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Mom's caregiver at night says she is becoming more confused and anxious in the evening. Says she wants to go home (she already is) wants to be alone, wants to call 911 on everyone. Got up last week and wanted to make breakfast at 130am. It takes a while to calm her down . The caregiver says there are meds she could take. I can't see Mom taking a pill when she's all worked up like that but maybe there is some thing she could take daily. Something that won't zonk her. I made her an appt in a few weeks but would like some suggestions about what you have done to deal with this problem.

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You call her MD now, and get a mild anxiolytic to start with. It won't zonk her. You add meds in a low dose and increase only enough to calm her, not knock her out. Then when you see the MD in a few weeks, you review the effectiveness. If you do nothing, the caregiver usually quits.
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My Mom has the same problem. She takes Ativan in the evening. It does make her sleepy, but it helps her sleep through the night. She takes a small dosage in the morning to keep things consistent.
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My mother who recently passed away was on Namdnda. It helped her a lot with her memory and anxiety.
Hug your mother everyday! Mind USB ' there any longer and I miss her hugs!
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I've tried both Ativan and lexapro low dosages for morning panic attacks neither works..They both make her sluggish when she awakes and last to well into the afternoon.. I just have to try to calm her down on my own..

I've been told by DR that the effects are different with every dementia patient...

She has an appt next week and we will be seeing about a geriatric neurologist and psychiatrist because the panic attacks are almost daily and I'm about to loose my mind too!! LOL
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The panic attacks are awful. I can't go out of town (mom's in assisted living). Because the panic attacks when I leave are much worse. Since traveling is so I love to do it makes me resentful. I planned on traveling when I retired, not taking care of an elderly woman
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Namenda seemed to help with some of Moms anxiety. : ) Good luck.
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Does the namenda make her sluggish?
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My mom takes Namenda. Doctor said it would HELP slow down, but not make her memory problems go away.
I highly recommend Alprozalam for anti-anxiety. Mom get crazy without it, she imagines she is in prison, that I have deserted her, tried to leave the hospital before they released her, claimed no doctors or nurses had come in or identified themselves, saw no white coats. Etc. awful for us both!
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Ask your mom's doctor about Risperdal, just 1 mg. by mouth each day-it is an antipsychotic drug, one I have worked with a lot & my husband who suffers Solvent Dementia has been on it for 17 years now & I could not deal with him otherwise. I am a Psychiatric R.N. & have worked in the field for over 40 years now. Just put it out there to the doctor & if he is open to it-do it for your own sanity.
I have found that I tend to stay with the drugs that are tried & been used for some time. So many of the newer drugs have devastating side effects.
Low doses of Xanax work for panic attacks, as well as Clonazepam, as a matter of fact, same drug compound-one acts fast the other has a longer half life & stays with the patient longer.
Blessings be....
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Everybody is different! What is good for one could harm the another one. You should consult with the doctor for any meds.
But, there are some very helpful natural remedies available on the market.
Essential oils diffused around the house can really help. Herbal tea can calm down some anxiety. Rubbing coconut oil with lavender (only pure organic grade!) to the skin at night will help your loved one to sleep better. Apply few drops on the pillowcase if her skin is too sensitive.
