Alzheimer's or other dementia?

Beauchene105

I brought my 94 year old mother who has many dementia symptoms to her first neurologist appointment yesterday. Her primary care doctor had acknowledged the dementia but had not felt the need for another doctor. However, because she has become noncompliant with her medications, her absence seizures are surfacing and I wanted to talk to the neurologist about liquid Vimpat. After the memory screening (I believe her score would've been equivalent to about a five, or severe cognitive impairment), she was interviewed by a second nurse and then by the neurologist who also tested her reflexes and asked many questions. The neurologist agreed to the liquid Vimpat so that perhaps she would at least avoid seizures. She also recommended Aricept, which the primary care doctor had not pursued due to the noncompliance, possible side effects, and late stage. However, the neurologist felt it might help with some of her symptoms. I asked if she knew what kind of dementia we were dealing with. She was vague and said it was "an age related type of dementia". Now my question: is Aricept only for Alzheimer's? Do more tests such as an EEG have to be performed in order to  make a definitive diagnosis of which type of dementia? Our follow up appointment is in six weeks. Thanks.

dayn2nite2

The only way to get a definitive diagnosis is to arrange a brain autopsy prior to her death to be done at death and it is pretty costly.

At her age, I seriously doubt it’s anything genetic and certainly not early onset.  

Ed1937

This link to Mayo Clinic may be helpful. https://www.mayoclinic.org/diseases-conditions/dementia/diagnosis-treatment/drc-20352019  

Michael Ellenbogen

There are places that do it for free if you qualify. Check with NIH.

LaurenB

There are many different types of dementia and can be “figured out” based on a persons history, medical history, current behaviors, blood tests, and brain scans.  Alzheimer’s can’t be fully diagnosed without an autopsy, but a brain scan can show overall brain atrophy that is consistent with an Alzheimer’s diagnosis or could show signs of strokes that are associated with vascular dementia.  It could show damage to the front-temporal region that leads to a diagnosis of FT dementia…etc.

harshedbuzz

Beauchene105 wrote:

She was vague and said it was "an age related type of dementia".

This does not surprise me. The definitive diagnosis for Alzheimer's is done at autopsy although a spinal tap will show biomarkers for Alzheimer's if it is done for some other reason like to rule out a prion disease. It is not a test I would choose for a 94 year old. 

The other thought is that it's possible she has more than one kind of dementia. I read somewhere that it was more likely to have mixed dementia than just Alzheimer's. My dad had mixed-- Alzheimer's and Wernicke-Korsakoff's. His neurologist thought some vascular could also be in the mix. My aunt was initially diagnosed with vascular around 72 and developed Alzheimer's in her mid-80s as well. 

Now my question: is Aricept only for Alzheimer's?

I have known it to be prescribed for Vascular, Alzheimer's and Lewey Body. It does seem to help some people function better for a time although it doesn't slow the disease progression. It does seem cause side effects- typically GI symptoms- in quite a few who try it.

Do more tests such as an EEG have to be performed in order to make a definitive diagnosis of which type of dementia?

The definitive test is autopsy. I assume her PCP did bloodwork to rule out any treatable condition that mimics dementia like a hormone or vitamin deficiency. S/he or the neurologist may have ordered a CT scan to look for loss of brain volume and evidence of past TIAs/strokes. 

My dad had a PET scan to determine if dad had WKS (an alcohol-related dementia that causes the brain to use glucose in a unique way when doing cognitive tasks) but many insurances won't cover the test and it wasn't a particularly pleasant way to spend an afternoon.

Her results from the cognitive screenings will also suggest a kind of dementia as she may show a characteristic pattern of strengths/weaknesses consistent with one kind of dementia or another. Her medical history and your reporting will factor into what the neurologist will propose as a diagnosis fits. There are subtle differences in the presentations of different dementias and these can sometimes suggest one kind over another. 

Our follow up appointment is in six weeks. Thanks.

Good luck with the follow up.

Beauchene105

Thank you, everyone. I really appreciate your comments. They confirm what I'd suspected. I am not planning to put my mom through a lot of testing. I simply wanted to know what to possibly expect in the time ahead. I am not optimistic that the Aricept will be a big difference-maker being that she is so noncompliant. I believe my mom's PCP, who knows her well, realized this and had held off on the Aricept for that reason. We'll give it a go for six weeks. Dementia is so awful and it's very hard to watch my mom deteriorate. I feel like I'm watching an ice cube melt. When I left, for the first time ever, she didn't say, "Call when you get there"...She had always said that. Sigh. Ah well... I'm trying to savor the good moments whenever they surface!

ZackFootInMouth

Beauchene105 wrote:

I'm trying to savor the good moments whenever they surface!

This is very commendable.