Transient dementia in the elderly... my dad

[Stoid]

My father, who is mostly bedridden due to severe arthritis and has been for a couple of years, is generally extremely sharp. He is 78 years old and he's always on the computer, learning new things, reading, stimulating his mind. He's had other health issues, but nothing life-threatening (gall bladder, gastritis, thyroid, blood pressure).

He has had some episodes of confusion and forgetfulness that were very noticable, but also very brief.

I don't think it's ALzheimers, because he hasn't had the kind of gradual decline that I've known and seen in Alzheimer's patients. He's been extremely sharp consistently, these have been distinct, discrete episodes where he wakes up confused and forgetful, sort of spends the day that way, and wakes up fine the following day.

I know there are multiple potential causes of dimentia in the elderly, (my mother had many very tiny strokes over years that gradually took more and more away from her) but I'm not really up on what they are or the way they manifest.

Any ideas for what to look at to see if there's a correctable cause? Is it possible that the transient confusion and forgetfulness is some side effect of a drug or other condition that we should be checking for?

[Lord Ashtar]

Take him to a doctor.

[Maggie the Ocelot]

Do the episodes tend to happen at around dusk? My grandfather had those, and the doctor said it was Sundowning syndrome. He only had the episodes for a little while, following a couple TIAs; we figured that when his brain repaired itself after the TIAs they went away.

[MsWhatsit]

Originally Posted by Lord Ashtar

Take him to a doctor.

Yeah. I read the OP twice through just in case I missed where you mentioned taking him to a doctor.

Take him to a doctor.

[The Devil's Grandmother]

While you're waiting for him to get into the doctor, you might try and see if there's any other pattern. Dehydration can cause temporary forgetfulness. How are his eating habits? Is he binging on sugar or alcohol just before every episode? Is he sleeping ok?

[Stoid]

Originally Posted by Lord Ashtar

Take him to a doctor.

Originally Posted by MsWhatsit

Yeah. I read the OP twice through just in case I missed where you mentioned taking him to a doctor.

Take him to a doctor.

Doctor? What's a doctor?



He sees doctors sometimes 2-3 times per month. Kaiser and the VA. They are getting the basics covered, although between them they did manage to nearly let him starve to death by ignoring his nearly constant nausea for almost two years until we had to have him hopitalized which motivated them to FINALLY take a look at his stomach and determine that he had one of the worst cases of gastritis they'd ever seen that had been blazing away while he and his wife told them over and over and over again that he was constantly nauseated and unable to eat and the doctors did nothing but tell her to monitor his diet and stop feeding him whatever made him sick and appeared to be deaf when they were told that it was pretty much everything.

And then there was last year when they were all set to remove his appendix before finally determining that his gallbladder was so diseased it was about to kill him and they had to do open surgery to get it out. His surgeon told me it was the most horrible gall bladder disease and surgery he'd ever done. And that adventure was the second time the same hospital ignored his chart, which stated plainly that he was allergic to penicillins, leading to some extra time in the hospital.

So his wife and I have learned through bitter, life threatening experience that keeping him alive and as healthy as possible takes more than just "going to the doctor", it takes being educated advocates on his behalf.

[phouka]

First, take him to a doctor.

Second, this happens with my dad a lot too. It's usually a spike in his blood pressure. His circulatory system is shot - small aneurysms everywhere, calcification, hardening, narrowing, all that. If his blood pressure spikes, he just doesn't get enough oxygen to his brain, and he starts getting confused and agitated. 180 systolic seems to be the threshold. Mom and I work hard to keep him at 140 or below.

He could very well be throwing very small clots to his brain that stick for a moment, starve the brain cells of oxygen, and then slip away. Those are the TIAs you mentioned. They may or may not do permanent damage. With my dad, if it lasts longer than an hour or so, it's very likely to be permanent.

