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Neurology Diagnosis
Posted: Thursday, November 7, 2019 7:31 PM
Joined: 8/1/2019
Posts: 7

Is this necessary?  My moms pcp diagnosed her dementia as irreversible and deteriorating. There is no cure but my brother is insisting I drag her to a neurologist. I just don’t see the point. Can someone provide some insight on what a visit to a neurologist would entail?
Posted: Friday, November 8, 2019 5:47 AM
Joined: 3/6/2017
Posts: 2217

It's hard to say.

A lot depends on how thorough your PCP was, how old your mom is, what her general health is otherwise IMO. I know some here who would insist of every step of the diagnostic process for their own loved one from blood tests, to high tech imaging to hours long neuropsychological testing. 

A dear friend felt satisfied with the bloodwork to R/O treatable conditions that mimic dementia for her 901 year old mother. Mom already showed symptoms of breast cancer which she had long said she would not treat after age 80 DF had all the documents she needed to step in to act for her mom and was already co-owner on her property and accounts. Her PCP took very good care of her medically until she went on hospice about 4 years after the diagnosis. She died peacefully at home just before her 94th birthday. 

I "subjected" dad to all of the medical testing. He had mixed dementia and some mental health issues which made his presentation complicated. My mother was a big piece of why we sought a complete workup; she needed a rigorous diagnostic process to buy in. 

I had seen personality changes and memory/reasoning glitches in dad as early as 2005 whereas she was oblivious until about a year before he was diagnosed. My concerns were blown off for almost 10 years. When dad developed psychosis and we took him to the ER where individually we each gave a history that mirrored our own belief. In the end, dad had a lot of imaging, bloodwork, and testing and we came away with a mixed dementia diagnosis- the Alzheimer's I sensed over 10 years prior and Wernicke-Korsakoff's Syndrome which got mom's attention. A complete workup was important for dad because the WKS was treatable- he had a blood draw which was borderline but his PET scan was much more conclusive. WKS is the result of a Thiamine deficiency. If caught early and treated (IV Thiamine and abstinence from alcohol when that's the cause) the person can recover some cognition and stop the progression of the brain damage. I have a cousin in his late 50s who was diagnosed with WKS related to alcohol abuse- he got treated and sober and is able to live semi-independently; he's lost considerable cognition and can't work or manage money but can live in an in-law apartment, heat meals, do his ADLs and take public transportation.

My aunt also had a soup-to-nuts diagnostic process. She was a childless widow with considerable assets and no documents around care she might need. My mom and another sister had to assume guardianship which required not just the usual medical tests, but also two afternoons of testing with a psychologist to get a sense of how and where her cognitive and executive function deficits were. 

My other aunt went untested; her daughter with special needs did not appreciate how impaired her mom had become and did not report any of her very concerning behavior. This led to them making the classic mistake of placing her mom in AL when the DD refused to live with her anymore. This aunt was not the pleasant little old lady with VD- she got into altercations with staff and residents.  She didn't have the bandwidth to show up for meals, attend to hygiene or engage in anything but fights. Alas, she had a fall and broke her hip and wrist. She had a big drop in terms of progression around this time that likely caused the fall. Her time in the hospital was a nightmare as she wouldn't stay in bed and clawed at her soft cast constantly. Rehab was even worse for her and her DD, DIL and sister who took turns "sitting" until she died 6 weeks after the fall.  

It's true that there is no "cure", but some people do seem to do well on some of the Alzheimer's medications for a time and in the case of something like a vitamin or hormone deficiency, there is treatment that can restore cognition. If the PCP did bloodwork, this is less likely to be the case.

If your brother needs her to see a neurologist for his own reasons, I might let him do that so long as he has a good relationship with her. She's his mom, too. 

Posted: Friday, November 8, 2019 10:19 AM
Joined: 12/4/2011
Posts: 18489

There are many causes for dementia. You need a proper diagnosis following current protocol to eliminate treatable causes. The PCP is rarely the person capable of making this diagnosis. Please go  online and read about the correct procedure for diagnosis and be certain that all of the boxes were checked for your mother.
Posted: Friday, November 8, 2019 10:44 AM
Joined: 10/9/2014
Posts: 1091

I think there are many factors that go into exploring details about the dementia, but, normally, knowing why is helpful, because it could be due to something that is treatable, as stated upthread.  After primary doctor diagnosis, we saw neurologist to rule out brain tumor, vitamin deficiency, fluid on the brain, etc.  We also got a good idea of her progression, as he did more tests of her reflexes, gait, etc. And, the MRI was helpful. as it gave a baseline.  

I do understand that some families do not pursue multiple tests, if there LO is already terminally ill, immobile, advanced in age, on Hospice,  etc.   

Posted: Saturday, November 9, 2019 9:08 PM
Joined: 8/1/2019
Posts: 7

My mom is 83 and frail. Her pcp diagnoses irreversible and deteriorating dementia. She panics at blood being drawn and is claustrophobic. I can’t wrap my head around a reason to put her through a neurologists tests
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