Delirium

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PhilD
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Delirium

Post by PhilD »

My wife ( who was diagnosed with Alzheimer five years ago) had colon cancer removed on the 18th of May. She recovered very well . After the operation we discovered that she had Urinary Track Infection. She took antibiotics for about 7 days and all was fine. I gave her lots of probiotics and prebiotocs to repopulate her microbiome with good gut bacteria. Everything was fine until 2 days ago when she had a delirium episode while shopping at the supermarket ... over a period of a few minutes she thought I was someone else and feared for her life. She keep calling for help while I was holding her trying to calm her down. The police came to her delight and took her home. My son arrived at the same time and she was safe with him and her normal self ... the next day my son had to go somewhere and my wife wanted to run away ... again the saw me as a threat. She went to the next door neighbor who happens to be a GP and he recommended that my son and I take her to hospital for assessment . It was a difficult decision because we can't visit her because of covid-19. Even though my wife has AD ... I found it hard to believe it has caused the delirium so suddenly . I think there is another cause .... could the antibiotic have caused it ???
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Julie G
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Re: Delirium

Post by Julie G »

So sorry, PhilD. That must be equally frustrating and heartbreaking for you. Both the anesthesia from the surgery, any overnight stay at the hospital, the trauma from the surgery itself, and even a bladder infection can contribute to the delirium your wife has experienced. Have you had her urine retested? It's very common for bladder infections to become chronic in this population and cause dramatically worsened dementia symptoms. Sending good energy for you both. Please keep us posted on her progress.
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Re: Delirium

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PhilD wrote:My wife ( who was diagnosed with Alzheimer five years ago) had colon cancer removed on the 18th of May. She recovered very well . After the operation we discovered that she had Urinary Track Infection. She took antibiotics for about 7 days and all was fine. I gave her lots of probiotics and prebiotocs to repopulate her microbiome with good gut bacteria. Everything was fine until 2 days ago when she had a delirium episode while shopping at the supermarket ... over a period of a few minutes she thought I was someone else and feared for her life. She keep calling for help while I was holding her trying to calm her down. The police came to her delight and took her home. My son arrived at the same time and she was safe with him and her normal self ... the next day my son had to go somewhere and my wife wanted to run away ... again the saw me as a threat. She went to the next door neighbor who happens to be a GP and he recommended that my son and I take her to hospital for assessment . It was a difficult decision because we can't visit her because of covid-19. Even though my wife has AD ... I found it hard to believe it has caused the delirium so suddenly . I think there is another cause .... could the antibiotic have caused it ???
I’m sorry you’re going through this PhilD. Both my parents have suffered delirium at different times for different reasons. It’s challenging.

It can definitely be a continuing UTI as Julie said. In addition to them becoming chronic, sometimes also the antibiotic given isn’t effective at all or enough against the strain causing the infection. This is a growing problem.

It could also be that there is some sort of internal infection relating to the surgery, I would think.

There was also a recent thread here that I can’t find about a particular manifestation in AD where the patient gets very paranoid about their caregiver. I hope someone can find that for you. If being paranoid about you is the only presentation, perhaps this is the cause (?). In my experience handling my parents’ delirium, it was expressed in a variety of ways from minute to minute, so to speak, rather than just one repeating expression of confusion.

I have also read that strokes can lead to delirium-like symptoms.

Delirium is also common with changes in environment.

I would definitely bring this to the various doctors’ attention asap.
ApoE 3/4 > Thanks in advance for any responses made to my posts.
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Re: Delirium

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PhilD wrote:My wife ( who was diagnosed with Alzheimer five years ago) had colon cancer removed on the 18th of May. She recovered very well . After the operation we discovered that she had Urinary Track Infection. She took antibiotics for about 7 days and all was fine. I gave her lots of probiotics and prebiotocs to repopulate her microbiome with good gut bacteria. Everything was fine until 2 days ago when she had a delirium episode while shopping at the supermarket ... over a period of a few minutes she thought I was someone else and feared for her life. She keep calling for help while I was holding her trying to calm her down. The police came to her delight and took her home. My son arrived at the same time and she was safe with him and her normal self ... the next day my son had to go somewhere and my wife wanted to run away ... again the saw me as a threat. She went to the next door neighbor who happens to be a GP and he recommended that my son and I take her to hospital for assessment . It was a difficult decision because we can't visit her because of covid-19. Even though my wife has AD ... I found it hard to believe it has caused the delirium so suddenly . I think there is another cause .... could the antibiotic have caused it ???
Hi Phil,

Julie G's advice is terrific, and I hope your wife is soon able to come home--with you having the information and support needed for her. My mother also became delirious during a hospital stage, so I know how shocking it can be to see happen in the moment. What happened with my mother is what I hope happens with your wife: with a minuscule amount of medication (a few different ones were used, but my recollection is that she finally needed only a tiny anti-depressant dose daily) she returned to her sweet, calm self.

