Agitation/Shadowing

Posted by ljchr @ljchr, 5 days ago

My DH is entering stage 6 of Vascular Dementia. He is beginning to get agitated at times and so far I have been able to redirect him. I fear that his agitation will progress. I wanted opinions on medication for agitation. Our PCP said that the meds could progress him faster. I hate to give him anything to escalate this disease.

He is mildly hyper-sexual but very clingy and shadows me everywhere I go. My fear is how much worse this could get.

Any experience with these types of medications will be appreciated.

Interested in more discussions like this? Go to the Caregivers: Dementia Support Group.

In reply to @ljchr

I'm sorry if I offended you by my flippant post addressed to Karla; and I didn't mean to treat your question lightly. (I was just trying to add a little levity to life ambushed by the intrusion of dementia. Again, my sincere apologies.)

I'm also sorry that your husband is entering stage 6 of vascular dementia. I know how difficult it is because my husband is also in a stage of alzheimer, Lewy Body's, Parkinson's and vascular dementia that is causing insomnia, agitation and shadowing. No medication has helped because his condition is complicated to treat. (We have tried Remeron, Seroquel, Rexulti and Ativan.)

I give George CBD/THC drops and gummies during the day and at night. They help a little but not enough.
CAVEAT: You have to be careful about mixing CBD with prescription medications. The reaction varies from individual to individual. Before I started giving George CBD, I researched drug interactions, and read that mixing drugs or mixing drugs with CBD, especially in the case elderly patients, can lead to breathing issues, coma, and death. I also made a list of all of George's prescription medications and consulted with a geriatric psychiatrist AND an MD who was an international cannabis expert. They were worth the out-of-pocket expenses and very reassuring.

Our shared journey is daunting, but as Karla regularly reminds us, "[w]e're all in this together"; and with the collective support of this group, "we can do it." Thank you for inspiring us to be better caregivers by your sweet remark: " He is beginning to get agitated at times and so far I have been able to redirect him." (It's impossible for me to redirect George, so I come to forum to recenter myself.)

In closing, I would like to repost a message from teacher502 | @teacher502 | Mar 2 10:54am, quoting "1st Corinthians 13:7,8,13":

'Love
bears all things,
believes all things,
hopes all things,
ENDURES all things.
Love NEVER ENDS.
So now faith, hope and live abide, these three; but the greatest of these is love. '

Love,
George's Wife

P.S. Sorry for any grammatical errors or typos. (I'm typing with one hand these days.)

This AI Overview I found might be of help to you:

"Manage Alzheimer's agitation by first identifying triggers. Before using medication, address underlying physical discomforts like pain or infections. If non-drug approaches are insufficient, FDA-approved pharmacological options include Brexpiprazole (Rexulti), an atypical antipsychotic, and Dextromethorphan-bupropion (Auvelity).

Alzheimer's Association
+4
1. Non-Pharmacological Interventions (First-Line)
Always try these behavioral and environmental strategies first to avoid the side effects of medications:

VJDementia
·VJDementia
+1
Identify triggers: Agitation is often a form of communication. Check for pain, hunger, thirst, fatigue, or a need to use the restroom.
Simplify the environment: Minimize background noise, harsh lighting, and clutter.
Establish routines: Keep to a consistent daily schedule for meals, waking, and sleeping to prevent "sundowning".
Use redirection: Offer familiar activities, comforting snacks, or soft, soothing music.

Alzheimer's Association
+4
2. FDA-Approved Medications
If agitation is severe, endangers the patient or others, and does not respond to environmental changes, a doctor may prescribe medication:

VJDementia
·VJDementia
+1
Brexpiprazole (Rexulti): The first atypical antipsychotic officially approved by the FDA for the treatment of agitation associated with Alzheimer's dementia.

U.S. Food and Drug Administration (.gov)
+1
Dextromethorphan-bupropion (Auvelity): The first non-antipsychotic, non-psychotropic drug specifically approved to manage dementia-related agitation.