Other possibilities that we've learned to look for with my dad is hydration - he gets dehydrated very easily, and it's a real effort to get him to drink more water - and sodium intake. He's been on a low sodium diet for decades now, but everyone still needs a little sodium. It's necessary for life. So, if getting him to drink water doesn't help, we switch him to Gatorade cut 1:1 with water, and that seems to do the trick.

Finally, Dad forgets to eat, and occasionally, his blood sugar has tanked out. Again, Gatorade 1:1 is good for getting him back up and running, and then we start pushing steak, beans, and anything else we think he'll eat.

But, yeah, get him to the doctor for a standard blood panel, just to see what's going on. (Even though the doctors are idiots.)

[MsWhatsit]

Originally Posted by Stoid

So his wife and I have learned through bitter, life threatening experience that keeping him alive and as healthy as possible takes more than just "going to the doctor", it takes being educated advocates on his behalf.

Uh-huh. But you're also going to take him to a doctor about this specific issue, right?

[Stoid]

Originally Posted by The Devil's Grandmother

Is he sleeping ok?

This has been an issue off and on, and my stepmother was sure this was probably the problem, but he slept poorly against last night yet woke up today clear-headed again.

[Stoid]

Originally Posted by MsWhatsit

Uh-huh. But you're also going to take him to a doctor about this specific issue, right?

This isn't a new issue. We've told the doctors every time. So far they wrote it off to his post-surgery issues, medications he was taking before but doesn't take now, and old age.

[Stoid]

Originally Posted by phouka

First, take him to a doctor.

Second, this happens with my dad a lot too. It's usually a spike in his blood pressure. His circulatory system is shot - small aneurysms everywhere, calcification, hardening, narrowing, all that. If his blood pressure spikes, he just doesn't get enough oxygen to his brain, and he starts getting confused and agitated. 180 systolic seems to be the threshold. Mom and I work hard to keep him at 140 or below.

He could very well be throwing very small clots to his brain that stick for a moment, starve the brain cells of oxygen, and then slip away. Those are the TIAs you mentioned. They may or may not do permanent damage. With my dad, if it lasts longer than an hour or so, it's very likely to be permanent.

Other possibilities that we've learned to look for with my dad is hydration - he gets dehydrated very easily, and it's a real effort to get him to drink more water - and sodium intake. He's been on a low sodium diet for decades now, but everyone still needs a little sodium. It's necessary for life. So, if getting him to drink water doesn't help, we switch him to Gatorade cut 1:1 with water, and that seems to do the trick.

Finally, Dad forgets to eat, and occasionally, his blood sugar has tanked out. Again, Gatorade 1:1 is good for getting him back up and running, and then we start pushing steak, beans, and anything else we think he'll eat.

But, yeah, get him to the doctor for a standard blood panel, just to see what's going on. (Even though the doctors are idiots.)

Thank you! That's a lot of good information I will pass along to my stepmother (who keeps a very detailed log of every meal, bowel movement, medication, sleep, activity, symptom... ) it will give her something to check when it happens.

As for the blood panel, just completed and results back three days ago: everything appears completely normal, making the issue extra-puzzling.

[The Devil's Grandmother]

Jeepers, medical staff who can't/won't read the damn charts make me stabby. Please ask his wife about hydration, and I think the blood pressure suggestion was also a good one. Does he have one of those at-home blood pressure readers?

[Stoid]

Originally Posted by MsWhatsit

Uh-huh. But you're also going to take him to a doctor about this specific issue, right?

By the way, the meaning of the term "advocate" in this context means that we advocate for him to his doctors, not that we skip doctors and treat him ourselves:

[Yllaria]

A possibility that I only learned about recently is that urinary infections can cause confusion. And in older folks, that may be the first noticable symptom.

[phouka]

Originally Posted by The Devil's Grandmother

Does he have one of those at-home blood pressure readers?

Actually, if blood pressure is a problem, I advise buying a medical quality cuff and decent stethoscope and learning how to take blood pressure manually (it's not that hard. I do it.)

