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Do You Need a Room in the Home for the Befuddled?

As if I didn't have enough to worry about. Just when I thought I had exhausted all the possible ways for me to eventually lose my mind obliging that my children throw me into The Home for the Befuddled, I find there is more. I have the symptoms of Alzheimer's, vascular dementia and regular old dementia knocked. One would think that that would be enough. But I recently learned that there are four more.

Although they are lesser known old person mental aberrations, I think it's important for the aging population (and their children) to memorize the symptoms in case, just by chance, someone (like you) discovers that, God forbid, you have one of the symptoms. The first is called Lewy Body Dementia and the other is Normal Pressure Hydrocephalus. Then there is Hysteria and lastly, a more hopeful one because there is something to actually DO about it. These are all the drugs whose side effects mimic Alzheimer's. These new diseases all have an entirely DIFFERENT subset of symptoms from the usual losing your keys and where did you park your car thing that we all know about Alzheimer's. Since Lewy Body Dementia, Normal Pressure Hydrocephalus and Delirium are new to me, I have to - darn! - memorize an entirely new set of disturbing mental abnormalities just so I can continually check in with myself to make sure I am not slipping into one or the other. And, nice person that I am, I thought you might want to know the symptoms, too, so we could worry together.

First Lewy Body Dementia: Its primary symptom is hallucinations. Yes, your little childhood "friend" is back and you can play with the little imaginary dog together. It happens mostly to men and it's underdiagnosed. The victims steadily lose cognitive ground, but since they are less prone to short term memory loss, it's hard to pinpoint what it is that is happening. They have trouble with complex tasks like grocery shopping, have trouble navigating or perceiving distances and might have Parkinson's-like impairments like slowness, abnormal gait, rigidity. They can appear drowsy, have staring spells (What's wrong with that?) and these "spells" wax and wane. There are drugs which can slow the progression of the deposit of the Lewy bodies (These are protein deposits, but not the beta amyloid protein plaques typical of Alzheimer's.) in the brain, but usually it's a fast decline and diagnosed late because it is rarely thought of in the differential diagnosis.

Then Normal Pressure Hydrocephalus, otherwise known as The False Alzheimer's Diagnosis. This affects memory and movement, so it looks like a combination of Alzheimer's and Parkinson's  severe confusion, forgetfulness and difficulty walking - but it is actually a build-up of fluid in the brain. And can be easily gotten rid of by first, a spinal tap to diagnose and secondly, drainage via a surgically implanted shunt. These people go back to normal immediately.

Then there is Delirium: (NYT (10/2/12) Doesn't this sound like something from the late 1800,s when Freud and Jung were in their heyday, suggesting pompously that the uterus somehow needed to be "tweaked" to rid the poor victim (it was always women) of her hysteria. Rent the movie with Maggie Gyllenhaal called Hysteria and you will catch my drift.

After the uterine "tweaking", all the hysteria, agitation, anxiety and mania of the handkerchief- fanning, laudanum-addicted women would apparently magically disappear. But let's look at other risk factors in the late 1800's: What about the no rights for women to vote or even own property? (Watch Downton Abbey.) What about the total domination of men over their women, especially financially? What about the unconscionably tight corsets which disallowed breathing and must have created eye-watering gas? I am sure we have all had gas that has rendered us semi-hysterical especially when we have to wear tight-waisted pants. Imagine every day, the stays, the corsets, the servant yanking it to an 18 inch waist? What about the no anesthesia for surgery and childbirth and no chance for respite from the pain? I think that just the mores of the Victorian Age could make a woman a teeny bit anxious, says she writing smugly in her comfy sweatpants.

But I digress: We are talking about Delirium, not Victorian Hysteria. The symptoms of Delirium include hallucinations, disorientation and agitation. Delirium often comes about from causes other than pathological mental breakdown, although someone on antidepressants or with diagnosed Bipolar disorder are more at risk. But things like a mild heart attack, surgery for joint replacement, urinary tract infections, thyroid or kidney dysfunction, and an imbalance of electrolytes, a surge in cortisol levels from the stress of hospitalization can all cause Delirium. You can be any age and either sex to suffer from delirium, but it's much more common in female patients over 70; in fact 1/3 of patients over 70 experience delirium during hospitalization. I think it's just nice that we all now know that this aberration exists and that our elderly parents aren't really going all gobsmacked after their knee replacement. It usually is fully reversible when managed early.

Then actually there is a fourth category: Certain pharmaceutical drugs which are handed out like Junior Mints nowadays - over 100 of them - can mimic dementia: Let's start with the statin drugs, which I have mentioned before and caused me to lose short term memory within three days of taking Zocor. Then there are these - some of the more common ones that you might know about: Zantac, Ambien, Aleve, Seroquel, Zyprexa, Valium, Xanax, Procardia, Benadryl, Detrol and many more.

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