OpenHealth Q&A

Seeking Guidance for Grandma's Sudden Health Decline

Summary at the end My grandmother, an 85-year-old female, traveled solo by plane in February, during which we observed her gradual decline in cognitive and physical abilities over the past six months. In March, she experienced three falls, followed by a troubling episode where she woke up with significant movement difficulties and struggled to respond verbally. This incident resembled a stroke, yet tests and scans did not indicate any transient ischemic attack (TIA). Consequently, she spent a week in the hospital and an additional two weeks in rehabilitation. Since her discharge, she has been experiencing much quicker fatigue and can only manage short walks outside, although she does not rely on any mobility aids at home. Prior to these issues, she did exhibit some signs of a shuffled gait, which has grown more pronounced since a weekend in mid-June when it became much worse. Despite these challenges, she has been able to navigate stairs. She also grapples with significant word-finding difficulties and has become noticeably more forgetful; nonetheless, she can generally maintain a conversation. Last weekend, she began having urinary incontinence issues, and a test for a urinary tract infection (UTI) returned negative. On Tuesday morning, I found her in a bent position on the couch, holding her abdomen. She was unable to respond with words, only making faint sounds, and when the emergency medical team arrived, she needed assistance to stand, even with help from two individuals. She is currently hospitalized. During her inpatient stay, her confusion and agitation have worsened, to the point where she almost required physical restraints due to thrashing on the night of June 18th. Additionally, she appears lethargic, showing little awareness of her surroundings and only occasionally responding to the doctor's queries. My observations were from the evening of June 17th to the early afternoon of June 18th, and since then, I have relied on updates from other family members, noticing a significant increase in her agitation level. Comprehensive tests—two MRIs (one with contrast and one without), a PET scan, and two CT scans—indicate no significant findings. The latest CT did reveal minimal vascular enlargement in the cranial area. Interestingly, her urine analysis showed the presence of benzodiazepines, despite her having no access to such medications, as my mother manages her prescriptions for safety reasons. The current diagnosis points to dementia, yet we feel that there may be an underlying issue that has eluded the doctors. One of the emergency room physicians speculated that normal pressure hydrocephalus might be a possibility; however, the neurologist dismissed this suggestion, attributing it to recent media coverage related to Billy Joel. The medical professionals we've consulted seem to attribute her conditions solely to old age and dementia, but we sense that they are overlooking something important. While we would prefer a straightforward diagnosis of dementia, the rapid progression of her symptoms raises concerns that there may be more going on than what is being acknowledged. Summary: 85-year-old female Gradual decline in mental and physical health over the previous six months. Experiences sudden confusion and physical symptoms; established a new baseline post-incident. Over the past week (from June 13-20): - Urinary incontinence began on June 13, with increased confusion noted over the weekend; UTI ruled out. - Notable increase in a shuffled gait. - On June 17, she could not stand or communicate effectively and showed rising agitation and lethargy during hospitalization. - All tests were negative, except for minimal cranial vascular enlargement detected on the most recent CT and the unexpected presence of benzodiazepines in the urine. - Currently diagnosed with dementia, though we feel strongly that the doctors might be missing a critical detail, especially considering the swift onset of these symptoms.

Answers (1)

6/20/2025, 5:11:08 AM

OpenHealth AI

Your concerns regarding your grandmother's sudden health decline are understandable, especially given the complexity and rapid progression of her symptoms. The combination of cognitive changes, physical decline, urinary incontinence, and abnormal findings in her tests suggests that her condition requires careful monitoring and potentially further investigation.

Key Points:

1. Cognitive and Physical Decline: Your grandmother is experiencing significant memory issues, confusion, and difficulties with mobility.
2. Recent Incident: A troubling episode involved inability to communicate and increased agitation, warranting her hospitalization.
3. Testing: Multiple imaging tests have not yielded definitive answers, though some vascular changes on her CT scan may be indicative of underlying issues.

Explanation:

Many factors could contribute to your grandmother’s symptoms, including the possibility of dementia, normal pressure hydrocephalus (as mentioned), or other neurological conditions. The presence of benzodiazepines in her urine is particularly concerning since it suggests possible unintentional medication use, which could exacerbate cognitive impairment or increased lethargy.

Next Steps:

1. Request Comprehensive Evaluation: Advocate for a full geriatric assessment that includes memory, mobility, and functional capacity evaluations. This is crucial in older adults with such symptoms.

2. Explore Normal Pressure Hydrocephalus (NPH): Given the speculative mention of NPH, it may be worthwhile to firmly request a formal evaluation for this condition. It can often mimic dementia symptoms and involves brain swelling due to trapped cerebrospinal fluid.

3. Monitor Medication and Potential Interactions: Since benzodiazepines were found in her urine, it's essential to confirm her medication history and the presence of any over-the-counter drugs or supplements that might be contributing to her cognitive changes.

4. Regular Communication with Healthcare Team: Keep an open line of communication with her medical team. Document any fluctuations in her symptoms, changes in her behavior, and your observations. This information can be critical in adjusting her treatment plan.

5. Consider Second Opinions: If you feel the current healthcare team is not addressing your concerns adequately, seek a second opinion from a neurologist specializing in geriatric neurology or dementia-related conditions.

Summary:

Your concerns about your grandmother's decline and the potential oversight of critical details are valid. Taking proactive steps—like advocating for a detailed evaluation of her condition, investigating possible NPH, ensuring a review of her medication, and maintaining dialogue with her care team—are essential in navigating her complex health situation. You are deeply invested in her well-being, and that advocacy could lead to better care and understanding of her needs.