Inappropriate Drugs in Elderly Patients with Severe Cognitive Impairment: Results from the Shelter Study
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3463565/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3463565/pdf/pone.0046669.pdf
Lipid-lowering drugs and antiplatelet agents (but not ASA)
followed by
anti-dementia drugs (acetylcholinesterase inhibitors and
memantine ) were the most frequently
inappropriate drugs used,....
Treatments for Depression in Older Persons with Dementia
PMCID: PMC3147175
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3147175/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3147175/pdf/nihms203041.pdf
PHARMACOLOGICAL TREATMENT OF DEPRESSION IN DEMENTIA
Therefore,
drug interactions and polypharmacy may help provoke BPSD
in some patients with dementia,...
Given their physical and cognitive frailty,
persons with dementia may also be particularly
susceptible to adverse effects.
Since dementia patients may be less able to communicate, clinicians and caretakers must carefully observe patent’s behavior for evidence of adverse events when new medications are introduced.
Prescription of new medications intended to treat depression or other BPSD in dementia patients should always be made using the familiar adage originated for dosing the elderly,
“Start low and go slow”
Memantine
Memantine, ... Glutamate signaling is important for learning and memory,...
A recent review and meta-analysis
of the research on memantine for the treatment of psychological symptoms of dementia showed
small...
In summary, a variety of pharmacological treatments have some efficacy in the treatment of depression in dementia,
but care must be exercised in their use with this population of generally frail older persons to avoid adverse effects.
Efficacy of memantine on behavioral and psychological symptoms related to dementia: a systematic meta-analysis.
http://www.ncbi.nlm.nih.gov/pubmed/18056833
CONCLUSIONS:
However, there are a number of limitations with the current data;
the effect size was relatively small
and whether memantine produces significant clinical benefit is
not clear.
Sunday, February 24, 2013
Saturday, February 23, 2013
Memary (memantine)20mg without BPSD
Without“behavioral and psychological symptoms of dementia”(BPSD), he is found to have got a medication of Memary (memantine) 20mg for Alzheimer's every morning since February.
Sunday, February 17, 2013
Risperidone-Induced Dysphagia?
I read your case report's abstract, Risperidone-Induced Balbar Palsy-like Synd
rome, PMID:20922432.
My family member, 97, has had difficulty swallowing
since the next day after admission to the Kobe Red Cross Hospital(May 18, 201
2)due to cerebellar infarction.He got diapered and strapped to the bed for the
first time. He surely had psychological trauma. The cerebellar infarction res ulted diagnosedly from March 12 falling resulting in facial contusion and internal bleeding. Since then till October 31, he had been given risperidone throu gh three hospitals. I asked the director of the third hospital to stop risperi done due to its side effects. And then, risperidone was completely withdrawn.
According to pharmacists' association, sudden drug withdrawal might result in adverse effect, or retroaction.They recommended dose reduction after long-term medication. Amoban has still been given to him. The doctors here said dysphagia is due chiefly to blood clot and age, and he won't get better. But at the third and fourth hospitals, he takes foods for dysphagia by mouth.
His symptons before admission are as follows:
Aug.2010 one-eye cataract operation, Since then, unable to walk without a sti
ck. neurologically nothing abnormal detected.
Aug. 2011 the other eye cataract operation, still unable to walk without a sti
ck.
Apr.26 2012 instead of a few years long steroid external medication by a town
doctor, resulting in internal bleeding and scrabbling, Yokukansan and Alrock
administered as a drink. after that, feeling sluggish.
May 9 tooth extraction
May 11 enema at the trauma department in hospital due to no effect of 30 year
every third day medication of sennoside by his town doctor
May 14 enema again there because of neglecting another prescription
of every after meal medication of a purgative by the surgeon after that, he fo
llowed the surgeon.
May 15 defecation since that night unable to lift himself and deliria
rome, PMID:20922432.
My family member, 97, has had difficulty swallowing
since the next day after admission to the Kobe Red Cross Hospital(May 18, 201
2)due to cerebellar infarction.He got diapered and strapped to the bed for the
first time. He surely had psychological trauma. The cerebellar infarction res ulted diagnosedly from March 12 falling resulting in facial contusion and internal bleeding. Since then till October 31, he had been given risperidone throu gh three hospitals. I asked the director of the third hospital to stop risperi done due to its side effects. And then, risperidone was completely withdrawn.
According to pharmacists' association, sudden drug withdrawal might result in adverse effect, or retroaction.They recommended dose reduction after long-term medication. Amoban has still been given to him. The doctors here said dysphagia is due chiefly to blood clot and age, and he won't get better. But at the third and fourth hospitals, he takes foods for dysphagia by mouth.
His symptons before admission are as follows:
Aug.2010 one-eye cataract operation, Since then, unable to walk without a sti
ck. neurologically nothing abnormal detected.
Aug. 2011 the other eye cataract operation, still unable to walk without a sti
ck.
Apr.26 2012 instead of a few years long steroid external medication by a town
doctor, resulting in internal bleeding and scrabbling, Yokukansan and Alrock
administered as a drink. after that, feeling sluggish.
May 9 tooth extraction
May 11 enema at the trauma department in hospital due to no effect of 30 year
every third day medication of sennoside by his town doctor
May 14 enema again there because of neglecting another prescription
of every after meal medication of a purgative by the surgeon after that, he fo
llowed the surgeon.
