There are no dementia indicators on an MRI, so what kinds of dementia wouldn't show up?

Palmetto Peg

My DH had an MRI last week. It showed basically what the previous two did - some shrinkage of the brain but not really any progression and about the expected shrinkage for a 78-year-old man.

What kinds of dementia would have no indicator on a brain scan? He walks and talks like a person with dementia - he is confused much of the time, has no short term memory, is delusional at times, and is progressing along the timelines and is in late stage 4 by what I can see.

The doctor is going to refer us to a neuro-psych doctor. Will that help get an answer? I know it probably doesn't matter, but how can nothing show up in his brain? What other ways are there to diagnose dementia? As always, your help is so appreciated!!

harshedbuzz

An MRI is only part of the diagnostic process. You might get more information from a PET scan which shows the brain working rather than just the structure.

Neuropsych testing can be very useful at parsing cognitive deficits and can be useful at pinpointing a likely cause.

charley0419

that’s one of reason put wife in trail in beginning as they do tests that insurance WON’T ok.

M1

Peg, no dementia really shows up on imaging procedures. Even PET scans are pretty nonspecific—they show activity of certain molecules (like glucose, or amyloid) in certain parts of the brain. But dementia is not really diagnosed by imaging, it's diagnosed clinically, by report of symptoms and by responses on testing (such as being able to name or recall objects, follow directions, do arithmetic, things like that—that's basically what neuropsychological testing is). The only tests that truly diagnose the kind of dementia are brain autopsies done after death.

trottingalong

my husband had all the tests 6 or 7 years ago. Inconclusive. Possible Alzheimer’s with depression. His MRI showed minimal shrinkage of hippocampus, but we were told that wasn’t substantial enough. The neurologist told us there just weren’t definitive enough tests and only time would tell. He sees no point in further testing and frankly, nor do I. What’s the point? He’s following the exact path as his mother, I can see pretty much where he’s at in the stages.

Palmetto Peg

Thank you so much! I was afraid that we were missing something with an MRI that doesn't really show anything. So, the symptoms and behaviors are what I need to keep track of. We will see the neuro-psych because right now I still want as much info as I can get, but I won't worry about the MRI.

Always a puzzle, isn't it?

Iris L.

MRI is to look for a tumor or stroke. But read about leukoairiosis and hyperintensities.

Iris

Dio

Most tests are done to rule out possible causes and certain biomarkers until, through process of elimination, what remains is the diagnosis based on symptoms and behavior. There isn't a clinical test that can definitively say what it is until post mortem. Even spinal tap is somewhat controversial. Yup, no medication will slow or stop the progression, only treat/control the symptoms and behavior.

Palmetto Peg

I was hoping to find something out that would tell me what the next stages might be. I am so much better when I feel armed with information. Since I don't know what type of dementia, I can only watch it unfold and try to guess what is coming next. It is so hard right now. He is absolutely stuck to my side - can't decide what to eat, what to wear, what to do! I can't even read the paper in the morning without constant interruptions with the same questions over and over. Dementia really, really sucks! Thanks for all the input - you guys are a lifeline!

Bill_2001

Tests are useful earlier on to rule out illnesses or conditions that mimic dementia. But if tests don't find anything conclusive, a diagnosis of dementia, cognitive impairment, or possible Alzheimer's may follow.

I have found any subsequent tests to be inconclusive.

Symptoms, behavior, and MMSE test may be used to suggest possible medications to make your loved one's condition more manageable.

Keep your expectations in check with regard to tests and scans. In my dear wife's case, we are way past that, and just trying to cope with each day.

Palmetto Peg

Thank you all for your input. I am going to put the thought of a diagnosis behind me now, and just watch symptoms and ask for help related to what he is experiencing. I was trying to make the illogical logical! There is nothing logical about dementia, and it is true - if you have met a person with dementia, you have met only one person with dementia. Thanks again!

DTSbuddy

Just over 3 years ago an MRI on my DH showed only very minimal shrinkage, nothing really unusual. Other testing said he had PPA. Now he has lost his executive function in many ways, 80% of language capacity, and has periods of paranoia, perseveration, wandering, etc.