Dementia

My mother was recently in the hospital; I was reviewing her discharge paperwork and it states that she has dementia. Before the hospitalization, she was living independently and managing her finances and medications. She was driving and never got lost. I realize she is 88 years old, but we have no family history of dementia. How did she get dementia in the hospital?

Doubting the Dementia Diagnosis

Dear Dementia Doubter,

There are two possible explanations for the dementia diagnosis. Many times when older people are admitted to the hospital, they have episodes of forgetfulness and confusion. This is called delirium. In older patients, delirium is a symptom of being ill, just like a fever can be a symptom of a child being ill. People can develop delirium with heart attacks, pneumonia, or uncontrolled pain from a fracture. Patients with delirium often behave similar to people with dementia. Studies show that people with dementia are more likely to develop delirium and people who don’t have dementia, but develop delirium are more likely to develop dementia in the future.

However, many (but, not all) episodes of delirium resolve once the patient returns home to familiar surroundings and a familiar schedule. Perhaps your mother did not develop dementia in the hospital, but did develop delirium. It is very difficult for a hospital physician who has never seen your mother before, to determine if the confusion she is experiencing is new (and more likely delirium) or a part of her normal personality (and more likely dementia).

The second possible explanation is that your mother had dementia prior to her hospitalization. Often times dementia is difficult to spot in people who are highly educated or highly functional. As long as they have a routine that they follow on a regular basis, they are able to live independently and their symptoms go unnoticed. It is only when they are taken out of their familiar environment that the short term memory deficits become apparent.

I am not sure which of the above categories your mother falls into, but please keep in mind that a diagnosis of dementia in this situation does not mean that she can no longer live alone and requires 24-hour supervision; she could be in the early stages of the disease and has many independent years ahead of her.

In order for a physician to make a diagnosis of dementia, he or she must perform memory testing, check labs, as well as a CT scan or MRI of the head. It is rare that a physician does such extensive testing in the hospital when a patient is sick and has other more acute issues that need attention. If the physician performed these tests in the hospital, then he or she may have diagnosed your mother with dementia. To confirm your mother’s diagnosis you may want to take a copy of her hospital records to a neurologist, geriatrician, or another physician experienced in diagnosing and treating dementia. I hope this was helpful in understanding your mother’s dementia diagnosis.

The Doctor

Dementia