A little bit of background: My mother is 80 years old and has had a knee replacement canceled twice due to issues with her blood pressure. The last time she was literally on the operating table. Now her knee has gotten so bad she's basically crippled, using a walker, and we are looking for (hopefully) temporary home care to prevent a bad fall.
She has never had a lot of emotional strength. My dad was the rock in our family and she depended on him for everything. She also likes to engage in magical thinking... like ignoring her medical issues until they become so bad she is forced to act. (She should have had this knee surgery several years ago). "Ignorance is bliss" is her favorite motto and she is incredibly stubborn to the point of exasperation. She also doesn't like change... her routine and her familiar environments are everything to her. Suffice it to say, she has always been a difficult woman and things are only getting worse.
My question is... can the extreme stress brought about the the canceled surgeries, her current state of limbo (we're waiting to get the next surgery scheduled, if she can even have it), my dad's death several years ago, fear over her worsening health... cause dementia? In the past few months, most notably since the last cancelled surgery, she is displaying clear signs of cognitive decline, and just overall decline. For example: She thinks the remote is the phone... she can't eat without spilling all over herself... she acts hysterical about this medical drama and calls her friends multiple times a day rehashing the awful events, but with fantastical embellishments. What really scares the crap out of me: The other day she said she thought my cousin was here helping take care of her... and I don't have a cousin. I'm her daughter and I'm the only one taking care of her. She has since "apologized" about this, and said she is just extremely upset about what's been happening. She thinks her brain couldn't accept the reality of the cancelled surgery and she kind of snapped. She's always been a bit forgetful and loopy, but this was totally shocking to me. I haven't even recounted what happened to my friends or significant other because I'm so disturbed.
I'm hoping that this is not as serious as it clearly appears to be. Has anyone else experienced frightening cognitive decline after a trauma? And can a person get back to normal eventually?
Thanks for your help!
1) UTIs can cause dementia-like symptoms - culture is best
2) Other infections can also cause dementia-like symptoms - blood work
3) Imbalances in electrolytes, etc can cause confusion - blood work
4) High BP puts her at a higher risk for strokes, TIAs and dementia
For # 4, even if treated with medications, it still can predispose someone to dementia (vascular.) My mother was treated for high BP for decades. No idea if she ever had TIAs, but by 90yo she developed dementia.
Stress can indeed impact one's thinking and result in some memory lapses. Quick lookup says increased anxiety and stress can possibly predispose someone to depression and/or dementia, but I should think this would take years to build up enough to result in suddenly seeming to have dementia. Being befuddled or forgetting things can be caused by stress, but thinking you are a cousin that doesn't exist???
Before setting a date for surgery, get her in for a thorough checkup, urine culture, bloodwork, to rule out anything else causing this. Sudden onset of dementia-like behavior is commonly seen with UTIs in elders (and NO obvious signs of UTI, like pain.) If all is negative, then potentially she should see a neurologist to determine if she's had TIAs, a stroke, or some other cause for her behaviors. If not, the anesthesia alone in elders can wreak havoc, more dementia-like symptoms and they could last for months or longer. Additionally, like others mentioned, is she going to be compliant with ALL post-op care and exercise? Knee replacement isn't magical, she won't hop out of the bed and walk!
Depending on what the doctors determine after various tests, consider trying injections in the knee rather than surgery. Those can alleviate a lot of pain - they will require periodic shots, but generally it is limited to 4x/year. Talk to the ortho surgeon about that (and mention her current state - BP is bad enough, but if she's not up to snuff, I wouldn't put her through the surgery.)
i have had a lot of luck finding referrals but zero luck with ‘accepting new patents’ unless I am interested in a state (Indiana) program where they will first connect you with a financial advisor.
You are correct on your insight. My struggle: do I really want to put my mom on mood stabilizers at 79 with doctor appointments every week, at least in the first few months. And who is responsible for getting her there and back? Me.
if she needed mood stabilizers (which I believe she does) is that worth the arguments, the headaches, the struggle to get her there and to make sure she has her meds on a regular basis? No.
At 59 I would of said yes but I’ve lost hope.
The surgery in itself should be evaluated because it requires a fairly long and intensive rehab. Part of it may be done at a facility but upon discharge from that facility she will need to follow precise instructions about exercises and weight bearing. Will she be able to do this on her own? Will you or some aides be available to help and monitor her during this period?
I'm so sorry you and your family are going through this but know that you are not alone. I wish you peace on your journey.
Not all these can be resolved, but some can.
Update her glasses and hearing aids. If her senses are not as clear, her thinking could get muddied exponentially. This could help explain the remote control situation, but regardless, if eyesight and hearing are as clear as possible, it will help her.
Check her medications by reading the pharmacy printouts or looking them up online. Look for bad drug interactions, warnings and side effects (confusion is often listed). Never take her off any drug without the supervision of a doctor. My mom was on drugs that had a confusion side effect and she was on some combinations that were strictly prohibited or warned against. Some medications build up in your body over time (so the causal effect may not be obvious). Mom was much healthier and happier (and so was I!) when we got this resolved with her doctors. Getting her weaned off the wrong medications (mostly added one at a time by her former PCP) was a miracle.
If she is taking any specialized medications, she should be seeing specialized doctors ... for each separate health problem, if possible. If your mom isn’t seeing a cardiologist, find a good one. I would avoid doctors close to retirement. My mom took high blood pressure medication for years but was never treated by a cardiologist. Once she saw a cardiologist, her medications were fine tuned and her health improved. (We were told her heart meds were still used but outdated).
