Dad was completely muddled yesterday and back to normal this morning. Is this the dementia starting?

#1ron-at-home(Joined Aug 2025 · 17 posts)January 12, 2026, 9:05 pm

Yesterday afternoon my father did not know where he was. In his own front room, in the chair he has sat in for twenty years. He asked me twice who was driving him home. By about six he was agitated and cross with me in a way he has never been in his life, and I sat in the kitchen afterwards genuinely frightened.

This morning he was completely himself. Made his own tea, read the paper, asked about the cricket, no idea anything had happened. I had spent the night reading about dementia and by nine o'clock this morning I felt ridiculous.

So I have not rung anybody, because what exactly do I say? He is fine now. If I ring and describe yesterday they are going to ring him or come out and he will be perfectly lucid and I will look like a son who panics.

Is this how it starts? Is a day like that the first sign? He is 84, he had a hip done in November, and he has been a bit slower since but nothing like yesterday.

#2tomsdaughter(Joined Jan 2025 · 31 posts)January 13, 2026, 6:52 am

Ring today. Please. The fact that he is fine this morning is not the reassuring part of your post, it is the part that would worry me most.

#3dee1972(Joined Apr 2025 · 24 posts)January 13, 2026, 9:14 am

I did what you are doing and I lost eight days to it.

Same pattern. Muddled and shouty by late afternoon, back to herself by breakfast, and every time I thought about ringing it was one of the good mornings and I talked myself out of it. On the ninth day she could not stand up and we went in by ambulance and it was an infection that had been building the whole time. The confusion was the first sign of it and I had been reading the confusion as the beginning of dementia.

What I have never forgotten is the doctor asking me when it started, and me being able to say Tuesday afternoon, and her face changing. Apparently Tuesday afternoon is an enormously useful answer. Months is a different conversation entirely.

#4Dr Nadia FarhatMedical moderator(Joined Nov 2024 · 54 posts)January 13, 2026, 6:31 pm

Ron, this is a same day call and I would make it in the morning rather than sitting on it, so I will put the reason first and the detail after.

Confusion that arrives over a day or two and comes and goes through the day is delirium until somebody has shown otherwise. Dementia arrives over months and years and is broadly stable from hour to hour. NICE's guideline on delirium, CG103, describes it as an acute onset with a fluctuating course, usually developing over one to two days, which is your yesterday almost word for word. Delirium is not a diagnosis on its own, it is a signal that something else is going on, and the things that cause it are very often treatable: infection, dehydration, constipation, pain, urinary retention, and extremely commonly a medicine.

Three things sort this, and memory is not one of them, because both conditions affect memory. Speed of onset. Fluctuation. And attention, meaning whether he can hold the thread of a sentence or follow a simple instruction, which is disturbed early in delirium and relatively preserved until late in dementia. The four feature version of that formulation that you will find everywhere comes from the Confusion Assessment Method developed by Inouye and colleagues rather than from NICE, so credit it correctly if you go reading.

Now the sentence I most want you to take from this. Fluctuation is a feature of delirium, not an argument against it. The good morning is part of the picture. When you ring, describe the worst part of yesterday and not the best part of today, and say when it started. Delirium is often worse in the late afternoon and at night, which is exactly what you have described, and it is also frequently missed in its quiet form: CG103 asks clinicians to be particularly vigilant for withdrawal, slow responses, reduced mobility and movement, worsened concentration and reduced appetite, because those changes are often missed. If he had gone quiet rather than agitated you might not have noticed at all.

Two things about his November put him in a higher risk group rather than a lower one. Delirium is common after surgery, and CG103 puts it at 10 to 50 percent of people having surgery, against about 20 to 30 percent on medical wards generally. After a hip fracture specifically the Scottish guideline SIGN 157 puts it as high as 50 percent. "Been a bit slower since November" is worth mentioning on the same call.

What to ask for, in these words: an assessment today, and the name of the person who will do it. If somebody says they will use the 4AT, that is the assessment NICE recommends since its 2023 update for identifying delirium outside critical care, it is brief and it needs no special training. Asking whether a 4AT has been done is a much more specific request than asking whether somebody has had a look at him.

On your actual question, whether it could be the start of dementia. It can be both. CG103 says plainly that it can be difficult to distinguish delirium, dementia and delirium on top of dementia, and its recommendation 1.6.3 is that where there is difficulty telling them apart, you manage the delirium first. That is not a fudge, it is the sequence: the delirium is the part that can be treated urgently, and treating it is what shows you where his actual baseline is. Families are very often told a relative went downhill with the dementia when what they had was an untreated infection sitting on top of it.

Who to ring today, and his own clinician first, because they know what he was like in December. In the UK that is his GP surgery, and NHS 111 out of hours. In Ireland the GP or the out of hours GP service. In the United States his own doctor's office, the nurse line his plan runs, or urgent care. In Australia his GP, or healthdirect on 1800 022 222. In Canada his family doctor or the provincial health line, 811 in most provinces. Immediately, and by ambulance, if there is changed breathing, chest pain, one sided weakness, changed speech, a first seizure, bleeding that will not stop, or he cannot be roused: 999 or 112 in the UK and Ireland, 911 in the United States and Canada, 000 in Australia.

Delirium or dementia sets the two side by side properly and spotting when someone is getting worse is the wider version of the speed rule.

Two last things. Please do not open the call with "I do not want to waste your time". Under reporting by carers is the problem in this subject; over reporting is not. And I have not met your father, examined him or seen his notes, so nothing here is a view on what is happening to him. It is a view on how fast the question needs asking, and the answer to that is today.

#5K. McAllister(Joined Nov 2025 · 11 posts)January 14, 2026, 4:40 pm

Just to add the practical version of the fluctuation problem, because it caught us out. Ours was assessed at eleven in the morning by someone who had never met her, was told she was oriented and fine, and that was the end of it for a fortnight. Nobody had asked me what four in the afternoon looked like.

If you can, be there for the assessment, and say the words "she is at her best right now" out loud if she is.

#6ron-at-home(Joined Aug 2025 · 17 posts)January 15, 2026, 7:44 am

Rang first thing yesterday. Said the word delirium, said it started Sunday afternoon, said it comes and goes, said he had a hip done in November. Was taken seriously in a way I was not expecting, given how many times I had rehearsed being told I was overreacting.

Doctor came out in the afternoon, did a short assessment I now know the name of, and he is being treated for something that was found on the spot and which I will not go into. Not going into hospital at this stage.

He was muddled again yesterday evening, by the way. So the good morning was exactly as much use as everyone here said it was. Thank you, all of you, and particularly for the bit about describing the worst part rather than the best. I would have rung and said "he seems fine now" and got exactly the response that deserves.