Earlier this week, while I was listening to a social work colleague (Mary Hulme of Moonstone Geriatrics) give a talk on dementia at the public library, the following question came up:
“How can one keep Alzheimer’s from getting worse?”
Now, Alzheimer’s disease — the most common underlying cause of dementia symptoms — does slowly get worse no matter what. (Given enough years, it will eventually damage the brain to the point of causing a slow death, which is why Alzheimer’s is a terminal disease.)
But on the other hand, we do know that some things tend to slow the progression of brain decline, whereas other things seem to speed up the decline. In other words, the actions we take — and don’t take — can influence a person’s dementia journey.
In my experience, people often have heard about things that might slow down decline (exercise is one of my favorites).
But it seems to me that people are often much less well-informed about the things that can speed up Alzheimer’s decline. This is too bad, because often it is possible to take actions to avoid or minimize things that might cause dementia to get worse faster.
So today I’m going to write about what I think is the most important of these potentially dementia-accelerating problems: delirium.
Delirium: What it is, why it matters
Delirium is a state of worse-than-usual confusion brought on by illness or some kind of stress on the body or mind. It is especially common during hospitalization.
Although the extra confusion of delirium does tend to get better with time (and of course with the treatment of whatever illness or stress brought on the delirium), it’s very important to know the following facts:
- Some people with dementia who experience delirium never recover all the way back to their previous level of thinking ability. Instead, they settle at a new, lower level of mental ability.
- People who’ve experienced delirium tend to mentally decline more quickly during the following years than people who haven’t had delirium. In this study, having had delirium was linked to thinking abilities declining twice as fast in the year after a hospitalization.
- Hospital delirium is very common in people with dementia. This study found that delirium affected 32% of patients with dementia during hospitalization.
In other words, experiencing delirium is common, and can really speed the decline of Alzheimer’s or another dementia.
This can be scary for patients and caregivers to realize. Fortunately, although it’s not possible to avoid all delirium (people get sick after all, or do need to have surgery sometimes), it is possible to take steps that have been proven to reduce the chance that an older person will experience delirium while hospitalized.
To learn more about how you can help prevent delirium during an older person’s hospital stay, I recommend this resource for patients and caregivers on the Hospital Elder Life Program website.
What caregivers can do about delirium
If you are caring for someone with dementia, here are three things you can do to avoid mental decline due to delirium:
- Educate yourself about delirium. For instance, you can learn more about what brings it on, how to have it managed, and how to prevent it. See 10 Things to Know About Delirium for more.
- Be careful about surgery and hospitalizations. If you are considering a surgery that is elective or otherwise not completely mandatory, be very mindful of the risks of accelerating the decline of Alzheimer’s or another dementia. For a sad story of how a family came to regret agreeing to a heart valve repair for an older woman with dementia, read this New York magazine story.
- Learn to spot delirium in the hospital. If you are a caregiver and your loved one with dementia has to be hospitalized, try to help hospital staff monitor for delirium. Yes, it’s their job to do, but studies have shown that busy hospital workers often don’t notice delirium in older adults. Families can help their loved ones get better care by watching for delirium and getting doctors to promptly address it if it develops.
Questions about delirium and dementia? Let me know in the comments!
And don’t forget to read our other BHWA articles on delirium:
- Hospital Delirium: What to know & do
- 10 Things to Know About Delirium (more in-depth and covers delirium vs dementia)
Linda C says
My husband is a 75 year old disabled veteran and has recently been diagnosed with Alzheimer’s. He is a retired fighter pilot and combat veteran of Virginia and Desert Storm. In April and August ofv2022, he suffered two serious falls involving multiple fractures, a brain bleed, and a serious elevation in his INR (possibly a result of a medication error in a rehab facility.) He spent many weeks in either a hospital or a rehab facility. He has multiple health issues including PTSD, diabetes, heart issues including afib, pacemaker, congestive heart failure etc. Prior to the two falls, he had some very mild short term memory issues but nothing very drastic. Since all of this, his dementia has accekerated rapidly, resulting in this diagnosis. Obviously, he has suffered many traumatic events in his life. My question is this: Is it likely all the trauma, possible delirium, and a compendium of likely brain injuries have led us here?
