Dementia/ delirium query?

[BonnesVacances]

My FIL has suspected dementia. He's 72 and it has come on very quickly, I'm talking a few weeks. His behaviour, sleep pattern, lack of filter, agitation all support this.

He's been on a cocktail of medication including very strong antibiotics and water retention tablets, which we initially thought was causing all this. He stopped them on Friday under the advice of the GP but the situation hasn't improved, though I thought he seemed calmer Monday. Though still not right by any stretch.

I personally think he's suffering from delirium caused by the medication and possibly a new or ongoing infection. Mainly because his parents were in fine mental fettle until death (dad heart attack in late 60s and mum at a very old age and sharp as a tack until the end) and also because it's come on so fast and from nowhere. The GP says she's eliminated most causes of delirium and he's going in today for a series of blood tests to check for infection. He's had a brain scan already.

In the meantime, the GP has prescribed olanzapine to settle him and referred him to MH services. (He took the first one last night so this won't be why he might have been slightly improved yesterday.) The NICE guidelines advise against this drug for delirium, so I'm a bit concerned they are forging ahead with the dementia diagnosis and prescribing something unsuitable.

Any advice please? MIL is struggling so I'm speaking to the GP on their behalf. Thanks.

I would wait for the blood test results, have you had the brain scan results back yet? What other medical conditions does he have?

The brain scan was clear, as were his bloods. He has kidney cancer (though stable), had a stroke 16 years ago and a current water retention problem.

He's certainly acting like someone with dementia, but I have read that the signs for delirium are the same. We are just waiting for the MH team to come out and assess him but that will take 2 weeks unless an emergency develops in the meantime. The doctor has spoken to them and they are leaning towards delirium too, because of how quickly it came on, and said it can take up to 6-8 weeks for it to subside after dealing with the cause (in this case some of his medication which he has now stopped).

But my word, it's difficult to manage!

Olanzapine is the standard (pharmacological) treatment for delirium where I work in hospital (alongside non-pharm techniques and treating the cause) so I wouldn’t necessarily worry about that. It was in the NICE guideline but was removed not because of any new evidence about its safety or whatnot but simply because another drug became licensed (when previously it hadn’t been). Lots of medicines are prescribed quite safely off licence and there may be a medical reason for avoiding the other drug you’re thinking of (haloperidol?) for your FiL. Hope that helps.

Thank you Grey. That makes sense.

The signs of dementia can appear much faster than you imagine - or the early signs may have been there but easily missed so by the time you get to this point, things have progressed more. My elderly neighbour (whom I see every few days at least) was exactly as you describe. However, they suddenly started seeing things and thinking we were aliens - seemingly overnight. We hoped it was an infection. The brain scan showed nothing and the bloods came back clear. A dementia diagnosis followed shortly after.
I realise this won’t be what you to hear and I’ll join you in hoping for the best. It may be something treatable but you need to be prepared that it may also be dementia. Family history doesn’t mean anything here as there is no familial link at all with some dementias.

I’ll keep my fingers crossed for you. It can be a slow process to get a diagnosis as it’s case of ruling other things out and that takes time. Do you have any support in real life? It is really hard to deal

I take it they have retested his urine after treating him for his uti, as water problems make the elderly go doolally overnight.

Thank you. It's all very difficult as DH is completely snowed under at work and on the verge of a breakdown, DD has long Covid after 5 years of ME, MIL's sister (so DH's aunt) has just in the past two days moved to end of life care with late stage dementia, so there is very little capacity all round to deal with FIL's potential dementia. I'm just about the only one who can think straight and after years of DD's illness, am pretty adept at dealing with doctors, doing research etc. But I do have RL support and some great friends, thank you.

He's had his urine tested again. We're just waiting for an assessment from the mental health team which we're expecting sometime this week. He does seem a bit more 'with it' recently so we are hoping it's delirium, but I won't be hugely surprised if it's dementia. It's just a case of knowing what's what, so it can be dealt with appropriately.

I am surprised that they are suggesting dementia so quickly too
We had increasing concerns regarding My aunts memory and functioning over last 14months. In summer she deteriorated badly.
Tests (urine and bloods) came back clear but she was prescribed antibiotic ‘just incase’
Medical professionals keep referring to delirium triggered by an unproven uti - highlighting it can last 6 months.
Concerns were so bad in December she was taken to hospital all tests completed - came back clear but they are still saying ‘delirium’.
Even though she can’t work out how to open a door or hold a phone.
Hope he improves
Perhaps it could be delierum and dementia - in that he will improve short term.
Good luck with next few weeks
Look after yourself

If he’s previously had a stroke years ago, is there any chance of TIA? Has anybody considered a form of vascular dementia?

My relative went into a home last year. I can pinpoint the day he had delirium. He is prone to UTIs, so we called home to let them know and requested a urine test. It came back negative. We asked them to retest (dip tests aren't that effective. They waited several days to do this. Test came back positive. He got antibiotics and was still delirious. We said he's normally ok within a couple of days of starting to take them (all after numerous calls etc as covid then happened). They said they had to wait a few days after the course. He tested positive. He was given stronger antibiotics and started speaking more sense. However, he has not recovered, is often very confused and thinks he is somewhere else, has since been diagnosed with Alzheimers. We were very involved in his care until he moved to home late jan, we were talking on the phone daily until this infection hit and it seems too fast and too much of a coincidence to me. However, apparently an untreated infection can be a trigger for Alzheimers.

I hope that it is not the case here, but I'm posting this in case you need to be prepared. Good luck OP and hope it's a good outcome.

That's an awful lot to cope with, I'm glad you have some RL support.

It does sound very much like my DMIL but she already had a diagnosis of Vascular Dementia when the delirium started.

What's happening now with his care? Do you have Attendance Allowance in place and how is currently dealing with him at night?