Did we miss something in the beginning?

ghphotog

My wife's father died from Alz and I've always been told that by my wife so when she first started showing mild symptoms years ago we both just assumed. She didn't want to accept it, deal with it or go to the doctor about it and I didn't force her. 
Several years ago I made an appt with her PCP and since I had POA I was able to speak with her doctor about her memory. 
Her doc performed a brief memory test that she failed and gave us a referral to a "neuro" that doesn't take insurance, long story but I passed. I had her provide a new referral to real neurologist  
The neuro did a very brief exam sad she was severe and ordered an MRI.
The MRI shows moderate cerebral parenchymal volume loss including the hippocampus as well as a white matter spot that "may" be from chronic microangiopathic disease.
No signs of any ischemic event, hemorrhage or infarct, or anything else for that matter to cause small vessel disease.
My wife has never had bad cholesterol, high blood pressure or heart trouble.
However, I'm scared we missed something concerning the white matter and the microangiopathy that could have been treated had we not put this off so long. 
Can SVD really lead to dementia when there is no evidence of any ischemic events?

Still waiting to have the neuro interpret the results but I'm scared as hell right now thinking we could've missed something early on that might've changed everything.

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Iris L.

ghphotog wrote:

The MRI shows... a white matter spot that "may" be from chronic microangiopathic disease.

My MRI has been showing multiple white matter spots, more each time I get an MRI.  I have had three MRIs since the early 1990s.

Can SVD really lead to dementia when there is no evidence of any ischemic events?

I believe the answer is yes.  The white spots represent microangiopathy, which can be seen only under a microscope.  This would only be done at autopsy or brain biopsy from a brain surgery.  This is my understanding.

In my case, I have memory loss and some other cognitive impairments that don't rise to the level of dementia.  Over the years, the pathology is worsening, apparently.  I pay attention to my cardiovascular health.  Also, diabetes is a risk factor, because hyperglycemia impacts blood vessels.

Iris

Kibbee

DH’s brain scans have shown diffuse white matter for the past 8 to 10 years.  From what I’ve read it is a progressive condition that can sometimes be an indicator for future dementia, and there is no treatment for it.  Since it was first noted on his brain scan, DH has been seen by two different neurologists and a neurosurgeon, and none of them offered any treatment so that fits with what I’ve read.  So it’s likely you haven’t missed anything that could have been treated.

MaryG123

As said, it wouldn’t be treatable anyway, so what would you have done differently?  While having a diagnosis is important to some caregivers, many just rule out the non dementia issues, and move forward.

M1

I think it's natural to ask those  "what if?" Questions, but almost certainly the answer is no, there's unlikely to be anything that you could have done differently. Hard fact is that findings on routine imaging studies do not correlate well with the degree of cognitive impairment so their utility is limited. They tell you more about what's not there-tumors, strokes, Lewy bodies.  So don't expect the neurologist s interpretation to shed much light.  We all wish there were better answers.

Ed1937

I hope the answers you received takes some of the pressure off of you. It would be great if there were more answers, but we're stuck with what it is. There comes a time with this disease when many of us have to make hard choices, then if something happens, we wonder if it would have been different if we made a different decision. 

My wife passed away a little more than 8 months ago, and I wondered if a decision I made had contributed to her demise. I don't know the answer to that, but I have learned to live with it, since I have no choice.

ghphotog

Thank you Ed, everyone!
Not likely we missed anything treatable that would've changed the future but there is always a nagging doubt. Even if it was small vessel disease of the brain her blood pressure, cholesterol and everything else is fine so there would've been nothing to change or "treat" to repair or stop the damage. . . if that's even what it was.
I suppose we all have the same doubts at times. "Woulda, coulda, shoulda"
I'll have more info if the neuro will ever call me back with the breakdown of the MRI report or maybe just more unanswerable questions after that.

ghphotog

Update, neuro said the MRI was consistent with Alzheimer's.