsych but at home) and realize how difficult it is. I wish you the best of luck.

Keep us posted.