Here is the tricky part, Paula was not aware that she was suddenly impaired mentally. So she went to work and only found out upon doing work that she had no memory of what to do. She then felt stupid. And then silently wondered why she did not know what to do and then forgot. She tried again, found that again she did not remember what to do, felt stupid [again] worried about it again, and the [again] forgot. She did not tell anyone, because she did not know, until she tried to do something. She was in this endless loop.
Paula did look depressed though, her face had no expression, and she was slower to move and her posture was slumped- most likely because of her difficulty breathing. She was short of breath and could barely speak and said nothing about this, because she’d forget.
Interestingly [for me-her friend], she tried to arrange a large event during our shared lunch hour. She would call to arrange for a delivery, and when she was asked for her address, she was shocked to realize that she had no knowledge of her address. I witnessed this happening again and again. She learned to bring an envelope with her address written on it [with my help]. It was most upsetting.
I gave her a digit span test. She had to remember 7 numbers forward and the 7 numbers backward. She got 5 forward and one backward. Her memory was destroyed!
And she did not know she was mentally impaired because she forgot each time.
This is why simple tests like the digit span test or even being asked for one’s address and phone number are so important to look for mental impairment.
No wonder these patients get upset and depressed. Even if they cannot say what is wrong, they know something is wrong and that they are suddenly failing at whatever they try to do.
When Paula got better, her memory returned- this was a quiet delirium, or a reversible dementia; it is important, in an acute condition-even if it becomes chronic- it is important to understand that spontaneous recovery or treatment is only successful if the mental impairment disappears and the patient’s baseline intellect returns; only then will the depression [or whatever it is] go away.
Apparently, depression and [hidden] difficulty breathing often occur together.