Dementia with sudden confusion and dehydration, infection, cancer, and old infarction.
Dear Sir or Madam,
You have already helped me very well once and I hope that you can also assist me with my following question. I am requesting support in interpreting test results that are 11 months apart, in the context of the ACUTE onset of confusion in an 89-year-old patient. General condition: cachectic after having recently undergone surgery for esophageal cancer (approximately 1.55 meters tall, 39 kilograms), long-term lack of appetite, acute dehydration, diagnosis of depression a few months ago, reduced overall condition. Severe pain and sensitivity in the abdomen for several weeks. Attempted self-treatment by the patient with painkillers.
The following test results are available:
11 months ago: Neurologist (reason for examination: unclear vision problems) - Information in the doctor's report: Current MRI of the brain is normal. Exclusion of brain metastases or a recent cerebral infarction. Doppler/TCD considering main and additional criteria consistent with macroangiopathy without hemodynamic relevance (LE 10%).
Currently, information in the doctor's report (hospitalization after sudden onset of confusion) - Dehydration, dry tongue. / Native CT: Small lacunar, presumably post-ischemic defect in the left cerebellar hemisphere. Signs of pronounced SAE. No clear evidence of a fresh infarct demarcation. No evidence of an intracerebral mass. Global brain atrophy, still age-appropriate. / Thorax: Faint, round density in the left paracardial middle/lower field, corresponding to a mass. / Lack of appetite due to gastritis / Urinary tract infection.
Regarding the confusion, aside from dehydration, no metabolic cause was found. Improvement in cognitive abilities was achieved under treatment for the infection and dehydration. We ask to ensure an adequate intake of fluids.
**Based on these results, the doctor concludes that infarcts have occurred outside the cerebellum and therefore diagnoses dementia.
Does the CT result in particular provide reason to believe that infarcts have occurred conclusively outside the cerebellum, or does this seem more like an interpretative view of the doctor? Does every infarct necessarily lead to dementia? Since the confusion occurred ACUTELY and SUDDENLY, I request an answer to whether the acute confusion must without a doubt be caused by dementia, especially considering that a fresh infarct - as I understand it - apparently cannot be detected, or what role dehydration, the long-standing depression, and the physical condition due to the cancer diagnosis might play here.
The doctor quickly assumes dementia. I would particularly like an answer to whether, based on the available test results, the acute confusion only allows for the diagnosis of dementia or if the acute confusion could have its cause elsewhere and should be further investigated.
Thank you for your effort.
