Expert: Mary Gordon - 12/20/2008

Question
my husband recently had cryo-ablation of a small tumor in his kedney, he
also has some large clusters of stones in both kidneys which keep causing
kidney infections.  The doctors put him on 1080mg of Potassium/Citrate
about 1 year ago.
With his health failing, getting weaker, confusion, fever, dizzy (actually acting
like a very intoxicated person, late evening)
Blood test were run and they found his potassium level was moderate.
Having discontinued the med, his potassium has returned to normal.
They also found he was an anemic, and ran a test for B12 and it came back
normal, so he is now taking iron.
He was given antibiotic for the infection, but is still running a fever.  He has
went thru 2 series of antibiotics.
My question:  can his medical problems, cause Alzheimers to be more severe?
The confusion, not being able to drive well, not being able to find the right
words to say what he wants to at times, etc.?

Answer
Hi Barbara, you sound like you have your hands full.

Yes, absolutely, medical problems like infections can make a person with Alzheimer's worse in terms of cognition. After all, if you think about it, when you have an infection that is causing fever, most of us will feel fuzzy headed, tired and not quite with it. If you tried to tackle something like your bills or taxes in that state, you'd probably sit there in a haze, staring at your papers and just not accomplish much because your brain is just not in gear.

Now imagine you have an injured brain on top of that, and were barely coping in the first place! Its no wonder that even a bladder infection can make them see so much worse on the congnitive front. The anemia would also do that  - if you've ever been anemic, you really feel tired and have difficulty concentrating.

Anesthesia also really impacts their cognition, and the results can be permanent. My mother in law broke a hip in early AD, and when she came out of the anesthesia, she was completely loopy to the point that the hospital would not believe that she had been reasonably with it prior to surgery. They thought we were in denial and were lying!! She came back some of the way mentally over time, as she healed over several months, but never to where she had been before surgery.

Having said that, as the AD progresses, your poor husband will get more confused, no matter how his health is otherwise, and the word finding issues are common. What does alarm me is your reference to his driving. He absolutely should not be behind the wheel of a car, and if his doctor is aware of his condition, his doctor should have spoken to you about this. In many places, doctors have a legal accountability to report anyone who may not be able to drive safely to the licensing authorities.

My mother in law's doctors did this in the early midstage. At that time, she was only driving very locally, and hadn't had any accidents. We thought it was too soon - but in retrospect, we weren't thinking clearly about the problem of just how impaired she was, and what could have happened if she had encountered some sudden situation on the road ahead that would have required her to make some quick judgements and react safely to avoid hitting a child or another car. Her license was suspended and she was asked to repeat both a written test and the road test - neither of which she could have passed if she had tried.

I know the loss of driving can be devastating, however, consider how you would feel if he was to hurt someone, or himself. Alzheimer's doesn't just affect memory - it impacts depth perception, judgement, ability to reason, emotional control, and muscular coordination and reaction time. These are all things you need to be able to drive a car safely.

If you have concerns, speak to the doctor and also have his driving assessed by a neutral professional who can confirm to you whether its time to stop, or limit his driving.  
http://www.aarp.org/families/driver_safety/driver_safetyissues/a2004-06-21-whent...

http://www.driver-ed.org/i4a/pages/index.cfm?pageid=104

Hope this helps.

Mary G.