Vascular dementia with sudden onset?
My question relates to an 89-year-old individual. She has always been mentally very sharp, but physically weakened due to a previous stomach/esophageal cancer (partial removal of stomach, esophagus, lymph nodes in 2010) with underweight. The family doctor attested significant problems with food intake as a result of the cancer surgery. The cancer has now recurred. Dehydration has been repeatedly observed.
In 1977, a diagnosis of depression was confirmed, and since mid-2011, recurrent episodes of depression have occurred. Suddenly, she had to be admitted to the hospital with confusion. According to confirmations from two doctors who have been treating her for months and years, there were no signs of mental impairment until that day.
Examination results in the doctor's report: significant anemia, dehydration, dry tongue. Small lacunar possibly post-ischemic defect in the left cerebellar hemisphere. Signs of severe SAE. No clear evidence of fresh infarct demarcation. Global cerebral atrophy still age-appropriate. No indication of a tumor or similar.
In the hospital, she shows (as she has since 2010) lack of appetite and is uncooperative with the hospital staff, although this behavior has occurred frequently in the past. I cannot detect a change in personality, but the doctors who are seeing her for the first time do not take this into account in their assessment.
Now to my question: There is a suspicion that this may be a case of vascular dementia with a sudden onset. However, as far as I know, this only occurs in the event of an acute stroke. I understand the test results to indicate that there was NO recent stroke. Two doctors who have treated her for years say that there is no dementia from SAE with a gradual course, but there may be temporary mental impairment due to dehydration. Alzheimer's dementia with a sudden onset has been definitively ruled out.
I am wondering what role dehydration and depression could play in the current symptoms. Specifically, I would like to inquire whether vascular dementia can also have a sudden onset, even if there is no acute stroke event, and whether it is even possible to definitively determine the cause of confusion in the present conditions.
