Medications and Lewy Body Dementia

There are so many different medications out there promising the world today.  There are also, still, those in the medical field who believe that all dementias are Alzheimer's related and can be treated the same.  This is a dangerous belief!  They are not all the same, nor can they be treated as such!  One must be aware of the differences between the types of dementias and the drugs associated with each in order to keep their loved ones from any more harm.

Remember, Alzheimer's is caused by a misfolding of the BetaAmyloid Proteins in the brain.  Lewy Body and Parkinson's are caused by Lewy Bodies, or Alpha-synucleic Acids wreaking havoc on and in the brain.  Different causes mean different means of treatment.  Treat an LBD patient for AD and you may have a wrongful death lawsuit on your hands.  Be Aware!

The following are drugs that ARE NOT for use with LBD patients.  This is a list of Anti-psychotics that are traditionally used, but are not to be used for the LBD patient:

chlorpromazine (Thorazine)

droperidol (Inapsine)

fluphenazine (generic only)

haloperidol (Haldol)

loxapine (Loxitane)

molindone (Moban)

perphenazine (generic only)

pimozide (Orap)

thioridazine (generic only)

thiothixene (Navane)

trifluoperazine (Stelazine)

- See more at: lbda.org

The following is a list of Atypical Antipsychotics that could be helpful if used conservatively:

aripiprazole (Abilify)

clozapine (Clozaril)

fluoxetine & olanzapine (Symbyax)

iloperidone (Fanapt)

olanzapine (Zyprexa)

paliperidone (Invega)

quetiapine (Seroquel)

risperidone (Risperdal)

ziprasidone (Geodon)

- See more at: lbda.org 
 
The following is a list of medications used in treating LBD as of 04/2014.

Purpose                                                     Brand Name                    Generic Name

Balance Restoration                                Goedon                             Ziprasidone

Hallucinations, apathy, mumbled
speech                                                       Seroquel                           Quetiapine
                                                                  Zyprexa                            Olanzapine

Increase Serotonin                                   Celexa                            Citalopram                      

Depression and Anxiety                          Lexapro                           Escitalpopram
                                                                  Prozac                             Fluoxetine
                                                                  Zoloft                               Sertraline

Increase GABA#                                     Ambien                             Zolpidem

REM Disorder, Insomnia                        Klonopin                           Conazepam
                                                                  Restoril                              Temazepam
                                                                  OTC Melatonin

Absolutely NO HALDOL!!!!!

Increase Acetylcholine                             Aricept                               Donepezil

Enhance thinking and memory-                Exelon                                 Rivastigmine

manage visual hallucinations                     Razadyne                            Glantamine

Increase Dopamine                                 Sinemet                                Carbidopa/Levodopa

Anxiety, insomnia, and sometimes            Mirapex*                             Pramipexole*

painful movement

Helps with slower processing and             Neupro*                              Rotigone*

impaired attention                                      Requip*                               Ropiniole*

Increase Dopamine/Epinephrine/              Provigil                                Modafinil

Histamine

Daytime Sleepiness                                  Nuvigil                                  Armodafinil

                                                                   Ritalin                                    Mythylphenidate

                                                                  Adderall                                Dextroamphetmine/amphetamine

*= Prone to Side Affects

#GABA:  Gamma-Amino Butyric Acid is an amino acid which works as a neurotransmitter in the central nervous system.  It inhibits nerve transmission in the brain, calming nervous activity.     It is commonly sold as a natural tranquilizer.      

While the list may seem a bit dated, it still holds.  For those with a Side Affect, please either look them up or consult with your physician.  Be sure your medical team knows and understands the differences between the types of dementias.  Remember, they hold a life in their hands - this is not to be taken lightly!  If you must find another doctor, be sure to ask when calling if they understand LBD and proscribed treatments.  If they need to think, find another doctor.  It took me a bit to figure out where to turn but the stars were in our favor.

                      

Medications - How To Get Patients To Take Them

Mom, with her LBD, needs to take her medications.  She doesn't like them, and many times she doesn't want to.  However, she must.

I'm not sure how they handle it at St. A's, but I believe they hand them to her and wait while she does.  This is also with a glass of water in hand, which is easily refilled as she ingests.

When I have the medications, she wants to know what each is for.  So, I tell her.  The first one is for her (back) pain (or any other pain she's experiencing at the time) - that's the Vicodin.
    The second is for her eyes and to help stave off the macular degeneration - that's the Selenium.
    The third is for her anxiety, and to keep her calm and able to think clearly (this is the hardest one to sell) - that's the Quietepine  (aka Seroquel).

Now, Mom takes but three during the day.  In the morning, she also takes her Vitamin C and her pills for her blood pressure.  The VitC's are gummis, and she chews on those.  They're enjoyable - almost like candy.  Before, though, she had a terrible time swallowing the pills, even after they had been cut smaller.  So, the gummis work quite well.  I'm sure if we could find the other medications in that form they would go down much more easily!