Alzheimer's Association
3. Off-Label Medications
Healthcare providers may also use certain medications off-label:

Consultant360
+1
Antidepressants: SSRIs (like citalopram or sertraline) are sometimes used if the agitation is accompanied by depression or anxiety.
Other Antipsychotics: Older off-label antipsychotics (such as risperidone or olanzapine) are sometimes prescribed, but they carry a Boxed Warning for increased risk of death in elderly dementia patients.

WebMD
+1
Read more about these behavioral strategies on the Alzheimer's Association or review the formal announcement for approved treatments via the FDA."

REPLY
Profile picture for dianaml @dianaml

@georgescraftjr
To all..
Who the heck cares about sex at this point!? I just want peace and quiet and to not be blamed for everything. I can relate to doing more and more everyday. My husband has mild cognitive decline and used to do so many complicated things regarding finances and the computer and now he actually comes to me and asked me. I am pretty techno deficient but I'm getting better at it out of absolute necessity. My dream would be to leave him but that is just not possible. And I don't know if I really want to live alone! Financially neither one of us could afford to live separately. Together financially we are good we are stable and have more than what we need. But he is just so difficult and it gets worse every day. And because he can't remember things, everything is always my fault. Discouraging!

Jump to this post

@dianaml

I am so sorry that your situation is so discouraging, and I understand your lack of interest in sex.

It's a positive that you found this support group. Caring for someone with memory issues is challenging. Although it can bring out the worst in us, it can also bring out the best. Without the support and genuine kindness of everyone in this group, I would be completely bonkers by this stage of my journey with George. (He kept me up all night again last night; so I am mildly bonkers, which seems to be what I am most of the time these days.)

Hugs,
George's Wife

REPLY
Profile picture for kjc48 @kjc48

@georgescraftjr I'm now laughing over your post, although my corrupt operating system, pales in comparison to your caregiving George, 4 toilets, two roofs, a desktop, laptop, cell phone, bills, investment accounts and contractors for even bats! Please know you wouldn't have had time for sex even if that had happened! And yes, when I asked the gal at Best Buy why the PC was so expensive, she said "tariffs." @judimahoney agrees she wants a care/wife too! We're all in this together. Best, Karla

Jump to this post

@kjc48

Thanks for the reminder: "We're all in this together."

Lilly

REPLY
Profile picture for georgescraftjr @georgescraftjr

In reply to @ljchr

I'm sorry if I offended you by my flippant post addressed to Karla; and I didn't mean to treat your question lightly. (I was just trying to add a little levity to life ambushed by the intrusion of dementia. Again, my sincere apologies.)

I'm also sorry that your husband is entering stage 6 of vascular dementia. I know how difficult it is because my husband is also in a stage of alzheimer, Lewy Body's, Parkinson's and vascular dementia that is causing insomnia, agitation and shadowing. No medication has helped because his condition is complicated to treat. (We have tried Remeron, Seroquel, Rexulti and Ativan.)

I give George CBD/THC drops and gummies during the day and at night. They help a little but not enough.
CAVEAT: You have to be careful about mixing CBD with prescription medications. The reaction varies from individual to individual. Before I started giving George CBD, I researched drug interactions, and read that mixing drugs or mixing drugs with CBD, especially in the case elderly patients, can lead to breathing issues, coma, and death. I also made a list of all of George's prescription medications and consulted with a geriatric psychiatrist AND an MD who was an international cannabis expert. They were worth the out-of-pocket expenses and very reassuring.

Our shared journey is daunting, but as Karla regularly reminds us, "[w]e're all in this together"; and with the collective support of this group, "we can do it." Thank you for inspiring us to be better caregivers by your sweet remark: " He is beginning to get agitated at times and so far I have been able to redirect him." (It's impossible for me to redirect George, so I come to forum to recenter myself.)

In closing, I would like to repost a message from teacher502 | @teacher502 | Mar 2 10:54am, quoting "1st Corinthians 13:7,8,13":

'Love
bears all things,
believes all things,
hopes all things,
ENDURES all things.
Love NEVER ENDS.
So now faith, hope and live abide, these three; but the greatest of these is love. '

Love,
George's Wife

P.S. Sorry for any grammatical errors or typos. (I'm typing with one hand these days.)

