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Topic Acute delirium Go to previous topic Go to next topic Go to higher level

By Claude Henderso On 2010.12.01 12:18
My wife has all the signs and simptoms acute delirium. I have a Dr's appointment today at 2:00. It is our family Dr. not her nero. I am not sure what to ask him. My son wants to take her off all her meds and try to get her detoxed. Any experiences or advice. Thanks

By karolinakitty On 2010.12.01 13:39
Acute delirium .... by definition it seems like she is having side effects from meds. You don't say what she is on, or how much or how long she has been diagnosed. This post may come too late but her regular doc may be hesitant in doing anything with her meds. Call her neuro and let him know. Like i said they could be side effects or even interactions with drugs she is on... Let us know how it goes and if you can give us more info we might be able to help out better.....

By susger8 On 2010.12.02 07:49
Be really careful about discontinuing the meds abruptly -- that can be disasterous. PD meds should be withdrawn slowly, especially dopamine agonists like Requip and Mirapex.

Pretty much all PD meds have the possibility of causing delirium. According to what I've read, amantadine in elderly patients is one to watch out for, and dopamine agonists also can contribute. Sinemet can cause delirium as well, especially the CR (long-acting) version.

I agree that the neurologist should be involved.

Sue

By dlsagen On 2010.12.02 13:07
I'm following this post with interest, as my husband is going through the same thing. He saw a primary care substitute, who gave some advice about his meds. But I also have a call into his Neuro, who is nearly impossible to get--no appointments till March. Hopefully he calls me back. My husband is not even recognizing me, and persists in thinking we are not in our own home. It's very scary for me, so I sympathize with what you are going through.
Diane

By dlsagen On 2010.12.05 13:21
The delerium became so bad he did not know who I was, was not able to sleep at night, thinking he was someplace else.

We got an emergency appointment with the neuro on Saturday, and he proceeded to do everything I thought he should, based on what I am learning on this site and Patients Like Me. He took him off the Mirapex, and put him back on 0.5 Klonopin at night. That has finally given both of us a full night's sleep without terrors, disorientation. He is nearly himself again. So I really think going off the meds sometimes is a good thing.

By rhen71 On 2010.12.05 14:32
I am going to post on here to try to shed some light. My dad is the original poster. My mom was diagnosed in 2001 with symptoms appearing, I think, a couple of years before.

My dad posted the med list to this forum back on 11/3/10. Those medications are listed below:

OMEPRAZOLE 20MG 30 MIN BEFORE BREAKFAST
SERTRALINE 150MG EACH MORNING AFTER BREAKFAST
NAMENDA 10MG BID
CARABIDOPA LEVODOPA 10/100 1 AT NIGHT DC 7/6/10 by DR. CONWAY
RESTARTED 10/6/10 DR. CHURCH DC AGAIN BY DR CONWY 10/12/10
METANX 2 -2.8 25 MG 1 PER DAY
NITROFURANTOIN (MACROCRYSTALS) 50 MG ONE AT BEDTIME
OXYTROL TWICE A WEEK (SUN & THURSDAY)
HYDROCODONE 5/500 ONE TAB 4 TO 6 HRS PRN
EXELON 1.5MG BID 7/6/10 DR CONWAY
AMANTADINE 100MG 1 TABLITS BID 7/6/10 DR CONWAY
SIMVASTATIN 40MG TABLET (ZOCOR) 1 EACH EVENING DR. CHURCH DC 10/4/10
SEREQUEL 25MG ONE TAB AT BED TIME DR CONWAY 6/12/10 CHANGED TO 12.5MG 10/19/10
CLONAZEPAM 1 MG ONE TAB AT BEDTIME DR. CONWAY 6/12/10
MIRAPEX 0.125MG TID DR. CONWAY 10/19/10
MELATONIN 3MG OTC DR CHURCH
CITRUCEL TWO TABLETS EACH EVENING
OTC STOOL SOFTENER BID
MIRILAX AND SENNA-LAX PRN

After my dad's post on Acute Delirium, she was admitted to the hospital on the afternoon of 12/1 by her primary care physician. Her neurologist was consulted during the hospital stay and on Thursday it was decided to discharge her to Home Hospice and to take her off of the Parkinson's medications and switch the focus to comfort. She came home on Friday. Home Hospice has installed a hospital bed at the house.

With the mental state that she is in now, it's hard to tell if it's her coming down from all the medication that she was on or if it's just the effects of advanced Parkinson's and the dementia that comes with it.

