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Question: Hi Doctor, My father was diagnosed (just by taking) with Vascular dementia in Aug'15,we started the following medicines -Aricep,Oleanz, olvance, etilaam, ecosprin and olvance, post these medicines he started deteroiting rapidly, and now he cant walk and talk, Current medicines are oleanz, olvance, ecospirn and etilaam,Current weight 40 kgs, my question is if we can stop the anti psychotics slowly at this stage as he is suffering from severe restlessness, always wants to walk or stand to get the relief beacaus of induced akathesia I believe, the doctor is advising to increase the dosage of oleanz which we are following as per the instructions but it is not helping him and becoming more depended on medications, I don't know if it's natural progression or due to medication as his memory is good and cognitive decline is not that bad,he remember things and give quick response and improving on that part may be because of daily virgin coconut oil intake, my request is to give me some clarity as I want to give my father relief from the continous akathesia which is is suffering from, please help
Brief Answer:
Dose of Olanzapine should be reduced
Detailed Answer:
Hello thanks for asking from HCM for your health related doubts
I can understand your concern. I have read the attachments you uploaded with query. To diagnose vascular dementia properly apart from clinical evaluation imaging of brain CT scan is needed. He has history of CVA and how is his present condition.
Does he walk at all without any assistance? Is power equal in all extremities or any weakness is there?
In dementia progressive loss of cognitive functions are seen. Recent memory in form of registration, recall is impaired first in course of illness. Forgetfulness in day to day things is seen. In some cases judgement, abstract thinking etc are impaired.
You have mentioned that his memory is good, cognitive decline is not bad. What are his common symptoms right now?
His symptoms like difficulty in walking or talking could be occurring due to high dose of Olanzapine. Though Olanzapine is safe drug but in high doses or in elderly the drug can cause symptoms like akathisia, increased sedation, dizziness etc. He is already on Aripiprazole and Olanzapine both of which are antipsychotics, which could also be contributing to the symptoms.
Considering his history of hypertension and CVA in my opinion its better to continue Aripiprazole in him and if possible reduce the doses of Olanzapine gradually.
Thanks, Hope this helps. Please discuss with his doctor before making any change in prescription.
You are welcome to ask follow up doubts.
Take care
Dose of Olanzapine should be reduced
Detailed Answer:
Hello thanks for asking from HCM for your health related doubts
I can understand your concern. I have read the attachments you uploaded with query. To diagnose vascular dementia properly apart from clinical evaluation imaging of brain CT scan is needed. He has history of CVA and how is his present condition.
Does he walk at all without any assistance? Is power equal in all extremities or any weakness is there?
In dementia progressive loss of cognitive functions are seen. Recent memory in form of registration, recall is impaired first in course of illness. Forgetfulness in day to day things is seen. In some cases judgement, abstract thinking etc are impaired.
You have mentioned that his memory is good, cognitive decline is not bad. What are his common symptoms right now?
His symptoms like difficulty in walking or talking could be occurring due to high dose of Olanzapine. Though Olanzapine is safe drug but in high doses or in elderly the drug can cause symptoms like akathisia, increased sedation, dizziness etc. He is already on Aripiprazole and Olanzapine both of which are antipsychotics, which could also be contributing to the symptoms.
Considering his history of hypertension and CVA in my opinion its better to continue Aripiprazole in him and if possible reduce the doses of Olanzapine gradually.
Thanks, Hope this helps. Please discuss with his doctor before making any change in prescription.
You are welcome to ask follow up doubts.
Take care
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Thanks for understanding the concern, following are the answers of your queries.
He cant walk without any assistance from last one month earlier he used to walk slowly and still has a good grip on hands and limbs but weakness is there and currently the spine is bended on one side so the gait problem is there.
And he has a good past memory, but the recent memory is impaired , also he completes the sentences if we give any hint or starting words, and somtimes oberserves the changes going on in the home and try to speak sometimes if he is stable.
He is always very hungry but weight is not increasing and decreased to 40 Kgs in one year- need your answer on this as well on how to increase his weight to avoid further dieseses
Also, as you mentioned Aripiprazole, wanted to check, is etizloam and aripirazole are same medicine as he is currently on Etilaam ( Etilozam ) with Olanzapine , also i managed to reduced oleanz to 2.5 MG on a daily basis from 5 MG with Quitipine 25 MG removal and he was sleeping with that in the past, but due to time or routine change , we had to increase the dosage which increased Akathesia , I will reduce the dosage of olanzapine again and really thanks for understanding the real cause.