Try to find out what might help your mom without addiction and side affects.
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Ativan can worsen memory loss, I believe, based on our experience with my mom. She took it daily, some days twice a day, for about 20-30 days, for severe anxiety/panic attacks when she was in her late 70s. She had very mild memory loss at the time, but it got much worse immediately after that course of Ativan. It seemed to disorient her permanently. Once she got on an antidepressant, the panic attacks went away, but she has never recovered her memory or her former sense of place and time. (A known side effect of Ativan is memory loss; in the elderly it could worsen memory loss already present.) Apparently Xanax is a similar drug, and may have similar side effects, but I believe Ativan is more known for it. Quetiapine fumarate may be a decent alternative - at a very low dose of 1mg, it has really helped my dad with paranoia, anxiety and anger, although it does make him a little sleepy, so he is only supposed to take it in the evening. He previously tried risperdal, which made his heart race, and Abilify, which worked well and did not have noticeable side effects, but was extremely expensive. (There is no generic for Abilify yet.) Note that all three are in a class of drugs, antipsychotics, that carry a 'black box' warning against use in the elderly. But they're commonly used in spite of the warning, because the negative quality of life effects of the anger, paranoia and sometimes violence are so extreme. (For us, it had gotten to the point where my mom was telling us she was afraid that my dad might hurt her in a rage, after he'd thrown and broken things in the house around her -- this was not something we could accept in the family. We felt that her peace of mind, and his, were paramount.) If you can, make an appointment for her with a psychiatrist, preferably a geriatric psychiatrist, who will have experience with these drugs and be able to prescribe the right one for your mom's situation. I hope things work out for you!
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The dr just increased my mother's dosage of seroquel from 25mg in a.m. and p.m. to 1 - 50 mg in a.m. and 2 at nite. He also px lexapro in morning and now Mother cannot keep her eyes open. Getting the meds right is so difficult.
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My MIL lived to be 98. The last three years particularly were terrible, not merely hard. No meds helped. Seraquel zonked her out even at 25 mg. She had been on 200 dose for combative dementia. She hurt me a lot, physically. She was angry, depressed, anxious and finally started not recognizing her son. Her sexual advances to him and exposing herself were the topping on an already over-frosted cake. Death is the healer. There was no real quality of life here and late-stage combative dementia is a brutal thing to live with. There is no magic potion. You can't stuff the genie back in the bottle.
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PS: This is only one of the many injuries she inflicted on me--the split lip right through to my skin that had to be stitched up because she smashed me to the floor with her walker and kept pounding me with it until her son, my husband, dragged her off. I decided to post that picture because many people on here just don't get it. They don't realize what combative dementia can do to the caregiver.
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Try some Melatonin at night or an antihistamine. Give those in the lowest dosages and see if they work. Let the doctor know what you have tried when you do see him/her. Try a bath with Epsom salt as it has magnesium (mostly) and it will relax her too.
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Good ole Benadryl helped Mom. she was on Lorazepam 0.5mg but it quit working. I would give her 1/2 of a 25mg Benadryl and the other half 2 hours later it helped a lot it helps take the edge off when she would get anxiety attacks. I get it at Costco. I use it if I'm having trouble sleeping it doesn't leave me groggy in the morning.
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Yes. There are definitely meds that can help calm dementia patients without zonking them.

