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Sudden dementia, or something else??? - Carers UK Forum

Sudden dementia, or something else???

For issues specific to caring for someone with dementia.
Just wondering if anyone has had a similar experience to what has happened to my 89 year old mother recently. In the space of 3-4 days she went from a very sharp, pretty capable lady, with all her faculties, to a very confused and agitated person. After her initial confusion I called an ambulance and she spent 7 nights in hospital. The only thing they found wrong with her was that on admission she was very dehydrated and had a low potassium level. They spent the following few days doing tests - CT head scan, bloods, urine, sugar levels (she's type 2 diabetic) and BP. They found nothing else wrong with her, but during her time in hospital she became more and more confused, agitated and delusional. She seems to be processing valid information, but it's coming out all mixed up and wrong. I brought her home Saturday afternoon as she was getting very distressed in hospital. She seemed calmer Saturday, but today was very quiet, non communicative and very disorientated. Today she kept leaping out of her armchair, wandering to another room or just to the hallway and leaning on her stick, staring at the ground. She has no interest in anything, asks no questions, no interest in her lovely garden which she used to tend, and has suddenly become incontinent (waterworks only). She sits and stares silently at the TV but doesn't seem to register anything. It's like her mind is closing down very, very fast. The consultant in hospital said it could be the effects of a virus, and if so his might take weeks or months to clear or ... it could be dementia, which had been masked, but has now emerged. But in only a few days?! Needless to say I am very upset and worried. I will be calling the docs first thing tomorrow for a home visit (she lives with me) and also SS to get an assessment. Not sure what else to do :( Has this happened to anyone else?
Check for a urinary tract infection? These are a very likely cause of confusion.
Congestive cardiac problems can also cause rapid deterioration in mental function.
My brother went into hospital for something trivial three years ago and came out confused. He is not demented. He had fantasies, which could be traced back to something that had happened but which had grown in his mind into some story which sounded mad. He would say things like 'Mrs. Fitzwilliam came and she is going to give me a wheelchair which whizzes very fast from one side of the room to the other', but there was no Mrs. Fitzwilliam and no such wheelchair, although there certainly had been talk about a wheelchair.
The GP explained this to us a few months after I moved back. My brother was relieved because he said 'I'm glad you've told me I'm not off my rocker'. I have since read that confusion often results from hospital visits. My brother is not as bad as he was, but not really better either. The doctor said it might or might not improve.

I was relieved at the explanation. I think your mother has it worse, but it may well be that my brother was like that straight after he came out of hospital.

The word to search for and discuss is 'delirium' (a word our social worker could not spell).
Thanks. The hospital checked her urine many times and said no UTI. Would it be possible that she has one, but they didn't pick it up? Surely they would have done? Maybe I should ask the GP to give her a course of antibiotics anyway, to be sure?

The only things I can think may have caused this are:-

- a recent flu jab - reaction to this? but unlikely, as she has had loads before with no problems.
- a stroke maybe, which was not picked up on hospital tests? But surely there would be some evidence?
- something else with the brain - a serious virus
- my worse nightmare - she does actually now have dementia, but there was absolutely no sign of this a week and a bit ago.

I brought her home from hospital (with their consent) on Saturday lunchtime as she was so distressed and confused there and the constant back and forth for me, plus being there all day with her, was exhausting me. I will pick up with SS this morning and hopefully book a needs assessment asap.

I think life has just thrown the hardest ever challenge yet at me - just hope I can survive it!
Do ask them to consider delirium. Of course it may not be that, but it is common in elderly people, especially after hospital visits:

http://patient.info/doctor/delirium-pro

http://www.icudelirium.co.uk/

This is from a Guy's and St. Thomas' PDF:

"Delirium is a common condition that usually affects patients’ brains for a very short period of time. In 6 out of 10 patients the symptoms generally disappear within six days and other patients may continue to experience one or more symptoms when leaving hospital. A small number of patients (around 5 per cent) may still suffer from delirium more than a month after they first experienced the symptoms.
Delirium can cause:
confusion
restless behaviour
sleepiness
a complete change in personality
a physical change in the patient’s condition, such as difficulty walking, swallowing or speaking."

I can't believe the UTI theory if she's been tested several times.
i think everyone with an older relative should familiarise themselves with the delirium algorithm.

NICE have a delirium care pathway. Its written for medics, but have a look at the info for people at risk of or with delirium. (Box 2)

http://pathways.nice.org.uk/pathways/de ... h-delirium
In fact this is even better

http://www.nice.org.uk/guidance/CG103/I ... nForPublic

not all nurses are aware of constipation, pain, cocodamol etc causing delirium, they think once the urine comes back negative for infection then its not delirium! So ask the questions-are they drinking enough? when did they last open their bowels? do they have pain? Have they been started on new pain relief? Etc

I read your post too fast and see your mother is at home. If her acute confusional state doesnt get better in a couple of days (and I wouldnt leave it any longer) then get back to the GP.
Update - she started a course of antibiotics on Monday afternoon as the GP who visited said it could be a UTI (said not always picked up by hospital!). But she is getting worse. She keeps me up all night - shouting for me. She then talks a load of nonsense about someone about to come to the door, two people wandering around the house, it's like she's hallucinating. I think she is dreaming all this stuff and waking up distressed. I'm suffering from sleep deprivation myself now. Does anyone have any ideas about how I can get her off to sleep at night so I can get some rest? I don't know where she is getting her energy reserves from! I will wait another day or two for the antibiotics to kick in (now day 2, not sure how long they will take, but it's a 7 day course). What on earth do I do if this continues? It's like she's gone totally mad :(
Would the GP let her be on something like Diazapam I wonder?

It does sound however as if she is 'delirious', in terms of the description above of delirium???

Also, wonder if she's having 'night terrors' which are kind of 'waking dreams' (young children can have them, and they don't seem to be able to 'wake up' from them, can be very disturbing and distressing to witness.)

Hoping that the docs can work out what is going on, and find some effective treatment, or that she quietens 'on her own' perhaps. KR, Jenny
She's still hallucinating, but thank God last night she was calmer. She did wake me up every few hours or so with toilet visits (have to supervise as she loses her way back to the bedroom) but at least I got a little sleep. It's amazing that an hour's sleep has suddenly become so precious to me!! She keeps going on and on about a man who will come to the door (so I mustn't every open it) and rape her and today she is going on about a man who will come to the window naked, and she doesn't "want to look at anything like that"! I wonder if her brain has dredged up some past experience, or maybe she dreamt something bad and keeps recalling this. Dull daytime TV seems to calm her and fortunately she does everything I tell her in relation to food and drink, tablets and toilet activities. She also doesn't seem aware of what's happening to her, which is a blessing. Adult Services didn't call me again, as promised, maybe it was a bit optimistic of me to expect that to happen. I will be on the phone to them again tomorrow.