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Hi all! My mom has been through quite a bit over the past few weeks. Long story short after a significant fall, she ended up back in the hospital after a few days of lethargy and diarrhea. She had been previously diagnosed with a mild cognitive impairment a few years ago. But after being in the hospital for what ended up being pneumonia, the Dr. diagnosed her with dementia. What’s the connection? I’m not sure how advanced the dementia is or what to expect from here. I live out of state from where my parent live and am curious how this diagnosis is reached. Any insight is appreciated. Thanks!!!

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My Dad got hospital-acquired pneumonia in an excellent hospital after a fall and subsequent complications. Yes, he had "hospital delirium" and yes, it has long-term consequences. Google "ICU psychosis" and you will learn that even young people can get a dementia-type syndrome after hospitalization. In the elderly , those already with cognitive decline or dementia, etc., the fallout can be severe, long-lasting, even permanent. There are some things you can do to help, but it is a long hard road. I am so sorry you and your family are having to suffer through this.
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bapkak Jan 17, 2019
Thank you. Prayers to you and your Dad. It is a scary road for sure.
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Hospitals can be very dangerous places. they stay in bed and quickly weaken, and nurses are afraid of them falling -- so they are thankful they stay in bed. and that's how they get pneumonia and even blood clots. Hospitals also carry all kinds of dangerous contagious bugs that go from patient to patient. Even the doctor's stethoscope can transmit bugs. In bed means they did not fall. I have to assume that fall caused some injury--so that alone will keep them in bed and they weaken and go downhill very quickly.
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Madtoe Jan 18, 2019
I agree!
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If she has had a sudden and atypical decline then she could be suffering from confusion or delirium brought on by her hospital stay and health conditions. In my opinion too may doctors see dementia in anyone they perceive as being old without bothering to look for any other cause.
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bapkak Jan 17, 2019
She has had an overall decline in her short term memory in that it's virtually gone. She also has glaucoma and has now become a fall risk. So she is declining .. but overall she still knows the key people in her life and cant eat etc.. With this latest incident she isn't able to be left alone anymore. But I agree.. I'm wondering if the Dr's saw the delirium and just wrote down dementia. I'd think there would need to be more of an in depth process than that.. but I'm not surprised if there isn't .. thanks.
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Mild Cognitive Impairment can be stable, or nearly stable, for a long time ... and then some incident takes you to a new (lower) plateau. Pneumonia reduces brain oxygen, which causes both 'symptoms of more cognitive impairment in the moment' and sometimes 'longer term symptoms' as a result of mild anoxia. Hospitalization can cause delirium, along with deconditioning, for all the reasons mentioned above.

And, many people with MCI eventually progress into a Dementia. It's awfully hard to manage this stuff at long distance. If you can get her a neurological exam or some neuropsychological testing, you can get a definitive answer about her mental condition. But since there isn't much that can be done about it ... unless you need it to justify, for example, using her long-term care insurance for a specific kind of facility, it may not be worth it.

Definitely do the bloodwork. Things as simple as vitamin deficiencies or other blood chemistry can show up as dementia, and be cured within weeks. But if her bloodwork is normal there may not be much that can be changed.

Your dad may need some support, as mentioned by someone else. If she can't stay hydrated, she can end up back in the hospital.
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bapkak Jan 19, 2019
Thank you! This is very helpful!!!
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Dehydration and pnemonia cause Dementia type symptoms but they don't cause Dementia. Wait till she is home where things are familiar. Give her some time to "get back to normal". If you feel there is a problem take her to be evaluated for Dementia. The lethargy could be dehydration as so the diarrhea. Keep her hydrated.
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bapkak Jan 17, 2019
Thanks. I guess she went through some delirium while in the hospital. That's part of the reason I'm starting to wonder how they came up with this diagnosis. I live out of state and my Dad is her primary caretaker. I fly home every three months or so to give him a break. My Dad isn't too concerned and isn't the best at asking questions of the doctors. So, I'm just trying to make sense of this on my end. Thanks for the advice.
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Oh, another quick idea - ask for the results from her blood work, which I assume they've done many of. BUT, do a little research on the "normal" range that you are given with her results. The ranges given are often HUGE (at least from my lab!) and do not necessarily flag a problem. What I look for is what is the OPTIMAL range and that's where you should be shooting for.

For instance, my ferritin level (basically stored iron) is only 36. BUT the lab range says 30 - 400 is "normal". But it is NOT optimal.

So maybe your mom has something wonky in her blood work that is showing a deficiency that could be improved through diet and/or supplementation.

It's probably more complicated than this, but just a thought. It's hard to find the answers but I like to at least try to keep digging to find out if there's something simple to do to help improve things.
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bapkak Jan 19, 2019
Thank you! I am digging, and plan to keep on digging until I do get answers! 😋
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Look into the medicines she’s taking, some can exacerbate dementia. Even something as seemingly benign as Benedryl or melatonin has been shown to increase dementia risk and symptoms.
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Have you asked the doctor how she was diagnosed? Can you ask for the specific test results? I wonder if they have an online system that you can be given access to, like we have at our health care system. I can go online and see the notes doctor made from appointments, test results, email the doc, etc.

If not that, perhaps they could email or fax you the info.

If the diagnosis was only done via a visual assessment, it may not be 100% accurate. As others stated, maybe when she's home in her surroundings and more recovered from her acute health problems, her dementia type behavior will improve.

Do you think you can get your dad to become a stronger caregiver? Like will he make sure your mom has plenty of water, good food, maybe some exercise to keep her mobile and regain her strength, etc.? If it's too much for him, then it's time to bring in some part-time help who could help with these kinds of things.

When my mom had the flu and a fever, she was completely out of her mind. Thankfully, when she recovered, she went back to normal.

As others mentioned too, I agree that the hospital stay itself can be damaging. A friend of mine, her mom went in for knee surgery and when she woke up, her dementia had increased dramatically and she has not recovered over a year later.

Good luck!
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bapkak Jan 19, 2019
Thanks! I can’t ask the Doctor as I’m out of state and not her POA. She’s also back home. My thought was if I called the hospital and asked for her test results they’d basically tell me they can’t release that information to me. This is something I have just started wondering about. It seems like years ago I started noticing changes in her and now that I am getting a dementia diagnosis I almost don’t want to believe it myself. My Dad, is coping in his own way as well but he doesn’t ask a lot of questions at medical appointments. I’m thinking there has to be away for me to get this information if and when she ever gets re admitted to the hospital. Could my Dad add me to the POA just to be able to call and get medical information from my moms appointments? Thanks again!
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Not sure if anyone mentioned it but pneumonia can make oxygenation poor. And yes, please check med side effects and also levels of ferritin and B12. A bad case of pneumonia also means she likely isn't able to eat or eat well. The other side of your question is that people with dementia are more prone to aspiration pneumonia.
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Request an MRI and/or PT Scan for your parent.
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