OpenHealth Q&A

Understanding Dementia and Delirium: A Personal Account

My father, an 81-year-old veteran, was diagnosed with mild cognitive impairment approximately a decade ago after a thorough evaluation by the Alzheimer’s department at our university medical center. As time progressed, about five years later, his condition worsened. He was reassessed by both a neurologist and a psychologist at a local practice, resulting in a diagnosis of frontotemporal dementia. Each of these assessments aligned perfectly with his exhibited symptoms. He has been prescribed several medications and, fortunately, his disease has advanced much more slowly than anticipated. I believe the last stage they indicated was stages 5 to 6. The medications he is currently taking include amlodipine, escitalopram, rosuvastatin, tansulosin, donepezil, memantine, trospium, vitamin B12, and a multivitamin. Recently, after undergoing evaluations at the VA, a geriatric physician informed us that my father's cognitive tests revealed he fell within the average range for all assessed areas. Additionally, they conducted a sleep study that confirmed the presence of obstructive sleep apnea (OSA). Remarkably, they stated he does not have dementia but rather is experiencing delirium due to insufficient oxygen supply to the brain. He received his CPAP device last week, but all assessments were completed prior to this treatment, during what they described as a delirious state. My mother and I were present during some of his cognitive evaluations and directly observed him struggling to draw a clock accurately, failing to recall certain words, and having difficulty connecting information, which leaves me perplexed by the conclusion that he tested in the average range. Considering his symptoms, it is hard for us to accept that his issues stem solely from sleep apnea. We truly hope this is the case, as I long for the return of the father I used to know. However, my father currently can’t recall my last name from my marriage, fails to recognize my home despite frequent visits, consistently forgets locations in my house—including where the bathroom is—cannot remember the names of family members he doesn’t see often, occasionally confuses the names of my sister-in-law and even my husband, whom he sees regularly. He struggles to recognize a family camp we owned for 15 years before selling it in 2007 and cannot remember how to navigate familiar routes, preventing him from driving. Simple tasks, like ordering from a menu, leave him indecisive, and he often makes impractical food combinations, such as mixing peanut butter with taco shells or drenching foods in syrup with cheese. The geriatric physician and physician assistant expressed frustration at our skepticism, but it is crucial to point out that my father underwent exhaustive assessments by other specialists, likely even more in-depth than the evaluations performed by the VA. The preceding diagnoses resonated with us; this recent one, however, doesn’t seem to fit. The notion that he tested within the average range for cognitive functions entirely baffles me. Is it possible that my father could genuinely improve? Can his symptoms really be attributed to sleep apnea and delirium? Has anyone encountered similar cases with these symptoms?

Answers (1)

8/20/2025, 4:03:49 AM

OpenHealth AI

It's understandable to feel confusion and concern given the complexities of your father's condition and the mixed messages from different medical assessments. While it is true that obstructive sleep apnea (OSA) can lead to cognitive difficulties resembling dementia, the severity and nature of your father's symptoms do warrant careful consideration.

Main Points:

1. Obstructive Sleep Apnea (OSA) can contribute to cognitive impairment and symptoms that mimic dementia due to oxygen deprivation.
2. Delirium, which may be temporary, can occur due to acute illness, medications, or other disruptions in health, but it doesn’t fully explain the longstanding cognitive challenges your father has faced.
3. Continuous monitoring and reassessment are crucial as treatment for OSA (like with his CPAP) begins.

Explanation:

Your father has a challenging medical history, and his symptoms indicate a level of cognitive decline that is concerning. The geriatric physician's evaluation suggesting that he functions at an average cognitive level could indeed seem baffling, especially in light of the observable symptoms you’ve described. Cognitive testing can be heavily influenced by various factors, including mood, environment, and acute medical issues.

It’s known that individuals with OSA may experience cognitive decline due to disrupted sleep and consequent lack of oxygen during the night. Treating OSA often leads to improvements in cognitive function, but the speed and extent of improvement can vary significantly between individuals.

Next Steps:

1. Start using the CPAP device: Ensure your father uses his CPAP device regularly, as this will be essential to improving his oxygen levels and potentially aiding cognitive function. Encourage compliance gently, as adaptations can take time.

2. Monitor Changes: Keep a daily log of his behaviors, cognitive abilities, and any improvements in memory or day-to-day functioning after starting the CPAP treatment. This will help to identify any patterns or changes.

3. Follow-Up Evaluations: Schedule subsequent follow-ups with the geriatric physician 4-6 weeks after he starts using the CPAP. This will help assess if there is any improvement in his cognitive testing that correlates with better sleep quality.

4. Remain Engaged: Engage in cognitive activities that he enjoys, such as simple games, puzzles, or talking about shared memories. This creates a supportive environment while being mindful of his fatigue and frustration levels.

5. Stay in Contact with Specialists: Given your father's history of frontotemporal dementia, it may be beneficial to maintain communication with neurologists or geriatric specialists for ongoing observations and support, especially if significant cognitive changes arise.

It’s natural to long for the father you once knew, and while the path ahead might be uncertain, focusing on the present and supporting him through these changes can make a meaningful difference. It’s important to remain hopeful while also realistic in your approach, given the complexity of neurocognitive conditions.