Drug induced dementia can and does happen, and it is important to make sure that we assess multiple factors before adding more medications!  Here’s the scenario: An 81 year old male presents with worsening confusion over the period of about 3-6 months.  The primary provider is considering an Rx for Aricept as she feels that this is Alzheimer’s dementia.

Prior to adding medications, it is always important to assess what other factors may be contributing to a medical issue (including my favorite of course…Drugs!).  This patients current medications include:

• omeprazole
• metformin
• amitriptyline
• lisinopril
• hydrochlorothiazide
• glipizide

It was decided to discontinued the Elavil which was being used for sleep and depression problems to rule this out as a potential cause of cognitive problems.  Discontinuing this medication change did not make an impact on cognition.

Now, we must remember that there are numerous medical conditions that can contribute to dementia.  One of those conditions is B12 deficiency.  Before adding a dementia medication, it was decided to check a B12 level to assess for possible deficiency.  Keep in mind that by looking at the medication list, this patient is on metformin as well as the omeprazole, both of which could contribute to B12 deficiency.

The B12 level was indeed low, and supplementation was initiated.  Dementia symptoms did not entirely resolve, but there was some notable improvement noted by the provider.

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