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March 6, 2015 / 15 Adar , 5775
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When What Looks Like Dementia Is Really Something Else

 


The moment we can’t remember where we put our keys, or the few seconds it takes to try to remember where we parked our car causes fear in everyone that I know who is over 50. Immediate thoughts of Dementia or worse creep into our minds as soon as we experience a momentary memory loss. As much as we fear for ourselves, well spouses may sometimes fear even more, seeing symptoms of memory loss or disorientation in their partners. With chronic illness, these symptoms may be a sign of the disease progressing to a new level, or it may be something else completely.


Chronic illness advances the body in its aging process. And so a person in his early 50s who is chronically ill may react to an infection the same way we’d expect from an 80- or 90-year-old person. Because of the chronic nature of the illness, the symptoms displayed are usually seen by family and even sometimes professionals as a natural progression of the illness and looking for other causes of the symptoms may not be the first course of action.


Moshe was hospitalized, yet again, because of pressure sores that were a result of his constant need to sit in his wheel chair. The hospital stay for this procedure was usually around six weeks. His wife was startled when Moshe called her at 3:00 a.m. one night.  When she answered the phone, she heard her husband’s whispered voice, “I think someone is trying to kill me.” Moshe’s wife panicked.


Despite years of chronic illness her husband had always been mentally competent. She knew that as the illness progressed there was a chance that his cognitive skills might deteriorate. But he had been mentally sound for so long she thought they had escaped this part of the progression of his illness. All night her husband kept calling with whispered stories of strange people trying to poison him, of being forcibly moved to unfamiliar places and even asking her to call the police before they killed him.


When she arrived at the hospital the next day, Moshe’s condition seemed a bit better. He would wax in and out of this paranoid state, alternating between recognizing the nurse and refusing to take medication convinced it was poison.  But as the day progressed, so did the paranoia and the nurses were talking about using restraints and forcing medication on him.


Moshe’s wife was beside herself. Could the illness suddenly progress to this stage so quickly? Two days ago they were talking about filing income tax and paying bills and today Moshe had accused his wife of being part of the group that was trying to kill him.  Things got steadily worse over the next few days. A neurologist was called for a consult. Even a psychiatrist was called in. Tests were ordered.


Moshe’s wife saw her life as a “well spouse” taking a turn for the worse in a way she never thought possible. Finally, several days after the onset of the paranoia, it was discovered that Moshe had a Urinary Track Infection. He was put on a dose of antibiotics immediately and within hours the bizarre symptoms he was displaying began to diminish. Slowly, his mental state returned to normal.


The doctor explained to Moshe and his wife that people with chronic illness react to infection the same way the aged do and they can often display symptoms that look more like mental illness than physical ones. This makes diagnosis difficult.  Especially when the person suffering from the chronic illness is relatively young, medical professionals sometimes forget to look for a simple physical cause and just assume it is the illness progressing.


Well spouses need to be acutely aware of this phenomenon. This is especially true if their spouses are young and have not shown cognitive impairment to date. A sudden change in behavior, memory, even onset of paranoia may be a result of nothing more than a simple infection. Infection needs to be ruled out as the cause before blaming the progression of the illness.


Unfortunately, it may be up to the well spouse to remind the doctors of this and insist on the testing, as too often the chronic illness is diagnosed as the total cause for any medical condition or change that we may see in those we love.


You can reach me at annnovick@hotmail.com.

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When one is blind one learns to use Braille to read. When one cannot walk, a wheelchair gives mobility. Sign language allows a mute person to speak and ocular implants assist in hearing when one is deaf. These are all compensatory strategies that help a person function despite his disability. But compensatory strategies are not just for physical problems. Understanding our psychological weaknesses and setting up our lives to ensure that we are not tempted to repeat our past mistakes, is as necessary as any aid to the disabled.

Well spouses have often discovered that their friends and relatives, despite their closeness to the situation, often don’t realize the tremendous emotional impact living with chronic illness has on the family. With the best intentions, suggestions, ideas and criticism are offered, based on the non-experience of those with healthy families. Even when the good intentioned get a taste of the difficulties, it is sometimes not enough for them to then identify and understand what the family of the chronically ill must face on a constant basis.

Over the past two weeks I have shared letters from a therapist and a well spouse. Both of the letters gave personal insights into the process of losing hope, how we react when that happens and some ways of coping when test scores, diagnosis and just simple repetitive behavior indicate that change for the better is impossible.

Dear Ann,

I’ve read your last few articles on psycho-neurological testing (Oct.8-22) with interest. As a therapist who has counseled couples dealing with chronic illness, I’d like to give you another perspective.

Dear Ann,

Your articles on the Neuro-Psychological Testing were right on (October 8-22). My husband underwent testing twice and your articles explained it things exactly the way they were. Besides the test, we also tried therapy.

Very often when we can’t face our big hurts or big loses we focus on the little ones. We can discuss those. We can cry over the small loses, be angry at the smaller hurts even though it may look trite and sound ridiculous to others.

Over the last two weeks we have been discussing one way in which well spouses can determine whether behavior displayed by their ill partners is caused by their illness or is a way they have chosen to act. We have focused on Psycho-Neurological testing, what it can tell us, as well as its pros and cons.

Last week I discussed a question that haunts many well spouses: not knowing if the difficult and often inappropriate behavior frequently displayed by their partners are caused by the disease and therefore not-controllable, or if the behavior is a choice the spouse makes and can therefore be changed. This doubt can be the source of much frustration and many marital disagreements. One way of alleviating this doubt is by having a psycho- neurological work up done. But that path is not so simple.

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