Nicole Didyk, MD says
Hi Linda and I’m sorry to hear about how difficult it’s been lately for your husband and you. Dementia symptoms can definitely be exacerbated by delirium, multiple transitions (home to hospital to rehab to nursing home, for example) and head trauma. Usually the person has an underlying dementia, such as Alzheimer’s, and sustains “insults” to the brain from those other issues. Head injury increases the risk of person having memory issues by about 28%. As your husband recovers from his recent hospitalizations, remember that there are things you can do to prevent a recurrence of delirium, as Dr. K discusses in this article: https://betterhealthwhileaging.net/delirium-how-caregivers-can-protect-alzheimers/
barbara klestzick says
The diet includes no meat, fish, milk, ice cream or cheese. Food should be organic. I’m also working out, cardio, weights.
Nicole Didyk, MD says
Keep it up, Barbara! Such healthy habits are sure to make you feel better and your mind clearer.
barbara klestzick says
I was diagnosed with MCI 12 years ago. A year ago I got Covid. Since then my cognitive abilities have gone down hill. I started on an anti alzheimer diet a month ago. I feel a lot better now. I dont understand can the diet be so powerful or is it psychological?
Nicole Didyk, MD says
I’m so happy to hear that you’re feeling better, and that you were able to find a diet that works for you.
Most of the articles I’ve found about nutrition changes to prevent Alzheimer’s, like this one: https://www.sciencedirect.com/science/article/pii/S0091305719300942?via%3Dihub, mention the anti-inflammatory properties of the diet.
A month seems like a short time to have such an effect, but if your previous diet was high in sugar and refined carbohydrates, you may be feeling much more energetic, sleeping better, and so on. And that could produce a better cognitive performance. There can be a psychological effect, or “placebo” as well, but in my opinion, that’s OK as long as the diet doesn’t have any dangerous side effects.
James W says
Thank You for the information.
I have a question regarding my father and something the family has been dealing with.
Our issue pertains to dad’s decline with a diagnosis of Alzheimer’s. He took the MMPI test and scored 20 at that time. I saw the clock test and could tell things were not going well. He also had an MRI done and it showed the white matter had grown in size. A year after the MMPI test he had a stroke a major one. He also reported that he was having mini TIA’s prior to the major one that blinded him in one eye. Then a few months later he gets married. My family was confused. Was dad capable of making that type of decision two years after his initial diagnosis? I know my question pertains to capacity and that issue is always up for debate. Yet, I wonder if dad had slipped into the moderate range for Alzheimer’s.
Nicole Didyk, MD says
I’m sorry to hear about all of the trouble your dad has had, it sounds like a rough time.
The MMPI (Minnesota Multiphasic Personality Inventory) is not usually used to diagnoses dementia. Maybe you’re thinking of the MMSE (Mini Mental Status Exam)https://betterhealthwhileaging.net/how-to-diagnose-dementia-the-basics/
Even with a diagnosis of Alzheimer’s or another type of dementia, a person could be capable of deciding to get married, but I can understand your concern. If you’re worried about your dad being taken advantage of by his new partner, I would encourage you to open communication with him. You may be able to convince him to get a post-nuptial agreement to protect his assets.
Mills says
Hi, my father was a fit healthy 70yr old who just retired in 2021. He went to answer door in March 2021 and passed out. Was disagnosed heart failure. Had loads of tests and heart was ok, just high pressure one side. So lungs were investigated. In mean time he was slowing up, often out of breath. Nose went purple, constantly cold and started sleeping more. They said right lung was damaged and possibly CO2 build up from sleep apnea. But then had blood gases and were normal. He is often confused and seems to have delirium every night. Strips off clothes, falls out of bed, thinks he’s got to go somewhere. He can now hardly walk so poor mobility and is confused a lot of the time. He also has legs that weep and need compression bandages. We don’t know what’s wrong and don’t know where to start again with drs as they were blaming everything on CO2 buildup. What do you think we should push drs to focus on?
Nicole Didyk, MD says
I’m sorry to hear about your dad’s difficulties. It sounds like many of the symptoms you describe are related to heart muscle dysfunction (or “heart failure”) which can be right sided (fluid in the lungs) or left sided (fluid in the legs) or both. This article gives an overview: https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142
Heart failure can have many causes though, including sleep apnea. The best way to diagnose sleep apnea is with a sleep study, where the person goes to a hospital or clinic and sleeps while having breathing and other physiological data measured.
A sleep study is often helpful to allow observation if unusual behaviours during sleep as well, so might be useful given your dad’s falls.
I hope you get some answers and your dad feels better soon.
