Rookie needs advise on neurologist

Bug Man · October 21

Rookie here.I learn a lot from the discussions and I intend to continue. I'm the caretaker of mu 82 year old wife, who was recently diagnosed with lesions on her brain, but no indication of stroke. The docs only say "altered mental status". She was fine one day and then started to lose it the next. She has COPD and is followed around by an oxygen tube. HOWEVER - my only question at this time is she has no neurologist because the only ones are quite a way off, and she doesn't do well with travel. How important is having a neurologist if she's already been diagnosed and sent home. From what I can find, there is not a lot that can be done.

SusanB-dil · October 21

Hi Bug Man - welcome to 'here', but sorry for the reason.

I have found that the neurologist is a huge help, as they can prescribe some of the meds MIL needs for the agitation. However… I've also seen posts where one is not totally necessary, especially if her PCP will really listen to you and work with you.

H1235 · October 21

Welcome. Does altered mental status mean dementia or could it be something else that is treatable? Do they want to do further testing to determine if it’s dementia of what kind of dementia. I’m not sure the kind of dementia is that important. I guess some have a slightly different progression and life expectancy, but the the results are the same unfortunately. Assuming it’s dementia I would agree with Susan. It really all depends on her pcp. Mom’s original pcp was useless. After we moved her to assisted living there was a doctor that visited regularly and she was much more dementia informed and willing to prescribe the appropriate medications. You might want to talk with her doctor to make sure he is willing to prescribe anti-psychotic medications if it comes to that.

harshedbuzz · October 22

My perhaps unpopular opinion.

Given your wife's age and COPD severe enough to require O2 at home, I would not escalate her care to a neurologist. Especially if it would be difficult for her. If your wife was a decade or 2 younger, healthy and interested in one of the infusion medications overseen by neurology it would be different.

IME, a neurologist can offer the most comprehensive evaluation which can be important if you need to qualify for an infusion or to rule out something like Lewy body or FTD. But if she's seen a PCP who ruled out treatable hormone/vitamin deficiencies and did imaging which shows lesions, that would be sufficient for me.

My dad's neurologists weren't comfortable adequately medicating his agitation. Once we had a diagnosis, they weren't very helpful. YMMV. We relied on a geriatric psychiatrist for meds. They are the specialists in that area. That said, she may never need that kind of care. Agitation is not always a given. My friend's mom and my one aunt remained their gentle selves throughout.

HB

SoCo Kirsten · October 23

Mixed results for my dad so far. First neuro was booked out 8-9 months, but we lucked into a cancellation. Neuropsych booked out almost a year. I moved him closer to me last month, and got a new neuro who is booked out 2 months. By the time you get in, it could be moot. I think in your shoes, the coin toss would be no. Sending good thoughts.

Iris L. · October 23

I too have lesions on my brain according to several MRIs. Make sure her blood pressure is under control. Do you have a home pulse oximeter? Are her oxygen levels acceptable? Is she able to walk outdoors? A daily walk might help. From now, the goal is to maintain a comfortable standard of living.

Iris

Maru · October 23

https://alzconnected.org/discussion/74407/rookie-needs-advise-on-neurologist

Altered mental status is not a diagnosis. There are things that can cause this that are treatable. Are these lesions treatble I would definately pursue a futher diagnosis. A sudden alteration in mental status doestn't happen without a cause

ARIL · October 24

Yes, you need to know more. Being “fine one day and then started to lose it the next” sounds like something potentially treatable.

harshedbuzz · October 24

Cobbling off what @Maru said, any sudden change can be the result of an infection— most often a UTI but an URI can do this too.

Rookie needs advise on neurologist

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