Atrial Fibulation / Multi-Infarct Dimentia(dementia)

  My father is a 74 y-o male who had an aortial valve replacement 6 years ago.  It is a mechanical valve and thus he has been on Cumadin (coumadin) subsequetly to attempt to control possible blood clot formation.  Atrial fibulatin lately appears to be causing more and more "small" clots to form which have caused a progressive mental decline.  In the last week he has become markedly confused and requires constant monitoring.  He was admitted to a nursing facility for "rehabilitation."  He has some orientation to time and person and place.  Yet is inappropriate about hygiene, social convention (wearing 4 shirts at once or none at all), and occasionally doesn't recognize family members.  We understand that this is a progressively deteriorating condition but can not get information about what the "normal" or "expected" or "statistically likely" progression might be.  Can you help us understand better what kind of time-line we might expect?  Are we waiting for "the big one" at any moment?  Are we waiting for another infarct to occur in his autonomic areas?  It is likely the slow deterioration will continue to slowly eat away at his Self or now that he is so confused will the decline become more rapid?  We get varying answers from doctors.  Some say he can live like this for years.  Really?  Given a more rapid decline in the last month?  Some say that he could live as much as two years but that admission to the nursing home will likely decrease his potential life span.  Evidentially just going into  nursing home diminishes his life span.  We're confused.  I realize this is a man you have not seen and my medical profile probably lacks information you need for clarification.  But if you can give us some honest feedback about potential lifespan at this point, we'd be most grateful.  Our family would like to know if we're looking at 2 weeks, 2 months, 2 years or potetially 20 years of life.  REALISTICALLY how long is he likely to remain even at this level of cognitive functioning, and what are the average lifespans left for someone in his kind of medical situation?
  The kindness of your reply is appreciated.

[CCF CARDIO MD APS]

Dear Joann,
I am very sorry to hear about your father's serious illness, however I can no
better give you the time frame than your father's physician.  I can tell you that
a physician will give you the time frame expected with the influence of prior cases
in his/her practice.  Now since this rapid decline is not all that common(it is more
common for the multiple infarcts of the brain to occur over years), no one really
has the numbers to surmise the timeframe.  If you have time it might benefit you to
submit this to our neurology department in the Neurology forum, as these are the
physicians that deal the most with such situations.  Actually, if there is an experienced
geriatrician in your area, a consult from him/her would be helpful for this is
someone who specialized in the elderly and certainly is the doctor who sees and deals
with the spectrum of dementia.  I agree that the life span for your father is limited but
how limited I truly can not say-it really could be 2 months and it could be 2 years and
it is unlikely to be longer than that.  Unfortunately, there are a lot of ethical issues to
deal with in a situation such as yours, for example when the dementia gets to the point that
the patient no longer realizes the importance of eating, a peg tube will be offered- i.e.artificial
feeding.  This is when the family of the patient needs to ask, is this something that dad would have
wanted, is it prolonging his suffering, etc.  These are converstaions best made by all the family
members as a group followed by a discussion as to your decision with the physician caring for your father.
You really need to take this day by day or week by week, and cherish the time you have left with your father,
visit him regularly and remember to talk to him as if he were not demented instead of letting his 'demented actions'
and your own concern over how much time is left determine your worries.  I hope this information has been helpful
and should you have any further questions, please submit them.  Good Luck.
Information provided in the heart forum is intended for general medical informational purposes only,
actual diagnosis and treatment can only be made by your father's physician(s).
  

[Pat77]

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