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Delirium after a stroke

My Dad has been diagnosed with having delirium after a stroke. He is continuously restless and agitated, he is always pulling at the bedclothes or taking off his own clothes. Is there any treatment for delirium and is it reversible?
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Avatar universal
Just wondering if you have had much luck finding the proper medications for your father's agitation.  My father (age 69) suffered a stroke on January 11, 2015 and has been suffering from the same agitation symptoms described in you post and Miller78s post.  Constant tossing and turning in his hospital bed, picking at his clothes and the bedding and calling out our names when we are not there.  He is awake and agitated all night long.   He was immediately put on Lexapro and Xanax, but developed severe leg tremors in addition to the restlessness and his sleep did not improve.  They put him on Requip and Neurontin and we discontinued the Lexapro and Xanax.  The tremors ceased, but the agitation continued.  We're going to start up the Xanax again.  It's so painful to watch his discomfort.
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Avatar universal
StuckinAK:Concerned your father has been prescribed Seroquel.  Please see here:http://www.abc.net.au/news/2013-11-27/growing-concerns-over-side-effects-of-seroquel/5120554  It is a drug for Schizophrenia which is being widely misused and prescribed to "manage" people with dementia and stroke patients, particularly those in instutionalised care.  A family member with stroke was prescribed this (10mg) this year and it has been a disaster.  Mirtazapene was also prescribed before this by a specialist to help him sleep and the dosage increased to 45mg.  Again we informed by a physician who gave us a second opinion that Mirtazapene is not recommended for those who have strokes, because it can in fact increase risk of more strokes.  After we brought him home, with the assistance of a psychiatrist, the seroquel was withdawn and he was monitored for two weeks.  After this the psychiatrist instructed us to reduce Mitazapene to 30mg and after a couple of weeks 15mg which he is currently still on.  We will be reporting back to the psychiatrist who will instruct us on the next step.

In our situation, it has taken a lot of patience, understanding and perseverance. In addition to withdrawal of these medications, we have been assisting him to walk with aids to improve mobility, weekly physio (again the physiotherapist should be experienced and knowledgeable about stroke patients-we have encountered many who completely ignored him because they said he couldn't take instructions - particularly when he was medicated with seroquel!) attempting to maintain a calm positive environment with music, and known people around without overcrowding him to make him feel secure.  Fact is it isn't easy, and still is very challenging, but we are seeing improvements so we keep persisting.  Self-care for carers is also very important.  Exercise, good food, proper sleep is also important important for carers, not just the patient!  Easier said than done...if there is no proper support for the carer/s.
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Avatar universal
I know it's been a few years now since anyone has posted here, but the comments and recorded history here are very helpful.  Janinaz, I hope you have found peace with your sisters.  Take the higher road, don't always outwardly express what you feel in the moment (think about it first), and things may work out with time.  Miller78, your historical account of your father's recovery is extremely valuable; I hope he is doing well.  

My father had a stroke on July 1, 2014.  He had a second and third stroke within the next month, and is now in a nursing home with 24-hour "sitters" because his agitation is uncontrollable.  He is 82.  He was a speech pathologist, and this is his worst nightmare come true.  I recognize many of the issues everyone has brought up in this post; and I have come to realize that every stroke is so different.  For example, my father drooled after the first stroke, and after the third stroke, it stopped.  He was much like Miller78's father, except mine could not read or write.  He had the same impulse control issues, ran away from home, and was very fit and strong when we brought him home after the first stroke.  Even with 24-hour in-home care, we could not keep him contained, and he was easily frustrated.  Now, 8 weeks after his last stroke, he is bedridden, incontinent, and very very agitated.  He is medicated with Seroquel and several other medications.  One of them is metropolol, which is a blood pressure drug, which has shown some effectiveness in reducing agitation in stroke patients.  So far, though, nothing has worked very well.  Dad is paralyzed on the right side, but has been able to reach over with his left hand and lift his leg to get his foot on the wheelchair peg.  His speech is mostly unintelligible, but he responds to basic commands (such as "Please give the phone back to Emily").  Everyone who knows my father believes this is the saddest thing they've ever seen.  