It may be that the particular environment of your grocery store that day (music, increased crowds, some with masks, lots of movement and snatches of conversations) was overwhelming. [Kids with autism spectrum disorders regularly find malls and crowded stores overwhelming, even though they can be fine in other settings.] My guess is that she reacted to you the next day because of an emotional memory of the day before. All of that is very likely to fade in her memory, and I hope she will continue to find comfort in your love and care.
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PhilD
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Re: Delirium

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Thank you all for responding so quickly to my query. It is really comforting to be able to get help from smart and caring people. This APOE4 website is really terrific and I shall make a donation sooner than later. There are lots of people in my situation caring for someone with some form of dementia who would find this site useful and comforting. To give an update you were all correct my wife ( Robin) does have a UTI and the antibiotic that was previously given to her was ineffective. She has has a virulent and nasty strain of E Coli which needs to be terminated for good.
Once again thank you all for your support
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Re: Delirium

Post by floramaria »

PhilD wrote:Thank you all for responding so quickly to my query. It is really comforting to be able to get help from smart and caring people. This APOE4 website is really terrific and I shall make a donation sooner than later. There are lots of people in my situation caring for someone with some form of dementia who would find this site useful and comforting. To give an update you were all correct my wife ( Robin) does have a UTI and the antibiotic that was previously given to her was ineffective. She has has a virulent and nasty strain of E Coli which needs to be terminated for good.
Once again thank you all for your support
PhilD
Hi Phil, thank you for posting the update. It is so good to know that the input you got here was helpful, and that your wife is now getting treated for her UTI.
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PhilD
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Re: Delirium

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My wife returned from hospital a few days ago and she was fine FOR A WHILE. We went for a walk ,,,,, she helped me clean the vegetables for dinner and helped me hang the clothing on the line to dry. All was good until the evening .. then she came unsettle ... had to get my son on FaceTime to convince her to eat , take her antibiotics, clean her teeth and go to bed. In the middle of the night she woke up and went to the toilet . I looked inside the toilet bowl and realized she did a number 2 but did not wipe herself ,,,, this is a worry as she had UTI from E-Coli. I tried to get her to go to the bathroom ( she returned to bed) to finish the job or even have a shower . Doing so got her mad ... she punch me in the face and threaten to kill me. She then ran downstairs but could not get out because I had locked the doors and had the keys in my pocket. By 2 am the ambulance arrived and had to take her away .... I was shattered . The worse thing is that I can't see her in hospital and talking on the phone is difficult. I have tried to get in touch with the doctor looking after her but so far I have been unsuccessful. I would get her a mobile phone and keep it simple for her to use but she can't use it. My question is this : Once we COMPLETELY get rid of the UTI will she return to the sweet lady she was before ? When she has these episodes she turn against me and shows real hatred ... it s like Dr Jeckyll and mr Hyde. I can't get my son to look after her ... he lives a long way away and has his on life. Is anti depressant the only way to fix this ? Before her cancer operation ( stage 2) on the 18th of May she was great ,,,,, even 4 weeks after the operation she was normal. This just came out of the blue although thinking about it she did became restless a few days before her first delirium attack at the supermarket. She had problem concentrating on TV shows which she usually enjoy. My hopes are that the Bug will disappear and so will the Delirium. After that I can concentrate on making sure she stays clean . With showers after number 2 just in case and using antibiotic soaps.
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Re: Delirium

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Phil, I am so sorry. The situation sounds absolutely devastating. Hopefully someone with more knowledge than I will respond re UTIs and delirium. What I want to add is this: what I have seen in my mom is that she is aware that she is changing, and for a long time, she was really awful to my dad. She told me constantly about how he was trying to control her, she is not an idiot, etc. etc. She perceived his attempts at care as something nefarious. She complained incessantly about him. The disease has progressed far enough that she no longer does this much. I mention this in case that is part of what is happening here, so you can prepare your heart.
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Julie G
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Re: Delirium

