Expert: Mary Gordon - 9/1/2009

Question
My father is 59. He has been a diabetic for a very long time. He is doing dialysis three days a week. He is very confused most days and seems spaced out. My family and I don't know if its the medicine or Alzheimers setting in. I began to notice changes in his memory about three years ago but didn't want to scare my mother. He's having seizures now when he finishes dialysis every few weeks and  it just seems like we're losing him slowly. How can I tell that its not a side effect from all the medicine he has to take or if its Alzheimers?

Answer
LaQuita, oh my goodness - have you discussed this with his kidney doctor? If not, you need to tell the specialist IMMEDIATELY and also ask for a referral to a neurologist on an emergency basis. This is very unlikely to be Alzheimer's but there are very specific syndromes that happen to people on dialysis that impair their minds and cause seizures.

One form is a kind of encephalopathy caused by aluminum toxicity. Aluminum is in the phosphate binders in the solutions used in dialysis and it can accumulate in the brain causing confusion and seizures. There is another common kind that is caused by thiamine deficiency.

The specialists may or may not be able to help your father with this - many dementias are not curable - but you absolutely will never, ever forgive yourself if you find out later that he might have been helped if he had been seen, assessed and treated sooner. You need to know exactly what this is from and what (if anything) can be done to help. It's also important for your family to know what to expect, so you can make good financial and legal plans for his future care.   

Get on the phone and talk to the doctor as soon as possible and make sure he knows all about what the family is seeing. If he is reluctant to explore this or if he is aware of it - to properly explain it to the family, ask to see another doctor.

Certainly diabetics are more susceptible to cardiovascular risks, and thus strokes and other brain injuring events (blockages etc. that lead to "multi-infarct dementia", but in this case I'd put my money on the dialysis being the culprit.

Hope this helps.

Mary