Sucking The Life Outta Him

Joe had been doing wonderfully since the bump on his head.  He went to physical therapy on both Tuesday and Thursday and had great sessions - his balance was so much better.  He still wasn't using his walking cane.

He had an appointment on Tuesday with Dr. Wheeler, the neurologist.   After talking to both Joe and I and the doctor doing a series of visual, mental and physical tests this is the results of the visit:

Joe does not have alzheimer's.

Joe may have vascular dementia which nothing can be done to change that.  Vascular dementia is one of the most common forms of dementia, ranking only second to Alzheimer’s disease. Vascular dementia is caused by chronic, reduced blood flow to the brain—usually as the result of a stroke or series of strokes. In many cases, the strokes are so small that you may not notice any symptoms. These are known as “silent strokes.” But over time, the damage adds up, leading to memory loss, confusion, and other signs of dementia.

Vascular dementia refers to a subtle, progressive decline in memory and cognitive functioning. It occurs when the blood supply carrying oxygen and nutrients to the brain is interrupted by a blocked or diseased vascular system. If blood supply is blocked for longer than a few seconds, brain cells can die, causing damage to the cortex of the brain—the area associated with learning, memory, and language.

Depending on the person, and the severity of the stroke or strokes, vascular dementia may come on gradually or suddenly. Currently, there is no known cure.

Vascular dementia affects different people in different ways and the speed of the progression varies from person to person. Some symptoms may be similar to those of other types of dementia and usually reflect increasing difficulty to perform everyday activities like eating, dressing, or shopping.
Behavioral and physical symptoms can come on dramatically or very gradually, although it appears that a prolonged period of TIAs—the mini-strokes discussed above—leads to a gradual decline in memory, whereas a bigger stroke can produce profound symptoms immediately. Regardless of the rate of appearance, vascular dementia typically progresses in a stepwise fashion, where lapses in memory and reasoning abilities are followed by periods of stability, only to give way to further decline.

Common mental and emotional signs and symptoms of vascular dementia:
Memory problems; general forgetfulness
Unusual mood changes (e.g. depression, irritability)
Slowed thinking
Hallucinations and delusions
Confusion, which may get worse at night
Personality changes and loss of social skills
Common physical signs and symptoms of vascular dementia
Dizziness
Leg or arm weakness
Tremors
Moving with rapid, shuffling steps
Balance problems
Loss of bladder or bowel control
Common behavioral signs and symptoms of vascular dementia
Slurred speech
Language problems, such as difficulty finding the right words for things
Getting lost in familiar surroundings
Laughing or crying inappropriately
Difficulty planning, organizing, or following instructions
Difficulty doing things that used to come easily (e.g. paying bills or playing a favorite card game)
Reduced ability to function in daily life

Joe has suffered several strokes - dates cannot be pinned down.  I think the big pivotal one occurred on 7/25 when I had to take him to the emergency room after the bad day at dialysis.  I'm beginning to think he may have had a mini-stroke a week ago in Georgia.

Joe most likely has hydrocephalus which is that he may have flluid in some of his brain chambers.  Hydrocephalus, also known as "water in the brain," is a medical condition in which there is an abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles, or cavities, of the brain.  Hakim's triad of gait instability, urinary incontinence and dementia is a relatively typical manifestation of the distinct entity normal pressure hydrocephalus (NPH).

Symptoms may include headache followed by vomiting, nausea, papilledema (swelling of the optic disk which is part of the optic nerve), blurred or double vision, sunsetting of the eyes, problems with balance, poor coordination, gait disturbance, urinary incontinence, slowing or loss of developmental progress, lethargy, drowsiness, irritability, or other changes in personality or cognition including memory loss.

Symptoms of normal pressure hydrocephalus include, problems with walking, impaired bladder control leading to urinary frequency and/or incontinence, and progressive mental impairment and dementia. An individual with this type of hydrocephalus may have a general slowing of movements or may complain that his or her feet feel "stuck." Because some of these symptoms may also be experienced in other disorders such as Alzheimer's disease, Parkinson's disease, and Creutzfeldt-Jakob disease, normal pressure hydrocephalus is often incorrectly diagnosed and never properly treated. Doctors may use a variety of tests, including brain scans (CT and/or MRI), a spinal tap or lumbar catheter, intracranial pressure monitoring, and neuropsychological tests, to help them accurately diagnose normal pressure hydrocephalus and rule out any other conditions
He is having a lumbar puncture (spinal tap) done next week to remove some of the fluid.  A lumbar puncture (an LP) is the insertion of a needle into the fluid within the spinal canal. It is termed a "lumbar puncture" because the needle goes into the lumbar portion (the "small") of the back. 
After local anesthesia is injected into the small of the back (the lumbar area), a needle is inserted in between the nearby bony building blocks (vertebrae) into the spinal canal. (The needle is usually placed between the 3rd and 4th lumbar vertebrae).
This is to see if fluid can be drained from his brain and/or if it returns.  If it returns, a shunt may have to be put in.  The lumbar puncture is being done first to see if this may take care of some of the problems he's been experiencing before a final diagnosis can be given.

I am so happy that someone is finally recognizing and naming and testing for what I've seen for the last three months.  All of the above is as I understand it.

Things had been going so well until his dialysis session on Friday.  When I went to pick him up, he said he had fainted when he got up from his bed and he looked drained and weak.  It was as though the "old Joe" was back again - very lethargic and no energy and that continued all weekend long.  The kids came to visit so they got to see a small portion of the way Joe has been acting.