General practitioners are like general contractors. They are qualified to oversee and coordinate a project, but they might not do the best job installing plumbing, electrical wiring and bricklaying.
In picking any kind of doctor, especially for patients with complicated health problems, look at-
(1) medical school/residency ranking (the best medical schools and residency programs accept generally the most qualified candidates who also had the highest test scores);
(2) undergraduate college ranking
(3)extra qualifications/certifications and specializations
(4) peer physician ranking and lastly
(5) patient reviews- read all the bad ones. If your loved one has a complicated medical situation make sure the providers are all medical doctors (not DOs or nurse practitioners).
Neurologists were not particularly helpful for us -so I wouldn’t put that specialty at the top of the priority list-we tried a couple different and highly recommended ones- they just read Mom long fact patterns and played “memory games.” We knew there was a problem we didn’t need that type of evaluation to know something was off. They just wanted to slap on some more prescriptions (some of which interacted with some of the other medications and later were eliminated by other doctors). Mom would leave feeling humiliated and sad. The stress from these visits made things worse and needed their own mini-recoveries!
When your mom is “off,” try de stressing her environment (to lower her blood pressure and clear her thinking). Put on soft music and low lights, hug her. Prepare her favorite foods from her childhood. Be careful not to scold or criticize because that can impact her BP.
if she makes errors, don’t be critical as that could stifle her desire to communicate.
After you try these suggestions and others, if you find that she has not improved, try your best to accept her for who she is, get help however works best -either in her home or out (so she is safe) and try not to show her any disappointment if she makes a mistake.
as a first generation immigrant I have experienced the trauma of fleeing a country under martial law and my parents experienced war and poverty so I have witnessed the effects of stress and PTSD, however, these factors do not necessarily lead to dementia, from what I’ve seen. In fact, such stressors can build resilience, especially if you are able to channel the energy into productive work and if you have spiritual strength. I think in your mother’s case her cognitive decline may be due to her denial, abd the problems piling up. Ironically, her dependence on others to make decisions for her May lead to this, because she is not exercising her mental faculties and has become too passive. Use it or lose it. This is why games, music, any new skill, is encouraged for the elderly. Her lack of confidence in her own abilities and enpowerment may have led to a mild depression.
Some types of anesthesia may aggravate dementia-like symptoms which may not be easily reversed. If the surgeon is made aware of her history, he can assure that the anesthesia she receives is the least harmful in this respect.
Extreme stress can cause dementia like reactions and dementia can be in itself stressful. You stated your mother has never been emotionally strong, believes in magical thinking, a bit forgetful and loopy. This behavior can also hide her dementia as it could appear to be her normal behavior until it gets more extreme. Was your mother under anesthesia when the last surgery cancelled. Anesthesia can have an adverse affect on elderly brains and can take longer to clear the system.
Have her Dr check her out and good luck.
i hope you’re ok!!
the last cancelled surgery...you said she was on the operating table.
did she get anaesthetics? it’s possible. maybe also other drugs?
this can cause dementia.
i know of an elderly loved one...
every time the loved one goes to hospital...they must give some drugs...the loved one comes back home with worse dementia, and slurred speech. then after a few weeks, the loved one is better.
the example i know, the loved one already has dementia.
anaesthetics is known to potentially cause, or worsen, dementia - sometimes temporarily, sometimes permanently.
your “cousin” example is worrying.
the loved one i know, says similar things, but is better now.
i hope your mother will be ok!! hug!!!! courage!!
Often people with dementia can "hide" it or work around it for years before that becomes impossible and others start noticing the decline.
Conditions like high blood pressure can cause little strokes leading to what would be called vascular dementia.
She should be evaluated by a neurologist or a neuropsychologist. this should be done before surgery as the anesthesia used for the surgery combined with dementia can cause a cognitive decline that may or may not resolve.
A good workup by a qualified doctor should be the first step, while waiting. I might also reconsider the surgery. My mother also put off knee surgery. She would often rub her knees and say she should get them done, but never did anything about it. After moving to MC, she had a prolonged (several days) of complaining about intense pain. PCP Rxed multiple doses of tylenol and advil, which I thought was ridiculous. I took her to the ER, but we spent 4+ hours there in agony (her with the knees, me listening to it) - although on arrival she denied having a problem during intake, and even stood up and walked to the scale! Later I took her to an ortho surgeon who took Xrays and said were she 20 years younger we'd be talking surgery. I requested an injection, even though by this time she'd not had any more pain.
Can you talk to the ortho about trying injections instead of surgery? She might get some relief and not have to go through surgery and PT.
Pseudodemenita does not cause degeneration of the brain, whereas dementia does. Actually, it's not the dementia itself that causes the degeneration, it's the disease that manifests itself in dementia symptoms that cause the brain to degenerate. It's important to determine the cause of dementia to properly treat or care for.
Your mom certainly exhibits dementia symptoms. An appt with a neurologist, neurophsycologist or gerontologist needs to be made for a proper evaluation.
It sounds as though she’s under a medical doctor’s care. Can you start with a thorough physical?
Some of the behaviors you mention are not terribly unusual, but having an expert opinion can help when you keep an eye on things for the next 3-6 months and see what direction the outward signs are leading in.
Start a “wellness” list and jot down what you consider unusual responses and/or typical Mom stuff. It will help you to keep your observations more objective too.