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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.

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Here's the latest info. Her latest bp reading was 126/66 and her pulse was 74. When she was on the Metoprolol, her pulse would occasionally drop below 60. I didn't go with her both times she went to the ER. I go to work at 4 AM and the attacks occured after I had already left for work. My brother took her. She was originally prescribed 25 mg Metoprolol once daily. This was the Fall of 2017. A few weeks to maybe a month later she started asking how many of us for supper. It thought it was an odd question to ask since it had just been the two of us the last 9 to 10 years. My dad passed away in 2008. In January, 2018 my mom's doctor at the time upped her dose up to 50 mg because her blood pressure was still high. My aunt was still living and still treating my mom like she was her on demand personal assistant. She died in April. It was maybe a few weeks before that when my mom first got confused about what day it was. I remember her saying she felt like she had been drugged and nothing seemed like it was real, kind of like a dream. In May she started asking me where the other person who lives with us was. She was thinking of a younger version of me. She asked if the car in the driveway belonged to me or the other one. That's also when I noticed her language problem. From what I've read about dementia, it comes on gradually and is continuous. My mom's symptoms came on rather suddenly and come and go. I started to suspect the Metoprolol when she forgot to take it for a couple days and her condition seemed to improve. Her condition worsened when she went back on it. That's whenI started thinking about the timing of her dementia symptoms and being prescribed Metoprolol. That's when I decided to wean her off the Metoprolol. I monitored her blood pressure carefully and was prepared to put her back on the Metoprolol should her blood pressure go back up. So far it hasn't and she's more like her normal self. She's more alert. She's always been an avid reader and she's back to doing that now. Her internal clock is now in sync with everyone else's. She sleeps at a normal time and her meals are at a normal time. She hasn't asked if there's going to be more than just the two of us for supper and she only sets two places at the table. I hope I'm right about all this and we can put this nightmare behind us.
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It may aphasia. Speech is the one thing that DW has with her dementia. And she is unable to write out what she needs. She went thru the wrong word thing and it became a very frustrating game to help her find the correct words. That no longer works. And all of this is without any meds for her dementia.
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.
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You know your mother best but I would certainly discuss all this with her PCP.

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.
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I'm almost convinced that the Metoprolol is/was the cause of all her symptoms. She started having panic attacks the Fall of 2017. During that past year, her sister was incapcitated and she about drove my mom crazy with all her needs and wants. Mom couldn't even take my aunt to the doctor without her telling my mom she was going the wrong way. So my mom would wake up with panic attacks and feel like her heart was going to beat out of her chest. She would go to the emergency room where they would measure her blood pressure and naturally it would be high. So they would give her Metoprolol to bring it down. Her regular physician then put her on 25mg Metoprolol and then upped it to 50mg. What I want to know is why didn't her doctor or the doctors at the hospital look for the cause of her high blood pressure and treat that rather than just treat the symptom? Her dementia symptoms started maybe two or three weeks after she started taking the Metoprolol. Everyone assumed that it was classic dementia and she needed to be treated for it with more drugs. No one thought that it could be a drug reaction. I read about Metoprolol interfering with melatonin production and the melatonin supplement did help some. I also read that Metoprolol can interfere with short term memory. That's when I got suspicious and wondered what would happen if she quit taking the Metoprolol. I weaned her off it gradually. I cut her dose in half for two weeks and then in half again for another week.
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.
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97yroldmom Feb 14, 2019
No. I think you should tell them she’s off of it. Tell them she couldn’t tolerate it.