We also initiated the Test of electrolyte to check for Restless leg - Reports were fine
Need your help to increase his weight as he is becoming very weak
He cant walk without any assistance from last one month earlier he used to walk slowly and still has a good grip on hands and limbs but weakness is there and currently the spine is bended on one side so the gait problem is there.
And he has a good past memory, but the recent memory is impaired , also he completes the sentences if we give any hint or starting words, and somtimes oberserves the changes going on in the home and try to speak sometimes if he is stable.
He is always very hungry but weight is not increasing and decreased to 40 Kgs in one year- need your answer on this as well on how to increase his weight to avoid further dieseses
Also, as you mentioned Aripiprazole, wanted to check, is etizloam and aripirazole are same medicine as he is currently on Etilaam ( Etilozam ) with Olanzapine , also i managed to reduced oleanz to 2.5 MG on a daily basis from 5 MG with Quitipine 25 MG removal and he was sleeping with that in the past, but due to time or routine change , we had to increase the dosage which increased Akathesia , I will reduce the dosage of olanzapine again and really thanks for understanding the real cause.
We also initiated the Test of electrolyte to check for Restless leg - Reports were fine
Need your help to increase his weight as he is becoming very weak
Brief Answer:
Etizolam and Aripiprazole are different drugs.
Detailed Answer:
Hello thanks for asking a follow up
Etilaam and Aripiprazole are different medicines. Aripiprzole is an antipsychotic which is related to Olanzapine but relatively free of serious metabolic side effects. Etilaam is benzodiazepine drug. The drug is safe and helps to reduce restlessness, anxiety and sometimes helps in sleep too.
Olanzapine 2.5 mg is low dose and will not cause serious akathisia but can increase sedation and can reduce mobility.
Regarding the low weight, I'd recommend to increase protein and complex carbs in diet. In my opinion any medicine to increase weight should be avoided because of risk of CVA. Get his thyroid functions done to rule out hyperthyroidism which could be the reason of weight loss. Random blood glucose would rule out diabetes. If both conditions are ruled out then check if he is having persistent loose motions. If he is having altered bowel then that should be treated. If nothing comes out then no need to worry for his low weight. With improvement of his general condition weight will improve spontaneously.
Thanks, Take care.
Etizolam and Aripiprazole are different drugs.
Detailed Answer:
Hello thanks for asking a follow up
Etilaam and Aripiprazole are different medicines. Aripiprzole is an antipsychotic which is related to Olanzapine but relatively free of serious metabolic side effects. Etilaam is benzodiazepine drug. The drug is safe and helps to reduce restlessness, anxiety and sometimes helps in sleep too.
Olanzapine 2.5 mg is low dose and will not cause serious akathisia but can increase sedation and can reduce mobility.
Regarding the low weight, I'd recommend to increase protein and complex carbs in diet. In my opinion any medicine to increase weight should be avoided because of risk of CVA. Get his thyroid functions done to rule out hyperthyroidism which could be the reason of weight loss. Random blood glucose would rule out diabetes. If both conditions are ruled out then check if he is having persistent loose motions. If he is having altered bowel then that should be treated. If nothing comes out then no need to worry for his low weight. With improvement of his general condition weight will improve spontaneously.
Thanks, Take care.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your reply and will follow the same, one last question, when he sleeps at night he gets continous jerks, as per my observation it starts from lower spine area and it disturbs his sleeps and it gets worse after that, I think these are myoclonus jerks as far I have studies basis the symptoms.do we have any specific medicine to cure the same and if you can recommend for this case, will be really helpful for him. Thank you
Brief Answer:
EEG can help to make diagnosis.
Detailed Answer:
Hello again and thanks for asking a follow up
He is not on any medicine that can cause such sudden jerky movements during sleep. After CVA a lot of patients develop seizures but sudden jerky movements in spine area can't be explained. Myoclonic jerks could be a possibility.
For making proper diagnosis an EEG is advised preferably during sleep. Sleep EEG will find increase muscle activity in temporal leads and can confirm myoclonic jerks. Sodium Valproate can be used to control these jerky movements but before that proper evaluation by a doctor is needed.
Thanks, Take care
EEG can help to make diagnosis.
Detailed Answer:
Hello again and thanks for asking a follow up
He is not on any medicine that can cause such sudden jerky movements during sleep. After CVA a lot of patients develop seizures but sudden jerky movements in spine area can't be explained. Myoclonic jerks could be a possibility.
For making proper diagnosis an EEG is advised preferably during sleep. Sleep EEG will find increase muscle activity in temporal leads and can confirm myoclonic jerks. Sodium Valproate can be used to control these jerky movements but before that proper evaluation by a doctor is needed.
Thanks, Take care
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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