INDOMETHACIN-INDUCED BEHAVIORAL-CHANGES IN AN ELDERLY PATIENT WITH DEMENTIA

OBJECTIVE: To describe a case of behavioral changes induced by indomet hacin in an elderly man with a history of senile dementia of the Alzhe imer type. CASE SUMMARY: A 92-year-old white man with a history of sen ile dementia of the Alzheimer type, glaucoma, and constipation was tre ated with indomethacin for an episode of pseudogout. After six doses o f indomethacin 25 mg, the patient became very agitated, confused, and was physically and verbally aggressive to the nurses. Indomethacin was discontinued and the patient recovered after receiving haloperidol 0. 5 mg/d po over a period of 10 days. DISCUSSION: Only a few cases of ps ychosis have been reported in the literature concerning the use of ind omethacin in patients over the age of 60 years. The mechanism by which indomethacin causes psychosis is not well understood, but it is postu lated that the acute psychosis may be related to the similarity betwee n the molecular structure of indomethacin and serotonin. Both indometh acin and serotonin have an indolic moiety, which may explain the devel opment of acute psychosis in this patient. CONCLUSIONS: Healthcare pro viders should be aware that patients with a history of dementia who ar e receiving indomethacin may be at risk of developing severe behavior problems along with gastrointestinal and renal adverse effects.