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?
My sister and I are POA over handling her finances. My two older brothers (as physicians) are in control of her medical affairs.
My issue with bro#1 is that expresses no compassion for my mom's well being. His only concern is the money that he will get when my mom passes away. He did nothing legally wrong by having my mother's properties appraise. Also, he did nothing legally wrong with consulting an attorney about my mom's trust to determine exactly what is his fair share. He is just counting his pennies - and maybe there is nothing with that. It is the fact that he doesn't give a f#?k about my mom that disturbs me.
Now, my sister wants to relinquish her acting position as the POA. She does not want to inherit the property because willed to her because she doesn't want to be financially burdened with paying taxes. About 2 years ago, my mom called us siblings together for a meeting to discuss the trust that my mother had just written. My sister, being made at the world and bitter at my two brothers, did not attend the meeting. She had the opportunity to voice her concerns and make arrangements at that time. A little while later she did sign the trust. She has had ample time to review the documents which she signed, but she took no action. Now that my mom is in poor health, she is frantic and giving me hell.
For bro#2, I financed a lot of his education. I never saw a penny of all the work I did except for a $900 guitar that I bought my senior year in high school and a few bucks here and there to buy a comic book or a frozen Coke. So I created a spreadsheet to calculate how much money I made. The amount is staggering. If it comes to the point where he is going to be a stickler for every nickel and dime, I will show him a detailed account of every penny that I earned.
But, I am not going to turn this situation into a battle. It's the feeling of being used, walked on, and disrespected from my siblings. Regardless, I love my siblings. That is something that will never leave my heart. Now, I am beginning to fell that they don't give a d*mn about me. Their actions speak louder than words. I have to pull myself out of this illusion.
Now, my mind is in a battle with itself. It seems that every angle of my life leads to no where. I have no job, and the prospect of finding one doesn't look good. I never realized that I would end up unemployed because I am over qualified. I have no money. No job plus no money equals no home, no wife, and I am at the age where I doubt that I will ever have a family. I have nothing to look forward to. I have nothing to dream about. I will lose my mom soon. Today the nursing center sent my mom to the hospital and she is in the ICU. I have nothing.
I am not blaming my siblings for that. My situation was my fault. I am not going to get into an existential discussion - this is not a support group. But I beginning to wonder what should I do? I am seriously considering joining the Peace Corps. Go to another country, learn a new language, interact with people, and give my life some meaning. With my luck, I will be disqualified due to my disability. For the moment, I will just have to be patient and see how things unfold. But this American Dream I have been striving to obtain is turning into the American Nightmare.
Your brothers are 'pieces of work' & I don't mean from the Louvre either - lets hope when they get to that age they are treated the same as they treat their mom -
Bro #1 has everything evaluated - is he P.O.A.? - WHAT GAVE HIM THE RIGHT & ACCESS TO BE ABLE TO BRING IN QUALIFIED PERSONNEL TO DO THIS INVATION OF YOUR MOM'S PRIVACY? - maybe he didn't actually do so rather he has written up items to his advantage to screw you & other bro
If you are exectutor don't accept these evaluations as he may have 'hand picked' certain items to be undervalued as those are what he wants while what you are in line for may have been overvalued so he gets the lion's share
I would make him sign a paper that if he sells anything within 10 years that is more than inflation extra, then that extra money reverts to mom's estate - I think his evaluator [if they exist] may be doing a 'fiddle' - has bro #1 got other dealings with this guy so they are buddies or near to it so evaluator 'owes' him something
I have been at war with my two brothers. It's embarrassing, but I am tired of feeling embarrassed for their actions. Both brothers have their medical office on the same street where my mother's nursing center is located - just about 1 mile down the street. You want to know why I felt embarrassed? One of my brothers #1 drives past the nursing home twice a day: on his way to his office in the morning and on his way home in the evening. He never visited her once, except for the time when we thought my mom was about to pass away. When he was there in my mother's room, he was cracking jokes and laughing to the point where could hardly catch his breath. It's funny because a few years when my mother was in a similar situation, she was in the hospital and rehab for 8 months. She had an infection in her blood and C-diff at the same time. At one point, we thought we were going to lose her because the only nutrition she could get was IV sucrose. You can only live on sucrose for a short period of time. It was an absolute miracle that she survived. In any case, over the 8 month period, he would visit my mom at most once a month for ten minutes and then complain about how the will was poorly written. Now that he knows my mom is about to pass away, I have never seen him so happy in my life. When we had our family meeting last week, I learned that he had all of my mom's assets appraised and consulted an attorney, but not recently - this was back in early May when my mom was in the ICU. My physician brother does not give a d*mn about my mom health. His only concern is the money he will get when my mom passes. That is not only embarrassing, it's disgusting!
My other brother #2 has ego issues. One time when my mom was in the ER, I was in a room with my mother along with my brother#2. The ER doctor wanted to sedate my mom with Haldol because her delirium was way out of control. My mom has had a very bad reaction to Haldol. I saw it with my own eyes and it was very disturbing to see her reaction. It is even stated in her medical records not to administer Haldol to my mother. Hadol is the first drug used to sedate elderly - a textbook approach. I told the doctor not to give her the Haldol and the doctor even said she read it in my mom's file not to give my mom Haldol. So what does she do, she came into the ER room with a syringe. I thought syringe contained Ativan, but a minute later after the doctor injected the contents of the syringe in my mom's IV, I noticed that she was having the same reaction that she previously had with Haldol. I asked the doctor what did you just give her - she replied Haldol and walked out the room. There are many drugs that are able to "reverse" these bad side effects of Haldol. I told my brother(a physician) to give her something to counteract the adverse reaction. He pulled out his phone and started to play video games while I watched my suffer.
What more can I say?
After an incident, few years later he was diagnosed as never to be able to walk / transfer again so now he's to NH - FYI he walks a few feet [to & from bathroom but not as far as dining room] & he self transfers - sometimes drs don't know patients well enough to do a realistic diagnosis -
FYI - dad [now 94] is a retired doctor/surgeon & he was able to understand what was said .... basically he said 'no way jose' & then went about proving them wrong by getting up & walking way more than the 'experts' thought - sometimes all our elder loved ones need is for someone to say 'NO YOU CAN'T' for them to go to prove them wrong - this only is good if the loved one is very mentally aware
I learned from this that you never know how someone will react - EACH PERSON IS ONTO HIMSELF - basically you need to watch & learn but sometimes the 'experts' can be wrong but generally take their advice as that is the worst case scenario but not always in stone
My mom has dementia but she shows a steady decline over years however that can also be over several years .... 'EACH PERSON HAS THEIR OWN NEEDS - TREAT EVERY PRESON AS THEMSELVES NOT JUST A NUMBER!
Also,each episode of anesthesia can worsen symptoms of dementia. You had mentioned your mother has had several surgeries, I am assuming the surgeries were under anesthesia and afterwards she developed delirium. Perhaps these episodes have also taken a toll on her?
That's terrible about the contrast dye. What were they testing her for at that time?
Sounds like your mom has been ill for some time. I hope you get some answers soon. Hopefully with time she will improve as the delirium resolves.
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.
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.
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.
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.
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.
Glad she pulled out of the renal failure. Do her doctors know what caused her kidneys to fail?
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]
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.
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.
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.
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.
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!