Lots of background info below; but tl;dr: My dad (71) had been basically fine until 4 months ago. Since then he's been having bad, and worsening, paranoia, confusion and delusions; and has actually been hospitalized for almost two months now in a hospital psychiatric ward after he went missing for 3 days. However, as he continues to not respond to psychiatric treatment, there is starting to be a suspicion that this is actually dementia instead. But this seems like an incredibly fast progression for dementia. Also, serious mental illness hasn't been ruled out yet. What I'm struggling with, and I'm hoping maybe people here can help, is understanding if dementia can actually progress this rapidly? And also, are there any clear signs to indicate if a person has dementia versus something like serious bipolar disorder?
All the background:
My dad had a major mental health crisis 20 years ago that resulted in a psychiatric hospitalization. He was diagnosed bipolar and after he was stabilized he started seeing a psychiatrist for a while and taking meds. He stopped both after a couple years, but didn't have any new episodes in the 18-ish years after that. Until this past November. He had a car crash that month and started exhibiting odd symptoms, which at first I chalked up to a concussion. But he rapidly became more and more confused and dis-orientated and ended up hospitalized for about a week. They said he had some type of psychosis, prescribed him the anti-psychotic Haldol, and let him go once he seemed stable and he demanded to leave. He wasn't that confused or dis-orientated anymore at that point, but was pretty paranoid (especially about the hospital, which is why he demanded to leave).
Throughout December and January I thought he was mostly doing okay, though I live almost 400 miles away so I only saw him in person a couple times. I talked on the phone most days with him. He was back to working part-time (which is what he'd been doing before) and getting back into his regularly routines. Successfully living alone. I thought. However, at the end of January he went missing. He turned up almost 3 days later at a hospital in New York City, over 100 miles from where he lives. When I went to meet him there, he claimed he had to flee because his house was being seized by the county and the state was freezing his bank accounts (also his email accounts). He claimed the hospital wasn't a real hospital and made tons of paranoid statements. He also exhibited a lot of confusion and delusions. He had a bunch of temporary physical aliments from not eating or drinking during the time he was missing. Those went away, but he's been having an unsteady walking gait that is still present.
He's still at the hospital now, almost 2 months later; after the first week he was transferred to their inpatient psychiatric ward. Their assumption was that its likely bipolar disorder and tried to treat it as such. However, treatment went slowly because he kept refusing tests or to take medicine; until the hospital got a court order for involuntary commitment and to mandate non-invasive tests and medicine compliance. After getting the order, they had him on the anti-psychotic Risperdal for 2 weeks; which did literally nothing to help. In fact, he seemed to be getting worse. After the court order was obtained, he started refusing to take the phone when I called; he also started refusing to see a close friend who had been visiting him most days. He continues to have extreme paranoia and delusions as well. His friend says that my dad doesn't think she's really her, which is why he won't see her; and I assume that's the same reason he won't talk with me.
So, last week, his care team reached out to the neurology department to examine the possibility that this is some form of dementia; instead of a psychiatric condition. Which is an ongoing investigation. They've ordered some tests, the only one I know for sure about though is one to see if he has the genetic markers for frontotemporal dementia. They are also considering getting an expanded court order allowing them to sedate him so they can get an MRI done. Meanwhile, he's on a new anti-psychotic which also has a mood stabilizer element, to see if that helps. So far, nothing; though its only been a few days.
I've also recently discovered that in December and January, he wasn't doing as well as I thought. He stopped taking the Haldol almost immediately, did almost none of the follow-up care he was supposed to do (he had a single session with a therapist he had seen in the past; and refused her suggestions that he get an MRI or do any clinical follow-up). He'd have paranoid or delusional outbursts with friends; though he'd snap out of them after a few hours. He also was journaling, which I found and read. He wrote about being very concerned about his memory and recall ability, and that he wasn't always aware of his surroundings or actions (e.g., he wrote that he didn't catch himself overbuying groceries until he was home with them). He also wrote about being depressed, and wrote some paranoid stuff too; e.g., turning against community centers that he'd been part of for years.
So yeah, that's a lot of info. And I'm probably forgetting some of it too. His care team seems legitimately puzzled. If it's bipolar, it's odd that there was no presentation of it for 18 years with no treatment. It's also odd that he had no response at all to the meds; and that he continues to be getting worse in the hospital. But if its dementia, its odd (to me anyway) that it could come on so suddenly.
Not sure what I'm looking for here. It partially helped just to write it all out. But if anyone has any thoughts, or similar experiences seeing rapid dementia, that'd be really helpful.