70 Year old female very confussed and smells a musty odor

My Mother has post polio syndrome, she recently broke her "good leg" and is in a cast.  She is now home from reabilitation and had to take medication for this injurry.  We haed noticed that she is VERY confussed, forgetful not herself. the meds have been decreased and some have been stopped   She takes methadone (which she has been on for about 10 years) and imipramine at bedtime.however when she was in rehab they stated that she had uti and that was cause of confussion treated it and said she was clear.  Needless to say I took her into emergency room last evening confussion was worst it's ever been they tested for uti said she did not have one  and they sent her home today and said she should start feeling better as time goes by.  She had this same problem about 8 years ago and ended up in icu for liver failure.  Where do i go from here..Dr. said that all tests are fine and she may have the beginning of dimentia (dementia)..They took cat scan and said that it shows that she has ha a slight stroke back in 2001 and we were never aware of this.  Finally along with the confussion she also has a problem with a smell that she can only smell (not body odor, and not a smell that is comming from her) but she's complaning of this musty, rubbery odor)  Can you please give me some advice for I recently lost my father, and my brother I don't think I could handle the thought of not doing everything I can to help her. Thank You, Sincerely,
Heather

[Enoch Choi, MD]

Heather, I'm sorry to hear of your mom's suffering, that sounds terrible.  Confusion in the elderly is a difficult problem, and medication are a common reason for that.  Urinary tract infections are a common reason for that also.  With a history of liver failure, I would ask the doctor to test for liver function test abnormalities, since liver problems can lead to confusion.  CT scans of the brain can be helpful in a workup of confusion.  Other tests are helpful as well, so many that it really depends on the examination of the patient.  It's important to figure this out, and getting a second opinion from a gerontologist would be a good idea.

Enoch Choi, MD