Is it normal for dementia to present and progress like this?

[Nasrine]

MIL is 84 and in poor health physically. Type 2 diabetes, pace maker, a whole host of gastric issues. She's pretty frail.

Over the past month of so she's been a bit confused. She's usually pretty sharp but there have been a few episodes recently where she's thought her dead husband is in the room, and her mother as well. She thought my husband was her father for a moment or two, and has been talking about the children coming home from school - her children - all in their 50's and 60's now. But mostly coherent and normal and not appearing senile.

About a week ago she suddenly became very confused all the time. GP checked - not a urinary infection. Eventually DH's sister took her to A&E and she's been admitted. She's very, very confused. Thinks she's supposed to be cooking for a party. Thinks her dead husband is coming to visit her. Just not herself at all. She's had a CT scan and nothing has shown up.

The Doctor who looked at her has said it's dementia, but this quickly and this badly? Is that common?

Reading this I was going to say UTI but can see she’s been tested for that. I’d insist on a second test. Does she have a temperature?

I’ve worked with dementia patients for around 10 years give or take. Honestly, it does sound like a uti or some form of infection (you’d be surprised by the reactions), medication changes or reactions?

unfortunately sometimes this can be normal and sudden though, if you’ve looked into all other options there can sometimes be no explanation other than dementia

Possible alternative is Charles Bonnet Syndrome. Hallicinations linked to degenerative eye disease where brain / memories full gaps left by loss of vision. Can cause hallucinations that last for long periods - not just fleeting one.

In my experience dementia can very easily slip into delusional behaviour, I hope the hospital are going investigate further. My mother had a chest infection which tipped her over but she did become less delusional over time as she improved and after she came home. Sadly it did foreshadow a faster descent into her dementia but over months and years.

How are the diabetic blood sugar readings? My Dad’s behaviour seriously changed, confusion etc because his blood sugar was too high. Hope you get answers soon.

There are different types of dementing illnesses that progress in different ways. Dementia caused by Alzheimer's disease typically worsens gradually, while the progression of vascular dementia (caused by impaired blood flow to the brain) is typically stepwise as new vascular events cause more damage.

I'm not a doctor, but what you are describing sounds like the progression of vascular dementia, especially with her history of diabetes and cardiac problems, which are risk factors for vascular dementia.

It's good that she is in A&E. I hope they can settle her soon and address whatever is going on.

That quickly I’m more inclined to think infection somewhere. I would push for antibiotics and see if that helps.

That sounds like infection causing delirium (I'm not a professional, mum has dementia and dad has recently developed post operative delirium which sounds like as you describe)

Just wanted to say like the PP says it sounds like delirium. My dad went through similar to what you’ve described.

Yes to delirium but also someone who is starting to show signs of dementia is going to be even more confused when in an unfamiliar place like a hospital.

I’m no doctor but I would suggest it’s vascular dementia, it’s not gradual like Alzheimer’s, because it’s mini strokes basically. UTI was my first thought though but ruled out I see

MIL had a similar set of tests after being admitted through A&E. No UTI could be found, although they did try several antibiotics. Her cognitive decline was very rapid, and they suspected vascular dementia. She spent approximately 3 months in an assessment unit before moving to a care home.

I agree. This was exactly same as my DM, thought initially delirium and infection but it’s vascular dementia and has progressed rapidly.

My gran had vascular dimentia and it showed after she feĺl and broke her wrist, she was mid 70s still working 2 days a week. It was like a switch because it is mini strokes the Drs think thats why she fell we hadn't noticed anything.

I hope your family get some answers op.

My DM was similar. She lived with us and I realised when she went into hospital how much I had been filling in the gaps for her, feeding her info before she realised she had forgotten and explaining away her confusion has Charles Bonnet syndrome.

But once she was in hospital there was no avoiding the fact that she was declining so quickly. They tested several times for infection but she was fine physically. She moved to a rehab hospital where she was assessed as needing full time care and from there she went to a nursing home.

The change was so sudden she went from being the perfect hostess (albeit unable to do anything but direct me whilst she held court with a family of strangers!) to being obsessed by the thought that Jenny Harries was hiding out from the government and working in our local hospital in the course of 48 hours.

Does she take a lot of different medications? My Dad had a rapid descent into delirium and tested negative for infection. Eventually he had his medication tweaked (he was also diabetic and heart problems) and he came back to himself at about the same speed as he had deteriorated.

This happened to my Gran a few years ago. DB, who is a pharmacist, said one of her tablets can cause hallucinations even after taking it for many months. We asked for this medication to be changed. Gran is still going strong at 87.

It sounds very like delirium, and that can worsen in hospital.

Has she changed medication for anything recently?

We were told that certain dementia goes in steps . Other stresses probably make it more obvious as it's less of a challenge to be in your usual routine and home. Hope its something else though, which might improve again. Looking back we thought we could see subtle changes before the big step. Hope you get some more answers.

Yes she does. So many!

My 90 year old mum had terrible delirium in hospital at new year when she was admitted after a fall which fractured her pelvis and her collarbone. I'm amazed she made it home after that.

When my mum became confused very quickly it was kidney failure caused by her chronic heart insufficiency. It caused a huge amount of liquid to be retained, in fact that bloating and associated weight gain was the clearest physical sign. Once that problem was addressed (as an in-patient) by adjusting meds the confusion cleared up quickly. I‘m not sure whether it would have shown up as a UTI on a blood test though.

There's also the effects of low or high sodium in the body. They can test for this as a cause of the sudden confusion