Dehydration or the start of dementia? So quick, so weird

[BreatheAndFocus]

Hi,
We’re having problems with DM (76yrs). She’s been absolutely until recently - energetic (walking for 1hr most days), always busy, chatty - but in the last two or three months there’s been a drastic change. She’s lost a lot of weight (due to not eating properly, we believe), is forgetful and sometimes disinterested in things. She can’t seem to organise tasks and got lost when driving (not driving now due to our concerns).She sits in front of the TV most of the day from what we can gather.

Recently, I stayed with her for a few days (she lives alone). One thing I noticed was that she wasn’t urinating all day (approx 12hrs). During this time she had two or three mugs of tea but didn’t pee. Isn’t that unusual? Does it mean she’s dehydrated? If so, could this prolonged dehydration be causing the forgetfulness and out of character behaviour?

She’s deteriorated physically too, apart from the weight loss. In the Summer she’d happily walk 5 miles with a stop for a packed lunch, but now she was almost shuffling and looked frail and feeble. But then, if she’s not eating, wouldn’t that be a possible cause?

At the beginning of Oct she was fine, now she’s struggling and so different 😞 Coincidently (or not), a volunteering thing she was doing ended around that time. Could that be connected? She used to have to get up to get ready and also prepared food for others and worked to a timetable. Now she lies in late and spends the day doing very little. Could she be depressed and missing the social interaction? But surely that wouldn’t make her confused?

Sorry to ramble on. It’s the speed of things that’s shocking. We’ve arranged a doctor visit for basic checks in the New Year, but I just wanted to ask if this sounds like dementia or if it’s ‘just’ a physical and mental deterioration due to lack of food and drink that can be reversed?

Any thoughts or comments welcome. I’m really worried. I spent most of Christmas looking at care options but I just wish I knew what’s causing this so I could help and could anticipate the future a bit.

How concerning for you. Well done with getting on to it all.

my advice is to get her into the system. Yoh don’t need to diagnose -once they have done some initial tests they will send her for an appointment with a neurologist who would actively consider diagnoses such as Parkinson’s. You don’t need to try and do their job. We got the doctor to call our mobile btw and then we can patch in the patient. Not sure if that actually would help but it means we are on the call too…

Order her some jelly drops - they're designed to increase hydration in older people.

https://www.jellydrops.com/?gad_source=1&gclid=Cj0KCQiA1rSsBhDHARIsANB4EJYbdsyyIfpjSWLYaRTc5nIKoUuOQFVFfW17GKO2jvAHSYQ9uuYC95IaAlwJEALw_wcB

I hope she's okay!

Definitely start poa ASAP. Do the letter from.her to the gp so you can talk directly to the gp. However you need to do this for the hospital ( if it gets to that stage). The gp receptionist told me that they could only tell after the event if she seen a consultant. Mum.was very confused about who she was seeing and why. The gp receptionist could tell me some things as it was obvious to her that I had mums letters in front of me. Convincing mum or my sibling this was alarming was impossible.

I noticed mums food cupboards only had instant mash and sardines in. Little things of concern.

If you don't already, get a apple watch, kettle WiFi notifications or whatever you can to check mum is up and about remotely.

But do poa now.

Get your mum to sign some blank letters so you can hand one to the neurologist or elderly care Dr

We had very similar symptoms with my DM not eating/drinking enough & it landed her in hospital where she stayed for 2 months. When I got her home I started giving her an electrolyte drink every morning (just a fizzy tablet from Amazon) and it made a huge difference. She's still having it daily a year on and is doing so well. But for a while in hospital we thought we were going to lose her. Electrolytes go out of balance very quickly when not eating or drinking enough in the elderly. Those tiny imbalances can cause huge issues.

But definitely check for uti or other infections first. My DF had similar symptoms from a cellulitis infection.

Thank you again for all the great ideas. I’m feeling much more on it now. You’re all very kind.

