Doctors Say Medication Is Overused in Dementia

[flashl]

Ramona Lamascola thought she was losing her 88-year-old mother to dementia. Instead, she was losing her to overmedication.

Last fall her mother, Theresa Lamascola, of the Bronx, suffering from anxiety and confusion, was put on the antipsychotic drug Risperdal. When she had trouble walking, her daughter took her to another doctor — the younger Ms. Lamascola’s own physician — who found that she had unrecognized hypothyroidism, a disorder that can contribute to dementia.

Theresa Lamascola was moved to a nursing home to get these problems under control. But things only got worse. “My mother was screaming and out of it, drooling on herself and twitching,” said Ms. Lamascola, a pediatric nurse. The psychiatrist in the nursing home stopped the Risperdal, which can cause twitching and vocal tics, and prescribed a sedative and two other antipsychotics.

...

Not until yet another doctor took Mrs. Lamascola off the drugs did she begin to improve.

The use of antipsychotic drugs to tamp down the agitation, combative behavior and outbursts of dementia patients has soared, especially in the elderly. Sales of newer antipsychotics like Risperdal, Seroquel and Zyprexa totaled $13.1 billion in 2007, up from $4 billion in 2000, according to IMS Health, a health care information company.

NY Times

[midnight]

1. Very interesting.

[patrice]

2. Yep. Been there; seen that.

My mother-in-law died a few months ago. She WAS 88, so there were health issues, but I'm still pretty uneasy about how morphine is used to manage the demented.

[Cassandra]

3. My mother's doctor tried Depakote on her...

since her forgetfulness exacerbated her tendency to rage. He hoped it would calm her but it seemed to have short circuited her cognitive ability and, even though we took her off it after a few days, she now has parts of days when she doesn't recognize my father, which makes her very upset because she then thinks he's gone off somewhere (he's not having fun with it, either). I went to visit last month and she mostly knew me with no problem but there were several times when she very pleasantly talked about me, to me, as if I were someone else. It's a real Twilight Zone kind of feeling.

[patrice]

4. We're taking care of my Mother at home, but even with nurses in the family, fine-tuning the meds

is THE BIGGEST problem and with my Dad, sometimes it lead to Crises in which we had to take him off of everything and start over. That required a hospital stay, because doing that is life-threatening in iself. Dad passed-on, hopefully, we'll be able to take what we learned from him and do better for Mom.

[enough]

5. I am a minority view on this. Seroquel has been a blessing for my father.

He's 87, physically very healthy but with quite advanced Alzheimer's. After consultation with a geriatric psychiatrist and a neurologist, he was prescribed a low dose of Seroquel starting about two years ago.

Without this drug, his mental suffering was acute, and his rage, paranoia and hostility were such that he would not have been able to continue living at home. He's a big strong man and my mother was tiny and frail. He was a danger to her, and would have had to go to a facility of some kind.

With the drug, was able to live at home for another year and a half, eating at the family table and sleeping in the same bed with my mother where they had slept for 60 years.

I realize that others have had a different experience, but in some cases the drug is appropriate.

[stray cat]

6. I've also seen medication allow my dad with Alzheimers to live with family until he died

Otherwise he might have hurt someone.

[xiamiam]

7. the drugs take away their will to survive..go to any nursing home or assisted living

facility...its a double edged sword...but i firmly believe that an older more fragile brain is unable to handle the daily dose of whatever they are experimenting with that day...long story short here about my mom...my 91 year old mom became agitated...got up out of her wheel chair and was walking over mountains in her mind as she walked the halls of the assisted living facility..i could not reel her in...delusional...the only way i found out what new drugs they had put her on was to get a new weekend staff person to get the chart and read me the side effects...(3000 miles apart)...i called her doctor immediately afterward on saturday and said to take her off those drugs which they had prescribed to calm down her agitation..long talk followed telling me that the mom i knew would never be there again...so what, take her off the drugs...within 2 weeks my mom was out of the deluded world...she did die a few months afterwards..her final act of independence in that she refused to eat..but we had the most meaningful conversation of our lives two days before she died..so there goes the theory that she would never come out of the prescription induced world they had trapped her in...i visited the assisted living facility as regularly as i could from the distance i live...and noticed the difference in the people from when they arrived and after being there for just a few short months..primarily, will to survive is gone...that being said, she was lovingly cared for by the staff..whaddya do?..just typing this brings up the heartache..

[Celebration]

9. and people wonder why our health care costs are so high

These drugs are terribly expensive, and we spend a ton as a society on drugs that put people in the last year of their lives in la la land. I am so glad you had that talk with your mom............ Whaddya do? It will take a complete change of mindset by patients, their families, the doctors, AND those entities that pay for prescriptions to make a difference.

[trotsky]

8. Medication is overused on almost every condition. However,

this is not something that can be totally blamed on doctors or even "big pharma." Many patients and/or their families DEMAND medication, even in instances where it's unnecessary or cannot help. Doctors are then in a bind - if they withhold the meds, will the patient leave to find a doctor with lower standards? Or just leave medical care behind? If they go ahead and give them the meds, if there's risk of side effects, what then? I don't envy professionals in that position, because they simply cannot win.

[HysteryDiagnosis]

10. Dementia.....

Pycnogenol, Lipoic acid, DHA, Vinpocetine and others.

http://www.lef.org/protocols/neurological/mild_cognitive_impairment_01.htm

Diet. In one prospective study, more than 500 participants age 55 or older without clinical symptoms of dementia were evaluated. Their diets were assessed at the onset of the study, and participants were screened for symptoms of dementia an average of two years later. After adjusting for other factors, participants with the highest total fat intake were found to have a significantly elevated relative risk of dementia. An increased risk of dementia was also associated with a high dietary intake of saturated fat and cholesterol. On the other hand, a high intake of fish was associated with a significantly lower risk of dementia (Kalmijn V et al 1997). These findings have been supported in several other studies (Solfrizzi V et al 2005; Solfrizzi V et al 2003; Solfrizzi V et al 1999; Panza F et al 2004; Capurso A et al 2000).

Inflammation. The theory linking inflammation to cognitive decline is relatively new, but it appears to be consistent with our increasing understanding of the damage of chronic inflammation (as measured by C-reactive protein or interleukin-6 levels). Various studies have examined the association between inflammation and mild cognitive impairment and found compelling evidence. For example, one study of 2632 participants (mean age: 74 years) found that people who had both metabolic syndrome and high inflammation levels were more likely to experience cognitive impairment than were patients who suffered from neither. Metabolic syndrome is a cluster of abnormalities including high blood pressure, high insulin levels, obesity, and abnormal blood lipid levels. It is closely associated with increased risk of heart attack and stroke. In contrast, those with metabolic syndrome and low inflammation were not at increased risk of mild cognitive impairment (Yaffe K et al 1998).

Free radical damage. Free radicals are highly unstable molecules that react with other molecules in a damaging process known as oxidation. Areas of the body with high energy output, such as the brain, are particularly vulnerable to damage from free radicals. The body normally defends itself against the harmful effects of free radicals with antioxidants, including superoxide dismutase and glutathione peroxidase, as well as vitamins C and E. Animal studies have suggested that diets high in antioxidants can delay age-related memory loss (Joseph JA et al 1998; Perrig WJ et al 1997).