Recommended Annual Screening

Chammer

I spoke with Nurse Practitioner at DH’s endocrinologist office - she is the closest thing we have to a primary physician - shared my concerns about his mental and neurological status.  I asked that it be confidential as he is already sort of paranoid.  There is testing she is going to recommend at his 3 month visit next week and their office has a psychiatrist on staff as well.  She said she will recommend these as “recommended annual screenings.”  She recommended that I add B vitamins as I also shared his significant alcohol use which I already do but he isn’t regular in taking his meds.  Fingers crossed that we figure out that either I am crazy or he does have some neuro or cognitive dysfunction.

harshedbuzz

This is concerning. 

Has the NP run any bloodwork on your DH ahead of suggesting B Vitamins?

There is an alcohol-related dementia, that has the potential to be reversible with treatment and abstinence, if caught early and treated promptly. The condition is Wernicke-Korsakoff's and is the result of a Thiamine deficiency usually from chronic alcohol use but also eating disorders, bariatric surgery, some cancers, AIDS, extreme morning sickness. There seems to be a genetic piece to it as not everyone who abuses alcohol will develop it. In my family my dad and his nephew were diagnosed and my sister likely had it in the last months before she succumbed to AIDS.

Symptoms noted are often a very poor short term memory, inability to regulate body temperature (always cold), unsteady gait, vision/eye issues and a strong tendency to confabulate. When the ER resident had a concern that part of dad's confusion might be WKS, he proactively started him on high doses of IV Thiamine which he was kept on for 5 days. We were told that vitamin tablets would not be absorbed adequately enough to get his levels where they needed to be to prevent permanent damage. He also was supposed to stop drinking which he was unable to do. 

I don't know what sort of testing she plans. A NP could do a quick MMSE or MoCA as part of an office visit. My mom's health insurance gives her an annual NP well check that includes the MMSE as a screening. This could show some memory loss that needs to be evaluated further. That said, some people can do fairly well on these if they bring a lot of cognitive reserve to the party. Dad scored surprisingly well on some of the tasks well into the disease.

HB

jfkoc

ALZ.org is at the top of the page where we sign in/out. There is wonderful information on this site.

Please make certain that your husband is diagnosed following proper protocol and that he has a Dr who routinely treats dementia.

Chammer

Thank you for your replies.  DH is very resistant to health care interventions which is why I reached out to the NP at endocrinologist office.  He tolerates her very well and doesn't get snarky with her.  She is limited in what she can recommend over a phone call and we are limited to what DH will allow as far as testing and treatment.  He doesn't have any cognitive or dementia diagnosis yet, is young (59), and a local active businessman (he has lots of support in that area including me as we have our own business).  

Even if we are able to get a diagnosis, there isn't a guarantee that he will accept treatment.  I had to start somewhere though!  

Chammer

Updating this old(er) thread – DH had NP appt on Nov 13 and she had checked his Vitamin B (thiamine) and it was within normal limits so I’m thinking WKS is not the current culprit.  There weren’t any other labs that were unexpectedly out of whack – his Hgb A1C is high, but he doesn’t take his medication regularly.  His liver enzymes, kidney function tests  were within normal limits.

NP scheduled him for a couple of “annual screening tests” – an ankle brachial index (abi) which is a measure for peripheral vascular disease and a "neural scan" – when I asked what this was the young receptionist could only say that he will have a couple of leads attached to his head and watch TV – so I played a little Dr. Google and found a company called Brainview (brainview.com) that does neural scans using EEG, ECG, visual and auditory speeds as a cognitive function screening test.  I am not sure that this is the exact company or test but sounds similar enough.  Has anyone else’s LO had a similar test and how did it go?  Was it able to provide any answers or a direction?  

Tests are scheduled for Dec 27 with follow up on Jan 6 for recommendations.  I am feeling a bit desperate – his behavior is becoming intolerable.  

M1

Frankly both sound like BS to me. ABI screening is not recommended for those without symptoms of peripheral vascular problems (such as leg pain with walking also known as claudication, and the other sounds like CompleteBS. I doubt whether either would be covered by insurance and would sure ask.

You need a competent primary care doc. Ask around and don't waste your money.

Chammer

@M1 - DH is type 2 diabetic of 18 yrs who has been non-compliant with treatment on more occasions than compliant.  He has discolored legs and hair loss on lower extremities, neuropathy in his legs and hands, ED, history of cardiac stent, diabetic retinopathy.  Abi testing is indicated.  The neural scan is apparently an evoked potential EEG which detects neurological changes (not specific) that aren’t apparent on physical exam.  If either of these tests are “positive” additional testing will be required for any diagnosis because these are general screening tests. They are covered by our insurance.  

DH is and has been resistant to meds and treatments.  If waving crystal coated Joo-joo beans over his elbows at least get us started on some sort of neuro diagnostic path, I will be grateful.  His behavior is intolerable; he is still active in our business community and not functioning well at that, and within the past 4 months have increased our business debt to a “scary” level.   I need to make decisions - either he is sick and I have to prepare to pull up my big girl panties and handle it all or divorce if he isn’t.  I love him and don’t want either of those, but I need to begin to have answers.  I was primary caregiver for my MIL with dementia for the last yr of her life, so I know many of the challenges.  I just need to know if those are the challenges I will be facing.