I haven't posted here in a while, I have just been to stinking busy with life. I have 2 busy sports minded teens, and work full time. But things with DH are heating up a bit. He is 48, dx 2 years ago. This anger thing has been building for awhile now and has not gotten any better. I have seen others mention avitan, what kind of drug is it and how does it help. Hubs is currently only on an anti-depressent and that is it. We also don't have a neurologist, our specialist moved out of the area so we are back to seeing out PCP. Hubs is prob stage 4, with moments of stage 5 creeping in there more and more. He gets so fired up, and in our 22 years of marriage I never saw him act like this!! It's so sad, yet very disturbing to me and the kids. So I need some advice on where to start and what to do. I figured this is the place to start.
For the younger victems risperdal or seroquel sometimes work wonders. Usually only a neuro or psych doc will order it. Sorry this is happening to your family. Let us know how things are going.
I am afraid most PCP's cannot help Alzheimer's Patients as well as neurologists with experience dealing with the disease. As samismom's husband gets worse, she should have a neurologist on board for the ride. Even if you see him or her once or twice a year, it's worth a trip. Then they can communicate with one another if you suddenly need a new Rx. If I didn't learn anything else, I learned how important it was to "plan ahead" or have a plan in place because bad things can happen very quickly, and then it's too late to check out doctors/facilities/options.
I went through Hell and back with Sid's rages, and I never would have survived without the neurologist putting him on Risperdal. It is not something a PCP can really do. I would highly recommend taking your husband to a neurologist or neuropsychiatrist who specializes in dementia. I travel 100 miles round trip to see our neurologist, but it's worth it. With dementia, anger can escalate quickly into physical violence, and you don't want to be dealing with that. I don't know where you live, but if you look up Memory Disorder Clinics - your State's name - in Google, you will get a list. I used to have a clinic finder on my home page, but that website was discontinued.
Joang is so right...The anger can get really bad really fast. My dh had been so sweet and easy to care for and a couple of weeks ago he just went off the deep end. I had to call the dr. on the weekend and send him to the ER. His neuro has now placed him on Risperdal and he is back to being easy to care far.
But, the neuro also put him on Ativan. I only give it to him if he seems to be getting very upset. So far in two weeks I have given him the Ativan two times. It makes me feel very comfortable to have this drug to give him when I see that he seems to be getting upset and I don't want his anger to be full blown.
My husband now sees a geriatric psychiatrist and she has him on seroquel and ativan. We first tried risperadal but that just made it worse. Sometimes it's a hit or miss on the drugs. Each person reacts differently to them. He is also on an antidepressant (cymbalta)
I agree with the others here that if anger issues are a problem, a neurologist, neuropsychiatrist, or geriatric psychiatrist would be the best type of physician to have on board. If there are no memory clinics in your area, I would check with the nursing homes with dementia units or any dementia-specific ALF's to find out if they can refer you to their specialists. At my husband's ALF, a geriatric psychiatrist visits once a week; I don't know if he takes private patients, but it would be a place to start.
Is the dx for AD or FTD or another dementia. Different drugs work differently with different types of dementia. Plus there seems to be a lot of variation within any type of dementia.
I think you need to work with your doctor(s) and try different drugs. Many Alz drugs cause problems with people with FTD, so starting with drugs that work with the type of dementia diagnosed first makes sense. Keep in mind that, I suspect, many dementias are misdiagnosed so you have to monitor the results.
In our case L's psychiatrist takes care of the medications, in consultation with the FTD expert neurologist. Our neurologist doesn't see L as often and, wisely, doesn't want too many doctors presiding drugs.
L is on anti anxiety medications, antidepressants, and mood stabilizers. Trazadone, which had bad side effects in the past, is now her most important drug and helps with agitation and helps her sleep through the night. She also takes Xanax, but we reduced that when we saw Trazadone was working so well (and we have had to increase Trazadone dosage during the past year). Paxil works as a mood stabilizer.
I don't have experience with resperadal and some of the other drugs mentioned here but they do work well with some people. Sometimes drug will help with aggression but have side effects and you have to decide if the benefits are worth the side effects.
