My 90-year-old wife is having memory lapses with aggressive behavior. Kindly help.

Hello,

Welcome to icliniq.com.

I would like to know some further details about the symptoms:

1) Since when symptoms of forgetting started?

2) Since when she started to become agitated and harming caregivers?

3) Does she have self-talking or talking with someone (without anyone being present near)?

4) Does she soil her clothes in urine or stool? If yes, since when?

5) Is there any history of previous head injury, stroke, seizure, paralysis, etc.?

6) Is her sleep cycle regular at night? Or an erratic sleep cycle?

I suggest doing the following investigations:

1) CEMRI Brain (contrast-enhanced magnetic resonance imaging), if the pacemaker is MRI (magnetic resonance imaging) compatible. If the pacemaker is not MRI compatible, get CECT (contrast-enhanced computed tomography) head.

2) EEG (electroencephalogram).

3) Serum Vitamin B12.

4) T3, T4, and TSH (thyroid-stimulating hormone).

5) Serum Vitamin D3.

6) Lumbar puncture and CSF (cerebrospinal fluid) examination (if needed).

Will need physical consultation so that examination and some psychoanalysis can be performed to decide treatment (medications cannot be decided via teleconsultation in such situation). Medications can be given for control of aggressive behavior.

If found to be degenerative dementia, usually no curative treatment, but few supportive medications are available.

I suggest consulting a local neurologist.

I hope this was helpful.

Hello,

Welcome back to icliniq.com.

Among reports, her urea or creatinine are toward the higher side. Vitamin D3 is low, and cholesterol is high, INR (international normalized ratio) is 2.5 (which is Warfarin effect) (attachments removed to protect the patient's identity).

MRI done five years ago (before the start of this forgetfulness) will not be of utility for looking for reasons of forgetfulness.

Likely a chance it being degenerative dementia with associated behavioral disturbances.

I suggest you do the following investigations:

1) MRI Brain (if pace make is MRI compatible), if the pacemaker is not MRI compatible, get NCCT (non-contrast computed tomography) head

(Avoid contrast during MRI or CT, as creatinine is on the higher side).

2) EEG.

3) Lumbar puncture and CSF examination (if needed).

4) USG (ultrasonography) whole abdomen with PVR (post-void residual urine).

Maintain regular nighttime sleep patterns. Avoid daytime somnolence. Keep the patient engaged in some mindful, playful, or learning activities requiring some intellect during the day, instead of making her sit idle the whole day.

She will require further investigations to search and refute some causes for such forgetfulness and behavioral disturbances.

I understand your apprehension pertaining to the COVID pandemic. But can plan if COVID cases have been fewer in your area. She will need to have a physical consultation with a neurologist and psychiatrist separately for evaluation and further management.

For low Vitamin D3, I suggest capsule Neuro D3 (Cholecalciferol) 60 units once weekly for two months and for high cholesterol levels can add tablet Contact 20 (Atorvastatin) mg HS and for higher urea or creatinine, I would suggest meeting a nephrologist.

I hope this was helpful.