My dad is 70 yrs old and was diagnosed with PMR last week and had been given prednisolone ever since. First 3 days the rheumatologist gave him prednisolone 40mg and he didn’t look like himself, mostly quiet, confused, dazing, couldn’t answer simple questions, couldn’t drink or swallow when we told him so. At first I thought he had dementia as before taking prednisolone, he was indeed forgetful and was not as sharp as the younger him. The doctor said it was the side effect of prednisolone and then he reduced it to 20mg on 4th and 5th day. My dad somehow became more ‘awake’ and could engage in conversation and became active in asking questions like usual, which made me quite relieved. The doctor reduced the prednisolone to 10mg on 6th and 7th day and subsequently 5mg on the 8th day till 2 months later. However, on the 7th day till now (10th day) my dad doesn’t seem to behave normally. He kept repeating question like he forgot the answer, a bit confused, he didn’t even know how to use his phone and just yesterday he said random stuff and talked to himself the whole night and only fell asleep in the morning (despite the fact that the doctor gave him Remeron 7.5mg to add his appetite which previously made him super sleepy). He also has been wearing diaper before being diagnosed with PMR because he got difficulty to rush to the toilet to pee (he can feel to pee but too last minute and he is aware he got some prostate problem due to his age). Normally he also could feel that he need to pass stools but now he totally couldnt feel it. I thought the ‘dementia syndrome’ earlier is caused by high dose prednisolone and I expected my dad to be back to normal as now he only takes 5mg, but he doesn’t seem normal now.
Few years ago he did take methylprednisolone 4mg for a short term before being diagnosed with PMR and he had no such side effect.
I was told by a neurologist that this side effect is due to the high dose prednisolone and my dad doesn’t have dementia (my dad had brain MRI scan prior to taking prednisolone and through consultation with neurologist, he thought my dad is alright). The neurologist said dementia gradually happens, not suddenly, and his behavior now could be because of his mood (my dad does have anxiety when he was in normal state), so he suggested to take Remeron as of now.
We also went to see a gastroenterologist because my dad needed to do gastroscopy as he did have history of gastric problems and thank god that his gastroscopy result turned good. However, the gastroenterologist thought my dad had dementia and refered us to a neurologist who couldn’t be sure if my dad has dementia because of not enough evidence (so no medicine given), then the gastroenterologist prescribed my dad with Exelon Patch 5. My dad used it for 3 days then he felt dizzy and spinning (I am not sure it is because of Exelon or Remeron, but the gastroenterologist told us to stop them first and see how it goes). We only restarted Remeron a day after that after talking to neurologist about his abnormal behavior and he thought it was alright to take. The neurologist didn’t recommend my dad to use Exelon as he thought my dad didn’t have dementia, so my dad stopped using it.
I am concerned if his ‘dementia’ or abnormal behavior now is because of:
1. Tapering off prednisolone dose, or
2. Side effect of prednisolone can come anytime and even on the low dose like 5mg, or
3. Side effect of suddenly stopping Exelon, or
4. My dad actually has dementia?
If it is because of the prednisolone, how to treat this dementia syndrome? When will my dad become normal?
Anybody can help me please? Thank you!!!