The most important thing for my dad, I believe, is to continue to give him hope and encouragement and to treat him as if he understands everything.  There is a serious gap in our healthcare system in dealing with people with agitation where they would be restrained in a hospital setting (terrible) and on private pay, caregivers cost $400/day, plus $300/day for the nursing home.  He cannot go to Board & Care facility because he is too disruptive, and he requires too much skilled care to take him home.  There is no good option for his care ongoing, and that makes this situation even worse.  

Don't give up on the person.  No matter what their behavior at the time, they can improve.  It takes a lot of love and attention.  When my dad dies, and he will, I will know I did everything I could to make his quality of life as good as possible for whatever recovery was possible.  The compassion expressed by people here in this community is what helps the most for your loved one suffering from stroke.  For such a significant problem, there is not enough in-depth information for people to access to know how to help someone who has had a stroke, contrary to what the stroke organizations and other funded sources claim to offer.  Sites like this really help a lot.  Thank you, everyone!
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Avatar universal
This is a follow up to my post of Jan. 30, 2011.  My mother passed away on June 8, 2011 at the age of 84.  She stayed in the original nursing facility for almost 3 months and they said that she had reached her maxium potential and Medicare ended and she went to "private pay".  We found a private residential care home that provided a home atmosphere with very good care.  Unfortunately, she kept developing fevers and infections and was hospitlized with aspirational pneumonia.  We then found another assistant care nursing home that was good.  She continued with physical therapy there.  I last saw here there in April 2011.

However, she knew something was wrong with her brain.  She had her good days and bad days.  She found a new friend named Dixie who was 93 years old who was as sharp as a whip.  They would talk together and laugh.

My mother developed "sun downers" and became agitated and depressed.  Her doctor prescribed Seroquel (spelling?) which is an anti-depressant.  She was also at risk for falling as she always wanted to get out of her wheel chair.  They had to put an alarm on her.  

She was eating dinner and laughing at the dinner table when she grabbed her head and said it hurt.  They put her to bed and when they went back in to check in on her she had already passed away.

I think the last 6 months of her life were awful for her.  She knew something was wrong and tried so hard to make it right in her brain, but couldn't.  Her "new" friend Dixie passed away one week after my mother.

Unfortunately, the tension with my two sisters continue to this date.  I have to find a way to deal with it or it will destroy me.  