But they all require trial-and-trial-again. This is true of "natural" remedies as well as prescriptions. If the first thing you try works, hallelujah! But it is more usual to adjust dosages, try different drugs, try some combinations, and finally arrive at the most effective with the least side effects.

Our neurologist's rules were to
1) try ONLY ONE new drug or remedy at a time. If you are taking multiple new drugs how will you know which one has the side effect?
2) start at a very small dose and titrate up until the dose is effective or you've reached the max without success
3) reevaluate the entire drug mix frequently

I don't know how we would have gotten through the 10-year dementia journey without a patient, knowledgeable doctor well versed in available drug therapy. We were very fortunate that my husband responded very well to medications. In the letter explaining his autopsy results the doctor remarked on that fact and said "we don't know why" drugs were especially useful for Coy. Wouldn't it be great if doctors had some clues, some biomarkers, that would reduce the experimentation and help them chose the best drugs right from the start, or to know that drugs would not be successful? My dear husband donated brain tissue for such research.

By the way, seroquel was one of the most useful drugs for Coy. It did turn him into a complete zombie for about 2 hours. I learned to give it to him only after he had his pajamas on and was in the bedroom. I wouldn't have given him any during the day. I know others who take a few doses throughout the day, and some who have tried it and it made matters worse for them.

Each brain is absolutely unique. There are no one-size-fits-all solutions. But there are solutions. Hang in there!
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Something new is arising-- Last year I had was living with Lynn, who had anxiety. Lucky for me there were two other caregivers and the neighbor across the street sat in when problems arose. I supported Lynn with her need for anxiety meds, as her intestinal issues were also helped. When she wanted to try heavier sleep med, I said OK. Her neighbor backed me up against the other two caregivers. This still did not stop Lynn totally, and one night --even though she could just call me and I would be there within a minute--she got up to come get me to help her. She fell and cut herself badly on the walker. I took her to the ER and after admitted they decided to keep her and run tests. They found her cancer had come back and diagnosed her death within 3 weeks. I hate to tell this, but be sure to have another person or two to back you up.
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mm4vea This sounds like sundowners. Try distractions give her a laundry basket with a bunch of socks/towels/scarves and see if she will fold/sort them. Give her something to do that will make her feel useful and appreciated, praise her for her help. Have her caregiver help her create a memory book of family photos/pictures out of magazines, play music from when she was a teen, give her a box full of artificial flowers that she can arrange. Sort out a sewing box. A lot of caretakers meet the daily living needs not the mental needs, having her mental needs met will give her a better quality of life and not want to give up and lessen the attacks. We all need to feel our life matters. Call a memory care facilities and ask to speak to the activity coordinator ask what other stimuli you could use to help Mom decompress.
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I agree with Pamstegman about contacting the MD, otherwise your caregiver could quit. This a really tough one. It might be better to talk with a pharmacist, as they are more knowledgable about meds and its side effects. I have started to be more "open" to marijuana as I saw a utube video about women patients that tried it and NO side effects! Never tried it, but there are lotions! apparently. Look into all options.
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When using Benadryl - it contains diphenhydramine which will cause a dementia-like symptom which will diminish when you stop using it. It is still good if you have an allergic reaction to something.
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It seems I can't edit my post, so I want to correct something I said in my comment above -- the dosage my father gets of Seroquel (quetiapine fumarate) is actually 25mg, not 1mg. Apparently, 25mg is the smallest available dosage. The range that the doctor prescribed was 1/2 to 2 tablets per day, not 1/2 to 2mg. My mistake!
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Love. One time, my husband was very upset. I approached him from his back, and gently hugged him. I said to him with very low and soothing voice as if I was talking with a sleepy baby, “don’t worry…you are all right…you are in safe…” whatever I could think of. He calmed down. After he went to the bed, I gently hold his hands until he fallen a sleep. Hope you will find something other than medication for her
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I too have been losing my mind with trying to find medications that can work to resolve issues or behaviors that are bothersome (drive you nuts) and trying to find something that does not sedate them to the point they are sleeping.

My Mom is one of those unlucky people that many medications were tried on and they did not seem to work. We have heard how great Seroquel was so it was tired and it was like she was taking water, same with Haldol, Valium and several others. Remeron and Celexa worked until she began getting headaches and had to come off, although they did make her tired and sluggish.

Now she is on Ativan .25mg 3 times a day and Ambian 2.5 mg at night and she is wide awake, not sluggish, BUT I have to tell you that this JUST BARELY controls her and sometimes, does not control her. I think it needs to be increased or add some Xanax to it, because she can and does drive me nuts! It does not relieve any of the bad behaviors. She will ask me 50 times a day if the dog has been fed, she will get mad and decide SHE WILL FEED THE DOG WHEN SHE WANTS AND WHAT SHE WANTS...(THE DOG IS ILL AND ON A SPECIAL DIET). She gets angry with me and says very mean hurtful things...."I am tired of looking at your face, pack your s--t and get out, you can live on the streets, what have you EVER done for me" You name it and it rolls out of her mouth! I have cared for her for 8 years and her sister, my father and brother in law for a total of 17 years. I am her POA for Medical and Financial and I do about 99% of everything that has to be done for her, so when she spouts off this stuff and does it for so many years, you do not care if "it is just the disease talking" you get upset eventually and I am about ready for her to go into a facility. It isn't what I wanted and is the opposite of why I took her POA, but mentally, physically and emotionally, this disease is not just a "person killer" it is a "family killer!" I am ready for it to end.

