Page 55 - AN-3-1

Advanced Neurology Dementia with Lewy bodies and substance misuse

2. Case presentation Table 2. List of medications at different phases

We report on a 68-year-old male who presented in April Prescribed during testing in 2014
2017 with complaints of loss of executive function, Dr. A (PCP) Dr. B (psychiatrist) Dr. C (neurologist)
visuospatial dysfunction, apathy, lack of self-care with poor Atenolol 50 mg QD Nefazodone HCl Methocarbamol 750 mg
hygiene and nutrition, fluctuating short-term memory 100 mg 4 tablets QD TID
loss, confusion, incoordination, imbalance, dizziness, Imipramine HCl 10 Donepezil 5 mg QHS
fluctuating difficulty walking, and subjective leg weakness. mg 3 tablets QHS
He had a history of falling out of bed and once fell down the Alprazolam 0.5 mg Tramadol 50 mg q4-6h
stairs while sleepwalking. The symptoms had reportedly 1 QAM, 2 QHS PRN
been present since his forced retirement in 2012. Thyroxine 25 mg 2
The patient had a 40-year history of harmful alcohol tablets QD
use, which started in a mild form as a coping mechanism Duloxetine HCl 20
for anxiety, for which he had been on alprazolam since mg 2 capsules QD
the 1980s. He gradually developed AUD with several long Old prescriptions in patient’s possession in 2014
periods of abstinence. When his alcohol use decreased, his Alprazolam 0.5 mg
prescription misuse increased and vice versa. XR 2 QAM, 1 Q
afternoon
In April 2012 and November 2014, he underwent a Alprazolam 0.25 mg
Mini–Mental State Examination (MMSE). He initially BID PRN
18
scored a 30/30 despite being functionally disabled Buspirone 15 mg
by executive dysfunctions, and the score dropped to QD
27/30 in 2014. Concurrent neuropsychological testing Medications in patient’s possession on April 16, 2016
revealed “severe fronto-executive dysfunction, attention Dr. A (PCP) Dr. B (psychiatrist)
problems, variable and reduced memory, mild dysnomia, Tamsulosin 0.4 mg QD (disp Nefazodone HCl 100 mg 4 tabs QHS
and visuospatial deficits.” The generalized decline was 3/16 #30) (disp 12/14 #60)
attributed to depression, alcohol abuse, and polypharmacy. Nefazodone 50 mg up to 7 QHS
The patient appeared “overly medicated, confused, and (disp 2/16 #630)
disheveled in appearance with marked psychomotor Dr. C (neurologist) Gabapentin 300 mg BID PRN
slowing.” Despite this, he was able to engage with the (disp 3/16, 4/16 #60)
testing doctors. He practiced committing the MMSE to Donepezil 5 mg QHS (disp Gabapentin 100 mg 1-3 TID PRN
long-term memory, according to his family. 2/16+3/16 #30) (disp 4/16 #180)
At the time of testing, the patient’s prescribed medications Methocarbamol 500 mg BID Alprazolam 0.25 mg QD PRN
included five different classes of antidepressant (with three (disp 8/15+3/16 #60) (disp 1/16+2/16, #90)
different prescriptions for alprazolam), methocarbamol, Alprazolam XR 0.5 mg QID
tramadol, and atenolol. After concerns of polypharmacy (disp 1/16, #60, 6 bottles)
were raised, his psychiatrist weaned the patient off of all of OTC Alprazolam ODT 0.25 mg BID
his medications, except donepezil, over a period of 4 weeks (disp 8/15 box)
from home. While his family noticed that he became Meclinizine 25 mg (#100/ Clonazepam 0.5 mg QID
more engaged, he started drinking again in June 2014. He bottle) (disp 3/16, #105)
subsequently was on three different types of alprazolam, as Doxylamine succinate 25 mg Brintellix 10 mg QAM
well as imipramine, nefazodone, gabapentin, clonazepam, (#96/bottle) (disp 11/15, #30)
vortioxetine, and methocarbamol over the next 2 years Ibuprofen 200 mg (#50/bottle) Mirtazapine 15 mg QHS
(Table 2). (disp 11/15 #30)
Naproxen sodium 220 mg Viagra 100 mg ½-1 PRN
The patient was hospitalized in April 2016 for dizziness, (#200/bottle) (disp 4/15 #6)
shaking, and dystonic-like movement and was transferred Imipramine 10 mg 2 tablets QHS
to the inpatient psychiatric floor. He underwent (disp 3/15, #270)
benzodiazepine withdrawal, where the majority of his Imipramine 10 mg 3 tablets QHS
medications were eliminated. He was given antipsychotic (disp 12/14, #270)
medications to manage his withdrawal symptoms, Note: The patient was prescribed up to three different benzodiazepines
including haloperidol. While hospitalized, his family at one time, along with five different classes of antidepressants.

Volume 3 Issue 1 (2024) 3 https://doi.org/10.36922/an.2232