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

Answered by
Dr. Hitesh Kumar
and medically reviewed by Dr. Sushrutha Muralidharan
This is a premium question & answer published on Dec 27, 2021

Hi doctor,

My wife is 90-year-old. She suffers from memory lapses. Sometimes wakes up at odd hours and steps into the kitchen thinking it is morning to prepare tea.

She forgets where she keeps the money, keys, etc., then gets upset or blames the workers. If I reorient her, she gets agitated. Sometimes she raises her hand to slap me or kicks me. Otherwise, she is a calm and gentle person. I am 93-year-old. I have impaired mobility and use a walker. Sometimes she neglects hygiene, does not feel like taking a shower. These are some changes that I am noticing in her.

Her weight is 65 kg, and her height is 5'7". She has pulmonary issues, hypertension and is fitted with a pacemaker for arrhythmias.

Her medications are as follows:

1) In the morning, she takes Thyroxine Sodium 12.5 mcg one tablet, Eplerenone tablet 25 mg one tablet, Dytor Plus LS half tablet, Metolar 25 one tablet, Cardace 5 mg one tablet and nebulizer Foracort respules 0.5 mg and Duolin respules 3 ml.

2) In the evening, she takes nebulizer Foracort respules 0.5 mg and Duolin respules 3ml and tablet Cardace 5 mg one tablet, Aspirin 75 mg one tablet, Warfarin Sodium 5 mg one tablet, and Telmisartan 40 mg one tablet.

Please help me.

#

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 doctor,

Thank you.

Below is my response to your questions:

1) For three years, symptoms of forgetting is there.

2) For three years, she started to become agitated and harming caregivers. It happens if we keep reminding her, for example, to take a shower, and she keeps postponing for days even though she had agreed to do so in the morning. She gets irritated and says, "I know how to take care of myself. I looked after myself all these years, etc."

3) No, she does not have self-talking. But she looks like she is in deep thought if left alone. Or she has started sucking her fingers one by one. Lip-smacking loudly. Or she uses her nails as a toothpick to pick on her teeth. What I am saying here is she has no awareness that it looks bad or unhygienic. She gets upset with me if I ask her to stop.

4) Twice, she has soiled her clothes in urine or stool in the past.

5) No previous head injury, stroke, seizure, paralysis, etc.

6) She sleeps, but I have to wake her twice to give me the urinal. She takes short naps from 9 AM to 11 AM and 2 PM to 4 PM on most days.

Investing:

1) MRI was done about five years ago. Due to COVID will not step out of the home.

2.) EEG was done three years ago and is within normal limits.

I am forwarding the test results for your reference. Kindly give your opinion.

#

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.



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