Daughter of Dementia - memory care

Mbanck

New to this site. I wish I had found it sooner.
My father had a stroke last year. He left the hospital without discharge under the dr’s strong recommendation that he stay. When this happened I moved him closer to me. He has lived alone for 20+ years and refused to stay with my family.
Please help.

My question: can prostate issues cause dementia symptoms?

My story:
Less than a year later he was found at 1am by the police 1.5 hours from home. He had run out of gas. He was sent to the hospital because he had no idea where he was, where he was going or the year. He was under surveillance for 3 days in the ER and after cognitive testing and his behavior, diagnosed with vascular dementia. They found his prostate was enlarged but wouldn’t do further testing. We also found his heart to be at an EF of 27. Very low. He was put on meds to help strengthen his heart. The hospital would not discharge my father unless into a 24hr care facility.
I took over as POA and moved him into a memory care facility 2 days ago. Since he has left the hospital he seems normal but very confused. He was unable to urinate at the hospital. They put him on a catheter and we are to follow up with a oncology or urologist appointment in a few weeks. He is also unable to control his bowel movements.

harshedbuzz

@Mbanck

Hi and welcome. I am sorry you have a need to be here, but happy you found this site.

From your description, it sounds as though your dad is in the later stages of VD. Placement in a MCF was the right call for you to make. Fecal incontinence is a stage 6 symptom in the 7 Stage Model of disease progression. While the symptoms of Alzheimer's and VD are very similar, VD tends to progress in a series of more abrupt drops following plateaus compared to ALZ which tends to follow a gradual but steady loss of skills.

I am glad he has you as his POA and advocate. You may be facing some difficult decisions in the near future.

Did doctors establish a cause for his low EF? Has medication improved the function of his heart?

Specific to the prostate, I have never heard of a relationship between an enlarged prostate and dementia. That said, my own dad who had mixed dementia had prostate cancer. He was initially diagnosed in 2005 about the time his initial symptoms of dementia were seen-- in his case personality changes to a darker side. He elected to do radiation treatment and believed himself to be in remission. In 2016, about 3 months before he was diagnosed, a new PCP noticed he had an elevated PSA. The follow-up biopsy was positive, and he began ADT (androgen deprivation therapy). Looking back at his old medical records, he probably never achieved complete remission as his PSA never went to zero. We never had to treat for enlargement that interfered with passing urine.

It could be your dad has PBH that is interfering with passing urine. There may be procedures to help with this. I guess you'll need to decide whether to go ahead with a biopsy to determine if this is cancer and what approach would be best. His age, general health and Gleason score will be factors to consider. IME, urologists and oncologists sometimes pose treatment options for prostate cancer as a kind of "choose your own adventure" even with otherwise healthy men. You may want to read up on this so you understand options if you'll be the one making the choice.

HB

M1

Welcome to the forum, I am sorry for the difficult situation you are dealing with.

I'm with HB on this one, I don't think the prostate problems are related to his dementia. If it's just an enlarged prostate without cancer (the most likely), both meds and surgeries can help. Managing a catheter in someone with dementia is quite difficult, he may be tempted to pull it out which can cause terrible damage. Even cancer they might likely leave alone given his poor mental state, but I guess you can cross that bridge when you come to it. It will improve his quality of life if you can get the catheter out, even if he's incontinent of urine at that point. He is unlikely to regain control of his bowels, regardless. Pretty tough.

HB is correct that there is a lot of controversy about how to treat prostate cancer. Most men with it die of something else--as your dad is likely to. They can probably make a diagnosis at the same time they do something to relieve his obstruction. If it's local to the prostate, it may be best in this circumstance to just leave it alone. The worst outcomes with prostate cancer happen when it metastasizes to bone, which can be very painful. You'd probably know it already if that were the case because he'd be complaining of terrible pain.

It usually takes three months at least to tell whether his heart function will improve--there is a very specific protocol (called guideline-directed therapy) to treat with a cocktail of medications and then reassess with an echocardiogram at three months. If his function does not improve, they will also want to talk to you about whether to place an implanted defibrillator, as folks with ejection fractions below 30% are at risk for sudden death. I wouldn't do it, honestly--if it were me and I were demented, I'd take sudden death any day of the week. But that's also down the road a bit.

Glad you have him in a safe place and he's lucky to have you looking out for him.