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    Dementia and Stroke Patient
    chicago_son posted:
    My 88 year old father had a stroke one month ago. He has been unable to walk since that time. After a short stay in the hospital, he was transferred to a nursing home & rehabilitation center for therapy. He has severe dementia which has made it difficult to communicate with him about his condition and treatment. He successfully passed a swallow test, but had no appetitte and appeared to eat very little for a period of two weeks. His physical and occupational therapy has been hindered by a lack of energy and lack of understanding of what has happened to him, and the importance of participating in the therapy. He sleeps a majority of the day. His communication is sporadic, at best. Single words mostly.

    Prior to a month ago, despite his deteriorating mental condition into advanced dementia, he was reasonably healthy, completely ambulatory, and no health complaints (of course, other than memory).

    Hoping that we could reverse a downward cycle in which his lack of energy was leading to little progress with his physical therapy, we began feeding him through a feeding tube to provide more nutrition and possibly more energy. The results over the past two weeks have not been any better. He continues to sleep a good part of the day, and has made little progress with therapy.

    The nursing home is preparing to stop the rehab sessions because they are not seeing measurable progress.

    Essentially the staff is indicating that he will not ever walk again. This appears to be a self-fulfilling prophecy because without the therapy, there doesn't appear to be any chance of recovering the mobility he lost with the stroke.

    Given that it often takes many months to recover from a stroke, particularly at his age, is it possible that his body needs more time to recover, and with persistence, and continued therapy, he could walk again? Or, are his age, his advanced dementia, and the effects of the stroke manifesting in the body being unwilling or unable to rehabilitate?

    Would appreciate any thoughts or suggestions.
    Richard C Senelick, MD responded:
    Thank you for your detailed description of your father's problem. It sounds like every possible effort has been made to try to improve the situation. The overall prognosis for an 88-year-old gentleman with dementia and a stroke is very poor. The truth is, the we can only do" so much."

    The famous physician, Dr. William Osler, one said, "pneumonia is the old man's best friend." It is meant to imply that there comes a point when families and doctors have done all that they possibly can. I think the combination of advanced dementia and a stroke, would leave your father with very little "brain reserve" and potential for improvement.

    It is common practice in all rehabilitation settings to discontinue therapy sessions when patients reach a plateau and it is felt that they would no longer benefit from aggressive therapy. This does not mean that you should discontinue sessions that can be supplied by a restorative aide or your family. This should keep him at his current level. If he seems to take a turn for the better, you can always ask for an evaluation to have his therapy restarted.

    It can be difficult to accept that there are times when there is little if anything that" modern medicine" can do to improve a situation. It would appear that your father's brain is at that point in life. I see many situations where therapy is discontinued prematurely, but I honestly do not think that this is one of them.

    Remember your father for the great man he was and all the joy that he supplied your family. Good luck
    After your stroke you may be experiencing a new normal, but remember what George Eliot said- It is never too late to be what you might have been. You still can achieve new goals.

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