Salvatore Geraci says
Follow up to to Dr. Didyk. thank you
Denise Wynn says
My 69 yr old brother who stays with me has dementia on top of a life time of anger issues. Was hospitalized with COVID, being septic and went blind. Hospital for 5 months then nursing home for 4 months. Ended up on life support for 9 days. He was very confused didn’t know anyone and hallucinating very bad after coming off life support. He still sees only light and shadows his anger issues are terrible. 9 massive heart attacks, strike, several amputations, and now has a defibrillator. He will not use oxygen, he falls, he threatens me, he’s caught house on fire and also burned couch bad. It was on fire. I’ve sought help everywhere. Doctors pulled home health and advised me I was not safe here. No one seems to be able to or wants to try to help with some options. He scares me and he’s dangerous to himself and to others. Any help would be appreciated.
Nicole Didyk, MD says
Hi Denise and thanks for sharing your story. Your brother sounds very medically complicated and dementia and anger issues on top of that would create a very difficult situation.
The advice from professionals that you’re not safe is somewhat alarming. If you’re not safe, then your brother would not be either. Going back to hospital would be another transition and may cause delirium again, but it sounds like there’s very little choice.
Other than that, rally any available family members, social agencies, elder abuse teams (Adult Protective Services Wayne County 919-580-4034) or even the police if you feel like there’s an imminent threat. Safety first, then work on developing a sustainable medical plan or even palliative care if that’s the direction that seems most appropriate.
Salvatore Geraci says
My 91 year old partner of 29 years, 10 months was diagnosed with Alzheimer’s about 7 years ago. We went to the ER, (back pain) and had a white cell count of over 22,000 and source was a UTI.
He was a renowned scholar, and the most unpretentious academic ever. (Ph.D…18 books published) And now Alzheimer’s. Discharged after 9 days and released to assisted living and began Hospice after 24 hours. 18 days later he passed.
I am devastated from his loss and have so many, many regrets. Did I go to the right hospital, Should I have gotten medical help earlier….he began go to bed in middle of day and was eating less. I was there 8 + hours a day and 18 hours before he took his final breath. Was the Alzheimer’s breaking down all of his organs? He did have COPD and some degree of renal dysfunction. I feel that I missed a lot of signs and in spite of his advanced age, if treated earlier he might still have had a good number of months to have lived.
I loathe my self….please tell me what you think of the clinical situation and what I could/should have done to prevent his death so quickly. 19 days an still in painful moiurning. Thank you, kindly.
Nicole Didyk, MD says
I’m so sorry for the loss of your partner. Nineteen days is a very short time to have been bereaved, and it’s common for this painful grief and mourning period to last for months, especially if the death is sudden and the relationship is very close.
Your description of the last part of your partner’s life sounds like what might be expected for someone lving with a later stage of Alzheimer’s disease. Many people with Alzheimer’s die because of an infection, like a severe UTI, pneumonia or the flu. Alzheimer’s disease doesn’t specifically affect organs other than the brain, but it can make a person much more susceptible to dysfunction in other systems. When an acute illness comes on, a peron with Alzheimer’s is more frail and more likely to have serious consequences of the illness, which can even include death.
It’s natural to feel like you could have done more. In the later stages of Alzheimer’s, it doesn’t take long when an infection comes on before the body is overwhelmed, and a care plan that targets minimizing suffering and enhancing comfort makes the most sense. It’s unlikely that a different hospital or a little earlier treatment would have made a significant difference in the way things turned out.
I hope it brings you comfort that you were able to be there with your partner when he passed. Please reach out to grief counsellors in your area if these feelings don’t pass. Most funeral homes can put you in touch with counsellors if you ask.
Salvatore Geraci says
Thank you so much Dr. Didyk for reading about my concerns. I have performed diagnostic ultrasounds for 40 years and have seen many people who have die in the hospital. Yet, I am in denial about my partners death; meaning, the “nose-dive” he took leading to his last breath. I (we) never even imagined that we weren’t going to return home at some point. I called upon one of the intervening MD’s asking him, did I make the worst possible decision not to have placement of a nephrostomy tube. My partner even understood what “procedure” meant and he refused as well. I was told “no” and he may have suffered more. I use to complain, especially when I was tired, about attending to him and now, I wish I could do it all over again….all over again. Saw a grief counselor and going for 2nd sitting….also going to try this support group, “Widows and Widowers”. Realizing he was of an advanced age, I felt maybe he could have lived a few months longer, people I have spoken with, said he would have been miserable…..maybe not, but maybe they are right. Thank you kindly. Sam
Nicole Didyk, MD says
Thanks for the follow up comment, Sam and I’m really glad to hear that you’re looking into peer support and counselling. Your feelings are natural and completely understandable. I would echo the words of the professionals that told you your husband was probably spared additional suffering. I wish you could have had more time, but it sounds like you had a very loving relationship, one that many never experience.