Brief Answer:
Prednisone typically not known to cause improvement in dementia

Detailed Answer:
Good evening. My name is Dr. Saghafi and I am a neurologist from XXXXXXX Ohio and would like to add a comment to your observation.

Typically and classically speaking- the use of steroids such as prednisone is generally believed to be somewhat risky to use in a person with dementia. Steroid psychosis is a well described phenomenon seen in people even with dementia when they take steroids. In demented patients there is definitely a larger than normal risk for worsening of dementia. Therefore, the best medical explanation of what happened in your husband's case is coincidental at best. Of course, one way to test your theory is to withdraw the steroid with the expectation that his mental status would revert back to a more negative level.

Then, reintroduce the steroid to see if his mental status positively responds again. If it responds twice consecutively then, that would certainly be much more compelling evidence that the medication was doing something of positive value to his mental status.

Having said all that...I certainly don't want to be a naysayer and believe that you witnessed something in your husband's improvement in his mental status. However, one other point to consider. Currently, modern thinking is that the dementia noticed in Parkinson's Disease is not a separate type of dementia as was previously believed. It has always been referred to as Parkinson's Dementia, however, now we believe that the dementing process in association with Parkinson's disease is really ALZHEIMER'S DISEASE. It is quite clear that prednisone is NOT a drug of choice for Alzheimer's. In fact, there is evidence that steroids make Alzheimer's disease worse. I would not recommend taking more prednisone in your husband's case.

I don't want to be negative and suggest that you are harboring "false hopes" and will agree that anything is possible, however, again I have no explanation for why prednisone should cause an improvement to any great extent of your husband.

Has your husband's Free Thyroxine and TSH levels measured recently? How about his Vit. B12, folate, and D?

I hope this answer satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with some written feedback?

Also, if there are no other questions or comments, I'd appreciate it greatly if you would CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary.

Please direct more comments and questions to me in the future at:

bit.ly/drdariushsaghafi and I would be honored to answer you and continue this discussion.

All the best.


The query has required a total of 20 minutes of physician specific time to read, research, and compile a return envoy to the patient.

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Brief Answer:
Possible Grade 1 effect per Rome & Braceland

Detailed Answer:
Good afternoon. I did some more investigative digging since I do believe you are accurately portraying what's going on in your husband with the prednisone and here's what I found. By and large (meaning, "the vast majority") authors talk about all the NEGATIVE COGNITIVE effects of corticosteroids in terms of decreased memory function, psychotic behavioral changes, and depesonalization syndromes. However, in the Grading system of Rome and Braceland they've described a SPECTRUM of clinical manifestations of patients who take corticosteroids such as prednisone. And actually, as it turns out one of the first levels of their heirarchy of presentations talks about an "increased sense of intellectual capacity." Once we get into Grades 2-4 of how patients present who are taking steroids....well, suffice it to say that "All Hell Breaks Lose" and I think that is why most doctors and training students are all so sensitized to the STEROID PSYCHOSIS side effect of prednisone. The truth of the matter is these different stages or Grades as described in their work...are apparently DOSE DEPENDENT. So that in smaller doses of <30-40 mg. daily patients tend to be at Grades 1 or maybe a little bit of the next level....whereas those on much higher doses end up being on the latter end of the Grading Scale and that's when you get all the bizarre behaviors, the hallucinations, poor short and long term memories, poor abstract thinking, and even psychotic symptoms that can be downright frightening in some cases.

Of course, those perturbations occur at the higher dosing constructs of the drug and because responses are so dramatically bad on the whole....people tend to remember them more. You don't necessarily hear too much about the people who are on very low dose steroid daily (5-10 mg.) and actually do not just well and tolerate it...but may even appear to be more robust and attentive to things making them appear and feel more cognitively capable, brighter, more awake.

Well, there's a reason for that....prednisone in the lower doses of 5-30mg. daily will stimulate dopamine receptors as well as cortisol from the adrenal gland. These chemicals and chemical reactions are well known to make people feel more alert, with more vigor and energy, and in general more intellectually charged and ready to go. So, in small doses we get GOOD...maybe even VERY GOOD results. I think that is exactly what you're seeing. Your husband for all intents and purposes is at that Grade 1 level of the Rome/Braceland Scale and so his improved sense and actual performance cognitively is improved.

The sad news, however, is those two researchers also discovered that after a shorter period of time (few months) the effects plateau'ed and then, over more time the effects started to wane just a bit.

Bottom line.....I think what you're seeing is real....but even if you continued the medication at its dose you will notice that the effects will stabilize after a few months then, start to decline. In other words, try as we may...we just really can't beat Mother Nature.

Now, here's something else to consider. If he Parkinson's disease then, tell me if he's ever been on Symmetrel or AMANTADINE. It is frequently used along with your dopamine drugs such as Sinemet to make the symptoms of tremor, rigidity, and stiffness better when it appears that Sinemet is no longer doing a job. Amantadine is known to rev up the GLUTAMINE pathway in the brain which can accelerate both mental and physical functioning when it comes to both Parkinson's as well as cognitive symptoms. However, the other side of this sharp sword is that using even small doses of steroids in an elderly person with both symptoms of dementia and Parkinson's for long periods of time could give us short term results but give us even WORSE RESULTS in terms of cognition if you were to either increase the dose or just continue it for more time.

One day we may find the way to really extend that Grade 1 type of phenomenon to people such as your husband so that he can benefit from the prednisone AND be able to safely continue to take it long term and still maintain the high clinical efficacy from the beginning when he first started to take the drug.

You're not imagining anything...it does work as you say it does...now we just need to know how to harness its benefits without risking any of its long term side effects.

I hope this answer satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with some written feedback?

Also, if there are no other questions or comments, I'd appreciate it greatly if you would CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary.

Please direct more comments and questions to me in the future at:

bit.ly/drdariushsaghafi and I would be honored to answer you and continue this interesting discussion. But for now, I would not recommend the use of steroids on a long or short term basis if cognitive function and its stability over time is of concern to you.

All the best.


The query has required a total of 43 minutes of physician specific time to read, research, and compile a return envoy to the patient.

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