Drug Enduced Dementia

[Billy__B]

Does anyone know anything about drug enduced dementia from morphine sulfate? My father has been on it since 1990 and takes cymbalta,zoloft for the depression side effects and just is OUT of it alot. He will sit down and just fall asleep. he falls asleep while eating dinner and even standing up talking he dozes off.  I know alot of it is the meds make him tired and (he's 64) just normal aging, but, what are the symptoms of drug enduced dementia?

He also like... hallucinates..... he sees bugs crawling sometimes in the house on the walls, and sees people standing in the room that have been dead for years and carries on conversations with them. he has VERY vivid dreams. and wakes up believing they are real and responds to them in real life. i.e. getting angry at me if i did something in his DREAM he didnt' approve of.  

Thank you all !

Billy B

[Jaybay]

You'll find a whole lot of info doing a Google search, but your job right now is to make sure your dad's doctors know what is going on.  It's best if you can accompany him to an appointment so the docs can speak freely due to HIPPA laws.  They can't discuss his case over the phone with you, but they CAN listen to your observations of your dad's behavior.  It probably won't be easy, so don't give up!

From rxlist.com:  http://www.rxlist.com/duramorph-drug.htm#

Geriatric Use
The pharmacodynamic effects of neuraxial morphine in the elderly are more variable than in the younger population. Patients will vary widely in the effective initial dose, rate of development of tolerance and the frequency and magnitude of associated adverse effects as the dose is increased. Initial doses should be based on careful clinical observation following "test doses", after making due allowances for the effects of the patient's age and infirmity on his/her ability to clear the drug, particularly in patients receiving epidural morphine.

From Medline:   http://www.ncbi.nlm.nih.gov/pubmed/7873091
Starr JM, Whalley LJ.
Division of Geriatric Medicine, Hammersmith Hospital, London, England.

Drugs are a frequently cited cause of dementia. There is a paucity of data regarding the incidence of drug-induced dementia, but it has been estimated that over 10% of patients attending memory clinics have iatrogenic disease. Drugs may impair cognition indirectly via metabolic effects, such as hypoglycaemia, by alterations of immunological factors within the CNS, and by actions that interfere with synaptic transmission. Classes of drugs most frequently responsible are the benzodiazepines, antihypertensives and drugs with anticholinergic properties. Each of these classes is likely to produce a different pattern of neuropsychological deficits. Prevention of drug-induced dementia will be aided by: (i) minimising the number of drugs prescribed; (ii) using shorter-acting preparations; (iii) avoiding agents that cross the blood-brain barrier where possible; (iv) evaluating renal and hepatic function regularly; and (v) briefly assessing cognitive function before treatment.

PMID: 7873091 [PubMed - indexed for MEDLINE]


Elderly patients may be more susceptible to respiratory depression and/or respiratory arrest following administration of morphine.

[Tuckamore]

Hi Billy,

Welcome to MedHelp. I am so sorry that your father is having these difficulties with his medications. Something is wrong..but than you know that. I do not know the doses of his medications so it is difficult to speculate into what may be going on. Is his behavior new or is it long term?

It is not his age, at least it certainly shouldn't be. My husband is older than I, he just turned 64. He is a Vice President for a very large multi-site international corporation. He is as sharp and extremely intelligent making million dollar decisions frequently. He has never fallen asleep standing up or while eating.  At 20 I'm sure you father seems "old" to you but he is not "old" even in the medical world. So it is not his age that is making him hallucinate or have vivid dreams.

Have you tried to choose a lucid moment and discuss your concern with your father? If not that would certainly be my first step. If you have older siblings or a mother in the home I would also get them involved in this discussion.

Is his physician aware of his mental condition? It sounds to me as if he is over medicated. He may have a terminal condition that calls for this heavy medication or some severe and chronic painful condition, even at that I think he is either over medicated or his meds are not working well together.

HIPPA has forbidden your father's physicians from discussing his condition or medications with you, unless you are his POA. However it does not stop you from contacting the physician that is prescribing his medications and reporting your concerns and his behavior. Their hands are tied, they cannot share anything with you without his written permission but your call will make them aware of what you are observing. Additionally you could ask your father if you may accompany him on his next visit to his physician. He can give permission if you are at the appointment for his physician to address your concerns.

If he refuses to allow you access into his medical information your hands are pretty tied. You have a right to be safe as does he. If you ever feel that his physical or mental well being is in jeopardy you may call 911.

You sound like a good son, one who is justifiable concerned for his father. I wish you the very best in your search for some answers or help for your father. Please keep in touch and let us know how you are doing. If you have additionally questions please ask.
Take care, Tuck

[Jaybay]

I seem to remember reading that these reactions to narcotics and some antidepressants are not all that uncommon in older patients.  You might get some better information on this issue from the Ask a Pharmacist board here at Med Help.  Just click on the Forums icon at the top of the page and look on the right side of the new screen under the "A"s to post your question.

Certainly you need to make your dad's doctor(s) aware of what is happening.  If he has several different specialists involved, each one may not be aware what the other is prescribing - a common problem with patients of any age, but far more dangerous to seniors who tend to have more than one medical issue.  The way the system is "supposed" to work is that a primary care phsycian is kept informed as to everything the individual specialists are doing, so he can keep an eye out for drug interactions, etc.  Doesn't always work out well though as I learned with my own grandparents.