Delirium

A primer for newbies and old pros alike.
PhilD
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Re: Delirium

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Thank you both for your replies. I appreciate the time and effort you both have spent responding to my query.
NF52 : Thanks for the Aphasia video link. I will look at it tomorrow.
RAJ64 : I took Robin to an optometrist about a month back and she could not remember her alphabet. She can't write anything down. However she can read with 90% precision. She also can't read large numbers. Every couple of days I take my scrabble letters and ask Robin to find the letters I call . She is getting better.

I will schedule a meeting with a neurologist to make an assessment. Robin has not seen one since she was first diagnosed. The neurologist wanted to give Robin Aricept and I refused to do it after reading lots of information about this drug. Instead I focused on mental and physical activities , her diet and supplements.

Will keep in touch.

PS: As soon as I found out Robin had AD we went overseas to do some long walks like Hadrian's Wall , The Camino Frances ( Spain) and walked across France. We were supposed to go to Portugal but Covid stopped that. I am a bit worried about taking Robin overseas now.
PhilD
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Delirium revisited

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Robin has been good for the past 12 months. No delirium . About 3 weeks ago she had a terrible delirious episode which required me to take Robin to emergency. She had to be taken by ambulance because she did not want to listen to me . She was given antibiotics and she became good for at least 10 days, In the past week however, she has has delirium episodes every day. Her GP thinks it is normal for a person with Alhzeimer to have delirium and suggested I give her Seroquel . My question is should I take her to hospital ( emergency) again to have a full assessment. Her Urine was tested a few days ago and she does not have UTI. Is it normal for a person with AZ to have delirium everyday
Regards
Philippe
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Re: Delirium revisited

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PhilD wrote: Thu Nov 10, 2022 3:40 pm Robin has been good for the past 12 months. No delirium . About 3 weeks ago she had a terrible delirious episode which required me to take Robin to emergency. She had to be taken by ambulance because she did not want to listen to me . She was given antibiotics and she became good for at least 10 days, In the past week however, she has has delirium episodes every day. Her GP thinks it is normal for a person with Alhzeimer to have delirium and suggested I give her Seroquel . My question is should I take her to hospital ( emergency) again to have a full assessment. Her Urine was tested a few days ago and she does not have UTI. Is it normal for a person with AZ to have delirium everyday
Regards
Philippe
Hello again, Philippe! It's good to hear that Robin had 12 good months up until very recently. It sounds like she must have either tested positive for E coli again, or another bacteria, or they decided to give her a broad-spectrum antibiotic just in case she had something triggering her delirium. Either way, it sounds like that helped.

Are the episodes lately similar in intensity or behaviors to the one 3 weeks ago, or more like her earlier behavior of being confused or generally agitated, without a particular trigger you can identify? If the latter, it may be that Robin is developing some of what is called "agitation" but can also be delirium as a part of what is, sadly, sometimes a later stage of Alzheimer's.

I know an advanced practice nurse who works in both AD clinical care and research in late-stage Alzheimer's. She believes that it is essential to find solutions that work, other than psychotropic medications--which sometimes are all doctors can offer. It seems like research into use of CBD (cannabidiol) and THC, ingredients in cannabis, are becoming recognized as holding promise, judging from a Google Scholar search.

Robin's doctor may think that's a crazy idea--and potentially harmful to go to your local medicinal marijuana store (if you have that in Australia) and get something with no way to tell its strength. Here's some info, however, if you and your doctor think this might be an option for Robin. The first gives you the big picture; the others highlight why this might work.
A narrative summary of the findings from the limited number of studies in the area highlights an apparent association between cannabidiol-based products and relief from motor symptoms in HD [Huntington's disease] and PD [Parkinson's disease] and an apparent association between synthetic cannabinoids and relief from behavioral and psychological symptoms of dementia across AD [Alzheimer's disease], PD, and HD. These preliminary conclusions could guide using plant-based versus synthetic cannabinoids as safe, alternative treatments for managing neuropsychiatric symptoms in neurocognitive vulnerable patient populations.
Cannabinoids in the management of behavioral, psychological, and motor symptoms of neurocognitive disorders: a mixed studies systematic review

Next is an excerpt from a chapter on Medicinal Cannabis and CBD in Mental Healthcare
The endocannabinoid system is involved in the pathophysiology of Alzheimer’s disease and, because of this, may be an important therapeutic target in the future.Preclinical and clinical research indicates that cannabidiol, tetrahydrocannabinol, and some of terpenes found in cannabis may be useful in the treatment of the neurobehavioural aspects of the condition. Medicinal cannabis may be a valuable part of a holistic approach to the treatment of AD that considers a range of factors including diet, exercise, stress reduction, and others.
Finally, a review of the status of research by Italian researchers: Cannabinoids: Therapeutic Use in Clinical Practice
Medical case reports suggest that cannabinoids extracted from Cannabis sativa have therapeutic effects; however, the therapeutic employment is limited due to the psychotropic effect of its major component, Δ9-tetrahydrocannabinol (THC)..Today, FDA-approved drugs, such as nabiximols (a mixture of THC and non-psychoactive cannabidiol (CBD)), are employed in alleviating pain and spasticity in multiple sclerosis.... In this review, we highlighted the potential therapeutic efficacy of natural and synthetic cannabinoids and their clinical relevance in cancer, neurodegenerative and dermatological diseases, and viral infections.
As summer approaches in Australia, I wish you both some peace and moments of joy.

