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You're right, Stressed, it is a guessing game. Your aunt may have developed vascular dementia after the stroke. However, there is a type of Alzheimer's that is rapid onset. There are also many other types of dementia as well as mixed dementias where people have more than one kind. It's no wonder doctors are sometimes reluctant to label the disease.

Great comments from everyone here.
Carol
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FWIW,

Many older people's minds have trouble bouncing back from a hospitalization, as the drugs don't seem to clear out very quickly like they do in the young. More hospitalizations make this worse. This is when a caregiver becomes familiar with the concept of "sundowning", as the confusion is worse in the evenings.

In trying to find a sitter for my mother, one of the interviewees mentioned checking into a UTI for some of my mother's confusion. I was skeptical as it seems so unrelated, but found it out to be the source of not only the confusion but increasingly bad urinary issues, which cleared up when meds were given.

I'm guessing that the UTI's tend to repeat because our dear ones' toileting habits have become less careful, and it is not something any caregiver jumps in to do without being asked. In my mother's case, her vision had so deteriorated with macular degeneration that she had developed a habit of looking at the tissue to see if it was clean, and I strongly suspect her reaching from the front was responsible for the UTI. I imagine diapers might have the same cross contamination effect.

In my mother's case, back pain resulted from the infection in the urinary tract when it was not immediately discovered, and unfortunately was wrongly assumed to be related to an earlier medical issue. Hence, it wasn't until hospitalization that the UTI was discovered and treated, and by then a great deal of damage had been done to the urinary tract.

My advice would be to: First, when seeing the doctor, don't assume you know what any pain is caused by...stick to the facts and let the professionals figure it out. (It might not be what you think.) Second, keep an eye (if you can) on toileting habits, especially if your loved one may have trouble "reaching around" or has visual issues. Third, if confusion arises, suspect a UTI and get help immediately.

Now of course, this is complicated by the fact that recent hospitalization may have caused the sundowning and some dementia, so I would imagine you wouldn't suspect the UTI for awhile, as they should have treated any such thing in the hospital, hopefully.
All you can use is your best judgment, when your loved one can't clearly tell you what is the matter. Most of us are ill-prepared for these things. A guessing game, indeed.
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Windyridge, I have come across numerous elderly hospice patients who lost a great deal of cognitive functioning after having surgery where anesthesia was used. Their spouse or family member often reports that their loved one never regained their prior level of cognitive functioning, or regained some but never returned to their full level of functioning prior to the surgery.. Studies continue to be done on this. They're not sure if it's due to some brain vulnerability related to the aging process, or if the person had undiagnosed vascular dementia prior to the surgery that was worsened with the use of anesthesia. Either way, I know I'll think twice...or three times...before making decisions about surgery knowing that this could occur! Not an easy decision!
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does anyone know if UTIs do permanent damage to the brain?
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