Wednesday, July 18, 2012

On Memory Impairing Illnesses



    Those of you who read this blog with any regularity know that my concerns for dementia are pretty well confined to canines.  One of my dogs is exceedingly ancient and regularly tears up his kennel room at night, upsetting his "spouse", looking for imagined animals.  He does seem to re-orient each morning, and to be functioning and enjoy his life during the day.

           As you all know, we live in an intensely rural area, and in order to get diesel fuel, regular gasoline for a reserve vehicle, bread, milk or anything else, we have to drive a long way, twenty miles long, each way. Anything that we need beyond those mentioned, we must go even farther.   It's practical because we lump all out trips into one or two, and do everything at the same time.  In the extreme heat, this not only takes some planning, but can be a long day.  My husband runs most errands after work, and some days we are simply here all day.

           In the last few months at around the nine mile mark from our farm, there is an elderly woman who is an avid walker. Literally every time, we drive past, she is walking in and around the road near her home in a pretty rural area.   At first, I mentally commended her diligence toward her fitness program.  As the weather got hotter, I thought she must be in pretty good shape to walk every single day in extreme heat and humidity. Eventually, since she was ALWAYS walking on the road when I drove past, I wondered if she did anything else.  Still, as is the custom in these parts, I waved, as did she, and I would drive on.   A few weeks ago, I noticed that she did not seem to be able to detect from which direction a car was coming.  Then, I noticed that as I waved, she not only didn't wave back, but had a blank "no one home" stare.  It looked as if our fitness oriented acquaintance has some type of dementia.  I resolved to keep an eye out when I drove past, and I wondered what else I could do.  I knew that she lived alone.

          A lot of the general public is quick to assume that acute confusion in the aging and elderly is Alzheimer's disease.  This is not always true.   There are a variety of types of dementia, some of which are fairly easily reversible. when a proper diagnosis is made.  Heat exhaustion can cause sudden confusion and inappropriate behavior.   Normal pressure hydrocephalus, or NPH for example may occur in a mature or elderly person rather rapidly.   Once diagnosed, usually by a neurologist, the patient can receive a surgically implanted shunt, and signs and symptoms of their dementia will subside, often completely.   Disorders of fluid and electrolyte imbalance can also produce dementia-like symptoms.  I remember an older woman who descended into pretty striking madness who had dangerously low sodium levels. Following slow correction in the ICU with multiple bags of intravenous fluids, we became clearer than I was that particular day.   Longer term hypothyroidism can produce a dementia which is also called myxedema madness. I once had a patient who was admitted to the ICU with a rapid onset change in her level of awareness. Her problem was eventually found to be a very severe sinus infection which moved on to her meninges. She was cured of her confusional state following two doses of intravenous antibiotics.    Don't expect all hypothyroidism patients to be obese or even overweight. Although their total metabolism is working at a snail's pace, many of them sense the speed at which their colon is working and adjust their total intakes downward. I have therefore had hypothyroidism and myxedema madness patients who have actually lost weight prior to the diagnosis being made, although normally we would expect the opposite.  Thus far, all of the causes I have mentioned for overt dementia, are rapidly curable ones.   Tuberculosis can also travel to the meninges, and produce a rather striking dementia.  This should be considered especially in patients from foreign lands where tuberculosis was more common than here.  This neurological manifestation of TB and presentation of dementia is also curable.   There are many other causes of dementia. Alcoholism, psychiatric disorders which are improperly diagnosed or treated, and drug treatment for other disorders can also cause some rather striking lunges off the beam.  Space occupying lesions within the brain can often be removed, and can also cause some interesting behavior.  Something called vascular dementia can also occur. An elderly patient can experience arteriosclerotic changes within their brains and the carotid arteries within their necks, and this too can produce dementia.  This can be treatable, but generally without the striking improvements seen with the aforementioned diagnoses.   Metabolic disorders which accompany liver, kidney and other disorders, as well as blood sugar excursions can also cause some interesting behaviors which can initially be thought of, at least by families, as Alzheimer's related, when they are not.  Heart rhythm disturbances and heart anomalies can also impact memory in some people.  There are also many other potential causes of memory issues which exceed the scope of a blog post.  (Potential in neurologic disorders and in porphyrias, also)

           If the final result IS the presumptive diagnosis of Alzheimer's Disease, make sure that the diagnosis is made by a board certified neurologist, and that your loved one is treated by a major university center which is on the cutting edge of Alzheimer's treatment. Many exciting new treatments and drugs are emerging which may slow the disorder or stop it in its tracks.

          The family of our road wandering friend came suddenly this week and removed her from her home.  One of them is cleaning out her home now, and removing tons of books, bookcases and a lifetime of her treasures.  I presume the woman doing the cleaning is her daughter, because she looks just like the woman, only appears to be about thirty years younger.  I will have to stop and ask her how her relative is doing,
         This is also important to mention on a preparedness forum.  Make sure that you have a physician who in a local emergency situation could treat infections before they evolve into a meningeal one causing you to give away your food or make another disastrous strategic error. Make sure you have trusted people around you to advise you, and get you help when you need it. Give some thought to what you would do in order to protect a family member who is even temporarily mentally incompetent secondary to a disease process.  Think about how you might limit their access to their weapons temporarily.  Make sure your family has all of the information in this blog post.  Forewarned is forearmed.