Dementia in 92 year old man
Please be kind enough to go through the full text..Patient(My father) is hardly moveable.Please be kind enough,if possible, to guide me whether to go for tests or prepare for compassionate/palliative care
DETAILED CASE HISTORY
1)He had been a patient of Diabetes for long 30 years.Subsequently some 3 years back he developed Carpal Tunnel Syndrome in finger and was operated on.He had been on Medication Gabapentin and Nortriptyline for some time,later on he had been taking Gabapentin(300) regularly ,but he recovered fully from his finger problem.He was taking Diabetes drugs (Popular Metformin Group) With long term use Metformin is reported to cause Vitmin B 12 deficiency(Nerve problem)Actually he developed Diabetes Neuropathy.
2)For last two yers he was suffering from Irritablele Bowel Syndrome(Constipation Dominant).He was never checked up by any Gastroentrologist.Now a days to the best of my knowledge Gastro Specialists prescribe Anti Depression (Nerve Medicines) Drugs for Irritablele Bowel Syndrome
3)This the point for which I am seeking your advice. For last 10 months he was having cognitive impairment (Demantia).His problem was like this detailed below
.a).Initially forgot recent incidents ,he could recall past incidents.Now total loss of memory
b)suffering from hallucination and delusion.
c)suffering from fear pshycosis problem and other dementia related problems
He was taken to a reputed Neuro Pshychriatist ,advised for MRI(Brain),but THE TEST COULD NOT BE PERFORMED ,AS HE BECAME
RESTLESS AND PSYCHOTIC AND THOUGHT THAT SOMEONE WAS TRYING TO PUT HIM TO DANGER.howver he was not given Sedative prior
to the test(NOT ADVISED)
d)He was checked up by another Psychriatist,the doctor told that things are to detereorate further in AND IN COURSE OF TIME HE WILL LOSE BOWEL AND BLADDER CONTROL WHICH HAS NOW SURFACED.Now he is bed ridden .He is being fed in lying condition He has Catheter for prostrate
problems.He cannot talk or recognize anybody.
e)He was initially given Serance and Nootropic Drugs(Pyrecetam) and as he was becoming restless he was given Quetipiane to help him calm down.For this Dementia problem no other drugs were followed except for some time loxapin drops were given
f)AS NO MRI/CAT SCAN WAS NOT DONE IT IS NOT POSSIBLE TO SPECIFY WHAT TYPE OF DEMENTIA HE IS SUFFERING FROM ie
ALZHEIMERS/VASCULAR/LEW BODY etc etc.
g)However all said that this dementia (any type) IS A PROGRESSIVE DISEASE(NEITHER CURABLE/NOR CONTROLABLE)AND ALSO THIS IS NOT A REVERSIBLE TYPE (LIKE DUE TO THYROID DEFICIENCY/.VITAMjIIN B 12 DEFICIENCY ETC FOR WHICH BLOOD TESTS WERE DONE REGULARLY)
H)FOR LAST 30 DAYS HE HAS DEVELOPED MUSCLE RIGIDITY IN HANDS AND LEGS FOR WHICH HE IS BEING GIVEN ANTI PARKINSON
DRUGS LIKE LEVODOPA AND CARBIDOPA.
I)HOWEVER IN THE LAST STAGE OF ALZHEIMERS ALSO IN MANY PATIENTS THIS RIGIDITY APPEARS TO BE A PRECURSOR TO THE
APPEARANCE OF OVERT PHYSICAL DEFORMOTIES IN THE FORM OF CONTRACTURES WHICH ARE IRREVERSIBLE DEFORMITIES WHICH
PREVENT THE PASSIVE OR ACTIVE RANGE OF MOTION
j)Now the patient is only on LEVODOPA AND CARBIDOPA.,bed ridden .not disturbing any body,MAY BE HE CANNOT EXPRESS HIS DIFFICULTIES.HE CANNOT TALK/RECOGNISE ANY BODY
X) HE HAS BEEN ALSO CHECKED UP BY PALLEATIVE CARE SPECIALIST WHO OPINED THAT GIVING HOME CARE IS THE BEST OPTION NOW .The question is that of some us are thinking of getting him checked up in a MULTI SPECIALTY HOSPITAL,but THE QUESTION IS WHETHER MRI/CAT SCAN/DOPAMIN SCAN WILL BE OF ANY USE AT THIS STAGE FOR THIS 92 YEAR OLD MAN.,ALSO AS HIS BODY RESISTANCE HAS REDUCED
VERY MUCH, HOSPITAL STAY MAY ALSO CREATE SEPTIC INFECTION.
IN CONSIDERATION OF THE FACT THAT EVEN World Health Organisation ALSO CONSIDERS DEMENTIA IN ANY FORM IS A PROGRESSIVE DISEASE,NO CURE AND MEDICINES DEVELOPED LIKE ACETYL CHLOLINE ACTIVATOR OR GLUTAMATE (neuro transmitters)RECEPTOR REQUIRE FURTHER DEVELOPEMENT
(CLINICALTRIALS IN PROGRESS).Hospitslisation will definitely,warrant some reversal/improvement of the conditions by the patient party.
Moreover taking new medicines at this stage may also have some side effects.it may also be difficult that he may not tolerate.to tolerate investigations such as scanning.One of the problems with scans is that the patient has to lie very still. This may be difficult for him in this condition.
I wish to know whether at this age THERE ARE VERY LIMITED OPTION FOR TREATMENT IN TERMS OF MEDICATION AND MORE EMPHASIS HAS TO BE GIVEN FOR COMPASSIONATE CARE
As you sre a reputed person in this line please offer your valuable comments RELATED TO POINT (X) ABOVE.With deep regards and thanks.Some of the medical words used may have spelling mistakes which may be excused
Please help me get rid of the agony of taking a decision With thanks and deep regards once more
All user-generated information on this site is the opinion of its author only and is not a substitute for medical advice or treatment for any medical conditions. Members and guests are responsible for their own posts and the potential consequences of those posts detailed in our Terms of Service.