I had noticed some decline in my stepparent over the last few years and had encouraged my parent to encourage their spouse to get medical advice. My stepparent had been refusing to do so, going as far as to look for a new primary care doctor.
Last month, my parent went into the hospital for two nights unexpectedly. Up to that point, my stepparent was doing everything for themselves, save for cooking dinner. They would get stressed about complex problems they could no longer solve (computer router, car starter not working, rewiring sprinklers - complex multi-step technical stuff they used to handle easily). Otherwise, they were walking 2 miles a day on their own, showering, dressing, talking about politics, and occasionally fuzzy about some things and a few delusions about "guests" being in the house.
After my parent returned from the hospital, my stepparent descended into vivid paranoid delusions - they became physically aggressive, so much so that my parent moved out of the house to recover from hospital stay. When my stepparent was no longer in crisis, they consented to go to the ER to rule out stroke. ER then put them on a 72 hour involuntary hold because the delusions and agitation "took over" again and my stepparent had to be restrained.
Since that day, it's been 5-6 weeks and my stepparent is barely functional (can walk some days, not others, barely audible, other days needing to be sedated because of aggressive behavior, not eating). No firm diagnosis has been established, because in bouncing around from psych ward, to skilled nursing, to hospital (infection), they've received 4-5 different opinions on a CT scan (none of them from a neurologist). My stepparent is very difficult to manage behaviorally and has been sedated to prevent another involuntary hold (where the focus is on keeping everyone safe and not on diagnosis/treatment). Because they are in a hospital right now, they have been seen by a neurologist (no diagnosis/prognosis as of yet).
A good friend has visited several times (who is a psychiatrist) and is as astounded as we are by my stepparent's rapid decline. Does anyone have similar experiences who could give me some insight into maybe what to push doctors into looking at? We have ruled out stroke via CT scan. The current infection is current - the psychosis and rapid decline was happening before that.
Many thanks.
Keep seeking answers. If family member was walking 2 miles a day prior this is alarming.
Make sure they have considered:
Delirium (which can last weeks or even months in older adults), often triggered by hospitalization, infection, dehydration, surgery, pain, or medications.
Medication side effects or interactions, especially if antipsychotics, sedatives, opioids, or anticholinergic drugs have been started or doses changed.
Autoimmune or inflammatory encephalitis, which can present with sudden paranoia, hallucinations, aggression, and cognitive decline.
Creutzfeldt-Jakob disease (CJD), which is rare but known for causing rapidly progressive dementia over weeks to months.
Lewy body dementia, especially if the delusions, hallucinations, and fluctuations began before severe memory loss. Hospitalization can make symptoms much worse.
Normal pressure hydrocephalus, depending on the CT/MRI findings and whether gait changes and urinary issues are present.
Subclinical seizures (non-convulsive status epilepticus), which sometimes require an EEG to detect.
Metabolic and endocrine causes (thyroid disease, vitamin B12 deficiency, electrolyte abnormalities, liver or kidney disease).
Less common infections or cancers affecting the brain.
I hope they find out what it is soon.
Please make sure that your stepparent is being treated properly and eventually placed in the appropriate facility.