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Mom had a brain bleed and had to go in for emergency surgery. They put a drain in and she was hospitalized for a week then went to rehab. (This will be the 2nd time in rehab in 8 months-she first went in after a hip fracture surgery) In rehab I've seen her confusion, Sundowner agitation, spinning elaborate tales that make no sense that she's convinced happened to her. When I mention dementia, Drs always say it"s "hospital delusions" and it should "clear up" as soon as she returns to her AL home. However, the Med Director at her facility says it's dementia. Mom is a former RN, so is great at talking "medical" during those lucid moments-her masking is amazing- and constantly argues about her care with everyone and refuses to see a neurologist. Even her neurosurgeon says there's no need to see one (and mom clapped with elation and gloated about it *sigh*). Should I just assume she's got dementia and live towards dealing with this? Who can actually give that dementia diagnosis? Any help is appreciated.

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Before "resigning" to an assumed dementia "diagnosis" first please have her tested for a UTI, which are very common in the elderly and especially if she was catheterized in the hospital. Make sure all other medical issues that can cause those types of symptoms are discounted and treated before her getting a cognitive exam, if she agrees to one. Dehydration, vitamin deficiency, thyroid issues, diabetes, high blood pressure, tumor and other problems can possibly create the symptoms she's having.

I would press the doctor for the actual medical cause for "hospital delusions"... like is it mental or physical? Why does it magically "clear up" once she's out of the hospital?
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Sorry about your mom. Two rehabs in 8 months sounds like an exhausting experience. I have been wondering that myself. My parents PCP sure isn't going to do anything. In fact I call her Dr. Princess. I think the healthcare system they use doesn't want to deal with old seniors. They want the younger, prettier oldies that are in the commercials and brochures used to get medicare dollars. I think that a lot of physicians don't want to make the diagnosis...so they don't. Also, my mom's confusion has cleared somewhat after her diabetes has been managed better at ALF. But I do kinda of assume they have dementia and work towards trying to deal with it. Sorry, I wish I could help you more.
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I have recently learned from personal experience that hospitalists are not specialists and are primarily focused on getting you to a condition where you can leave the hospital. Similarly, surgeons's jobs are to cut out or repair what's ailing you, but follow-up is not their purview. As a result of not understanding that (having not previously been in the situation I found myself in early December), I am only now going to see a specialist in what ails me tomorrow -- a full two months after ending up in the hospital for emergency surgery.

That's a roundabout way to tell you not to listen to the neurosurgeon, because dementia is not his specialty, nor to the doctor in the hospital. She needs to be examined by a neurologist.

My mother suffered from delirium in the hospital, but that's also because she had dementia. The hospital was an unfamiliar and scary place, people were poking her with needles, and she didn't know where she was, so of course she freaked out. Once I got there and was a familiar face she calmed down somewhat, but getting her back to her memory care and the established routines there was crucial to bringing her back to her usual state.

For your mom, throw anesthesia into the mix, and yeah, she's going to have all sorts of things scaring her.

Get her to a neurologist because "the doctor requires it" or whatever excuse you need to use.
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