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Suggest Treatment And Medication For Frontal Lobe Dementia And Early Alzheimers

Posted on Tue, 6 Jan 2015

Question: I am a 72 year old female. I have been diagnosed with frontal lobe dementia and early Alzheimers. My symptoms are anxiety, and no motivation or ability to do anything. My husband dresses me, feeds me, and gives me medicine. I am on Gabapentin 3 times a day about 900 mg, and mirtzepene 15mg at night. I use ativan to help with anxiety about 2 mg a day. Recentlly the doctor has talked about effexor xl for my condition. I want a second opinion on the medication listed for my age and condition..

Answered by Dr. Shubham Mehta (57 minutes later)

Brief Answer:
Effexor XL is safe for your age.

Detailed Answer:
Hello
Welcome to HCM.

I have read your query and understand your concerns.

First regarding your query about effexor: It is relatively safe in depressive patients of your age. But the most important things to take care of with effexor are BLOOD PRESSURE (it can cause hypertension in some cases in higher dose above 150 mg) and HYPONATREMIA (it can cause low sodium levels if kidney functions are already compromised).

If you dont mind, I would just elaborate on two more points regarding your health issues and its management:

1. In my opinion, an increase in dose of mirtazapine would be a preferable action if you are tolerating 15mg well with no therapeutic effects. It can be dosed to as high as 45mg provided the person tolerates it.

2. About frontal lobe dementia: You have mentioned that you have no motivation to do anything. This could be due to frontal lobe dementia itself or could be superimposed depression.
If this is due to frontal lobe dementia, it will show poor response to any antidepressant.

If you also have sad mood, hopelessness, decreased interest in work, no pleasure from anything, worthlessness, these feature are suggestive of superimposed depression. The antidepressants might help in this case.

You can discuss these issues with your treating doctor.
Any drug/dose changes are to be strictly made under your doctor's supervision.

Hope this helps.

Any further queries are most welcome.

Kindly close the discussion if you are satisfied with the response and please give your valuable feedback.

Wish you good health.

Thanks.

Dr. Shubham Mehta.
M.D. (Neuropsychiatry)

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Shubham Mehta (1 hour later)

Doctor, thanks so much for your reply. Our doctor, who is a psychiatrist, seems to be at a loss as to how to handle my wife's illness. To be honest Ativan is about the only med that seems to help her anxiety. She does not like to leave home or the security of home and if we go anywhere she will ask to go back into the house as soon as we back out of the garage. She sleeps a lot and always wants someone in the bedroom with her.. She has been on Namenda and the other alzheimer drugs. The mirtzapene seems to have helped her anxiety some. The Gabapentin is a mystery and seems to not have helped or not helped. Why would a doctor prescribe it for our condition. So the Mirtzapene and ativan seem to help the most with the anxiety. Her memory is ok but she gets lost easily when leaving home.
What about the gabapentin, is it helpful in anyway. Thanks for your reply.

Answered by Dr. Shubham Mehta (12 minutes later)

Brief Answer:
there is no role of gabapentin in your case.

Detailed Answer:
Glad that my advice was of help to you.

In my opinion, There appears no reason for prescribing gabapentin to your wife.

If Mirtazapine and ativan are helping enough in anxiety, there is no need to switch to effexor.

For decreased memory, nootropics like piracetam can be tried. These are safe and might show some improvements in memory.

But please donot make any changes on your own. Talk to your treating doctor first.
Hope this answers your query.
Feel Free to ask any more questions.
Take care.
Thanks.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Shubham Mehta (16 minutes later)

Doctor, you have been so helpful. Your information is more detailed than I have had in the past and I appreciate that. If we discontinue Gabapentin would I notice any difference in her behavior. This medication seems to be a pet medicine of his as he has many other patients on it also. He calls it a mood stabalizer. I have never been able to get a positive response on it even from my pharmicist. It is a puzzle and I just didnt understand the need for it. I will keep in touch with you and probably will go to another doctor for a complete review of our meds.

I believe you are correct in the fact that with frontal lobe dementia she has really not shown any response to an anti depressant. Is there a medication that could help in this area?

Answered by Dr. Shubham Mehta (19 minutes later)

Brief Answer:
gabapentin can be discontinued without any problem

Detailed Answer:
I am happy that i was able to help you.

He is right when he says that gabapentin can act as a mood stabiliser. But i must tell you that if we have to give a drug for mood stabilization, there many better options over gabapentin. Infact gabapentin is a fourth line mood stabilizer or probably beyond that.
Gabapentin has some anti-anxiety and sleep inducing properties as well.
Since she is taking 900mg of gabapentin, withdrawal from it may cause slight insomnia. But a gradual downward tapering of dose (under your doctor's supervision) would probably not cause any problems.

Regarding treatment of frontal lobe dementia per se, i feel sad to say that there are no appropriate treatments for this condition. At the most, escitalopram or sertraline can be tried for her if not given earlier.

You are most welcome with your queries anytime. If you wish, you can ask a direct query also at your convenience.

Happy to help you.

Thanks.

Dr. Shubham Mehta.

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Raju A.T