Right now, the only medication that she's on prescription wise is a low dose antibiotic to prevent UTI, an incontinence medication, and morphine which was started after she got home by Hospice. Her mental state remains unchanged.

I guess we don't know what to expect -- is the just the relentless progression of Parkinson's, is it the medication, is it dementia... What is it?

The reason that she's on the morphine is because of pain. Right now she seems to be in constant pain. It hurts her when we have to lift her on to the bedside toilet or anytime she has to be moved.

She is sometimes responsive to questions but most of the time not. She is having hallucinations and just does not seem to be mentally in the present.

She is totally immobile now and needs constant care -- just two months ago she was able to walk with a walker. My brothers and I are doing the best we can to help my dad. It takes two to help her on to the toilet so we are taking turns staying there at night.

She is still able to swallow and to drink her Boost and eat solid foods -- that is a good sign.

Anyway, this is my first post here. I've been lurking for the past two months since Mom's health started rapidly declining. This forum has been a treasure trove of information and the responses are very much appreciated.

By caregivermary On 2010.12.05 15:21
My husb had been in a similar state just recently as your Mom. However, he was/is not on the number of meds like your Mom. He too is in pain-neck and head. At the neuro's direction I decreased his sinemet and the trouble started. Very agitated, hallucinating, pyschosis-call it want you want. Started hospice and he was given hydrocodone and that put him way over the edge. I stopped the hydrocodone immediately and he was given antibotic for ??UTI??.

10 days now he is doing better. Started Lyrica for the pain and backing it up with ibpuprofen. Still having some psychosis but not as bad as two weeks ago.

I tell you all of this because I do think your Mom was on too many drugs but stopping them all at one time will cause a lot of problems.

Please do not misunderstand this question-are you all ready for your Mom to pass on? Has this conversation taken place with the Drs and your Dad? Stopping all drugs like this and calling in hospice is a big move. I don't know all of your Mom's issues but I would think she might be able to bunce back if someone tried to get a handle on the drug issue.

Back in July my husb's neuro starting him on nameda and he was a zomby. Stopped it after three weeks. He has been on the Exelon patch for 2 yrs and does very well with it.

Hydrocodone and other pain killers do not mix well with PD drugs and will cause hallucination, etc. Amantadine and Mirapex overtime will do the same thing. I believe late stage PDers should not be on these drugs.

My husb uses senna plus which is a stool softerner and laxative together in one pill.

Serequel is used to treat psychosis for PDers and you can increase that med and see good results.

I believe the question I have for you right now is are you all ready to let your Mom go or do you want to try and determine if she can keep fighting this?

I do not mean to offend you by asking these straight forward questions.

By rhen71 On 2010.12.05 16:23
I appreciate your response and I'm not offended.

I want my mom to fight as long as she's able. But I want her to also be as comfortable as possible. I don't think some of the medication that she was on was helping her PD.

I know Nemenda can even cause hallucinations in some cases. The Sertraline (Zoloft) can have some withdrawal symptoms.

The neurologist took her off the Carbidopa-Levodopa. I know you said this decrease is what caused your husbands issues. My mom was having these issues before this medication was stopped. So I don't know. She's been off of the Mirapex since October.

I hope I've answered. I just want my mom to be comfortable. I wish there was a magic pill that could make it go away. I hate what it is/has done to her.

By LOHENGR1N On 2010.12.05 16:24
rhen71, Just the fact of stopping all the medicine can cause the reactions you've stated. Also with all that medicine she was on she might very well suffer from delirium and not dementia. Many PDers do eventually develop dementia however many do not so please don't resign yourself to advanced Parkinson's automatically bringing dementia with it. Just the number of different med's she was taking, their effects and interactions? One can only guess which problems they might cause. Stopping them abruptly? I would have thought withdrawing them over time but then I'm not a Doctor and hopefully Her doctors are on top of the situation. It could take awhile to get the medicines out of her system. Her immobility could be caused from the fact of medicine withdrawal or the morphine (most of the time pain killers will make the symptoms of Parkinson's Disease worse) If She was having problems moving about and her medicine was helping with that, well combine the cutting out of that med along with the effect of morphine, could explain the immobility now. I'm sorry your first post was in crisis mode, we'll all try to help you and yours all we can. Welcome to our forum and please feel free to post as much as you need, we do understand! Best of luck and hang in there.

By parkinit On 2010.12.05 17:46
I, too, understand there are many issues here, but my first thought in reading the med post was that the carbidopa/levodopa is truly only administered once per day? My spouse takes it 7 times a day and 150 mg each time. This would help stiffness and tremor issues.