The blood pressure medications she takes after they tell her what it is.  She may tell them she's healthy and doesn't need it, but take it she does.  Whew!

About a year ago, though, Mom had to take so many different pills after visiting the Optometrist.   There was an entire regimen of minerals and vitamins (over $100 worth) she needed to ingest just to keep the macular degeneration at bay.  Then the doctor told us just to take Accuvite, which has everything already in it and it's much cheaper!  So, Mom went from taking about 16 pills in the morning to about 7 (the gummis account for 4 of those).  Much better!

I also realize there are others who have troubles getting their loved ones or patients to take their medications, and aside from just handing them to them and waiting, there has to be something else.

If you're still interested in more reading on the topic, I've listed a few sites below for reference.  Good Luck!

When Dementia Patients Refuse Medication

Refusing To Take Alzheimer's Medication

How Do You Get An Alzheimer's Patient to Take Her Medication?

What To Do When Patients Refuse Medication?

Helping Alzheimer's Patients Take Their Medications

What Does the Doc Say?

Quite a busy week for Mom!

However, today is the topic for this post.

We went to Providence to see a new doctor, this morning.  What a difference!

After filling in the paperwork, and Mom needing to review everything I wrote (talk about nerve wracking - she used to try to disagree with my writing down the diagnoses from previous doctors, but today she was mis-reading most of what was there...odd).

For once, she allowed herself to be weighed, as I told her I would wait down the hall and around the corner to provide her privacy.  Later, she confessed her weight.  I'm not telling, but she wasn't happy with the number.

Now, the primary issues we wanted to discuss with the doctor were her pain in her hips and legs, as well as the swelling in her legs.  But first, the doctor wanted to get to know Mom, and to determine the depth of her LBD diagnosis.  Her answers came all through the examination!

Mom exhibited a bit of her condition (mental) when the doctor asked her some questions.  When she asked Mom something Mom would respond, mostly from her imagination.  The doctor would then glance at me and I would be mouthing, "NO!" or "YES!" while moving my head in accordance with the response.  The doctor would make a note and was quite respectful with Mom.

She probed and prodded where Mom stated she was having pain.  Mom would exclaim her pain, but then moments later when the doctor re-probed the same spot Mom would state there was no real problem with that area.

The diagnosis for her pain in walking?  Arthritis.

Next, we addressed her swollen legs.  She concluded this was, indeed, Edema.  She printed out an article for me on Edema, which explained that the cause comes from Mom sitting too much, and the veins and their parts were collapsing.

Here are two articles that she provided me through Mom's online chart on Edema:
Peripheral Edema: Bilateral      and
Peripheral Edema: Unilateral

She prompted Mom to get some compression stockings - Mom was not happy.  She hates those!  However, we may need to make a trip to find some.  Also, she was told that she needed to do as much walking about as possible, and to keep her feet elevated when seated, as in when she is using her recliner.  Mom said she did that already - I've not seen it, but I'm not there all the time.  She also liked the idea of the massages.  She wanted those kept up.

She also addressed Mom's sleepiness during the day.  She prescribed Melatonin, and I stated I would bring a bottle by this weekend, but we needed doctors orders in order for them to administer it to her.  She gladly complied.

The next step was for her to draw blood.  They need to run the tests to see if the Edema is linked to her liver, heart, or kidneys.  So, the assistant came in and drew the blood.  Mom loved the attention, but wasn't keen on the stab of the needle - which was instantaneous.

She also stated that there was no reason, at this time, for Mom to be taking her Donepezil (Aricept), as that was showing no effect.  If it was working, we would notice within a couple of weeks.   She stated that it works for about 20% of the population, and that for Mom it may have been a stop-gap measure, insofar as to slow the progression of the LDB, however at this stage, it was apparent there wasn't the need any longer (this was a little sad).

About the Quetiapine (Seroquel), she noted that the dosage was low, and may need to be increased.  We will find out quite soon, I'm sure.

So, we have a doctor who actually cares and pays attention!  What a difference!  Before we left, they linked me up to their system via my phone, and explained how to do it at home on the computer.  Simple!  And it has so much information!  I'm so grateful!

So, next week, I hope, we will have a few more answers.    Also, I'm hoping to hear from the neurologist in the near future, and if we can get the two of them to provide some sort of coordinated care, then we'll be doing much better - and there will be peace of mind.

Below, I have added a corny video for anyone who enjoys Ylvis, and the parodies on "What Does the Fox Say?"  This is for those who have a good sense of humor - especially those who have worked in the hospital environment.  Enjoy or ignore.

I'll be back around Sunday, with the week-in-review for Mom! And pictures, too!  Whoo Hoo!

http://youtu.be/yeu1zUf7Qlk