The moment we can’t remember where we put our keys, or the few seconds it takes to try to remember where we parked our car causes fear in everyone that I know who is over 50. Immediate thoughts of Dementia or worse creep into our minds as soon as we experience a momentary memory loss. As much as we fear for ourselves, well spouses may sometimes fear even more, seeing symptoms of memory loss or disorientation in their partners. With chronic illness, these symptoms may be a sign of the disease progressing to a new level, or it may be something else completely.

Chronic illness advances the body in its aging process. And so a person in his early 50s who is chronically ill may react to an infection the same way we’d expect from an 80- or 90-year-old person. Because of the chronic nature of the illness, the symptoms displayed are usually seen by family and even sometimes professionals as a natural progression of the illness and looking for other causes of the symptoms may not be the first course of action.

Moshe was hospitalized, yet again, because of pressure sores that were a result of his constant need to sit in his wheel chair. The hospital stay for this procedure was usually around six weeks. His wife was startled when Moshe called her at 3:00 a.m. one night.  When she answered the phone, she heard her husband’s whispered voice, “I think someone is trying to kill me.” Moshe’s wife panicked.

Despite years of chronic illness her husband had always been mentally competent. She knew that as the illness progressed there was a chance that his cognitive skills might deteriorate. But he had been mentally sound for so long she thought they had escaped this part of the progression of his illness. All night her husband kept calling with whispered stories of strange people trying to poison him, of being forcibly moved to unfamiliar places and even asking her to call the police before they killed him.

When she arrived at the hospital the next day, Moshe’s condition seemed a bit better. He would wax in and out of this paranoid state, alternating between recognizing the nurse and refusing to take medication convinced it was poison.  But as the day progressed, so did the paranoia and the nurses were talking about using restraints and forcing medication on him.

Moshe’s wife was beside herself. Could the illness suddenly progress to this stage so quickly? Two days ago they were talking about filing income tax and paying bills and today Moshe had accused his wife of being part of the group that was trying to kill him.  Things got steadily worse over the next few days. A neurologist was called for a consult. Even a psychiatrist was called in. Tests were ordered.

Moshe’s wife saw her life as a “well spouse” taking a turn for the worse in a way she never thought possible. Finally, several days after the onset of the paranoia, it was discovered that Moshe had a Urinary Track Infection. He was put on a dose of antibiotics immediately and within hours the bizarre symptoms he was displaying began to diminish. Slowly, his mental state returned to normal.

The doctor explained to Moshe and his wife that people with chronic illness react to infection the same way the aged do and they can often display symptoms that look more like mental illness than physical ones. This makes diagnosis difficult.  Especially when the person suffering from the chronic illness is relatively young, medical professionals sometimes forget to look for a simple physical cause and just assume it is the illness progressing.

Well spouses need to be acutely aware of this phenomenon. This is especially true if their spouses are young and have not shown cognitive impairment to date. A sudden change in behavior, memory, even onset of paranoia may be a result of nothing more than a simple infection. Infection needs to be ruled out as the cause before blaming the progression of the illness.

Unfortunately, it may be up to the well spouse to remind the doctors of this and insist on the testing, as too often the chronic illness is diagnosed as the total cause for any medical condition or change that we may see in those we love.

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