This AI Overview I found might be of help to you:

"Manage Alzheimer's agitation by first identifying triggers. Before using medication, address underlying physical discomforts like pain or infections. If non-drug approaches are insufficient, FDA-approved pharmacological options include Brexpiprazole (Rexulti), an atypical antipsychotic, and Dextromethorphan-bupropion (Auvelity).

Alzheimer's Association
+4
1. Non-Pharmacological Interventions (First-Line)
Always try these behavioral and environmental strategies first to avoid the side effects of medications:

VJDementia
·VJDementia
+1
Identify triggers: Agitation is often a form of communication. Check for pain, hunger, thirst, fatigue, or a need to use the restroom.
Simplify the environment: Minimize background noise, harsh lighting, and clutter.
Establish routines: Keep to a consistent daily schedule for meals, waking, and sleeping to prevent "sundowning".
Use redirection: Offer familiar activities, comforting snacks, or soft, soothing music.

Alzheimer's Association
+4
2. FDA-Approved Medications
If agitation is severe, endangers the patient or others, and does not respond to environmental changes, a doctor may prescribe medication:

VJDementia
·VJDementia
+1
Brexpiprazole (Rexulti): The first atypical antipsychotic officially approved by the FDA for the treatment of agitation associated with Alzheimer's dementia.

U.S. Food and Drug Administration (.gov)
+1
Dextromethorphan-bupropion (Auvelity): The first non-antipsychotic, non-psychotropic drug specifically approved to manage dementia-related agitation.

Alzheimer's Association
3. Off-Label Medications
Healthcare providers may also use certain medications off-label:

Consultant360
+1
Antidepressants: SSRIs (like citalopram or sertraline) are sometimes used if the agitation is accompanied by depression or anxiety.
Other Antipsychotics: Older off-label antipsychotics (such as risperidone or olanzapine) are sometimes prescribed, but they carry a Boxed Warning for increased risk of death in elderly dementia patients.

WebMD
+1
Read more about these behavioral strategies on the Alzheimer's Association or review the formal announcement for approved treatments via the FDA."

Jump to this post

@georgescraftjr
Hello again to George's wife. I had hoped the CBD would help George a lot more. My sweet hubby had so much agitation and severe combative issues that he was becoming impossible to handle and choices had to be made. Little by little all medications were stopped and then the CBD worked beautifully. Now he has lost so much ground, but I am grateful we were able to give him a bit more peace through this terrible diagnosis. Many times I wanted to give up, but the verse shared above has fueled my determination to love him regardless of the challenges of LBD.
Thank you for your posts! I enjoy every single one!

REPLY
Profile picture for kjc48 @kjc48

@georgescraftjr I'm now laughing over your post, although my corrupt operating system, pales in comparison to your caregiving George, 4 toilets, two roofs, a desktop, laptop, cell phone, bills, investment accounts and contractors for even bats! Please know you wouldn't have had time for sex even if that had happened! And yes, when I asked the gal at Best Buy why the PC was so expensive, she said "tariffs." @judimahoney agrees she wants a care/wife too! We're all in this together. Best, Karla

Jump to this post

REPLY

Y’all are cracking me up- are you sure you are not living my life?
Not only do I fix things now, pay the bills, and do all the driving, I have to tell my husband that winning the lottery is not going to help solve our financial mess.
He only remembers the years we were debt free- before doctors, therapists, personal trainers, two gym memberships to keep him happy, and countless meals not at home.
Even if I show him our negative balance sheet - he just talks about buying new ….

After my lowest point today - I needed your humor
Bless you

REPLY
Profile picture for minniem @minniem

Y’all are cracking me up- are you sure you are not living my life?
Not only do I fix things now, pay the bills, and do all the driving, I have to tell my husband that winning the lottery is not going to help solve our financial mess.
He only remembers the years we were debt free- before doctors, therapists, personal trainers, two gym memberships to keep him happy, and countless meals not at home.
Even if I show him our negative balance sheet - he just talks about buying new ….