We've had very poor luck with automatic blood pressure readers. They're expensive, they're inaccurate, and they crap out in months.

My mom, an RN, taught me how to take blood pressure with a manual cuff. You'll need to find someone to teach you, because it's much more of a tactile skill than a cerebral one.

[PandaBear77]

IANAD.

My mom had similar symptoms before she died.

She'd had 4 TIA's, mind you. Your dad might not be having those (although with his blood pressure he's certainly at risk). However, after she died I got her medical records and discovered that her carotids were about 50% blocked.

Now ... a 50% blockage sounds horrible, but most doctors won't touch you unless you're at least 70% blocked. They might touch you at 50% if you're high risk for a stroke -- which she was, and I'm 99.999% sure that's what killed her ... but I still understand WHY her doctors didn't clean out her carotids - it's a very risky procedure.

My point is this: over the last few years of her life, she'd have episodes of confusion. She'd have trouble finding words. She'd irritate the shit out of me by insisting that I'd never mentioned something to her when we'd had an in-depth conversation about it a day or two before ... I always thought she was just being stubborn ... which she was, true, but after seeing her brain MRIs after her death I realized she had some dementia going on. Her brain was being starved of oxygen and we simply didn't know it. Some days she was normal, other days she couldn't remember jack shit -- and she knew it and it frustrated her to no end.

Guess what goes hand in hand with blocked carotid arteries? Hypertension, yep.

Get him to a doctor and get his carotids checked and pitch a fit if you have to. A brain CT or MRI would also be a good idea. (My mom's showed way, way more white matter disease than was normal for someone her age.)

[Nava]

The Grandpa From Hell had a large stroke when he was 90, then spent several years having ministrokes (TIAs). The ministrokes did look a lot like what you describe, but for some reason in his case they often came up midmorning: he'd wake up his usual grumpy self, then get disoriented, spend the rest of the day disoriented and with worse hand coordination than usual or a leg refusing to hold him up, was back to normal in two days tops.

[USCDiver]

What you are describing is transient delirium and not dementia (which as you said is indolent and not waxing/waning). Here is some information on both diagnoses.

ETA: IAAD, but I'm not your father's doctor.

[Becky2844]

I read these posts with interest. You all can be incredibly helpful. IANAD but I took care of my younger brother for two years before he died. He became bedridden and had dementia. But he took a medicine that actually helped quite a bit. Aricept 10 mg. I could tell a difference whenever he ran out for a short while for whatever reason. You might want to look into whether that could be of help.
About your father's circulatory issues...after some disasterous surgery it was discovered that I have Factor IV Leiden, a blood clotting disorder. I'd already had tons of tests but this seems not to be something usually suspected, so you might think about requesting that test? I've been taking Coumadin for 15 years now but if that sounds too "risky" there's also Plavix, a milder blood thinner, I think.
And the other posts have exellent suggestions about things to keep a handle on. I so understand the need for you and your stepmother to keep on top of things. I got to the point of yelling (a couple times, when they were obviously NOT listening) in order to get his needs addressed. Your stepmother sounds like a stellar woman and I hope she's also been a hot babe trophy wife to him. Good luck.

[Becky2844]

Originally Posted by USCDiver

What you are describing is transient delirium and not dementia (which as you said is indolent and not waxing/waning). Here is some information on both diagnoses.

ETA: IAAD, but I'm not your father's doctor.

How come I seem to have that every time I try to balance the checkbook?

[Stoid]

Originally Posted by USCDiver

What you are describing is transient delirium and not dementia (which as you said is indolent and not waxing/waning). Here is some information on both diagnoses.

ETA: IAAD, but I'm not your father's doctor.

Thank you for the distinction! I can't read Medscape however, because IAnotAD and they won't let me in. Poo.

[Stoid]

Originally Posted by Becky2844

Your stepmother sounds like a stellar woman and I hope she's also been a hot babe trophy wife to him. Good luck.

