Re: Xanax, dementia behavior (was: Hello! New to the group & have a few...)

[Guest guest]

in your last paragraph you mention stimulents - are you talking about those used

for ADHD (ritalin, concerta, etc) thr paranoia is the worst part of this for my

mom... if they true stimulents help, I'll talk to her doc about them.

is there an article describing the use of DLB that I csn read and bring with me

when I talk to him

thanks

heddy

>

> Why such strong feelings about benzos?

>

> Simple: they're delicious with a couple of margaritas. Responsible

> doctors don't want anyone having any fun.

>

> *KIDDING*

>

> In the well elderly in general, the risk of sedation is what links

> them to problems; by definition all of these drugs (Xanax, Ativan,

> Valium, Klonopin to name a few,) cause sleepiness and confusion.

> This can cause falls, hip fracture, various forms of amnesia, etc.

> They impair driving performance, even hours after dosing. They are

> pharmaceutical Big Guns - they have direct effects on some of the most

> important " feedback " receptors in the nervous system. The Beers

> criteria (a list of drugs that should be avoided in the elderly)

> cautions against them because older adults tend to clear them from the

> body less effectively than younger adults, and the risks (up to and

> including death) go up the longer that they linger in the system.

>

> In DLB, part of the concern is the " hangover " effect - many of us have

> seen this with Ativan for example - a tiny dose that I personally take

> to get through the airport and comfortably onto the plane (and can

> still do the NY Times crossword puzzle in ink) will leave Cal asleep

> for 12 hours without moving an inch, and we're roughly the same

> weight. Then, when he wakes up, he's grogged out and confused for

> another 24 hours. The decrease in function from the unmedicated

> baseline is just too great, even with a dose I'd describe as

> " homeopathic " .

>

> So, in general, the tradeoff of " calmer " with a benzo vs. " cognitively

> impaired " is a big one. Xanax and Ativan have a half-life of roughly

> 12 hours, Klonopin is roughly 35, Valium is roughly 35 too, and Valium

> has an active metabolite that has a half-life measured in days. So

> just because you take it every 8 or 12 hours, or just at night, it

> never really leaves the body completely if you're using it regularly.

> The question is, do these sub-therapeutic levels between doses matter?

>

> In the case of DLB they probably do. These are people who aren't

> operating with a lot of cognitive reserve. If 3% of the receptors in

> a normal brain are bound with this drug (a roughly normal binding from

> a single dose of Ativan), where there's neuronal death in DLB, we

> might be binding a larger percentage of receptors, ergo, getting a

> bigger effect. If there's neurotransmitter imbalance (and there is),

> inhibiting the feedback channel (GABA) is going to be unpredictable.

>

> I'm not denying that these are useful drugs. Klonopin for RBD is the

> gold standard of care, and on top of all his other charms, Dr. Boeve

> is fellowship-trained and board-certified specifcally in sleep

> medicine, so if he says " Use Klonopin " , I'm gonna tend to ask " How

> much? " . But in general, I would have to question using something

> sedating, on a daily basis, in our loved ones when *so many* of the

> cognitive and behavioral symptoms of DLB are starting to emerge as a

> problem of a brain that isn't " fully awake " .

>

> As wacky as it seems, as broken of a record as I am, I am amazed that

> the stimulants seem to relieve the paranoia, the delusions, the

> hallucinations. . . and the anxiety they produce - just as well as a

> shot of Ativan, to be honest, with the " sife effect " of better

> cognitive function. I wouldn't have believed it until I saw it.

>

>

>