Stroke confusion - how much fluctuation is normal?

About 1.5 years ago, my dad (age 78) underwent triple bypass heart surgery and hasn't been the same since. He has suffered some mini strokes (confirmed by MRI) and diagosed with vascular dementia. Damage was to the frontal lobe? affecting his cognitive functioning. He speech is fine (when he talks).

His mental 'alertness/confusion' swings wildly from day to day and has definitely gotten worse over the last year. He has become very quiet and never initiates any conversation. But, a good day means that he's pretty alert and can answer most questions, laugh at jokes, recognize people in pictures, etc. A bad day being he doesn't remember my mom's name, but he does recognize her. On good days, he has pretty good strength to stand up and walk with a walker. He has a tendency to fall backward though, so someone is always by his side. On bad days, he has no energy and can barely get out of bed let alone walk more than a few steps.

He has been on Razedyne (sp?).

Is this type of mental fluctuation normal for someone who has had mini-strokes with diagnosed dementia or does it signal some other health problem? His temp is normally low (around 97.5).

[lahinva]

My dad age 80 had a stroke 10 months ago.  He also had the vascular dementia and loss of short term memory.  His confusion also varies greatly each day.  One day I will talk to him and he sounds like his old self, the next day he will barely remember me....  It is very difficult to deal with because just when we think he is doing better, he has one of his days in which he is very confused and very weak.  I feel the worst for my mom because she has to deal with it every day.   Some days he gets very mean  and other days he is as sweet as can be...  When we ask his doctor about the changes in his mood, he says that it is very common for stroke patients to have those extreme changes.

[caregiver222]

Razedyne is a well-promoted Alzheimer's drug that should have been marketed as an alternative to electrocution in states that have death penalty laws. Just a valueless personal opinion. What do I know? I'm only eleven and my mom lets me use this computer to upset people.  Nevertheless, many physicians with fascinating curriculum vitae who have been treated to all-expense-paid vacations to Hawaii for seminars on the drugs effectiveness give massive testimonials on its effectiveness. Wide variations in lucidity generally have simple explanations. Variations in glucose utilization being the first choice. Disturbance of circadian rhythyms being another good second choice. We have two different directions here. One is "stroke" and the other is "Alzheimers", which may or may not be present. First of all you must purchase a pulse oximeter.A must.  Do not pass go. Do not collect two hundred dollars. This measures percentage of oxygen in the blood by a clip on one of the fingernails. Next you need to have an insulin clamp test performed, which they probably won't do, because it isn't on the insurance protocol. So spent thirty bucks on a digital tester and start checking his blood sugars. I have to wonder about the etiology of the stroke following a bypass. No doubt the surgical notes and the hospital review documents have a classification comparable to that accorded the Al Queda attack on 9/11 and you'll never see them. "Good job Joe!" "Sure thing Harry - how about golf saturday?"  First try come co-enzyme Q-10. Start at 60 mg, and studies suggest that up to 1000 mg a day can produce mental improvement. Then start DHEA. Just a teensey weensey bit for a week at a time. Start with 5 mg and work to 50 mg. Then see if he will tolerate pomgranate juice. If not the dry pomgranite capsules, for 60 mg a day.  A small quantity of niacin every day produces vascular dilation. Not too much. A multi-vitamion every day. A teaspoonfull of cod liver oil. Omega-3 fish oil supplements. Perhaps more later when I am in less pain.

[caregiver222]

Blood sugars are often kept under control by cinamin (the spice) supplements (lots), and Chromium GTF (Glucose Tolerance Factor). Circadian rhythyms can be moderated by exposure to 45 minutes of sunlight every day, between six A.M. and 9 A.M. in the morning. As much outdoor exposure to sunlight every day as possible. There is a sensor in the eye that mediates the process. Do some look-see on google on circadian rhythyms.

[Debbe883]

Thank you both for answering.  Today was a good day for dad after four down days. Yesterday he barely knew how to move his legs to walk, today mom said he practically "sprinted" with his walker.  I will print your post with recommendations and see which are do-able. He's on 8 different pills for things ranging from hypertension to cholestrol to depression to bile acid reducers.  I have to make sure nothing interfers with the others.