I miss my mother and I have to think that she is in a better place.  She was a very strong force in our family and it is still hard to realize that she is gone.  I appreciate finding this site and reading all the posts.    
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1346447 tn?1327862572
These posts helped me to conferm the things my wife is going through after stroke. One new word I learnt is Delirium to describe the condition of my wife. I am now not worried about her physical fitness but her mental fitness. What is the relation between Dementia and Delirium? I some time feel my wife's condition may be out come of psychology rather than neurology. Or combination of two. Doctor is doing sort of experimentation by giving different medicines.Thank you millertime 78 for presenting very nicely for the benefit of all stroke survivers.
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Avatar universal
My Dad had an ischemic brainstem stroke 5 weeks ago, he is 67.  I am aware that a stroke in this area can be fatal as this area of the brain controls breathing etc.  My Dad can breathe an cough on his own.  He has not opened his eyes since the stroke (on occassions they open half way).  He will answer commands on occassions by nodding but this tends to fluctuate.  My Dad has lots of movements in his body, especially his left side, right side is improving.  We were told in the first week 3 times he would not make it but he seems to be getting more fiesty every day and the physios say he is very strong.  
Doctors cannot give us a prognosis.  
Dad has a trachestomy which they are hoping to remove this week.  He had a chest infection which has greatly improved and continues to improve as he is able to cough on his own which clears his chest.  We just dont know what to think as although there has been small improvements since he was first admitted to hospital, the fact he has not opened his eyes and he fluctuates full conciousness we dont know what to think.  He makes a lot of facila expressions and moves about as if he is having conversations in his head.
Does anyone have any experience with this?
Thanks
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Avatar universal
So sorry to hear about your mother and all the drama with your sisters.  
My father has recently had a stroke, and would agree, if he could express himself well enough, that yes, it is hell not being able to control your own life anymore, not being able to communicate like you used to, and not always understanding or comprehending things you once could.  
I have appreciated reading the posts on here, and wish there were more updates!  But I think that we can glean from what's here that it's important to keep trying, stay patient, and expect slow but gradual improvements.  
We're grateful for even the slightest improvements over here!
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Avatar universal
Just got through reading your posts and updates about your father.  My mother, age 83, suffered a stroke on Dec. 19, 2010.  She had brain surgery to remove a blood clot on the right side of her brain.  Her left side is affected.  It is so heart breaking to see my mother.  She had been living alone in her house, driving and very independent.  She was transferred to a nursing home where she receives some physical therapy.  She had her right knee replaced on Nov. 9, 2010 and I can't help but think this is all related, but she insisted on having the knee surgery.  Plus she has a heart pacemaker.  She has short term memory, however, she can talk and recall things from the past.  She cannot walk and has to be helped with everything including all the toilet issues.  I have 2 sisters and a brother.  We all live in different areas and I ended up having a major disagreement with my sisters about my mother's aftercare and chosing her nursing home.  I live in another state about 850 miles away.  I stayed there for about 3 weeks and flew home 2 weeks ago.  I talked to my mother twice on the phone since then and she was more or less out of it, but said that "this is hell".  It was so upsetting.  My older sister has power of attorney and she lives even further away.  The only one in the area is my younger sister and she is not responsible and was "suppose" to be helping my mother after her knee surgery (my mother was paying her), but she was NOT checking in with my mother.  To make a long story short, my older sister is not talking to me now because I told her that she dropped the ball when she agreed on this nursing home and then left the state BEFORE my mother was even released to the nursing home. I was appalled with the way they "dumped" my mother off there (another drama) with staples in her head and put her in a dirty room with only a bedspread on the bed.  No one even came into the room until I made a scene.  The older sister then flew back to see what was going on.  I begged her to talk to me about certain things about our mother's care, her house (may have to be sold as the doctor is doubtful she can live alone), but she would not.   I can only pray for my mother and her recovery.  I know that this was her worse nightmare come true.  I have not seen any posts from you on this site for over a year.  How is your father doing?  It was very insightful to read the history and progress of your father.  What an emotional roller coaster for everyone.      
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Avatar universal
Hi All

A long overdue update. My Dad is being cared for at home still. He has a reasonably good quality of life. He never recovered his speech and has only maybe 50% cognitive ability. Most of the time he's in good form, he reads books and papers but we can't tell how much is going through. He has vera very short attention span and is very restless often walking randomly around the house. Physically he's in good shape. Communication is very tough but we can understand each other now.My mother is the primary carer and she's with him more or less 24 hrs a day. Its tough but we're getting on with it. He was never receptive to speech & language therapy so we really made no progress in this area. Its clear that the stroke wreeked major damage on his brain causing him to lose all memory,basic life skills and affecting his behaviour. However we persevere with him as we love him so much.

Thanks for reading this.

God Bless
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Avatar universal
MULTIMEDIA SPEECH PATHOLOGY
1/14 Miami Shore Parade
MIAMI QUEENSLAND  4220
AUSTRALIA

Ph:           0407293579
Fax:         (07) 5578 6373
Email:      ***@****
Website: www.mmsp.com.au

They have a great computer program for speech therapy - I used it with my Mum who had severe disphasia. It made learning fun - and its aimed at adults! Check out their website - they are well worth it!
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Avatar universal
Hi All

