“I need a second opinion for my Dad's treatment?”
My father is 89 and a retired private pilot as of a year ago with heart issues. Until a year ago he had been doing his own maintenance and certifications on his plane. His chart said he could not tolerate Morphine (responds violently, uncooperative) and has claustrophobia.
Recently, Dad went to the hospital because he was having chest pains and wanted to make sure he was ok (maybe just indigestion). During the exam, he was administered Ativan. He had a very severe reaction to it including strong aggressiveness and confusion so it was noted that he did not tolerate Ativan. One hour later, Dad was given cognitive tests which he completely failed on all fronts. (Couldn't even draw a clock). The hospital reported Dad to the DMV and said he was incapable of driving and suffered from Dementia because of his cognitive test results and uncontrollable actions. Several days later, Dad had all his wits back but could not remember everything that happened at the hospital due to his drugged state while there. He went to his PCP and the doctor said all was normal at that point.
My first question is, was it reasonable to give cognitive tests one hour after the patient had a severe, intolerant reaction to Ativan?
My second question is, was it reasonable for the staff to decide my Dad had Dementia because of his drug reaction and failing the cognitive tests?
Question three is, what would you recommend we do next?
Please let me know if I did not give the right information for you to do your analysis.
Recently, Dad went to the hospital because he was having chest pains and wanted to make sure he was ok (maybe just indigestion). During the exam, he was administered Ativan. He had a very severe reaction to it including strong aggressiveness and confusion so it was noted that he did not tolerate Ativan. One hour later, Dad was given cognitive tests which he completely failed on all fronts. (Couldn't even draw a clock). The hospital reported Dad to the DMV and said he was incapable of driving and suffered from Dementia because of his cognitive test results and uncontrollable actions. Several days later, Dad had all his wits back but could not remember everything that happened at the hospital due to his drugged state while there. He went to his PCP and the doctor said all was normal at that point.
My first question is, was it reasonable to give cognitive tests one hour after the patient had a severe, intolerant reaction to Ativan?
My second question is, was it reasonable for the staff to decide my Dad had Dementia because of his drug reaction and failing the cognitive tests?
Question three is, what would you recommend we do next?
Please let me know if I did not give the right information for you to do your analysis.
Male | 89 years old
Complaint duration: This took 4 days from treatment/drugs/testing/normalcy5 days till recovery from treatment/drugs
Medications: Ativan: had no tolerance
Conditions: chest pain/clostrophobia
5 Answers
The severe reaction to the Ativan probably did affect his cognitive tests. He may have been falsely diagnosed with dementia. Consider seeing a neurologist to get help with this situation.
Whenever we administer any battery of neurocognitive testing, we make sure that there are no drug effects. At this point, it would be good to get another set of full neurocognitive testing to be cleared to drive. A neurologist can document resolution of symptoms. If it's a complete normalization of testing, it’s likely that he doesn’t have dementia.
No, it was not reasonable to test him after administering Ativan that is ridiculous. He had a predictable reaction to Ativan for an 89 yo, which includes confusion and memory loss. Once the effects of the drug go away completely, which could take some time in an elderly pt with slower metabolism, they will return to baseline. They should have never made any formal decisions about his cognitive abilities without a repeat test after the medications had completely worn off. (By the way, there is a drug called I think called flumazinol that reverses the effects of a benzodiazapine like Ativan and they could have given that to him in the ER to reverse his bad reaction, at least before testing him.) Now he needs to be retested and then a note provided to the DMV that he is actually okay, but that might not be so easy. Different states have different rules and you may find that it is really hard to get his license back. I would speak with the hospital administration, lodge a formal written complaint with them, and see what they do to help you. If they refuse, you could consider getting an attorney involved.
A cognitive test after Ativan is ridiculous. In terms of driving, the laws vary from state to state, but his pcp’s documentation will likely do the job. If he needs an FAA medical to do his airplane certification, the FAA has their own rules and will request a particular evaluation.
So your first question about should we do neuro testing after Ativan? We cannot do it for at least 8 to 12 hours. Secondly, he does not have a reaction to Ativan, it's just cognition got worse with whatever dose he got. Yes from the history that you are giving he has dementia. It's good to take the car away from him. He will have to change his lifestyle.
