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Drug-induced delirium led to mistaken Alzheimer's diagnosis

Those interested in learning more about clinical trials on Alzheimer’s disease, including the POINTER study, can go to j.mp/alztrials for further details from the Alzheimer’s Association.

In 2017, I almost died three times. I had gone to my ophthalmologist for the annual appointment and was asked by my doctor: “Did you know you’re blind in the right eye?” Giant cell arteritis, also called temporal arteritis, was considered as the cause and was confirmed following a biopsy of the right temporal artery.

I was rushed straight from the doctor’s office to the E.R. My friend Jill became my advocate until my nephew Harvey arrived from Atlanta. At this point we must rely on Jill’s account of my serious collapse because my memory had deserted me. When she came to visit, I was either asleep or unconscious, she said. My face was flushed, and I was “hooked up” to monitoring devices. Jill thought I was going to die.

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My only memories of the 21 days in the hospital are of lying in a narrow cubicle. I was started on a high dosage of prednisone. This powerful steroidal anti-inflammatory drug can cause delirium, and in my case it did. My world seemed eerie and frightening. At times, I felt I was watching a scary movie.

With all of the beeping of machines and checking of vital signs, patients in the intensive-care unit often have trouble sleeping. This, along with other hospital conditions, like lack of natural light and familiar surroundings, can lead to disorientation.

Jill and another woman came to discuss their editing of my book of photographs. It is hard to believe that as incapacitated as I was, part of my brain was still functioning. Nonetheless, my mind continued to play strange games. Was this the first stop on the way to dementia? My internist explained that the brain is injured during delirium, and that the resulting cognitive impairment takes time to clear.

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They sent me to a rehabilitation center to regain the strength I had lost in my arms and legs. There I caught a flu that turned into a serious case of pneumonia. In the hospital again, I was hit with one crisis after another. I developed a cardiac arrhythmia. Several doctors fought all day to save me. Though I don’t remember their struggle, I must have been subliminally aware of it because that night I thought of my patients and called a colleague asking her if she would take over for me if I died. The next day my heart was normal. When I returned to the rehabilitation center I learned to walk with a walker.

I finally got back to my house, with 24-hour care provided by Tribute home care. The kind and skillful assistance of the aides was an important factor in my recovery. My new doctor came to my home.

She diagnosed me with Alzheimer’s.

I'm on steroids for two weeks now. The effect has been about as subtle as a sledgehammer. Any athlete who says he didn't understand or notice the effects has got to be telling something less than the truth. | McNamee the scribe

There are serious consequences to this misdiagnosis. With Alzheimer’s, patients, relatives and doctors give up all hope of recovery. With cognitive impairment due to delirium, however, there is an expectation of recovery once the cause of delirium is identified and successfully treated. For me, this happened when prednisone was very slowly tapered, and methotrexate gradually substituted.

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I would not be alive today had it not been for the loving assistance and support I received from my family, friends and doctors.

In November, I moved into the friendly community of Symphony Manor where I am learning to take care of myself. I have completely recovered from the effects of the injuries to my brain caused by delirium. After having huge, coffee-colored cataracts removed from both eyes, vision in the left eye is good.

People with early-onset or young-onset Alzheimer's make up about 5 percent, or 250,000, of the roughly 5 million sufferers of Alzheimer's across the nation. Symptoms for young-onset sufferers can include memory loss and an inability to solve problems and poor judgment.

If you or your loved ones are ever caught up in an illness that involves serious changes in mental status, be sure that your doctor can recognize the difference between permanently dementing Alzheimer’s and the temporary cognitive changes caused by delirium. Many doctors can’t.

Barbara Young is a psychiatrist, psychoanalyst, photographer and author. Her most recent books are “The Persona of Ingmar Bergman: Conquering Demons through Film” and “Photographs Are Memories.” Her e-mail is: youngmdbarbara@gmail.com.

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