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Ask the Mental Health Expert Archives 2001-2004

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Kleptomaniac with Alzheimers

Q. My husband is a diagnosed Alzheimers disease victim, still viable, but shows classic signs of memory and confusion/judgement problems. He is manifesting kleptomania recently of my daughter's and my jewelry. He stole about 8 lbs (literally) of costume and some good pieces and mailed them to a friend. There were also other items besides jewelry (a kind of Robinhood syndrome)

We were able to get most of it back and are being more watchful now in that he cannot send any more packages out without our inspection, but I'm finding he's still confiscating anything that he can get his hands on and hiding it away. He will lie through his teeth that he has not taken an object, until we find it in his possession. (Something I'm not proud of doing - I've been looking through his belongings.) He is on Aricept and 100 mg of Zoloft daily. Any suggestions? We're getting desperate!

A. I am sorry to hear of your husband's condition, which, I am very sure, is painful and upsetting for you and your family. I certainly don't know of any miraculous remedies for your husband's kleptomania, and the regimen he is already on (Aricept and Zoloft) is quite reasonable, based on clinical and research experience. However--there are always new ideas to consider, in consultation, of course, with your husband's doctor.

First, depending on how your husband is tolerating his medications, a dosage increase in one or both agents might be worth considering. Both Aricept and SSRI type medication (Prozac, Zoloft, Paxil) may reduce inappropriate or impulsive behavior in dementia patients, and an increased dose of either might be helpful; e.g., going up to 125-150 mg/day of Zoloft.

Another option would be to try the new medication for Alzheimer's disease, rivastigmine [Exelon], which might be more effective than Aricept for some patients. Other medications or combinations have been used to treat kleptomania, though not in patients with dementia; e.g., fluoxetine [Prozac] in combination with lithium (Burstein, 1992); paroxetine [Paxil], nefazodone [Serzone], or fluovoxamine [Luvox] in combination with buspirone (Durst et al, 1997).

It might be worth trying any one of these options, assuming your husband has no medical contraindications to these agents. It is also important to determine if your husband's behavior might be related to an underlying psychotic (delusional) process; e.g., some patients with Alzheimer's disease may develop a delusional belief that others are stealing from them; hence, they collect or hoard objects to compensate for their loss. In such cases, treatment with low doses of an atypical antipsychotic (e.g., risperidone 0.25-0.5 mg/day) might be worth considering.

Even if such a delusion were not present, I would not rule out an empirical trial on a low-dose atypical antipsychotic. Trial of an anticonvulsant/mood stabilizer, such as valproate [Depakote] would also be worth considering, though the evidence that it has specific efficacy for dementia-related kleptomania is minimal, so far as I know.

I assume, finally, that your husband is still at home-a very difficult situation for families whose loved ones have Alzheimer's. Short of a nursing home, would it be feasible to have some home nursing assistance or aide to help monitor your husband's activities? I realize you may already have tried this, or that your insurance might not cover the cost. In that case, I would suggest contacting the Alzheimer's Association (http://www.alz.org/) for their advice and support.

The Elder Care Locator Service (800-677-1116) might also be able to provide some helpful leads for assistance, in cooperation with your husband's doctor. I hope you are able to find some help for this difficult situation.

February, 2001

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