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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?

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Any change of residence can affect Alzheimer's or Dementia. As for the delirium, 90% of elders have that when they are in the hospital, around 20% of young people have that after a serious surgery.

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 :(
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freqflyer, I recognize that my mother is experiencing delirium. However, maybe her symptoms of Alzheimer's are evolving. It could be that a combination of delirium and Alzheimer's is complicating things. The strange thing is that I am having a hard time accepting the fact that my mom has Alzheimer's. I remember back to when I was in junior high. I would go to the nursing home to visit my mom's aunt who was in the advanced stages of Alzheimer's. It was traumatizing. My mom said something to the effect that if she were to ever become like her aunt, then "let me go." So it hurts knowing that my mom is heading in that direction.
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.
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There is a saying, "If you've seen one case of Alzheimer's, you've seen ONE case." Much of the literature is based on what is typical. But everyone is different. It is not uncommon for an infection or hospital stay to "Kick start" Alzheimer's in a drastic manner. This happened to my husband after a relatively minor URI, and he wasn't even hospitalized. Your best chance of having some recovery for your Mother is to get a diagnosis from a Neurologist or other specialist and then be prescribed medication for this disease. Aricept, Namenda, and similar medications really do make a difference in many patients. In addition, if you see symptoms of hallucination, illusions and/or delusions, then some of the atypical antipsychotics can help too. Quetiapine (at very low dosage) is one medication that is often used with good results.
Blessings,
Jamie
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Luvu you may want to Google symantic dementia. The wife of a friend was diagnosed with this, it is a type of frontal temporal dementia. FTD. She had trouble remembering words for every day words. Bird, flower, tomato, for example. That is when the family realized there was a serious problem.
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Curious, why is she getting scopolamine? Has there been any discussion of d'c'ing it in favor of another drug?
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I'm sorry to hear about your mom. Yup, hospital stays and any anesthesia will mess with the elderly brain function. My husbands brother is a family doctor and confirmed this. Our mom broke her hip (85yrs old) and recovered. Since then a down hill memory decline. She's 91 now, knows just us 2 daughters. Thankfully we got her moved to a facility that's independent to CBRF before she got to the worse point and it wasn't easy for any involved. We had to get her declared incompetent for safety, our peace of mind and all the mixed up stuff she did and said someone else did it. NOW looking back before this sad turn of her life we recognize the signs of her on set Alzheimer's. We don't correct her or give her to much information. This confuses, upsets her. We listen, learn, love and laugh with her. It's still tough!!!
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GardenArtist, I actually have a second post about my mom's current condition that about scopolamine. My mom is in a rehab center. She has become so frail that she spends most of the time just lying in the bed. She can hardly move. It got to the point where saliva was collecting in her mouth and going down her throat. She started choking. So they put her on a scopolamine patch to dry out her mouth.

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!
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jjariz, I couldn't agree with you more. The textbook description of Alzheimer's gives you the impression that everyone with Alzheimer's goes through the "seven stages" along a certain timeline. That's just a model. The fact is that I do not know of many elderly people that do not have other illnesses (such as diabetes, heart conditions, arthritis) in addition to Alzheimer's or Dementia. Many elderly people are also taking a ton of meds. Some of these meds (such as opiod painkillers) can impair cognition of anyone of any age. I believe this to be the most challenging aspect to understanding and treating Alzheimer's/Dementia.
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gladimhere, Interesting that you mention "frontal temporal dementia." My mom fell and bumped her head. She was fine, but being on blood thinners, the doctors were afraid of brain hemorrhages. So was held for observation at the ER and had several imaging tests done (MRI, CT). My brother (a neurosurgeon) explained the results to me. She had no issues from bumping her head. However, he said something to the effect that my mom has voids (brain matter) missing from the front part of her brain. At the time, I did not realize the significance of this although it sounded serious. I am glad that you brought that up. I am going to ask my brother about this. Thank you.
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loveu, you are welcome. When you are new to this, it is very hard to even know the questions to ask. That's what us oldies are here for.
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if it was my LO, I would definitely question the drug(s) being administered.

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.
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i recently found out when my moms kidneys were shutting down that it lowers their sodium levels and that can cause sever memory issues, also lowered sodium levels can cause water to build on the brain causing further memory problems
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Hi, I would always question the meds they are giving ask why and are there alternatives. Even in the rehab you can get your mom's primary doctor involved. Call their office and ask their advice, her primary can still change her meds and offer a course of treatment. I did this with my mom. The doctor they assign her at the rehab may be good, but does not know her history.

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.
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Loveumom, I would check the meds. My mom started having hallucinations when she was put on a different treatment and stopped having them when they adjusted her treatment again. It is worth a try at the very least.
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My Mother has Alzheimer's and when she broke her hip it caused her to spiral down significantly. From the trauma to the pain and rehab to moving her several times did unbelievable damage to her mind. In a few months time, on a scale of 1 to 10, she went from about a 4 to 10+++. A nurse told me trauma and moving them from place to place does a number on their brain. On this subject I was dismayed at how often during this journey with Mama, we ran into medical personnel that did not know what to expect from an Alzheimer's patient. I told
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.
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Yes, ALZ can change fast, not sure if because of age (85) but from the time he was diagnosed in 2015 his memory went fast, and now he is in a ALZ facility, thinks he is 18, never married or had a family etc. It is rough for the family. When he broke his hip the surgeon said he needed to be restrained in the wheelchair because he could not remember that he had surgery. The rehab center refused said it was illegal to restrain him. He fell at lease 8 times there and still falls where he is now. They need to read the full bill which allows a doctor to order a restraint.
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My experience with my parents has who both have dementia is a roller coaster. They go from bad to worse, then better, and start the cycle again. Currently both are stable. It's been 6 months since I moved them closer to me to assisted living. They started out together at the basic level, my dad progressed to level 2 while my mom had an incredibly awful month of delirium and had to be transported to a behavior hospital. After a month there she lost an incredible amount of weight became lethargic was transported to a hospital where the doctors seemed to believe she was in the later stage of ALZ. We brought her back to assisted living in the memory care unit and she suddenly started eating well, walking (was in a wheel chair in the hospital) and became more lucid. I think each case is unique
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There are more than 50 kinds of dementia. ALZ is the most common, but 40% of people with dementia have something else. It is often hard to make a correct diagnosis early on.

