TIA vs. stroke, Encroaching dementia, or meds?

ericasjJune 8, 2008

OK. They seem to be classifying my mother's 2nd episode as a TIA because they can't find evidence of stroke damage on an MRI. I thought the difference was whether there are symptoms after 24 hours have passed.

It's true her language abilities came back amazingly. But I see definite memory problems that she didn't have before to any degree, and it's been about a week. I'm afraid they are assuming that her mind was like this before, just because she's 90.

It's lapses like, one day she's telling me about the CNN coverage of Clinton and Obama she was watching earlier in the day, they move her to another room and ask if she had tv in the first room, and she says no. She tells me in detail about a guy she wants to sell antiques to, down to how to spell his name and where the paper is with his phone number. Five minutes later she's searching for his name. I'm there when the speech therapist, or neurologist, or social worker comes in and she seems to understand everything they've said. She's had a normal conversation with them. Then the next day she doesn't remember having met them at all, even when I try to jog her memory by describing what the person looked like, or something they did while there, like showing her pictures or giving her applesauce.

She had an episode yesterday of being very cold, they had to put five blankets on her. She told me it was very strange and scary, her body was twitching and shaking and she couldn't control it. It's like she'd forgotten the concept of shivering.

I asked a nurse at her first hospital about it, and she kind of blew me off. Said it was common for older people to get disoriented in a hospital setting, especially at night, and used the term sundowning. But during her April hospitalization she didn't get disoriented at all.

She has been on numerous medications off and on this past week--norvasc, plavix, prilosec, colchicine for gout, ativan, tylenol and an antibiotic for an infection in her initial IV port. Maybe more--this is just what I've picked up through eavesdropping.

I think we need to find out if her memory lapses are a result of a true stroke or the medication combo. I need to be either getting her house ready for her to come home, or getting her placed in assistive living. If she a continuing downward mental spiral, I don't want her to live at home or try to drive. The shape she's in now, I'd worry about her safety. But if this memory stuff is a result of the meds, I don't want to sign her up for assisted living unnecessarily.

How do I get the medical people to try adjusting her meds or giving her some kind of therapy if they don't even admit there is a memory issue? How do I get the answers I need to figure out where she should live?

They are assuming assisted living because when feeling her most rotten she said she was nervous about living alone again. But by the time we had to help her fill out an entrance form for rehab, she listed her goal as getting back home. I sure didn't want to tell her, sorry, no matter how hard you exercise we're shipping you off to assisted living anyway.

Any thoughts?

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No matter what the cause, she is going downhill. It's possible that it is medication, but that's usually an all the time problem. She wouldn't have good times, with good memory, sometimes, and then shortly afterwards have an entirely different viewpoint.

Sometimes it is impossible to find out exactly what is causing memory lapses or some sort of dementia, so you must make the choice as to what is going to be the best solution for her.

TIA is a peculiar happening. A lot will depend on what section of the brain is affected. One time it may affect memory, the next, the ability to understand simple things. Sometimes langage. Sometimes it will cause a fall. I had a neighbor that all it did was numb one side of her face for a few hours. When it was over, she just went on about her usual business. My aunt would find herself lying on the floor and assume that she had just laid down there for a nap. TIA is an odd thing.

My personal opinion, (and that's not worth much I know) is that she definiatly needs some sort of assisted living arrangement. Most of the elderly do better in a controlled environment. They have the stimulation of more people and can interact with staff too. Being alone at home with just the TV and a few friends and relatives, doesn't always offer the same stimulation.

It's easy to assume that they go down faster in an AH, but in reality, they would have probably gone down just as fast staying in their home. There's no way to compare after the fact.

This is such a hard decision. No matter what you do, you will always wonder if you did the right thing. Take care of yourself too. AT this point, you need to watch out for her safety and general well being.

    Bookmark   June 8, 2008 at 10:21AM
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What is TIA?

    Bookmark   June 8, 2008 at 10:24AM
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Transient Ischemic Attack, also known as "mini-strokes". You can have one and not even know. Scary.

    Bookmark   June 8, 2008 at 11:28AM
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Key word is "transient"....they come and they go away. Sometimes large effect. Sometimes barely noticeable. Sometimes lingering effects. Sometimes nothing. Frequently they happen numerous times in succession. Sometimes they are single, discreet events. It can be a mystifying and annoying continuum. Difficult situation.

Please do prevent her from driving.

    Bookmark   June 8, 2008 at 1:48PM
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I may have had one of those. I got up from the computer one day and started walking to the left. I was like that for a month or more and still have a tenancy to step sideways occasionally, but it's no problem now. I was checked in the hospital over night so they could run test, found nothing.

    Bookmark   June 8, 2008 at 2:11PM
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There are blood tests for TIA's but not every medical center or hospital will do one. Sometimes you have to INSIST on it.
As to your Mom, who diagnosed it TIA? Heart Specialist? Family DR? etc To me sounds like too many meds and they may conflict. Find out who is prescribing meds, and why. Take the list to a pharmacist. Are your legal papers in order. Make sure you have your name on every file needed--medicare A & B, yes you need both, any other insurance files, banks, medical centers etc. If you have trouble with any nurse, ask to speak to the supervisor. Most nurses are overwhelmed and just don't/can't contribute time necessary. And one other big thing. Most Asst Care homes and nursing homes, nurses determine what meds to give to keep the patients under control. Like I said, find out who, what, when and why. Keep a list of meds, who, what when and why.

