Doctors' Answers to "Frequently Asked Questions" - Dementia

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Elaborate Dementia and Medical Problems [posted 11/18/98]
Question: My question is really more complicated than I am certain there is time to ask here, but I'll try to be succinct. In February of 1996, my father, who is now 49, was admitted to a hospital for what was believed to be dehydration and exhaustion. It turned out he also needed his gall bladder removed. Following the operation, which healed nicely, he and my family were informed that it was believed he was HIV+ and would die soon, as he had an infection - pardon the spelling - called cryptosporidial meningitis. As it turns out he is still living. Infectious disease specialists at Vanderbilt University in Nashville, TN, told him that there was no way he could have been HIV+ and that the hospital he was in used outmoded criteria to make their diagnosis. They also could not find HIV in his bloodstream with repeated tests, even sophisticated ones. Regardless of all this, my chief concern now is for his mental health. Since his illness and subsequent hospitalization, he has behaved disturbingly. His personality, however you choose to define that, is *drastically* different. He has a spitfire temper and a foul mouth. He drives recklessly, has no patience with anyone in my family, and frequently lies to us about his activities and where he has been. Moreover, he is also *very* confused, for lack of a better word, about the details of his life, his family life, his early childhood, and other key pieces of information it is not outside the realm of reason to expect him to remember at his age. To top it all off, I am convinced, and have been for some time now, that he is delusional. The list of evidence I have pointing me in this direction is long. I'll just mention a few key  things he's told me since his illness that lead me to believe this. First, he believed shortly after he was released from the hospital that he had the stigmata of Jesus Christ on his wrists and ankles. I examined them and noted some discoloration but I just can't believe it wasn't due to his hospitalization for over 2 months. And for several years now, he has intimated that he *actually* believes he is the secret member of the Romanov family in Russia. This particular belief has gone on for probably 5 years now, and he still mentions it. Additionally, I believe that he fantasizes about knowing famous/important people. He works (and does a good job) at a  car rental agency. In that time, he has told me and my mother in conversation that he knows and is buddies with Rick Pitino (former U of Kentucky basketball coach), and that he frequently has long conversations with William Shatner (i.e., Captain Kirk of Star Trek Fame). He has also told my mother that William Shatner told him that he has AIDS and is dying. For the most part, my father functions relatively effectively, and has held his job for over a year now. He knows all of his family members' names and bathes and grooms himself appropriately. However, these other behaviors I have mentioned are beginning to overwhelm us. We are, to put it simply, concerned that he is a danger to himself and to other people. And trying to confront him, even politely, about the inaccuracy of his stories only leads to indignance and denial of any problem or deficiency on his part. He also refuses to go to a physician of any sort, and jealously guards the medical information we do have about him. This makes explaining the problem on a service like this even more difficult, but nonetheless necessary. I am frankly beginning to wonder if he needs to be institutionalized, and I don't mean at a nursing home. If so, I do not know how to proceed. My family and I would really appreciate any advice, information, or suggestions anyone could give. I have tried to research this on my own, but don't really know what to look for in a library. His physician has told my family that he does not have AIDS, so I can't really look at this as some form of AIDS-related dementia. Any response at all will be appreciated. Thanks.

Answer: He certainly needs to be examined -sounds like a psychosis. However, what were the results of the lumbar tap ? I can't believe that they would make the meningitis diagnosis without some data. You need a neurologist and a psychiatrist, maybe an infectious disease specialist. If your dad won't cooperate, most states have committal laws for this circumstance. It usually requires 2 physicians, check with his primary doctor.

Dementia & Alzheimers Disease [posted 11/10/98]
Question: My father is 80 and has stroked induced dementia and some form of alzheimers. He is on 20 mg of Aricept, this drug worked well until this past 6 months. His gallbladder had to be removed and since then his memory, desire to live, bath or eat have been lost. He also frequently wants his mother and father. I am at a loss, I am the only child, and the only caregiver available. I am now afraid to leave him for longer than a quick errand. I have not had a day off in over 3 months. He is a physically, an extremely healthy man, yet, mentally he is regressing. Please, tell me what I need to do or where to turn. Thank you.

Answer: Hard to know if it is a continuation of the Alzheimer's decline or another problem superimposed on the previous dementia. I would vote the latter and check with his physician for a complete evaluation. If it is the Alzheimer's there probably won't be much improvement, so look for other causes. Even something as a small urinary tract infection will tip these patients over.

Dementia caused by medications
Question: I am doing research for a book, and am curious to know if it is possible to have Alzheimer's-type dementia with administration of benzodiazepines in a sufficient dose? If not, is there any medication that would cause such symptoms? Is it possible to receive a diagnosis of Alzheimer's incorrectly with something such as drug overdose the culprit? Any information or references would be greatly appreciated.

Answer: Lots of drugs could mimic dementia, but not specifically Alzheimer’s Variety. A good examination would detect this, a cursory examination would not. Digoxin and seizure drugs would be high on the list. Other medical conditions would be hypothyroidism, B12 deficiency, hypercalcemia, hyponatremia. These are all rapidly reversible as opposed to many other types of dementia.

Dementia
Question: Patient has dementia, cannot sleep longer than a few minutes at a time, and wanders throughout the house. What would be the best sleeping medication to help?

Answer: This type of problem is common with dementia. Usually we start with haldol (haloperidol) for sedation and increase the dose until the right amount of sedation is achieved. That is, start at 0.05 mg and increase 0.05 mg until a maximum of 5-6 mg until sedation is reached. There is a newer sedative called risperidol which also works better tolerated, but is very expensive. If this doesn't work klonopin is usually tried next.
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