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.
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Loveu - it would seem your mom had some dementia prior to hospital [struggling with words] & it is a known fact that change of venue shows up how serious because it is easy to hide/go below the radar when doing a daily routine in a familiar place however the combination of being in new place & meds in hospital have not caused this but highlighted it -

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]
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Read Understanding the Dementia Experience. Sign up for Alzheimer’s Reading Rm. Go to a alz support Group. Go more than once as takes time to feel it's affect on you. Every person is different but my husband of 63 yrs has been diagnosed 9 yrs ago. His mainly is short term memory but spends hrs w dot to dot numbers & 100 pc puzzles. He doesn't know me sometimes but I read that could happen so wasn't devastating. Doesn't know his kids but they just tell him many times. Tell them you love them & they are safe many times. I tell him if I go somewhere someone will be with him. Never leave him along. Step into their world where you cannot make changes like our world. Enjoy your moments. Take time for yourself so you can be a gooder caregiver & not get burned out. God be with you in this journey. If I am calm he is calm soooo important.
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I would think her acute renal failure may have precipitated this change in mental status. As someone stated above change in electrolyte status especially sodium levels in elderly folks can be detrimental to mental status.
Glad she pulled out of the renal failure. Do her doctors know what caused her kidneys to fail?
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Your mother is 78 years old, has had repeated back and neck surgeries (what for?), and has recently spent a considerable length of time in ICU following acute kidney failure (how caused?).

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.
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My Mom fell and broke her pelvis in 2 places. And her back. I put a post on here that in 3 weeks she went crazy. She had so much morphine and other black box meds in the I.C.U. and the hospital. Then in the rest home for rehab she forgot she couldn't walk so she got out of the wheelchair abd fell 6 times in 9 days. They have her benadryl and halidoll and every other dang thing. By this time she was screaming at night abd they made me sleep there. Awful U.T.I. abd yeast infection found. Low sodium abd potasium. Next stop the behavioral hospital. Finally an Alzheimer's diagnosis. Then next rest home rehab for 1 1/2 months. Now on nemenda, lexapro, depakote, b.p. med. And remeron. Now back at her house. 3 1/2 months later and all is calmer. She walks, not near as irritated, has p.t. and o.t. at home. She does not remember any of this. So much medicine and hospitalization and changing places. Everything people have said above happened to her in 3 months. Now with new medicine and time,staying in 1 place all is better. Her short term memory is about all gone now. But when all the medical problems are taken care of 1 by 1 things get better. It truly is amazing what a little time can do. When you combo in the Alzheimer's and medical problems together it does seem CRAZY! Hang in there because it will get better or even out.
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I thank you all for your replies. I can relate to almost everyone’s post. I have lived with my mother and know her like the back of my hand. I took her to every doctor appointment. I managed all of her meds, I can tell when she gets a UTI, the effects she experiences when taking opioid analgesics, etc. Only I (and a geriatric psychiatrist) knew her baseline prior to entering the ICU for acute kidney failure.

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.
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What are systems of symnantic dementia 
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From Wikipedia (Semantic Dementia)
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.
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Interesting that you mentioned Semantic Dementia. My mom's difficulty in searching for words while conversing is what led me to suspect my mother has Alzheimer's. Maybe, it's Semantic Dementia. There are so many wild cards when treating the elderly. I have come to realize that, in geriatric medicine, diagnoses and treatments are not so obvious and clear cut as I originally thought. Geriatric medicine is such a challenging discipline.
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loveyoumom1 - my mom "fell off the cliff" 2 years ago. All of us children lived far away from mom, so I'm not sure how far along she was, but suddenly she was seeing things and decided that my sister and I were part of a gang selling drugs. Wow. She ended up in a psych ward and is now on Seroquel. The delusions and hallucinations are under control most of the time except when she has a UTI. So, yes, I think that AD can suddenly get worse. Now that mom is on higher doses of Namenda and Aricept, she's been fairly stable for the last 2 years. She is also now living with me, so I think that's an added level of security for her that she did not have in her own home. She thinks she is living in Paradise. Can't ask for much more than that! BTW, she had undergone oral surgery before everything went south.
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Just a general comment: It was recently reported in the news that many patients are - misdiagnosed with Alzheimer's - because there are multiple variables involved and a doctor isn't an expert at "everything". No joke. And then these patients are put on toxic medications for a wrong diagnosis. How awful.

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.
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Love u mom, been reading this thread, lots of info from people and about your moms history. I appeciate posters like yourself who respond and have good discussions, not just get an answer and disappear.

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.
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