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Suggest Cure For Acute Dementia
Question: my father is taking belsomra 5mg and instead of sleeping he gets up middle of night and is constantly walking and won't calm down. He is screaming at the caregiver. He was also prescribed risperidone to calm him down. what is wrong with him? He is 94yrs. old and has acute dementia
Brief Answer:
Read below.
Detailed Answer:
I read your question carefully and I am sorry about what is happening to your father.
I must say first that the term acute dementia needs a little clearing. Usually dementia, the most common Alzheimer's disease, is chronic over many years. It may have reached now a stage where it is decompensated, where there are episodes of delirium, psychosis, agitation, but the process starts long ago. Otherwise if you really think it's acute, then blood tests and imaging tests are necessary to determine the cause, as acute onset is usually due to treatable a metabolic issue or stroke.
If indeed it is a case of Alzheimer's, then the mainstay of treatment is acetylcholininesteraze inhibitors like donepezil/rivastigmine/galantamine which at advanced stages are combined with a drug called memantine.
Regarding the treatment of agitation and psychosis I do agree with the choice of risperidone. Personally I have had better efficacy with a drug called quetiapine, but belonging to the same group as risperidone anyway, its use in the evening should help his sleep and prevent those episodes.
However for anxiety I personally prefer antidepressants of SSRI class like citalopram. Drugs like risperidone have many side effects and do not improve cognition itself they are used only to control thr patient when it's difficult to manage, so should be used as rarely as possible in the lowest possible dosage.
All that being said it should be discussed with the neurologist and the type of dementia be precised. There are several types and causes, management can vary, I am addressing Alzheimer's as by far the most common.
I remain at your disposal for further questions.
Read below.
Detailed Answer:
I read your question carefully and I am sorry about what is happening to your father.
I must say first that the term acute dementia needs a little clearing. Usually dementia, the most common Alzheimer's disease, is chronic over many years. It may have reached now a stage where it is decompensated, where there are episodes of delirium, psychosis, agitation, but the process starts long ago. Otherwise if you really think it's acute, then blood tests and imaging tests are necessary to determine the cause, as acute onset is usually due to treatable a metabolic issue or stroke.
If indeed it is a case of Alzheimer's, then the mainstay of treatment is acetylcholininesteraze inhibitors like donepezil/rivastigmine/galantamine which at advanced stages are combined with a drug called memantine.
Regarding the treatment of agitation and psychosis I do agree with the choice of risperidone. Personally I have had better efficacy with a drug called quetiapine, but belonging to the same group as risperidone anyway, its use in the evening should help his sleep and prevent those episodes.
However for anxiety I personally prefer antidepressants of SSRI class like citalopram. Drugs like risperidone have many side effects and do not improve cognition itself they are used only to control thr patient when it's difficult to manage, so should be used as rarely as possible in the lowest possible dosage.
All that being said it should be discussed with the neurologist and the type of dementia be precised. There are several types and causes, management can vary, I am addressing Alzheimer's as by far the most common.
I remain at your disposal for further questions.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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