When we look at these medications, we want them to have as much of themselves as possible for as long as possible, but when their actions and behaviors become such that we or our paid caregivers can no longer handle them or put up with their behaviors, I think we need to either increase meds or change them. My mother could go on living with these same exact medications, but I CANNOT GO ON LIVING WITH HER TAKING THESE MEDICATIONS, she is too difficult for ME TO HANDLE!

So if you are paying someone to care for your mother, you need to look at other medications that may make her a bit sleepier, but if your caregiver cannot take it any longer, chances are YOU WOULD NOT BE ABLE TO HANDLE IT EITHER AND YOU NEED TO MAKE CHANGES.

My two sibling have no idea what I go through daily, they come over to visit and Mom is fine all day on her best behavior. On Monday when everyone is gone, she is back, screaming and yelling at me.

Don't lose a good caregiver, make sure to tell her you will get on it immediately and see about some changes.

Good Luck and Best Wishes
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I knew I liked assandache7 my mom is from Boston Sicilian hard to the core. Love her she is one of a kind. I have been in denial about her dementia but for two weeks now it has been awful, hospice gave her morphine n Xanax but as a result she is not awake or drinking or eating. If it works for one issue it brings on three more. She has suffered a longtime .
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Thanks for the advice everyone.
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Mover2: I do not want to sound insensitive so I want to see if I can ask this question gently. You said your Mom was in hospice and was on Morphine and Xanax and you are concerned about her not eating, drinking and sleeping too much. I just wanted to ask is she in the final stages of her illness? I only ask because when my father was very ill and hospitalized they put him on morphine to keep him comfortable until he passed. You said she has suffered a long time, perhaps her sleeping a lot is a good thing at this point. They tried morphine on my Mom as a way of stopping the sundowning in the hospital and allowing her to sleep, but it did not work she is able to override almost everything, this is very frightening to me, I would rather have my mom comfortable and sleeping.

God Bless You Both!
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The past weeks she has been experiencing the sundowner thing, it's like we trade off one thing and have two more things come up, not eating or drinking now, but no pain or severe anxiety. I am very scared, I am unsure if this is the right thing. I am here next to her now, I want her to be comfortable
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hi mrn4eva,
In general, the safer & less "zonking" medication options for angry/anxious dementia patients would be an SSRI antidepressant; in geriatrics we tend to use Celexa, Lexapro, & Zoloft. Namenda is another class of drug; seems to help some patients, and generally doesn't seem to make thinking/balance worse.

Ativan and Xanax are benzodiazepines and do make thinking & balance worse. They, along with the antipsychotics, are on the list of 5 things to be careful about when it comes to healthcare for aging adults:
http://www.healthinaging.org/aging-and-health-a-to-z/topic:choosing-wisely/

You may still find the benefits of trying these medications outweigh the risks...in the end it's often necessary to make difficult choices in order to maintain sanity.

Safest is to use non-drug approaches for anxiety/anger, like having a regular routine, treating pain/constipation (this does require meds sometimes), regular exercise & fresh air. Aromatherapy massage, pet therapy, music therapy and more have worked for some people.

Good luck!
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One thing I have found to work for me is that I made a bracelet out of turquoise & amethyst. I wear it on my wrist. As my husband, who I now live next to because I could no longer live with him, comes at me as the enemy(??), all I can do is to listen as if it makes sense to me, in his anger & all. He suffers from early onset solvent dementia & is only 64 but is on meds & I am a Psychiatric R.N. too. I use my prayer bracelet to pray on when I am being verbally attacked & it puts things into proper perspective for me. He is my teacher-as weird as that may sound. Not a day goes by that he teaches me not.

Having a strong spiritual take on it all help me so very much.
Blessing are....
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