By Claude Henderso On 2010.12.05 20:03
Thanks everyone for your input. And thanks too for my son for giving you a very accurate update. I have been pretty busy the last several days and did not get to look at the forum until just now. I too was concerned about the abrupt withdrawl of all of her PD meds. Particularly the exelon. I had read some warnings about that one. They were withdrawn while she was in the hospital. The Home Hospice folks are keeping a close watch on her. The Dr. reasured me that the assignment of Home Hospice is not considered the 6 months to the end that it used to be. It is so I can get the help that I need while she is withdrawing from her meds. I am hoping that they can start them (or others) up again one at a time until they cah find something that works. I will try to keep you posted. Thanks again. Claude

By kachan On 2010.12.05 22:47
I am Claudes daughter. I am the far away child and visit as often as I can. Since I have seen Mom every couple of months over the last couple of years the ups and downs of her PD are always dramatic. Her list of medications has almost always been this long, the combination has changed many times, but there seems to have always been several with serious side effects. The requip episode was very regretable. Its the same old question is it the medicine or the Parkinson's. It has been a long time since we have seen who and how Mom really is. We felt like we really needed a clean slate, so to speak. I have seen Mom make remarkable shifts in her cognition and her mobility, both up and down. Her last UTI incident had me trying to keep her from running away in the golf cart, and having a hard time doing it. That was only a year and a half ago. Just two months ago she was still trying to sell her possesions on e-bay. We do have an appt. for her with a movement disorder specialist, in Jan. We just learned that there was even such a doctor from this forum, which I too have been lurking in for the last couple of months. It has been such a blessing. So we are hopeful that Mom will regain her mobility, and hopefully some kind of sense of peace. Her fear and paronoia are just devastating. I can not imagine what it must be like for her to be in such a state, helpless and afraid. My Father and my brothers are all remarkable men and my mother is blessed to have the family she does. We will do everything we can to make moms life all that it can be, knowing that it can all change so quickly. Thanks to everyone for your insight and input. I will never take the word caregiver lightly again, a simple straight forward word, but such a weight it carries.

By Emma On 2010.12.06 07:07
I want to welcome your family to the forum and tell you how sorry I am that you are going through this right now. How lucky your wife/mother is to have such a loving and devoted husband and children.

My husband has fairly frequent hallucinations, delusions and paranoid episodes and has had since almost the beginning of his Parkinsons. Since they started so early in the disease I suspect that for him they are not so much medication related as they are some kind of misfiring in his brain, much like someone with a psychotic disorder. That said, he was on Morphine for pain last summer and those episodes increased dramatically. He was in such severe pain and the Morphine was the only thing that gave him even a tiny bit of relief that we left him on it as long as we could. When he was taken off the Morphine the psychotic episodes went back to their normal frequency.

Also, in the vein of everyone is different, last year my husband's neurologist discontinued his Requip (which he had been taking four times a day) abruptly due to obsessions with sex and gambling with no ill effects except for a slight increase in his restless leg syndrome. He has since been put back on one 4mg. tab a day for that.

You are right, with this disease it is so hard to know if symptoms are caused by the medication or the disease itself. It's frightening and frustrating. Blessings to all of you.

By caregivermary On 2010.12.06 21:32
I sincerely hope your wife/mom will improve with time. Take care and keep us posted.

By rhen71 On 2010.12.21 23:42
I wanted to say thank you for all of the responses on this thread that my dad started. They have all been helpful. I wanted to give an update of my mom's current status in hopes that it may help someone else who is going through the same thing.

It's been 21 days since she was admitted to the hospital and 18 days since she came home.

She's not in the pain that she was in when she was in the hospital and right after she came home. She is still rigid and immobile. She is eating and drinking fairly well -- she is not able to feed herself.

Mentally she is less agitated. She is able to recognize me on some days. She is talking more now although the things she says make little sense.

In my research recently, i ran across a blog that talks about acute akenisis. This blog is written by a woman that takes care of her husband who has early onset PD. It was the first time that I'd seen that term and I wonder if that's what my mom is going through. My dad posted another thread on that subject.

My dad is an amazing man. The patience and love that he has for my mom is an inspiration to me daily. My dad is a true caregiver in every sense of the word -- I can't even imagine. My two brothers and my sister too have been wonderful.

I don't know if it's acute akinesis that my mom has or not or is her state now just what it is.

Once again, thank you for all of the responses and well wishes and the -- they are truly appreciated. I watch this forum almost daily now and I pray for those of you who are going though this personally as someone with PD and those who are going through it with someone they love.


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