Mailbox Response

The question was submitted 26/10/2008

Subject: Coming in and out of "reality"

Hi there,

My Mom is in a SNF after a fall at home 2 weeks ago. Nothing was broken but she so far has not been able to walk or sit unassisted. Her memory was beginning to fail but now she is exhibiting many more symptoms of dementia. We saw her the night before last and she was aware, engaging, interacting with her granddaughter, very encouraging. Then yesterday we went to see her and all day she had been switching between this low moaning sound like she's saying the vowels...aaaaaaa,eeeeeeee,ooooooo and then after 5 minutes she would have a minute or 2 where she is clear as can be, tells about someone going to see her, how they were dressed, etc then she'll go back to the moaning. She also has her fists clenched and arms rigid. If you take her hand, she will unclench the fist. She is not on any new meds and they were giving her tylenol for pain even though when she was "clear" she would say the pain wasn't bad, she could tolerate it. The Dr's are telling us nothing, she always seems to be "on" when the Dr. makes his 5 minute morning visit so he thinks she's "doing well". Is this a common symptom with dementia? I have had no experience with this disease so it's really freaking me out. Thanks for any suggestions or help you can provide. Joan

Answer from DementiaNet

It is more likely that your Mum has delirium which is an acute deterioration in brain function. It is characterised by fluctuations in attentiveness and clouding of conscious state. It is very common amongst elderly people who with existing memory problems who suffer an acute illness or injury and are then hospitalised.

Drugs are a common factor in aggravating delirium but other factors are also relevant e.g. bladder infection, impacted bowels, uncontrolled pain, pneumonia, poor nutrition, electrolyte disorders and unfamiliar surroundings. Mum needs a full medical work-up to exclude all these factors. I am sure the doctors will have done all this but it would be worth your while to ask. Has a brain scan been done? Sometimes delirium can last for a few weeks despite medical care being optimised. Full recovery is usual but on the other hand it is not uncommon for the pre-existing memory problem to worsen once recovery from delirium has occurred.

The answer was published on DementiaNet 28/10/2008