Delirium vs. Dementia

“I think, therefore I am,” according to Descartes anyways. But this philosopher asks, “if I have my head up my behind, am I still?” This came to me a few days ago when I went to buy takeout, paid, then discovered on my bike halfway home I’d forgotten the food. I hope this doesn’t make you think twice about using Pre-R. But it leads me to write about delirium vs. dementia.

The first often needs the ER. The second often not, and may very well be worsened by hospital chaos. These may help:

Red Flags:

  • New anything really… fevers, headache, sudden memory loss, neck pain, slurred speech, unsteady walking, personality changes, noticeably less drinking/eating
  • Recent trauma
  • More frequent falls
  • Blood thinners
  • Recent alcohol, barbiturate or benzo use or withdrawal
  • Recent new meds or dose changes
  • Hallucinogen exposure… intentional or not

Happy Words

(not really happy, but less concerning for delirium)

  • “This is how dad usually acts. We just want to get him checked over because his home health nurse said he vomited.”
  • “I think he’s just a little dry. We came here a week ago for the same thing and a liter of saline perked him right up.”
  • “Strangely, her symptoms always evaporate when it’s time for bingo.”
  • “I’m certainly losing my mind! I can’t remember anything and I keep losing my keys… (and I have toddlers).”

ERs are a lot better for managing delirium. For patients with dementia, we essentially look for low hanging problems with easier fixes like UTIs, dehydration, medication side effects, etc. Occasionally we discover brain bleeds, cancers, or other life threats. But very often following hydration and large workups, we’re left saying to families “Godspeed and best of luck.” Like homelessness, addiction and depression, were just not very good at fixing dementia in ERs.

Before Pre-R, however, I never really realized what kinds of hoops families have to jump through to help their relatives with dementia to carry on. Most recently I visited a family on the insistence of a funeral home who required a woman’s signature following the death of her husband. Unfortunately, she’s had Alzheimer’s for 15 years. They needed me to drive 40 miles for a simple signature to attest that she was incompetent to sign… and telemedicine wasn’t an option.

Pre-R can’t fix dementia, but give a call if we can help you navigate/negotiate some of the hills and valleys. If we can save you and your loved ones a worried, fruitless drive, that may be good too.

Frankly, this topic hits close to home for me. My parents have been on Alzheimer’s watch for as long as they’ve known the term, in part because my great grandfather had it. But as long as mom can still navigate Photoshop and dad can keep her gigabytes organized, I’m not worried. Probably when their worry stops should mine begin… or if I forget the food again.

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