I would suggest a good starting point would be to request request a referral from your PCP to an appropriate Neuro specialist in your area. if you have to go to a regional vs local resource, it's to your advantage to have your put local PCP In the loop and communicating with the specialist. Not knowing your Hubs specific Dx i don't have any comment on meds
Thanks for the help everyone. Hubs has EOAD, and I will have to get on board with a local neuro. Also several of you mentioned a psychiatrist. If I wanted to check into that would it be a geriatic psychiatrist even though he is only 48 year old?!? Things are calmer today, but that is always the problem, things come up suddenly and often out of no where. It doesn't help that we have 2 active busy teens and our house is far from quiet, the chaos of it all does make things worse for him. We have worked to make things calmer, but it's a busy time of life for our kids.
Thanks again for the continued insight, it is so helpful, I feel that i have better insight when I do get in to see a neuro.
Start with the neuro who specializes in memory disorders, and he/she will either be able to prescribe the correct meds. or refer you to the appropriate psychiatrist - neurospych.
samismom--yes, a geriatric psychiatrist is appropriate (when dementia is present), regardless of the age of the patient. I was also surprised to find out that a geriatrician was helpful for my husband, rather than a regular internist, although he was early 60's at the time. They are more familiar with how drugs for other conditions affect a patient w/dementia. Our internist is very good, but Steve was the first dementia patient she had ever treated in the early/middle stages (and with EOAD).
I agree with Joan. You want to work with doctors who deal with dementia problems. Otherwise you might be told that you are the problem or that these are simply marital problems. Or they might just scratch their heads.
And as marilyninMD stated, a geriatric doctor could be better because they usually deal with dementia issues.
for what it is worth my wife was not helped by the resperdal but the ativan did help her anxiety and quiet her down quite a bit. Toward the end she was on it four times a day because of restless and anxiety when she was awake. Hospice Dr had put her on the resperday and stopped the ativan but that made it worse. So in my opinion it is best to talk to the Dr who knows him best and start there and ask him for recommendation. I do not mean to contradict anyone but I did not have very good luck with Dr's who did not know her condition. Our pcp had treated her for over twenty years and is also a pcp at the local nursing home so he is familiar with AZ across many different ages and stages. Just my take on it. nothing personal. Bruce D *
Well the anger continues, but we saw our PCP tonight and they put him in Risperdone (same as Risperdal??) We will see if that helps some. And the good news is I got an appointment with a local neuro who works with Alz patients. We were able to get in for June 4th, so it is not that far off. I am thankful!! :) Thanks for the wisdom, Lord knows I need it these days! :)
Someone can correct me if I am wrong. But, I have been told that one the reasons you may very well need a neuro or that type of doctor instead of your PCP for Alz person is that some of the medications cannot be prescribed by your PCP without at least an examination and/or evaluation of a neuro. So I am glad to hear you will have an appointment with a neuro.
My dh gets all his meds through the VA and one of his drugs the neuro prescribed the VA will not fill the order unless I take my dh to the VA neuro for an evaluation. Well...I'm not going to do that because I would still want my dh on the drug regardless of what the VA says because I could see it was helping him.
JudithKB, I thought the same about the AZ meds not being able to be prescribed by a PCP, but after my DH refused to go back to the neuro our PCP told me that he would prescribe any meds that DH needed. He was already on Aricept & Namenda so out PCP just wrote refill prescriptions, but when the aggression started & the good people here suggested that I try Seroquel I called our PCP & he wrote a prescription for it (& thank goodness it worked).
Good point JudithKB, I think the reason the PCP felt fine with prescribing something was that we would be seeing a neuro in a few weeks. She even told me normally I don't prescribe this type of med, but since you are seeing a neuro for follow up and I explained the current anger issues we are dealing with she wrote out the script, don't think it would have happened if I didn't have an appointment scheduled. WE do go to a wonderful family practice btw, been there for years.
The drug they said a PCP can't prescribe is Depakote. My dh takes this drug for seizures that he has a night. You probably won't have any problems since you will be seeing a neuro. Good luck to you and your dh.
From what I understand, depakote is a mild drug and useful to many. However, for my H is did not work well. It increased his delusions and what disturbed me the most is those delusions made him want to "act", such as "I need to go to my office today" when it had been at least a year since he was employed.
On the other hand, you mentioned ativan which while H was here, and even now at snf, is my go to. It is a short acting "pam", in the same family as valium and xanax. In my experience, the effectiveness of it builds quickly. Nevertheless, it helped H with his mood but not so much with pacing. I don't know what they are going to try next, "trazodone" has been mentioned....