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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!



Jaime

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She should see her doctor for several reasons:

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.)
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Reply to disgustedtoo
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Imho, your mother should be seen by a geriatric neurologist.
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Reply to Llamalover47
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JWill0308 Jul 27, 2021
Fact! That’s the absolute truth.
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.
Um…
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.
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This woman is elderly and has physical issues. It is only natural due to the aging process that she is likely developing dementia. The trauma is making it worse. Please accept it as there is nothing you can do to stop it.
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Reply to Riley2166
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Yes. Personal experience? The death of our eldest son greatly hastened my husband's dementia.
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Reply to Octogenarian
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Before she has the knee surgery, I would suggest you speak to her PCP about the incidences you have observed. A UTI can cause confusion but she has BP issues and may have had a TIA. Anesthesia for surgery can sometimes play mean tricks as we age and increase dementia, particularly if it is already there, so you want to make sure her surgeon is aware of her mental state prior to surgery so he can accurately evaluated her as a surgery patient. You might also wish to have her evaluated by a neurologist for Parkinson's or other neurological abnormalities, again prior to surgery.

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.
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Reply to geddyupgo
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Since you are seeing concerning signs, please get he thoroughly evaluated by her doctor. She may not be sleeping well and that could be the reason for the things you are noticing. She could have also have had a minor stroke or two since she also has blood pressure problems. Do not be surprised if her doctor makes referrals to a a neurologist and/or a geriatric psychiatrist. Only a compete medical evaluation can get to the cause - and treatment - of this problem.
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Reply to Taarna
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I can see why you are worried. All the best to you and your mother! Cognitive decline is unpredictable. Operations and perhaps even the preparation for operations can take a lot out of seniors. Anasthesia is also somewhat risky. You just have to be observant and try to get your mother to relax and not stress about things. Talk to your mother's doctor about this. Maybe some counseling would help. Make sure all of her paperwork is in order while she is mentally capable (hopefully this won't stress her out more). She needs to set up power of attorney for medical and financial matters, have a living will so that you know her medical directives, a will if she has assets, her POA needs to be on file with social security and medicare to be able to speak on her behalf, and most financial institutions (banks, credit card companies) have their own POA forms. My mother's credit card company recommended that I get a card with her account with my name on it. You may need an attorney for the legal papers. In the meantime, can you make her more comfortable using the walker, and perhaps even get a wheel chair? There are walkers with seats on them that are very convenient if she has to be places where there are no places to sit. There are portable wheel chairs that fold up and fit in the trunk of a car. Is it time to start thinking about getting some home care for her? It sounds like you are also stressed by this. Be sure to take some breaks and take care of yourself!
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Reply to NancyIS
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could you have her evaluated for mental stability? if she has always been sorta out of mind on certain things, the stress could have played a part. she might be scared on how things are going to go especially since her spouse is no longer there to do everything. maybe tell her and assure her that once the surgery is done, she will be able to do so much better (of course after doing therapy) in getting around without pain. Tell her that she will meet some new people doing the therapy (might give her some incentive cause she will have other people to talk to). But some people live on drama or pretend to not understand, but I am sure you know how she is so other than having her evaluated, you won't know. Depending on how much the brain was tramatized, it could take time, but i am no doctor. i wish you luck
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Reply to wolflover451
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I would definitely make sure she doesn't have a UTI infection. They can make the elderly VERY confused. My MIL had one and was talking in numbers!
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Reply to laneedwards
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High blood pressure can absolutely cause confusion. So can overmedication/reaction to medication, kidney failure, lung failure, stress and many other serious health problems.

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.
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Reply to ACaringDaughter
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Dear Jamie, please get your mother to her PCP to discuss your concerns and possible help for your mother. It does not really matter what caused the dementia. It is there and it is only going to get worse; not better.
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Reply to Ricky6
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Your situation is much like mine. I don’t have a medical degree but I will say that every time my mom has had stress which we try to avoid that in any conversations, or fallen, her mental health seems to decline. She also sleeps a lot and has no appetite. My mom was diagnosed with vascular dementia three years ago. Since then I have researched any and all things related. I do have a brother that lives out of state that is very good at playing out of sight, out of mind. He’s the golden child, calls twice a week, scoops in about twice a year, takes everyone to nice dinners, then leaves. Okay, vented there! Anyway, my answer to your question is yes, I believe so. One of the most frustrating aspects about dementia is that there are no answers. Each person is different and therefore medical experts cannot predict nor provide me with answers. I am sorry you are put in this situation. It’s hard to watch.
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Reply to JWill0308
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I’m not a mental health expert but I have experienced trauma so I am just sharing knowledge from experience, but I strongly urge you to consult with a professional.
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.
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Reply to LeahO71
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I know this was not your question, but I am wondering if she does have dementia if she's a good candidate for the knee surgery she wants, and which was going to be performed by a surgeon who probably didn't know there were dementia concerns. After knee replacement surgery, intensive physical therapy is a must, as well as compliance in terms of doing what you're told to do regarding knee care: e.g., icing, heat therapy, not bearing weight, bearing weight, etc. If the knee is replaced and the exercises are not performed, she may end up in an even worse situation in terms of mobility and pain.

There will of course be therapists teaching her, guiding her, and helping her; but my own recollection of therapy after knee replacement (in my 60s) was at about 2-1/2 to 3 hr/day on days when I did not have the therapist in my home, or later, when I went to out-of-home therapy, about the same amount of time on non-therapy days. I also had asked for and did have pre-op therapy for about a month prior to the surgery. I would add although she will be given notes, diagrams, and perhaps videos to watch to help her remember how to do things correctly. If she cannot remember from moment to moment and does not have any memory of what she did with the therapist, a good recovery is going to be very difficult. I really am sorry to bring up this point, but it seems it may be necessary to consider it.
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Reply to caroli1
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If your mother does end up having surgery, speak to the surgeon prior to surgery about her mental symptoms. She may not actually have "dementia" but some sort of pseudodementia, as mentioned previously.

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.
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Reply to Dosmo13
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I'd start with her PCP have him/her do a cognitive assessment and go from there and if necessary get a referral to a neurologist who specializes in dementia and related conditions.

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.
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Reply to cweissp
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dear jaime,
:)

hug!!

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!!

bundle
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Reply to bundleofjoy
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Have you considered that this is actually a cognitive decline due to dementia of some type?
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.
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Reply to Grandma1954
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disgustedtoo Jul 27, 2021
If she's having these kind of issues, then as Grandma1954 said, surgery may be a very bad idea. The anesthesia can exacerbate her condition and bring on even worse dementia-like symptoms.

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.
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Extreme stress or depression can cause dementia like symptoms referred to as pseudodementia. Conditions like depression, vitamin B deficiency, hypothyroidism, medications interaction, can all cause pseudodementia. These conditions are treatable. However, it is difficult to differentiate true dementia from pseudo. A physical workup by a clinician, including a brain scan, can determine if the symptoms are truly dementia or pseudodementia. Treatment for pseudodemntia is usually some kind of therapy such as CBT.

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.
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Reply to sjplegacy
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Severe prolonged stress can certainly cause PTSD, and intense unrelieved periods of continuing stress (like pandemics, maybe?) can cause negative changes in overall functioning.

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.
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