Can Alzheimer's or dementia significantly worsen in 3 months?
Three months ago, my mom was admitted to the ICU for acute kidney failure. Since that time she has suffered with an extreme case of delirium. Before entering the ICU, my mother's mind was very sharp but she was beginning to become a little forgetful. Now, after three months, she resides at a rehab facility. The doctor and staff are treating her as if she has full fledged Alzheimer's or Dementia. I have been a caregiver for my mom for over three years now and I know her inside out. I can recognize when she gets a UTI or becomes delirious. I do not agree with the medical staff at the rehab center where my mother currently resides - especially since she was recently put on a drug (scopolamine) that is notorious for inducing delirium in elderly patients. So, can Alzheimer's or Dementia progress from being slightly forgetful to talking about weird things that don't exist or make any sense over the course of three months? I know Alzheimer's progresses slowly. But what is considered slowly? One month, six months, a year, two years, ten years?
Falls can also fast-forward memory issues. I noticed any time my Dad had a fall his memory slipped a little bit more... it wasn't affected by any small tumbles.
My Mom went from being fairly clear minded into accelerated dementia after have two major falls two weeks apart that had head trauma :(
I began doing some online research on Alzheimer's. Before my mom went into acute kidney failure three months ago, she had difficulty recalling words while conversing - mostly words associated with specific names of things that she knew very well, like hydrangeas, nutmeg, crocheting. Also, she expressed her frustration on her inability to recall these words. From what I gathered, this type of memory loss is a classic symptom of early Alzheimer's.
Getting back to my original question, I read an online article. (I would post the link to the website, but I am unsure if doing so is allowed here.) In any case, the author did a nice job outlining the timeline and "the seven stages of Alzheimer's. In this article and others, timelines for each of the seven stages are given in terms of years. That's why I was skeptical about the drastic change in my mother's cognitive abilities over the course of three months.
I learned the difference between dementia and Alzheimer's. Many people incorrectly use these words interchangeably. If I am correct, dementia is a general term that refers to a condition of cognitive decline. Many diseases (such as Huntington’s, Parkinson’s, and Alzheimer's) can cause dementia. So, I suppose Alzheimer's is a specific disease that manifests itself as dementia.
At this point, I know that three months ago (just prior to being admitted to the ICU for acute kidney failure), my mother had early Alzheimer's, and, since that time, she was and still is struggling with delirium. I am hoping that her current status is a result of both Alzheimer's and delirium. I say this because if she recovers from delirium, she would revert back to her status prior to being in the ICU - which is early Alzheimer's. If this happens, then I can at least have a conversation with her again. Everything comes down to "if" - is this wishful thinking? Although my mother is alive, I feel like I have already lost her.
Blessings,
Jamie
I have a hard time believing that all of the doctors taking care of her say that there is no alternative to scopolamine. Here's what I do know:
- Antihistamines can be used to slow down the secretion of saliva in the mouth in order to prevent choking on saliva before it enters the airway.
-Scopolamine is known as a "first generation" antihistamine. There are also newer "second generation" antihistamines.
-The second generation antihistamines are unable to enter the brain. But, the older "first generation" antihistamines can enter the brain. That's why the first generation antihistamines can cause psychological effects such as delirium, but the newer second generation do not.
If anyone knows of an alternative to scopolamine to dry out the mouth, please let me know!
you also have the right to bring her home again where you will definitely have better control.
my DH was supposed to go to a 'swing bed' but none of the ones I would approve would take him, so I brought him home. I later learned that there is a terrible chance he never would have survived the 'swing bed' but he is thriving at home with me, 20 months later.
I would say that dementia can advance quickly, but this sounds more like a medicine induced stupor - nursing homes are notorious for drugging-out their patients "to keep them calm."
bring your mother home again and see if she starts to improve - my guess is she will improve with your tender, loving care.
As the stages go, there is no way to know especially when or how long each will last. They do appear in different orders, there is no set map. Then if there are other medical conditions involved things can be very atypical. I believe my mom had signs of dementia for years, unfortunately we did not notice, she hid them well. She began to have issues that were very visible after a diabetic event. I finally got an official mixed dementia diagnosis in Sept 2016. With every fall, UTI and diabetic issue I saw my mom quickly move through the stages. My mom passed last month, there just is no way to guess how long our love one will battle through Alzheimer and dementia.
I also mourned the lost of my mom, early on. She still know who I was, but she was not the women and mom I grew up with. It is hard, but you have to enjoy the moments that you have.
every worker that came into her room that she had Alzheimer's. They would either nod or say "Yes, I know". Then they would proceed to try to treat her like a regular patient. Example: I came in early A.M. and saw some sort of plastic contraption sitting on her nightstand. It sat there all day and late that afternoon I asked her assigned nurse what it was. He said "Oh, that is her breathing tube. It is to help clear her lungs after having surgery. I gave it to her this morning and told her to use it several times a day." I said "Hello!! Alzheimer's". We ran into this every place we went in regard to medical personnel, from the ER, Floor, Rehab, Nursing Home, etc. With so many more seniors getting this disease, this is unacceptable. Medical personnel MUST be trained to deal with it.
My husband had Lewy Body Dementia for 10 years. The first year was the worst. His neurologist's theory was that he also had inflammation in the brain the first several months. When that subsided and he was "only" exhibiting dementia it was much less severe. So it seems plausible to me that if your mom has other things going on besides dementia that could make the dementia seem much worse. The dementia won't get better, but she may recover close to her pre-trauma condition. There is no way to tell except to let it play out.
