OpenHealth Q&A

My Wife [37F] Frequently Experiences Confusion and Verbal Blunders in the Evenings

Greetings, For several months now, specifically since October 2024, I have noticed my 37-year-old wife displaying unusual behavior most evenings. - She often begins the evening with a burst of energy, as if the activity she’s engaged in is the utmost priority. - This isn't merely innocent enthusiasm; it includes exaggerated hand movements when searching for items or becoming overly invested in conversations with our children. - Repeatedly, she will ask the same questions or revisit the same topics multiple times during our conversations. - Her physical demeanor changes dramatically; at times, she struggles to keep her head upright and often angles her chin toward her chest. - On good evenings, this might just be the extent of her symptoms—perhaps one out of five times. - However, as the night progresses, her speech deteriorates, leading her to stumble over her words, which she attempts to correct upon realizing her mistake. - She exhibits confusion, appearing lost and unaware of her surroundings. - The deterioration in her verbal communication can escalate to a point where she tries to articulate thoughts but fails to form coherent sentences, often utterly clueless as to why her words make no sense to others. - A specific incident prompting my post was her struggle with the word "geometry." I recorded a video of her attempting to pronounce it around twenty times; by the end, she was convinced she had said it correctly, despite still being incorrect. - Additionally, she occasionally becomes clumsy and unsteady on her feet; this isn’t frequent, but once, she took a serious tumble getting out of the shower and ended up damaging the wall with her foot. Surprisingly, she seems back to normal by the morning yet often has no recollection of the previous night’s incidents. To help her understand, I’ve taken to recording some of the more notable verbal mishaps for her to watch the following day, as she was completely unaware of the shower mishap. When her symptoms are severe, she often feels exhausted, leading her to go to bed around 7 PM. While she sometimes sleeps through the night, other times she wakes up later, at which point her demeanor tends to normalize. Initially, I suspected she might be drinking alcohol secretly, but I’m fairly certain that's not the case. I mentioned this pattern has been ongoing since at least October because I started tracking her symptoms in detail then, and I suspect it may have begun even earlier, as it took time for me to decide to document them formally. Initially, I jotted down detailed notes when the episodes were particularly severe, but now I simply note the dates when odd behaviors occur—it's becoming increasingly frequent, about 80-90% of the time. She has consulted a doctor, who has conducted routine blood tests twice, revealing no significant abnormalities. Initially, her tests showed low folate levels, which have been addressed. The doctor theorizes the issue may be psychological, but he intends to refer her to a neurologist just to be thorough. The neurologists agree with this psychological perspective but believe it warrants their investigation due to its peculiarity. Unfortunately, her appointment is still six weeks away. I continue to document her experiences nearly daily as I await the appointment. It’s worth noting I have shared my video recordings with her doctor, who confirms that what I captured is concerning and abnormal. To provide some background, my wife is currently on a low dose of escitalopram for anxiety and takes co-codamol for back pain. She also appears to have undiagnosed ADHD. Recently, she began taking vitamin supplements following her blood tests for low folate: a multivitamin, vitamin D, evening primrose oil, and folic acid. These have not shown any improvement or adverse effects, at least from my observations. Lastly, an interesting detail: If her symptoms are indeed psychological, they don't seem triggered solely by exhaustion or stress. They commonly arise during unstructured time at home, especially after she finishes work around 3 PM and begins attending to various household tasks (like preparing dinner, making the kids' lunch, and doing laundry). Conversely, when her activities are more structured or varied, such as during outings or lengthy car rides—even if those are more demanding—she remains coherent and engaged until she eventually drifts off to sleep. So, I’m reaching out to see if anyone has insights into what might be happening. Is a psychological explanation more likely than any physical ailments? I am profoundly worried and uncertain about how to proceed. This situation has been a significant source of stress for me. Thank you in advance for any help or perspectives you can share!

Answers (1)

6/18/2025, 8:31:13 PM

OpenHealth AI

Thank you for sharing such a detailed account of your wife's experiences. It's clear that you are genuinely concerned about her well-being. The symptoms you've described, particularly the evening confusion, verbal blunders, and altered physical demeanor, warrant careful observation and management while you await further medical evaluation.

Key Points:

1. Symptom Overview: Your wife's symptoms appear to worsen in the evenings, involving confusion, difficulties with speech, and physical unsteadiness. These might be compounded by her existing anxiety condition, ADHD, and current medications.
2. Potential Causes: Possible contributors could include physiological factors (like fatigue or chemical imbalances), side effects from medications, or psychological stressors. However, the pattern you've observed also suggests a potential cyclical or situational component to her symptoms.

Explanation:

Given the complexity of her symptoms and the absence of clear medical findings so far, it’s prudent to consider both psychological and neurological evaluations. The behavioral changes that occur predominantly during unstructured time may hint at cognitive fatigue or a response to stress that manifests in the evenings. Furthermore, her reactions after work and structured activities suggest that environmental triggers and routine might play a critical role.

Next Steps:

1. Monitor Symptoms: Continue to document her behavior with a focus on triggers (e.g., time of day, activities leading up to episodes) and responses to different situations. Keeping a detailed log will be invaluable for her upcoming neurologist appointment.

2. Routine Structure: Try to establish a more structured evening routine that includes low-stress activities. Perhaps focusing on calming, predictable tasks can help her feel more grounded.

3. Hydration and Nutrition: Ensure she stays well-hydrated and eats balanced meals. Sometimes, dehydration or imbalanced meals can exacerbate cognitive symptoms.

4. Medication Review: Discuss with her doctor the potential side effects of her current medications (escitalopram and co-codamol) as they could influence cognitive clarity, especially during evening hours. An adjustment or alternative approach might be necessary.

5. Mindfulness & Relaxation Techniques: Introduce simple mindfulness or relaxation exercises during the evenings to help her wind down from daily stressors, which may assist in reducing confusion or anxiety later at night.

6. Safety Precautions: Given her occasional lack of balance and previous falls, provide safety measures when she’s in areas like the shower (e.g., non-slip mats, grab bars) to prevent injuries.

7. Maintain Communication with Healthcare Providers: Keep in close contact with her healthcare team, providing updates on her symptoms and any changes you observe. This will help them continue forming a comprehensive view of her condition.

It’s understandable to be stressed about the situation, so ensure you also take time for your own self-care. This will help you support her better in this challenging time. Stay hopeful and proactive as you await further medical assistance. If you have more questions or need further support, feel free to ask.