Update - 9 months after stroke

Dad is physically 100% and has regained some mental capacity. He has some communication but its difficult and he still gets frustrated. He's starting to get out into the community again -attending church on Sunday and going for walks on the road. Speech therapy is difficult as his attention span is v short but sometimes we can make sense of what he's saying. Its still slow going but we're making progress. The best therapy is spending time with him, engaging him in activities he enjoys and can do and keeping a routine.
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Avatar universal
Dear PamRam228,
I feel so hopeless today.I just read most of your posts and got some hope.I am so happy that your husband has improved so much, and I hope he will completely recover. I decided to ask you some questions and comment since I noticed you have good knowledge and very positive.
It is 2 weeks after my mom(61years old) Stroke and is still in hospital. She can talk, aware, able to swallow(not completely but getting better). Her left side has been paralyzed, not able to empty bladder yet, not able to sit yet. Today, her physiotherapist tried to bring her out her bed and sit on a chair, but it was a hell. I lost all my hope in a second. She is heavy and even with 3 people it was impossible to control her, I was afraid of arm or hip breaking. As soon as she improves to empty her bladder and gets rid of the urinary infection, we are going to take home. In my country, we don't have a rehab center, and I am not sure even what rehab center is and what people do in rehab center. We are trying to get some info, so we may able to do the same at home. Also, how long after stroke was your husband able to sit. I am wondering if your husband had the same problem in the beginning and how he improved. Also, we are not sure how we can help her to use a bathroom once she comes home, ...if you have any idea or suggestion please please help us out. Thanks in advance.
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Avatar universal
Hi Lesreg, sorry to hear about your grandpa. I can only hope that the medical staff are making him as comfortable as possible. The doctors will do a swallow test to establish if its safe for your grandpa to eat by mouth. This would be a great help as it means the tubes would go. However it may take some time for the swallow reflex to return but don't give up hope. Its hard to hear him crying I'm sure, that kind of thing would break your heart but you must be strong and try to spend time as his beside reassuring him.
I will say a prayer for you, your family & grandpa.
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Avatar universal
Hi Pam, I've been extremely busy these past weeks so haven't had time to post. Dad is doing ok, he's at home & living semi independently. He needs somebody with him all the time in case he wanders off though he does seem to have a good sense of danger. Communication is still the big problem. Sometimes he responds , other times he just ignores us. Speech is very clear when he's reading aloud but when he talks its very jumbled. The speech therapist is struggling to get through to him as he doesn't realise there is a problem. He gets extremely frustrated when prevented from going outside but we have no choice esp at night. Its slow going and a struggle sometimes but overall he's improving. He is selfish and inconsiderate esp with my mom, always demanding something but this phase passes after a while. I'm delighted to hear how your husband is doing. You must be thrilled. Take care
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Avatar universal
my grandpa had a stroke this past sat. now no one is telling us anything. like what to expect is it a big stroke, what can we do to help, etc. I am weary because he is 92 and he is crying all day and night loud. he gets all frantic when we visit and he points to the door, he cannot speak, his right side is affected but he sometimes moves his leg. The hospital wants to discharge him already and send him to a long term facility. He has a tube down his nose for meds. a tube for food, he needs oxygen and he has those moments of loud crying, they gave him something that just placed him in a drowsy cant feel a thing stage...im worried is this all normal, well for a stroke victim??
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338899 tn?1195791969
It's been a month since you last posted.  Just thought I'd drop by to check on your day.  I really liked hearing he is progressing.  Seems like he's coming back to himself.  Hubby is still doing wonderful.  He's happy that he's got his life back, basically.  He can drive so he doesn't feel trapped inside the house all day.  

Hope to hear from you soon.
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Avatar universal
Hi Pam, things are ok. I've just been very busy trying to juggle work etc. Dad is ok. Communication is still the big barrier. He's interacting much more now with us, he'll play football in the back garden & even help cut the grass. However verbal communication is still a big problem. We try to treat him as normal as possible and he responds well to this. he hates being restricted but sometimes I have to bring him inside in case he''lll wander off. He loves reading subtitles off the tv & I am looking for speech & language therapy dvds to help him do this more. Overall he's doing ok, progress is slow but we must have patience.