Has her medications changed recently? Or any new stuff? That can sometimes cause a conflict which can lead to new issues, happened to my MIL

I was going to say mini strokes too. Sounds like my DF. Get to a GP fast.

Did something change around that time? Has she started new medication?

There’s another vicious cycle - worries about falling —> drinking less so don’t have to go to the loo —> dehydration and UTIs.

I hope you manage to get her to the GP: it’s likely you will have to physically take her yourself. Welcome to the wonderful world of caring for elderly relatives. Buckle up, it can be a bit of a ride.

Hi OP

Have you looked at B12 ? Had an elderly relative that was low and mimicked the symptoms of dementia. Injections put it right and she's bright as a button again !

I remember finding several articles in US/UK online medical libraries about how the impact of vitamin B12 on cognitive function and physical ability was/is being underestimated or overlooked.

I disagree that it's an 'obsession'.

You're right, a full review by a GP is essential, and of course it may not be an UTI.

Having been involved in the care of several elderly relatives, I can say that it was revelatory how much of an impact a UTI could have, and how quickly. It's almost always where a GP / hospital will start, with these symptoms, before progressing.

She’s not on any meds. She was in good health prior to this - good blood pressure, etc.

seconding @AnnaMagnani - MN is obsessed with UTIs in older folk! While it is a (small) possibility that this change is infection related, there are plenty of other things. Probably in a normally fairly fit 70-something yr old with unexpected weight loss one of the first steps should be looking for a cancer somewhere as it would be one of the most time-critical diagnoses to exclude, but also a potentially curable condition. Impaired kidney function with associated electrolyte imbalances can certainly cause the sort of picture you're describing, and are also easily picked up from basic bloods, but usually is a symptom of another underlying problem rather than the primary cause of a deterioration. The rest of the suggestions all made so far are important, but more diagnoses of exclusion....a neurologist certainly wouldn't be my first port of call for something like this.

Good luck getting some assessments and support in place. I just wanted to say that yes, your thought of depression is also a definite possibility, in older people depression absolutely can mimic dementia.

As you can see from the range of things mentioned a thorough general medical assessment is the first thing needed to provide clues as to which explanations are most relevant and then try to optimise things accordingly from there.

Just an update. Mum saw the GP and was given some antibiotics. That’s all I know as they won’t talk to me due to my mum not having signed a letter giving me permission yet. This is very frustrating because she doesn’t seem to remember what they said to her or get its importance. She wouldn’t normally be like that. She’d have told me exactly what was said and what was happening.

Anyway, she has some antibiotics. I just hope she remembers to take them. I also hope they’re going to do some kind of follow up. I don’t even know if they weighed her.

When are you next seeing her? Definitely get her to do the letter and take it round as it's possible without your extra info she didn't even give an accurate history.

After New Year sometime. That letter is now top of my list before even the Power of Attorney.

She needs to see a geriatrician - sounds like Parkinson’s with dementia and depression to me. Dehydration and constipation can make cognitive symptoms worse.

Hello! Came on to say the permission letter for the GP is really important as you're going to be making more of these calls. Also - another simple but common thing which can seriously affect older people's health and mental health is constipation (which can actually present as diarrhoea). We seriously thought dad was on his last legs and it was this.
Hope it is nothing more serious.

Has she had COVID?

We have gone through the same, including GP considering a UTI.

DM diagnosed with COVID induced paranoia. This has left her with dementia. Shockingly rapid decline from driving to not knowing who any of us are.

I don’t know if you live local but it would be ideal to go to appointments with her. It always helps to have two people as each remembers different bits.

The letter has been a godsend for me and my DM.

I also have my mobile number on her records as first contact (no idea how this happened, wasn't on purpose) and book all her appointments - if you have eConsult it's great as you can fill out all your concerns that she might not mention.

If it's a telephone appointment they invariably ring me first and I get to fill them in before they speak to DM.

And sometimes I have just had to take time off work and go with her.

Sorry to hear that @Amana That must be incredibly hard.
No, she’s not had Covid.