One day in 2013, when dad was still an actively practicing dentist, the bottom suddenly fell out. Within an hour of getting home – he experienced a sudden stroke-like incident that sent him to the hospital.
Over the next 3 days of observation, doctors could not find anything wrong. Yet they detected a slight cognitive concern – enough to require him to receive Occupational Therapy at discharge.
Dr. Crandall was very compliant. Therapy quickly returned him to baseline. But then the headaches started, and fevers, insomnia and later, after a week or so, his joints started to swell.
Lyme was immediately suspected, and Doxycycline was started. Despite receiving a full 2-week course of antibiotics, Dr. Crandall indicated that his condition was unimproved. Lyme testing came back negative. By this point, he was in excruciating pain and desperate for answers.
Visits to every ER in the cities yielded diagnosis’s ranging from mental illness to drug seeking. Interesting, everyone offered him opiates. But no one could offer him an answer to what was really causing his joint swelling and pain.
At the point he was unable to walk, Dr. Crandall visited his Neurologist. He was hospitalized immediately for a full work up. Infectious Diseases administered a cocktail of antibiotics intravenously as they ran more tick borne testing. By the second day, Dr. Crandall was in the fetal position, unable to talk. When asked what day it was, he said “banana.” He had no orientation to person, place or time. The doctors were all very visibly concerned.
The Infectious Disease testing was all negative and so the antibiotics were discontinued. In replace, the Neurologist administered 100 MG of dexamethasone via IV. In 20 minutes, Dr. Crandall was standing independently. He was able to identify where he was and did jumping jacks in front of staff. He said “I have not thought this clearly in years.”
Dr. Crandall was referred to Mayo Clinic in Rochester https://www.mayoclinic.org/where he was seen by virtually every discipline. It was determined by Rheumatology that he had Polymyalgia Rheumatica (PMR) which is an auto-immune disease. Dr. Crandall was placed on steroids in effort to stop his body from attacking itself. The treatment was very successful in reducing joint swelling and pain. An added unexpected bonus was that the high doses of Prednisone also helped DEC’s cognition. In fact, his scoring in standardized testing (MOCA) were drastically improved from his baseline at intake.
Over the next 6 years, Dr. Crandall had been on increasing doses of steroids. Initially the dosing was meant to enable him to maintain his independence. But later the steroid increases have been used to prevent Apraxia – which sets in when his steroid dosing falls. It’s important to note that to this point, Dr. Crandall’s Neurologists have never known Apraxia to be steroid-responsive. But in Dr. Crandall’s case, it most certainly was.
This story of cognitive steroid-responsiveness has perpetually intrigued doctors. Especially since much of our current knowledge of Dementia asserts that steroids can cause delirium and agitation in these patients. But in Dr. Crandall’s (my dad) case, just the opposite is observed. The question therefore is why?
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