Sudden delirium - is this dementia?

[lorisparkle]

Until Tuesday my 82yr old uncle was able to do the crossword, answer questions on Pointless and had started doing DIY for my cousin.

On Wednesday he woke up in a panic that the DIY was going badly wrong and became increasingly confused.

On Thursday he was ‘a different person’. Doing things he never does - one moment crying, another apologising for the past, another sitting in silence, another repeating words over and over again, another being anxious, another talking about weird views of the world and reality, another being paranoid.

He was checked by paramedics, GP and A&E who did physical tests, blood tests, ECG, and CT Scan and could find no sign of infection or stroke. He initially struggled with memory questions but has since ‘passed’ them.

He was seen by the GP again on Friday who felt that the decline was too rapid so sent him back to A&E. He eventually saw another doctor who agreed it needed more investigation. However this can’t be done until after the weekend.

Is this similar to anyone else’s experience? The doctors don’t seem to have any explanations.

I know you mentioned bloods were taken but did they check for a UTI? It can cause some strange behaviors in elderly people if they go unchecked.

My first thought was UTI as well. Did they definitely check for infections?

My first thought (and actually hope) was UTI too but GP checked this. They have just taken another sample to be checked at the lab. We are waiting for MRI scan.

My Mum was hallucinating with a UTI. The first test didn't pick up anything but the second did. Five years later she was bossing me in the car today re right of way on a mini roundabout and was right. Hope it is the same for you but might have to push.

Has he had any recent infections or operations? Any recent low mood? Dementia doesn’t come on that quickly. It will probably either be an existing depression that has got suddenly worse or delirium.

That is interesting @ForPearlViper. The second test has been sent off to the lab so hopefully this will pick up a uti if the first didn’t. My concern is that he did have a blood test which was clear for signs of infection but I am not sure how quickly blood tests show signs of infection.

@BeLimeTigerhe hasn’t had any recent infections, operations or falls.

He has had the occasional feelings of deja vu in the last month which from Thursday has become intense and overwhelming.

prior to Thursday he did not report being depressed but the DIY work was causing him stress (even though he wanted to do it)

Df had bloods taken, no sign of infection apparently but the next day was delirious and taken to hospital where he stayed for some weeks. He had a UTI and chest infection but no infection markers in the blood the day before, idk how that works.
Delirium lasted some time until they found the right combination of antibiotics.
He recovered with no signs of dementia.

For the UTI check make sure they do a urine culture, not just a dip test. The former is more sensitive.

Obviously it's not possible to say he doesn't have dementia, and dementia can progress in steps, but it would be unusual for it to take such a big step so suddenly. So I would strongly suspect that whether there's dementia or not, there is also something else acute going on. Keep pushing for investigations.

Make sure they aren't just dip testing because if they have symptoms the dip tests aren't always accurate. I don't want to scare monger but blood clots/blockages can sometimes cause this if they don't cause an immediate stroke also. Has he had any issues like that before?

Did the bloods check for things like sodium levels? My DM at one stage got very confused, had speech problems, lots of things out of the ordinary, and it turned out to be very low sodium levels caused by a medication she was on.

100% I'd want a follow-up check to rule out a UTI, using a culture and not a dip test! My stepfather had this for the first time last year- in his late sixties- and it was unsettling how quickly he seemed to become a completely different person. With a round of antibiotics he soon got back to his usual self, though now he knows what it can feel like I think he's still scared of it happening again.

My grandmother had a combination of Alzheimer's and vascular dementia which came on very gradually at first until she started having TIAs. I can't imagine it progressing in such a sudden jump without that sort of trigger. The deja vu could be indicative of some kind of neurological event- I think it's typically most associated with seizures- but I'd focus on getting the UTI ruled out for certain before going down those more worrying paths.

I hope you get answers and some treatment for your uncle soon! I know how terrifying these sorts of things can be but try not to scare yourself too much, you're already doing the most important things by asking questions and being part of his family support system.

Dementia doesn’t come on suddenly. It’s highly likely he has an infection somewhere in his body. My MIL had sudden onset delirium caused by an infected leg ulcer.

Delirium is a big thing at the moment for older people and can be caused by infection anywhere. Usually with dementia there are fairly longer standing signs so if he has been fully comprehensive before it is probably an infection somewhere.

Just popping in to support above posters’ info - delirium is a condition in its own right, usually triggered by a specific cause such as infection, given that his blood didn’t show anything I would definitely push for further investigations. Delirium comes on suddenly and is temporary (although it can last weeks or months) as long as the underlying cause is treated. Dementia comes on far more slowly, gradual onset, it’s more insidious.
I would definitely push for further testing to establish what happened.

My first thought was a UTI.

YY to the sodium level check - that can definitely send someone doolally.

Sounds like they have ruled out infection, obviously this needs to be monitored but has he had any changes to medications recently?

Thank you so much everyone. It is an incredibly scary time but you have reassured me that my Aunt is doing the right thing by pushing for more investigations. They don’t have children and I worry she can be a bit ‘old school’ (e.g we don’t want to take too much of the Drs time, etc) I will do my best to support them.

Yes that was another factor with my df, low sodium.

They don’t have children and I worry she can be a bit ‘old school’ (e.g we don’t want to take too much of the Drs time, etc) I will do my best to support them. @lorisparkle

Dealing with hospitals can be infuriating and I found that I really had to be pushy.

Every staff member I spoke to every single day I reiterated that he does not have dementia, this delirium is from infection (when it was discovered) and that he was very much loved by family.

Otherwise they can assume dementia and thereby not offer treatment, which turned out to be weeks of antibiotics.

Your instincts to help your aunt are right, you sound lovely.

I'm a mental health nurse and work with older adults.

If a stroke has been ruled out, this does sound like delirium. Delirium is sudden and acute, and people's cognition/capacity usually fluctuates. People will seem like they're on another planet.

Use the PINCHME tool.

P- does he have any pain?
I- infection markers in bloods/wounds etc
N- nutrition. Is he eating enough?
C- is he constipated?
H- is he drinking enough?
M- any recent meds changes? Some meds are more likely than others to cause delirium. Some strong pain meds and are quite common medication causes.
E- any changes to environment?

Various blood results can present like delirium- common ones are sodium/potassium levels or uncontrolled blood sugars (HBA1C)

As others have said, push for a irine screen.

There's a temporary condition that I think is called "global" sonething. Happened to someone I know and they thought they were having a stroke. It was really scary for them and they acted in a very out of character way for around an hour. Had lots of tests and there was nothing else going on.

Transient Global Anemia is what I was trying to think of.

UTI check - really really common with older age groups.

I do think that when we went to A&E first it was very ‘he is old therefore he has dementia’ and they did not really take on board that a couple of day previously he was fine with just a few Deja vu episodes over the previous month and no confusion. When you are tired and worried it is difficult to be pushy with the hospital but as time has gone by I think we are getting better. Thank you so much for all your thoughts and expertise it has really helped.