Question

My Dad has trouble remembering, but he doesn't have any problems in everyday living. However, if he falls asleep sitting up, and then wakes up, he is confused and has a mood swing. My husband said this is a sign of hardening of the arteries. Is that true? He doesn't get confused if he falls asleep in bed, just when he sits up.

Answer

We understand your concern about your Dad, and your husband is not incorrect in what he says, but there are several other causes of deteriorating intellectual capacity in the elderly, as well as atherosclerosis ( hardening of the arteries) in the brain. We do not know anything about your Dad, his age or medical history, so it is important that he be assessed and his symptoms investigated by his own doctor, to out rule atherosclerosis, or diagnose his condition.
 

You say your Dad has trouble remembering, can be confused and has mood swings. Perhaps your Dad may be depressed. It is not unusual for elderly people to experience sadness, social isolation and loneliness. These three symptoms of depression - Confusion, irritability or demanding behavior, memory problems; difficulty concentrating are only 3 of many symptoms the depressed elderly can portray. (See the long list in the first link below). Because he is elderly he may be conditioned by the stigma of an earlier era and try to hide his depression from you and his doctor. Also many people think that depression will go away by itself, they're too old to get help or getting help is a sign of weakness. Such views are simply wrong. Depression is a treatable psychological problem.
 

There are many other possible causes for depression in the elderly Other causes may be : fear of death - frustration with memory loss - difficulty adjusting to stressful or changing conditions (i.e., housing and living conditions, loss of loved ones or friends, loss of capabilities, etc.) -being unmarried (especially if widowed) -recent bereavement -decreased mobility due to illness or loss of driving privileges -lack of a supportive social network - vascular changes in the brain-chronic or severe pain - a vitamin B-12 deficiency (as yet unclear if this is caused by poor eating habits or a result of depression).
 

Depression by itself can mimic dementia; a situation sometimes called pseudodementia. When people are depressed, they can have difficulty concentrating, and this leads to forgetfulness. Making matters worse, many people are reluctant to seek help because they fear they are developing dementia, when in fact they are delaying a diagnosis for a treatable condition. It is possible that elderly people will become forgetful, disoriented and confused due to a quickly reversible condition that is totally unrelated to dementia.
 

Mood changes may indicate dementia, although you have clearly indicated that your Dad "doesn't have any problems in everyday living." Dementia is a term used to describe a number of physical disorders of the brain arising from several different causes. However they all have in common a decline in intellectual function, especially loss of memory, difficulty in finding the right words or understanding what people are saying, and mood changes. Alzheimer's disease is a degenerative brain disease that impedes, among other things, the ability to remember. Because this disease begins with memory loss, many people who experience forgetfulness fear they may have Alzheimer's disease.
 

Atherosclerosis is a condition in which fatty material collects along the walls of arteries. Alternative names for this condition are Arteriosclerosis or hardening of the arteries. If blood flow in the arteries leading to the heart is reduced, chest pain can occur. When atherosclerosis narrows brain arteries, it can cause headache; dizziness or confusion; weakness or paralysis on one side of the body; sudden, severe numbness in any part of the body; visual disturbance, including sudden loss of vision; difficulty walking, including staggering or veering; coordination problems in the arms and hands; and slurred speech or inability to speak. If symptoms disappear in less than 24 hours, the episode is called a transient ischemic attack (TIA). Sometimes symptoms occur only with activity. In some people, however, they may occur at rest. Intellectual impairment can result when a series of small strokes occurs (multi-infarct dementia). Although damage from small strokes is typically irreversible, built-up atherosclerotic plaques can be surgically removed or medically treated in order to prevent future strokes from occurring. If action is taken early enough, the person can be helped. However, the National Institute on Aging states that some 100 conditions which mimic serious disorders are actually reversible. These are sometimes called 'pseudodementias' and are often treatable.
 

Related Links
Depression in the elderly
Frequently Asked Questions (FAQs) About Memory Loss