Post-Shingles Treatment: Confusion and Hallucinations in Elderly Patients

Q: Post-Shingles Treatment: Confusion and Hallucinations in Elderly Patients

Hello： The tasks to be done are： 1. <br>Discontinue the medications given for the treatment of shingles and <a href="https：//adoctor.tw/article/30129">#30129</a>; rash. <br>2. <br>Refer the patient to a neurology outpatient clinic as soon as possible (preferably at the same hospi

After treatment for herpes zoster, there were instances of nonsensical speech?

Hello, Doctor Huang! My mother-in-law is in her eighties and, due to excessive stress and prolonged fatigue, developed herpes zoster three weeks ago (she has never had it before) and has experienced abdominal pain.
She was hospitalized for treatment and is currently scabbed over and starting to recover, but she still requires catheterization and rehabilitation, and is very weak.
She was discharged yesterday to rest at home, but has started to exhibit signs of confusion and incoherence, which have worsened today, seemingly accompanied by hallucinations and a faint voice.
We suspect this may be drug-related, as she showed no signs of dementia prior to hospitalization and was clearer-minded than most elderly individuals.
I would like to ask the doctor if the medications used to treat herpes zoster could cause such symptoms.
Since her infection extended from her lower back to her face and crossed over to the other side, the attending physician was somewhat concerned about potential effects on the cranial nerves.
However, a CT scan of the brain performed before discharge showed everything was normal.
Should we be worried about other complications or diseases? Since she has already been discharged, we would need to make a new appointment for a follow-up.
Should we return to the original dermatology department, or consult neurosurgery or another specialty? Thank you in advance for your response!

Xin huang de jia ren, 40~49 year old female. Ask Date: 2010/10/21

Dr. Huang Ruiyun reply Dermatology

Hello: The tasks to be done are: 1.
Discontinue the medications given for the treatment of shingles and #30129; rash.
2.
Refer the patient to a neurology outpatient clinic as soon as possible (preferably at the same hospital, as there is a complete medical history).
There are several possibilities: 1.
The elderly may have slower metabolism and reduced brain function compared to younger individuals, which could lead to altered consciousness at doses considered safe for most people.
2.
Poor immune response may allow the shingles and #30129; virus to invade the brain.
3.
Changes in the patient's condition may be unrelated to medication or shingles and #30129; rash (neither 1 nor 2), indicating the occurrence of another condition.
Many elderly individuals who appear to be functioning well may actually be gradually entering a "dangerous balance" state, where situations that are not severe for younger people (such as falls or colds) could escalate to serious conditions.
This is something that younger family members with elderly relatives should always be mentally prepared for.
Wishing you success.

Reply Date: 2010/10/21

More Info

Post-shingles treatment can be complex, especially in elderly patients who may have underlying health issues. Your concerns regarding your grandmother's recent confusion and hallucinations after her shingles diagnosis are valid and warrant careful consideration.

Shingles, or herpes zoster, is caused by the reactivation of the varicella-zoster virus, which can lead to painful rashes and, in some cases, complications affecting the nervous system. The treatment for shingles typically involves antiviral medications (such as acyclovir, valacyclovir, or famciclovir), pain management, and sometimes corticosteroids to reduce inflammation. While these medications are effective in managing shingles, they can also have side effects, particularly in elderly patients.

Confusion and hallucinations in elderly patients can arise from several factors, including:
1. Medication Side Effects: Antiviral medications and pain relievers can sometimes lead to confusion, especially in older adults who may metabolize drugs differently. Opioids, which are sometimes prescribed for pain management, can also cause sedation and cognitive impairment.

2. Dehydration and Malnutrition: Elderly patients are at a higher risk for dehydration and malnutrition, particularly if they have been ill. These conditions can lead to confusion and altered mental status.

3. Infection: Although your grandmother's shingles rash is healing, the stress of the illness and any associated infections can contribute to confusion. Additionally, if she had abdominal pain, it’s essential to consider whether there was an underlying infection that could still be affecting her.

4. Underlying Cognitive Decline: While you mentioned that your grandmother did not show signs of dementia prior to her shingles, it’s possible that the stress of her illness could have exacerbated any pre-existing cognitive issues.

Given these considerations, it is crucial to address her symptoms promptly. Here are some recommendations:
- Consult a Healthcare Professional: Since your grandmother has recently been discharged, it is advisable to follow up with her primary care physician or a geriatric specialist. They can evaluate her current mental status and determine if her symptoms are related to medication, dehydration, or another underlying issue.

- Neurology Consultation: If her confusion and hallucinations persist, a referral to a neurologist may be warranted. They can conduct a thorough evaluation to rule out any neurological complications that may have arisen from her shingles or other health issues.

- Follow-Up with Dermatology: While her primary concern was shingles, if there are any lingering skin issues or concerns about the rash, a follow-up with the dermatology department may also be beneficial.

- Monitor Hydration and Nutrition: Ensure that your grandmother is adequately hydrated and receiving proper nutrition, as these factors can significantly impact her recovery and cognitive function.

- Medication Review: A review of her current medications is essential. If you suspect that her confusion is related to her medications, discuss this with her healthcare provider. They may consider adjusting dosages or switching to alternative medications with fewer side effects.

In summary, while the medications used to treat shingles can contribute to confusion and hallucinations, it is essential to rule out other potential causes. A comprehensive evaluation by her healthcare team will help determine the best course of action to support her recovery and improve her quality of life.

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