Post by Julie G »

Oh dear, one step forward, two steps back. I'm so sorry, Phil. The good news is that you've identified one of the causes of the delirium and she's being treated but as you've noted, without proper hygiene, the issue is likely to continue to reoccur. To the best of your ability, you may want to try to attend bathroom breaks with her, using wipes (front to back) for cleaning. After this course of antibiotics, don't assume the UTI is cured, have her tested. For many with frequent UTIs, a supplement called D-Mannose can be very helpful for prevention.

It's very likely that the anesthesia and other trauma from the surgery and now multiple hospital stays is also contributing to the delirium. For the anesthesia, you may want to consider liposomal glutathione to help promote detoxification with lots of cruciferous vegetables and clean filtered water. To calm anxiety and improve cognition, other supplements to consider are ashwagandha and/or bacopa monnieri.

I'm sending good energy your way. Please keep us posted on her progress.
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Re: Delirium

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PhilD wrote:... My hopes are that the Bug will disappear and so will the Delirium. After that I can concentrate on making sure she stays clean . With showers after number 2 just in case and using antibiotic soaps.
Phil, your "shattered" heart is the sign of a heart full of love and hope. As a parent of a child with a brain injury once told me: "Hope is a perfectly good state to live in." Her daughter did not return to the "before" time, yet she did thrive with love, skillful therapists and teachers and accommodations to make her new world easier for her. So I'm going out on a limb with some hopeful suggestions, which you can adapt or toss:

* It may be helpful to consider getting a bidet for your bathroom; some new models are designed for older women and include multiple temperature controls and drying, basically eliminating the need for toilet paper. Here's a link to Aging In Place's 2021 review: https://aginginplace.org/best-bidets-for-seniors/ (Note: the electric model is more expensive, but seems to be the most suited to your wife's needs). While I'm sure she's not used to a bidet, she might respond to practicing seeing it used so that she can see and hear it and know "it's safe and easy".

* Although you probably have a long-established bedtime routine, it may be that your wife needs to go to sleep earlier, and take naps during the day, in order to reduce "sundowning" behaviors--the sudden change of some people with AD in the early evening hours or near bedtime. You may want to see if an earlier bedtime, or use of a while noise machine, or even calming music at bedtime, helps her get to sleep and stay asleep.

* Having worked with kids with brain injuries and autism who often have difficulty in transitions and often seek patterns, order and routines, it seems to me that people who are struggling to make sense of reality due to dementia need those same supports. You may want to try a visual schedule on the fridge or the door of your bedroom with either pictures of the actual objects (her toothbrush, pill container, nightgown, etc.) and cues of when certain activities happen. For example, she might watch a favorite show and then "when the show is over you have your pills" becomes a routine linked to something she enjoys. Even better can be "show/pills/cookie (or some small evening treat"). Having a laminated schedule on which she can draw a line for "all done" tasks may also help make life more predictable and give her a sense of control.

* A "social story" is a script that helps people deal with challenging situations. For your wife, it may be helpful to have your son record a message like "good night Mom; sweet dreams; I love you" that you have on your phone and can play for her each night, since his voice is reassuring to her. If she asks to talk to him you can remind her that he's called and suggest "let's get in touch with him in the morning; he's sleeping right now." [Dr. Jason Karlawish, Director of the U. of Penn Memory Clinic, call this "loving deception" which is ethical as long as it respects the person's ability to understand the truth.]

* If there is a day program for people with AD in your community, your wife may actually benefit from the stimulation of being around other people and having activities to do, leading to a better night's sleep and much-needed respite for you. A good friend was reluctant to have her mother go to a day program, but amazed when her Irish Catholic mother came home happily and told her "the angels at that place are very pleasant."

The goal of all of these accommodations of course is to respect her feelings and reduce her agitation. You're an expert on her; give yourself permission to hope for a return to exactly what she was like in April and still plan for how to support her possible changing needs.

Hugs from someone who already has already reassured my husband that I love him for the future decisions he may have to make on my behalf. I know your wife feels the same, Phil.
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