Is there any merit to stuff I've read about apple cider vinegar cleaning out clogged arteries.  The neurologist says his brain arteries have narrowed, reducing blood flow, from the same gunk that clogged his heart and carotid artery.  Seems to simple to be true...

Thanks again!

[caregiver222]

The apple cider data is anecdotal, however there are no serious side effects so it's worth a try. Blood vessels narrow for various reasons. Sometimes it is because of deposits. Interestingly, people think of "cholesterol deposits" as something nasty, but they serve a purpose in the immune system by encapsulating pathogens. Sometimes it is the elasticity of the vessel that is the issue. Some naturopathic treatments, such as cod liver oil and omega-3 oils increase the lubricosity of the blood, enabling red cells to squeeze through narrow passageways more easily. That is the conclusion of several researchers, although the exact mechanism of action in improving circulation is unclear.  Niacin causes dilation of blood vessels, but I would cautious about using it on anyone on a so-called "blood thinner". I have been providing pomegranite extract and co-enzyme Q-10 to my little 102 year old and I believe it definitely improved her ability to speak. B-12 and folic acid, at least twice a day. We get enough of these supplements, but the receptor sites don't absorb them well. Sublingual B-12 is best. I am very cautious about vitamin E and do not provide it to my sweety-pie. People pop it like candy, but it is not an innocuous substance. One patient I am aware of developed a stroke from vitamin E after taking 2400 IU daily for several months. I don't think you can get into much trouble with up to 600 IU, if you insist on using it. I am also a believer in saunas, both hot and cold, and massage, if the patient is not too elderly. The best place to have this done is at a specialty medical spa with a physician present. There are several clinics with korean physicians (M.D.'s) who provide this service. It is part of traditional korean medicine, they tell me.

[Debbe883]

Thank you again for such detailed advice.  We did have his B12/Folate/etc checked and they were all either within normal range or way off the charts. Two different docs said the numbers were fine.  I just saw an ad for omega-3 that comes in a squeeze pouch. Dad sometimes has trouble swallowing pills, so I'm going to look for this pouch.  I bought some pomegranite/blueberry juice for him to try (don't know if he has yet), but I'll look for the extract.  My mom makes him milkshakes every day with Boost, ice cream and puts alot of his vitamins/supplements into the shake. If the extract isn't too flavorful, it might be easy to add it to that.

Dad has been having a really good week. My mom finally convinced the overnight CNA to stop waking him up in the middle of the night just to change his Depends, so he's been getting much better sleep.  Not sure if  that's affecting things or not, but he's been much more alert this week than last.

Thanks again.

[lahinva]

My dad's confusion is definately tied to how tired he is.  If he has had a good nights sleep he is usually much more with it the next day.  You may want to try an external catheter at night.  They have definately helped my dad with sleeping.  Unless it comes off during the night he sleeps straight through the night.  

[lahinva]

Can you explain the test scores?  I have never heard of this with my dad?

[Debbe883]

Thanks for writing. I'm thinking there might be something to this 'good night sleep' issue. Dad is still having good days.  Actually admitting to being bored and getting cranky about doing his PT and speech exercises. Even the Physical Therapist commented on how much better he was mentally and physically.  

I did suggest the external cath. to my mom a while back, but she seems to think my dad wouldn't go for it.  If his sleep quality goes downhill, I'll suggest it again.

We're taking Dad on Thursday for another MRI.  It's been about 10 months since they confirmed his strokes. The last visit to the doctor was terrible. His test score dropped from around 20-ish to 8, so he wanted to check for further damage.  If he were retested today, I think it would be back up near the 20 mark.

The fluctuation has been incredible.

[Debbe883]

Sorry for the delay.  The test the doctor gives my dad is called the Mini-Mental State Exam.  It's just a series of questions to gauge the level of his dementia. He gets partial credit for answers that are partially correct. Here's a web site you can down load it from:

http://www.chcr.brown.edu/MMSE.PDF

Dad's still doing really well. He had his MRI on Thursday but we won't know the results for a few weeks.  Dad seems better now than he's been in over a year.