Suggest Treatment For Dementia, Urinary And Bowel Incontinence

Posted on Mon, 23 Nov 2015

Question: My father who is 72 years is being treated for dementia but no improvement. He does not have control of urination or passage of stool. Does it any where. He hardly sleeps in night. Always attached with his slippers. Hardly bothers if he has clothes on is body or not. Reports attached

Answered by Dr. Ajay Panwar (2 hours later)

Brief Answer:
Regular medicines/Physical and mental rehabilitation.

Detailed Answer:
Hi XXXX,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.

I have gone through all the medical documents you have uploaded. Apparently,the probable diagnosis of your father is 'Multi-infarct dementia' in the backdrop of Diabetes,Hypertension and Cardiac disease.
I would like to know that since when he is having difficulty in control of urine or passage of stool?You said that -he hardly bothers if he has clothes on his body or not.'-since when he is having these complaints?Were these symptoms present at the time when his diagnosis of Multi-infarct dementia was made?

Please follow up with details so that I can answer this with my best concerns.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ajay Panwar (1 hour later)

In the year 2011 he fell in bathroom and had head injury. He recoverage from brain heamorrage after 6 months. But for last 6 months he is suffering from Dementia. Urine control issue has been there for fast few year but was occasionally. Now due to Dementia he till 2 months back if used to pass urine at the bathroom door itself. But, after the latest treatment 1 and half month back at KIMS and then at XXXXXXX Hospital, control on urine and stool is very less. Now a days he is roaming in and out of house without clothes. Dr. Sarma of XXXXXXX hospital asked to stop Quitepine tablet and gave his medication. That medicine apart from drowsyness making him sleep in nights hardly improved. We try to pit diapers but he removes it immediately and sometimes cut it into pieces. He hardly sit at single place even for a min. He always wants my mother to stay in front of her. Beacuse of this she is under stress as she is unable to do her daily work. My father gets irritated and sometimes try to beat when some tries to clean him or help him to wear clothes

Answered by Dr. Ajay Panwar (31 minutes later)

Brief Answer:
Please list all the current medicines with doses.

Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.

Though,I could see the prescriptions of both KIMS and XXXXXXX hospital,as you have uploaded.I would precisely like to know,that out of both prescriptions,which medicines are you currently giving to him.So,please list all the current medicines with dose and timings.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ajay Panwar (4 hours later)

Hi Doctor,
Please find the details. The hour mentioned below is indicative. Variation of 30 min to 1 hour can be possible.
KIMS Prescription
1. CLOPILET 75mg - 1 tab - 2 pm
2. TONACT 40 mg. - 1 tab - 8 pm
3. MET- XL 12.5 mg- 1 tab - 8 am
4. CARDACE 1.25mg- 1tab - 8am
5. GALVUS MET 50/500 mg- 1 tab before breakfast; 1 tab before dinner
6. ADMENTA 5 mg - 1 tab 8 am; 1 tab 8 pm
7. DONEP 5 mg - 1 tab 8 am; 1 tab 8 pm
8. VIBRENIA - 1 tab 8 pm
9. PANTOP 40 mg - 1 tab before breakfast 7 am
XXXXXXX hospital
10. HALOGEN 0.25 (HALOPERIDOL TABLET)- Half tablet morning; half afternoon; half night
11. LOZEM-1 (LORAZEPAM)- 1 tab night
12. COGNIFAST (CEREBRO PROTEIN HYDROLYSATE) - 1 tab morning

Regarding HALOGEN docotor advised 10 days back to give one fourth part of the tablet each time and gradually raise the dose so that too much drowsiness isn't there. As of now it is half tablet each time thrice in a day. Dr. Sarma (Manasa Hospital) advised all the three tablets for three months.

Answered by Dr. Ajay Panwar (1 hour later)

Brief Answer:
Increase the dose of HALOGEN.

Detailed Answer:
Hi XXXX,
Thanks for being in follow-up and providing the details of the medicines.

After reviewing the clinical and medical details,I am of the opinion that HALOGEN should be given in a slightly higher dose.It's starting dose is 0.5 mg twice or thrice a day.I suggest you to make it 0.5 mg twice a day and see if the symptoms improve.Also,please discuss with Dr.sarma to stop LOZEM so as to avoid excessive sedation.

Further,precautions should be taken to avoid sundowning.He should not be given tea or coffee,after 5.30 pm in the evening.Keep his room brightly lit in the evening time and atleast dimly lit during night.Never make it dark.Maintain a calm and quiet enviornment in his room,particularly after evening.TV may be put off.Night meals should be light.Keep his favourite items in his room.Promote his sleep hygiene.These are simple things but can be of immense help.

Hope that I have answered your query.If you have some further questions,I shall be glad to have you in follow-up else please close the thread,rate it and write a review.
Please get back to me in case you have any query in future.
You can also put up a query directly to me on HCM address- http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69273

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar