My father 61 years old has history of colon cancer surgery, currently on CAPOX/XELOX chemotherapy (Oxaliplatin + Capecitabine/Xeloda).
After surgery he developed major behavioral changes:
- confusion and poor judgment
- fixed ideas/delusions
- irritability and aggression
- occasional visual hallucinations
- leaves home at night and may not return unless family brings him back
- sleeps only 4–5 hours without medication
- often refuses medication
Brain CT showed cerebral atrophy and chronic ischemic white matter changes, with no stroke or brain metastases.
He improved significantly on Haloperidol, Seroquel, and Lorazepam, but symptoms returned. Recently Lorazepam was changed to Diazepam 5 mg twice daily.
After the first cycle of CAPOX/XELOX chemotherapy, he became much more agitated again, similar to the period immediately after surgery.
Questions:
- Does this sound more like prolonged delirium, dementia, vascular cognitive impairment, or another psychiatric disorder?
- Should a neurological evaluation (MRI, EEG, cognitive testing) be considered in addition to psychiatric follow-up?
Any similar experiences or suggestions would be appreciated.