    Bookmark   June 8, 2008 at 5:04PM
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could you perhaps get her sent to rehab for 30 days to give you more time to determine whether or not to let her go home? I suspect Assisted living is what you will need to select - I know very few 90 year olds who can truly live alone. My Dad will be 95 next month and he still drives to the grocery store and the doctor's office, both only 5-10 minutes from his home, and only during the middle of the day (no rush hour traffic) but he is absolutely terrified of living alone (Mom went into a nursing home end of April). He had a couple of TIA's 2 or 3 years ago.

We are making arrangements to empty out the house except for his basic necessities, fix whatever main items need to be fixed and sell it. He then plans to purchase a travel trailer and move it to our property in the country next to my brother's RV. I will be retiring next year myself and moving out there also. Good luck with whatever decision you make. Carolyn

    Bookmark   June 8, 2008 at 10:05PM
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barker, I think that is the best idea for caring for the elderly, but most people don't live in the country. I know of a couple of situations like that. The elderly feel like they are still on their own and the children are there if they need them.

    Bookmark   June 9, 2008 at 2:12PM
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Oh I realize most people don't have the option I chose - my DH was raised in the country and although we live on the edge of Houston TX it is not the country like he grew up in.....I promised him 15 years ago when I retired we would move further out (my job skills require living where large corporations have their offices). So last year we started looking for a 'retirement' home, planning to sell our current suburban home in '09.

Unfortunately, DH was diagnosed with esophageal cancer shortly thereafter; however, we went ahead and purchased our five acres of heaven as my SIL calls it; had our oldest grandson move out there to live. In the meantime, brother and SIL retire, sell their home, buy RV so I suggest they 'park' it out there in exchange for doing some yard work (it does take a bit of time to keep 5 acres neat) and I can only get out there weekends, frequently DH cannot do much of anything (he is on his 3rd round of chemo) and I must continue working full time so he has insurance to pay for his medical care.

So I count myself very lucky to have found a wonderful place to 'retire' to and hope DH is around for a few more years to enjoy it also. It is also wonderful to have a young, healthy grandson (24 years old) on the place along with bro and SIL (they are also younger than I am - late 50's).

I am so looking forward to retirement out there. Carolyn

    Bookmark   June 9, 2008 at 9:36PM
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Sorry to hear about your husband. Two and a half years ago my husband and I bought a Patio Home, he died a year after that. I am so glad we bought when we did. The outside work is done for me. It's fun to sit back and watch someone mow the grass and shovel snow. I don't know if I would have had the nerve to buy if I was alone.

    Bookmark   June 9, 2008 at 11:02PM
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Sorry it's taken me so long to come back and say thanks for your thoughts. It's been kind of hectic.

I managed to sit down with the nurse on Sunday and get some info. I was surprised to hear they hate "no memory deficits noted" in her paperwork. However, after I voiced my concerns to the nurse, yesterday they had a speech pathologist working with her, giving her tests for memory and thought processes. According to my mother, she was nervous about it but was relieved to find she did well. She had a great day at physical therapy also, and felt full of beans. As of yesterday, she was really psyched to go home.

They are having a meeting in two days to discuss her progress; unfortunately I can't be there. But I'm going to try to let the social worker know my concerns about her living situation, so she can mention them at the meeting.

The nurse said she couldn't tell me whether the diagnosis was an actual stroke, the doctor would have to. But when I brought up driving, she said after a stroke the DMV is notified and you have to be retested. Her dropping that tidbit told me it WAS a full stroke and that I would not be wrong in keeping the keys away at this point. Also, my mother eventually told me the reason she was in rehab was because of a stroke diagnoses--otherwise the insurance wouldn't have approved it.

As far as the meds, she is down to an antibiotic for a bladder infection, a second round of colchicine to try and knock out remaining gout, plavix, and norvasc only when her blood pressure is up. I was actually glad to hear she had a bladder infection because that explained a lot. Several times in the past I was worried about dementia, and it turned out to be a bladder infection. (She gets them a lot.) If she was better mentally yesterday, I have to think it was partly the antibiotic kicking in.

I got the application form for the sr. apartment, and a floor plan but I'm also trying to get the house in shape if she insists on going back.

Oh, as far as who diagnosed the TIA and stroke. Her first one was a visual disturbance, and her eye doctor was the one who first suspected it. She told my mother to get checked out, and at the hospital she was seen by a neurologist among others. For the second episode, she was treated by the same neurologist. Don't know about a specific blood test for it, but they've done CAT scans, MRI's, an EEG, checked the circulation in her carotid arteries, can't think of what else. I'm pretty confident that they've checked everything they can, sometimes twice!

    Bookmark   June 10, 2008 at 8:11AM
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"...bladder infection..."

These things can be very sneaky, especially in elderly. Symptoms can masquerade as all kinds of other stuff. Wondering if that might be cause of much of what you've described.

Glad things are looking up.

    Bookmark   June 10, 2008 at 11:04AM
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