My mom is being treated for dementia. She's been prescribed Aricept and Memantine. I live with her and I first noticed something was off late winter of 2018. At the time she had recently started taking Lisinopril and Metoprolol for high blood pressure. The first thing I noticed is she has trouble keeping track of the passage of time. She'll take a nap and wake up and think it's the next day. This isn't your usual what day is it type things. She will start her morning routine even if morning isn't for 12 more hours. This doesn't happen all the time but it doesn't happen enough. The second thing is hard to describe. She recognizes all of us but she also thinks there's younger versions of us. This is especially true with the two youngest children. She refered to my younger sister as "that woman who was here". She called her by her correct name. She knew who her husband was and her grandchild but the woman was not he daughter in her mind. The third thing is she's having trouble with speaking and language. She has trouble finding the right word and she mumbles. Her memory is unaffected. If she has anything planned for the near future whether it's an appointment or a social engagement, she remembers it. She doesn't misplace things and she's never gotten lost while driving. She keeps track of her own finances. After being on Aricept and Memantine for six months, there have been no changes one way or another. It's just the problem with time distortion, recognizing her children as they are today and not 20 years ago, and the speech problem.
Sometimes a speech therapist may be able to help. It did not work for us.
She is so far gone on this journey that nothing will help us now.
Have you spoken with your health care team about this? It might help.
Some BP meds around today are given preventatively - lisinopril being one of those. Many doctors follow standards for treatment of heart disease these days which are ACE or ARB & a beta blocker. Often doctors prescribe an ACE inhibitor (which is the Lisinopril) & a beta blocker (metoprolol) together.
The goal of these medications are not only blood pressure control but they help the heart muscle pump more effectively. The ACE inhibitors shunt blood to major organs to assure the organs receive better oxygenation. The beta blocker slows the HR down so the heart muscle works better as well.
I am of the opinion that you must inform your mother’s providers of the changes you made with her medications. Or any other provider. Should she need to go to the ER or acute treatment center your mother’s list of medications should follow her, this way if she needs acute treatment the providers are aware your mother is not on metoprolol even if it’s on her prescribed “list” but not what she takes. So keep that list handy but note that although the metoprolol was prescribed she is not taking it.
I didn’t see your mother’s age mentioned; maybe I missed that.
You are an astute caregiver and your mother is fortunate to have you taking care of her. But you are not a pharmacologist or physician. Decisions such as what you have done with DC’ing her metoprolol need to be shared with her providers.
I am not judging you, quite the contrary, but please collaborate with her medical providers. They are not unreasonable people (doctors) & a good provider should welcome your input and address your concerns.
She's been completely off the Metoprolol for two weeks now and her blood pressure has remained normal. I'm still giving her the Lisinopril because that doesn't seem to be causing any harmful side effects. I've also taken her off the Aricept and Memantine because they weren't doing a thing. They might have been making things worse but I'm not sure. She's still taking a 5mg melatonin tablet each night and her regular calcium, fish oil, and iron supplements. She's still taking Lexapro for anxiety and stress. I'm keeping my fingers crossed but so far she seems to be doing much better. She's more alert and even her problem with language has gotten better. Now here's the tricky part. I haven't told anyone that I've quit giving mom several of her medications. They all believe that the more pills she takes, the better she'll be. How do I convince them that her problem might have been the Metoprolol all along? How do I convince her doctor? Her new doctor specializes in internal medicine. I wonder if I should just stay silent to avoid any conflict.
What did your mom tell the ER docs or her own doctor was her problem? Did she mention her sister? Did you go with her? You know some doctors are in a big rush. Not going to sort things out like a therapist might. Panic attacks can be awful so I can understand why your mom went to the ER.
If her bp is good now then they shouldn’t question what you did in taking her off the med. You are doing the right thing to dig deep and figure this out. You need them to help you but you have to use your own judgment too.
