December 21, 2021

After doctor appointments this week with both the Psychiatrist and the Neurologist, we've decided to make some medication changes. We're upping the seroquel dose from 75 to 100mgs per day, but are splitting it so he's taking half in the morning and half in the evening. The hope is that some of the relief from the evening dose will still be impacting him in the morning, so it'll help the morning agitation before the morning dose kicks in. In the future we will probably switch to a timed release formula so that it's continually active. We're dropping Aricept/Donepezil. That's a memory medication that doesn't do much for the majority of people. I'll watch to see if there's any change in memory as a result. It's typically the first medication that is given for memory loss, but it doesn't have a great track record. I remember way back, before John was anywhere close to a diagnosis, but was discussing his memory problems with our doctor. The doctor prescribed Aricept. I remember he said that if it helps, it's not a good sign, because that probably meant he was in early stage dementia. I don't remember if John felt that it helped then. Over the years he's been on and off of it a couple times. I do remember an uptick in cognizance at one point when we restarted the medication, but he was angry and frustrated by it. So we'll see what happens now, if anything. We're continuing Namenda, a medication that is usually prescribed once dementia has progressed to the moderate stage. The Dr said that some studies show it actually slows the progression of the disease, so she recommended that we continue that one. I agree. I'm not a fan of extending life when the quality of life sucks. My goal is to improve John's quality of life wherever possible, but I don't want to extend misery. I wouldn't want that for myself, and I don't want that for him. I discussed that with the doctor, and she is supportive. But I don't think John is miserable now. He's confused, frustrated, agititated and generally unhappy, but not miserable. He still finds joy. The Neurologist also gave John the MMSE - the Mini Mental State Exam. It's a simple 30 point test that measures cognitive function. Today John scored a 10. 6 months ago he scored a 12. That's a typical drop for that time period. (A score of 20-24 suggests mild dementia, 10-19 suggests moderate dementia, and scores below 10 suggest severe dementia. But I've also read that anything below 12 suggests severe dementia. The Neurologist pointed out that what is important is daily life skills - dressing, eating, toileting, etc. The longer those skills are present, the better the quality of life. So we focus on quality of life, and maintaining life skills as much as possible.