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Hi all, I’m here again asking another question. So many from me these days! My 79-yr old father had a severe fall about 10 days ago. We don’t know how it happened. He was alone and doesn’t remember the incident. He hit his temple area and required stitches and also fractured a number of ribs. Before this he had been suffering from UTIs for about 8 months and had lost weight / become more frail. I had noticed general forgetfulness over the last few years but it didn’t seem like anything serious. Perhaps I should have taken it more seriously as his mother had Alzheimer’s. In any case he went to the hospital after the fall for about 8 days and recovered well physically. Mentally, it was another story. It was like he went into the hospital one person and came out another. He makes up stories about things, rambles on. He also started getting up from his bed in the middle of the night, wandering in the hospital. He is now in a rehab unit getting PT. The rehab unit is also for mental care patients. I’m trying to get him a neurological evaluation. I guess my question is, can a fall really trigger dementia in this way? Can it go from 0 to 60 that fast?

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This is exactly what happened in a family member of ours. He went from driving his car and remembering everything to not recognizing his wife and thinking he was in the army in one weekend after a bad fall.

We hoped it was a UTI or something we could fix. But it wasn't. He's in memory care now.

If you get a choice, try to get a memory care facility that feeds into a good nursing home. Getting into a good nursing home takes some planning. Unless you have lots of money, you don't just walk in.
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One useful piece of information I got when my mom fell was that sometimes, something CAUSES the fall. The hip beaks and then you fall. You have a TIA or small stroke and then you fall. Not the other way around. Did they do any brain imaging?

UTIs can cause severe and sudden behavioral changes in elders. So can imbalanced electrolytes.

You need to make sure that the rehab docs and PAs know that this is a change in mental staus for your dad. That always needs to he investigated. Remember that they didn't know him before.
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ExpatInLondon Feb 2020
They did a CT scan but not an MRI when he was first admitted to the hospital. They didn’t see anything on the scan that suggested a stroke or otherwise. Dr in rehab said today same thing for the first time since the fall...that some event may have caused him to fall. We’re waiting for a referral to a neurologist who can hopefully shed more light and take an MRI. Speech pathologist senses a lot of confabulation. The major issue is that he keeps trying to leave the rehab unit at night and making up stories about why he needs to leave. He can’t come home if he is constantly trying to leave. He’ll endanger himself or someone else...whatever the reason the fall happened in the first place.
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A lot of factors can be involved when someone starts with multiple symptoms, but, I agree about how sometimes, the brain problem happens first and causes the fall. It's the fall that gets 911 called and a lot of the attention. Did they do a head scan at the hospital after he fell?

I know that my LO went downhill pretty fast after she fell and fractured her wrist. She was never able to explain how it happened and within a few weeks, her Primary diagnosed her with significant dementia. Before this, she had been maintaining her own household. I later found out that she had been having some struggles before and since the incident, but, it really got bad afterwards. Once we got more eyes on her, we were able to see that she had INCREDIBLY poor balance. She would fall down for no reason, except poor balance. It wasn't like she tripped on something. The poor balance was likely due to her dementia. Her MRI showed multiple strokes.
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My Mom was showing signs of Dementia before her fall, caused by neuropathy in her ankles. She really hit her head needing stitches. From that point on started her decline. That was 2011 to 2017.

Was he checked for a stroke that could have caused the fall. Was he checked for a concusion or brain bleed?
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Grandma did something similar after her fall. She went into rehab her normally chatty self after a couple of days in the hospital. After 2 weeks in rehab she was a zombie. Quiet, incontinent(she was completely continent before) and pretty non-responsive. The doctors at rehab diagnosed her with dementia. When I responded that she was pretty independent before the fall, they brushed it off as she was hiding how bad she was. They ordered hospice house.

I decided to bring her home instead. 2 weeks after I had her home, she was basically back to herself. Chatty as always and we had to go through weeks to train her to just go in her diaper. She would hold it and yell at me to take her to the toilet.

For grandma, the problem was rehab. I don't know if it was the environment or maybe medication, but something was making her not herself. Once she was out of that environment and back on her normal meds, she was back to herself.
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You could be dealing with a delirium which mimics dementia but onset is very rapid. Med changes, changes to routine, there are lots of causes and once that trigger is dealt with symptoms improve. You also mention you’ve noticed some memory issues before the fall This could indicate a possible dementia. The brain will sometimes “compensate” for the deterioration in dementia and as long as a person is in familiar setting with long-held routines they can appear to function normally. Once the dementia progresses to a point that the brain cant compensate or a trauma or injury occurs, the dementia becomes very apparent. The decline seems rapid but the pathology has been present for a long time. An evaluation is a good step, but should include MRI and other more comprehensive knowledge gathering and cognitive testing to help see if there is damage/degeneration of the tissue in the brain. Good luck!!
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I agree to check for other conditions that might have caused the fall but could also be hospital-induced delirium or sundowning?
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There is evidence that a TBI (traumatic brain injury) can cause dementia but it would not happen so quickly. It happens after years of multiple injuries like the ones football players, boxers and other athletes get.
This is not to say your dads dementia is not caused by a TBI you do not know what happened to him this time or 5, 10, 15, 20 or more years ago.
There are some TBI's that can accelerate dementia that was in progress already.
Getting a proper diagnosis is important. And if he is a Veteran possibly get the VA involved as this also could be a result of military service.
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When he sees the neurologist, someone needs to be present to provide correct info on the symptoms and provide the full picture. If alone, he could give the doctor erroneous information.
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When they are in their normal environment that they have been in for years, it is easy for them to mask a lot of their cognitive decline.  There may be a lot going on that you are totally unaware of.   We typically don't ask someone we have known our entire lives a point blank question.  You might be surprised at his answers.  Ask him the name of his bank, how old he is, what he had for dinner lastnight.  When you start drilling down with the questions, its shocking.  The UTI's are also a problem for the elderly and can make them act bonkers, so stay on top of that for sure.   I think you're on the right trail getting him evaluated.  I'm sorry Expat.
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