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Suffering from memory loss. MRI showed constriction of blood vessels. On reminyl, fuoxetine and cavinpon. Advise?

DOCTOR OF THE MONTH - Nov 2013
Nov 2013
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Hi my mother is 77yrs and is suffering from memory loss. She has done a MRI of the brain and blood tests. MRI has showed constriction of blood vessels in the brain. Her blood count is a bit low at 10 when it should be more than 12. Also
her cholesterol is 252 and her LDL is also high. Other blood test are normal. She is using the following once a day:
Reminyl 8mg
Cavinpon forte 4mg
Simvastatin 20mg
Aspirin coated 81mg
Fluoxetine 20mg
B Complex with iron
Could i get some advice or second opinion from a specialist in this area on this line of treatment. Thanks
Posted Sun, 7 Jul 2013 in Brain and Spine
 
 
Answered by Dr. Sudhir Kumar 5 hours later
Hi,

Thank you for posting your query.

I have gone through your mail and MRI brain reports.

As regards her memory loss, it seems to be a case of mild to moderate dementia. The underlying cause for the same include mild Alzheimer's disease (AD) and ischemia (lack of blood flow) to brain.

Treatment seems to be mostly along the correct lines. I have a few additional suggestions:

1. Memantine may be added. This medicine is very useful in cases of mixed dementia (combination of AD and ischemia), as in your mother's case.

2. The dose of aspirin may be increased, usually 150 mg or more is recommended.

3. Reminyl (galantamine) may be replaced with rivastigmine, which is more effective and safer. The additional benefit is rivastigmine may be given in the form of skin patch.

4. If vitamin B12 level has not been checked, it can be checked, and if found low, a vitamin B12 supplement may be started.

I hope it helps. Please get back if you have any more queries.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Above answer was peer-reviewed by
 
Follow-up: Suffering from memory loss. MRI showed constriction of blood vessels. On reminyl, fuoxetine and cavinpon. Advise? 24 hours later
Thanks or your reply. Could you recommend what strength should be used for:
Memantine and Rivastigmine. Also blood flow seem to be a critical. Is cavinpon 4mg per day adequate? Would this treatment result in significant changes? Is simvastatin 20mg ok? look foward to your reply
 
 
Answered by Dr. Sudhir Kumar 27 minutes later
Thank you for getting back.

Memantine is usually started at a dose of 5 mg daily, and increased to 10 mg per day later.

Rivastigmine is started at a dose of 1.5 mg twice daily and the usual maintenance dose is 3-6 mg twice daily.

Cavinpon 4 mg per day is adequate. But aspirin dose may be increased to 159 mg daily.

Simvastatin is ok.

She would get better with this treatment, even though complete recovery is unlikely.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Suffering from memory loss. MRI showed constriction of blood vessels. On reminyl, fuoxetine and cavinpon. Advise? 13 days later
Hi Dr S XXXXXXX Re to my mum BISSOONDAI GANNESS , i had contacted you with MRI scan. You had recommeded Memantine and Rivastigmine to be used as well.
Both myself and my mum live in Trinidad. These drugs are not available in Trinidad. I had gotten a doctor at home to write a prescription. However when i tried purchasing online and i sent in the prescription they were not seeing the doctor's name on their system or obvious reasons. What i am asking is if you could write a prescription for these medication so i can try to purchase these online with it. Also do you have any pharmacy sites you could recommend.
Look foward to your response. thanks
 
 
Answered by Dr. Sudhir Kumar 5 hours later
Thank you for getting back.
It would not be proper for me to write the prescription, as I have not examined the patient. You could get it written by one of the doctors in your locality.
Regarding availability, these are available in India. The local pharmacy can help you regarding how to get them in Trinidad.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
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