Funny you should say that, since she definitely had her moments... (One of her campaign posters: she was the Libertarian candidate for Lt. Gov. of California in the late 80's -these days when she's not caring for dad she makes genuinely spectacular Halloween wreaths. Pictures don't do them a bit of justice. ) She worships my father and cares for him without complaint. For which I am deeply grateful. Because I worship my father, too, but I couldn't do what she does for a host of reasons.

[Becky2844]

roflmao Tell me that's not your stepmom. (Your dad's just TIRED.) Those wreaths are awesome BTW.

[Stoid]

Originally Posted by Becky2844

roflmao Tell me that's not your stepmom. (Your dad's just TIRED.) Those wreaths are awesome BTW.

That's her. She's a trip. So's my dad.

And thanks about the wreaths. They really are, you should see them in person, the craftsmanship is exquisite and every doll is completely original, unique and handmade in every detail.

Same thing for her OJ Trial Chess Set.

[Becky2844]

Wow. Not only is she very, very talented, I vote for you as possibly having the best set of parents ever.

[Stoid]

Originally Posted by Becky2844

Wow. Not only is she very, very talented, I vote for you as possibly having the best set of parents ever.

Assuming you dug a little deeper and got the bigger picture, here's the kicker: my real mother was an ordained minister in the Church of Religious Science.



it's one of those things that would be rejected as too far-fetched if it were written as fiction.

[syncope]

(BG: I am an RN)

If your dad is essentially bedbound, he is at very high risk of developed deep vein thromboses (DVT's) in his legs. Clots in the legs can cause tiny clots to shower to the brain, causing strokes or TIA's (transient ischemic attacks, or "mini-strokes").

Your dad's symptoms sound like TIA's to me.

Has he had dopplers done of his lower extemities (translation: ultrasound of his legs) to see if he has any clots? This is a painless and simple procedure.

If a patient has DVT's, it may be appropriate to have a Greenfield filter placed. This is like a little colander that's placed in the main vein to the heart, to catch any clots that come up from the legs.

I don't know if the VA's computer system is up to par. I know that where I work, we can easily access our patients' records, and our care definitely benefits from this. Knowing that your dad is mostly bedbound would lead me to ask the doctor for venous dopplers if he didn't think of it himself. IMO, venous dopplers would be the very first thing to be done, and then you can go from there.

[USCDiver]

Originally Posted by Stoid

Thank you for the distinction! I can't read Medscape however, because IAnotAD and they won't let me in. Poo.

Sorry about that; at least you have some terminology to google, if you want more information.

Originally Posted by syncope

(BG: I am an RN)

If your dad is essentially bedbound, he is at very high risk of developed deep vein thromboses (DVT's) in his legs. Clots in the legs can cause tiny clots to shower to the brain, causing strokes or TIA's (transient ischemic attacks, or "mini-strokes").

This is incorrect except in exceedingly rare cases. DVTs are in the venous circulation and will be filtered out by the lungs (pulmonary emobolus) unless there is a septal defect in the heart to allow the embolus to cross into the arterial circulation.

I agree that the symptoms could be ischemic in etiology; I disagree that DVT is a likely source.

[Becky2844]

Originally Posted by Stoid

Assuming you dug a little deeper and got the bigger picture, here's the kicker: my real mother was an ordained minister in the Church of Religious Science.



it's one of those things that would be rejected as too far-fetched if it were written as fiction.

.........It can't be rejected if you put it in an autobiography. lol

[Captain Amazing]

Originally Posted by Stoid

Thank you for the distinction! I can't read Medscape however, because IAnotAD and they won't let me in. Poo.

I'm not a doctor either, but I just filled out the registration information and they let me in.

[Stoid]

Originally Posted by Captain Amazing

I'm not a doctor either, but I just filled out the registration information and they let me in.

Seriously?? That's fantastic! I will have to give that a whirl, thanks!