After my lowest point today - I needed your humor
Bless you

Jump to this post

@minniem I needed your humor this morning. Thank you for chiming in, and validating, we're all in this together. Same events, same situation, just different names/people living in our house. It's all too consuming at times, why I like to get up early, log in, see this site, and post when I can add any value - or at minimum a bit of humor.
Best, Karla

REPLY
Profile picture for georgescraftjr @georgescraftjr

@kjc48

Thanks for the reminder: "We're all in this together."

Lilly

Jump to this post

@georgescraftjr I always find your posts so rewarding, filled with so much education about this disease, elegantly written, where although you tell me my posts sound like prose, your writing has this beautiful flow, that lyrically plays out on paper. There's so much wisdom from your experience with this disease and for that I'm grateful. I received a response back this week, where either I wrote my post in a confusing way, or the reader just read it wrong. That bothered me for days, and I don't know why, as the advice we give, comes from our hearts and our own vantage point. Therefore, we use what's valuable and set aside the rest for if and when we need it. Because of you, I'm listening this morning to Jelly Roll and Lady Gaga, "God I'm Tired of Trying, and Holy Spirit Fill Again". "Lord, I'm fragile, sweep through the cracks of my heart, where the brokenness lies, Holy Spirit fill again. When I'm too weak to stand, you lift me with your hands." Every little gem of wisdom on this site, has lifted me. Thank you. Best, Karla

REPLY
Profile picture for kjc48 @kjc48

@georgescraftjr I always find your posts so rewarding, filled with so much education about this disease, elegantly written, where although you tell me my posts sound like prose, your writing has this beautiful flow, that lyrically plays out on paper. There's so much wisdom from your experience with this disease and for that I'm grateful. I received a response back this week, where either I wrote my post in a confusing way, or the reader just read it wrong. That bothered me for days, and I don't know why, as the advice we give, comes from our hearts and our own vantage point. Therefore, we use what's valuable and set aside the rest for if and when we need it. Because of you, I'm listening this morning to Jelly Roll and Lady Gaga, "God I'm Tired of Trying, and Holy Spirit Fill Again". "Lord, I'm fragile, sweep through the cracks of my heart, where the brokenness lies, Holy Spirit fill again. When I'm too weak to stand, you lift me with your hands." Every little gem of wisdom on this site, has lifted me. Thank you. Best, Karla

Jump to this post

@kjc48

Karla,

I needed to see a post by you first thing this morning. I slept but an hour or two cobbled together last night, George was so agitated he could stay still: He got in and out of bed all night long. (His doctor increased the dosage of his Ativan from .35 mg to 1 mg. I'm going to research whether it takes awhile for the medication to work effectively.)

Thanks for mentioning a song I haven't heard but will play today when George is not within earshot. (He gets irritated when I play anything except classical music!)

Hugs,
Lilly

REPLY
Profile picture for georgescraftjr @georgescraftjr

@kjc48

Karla,

I needed to see a post by you first thing this morning. I slept but an hour or two cobbled together last night, George was so agitated he could stay still: He got in and out of bed all night long. (His doctor increased the dosage of his Ativan from .35 mg to 1 mg. I'm going to research whether it takes awhile for the medication to work effectively.)

Thanks for mentioning a song I haven't heard but will play today when George is not within earshot. (He gets irritated when I play anything except classical music!)

Hugs,
Lilly

Jump to this post

@georgescraftjr what was the song or utube video you posted with Jelly Roll and Lady Gaga a while back. Was it "God I am trying?" I went to play it, but it didn't sound exactly the same, so I landed on the other one. Those two artists together are incredible. PS, in between all this craziness, my husband yesterday, bent down and tied my shoe, and told me he was my "care partner." that's the love you talk about in all your posts. Unconditional love - where you can turn the other cheek on your own problems, to that of a loved one. Best, Karla

REPLY
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