Grandpa Sam

In Fresno I have a granddaughter who has another set of grandparents, Sam & Nina. Grandpa Sam is pushing 90. He is a retired cop and although generous and civil, he’s never been a really warm guy. Nina called me a few weeks ago to ask what she should do about Sam, as he seemed to be getting confused. They had made an appointment with a neurologist to have him evaluated. I saw Sam at a recent visit and noticed he was friendlier than in past years. He was warm. He asked a lot of questions about our drive, about the kids, about the drive, and about the drive. Nina said he had started to get lost just after that and he was having periods of disorientation and forgetting.
Since Sam had a quick decline in function rather than a long, step-wise change, I told Nina a Geriatrician might better diagnose him than a Neurologist. If it’s not a specialty you’re familiar with, think Pediatrician-Geriatrician, a Gerontologist studies in the field of sociology, not medicine. I told her to be sure they did a Chemistry Panel, Blood Count, B12 and Folate levels, Urinalysis and chest X-ray. Urinary tract infection or pneumonia are the most common causes of rapid change in mental status for older adults.
Nina called back after a few weeks to let me know after the work-up a little sub-lingual vitamin B12 had fixed Sam right up! He didn’t have Alzheimer’s, or a stroke or any of the things everyone was expecting. Absorption changes in the gut with age and injections of vitamins aren’t always the remedy. See your doctor if you think you may be having changes in mental ability and expect some silly requests like drawing a clock. Those are some of the most important screening tools used. If there is an immediate change in mental orientation in an older person you know, ask the older adult to repeat a simple sentence, smile and raise both hands. If they suddenly can’t do those things, call 911. The first hour of a brain attack is the most important for full recovery.
I hope Sam’s still warm when we go back next visit.