May 15 defecation since that night unable to lift himself and deliria
Saturday, January 12, 2013
Antipsychotic-Induced Dysphagia
Risperidone-Induced Bulbar Palsy-like Syndrome
Department of Neurology, Yale University School of Medicine,
PMID: 20922432
Risperidone-Induced Tardive Pharyngeal Dystonia Presenting with Persistent Dysphagia
PMID: PMC 2292443
Neuroleptic-Induced Dysphagia
Service of Speech Pathology, Rehabilitation Institute of Toronto, Canada
PMID: 9294935
Dysphagia Due to Olanzepine, an Antipsychotic Medication
PMID: 15778537
Sudden Dysphagia with Uvular Enlargement Following the Initiation of Risperidone Which Responded to Benztropine: Was This an Extrapyramidal Side Effect?
PMID: 11569473
Department of Neurology, Yale University School of Medicine,
PMID: 20922432
Risperidone-Induced Tardive Pharyngeal Dystonia Presenting with Persistent Dysphagia
PMID: PMC 2292443
Neuroleptic-Induced Dysphagia
Service of Speech Pathology, Rehabilitation Institute of Toronto, Canada
PMID: 9294935
Dysphagia Due to Olanzepine, an Antipsychotic Medication
PMID: 15778537
Sudden Dysphagia with Uvular Enlargement Following the Initiation of Risperidone Which Responded to Benztropine: Was This an Extrapyramidal Side Effect?
PMID: 11569473
Saturday, June 23, 2012
Only the Excuse of Staff Shortage Blocks Japan's Therapy to a Cerebellar Stroke.
According to the Health imformation offered by JFK Medical Center,
The cerebellum is located in the lower part of the brain, towards the back. It plays a role in body movement, eye movement, and balance.
The stroke harms these roles.
Except difficulty walking, including problems with balance as symptoms of a cerebellar stroke indicated by most doctors in Japan,
some notable ones, whcih Japanese doctors hardly touch on, ALSO include:
Speech problems (eg, slurred speech) and difficulty swallowing
Problems sensing pain and temperature
Difficulty hearing
Problems with eyes (eg, small pupil, droopy eyelid)
And they are promoting awareness like this:
"If you or someone you know has any of these symptoms, call 911 right away. A stroke needs to be treated as soon as possible. Brain tissue dies quickly."
It means these symptoms should BE CONSIDERED SERIOUS.
Of course, these applies to my senior family member, but he is thought to have senile dementia only because he slurs, and is hard of hearing and speaks louder.
Unfortunately, a local Red Cross Hospital in Kobe City, as well as others in Japan wouldn't offer senior patients and their families such rehabilitation programs
only due to shortage of staff(in fact, due to too many staff members' sluggishness):
only due to shortage of staff(in fact, due to too many staff members' sluggishness):
Saturday, June 16, 2012
Difficulty Swallowing after Stroke
A family member of mine suddenly began to feel it difficult to stand and walk on May 15th, and finally on May 17th I took him to a local Red Cross hospital. He was diagnosed as stroke or lood clot in the cerebellum.
Come to think of it, on March 12 he slipped on a wet iron gutter cover in front of a nearby small hospital offering Saturday consultation time, fell down, and hit the right side of his face with swelling and internal bleeding. The Red Cross neurosurgical doctor said in a month after such a hit a brain could often suffer a blood clot. The doctor also said the disease in the cerebellum caused him lose their sense of balance and prevented him from standing and walking. But he is a post-stroke patient, not couldn't get treatment. He said we should see how it would work, and we came home on May 17th.
On May 18th morning, I saw he suffered an attack of delirium and got placed in the Red Cross hospital. On May 19th the day after hospitalization, he obviously suffered difficulty swallowing.
So, he had been taken food with thickness by mouth, but he disked it.
Since May 23 he has been fed by a tube.
So, NOT to PULL the TUBE, he is forced to wear mittens and tied to the bed frames when his family are not with him. Isn't it an abusive treatment ?
The doctor has never offered direct or EVEN INDIRECT trainings for improving his ability to swallow because he worries about aspiration pneumonitis.
According to the Internet, Brain stroke is often associated with dysphagia or difficulty swallowing. Especially a blood clot in the cerebellum causes severe dysphagia. In Japan, methods for the effective treatment of patients with difficulty swallowing have never become popular yet.
Come to think of it, on March 12 he slipped on a wet iron gutter cover in front of a nearby small hospital offering Saturday consultation time, fell down, and hit the right side of his face with swelling and internal bleeding. The Red Cross neurosurgical doctor said in a month after such a hit a brain could often suffer a blood clot. The doctor also said the disease in the cerebellum caused him lose their sense of balance and prevented him from standing and walking. But he is a post-stroke patient, not couldn't get treatment. He said we should see how it would work, and we came home on May 17th.
On May 18th morning, I saw he suffered an attack of delirium and got placed in the Red Cross hospital. On May 19th the day after hospitalization, he obviously suffered difficulty swallowing.
So, he had been taken food with thickness by mouth, but he disked it.
Since May 23 he has been fed by a tube.
So, NOT to PULL the TUBE, he is forced to wear mittens and tied to the bed frames when his family are not with him. Isn't it an abusive treatment ?
The doctor has never offered direct or EVEN INDIRECT trainings for improving his ability to swallow because he worries about aspiration pneumonitis.
According to the Internet, Brain stroke is often associated with dysphagia or difficulty swallowing. Especially a blood clot in the cerebellum causes severe dysphagia. In Japan, methods for the effective treatment of patients with difficulty swallowing have never become popular yet.
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