Sedative Medications in the Dementia Patient

Mr. S  is a 79 year old retired laborer who has had gradually progressive symptoms of memory compromise and combative behavior for about two years. He is brought to your clinic by his wife of nearly 60 years, and his oldest son.A short muscular man he has an iron-grey crew cut and looks ten years younger than his real age. He is cordial with you during the interview but most of the history is given by his wife.

His speech is heavily accented and he has little concept of dates and time. He remembers Franklin Roosevelt as the president and expresses considerable affection for him. He has enjoyed good health during his life. He drank to excess during his younger years and would drink more now than the limited amount of wine and beer his family let's him have. He and his wife have lived in the same house for nearly 50 years.

His physical examination and laboratory screen are essentially normal. On the Mini-Mental Status examination he scores 15/30. He completed only grade school, and that in the old country. The son takes you aside and tells you that his father's behavior is becoming a real problem. He becomes angry easily and has threatened to hit his wife, though the son thinks he has not done so. In any event, his mother has denied his when asked directly by the son. He roams the house at night and is obsessed that intruders may break in. He has been seen by two doctors in the past year who have attempted to alter his obstreperous behavior with drugs.

Amitriptylene did help him to sleep at night but caused him difficulties with urination and he was seen twice in Emergency Service for acute urinary retention. Alprozolam made him more relaxed but it was hard to get him to take it, he thought he was being poisoned by the little white tablets. Diazepam made him quite unsteady and he fell twice, once needing stitches on his head. 

Respond to the following questions from the above case:

1. Would you consider depression and the likelihood that he would benefit from an SSRI drug like sertraline?
   
   

2. Can you think ways to modify his behavior other than use of medications?
   
   

 3.  Would you consider alcohol as a bedtime sedative?

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