Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Father, white male, 73 Approx 170, 58 Date of onset 2015My father is currently in a nursing home with the diagnosis of dementia. What is odd about this is that the dementia was sudden onset. The first thing that happened was that my father had an episode they called syncope in December of 2015. He fell down and according to my mother he appeared to seize up. My father is a poor historian since all this and my mother as well so I have to relay this as my memory serves and as she told me so some pieces are missing and some things may be confused.After the syncope episode he did go to the hospital. I am not sure what treatment he started at that time. I believe he had a work up for stroke and seizures and it was negative. In the subsequent months/years my father began to become obsessed with checking his blood pressure. BP readings were not abnormal at this time but he was convinced something was wrong with him. In the medical records it was documented that my father stated something is wrong. That was the last time my father was ever somewhat normal. He lost interest in his usual interests. He appeared quiet and withdrawn. I believe at this time he was taking medication for high blood pressure, prostate medication, cholesterols meds, and Zoloft.My father deteriorated badly enough that he was especially confused one night. My mother and I were concerned enough to take him to the ER. He had severe hyponatremia. I believe his sodium was in the critical range. He had a long hospital course. I believe the hospital corrected the hyponatremia carefully and slowly and I do not find fault with them over this. During the hospital stay my dads heart went bradycardic and he coded. He had to receive a pace maker.After they corrected the sodium my dad never came out of the confusion. He underwent so many work ups to see why he was experiencing the confusion. All the scans, PET scan, blood tests were negative for anything that would explain the confusion.My dad came home with the pacemaker and remained confused. He remained with a flat affect. Loss of interest in hobbies. Diagnosed with dementia at this point. The doctors couldnt explain why a sudden onset of dementia but said this wasnt the usual presentation.Sometime after this my dad had an episode of status epilepticus and went to the hospital. He was placed on a seizure medication at this time. I dont know which one but I can tell you that after he began seizure treatment his personality returned. He improved somewhat.After this he began to deteriorate to the point of not being able to use the restroom in his own. He started wearing diapers. He became bedridden. My mother decided to place him in a nursing home. He recognizes family but isnt oriented to time and space. I do know he began mirtazapine around this time. I was hopeful this would improve his condition if it were not truly dementia. I believe its been about a year since and my dad remains confused. Hes still wheelchair bound.I read promising studies regarding mirtazipine but as time goes on Im not hopeful he doesnt have dementia. Im posting this in hopes anyone can provide any insight over my dads case. My hopes are that he had pseudo dementia.Ill add that all of his care was provided by the VA. We never accused them of any wrong doing. His primary care doctor and neurologist no longer work at the hospital. They asked us repeatedly if my dad was an alcoholic. We would ask why he seemingly developed dementia overnight and they would ask us if he were an alcoholic. My dad was a heavy drinker at times but we didnt feel like alcohol contributed to anything so said no. I know from working in GI that if someone is an alcoholic its hard to hide from a proper work up. Its possible my dad drank more than I knew and its possible that he truly did have dementia but hid it. I guess my question is does this sound like true dementia? Is there anything else that can be ruled out?. ### Response: You say sudden, but it sounds like this has been slowly progressive now for almost 6 years, not overnight. That's a fairly typical course for Alzheimer's disease, with initial loss of memory, later urinary incontinence and more global confusion, and later loss of mobility and total impairment. Pseudodementia has particular findings on assessment that indicate for or against; one element is depression. Your father has been on antidepressants, but it's not really clear, at least to me, what depressive symptoms he has had other apathy and loss of affect.But other things don't fit. Neither pseudodementia nor Alzheimer's dementia present with seizures. Severe hyponatremia can, but that would need a workup and cause. Sometimes the cause is brain injury causing syndrome of inappropriate antidiuretic hormone (SIADH), which lowers sodium, which can cause seizures, but it's still not obvious why the first episode of syncope. Eventually severe bradycardia requiring a pacemaker, but not initially?Timing and type of head imaging makes a difference. With the the triad of dementia, incontinence, and now loss of mobility, has there been any discussion of normal pressure hydrocephalus? It would usually be picked up, or at least suspicion identified on CT at some point, but it partially fits and should at least have been ruled out..