Dad w/ PD getting aggressive - Need help/advice

[MWLE]

Hello all,

My father has PD for about 20 years and diagnosed about 18 years ago. My mother has been taking care of him all these years. His condition has changed a lot this year and the PD Doc is having a hard time address it/figuring out what is causing it. Of late, he has gotten more aggressive and confrontational with my mom.

I know this is due to depression, dementia and hallucinations like other things that PWP has to deal with. His condition gets worst if he doesn't sleep well which is everyday. I know part of it is my mother's use of words - see has the lowest EQ of anyone I know. The other part is my father use to over think everything and thinks worst of everything - growing up poor and can't afford to take risks.

My father is taking Rytary, Azilect, and Donepezil. I also have him on NAD, B1/Thiamine HCI and Alpha GPC.

I worry about my mother when my father doesn't get enough sleep and my mother says something wrong.

Should I talk to my dad's neuro about antipsychotic medicines?

[Hidden]

Determine the cause first.

[Hidden]

see has the lowest EQ of anyone I know. The other part is my father use to over think everything and thinks worst of everything - growing up poor and can't afford to take risks.

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I also tend to "overthink" but it's not necessarily always a bad quality. I'm not sure if that's from his "background". I often think it has some neuropsychological basis.

He's probably a cautious guy, who unfortunately notices "bad" in people/things when they are "bad" in some ways as well as positives.

I am aware of some people, who get confrontational and raise his voice. I don't like that at all. Usually, a red flag. Having said that, if that's what your mother's words are triggering.... If someone is sensitive and has the tendency to think deeply, maybe, he is upset, angry or hurt. I suggest a counselling, rather than anti-psychotic drug.

[Hidden]

Has your Father had a diagnosis of Dementia with Lewy Bodies or any other dementia?

[MWLE in reply to Hidden]

Dementia but notLewy Bodies. Notice that is part of his anger - mixing reality with fantasy.

[kamille]

Hi, I am normally on another site. My Mom had PD so I have some experience. Just a point to see if anti depressants might help( I don't know if contraindicated.) Men particularly get agitated with depression and clearly the sleep problem needs attention. The worst park of PD for my parents was that it was very bad for the relationship which was otherwise a good one. It stinks doesn't it.

[LouThomas]

How much Alpha GPC (choline alphoscerate)? Typical doses in dementia studies seem to be 1200mg per day in divided doses. Usually in the studies they use 400mg doses, 4x daily, but what seems to be available OTC is 300mg, so that four times a day is what I was using for my Dad.

Also, you are combining donepezil with Alpha GPC, which I assume is based on the ASCOMALVA study. That study showed that adding Alpha GPC to donepezil dramatically increased the benefit to the patient. But I wonder whether the Alpha GPC by itself might have been even better? Because AChE inhibitors like donepezil have all kinds of side-effects.

Also, have you checked his meds to see if any have anticholinergic effects? Combining donepezil with anticholinergics is considered a prescribing error, since they cancel each other.

[MWLE in reply to LouThomas]

Lou - Do you know if Donepezil is an anticholinergic? My dad is taking 10mg once a day.

[LouThomas in reply to MWLE]

Donepezil is not an anticholinergic; it is an acetylcholinesterase inhibitor (AChEi). Acetylcholinesterase is what breaks down acetylcholine after it has been released into a synaptic juncture during a the firing of a cholinergic neuron.

You need to break down this released acetylcholine in the juncture before the neuron can fire at that synapse again. I suspect that AChE inhibitors slow the process of clearance, which may make neurons unready to re-fire for longer intervals than otherwise. I suspect that this is what causes the sometimes nasty side-effects of AChE inhibitors.

Alpha GPC does not have this problem; it just supplies more acetylcholine through a fairly direct process. The AChE inhibitors also raise acetylcholine levels, but their method for doing it is by slowing the action of AChE so that acetylcholine breaks down more slowly, allowing more of it to hang around from the same sources (which in cases of dementia, are often diminished below normal levels). This works, but there are side-effects, as mentioned above.

Sarin nerve gas is actually an AChE inhibitor, but the difference is that Sarin is an irreversible inhibitor, while donepezil, rivastigmine, etc. are reversible. Sarin accomplishes its disastrous effects by shutting down the ability to clear acetylcholine from cholinergic synapses, resulting in the inability of those synapses to re-fire at all. This of course does not happen with AChE inhibitors that are used medically, but the process is similar; it just occurs to a lesser degree, and the effect reverses as the drug wears off.

[BUZZ1397 in reply to LouThomas]

👍

[MWLE]

My dad has improve since getting him off of Rytary. He is now back to C/L. He actually back to a lower dosage and doing better.

Lou - My father is on 400 mg of Alpha GPC 2-3 times a day. I will look to see if any his med is anticholinergics.