Nancy
4/4 and still an optimist!
PhilD
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Re: Delirium revisited

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Thanks Nancy for your quick response. I don't think the delirium is caused by the fact that Robin has Alhzeimer. I think she just has chronic UTI . I have given her Hyprex in the past but I don't think it is working, I also gave Robin D- Maltose but I ave used one that does not a PAC rating. I am looking to buy D-Maltose with PAC 36. What do you think? Also there is a new drug coming out called CRISPR which can fix permanent UTI . Have you heard of it ?
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Re: Delirium revisited

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PhilD wrote: Sun Nov 20, 2022 5:11 am Thanks Nancy for your quick response. I don't think the delirium is caused by the fact that Robin has Alhzeimer. I think she just has chronic UTI . I have given her Hyprex in the past but I don't think it is working, I also gave Robin D- Maltose but I ave used one that does not a PAC rating. I am looking to buy D-Maltose with PAC 36. What do you think? Also there is a new drug coming out called CRISPR which can fix permanent UTI . Have you heard of it ?
Hi Phil,

I don't have any knowledge of D-Maltose, (dextrose-maltose), and couldn't find much about it with a quick search. You may want to post a question with the subject heading of "D-Maltose for chronic UTI" to see if anyone else can help.

CRISPR generally refers to a gene-editing process that was developed in 2010 that has allowed many promising discoveries for gene-editing. This excerpt is from a 2017 article appears to be about using CRISPR to identify strains of UTIs, with hopes that they may be able to develop new drugs against those strains.
We conclude that genome editing by CRISPR-Cas9 system is an effective tool to dissect the molecular mechanism of biofilm formation in medically important strains, and the study may serve as a basis for developing novel medical intervention against UTIs caused by biofilm.
CRISPR-based genome editing of clinically important Escherichia coli SE15 isolated from indwelling urinary catheters of patients

Robin continues to be a lucky woman to have you as her partner and loving advocate.

Nancy
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Tincup
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Re: Delirium revisited

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PhilD wrote: Sun Nov 20, 2022 5:11 am Thanks Nancy for your quick response. I don't think the delirium is caused by the fact that Robin has Alzheimers. I think she just has chronic UTI .
Here is a different UTI approach: methylene blue. It was used for years until antibiotics became popular (though it is more effective). Methylene blue has a biphasic dose response. At low doses, it is an electron "recycler" for the electron transport chain. At high doses, it is a pro oxidant. When low doses are taken chronically, the methylene blue is excreted by the kidney. It will collect in the bladder at a high enough concentration to be a pro oxidant & this can kill the bacteria in the bladder without "carpet bombing" the microorganisms throughout the whole body. In this post, I list a number of podcasts by Dr. Francisco Gonzalez-Lima. The Mercola one is a good overview. Dr, Gonzalez-Lima mentions his mother was on a specific product for this purpose, but it is no longer sold. It provided 60 mg/day of MB. The product is not needed. Not sure what is available in Australia. In his research, Dr. Gonzalez-Lima has a compounding pharmacy compound MB with ascorbic acid (the ascorbic acid makes it more bioavailable). In IV form, it is likely available in IV form as an antidote for methemoglobinemia in almost every hospital emergency department. In the US, MB powder in USP purity is available on Amazon. Here is a search for other posts I've written on MB on this site.

I have taken it for some while at a dose of 23 mg/day (about 0.3 mg/kg) for the electron "recycler" purpose for cognition purposes. In liquid form, it is can be messy and will stain. I use ascorbic acid powder to clean up any stains.
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Julie G
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Re: Delirium

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I think she just has chronic UTI .
So sorry to hear this, Phil. She may very well have interstitial cystitis, in which her urinalysis will turn up normal but her bladder wall can be severely affected. A cystoscopy is the typical way to DX which may be too difficult for Robin to tolerate now.

See this Mayo Clinic link for treatments. Tricyclic antidepressants and antihistamines will worsen her cognition, so please consider alternatives. I use D-mannose and a new Cranberry Concentrate supplement that are very helpful.

You're a wonderful husband to be so tuned in to her symptoms and to be providing such loving care. Please let us know what you find out.
PhilD
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Re: Delirium

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Thank you all for your wonderful feedback and supporting comments. With the information you provided I will keep trying finding a solution that works. Methyl Blue was in indicator that I used for doing acid - base titrations. interesting suggestion that I will investigate. And yes will raise an item for D-Manose to see what peope have to say. Will also look the Mayo clinic link. Thank you .... you are all wonderfull
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Re: Delirium

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PhilD wrote: Thu Nov 24, 2022 5:19 am Methyl Blue was in indicator that I used for doing acid - base titrations.
As noted in the podcasts, you want MB that is 99% "pure" as many of the products for the lab have heavy metal contamination.

Though Dr. Gonzalez-Lima suggests not using the MB for fish tanks. I had a chemist friend test the Kordon brand on her mass spec machine for heavy metals. My reasoning was that if it wasn't pretty clean, it would kill the fish. She told me it met drinking water specs. I've been using it & I also get a hair test for heavy metals every couple of months. I think there is risk to what I'm doing so don't suggest it for others.
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