Advanced Dementia

S – Situation

87-year-old female with PMHx of CVID (on monthly IVIG since 2014, now discontinued), HTN, HLD, DM2, HFrEF, RA (on celebrex and gabapentin), glaucoma, and progressive dementia. Recently admitted (8/2025) for agitation/paranoia. Now presenting with active hallucinations and ongoing behavioral disturbance.

B – Background

• Neuro eval 8/14/25 → likely frontotemporal dementia; Geri note suggests possible DLB.

• Past admission for similar agitation/paranoia.

• Daughter reports patient has not received IVIG for ~5 months; family does not plan to continue treatment.

• Masonicare denied admission due to assumption of ongoing IVIG; CM and family working on obtaining immunology letter to clarify discontinuation.

• Medications include Aricept, Lexapro, Trazodone, Zyprexa (PO vs IV if not tolerated), Coreg, Losartan, Lasix, Crestor, and glaucoma eye drops.

• On SQ Heparin for DVT prophylaxis.

• Code status: Full Code.

• Diet: Cardiac.

• PT/OT AMPAC Mobility scores: 23/20; disposition recommendation: low complexity.

A – Assessment

• Progressive dementia: Likely DLB vs FTD; psychotic features possible. Patient continues to hallucinate. Work-up negative so far. Sitter at bedside.

• CVID: IVIG discontinued; awaiting formal immunology letter for Masonicare.

• HTN/HLD: Stable on current regimen.

• Medically stable for discharge, though sitter requirement complicates psych placement.

• CM aware, coordinating with Masonicare and Cel 5.

R – Recommendation

• Ensure Zyprexa dosing linked PO/IV to avoid missed doses.

• Continue Aricept, Lexapro, Trazodone, Zyprexa.

• Provide documentation to support discontinuation of IVIG while awaiting immunology letter.

• Continue DVT prophylaxis (SC Heparin).

• Monitor for discharge readiness; disposition pending geripsych acceptance (unclear with sitter).

• CM to continue coordination with daughter and Masonicare.