Keep an ongoing log of her bp and pulse so the dr can see her normal bp and not just the number in his office. When your mom’s is high, think about what she did that might have caused it. Make sure she has been sitting quietly for a few minutes before you take it with her arms and legs uncrossed. Do some deep breathing first and have her relaxed. Try taking it the same time everyday. Note whether it is before or after the lisinapril.
What is your mom’s bp with and without the bp med?
The proper way is to take it three times and then average it. That’s never happened for me at a docs office but I’ve read that’s what should happen before adjustments are made to the dosage being taken.
My mom’s would shoot sky high in the dr office. White coat syndrome.
If her heart is racing the safe thing is to slow it down. It sounds like that’s what they were trying to do.
Where you took her they did all they know to do. Drugs.
They were trying to keep her from having a stroke or cardiac event. Never mind if it ruins her brain at the same time. The stroke could happen right then on their watch. The dementia is a little slower, takes longer to show up. So to be fair, they were trying to keep her safe.
Take her to a yoga class and see if she could use that to control her panic. Buy a meditation tape or look for one online. It takes as little as a minute a day to show results. Get her a massage. Check our her diet. Do regular exercise. Some folks can’t use a lot of caffeine, alcohol or nicotine.
Set up a routine of something that feeds her spirit and relaxes her.
It sounds like you had it pegged with your aunt causing so much stress. Is she out of the picture now?
Does your mom know your youngest sister now?
Doctors have a license to practice. That’s what they do. Our job is to remember that and try to find the ones who seem to use a measure of common sense along with test results.
Many elders want to just pop a pill and it might be why we have so much dementia with elders who are otherwise in pretty good shape? Who knows? but we each have to be responsible for our own health and pay attention to what we put in our mouths. The food we eat is sometimes just as detrimental as the drugs.
It sounds like you are doing a great job looking out for your mom. Metoprolol saves lives and is considered a great drug if a person truly needs it.
I didn’t want my husband to take it either. He was put on it in the hospital.
His cardiologist took him off due to the side effects. Thanks for giving us the update.
One of the BP meds she takes can make her really tired.
Do you routinely check her BP and pulse?
An oximeter can check both her pulse and her O2 saturation.
The Metoprolol is a Beta Blocker and if her pulse goes below 60 you should notify her doctor. Is she by any chance a diabetic? Metoprolol can also mask the signs of low blood sugar such as shakiness and trembling so you have to monitor her glucose regularly if she is diabetic.
Did the same doctor put her on the Aricept and Memantine?
My aunt (92 vascular) takes all these meds and doesn’t have your mom’s symptoms. Aunt actually takes Namzeric which is a combo aricept/Namenda. She also takes one extra bp med, amlodipine. When her pulse goes below 60 she holds the metoprolol and takes an extra amlodipine.
I would track your mom’s bp and pulse for a several days if you are unsure of how her meds are affecting her bp and pulse.
Even though my aunt has taken the metoprolol for many years without a problem (until the pulse issue), my husband could not take it due to severe tiredness. He took it for two weeks and his cardio took him off.
So if I were you I would ask the doctor to review her meds. Is her doctor a geriatric primary or geriatric psychiatrist or neurologist?
No two patients are alike. I can’t imagine my aunt being able to do some of the things your mom does yet she is no where as confused as your mom appears to be.
Let us know what you find out and how she is doing. We learn from one another.
I hope this makes sense. I write stuff and then think of stuff later and have trouble figuring out where to insert it.
"At the time, winter 2018, you said she started taking Lisinopril and Metroprolol".
Look there. Get a second opinion if necessary.
Has she been diagnosed by a geriatric neurologist?
Vascular Dementia is totally different from Alzheimers. My mom, with VaD, recognized all of us until the very end of her journey. Her reasoning skills were totally shot. Her language skills had very much been affected by a stroke and she had expressive aphasia.
There are many different kinds of dementia. Some folks have more than one type. Something that is often said: " If you know one person with dementia, you know ONE person with demtia".
There are many facets of the brain, and dementia affects the brain in different ways. The important thing to remember? There is no fixing this. There is mostly just going with the flow.