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.
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My dad has dementia and he has many of the symptoms you state here. He takes Memantine. Several years ago I bought him a 'dementia' clock with big digital numbers, date, time, AM and PM. When he wakes up and is confused he looks at that clock and it resets things for him. He is unable to remember which one of his brother and sister belongs with which one of my cousins. I am very surprised by this as he always so sharp on this kind of thing. Also can't remember which sister is which when looking at photos of them (of course, he was one of seven and he is the last one so I guess that might be hard for him to remember). It takes dad a long time to spit out words so I just listen and be patient and when I realize he can't do it, I politely fill in the blanks for him. And yes, he still keeps track of his own finances. Even though I have conservatorship, we have allowed him to pay some of his own bills. And he catches me on some stuff! He does not have Alzheimers but 'mixed dementia' as diagnosed by his geriatric psychiatrist. I think it leans more to the Lewy Body side from the articles I've read. But for whatever reason, that part of his brain that manages the numbers and the bills still works properly. The reason for the conservatorship was more because he does not spend enough money on himself to get the care and food he requires. It has given me more leeway in the decision making as he is totally incapable of making a decision anymore. He has care that comes in for 4 hours a day every day except Saturday (I take that shift) but he really should have more. Baby steps with him. If I push, he will lock up and then I will get nowhere.
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ds99302 Feb 11, 2019
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I was wondering if your mom has been back to the doctor since she started these meds?

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.
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ds99302 Feb 11, 2019
Here's more information about her meds and condition. Her first doctor put her on Metoprolol and Lisinopril. He also prescribed an anti-anxiety medication. I can't remember what it was but she said it gave her vivid nightmares. She didn't take anymore. The second doctor prescribed Lexapro, Aricept, and Memantine. She started taking the Lexapro first. She's also been taking 5 mg of melatonin at night because I've read that Metoprolol is a beta blocker and it inhibits the body from making its own melatonin. When she was on just the Lexapro and melatonin, I notice a big improvement. She was back to her old self. A month later she started taking started on the Aricept and Memantine and I think it made her worse. The other day I went to refill her prescription for Lexapro and the pharmacist said if you take Lexapro and Aricept together, it can cause a rapid heartbeat. So she was on Metoprolol, which slows down the heart and the combination of two other medications which can speed up the heart. A few weeks ago I read that beta blockers can interfer with memory. So I gradually weaned her off the Metoprolol over the course of a few weeks. Her blood pressure has remained the same, although her pulse rate did go up slightly. Her pulse when she was just on the Metoprolol would frequently be below 60, which is way too low in my opinion unless you're an athlete. Then I found out about the reaction between Lexapro and Aricept causing a rapid heartbeat. So now I've quit giving her the Aricept and the Memantine. I'm monitoring her blood pressure and pulse regularly. So far they've been normal. She's also getting back to her old self again. So it does make me wonder if the blood pressure medications caused her dementia or if she had the propensity for dementia and the medications brought it out. My mom is very sensitive to medications which is why I believe the fewer things she takes, the better off she is. This is the reason why I have trouble trusting doctors. So many of them look for the easy answer and simply prescribe something to alleviate the symptom rather than trying to find the cause.

I hope this makes sense. I write stuff and then think of stuff later and have trouble figuring out where to insert it.
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Traditional Medicine Practice searches the simplest explanations first.

"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?
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So, if she has had high bp over time, she might be suffering from Vascular Dementia. Who is following her now?

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.
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ds99302 Feb 9, 2019
She only started taking medication for high blood pressure about a year and a half ago. She was under a lot of stress and was waking up with panic attacks. Before that, her blood pressure was actually low. Everything I read about Alzheimer's is that it affects memory first. Her memory hasn't been affected. Also, her symptoms didn't come on gradually. It was suddenly one day she couldn't figure out whether it was morning or night or one day or the next. She does okay if she has activities to fill her waking hours. There's something to associate with each passing minute.
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I would certainly talk with her doctor to make certain she isn't having a reaction to her medications.
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Has she had a stroke?

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.
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ds99302 Feb 9, 2019
Brain scans show evidence of one or more mini strokes but they occured long before any of her current symptoms appeared. She obviously didn't have any symptoms of having a stroke although a few years ago she was having terrible dizzy spells. Unfortunately, her doctor at the time wasn't up on things and chose to treat the symptom rather than trying to find the cause.
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