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Suggest Treatment For Dementia In An Elderly Person

Posted on Wed, 28 Sep 2016

Question: My mother is treated for psychosis and dementia. She has been under varied medicines in the last ten years. Now she takes pramiprax 0.125, pacitane and donep in the afternoon pramipax 0.125 and arip mt 5 pramipax 0.125 and lonazep and pacitane in the night. The pramipax is added in the last one month when she refused to eat. However since the last few days she has stopped taking food. She only takes somes drinks with a straw. Dont know how long can she be sustained like this. Pl advise. She has also become very aggressive. She is 72 years old.

Answered by Dr. Seikhoo Bishnoi (1 hour later)

Brief Answer:
Dose of Pramipaxole should be reduced.

Detailed Answer:
Hello thanks for asking from HCM for your health related doubts.

She is on treatment for psychosis and dementia and is on Pramipaxole 0.375, Pacitane 4 mg, Donepezil, Aripiprazole and Clonazepam.

Pramipaxole is one drug that is associated with significant nausea, reduced appetite and is known to cause weight loss. The drug could be the possible reason for her reduced appetite. Pramipaxole is commonly used for Parkinson's disease and some times in resistant depression also.

Did she show any symptoms of Parkinson's or any drug related adverse effects in past?

Why she was prescribed Pramipaxole?

Reducing the dose of Pramipaxole should improve her appetite. If Aripiprazole is not able to control her aggression then other stronger antipsychotics like Olanzapine or Quetiapine can be used. These drugs will improve her aggression and will improve her appetite too. The drugs are safe to use and can be used at her age too.

You can discuss about these drugs with her doctor.

Thanks, Take care

I hope this helps, please don't hesitate to ask again for more doubts.

Above answer was peer-reviewed by : Dr. Priyanka G Raj

Follow up: Dr. Seikhoo Bishnoi (48 minutes later)

Thank you sir for the response. In fact the doctor had reviewed her physically and prescribed pramipaxole. She was physically sluggish and was not talking significantly. After pramipraxole she is stronger and louder but has become aggresive and refuses to take food. She is somewhat better after taking arip mt 5 in the night. Can arip mt 5 be given in the morning as well? shall be seeing the doctor XXXXXXX Let me discuss with her.

Answered by Dr. Seikhoo Bishnoi (1 hour later)

Brief Answer:
Yes Aripiprazole can be given in morning.

Detailed Answer:
Hello again and thanks for asking a follow up.

Pramipaxole can cause reduced appetite and you can ask her doctor for review. Arip MT usually cause slight insomnia so yes the drug can be given in morning even it would be better if you give her this drug in morning.

Consult your doctor and follow up with me again.

Take care

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Seikhoo Bishnoi (5 hours later)

Thank you sir. Just consulted with her doc. She has advised for quitin 25mg. My mother has a history of seizures from the usage of schizopin. I hope this drug is safe. Another change after using pramiprax is saliva continuosly pouring from the mouth. Anyway shall be meeting the doc in person to further discuss and shall update you tomorrow.

Answered by Dr. Seikhoo Bishnoi (3 hours later)

Brief Answer:
Quetiapin 25 is relatively safer.

Detailed Answer:
Hello again

Sizopin or Clozapin is known to lower the seizure threshold and precipitate the seizures but Quetiapine is relatively safer though some risk is there. 25 mg dose is a lower dose and should help her in sleep and her appetite should definitely improve. Discuss with her doctor and if possible ask for reduction of the dose of Pramipaxole. Donepezil in some individuals can cause increased salivation but in high doses. Mention this to her doctor too.

Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Seikhoo Bishnoi (20 hours later)

Sir, just had a consultation with her doctor. Her doctor has increased the dosage of donep to 10mg and has stopped pramiprazole for the time being. Is there is any side effect of increased donep? She is not taken too much solid food. Hope these medicines dont work on the adverse.

Answered by Dr. Seikhoo Bishnoi (3 hours later)

Brief Answer:
Donep is safe to use.

Detailed Answer:
Hello again, thanks for asking again

Good that Pramipaxole has been stopped.

Donep is used for dementia and the drug is a safe drug, can be used safely in elderly. Increasing the dose might cause increased salivation, nausea, diarrhoea etc symptoms. Otherwise there are no other serious side effects.

If she develop loose stools or complains of nausea then report to her doctor again.

Thanks, Take care

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

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar