Risperidone for ALZ

LB3 · June 15

I'm seeking advice about starting my 76-year-old mother, who has Alzheimer's, on Risperidone. I’m aware of the many risks associated with this medication, and I’m struggling to make a decision. From my research, it seems like Risperidone can be a gamble—it can either work as a miracle drug or potentially cause Parkinson-like symptoms, stroke, and speed up mortality. Previously, we tried Seroquel, but it made her dizzy, increasing her fall risk, even though she typically has excellent mobility and balance for her age.

I should mention that over the past month especially, I've noticed an intensification of her symptoms. She has expressed suicidal thoughts, self-harmed by kicking a pot and cutting her foot, become more aggressive, experienced bipolar-like mood swings, had a couple hallucinations, and spiraled into emotional despair. She is currently in assisted living. Her current state is very concerning and I'm worried that she may become unmanageable for the staff as well.

The other suggestion from her doctor is to try Klonopin which also sounds like it causes dizziness. This feels like an impossible decision and any insights or experiences with using Risperidone or Klonopin for managing such symptoms in Alzheimer's patients would be greatly appreciated, thank you!

harshedbuzz · June 15

@LB3

The risks for Risperdal are going to be very similar to those of Seroquel as they are the same class of medication; both are atypical antipsychotics. That said, some people will fare better on one rather than the other making it worth a try if her current mood and behavior are impacting safety and quality of life. At the end of the day, it's a risk/benefit situation you have to weigh the risk of a fall vs a miserable quality of life.

Klonopine is a benzo and, IMO, best reserved for "as needed" or situational use rather than as a daily medication. Klonopin comes with a risk of dizziness, as well as risks around addiction and tolerance. One way in which benzos can be used is as a bridge during a trial of a new medication to provide a level of calm as the new medication becomes effective— a low dose would be prescribed with something like Risperdal or an SSRI and then weaned after 2-4 weeks.

HB

Jeanne C. · June 15

Risperidone has been a game changer for us. My husband was hallucinating, having delusions, confabulating, agitated, and, frankly, mean before risperidone. We've had to increase dosage a few times, but there is no way we could have carried on like we were. I definitely feel the results have outweighed the risks. The hallucinations and delusions are managed. He's never going to get better so I will do anything I can to keep him calm rather than letting him suffer anxiety and agitation.

LB3 · June 16

Thank you both for your thoughtful responses, I truly appreciate them!

Jo C. · June 18

Best approach with these types of meds - start low and go slow . . . . much easier to assess and then if all if good, can increase. Every patient is different in how they will respond to meds.

Risperdal was something I resisted strenuously; I was so worried about side effects with my mother. However, it was necessary to prescribe as she was over the moon with dementia effects. To my utter surprise she did great and much of herself was pretty much restored. Yes; she still had dementia, but her behaviors and some capabilities were much improved. Every person is different, that goes with med effects too. That is why I insisted with the MD that the med be prescribed in low amount and adjusted slowly if and as needed. Worked great and what a positive difference for my mother. I was so grateful for her positive reaction.

J.

Jackie M. · June 24

https://alzconnected.org/discussion/comment/213171#Comment_213171

Thank you for your insight. I have been resisting giving my mother Seroquel. You state she is doing great but was there a period of adjustment? Was she in a sedated like state the first few days/week?

Thank you!

towhee · June 25

I second Jo C. Start low and go slow and monitor.

fesk · June 28

I think the thing to remember is all of these drugs carry risks and everyone reacts to them differently. There were several tried for my mother that she could not tolerate. I agree with all above, start at a very low dose and increase very slowly tracking all changes.

Kozoveetch · June 29

Okay, this might seem kind of obvious, and in all likelihood it's been addressed, but has she been checked for a UTI? Behaviors you're relating are not inconsistent with a raging UTI. As to risperidone, I am now just looking and asking similar questions for my dad.

Risperidone for ALZ

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