Hope all is well with you & your husband
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338899 tn?1195791969
Hello, millertime...just wondering how things are going with your dad.  Haven't heard from you in a while.  Hope things are looking better.
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Avatar universal
My dad also still has his delirium.  It has been two years since his stroke and he still talks strange.  My mom helps him get into the chair, and then five minutes later he says he can walk and that he doesn't need any help.  As time as gone on, he as been sleeping more and more and actually becoming weaker.  When he first came home he could walk with some help, now he can barely stand.  We have continued to fight for more therapy, but as soon as he gets a little stronger, the ins. company says he has reached a plateau and they won't authorize more sessions.  It is sad to see my dad this way.  I wish he would continue to improve...  Good luck with you dad, it is a long road.
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Avatar universal
Hi,
Delirium is the presenting feature in a few stroke patients, but can complicate the clinical course of acute stroke in up to 48% of cases. Old age, extensive motor impairment, previous cognitive decline, metabolic and infectious complications, and sleep apnoea are all predisposing conditions for delirium. Patients with delirium have longer hospitalizations and a poorer prognosis, and are at increased risk of developing dementia. The identification of the patients at risk and non-pharmacological preventative interventions are the key measures in the management of delirium.
Delirium is defined as a transient, usually reversible, cause of cerebral dysfunction and manifests clinically with a wide range of neuropsychiatric abnormalities. The clinical hallmarks are decreased attention span and a waxing and waning type of confusion.
Changes in the environment include: Reorientation techniques or memory cues such as a calendar, clocks, and family photos may be helpful.
The environment should be stable, quiet, and well-lighted. Support from a familiar nurse and family should be encouraged.
Family members and staff should explain proceedings at every opportunity, reinforce orientation, and reassure the patient.
ref:http://www.emedicine.com/med/topic3006.htm
Medications to treat underlying cause will be prescribed by the attending doctor.
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338899 tn?1195791969
Thanks for the update, millertime78.  I know this is hard and frustrating seeing your dad like this.  It's really uncanny how much he is like my husband.  I'll tell my husband to do something or not to do something and he'll just do the opposite of what I say.  When I ask why he'll say the usual "I don't know".  Is your dad still in therapy?  I'm sure the speech therapist can help him control his speech.  

My heart goes out to you because I know you're doing all you can.  I sure hope and pray things will get better for you and your family.  Your dad still has more time to heal so that's a plus.  Hope to see more posts from you in the future!  God bless!
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Avatar universal
latest update

Not much change. He has mood swings when prevented from going outside etc and can get very upset(physically & verbally abusive) at times. Communication is so difficult. He just seems to do the opposite to what is asked sometimes which is awfully frustrating. Physically he's in good shape, he rambles endlessly when talking only some of which is clear. We cannot yet have a conversation with him as its all one way traffic. its hard to keep going sometimes
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Avatar universal
Hi Pam

Just to answer your questions
Swallowing is excellent as is his appetite
Eyesight is good, he can read aloud no problem & he can count
He's not on dilantin, he was on seroquel/quetapine but he's been off it for a month and is much more alert & normal as a result
He still has cognitive issues, he'll put on clothes back to front or try to put on shoes when he still has shoes on etc
Speech is improving but communication is difficult. Very hard to get him to follow directions etc but we're managing.

The good news is that the incontinence is now almost gone which is a huge lift in terms of caregiving. He's going in the right direction so hopefully the communication will improve more
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338899 tn?1195791969
Hello, again, millertime78!  It's wonderful to hear your father is improving.  Just a few questions, though...how is his swallowing?  Was that effected?  What about eyesight?  Is the delirium totally gone?  You mentioned the dilantin made him do crazy things.  Is he still on it?  Does he recognize everyone now?  My husband is on dilantin and I think that's what is causing his mild cognitive issues.  How many milligrams does your dad take of the dilantin?  
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