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Conflicting Medical Diagnoses
MyMaxie
Posted: Thursday, September 12, 2019 6:40 PM
Joined: 7/20/2019
Posts: 3


DH has had memory issues for over ten yrs.that have gotten rapidly worse over last two years.  Psychiatrist initially diagnosed him with anxiety then major depression and Wellbutrin has helped.  Neuropsychologist did testing which found memory issues including significant discrepancy between IQ and executive functioning and thinks problems are due to chronic kidney disease (stage 3) which he was diagnosed with awhile ago. Psychiatrist now suspects EOAD and sent us to neurologist after several instances of significant safety issues in a one month period.  Went yesterday to neurologist and he said there is no indication of memory loss and MRI looks fine and suggested a sleep study; said may be too early for Alz to be showing up since his IQ is so high. Do I continue taking him to more specialists or wait until things progress further?  I am at wits end and no longer trust him to be left alone because of poor decision making, lack of awareness of situations, his safety and that of our dogs and horses, etc.  Psychiatrist and other specialists have told him not to drive..  Everything hit the fan in December 2018 when I discovered he was stockpiling his prescription meds for years for HPB, kidney disease, heart disease, etc. yet going for follow-up appts. with doctors acting as if he was following their advice.  Neurologist said since he is still able to hold a technical job (he works from home) and he denies any supervisor concerns with his job performance that it is doubtful if is EOAD Do I wait until things deteriorate further?   Has anyone else gone through this issues of conflicting diagnoses and if so how did you cope?
Victoria2020
Posted: Friday, September 13, 2019 11:12 AM
Joined: 9/21/2017
Posts: 936


Are you near any major teaching hospitals with a Memory Unit? Maybe the specialists there can untangle the cause of the behaviors.

Does he drink excessively?


jfkoc
Posted: Friday, September 13, 2019 11:28 AM
Joined: 12/4/2011
Posts: 17275


Take a look at this and see if the diagnosis protocol was followed;

https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers/art-20048075


Marta
Posted: Saturday, September 14, 2019 1:48 PM
Joined: 6/3/2013
Posts: 711


IME chronic kidney disease stage 3 does not, by itself, cause cognitive issues. By definition, in stage 3 the kidneys are clearing 30-59 ml/min of blood, which is adequate to prevent the accumulation of toxins that could cause cognitive dysfunction. Many of my patients over the age of 65 (or younger), have CKD3, but no cognitive dysfunction.  I, myself, have CKD 3, and am practicing as a PCP.

I think what you are saying is that your husband is showing further cognitive decline than what his physicians are able to account for. Remember thatAD and many of the other dementias are diagnoses of exclusion. His doctors may not be willing to commit to a dementia diagnosis until they have seen an objective decline in cognitive functioning, through neuropsych testing, over time:  a minimum of six months, more typically a year. 

In the meantime, you ought to proceed as if he has dementia, based on the behaviors you have observed. 


Caring4two
Posted: Saturday, September 14, 2019 2:09 PM
Joined: 7/6/2014
Posts: 645


MyMaxie wrote:

 Neuropsychologist did testing which found memory issues including significant discrepancy between IQ and executive functioning

 memory issues for over ten yrs.that have gotten rapidly worse over last two years

Sounds like you’ve had some baseline testing done but I would push for more. Specifically fdg-18 PET scan and a spinal tap to check for three biomarkers; t-tau, p-tau, and ab42. This will help in determining a differential diagnosis between AD and FTD. 

My husband (now deceased) was part of an Alz research program at Northwestern in Chicago. He also had a very high IQ and the first symptoms noticed involved executive function. It was these specific tests that helped with the diagnosis. BTW, he had both AD and FTD (Brain autopsy confirmed).


MyMaxie
Posted: Friday, October 4, 2019 9:53 AM
Joined: 7/20/2019
Posts: 3


Thank you all.  A local neurologist saw him on one of his "bad days" when memory was poor, forming sentences was slow and inaccurate in response to questions, and agitation was high.  PET/CT scan and other testing was ordered.  Even if this all shows nothing it was wonderful for my mental health for a medical professional to see firsthand what I experience and acknowledge something is amiss instead of being dismissed.
markus8174
Posted: Saturday, October 5, 2019 7:26 AM
Joined: 1/25/2018
Posts: 535


I think you are on the correct path. Before I saddle a loved one with any dementia diagnosis I would want EVERYTHING ELSE ruled out. Many conditions can mimic Alzheimer's (or other dementia). Once you get the label "*** dementia" you are in for a different approach to his health care that you will run up against with every interaction. Most dementias have little in the way of therapeutic intervention. Sleep apnea, carotid occlusion, electrolyte imbalance, hyperglycemia, endocrine anomalies ... the list is endless of conditions that may give you your husband back. Hears praying that after the full work-up, you will have a treatable answer, and never have to visit ALZconnected again.
Ed1937
Posted: Saturday, October 5, 2019 8:01 AM
Joined: 4/2/2018
Posts: 1514


markus8174 wrote:
Before I saddle a loved one with any dementia diagnosis I would want EVERYTHING ELSE ruled out. Many conditions can mimic Alzheimer's (or other dementia).  the list is endless of conditions that may give you your husband back. Hears praying that after the full work-up, you will have a treatable answer, and never have to visit ALZconnected again.

Absolutely! Every possibility needs to be ruled out before a diagnosis.