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Alpenglow33 Asked June 2023

Sudden, dramatic improvement in cognitive function lasting weeks?

My mother-in-law has been in a memory care facility since last November after a very fast stair-step decline. In 2020 she was completely independent, and by this January she was unable to walk or complete any ADLs on her own.


 


She has had a few illnesses since entering the facility - covid in December, and various stomach flu and respiratory viruses since then. They seem to have accelerated her decline. She also had a couple UTIs that were tested and treated.


 


For the last five or so months, she's had two modes: crying hysterically and babbling nonsense, or keeping her head down and her eyes closed. About two months ago, she stopped speaking and stopped chewing her food, so the facility put her on a pureed diet. They tried unsuccessfully (many times, apparently) to get a urine sample to test for a UTI, and she didn't get any new medications or therapies during this time.


 


Suddenly, about three weeks ago, it was like she went back in time to last December before she got covid. She's following conversations, speaking in full sentences that sometimes make sense, and eating solid food again. She seems to understand where she is and why, which is a first - she's been very confused about all that for the last year, even when she lived with us. We were about to put her on hospice and we're pretty confounded.


 


We've heard of dementia patients rallying right before death, but this doesn't seem like that; my understanding is that usually only lasts for a day or two. She has consistently been doing much better for weeks now. We don't know what kind of dementia she has because her decline was so swift, she was unable to withstand any testing, but it seems like vascular.


 


Has anyone else experienced something like this, or heard of it?

Llamalover47 Jun 2023
Alpenglow33: Perhaps it is possible for the dementia patient to rally. As the brain is a complex organ, maybe days of lucidity can extend; perhaps her physician can provide an answer.

my2cents Jun 2023
It's very possible Covid played a huge role in sharp decline and in recovery. Many people have talked about the brain fog they had for a very long time after having it.

It's also possible she had a urinary infection....very similar symptoms. Even when treated with antibiotics, sometimes it takes another round of meds or even IV meds to clear it up.

I certainly hope she has truly recovered from a medical issue and her family will once again have her back!

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Santalynn Jun 2023
Sounds like your mom had long term effects from her bout with Covid. In Oriental Medicine they have a term called 'Toxic Heat Syndrome' that follows a severe inflammatory event, such as severe viral infections, etc. Remember, it is the immense cytokine 'storm' of inflammation that killed so many Covid patients; inflammation is the body's attempt to repel an 'invader' but too much is itself can be deadly. It's also the inflammatory response that worried some folks who took the Covid vaccines, not understanding the temporary inflammation (discomfort, feeling funky) was their body being alerted to defend itself. Perhaps this period of debility was sort of 'healing crisis' for her brain, her entire body; that she has 'rallied' is a great sign of resilience in her system. May she continue to improve. My mom had the more typical 'rally of about two days, sitting up in bed, able to speak a bit, shortly before she did pass away. Your mom's 'rally' sounds like an equivalent, or similar to, coming out of a coma. All the best to all of you!

AlvaDeer Jun 2023
I am assuming utterly no change in medications?

And no change in the food itself, but only in its being now mechanically soft?
I don't know what electrolyte panels were consistently run, but I can only wonder if there was malabsorption of some food.
I think few of us know how married to our brain our guts are.

Interesting anecdotal story here. Really is. Every patient is such a mystery. I can only wish you the best.

ChoppedLiver Jun 2023
Yes, it happens. The brain is a remarkable organ and it does have the ability to heal itself. (e.g. stroke victims) or find alternative pathways to do the same task. Contrary to popular belief, people with dementia do have the ability to learn as I have seen it happen to different people in the MC unit that my Mom is in.

Use this time to get her strength up (PT), work on hand/eye coordination, etc. Enjoy the phase while you can.

DaughterfromCA Jun 2023
We went through some alarming several months which looked like a sudden dementia nose dive, but from which Mom “recovered.” Seemed to start with a UTI. Which got treated, but for months after, there were constant bouts of acute confusion, disorientation, restlessness. We had to put rails on the bed.

Eventually these abated. Meds helped. Mom still gets quite confused occasionally, and new odd behaviors come and go, but no distressed behavior for quite awhile. Currently she’s mostly lucid, though rather creative with confabulations, but her sweet, gentle personality is usually intact.

I think of the scary months as episodes of delirium overlaid on, and exacerbating, slowly progressing dementia. I keep reading how unpredictable dementia can be, and expect sharp downturns or sideway swerves can happen any time. But thought someone should report that there can be long stretches of stability too. Of course there are good days and bad days, but gently stable decline overall.

Stilwtrs003 Jun 2023
I experienced a similar thing with my stepfather. He was noncommunicative for quite some time and we visited him often, but one day I went to visit, and he looked at me and said, "Judy! It's so good to see you. You've lost some weight." I was shocked to hear him speak this way. It was like he had been asleep for months and finally woke up. Sadly for him, this period of lucidity only lasted one day. I believe it was his final rally. Your situation seems different though if it's lasted weeks. My mom is in her final days of the alzheimer's battle, and I can only imagine how I'd feel if she rallied like this. I wouldn't know what to make of it. It's such a tough road for everyone. Keeping you in my prayers.
NeedHelpWithMom Jun 2023
My brother rallied like your stepdad when he was in hospice.

It’s kind of shocking to see a person on death’s door one minute and then laughing and talking the next.

My brother married a woman who had four children. He loved those children.

The youngest one was in diapers when he first met her. They were very close. She moved away and my brother missed her terribly even though they kept in touch.

I called her when my brother entered hospice. She drove for hours to see him. I was wondering if he would die before she arrived at hospice.

A switch flipped on when he saw her. I told my niece that I think he was waiting for her before he died.

He was ecstatic to see her! He started talking and laughing. His last rally!
NeedHelpWithMom Jun 2023
It’s amazing how the brain works. My father had a stroke immediately after major heart surgery.

He went to speech therapy three times a week. He struggled to speak with us.

Every now and then he would be able to speak very clearly. We were amazed when he spoke clearly.

His clear speech didn’t ever seem to last long that long. It was sporadic and brief.

I suppose in your mom’s case, only time will tell how she is doing.

Wishing you and your mom all the best. It’s really hard to see a parent dealing with life altering conditions.

lealonnie1 Jun 2023
My mother lived in Memory Care Assisted Living for nearly 3 years. She went in with moderate dementia, thought to be vascular, and passed away with advanced dementia at 95 in Feb of 2022 under hospice care for 2 months, so very swiftly and w/o warning. She had MANY periods of lucidity scattered in there amidst her advanced dementia periods where she was insisting I was hiding her parents in the closets of the MC, or that her girls were moving her to a different hotel every night! Sometimes I was gobsmacked after dh and I would leave after visiting her and she'd had a particularly lucid day. I'd think to myself, my God, this woman is going to live to 100, run out of money and wind up in a SNF on Medicaid with a roommate sharing her toilet, which would've enraged her.

That said, periods of rallying at end of life can also last for a while, not just days. Some elders can go on for months and be taken off hospice care, as it says in this article:

https://hospicecarelc.org/rallying-at-end-of-life/

Wishing you the best of luck with all you're dealing with.

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