And, yes, any dementia can show a sudden and severe decline, even though that is not "typical."
My heart goes out to you. Stay in touch here. We care.
You were the one taking care of her daily so you would actually be the last one to see a change [just like parents don't see their kids grow] because you are so close spacially - I actually have asked someone who sees my mom occationally to note any changes because I would be less likely to see this because I visit so frequently
Your mom's slide downwards would have happened anyway but most likely she was more comprimized that anyone in family realized - good luck & try TEEPA'S GEMS as a site because Teepa Snow should be called the 'dementia whisperer' & I've learned a lot from her videos [most 4 to 8 minutes long]
Glad she pulled out of the renal failure. Do her doctors know what caused her kidneys to fail?
All of these factors - the reason for the surgery, post-op effects, severe (nearly fatal) infection, and the trauma of being in ICU in itself, which is well-documented - will have stressed your mother's brain enormously. But you're intent on arguing with her doctors about whether this is normal progression of Alzheimers Disease? Really?!
Hyoscine/scopolamine is used to reduce secretions, for example when they are causing breathing difficulties. I only know of it because it was included in my mother's end of life drug package, though thank goodness it wasn't needed. It is not given to patients lightly.
What I'm saying is that you need to focus on what matters, and to do that you need to get a full, clear, detailed picture of your mother's overall condition. If what the doctors are prescribing doesn't make sense to you, then for heaven's sake don't go online and start a fight with them. Get one of them to sit down with you and explain the care plan until you are confident that you understand it.
You have every right to an opinion. And your knowledge of what is normal for your mother is hugely valuable - that's the baseline her doctors can work with. But there is clearly a heck of a lot more going on than "age-related decline" and it's really important that you see the full picture.
To address Shane's question, my mother went into acute kidney failure due to what is known as Contrast-Induced Nephropathy (also known as CIN). My mom went for a CT scan where she was given a contrast dye. The contrast dye is used to enhance imaging for the CT scan. A very small percentage of the population can experience acute renal failure when given contrast dyes. Unfortunately, my mom is among this very small population.
Countrymouse, please do not find this offensive, but you would not believe how much time I spend each day on the internet educating myself and researching solutions for my mom. As far as talking to doctors, I have had very many conversations with them. I reviewed with them each and every medication she was and is given. I have discussed the reason why she was placed on each med, side-effects, drug interactions, you name it.
I finally consulted a highly-respected geriatric psychiatrist who knew my mom's baseline (as I mentioned above) not very long before she was admitted to the ICU. Although my mom began to show early stages of Alzheimer's, he affirmed that most of what my mother is experiencing is attributed to delirium. He emphasized that focusing on bringing her out of delirium should be the top priority at this point. He recommended eliminating all unnecessary meds including the galantamine.
Maybe I should have mentioned some other things about my mom’s situation. First, the neurologist who diagnosed my mother with Alzheimer’s did so only a month after her admittance to the ICU. She was in the ICU for two and a half weeks, so his diagnosis was proposed only a week and a half after she left the ICU. I am not saying that my mother doesn’t not have Alzheimer’s, but I disagree with making this diagnosis at that time when any healthy person would exhibit cognitive impairment – especially when under the influence of potent opioid analgesics.
Also, my mom has a history of prolonged delirium after every major surgery. I have reviewed all of this with the neurologist, and he agrees that my mom is suffering with delirium. However, he is very reluctant to make changes. Now that I consulted with the geriatric psychiatrist, I hope things will improve with my mom’s health. But as someone stated earlier, every case is unique, so I am not ruling anything out. I am not discounting Alzheimer’s as a contributing factor. I only disagree with the fact that it is the only factor.
Signs and symptoms Edit
SD patients often present with the complaint of word-finding difficulties. Clinical signs include fluent aphasia, anomia, impaired comprehension of word meaning, and associative visual agnosia (inability to match semantically related pictures or objects). As the disease progresses, behavioural and personality changes are often seen similar to those seen in frontotemporal dementia although cases have been described of 'pure' semantic dementia with few late behavioural symptoms.
loveumom1: Stick to your guns and continue to do your research. Don't let anyone sway you until you feel it in your gut that this is what is happening to Mom. No one knows your mother - better than you. Doctors are intimidated by strong advocates who do their research and know the patient better than the doctor. Many doctors who don't know what is the actual diagnosis will decide to categorize the patient in an all-in-one category such as Alzheimer's. With the aging population and all of its possible health issues that overlap one another, it's very, very frightening how misdiagnosis can happen. Doctors do the best they can but geriatric medicine is a challenging discipline, just as you stated.
In reading your comments it strikes me that you going about this very clinically, trying hard to diagnose, treat and fix the problems. I understand that, I'm an analytical person also. It's instinctual to approach it this way for most people. We love our elders and want to fix it just so,so.
But I think we get to a point where the perfect drug/treatment/procedure just don't matter that much. Your mom has had a multitude of serious health problems and it's not surprising that her mind is not good. You're not going to fix this.
Is it time to consider her quality of life? It doesn't sound like there's much there. I'm not suggesting she doesn't need proper meds and care but How about dropping back a notch to palliative care or hospice. Make her comfortable.