Mamadoc can u answer a quick question?

[Carrie5608]

Hi, I just noticed you have been about this morning and I was wondering if you can answer a quick question.

Dad has mixed dementia Lewy body and Alzheimers. For a large part of the time he is relatively ok, lives with Dm who is his carer with support from me. Two weeks ago memory team stopped his Aricept and started memantine 5mg to see if it would help more with the hallucinations. A week later he went into a coma and now has severe aspiration in pneumonia. Do you think this was due to stopping the Aricept? He was still walking, talking and managing toileting with a bit of assistance with belts & buttons.

Thank you.

I'm so sorry that sounds really horrible.

I don't think it is related to the meds change though. More likely just a very nasty coincidence.

Memantine is usually quite a benign medication. You can't have it if you have seizures but otherwise it has relatively few bad side effects. The only thing is it can be very sedating. At an outside chance it is possible he was very oversedated and aspirated (food went down the wrong way into lungs causing pneumonia).

Another possibility is that the hallucinations were worse because he was already brewing the pneumonia

I do hope he gets good treatment and gets over this. You could then ask for him to restart the Aricept if he was better on this.

It is a very controversial area but a lot of Drs would carry on the Aricept and add the memantine to it rather than stop Aricept. The only thing we know from studies (domino AD study) really is that stopping Aricept altogether (not swopping) is a bad idea even in moderate dementia. It used to be thought that at MMSE less than 10 people did not benefit but we now know that they still do. In the study people who stopped all medication did badly but people who carried on Aricept or swopped to memantine or took both did about the same. However it was a smaller study than planned and there may be differences in these groups that could not be shown.

That might be more than you wanted to know!

Best wishes to your dad for a speedy recovery

Having read your other thread I also wanted to say that when someone with dementia has a physical illness it affects their mental state often severely. The more serious the illness the worse it is. When you say he is much less responsive than usual that is probably a 'hypo active delirium' ie the physical illness affecting the brain.

After the physical illness is treated it takes 6-8 weeks for the brain to recover so it is likely that he will slowly get better again but maybe not all the way back to as good as he was.

Thanks Mamadoc he hasn't responded to any of the antibiotics so far and it's a full eight days. His concious level has improved slightly but i am very concious that microbiology have few weapons left if the current regimen (Vancomycin and Meprenem) fails to work.

If he recovers enough I think we will definitely ask for Donzepil to be restarted but at the minute we are long way of that stage.

Thanks for your advice.