Dementia and Illness

August 10, 2011

by Daniel C. Potts, MD, Co-author, A Pocket Guide for the Alzheimer’s Caregiver

Consider this scenario:  An elderly woman who lives independently and has little or no known cognitive/memory issues is admitted to the hospital with pneumonia.  While in the hospital, she becomes confused, agitated, difficult to handle.  Her family is concerned and so are the doctors.  This poor woman, who seemed fine until the week before, suddenly doesn’t recognize family members, doesn’t know where she is, and is combative.  What has happened?

She has developed a very common syndrome in the hospitalized elderly patient: delirium.  This is due typically to many factors acting together at the same time.  First of all, the hospital (especially the Intensive Care Unit) is a confusing place where the patient can’t really discern night and day.  Normal sleep patterns are not possible in a noisy environment with people coming in and out to check vital signs.  Second, some medications, and especially anesthesia, can cause confusion.  Elderly people take much longer to recover from the effects of anesthesia than younger ones. Often, elderly people are on multiple medications which may negatively affect cognitive function.   Pain and nausea medications particularly can cause temporary cognitive problems.  In addition, infection and/or problems with other body systems (such as the kidneys, lungs, liver) typically play a large role in causing delirium.

Doctors always should rule out stroke in this situation, since elderly people who are ill or who have had surgery are at higher risk for stroke.  If the person has equal strength on both sides, can speak normally and can smile equally on both sides, stroke is less likely, but not completely impossible.  It may take a brain scan (MRI or CT) to rule this out.

The most likely end to this scenario is that the elderly lady, if she recovers completely from the pneumonia, will return to normal or something near normal.  However, people with any type of dementia, even very mild dementia, who have an illness or injury which requires hospitalization, often never return to their baseline.  The illness “unmasks” cognitive issues that may not have been very apparent before.  In fact, my own father had exhibited only mild signs of dementia, and after an elective surgery, his memory issues became much more pronounced.

While our elderly lady’s confusion is certainly a cause for concern, it is not cause for panic.  However, episodes of delirium like this should alert us to the possibility that an underlying cognitive or memory problem (early dementia) may be present.  If someone you love has had delirium, you should encourage them to seek evaluation by a healthcare professional.

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One Response to “Dementia and Illness”

  1. This is a great article.

    I hear this so often on my own website. The patient enters the hospital, with/without anesthesia, and they are completely changed afterwards. Sometimes it goes away quickly, but often lingers.

    This happened to my own mother though she was only hospitalized for tests.

    You offer much understanding to this situation.

    Sandy

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