In both cases, this may be because underlying risk factors — poor sleep, for instance, or poorly controlled diabetes or thyroid disease — have been addressed. Still another group of patients fluctuate, sometimes improving and sometimes declining, with periods of stability in between. Specialists versus generalists. Arvanitakis of Rush University agreed. Visit khn.
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We appreciate all forms of engagement from our readers and listeners, and welcome your support. Mild cognitive impairment is a clinical diagnosis representing a doctor's best professional judgment about the reason for a person's symptoms.
A medical workup for MCI includes the following core elements:. If the workup doesn't create a clear clinical picture, the doctor may recommend neuropsychological testing, which involves a series of written or computerized tests to evaluate specific thinking skills. Research findings Research has demonstrated a significant reduction in the risk for developing mild cognitive impairment and dementia through the treatment of high blood pressure.
Treatment with aducanumab should be initiated in patients with MCI or mild dementia stage of disease, the population in which treatment was initiated in clinical trials. There is no safety or effectiveness data on initiating treatment at earlier or later stages of the disease than were studied.
Individuals who have been diagnosed with MCI should be reevaluated every six months to determine if symptoms have progressed. Sign up for E-News today. It also helps for the older person to be accompanied by a family member for the visit, if possible. The risks of self diagnosis are much worse than the risks of being misdiagnosed by incompetent medical professionals…. Both approaches are risky!
Good article…I shared with my adult children to help them from jumping to ill-founded conclusions…but also what to be aware of. Yes, as you point out, a diagnosis often is necessary for legal and financial issues. A diagnosis — or even evidence of some cognitive impairment — should also prompt the medical team to reconsider some of what they are doing. The first step is to get the ball rolling with an initial eval and hopefully to not get too much of a run around. Too often they just refer a patient to a Specialist.
Then they refer you to another one. I live by myself, have no living or trusting relatives, and just a few friends. Please consider seniors who are aging alone.
This was a very informative article. Thank you. Thank you for sharing these comments. You could see how others are tackling this type of issue. Good luck! Primary Care Physicians are unsung heroes. God bless them! I agree with you that Primary Care providers are key players in healthcare. As a specialist, I collaborate with family doctors and primary care nurse practitioners daily.
Some time ago, I wrote about a relative with memory problems. Twice now I have called and said that there are memory problems prior to scheduling checkup appointments. And twice my relative has proudly outwitted the doctor! Second visit doctor said that I had suggested there was a problem — I took some abuse without knowing the cause until just recently!!
This third visit I said nothing, and my relative breezed through the exam and was declared perfectly healthy!!! I believe it! Thanks so much for the heads up on Smart Patients — their help and support got me through sarcoma cancer. Unfortuantely, this kind of thing does happen. Sometimes the older person really does have minor deficits, but in other cases, the clinician is not being thorough enough or attentive enough.
There are also online caregiving forums, such as the one at AgingCare. Good luck and take care! I was noticing severe mood swings in my Mom, and it became more obvious after a fall that resulted in a broken wrist. At first I heard that it was sprained so I went to see her because I also know she has osteoporosis. Sure enough, it was purple and swollen and I told her it should be x-rayed to determine how extensive the damage was. Although I shared this information in writing to her PCP, he ignored me.
I continued to observe problems and reported them to this doctor, thinking he would eventually evaluate her, especially given her treatment of my Dad after he suffered a stroke. He would not address my concerns. My brother, a state licensed teacher enabled Mom and our relationship has been damaged. Ultimately I have had to step back. I have a sense of peace in knowing that I did my best for both parents. I appreciate the recommendations here for support groups and counseling.
Even when you do the right thing, it can be painful. My question is related to cognitive testing and the interpretation of results. At what point, is a senior considered unable to make medical decisions?
However, my loved one is testing as severely impaired with a score of 1. They are taking advantage of him by having him attend care meetings without family and signing paperwork without family present too.
Interesting issue you are raising! Even if the agent has authority immediately, if the agent and principal disagree, the principal gets to decide, unless the principal is incapacitated. Incapacity does sometimes reverse. Not at all clear it was reasonable for them to do so under the circumstances you describe. It sounds like the nursing home decided that your father currently has the capacity to make his medical decisions, and so they are relying on him to participate in care meetings rather than involving you, his healthcare proxy.
The issue for you will be figuring out an effective way to intervene. If you look like you understand what capacity involves, this might impress them. You can also sometimes hire a clinician to go into the nursing home and see him.
There are also some patient advocates who are doctors or other clinicians qualified to render an opinion on capacity. Do you think it makes sense for doctors to conduct routine cognitive function screening of all patients at a certain age, e. He checked his BP, blood work, an occasional viral illness or infection, and physical aches and pains, but that was it. My mom had been taking him there but was no help, since she was in denial that anything was wrong.
When I finally took my dad at age 93 to his doctor and provided a list of behaviors that had changed significantly over recent years, the doctor administered a mini-mental test. My dad scored 16 out of Yes, ideally his impairments would have been detected earlier. Unfortunately quite a lot of research indicates that older adults with impairment and even frank dementia are often not assessed or diagnosed by their usual physicians. This is one of many ongoing quality and safety issues relevant to the healthcare of older adults.
In terms of whether doctors should screen: the US Preventive Services Task Force reviewed this question a few years ago and concluded that the evidence was insufficient to make a recommendation. Cognitive Impairment in Older Adults: Screening. Medicare beneficiaries. If there are problems with IADLs then we are quick to consider cognitive impairment. Generally a medical clinic that is specifically designed to care for older adults will do a better job of detecting these problems, compared to a general primary care office.
In short, much work remains to be done. Until the medical system is better at addressing this, we must keep encouraging family members to speak up and be proactive. Your information is most helpful, clear and caring. As someone who has lost a parent, friends and other family members to various types of dementia, and now my husband has been diagnosed, I know how stressful and exhausting this disease can be for caregivers.
However, they overlook the families and friends who are trying to help the patient. Your recommendation to find a support group is spot on! Talking with others who are going through the same thing, or have been there, will provide you with information you will not get from a doctor.
Plus you will make friends who will understand, support and advise you through the various stages, and grieve with you as your loved one declines whether through dementia or a physical condition. What do you suggest when your parent is in denial? My heart is in pain and she lives where Dr. Pickings are poor. Terrible options available and she just refuses to believe that there is a problem.
I do recommend connecting with others facing similar challenges; the online caregiving forum at AgingCare. Am finding your articles very helpfull, thanks. I was using low dose mg of Diazepam per night for several years to help me fall asleep again half way the night. Was told low dosage like that would be OK, but am now beginning to wonder if there possibly is a relation with my memory loss? Glad you are finding the articles helpful.
Diazepam and other benzodiazepines have actually been associated with an increased risk of later dementia, but there has been some debate about whether this is really a causational relationship versus an association.
I have suggestions on optimizing brain function in this article: How to Promote Brain Health. When we go to the Dr. This got her in reversible financial trouble twice last summer that would have cost her thousands of dollars had I not caught them. Ideally, the doctors would come to some conclusions and give you more advice.
You may want to get a second opinion, especially from an attorney with particular experience in elderlaw. Hello Dr. Kernisan, My mom is 67, she has been taking mg of wellbutrin and mg of Venlafaxine for maybe 25 years. But she believes she has been taking these same two for a very long time. She said that sometimes the amount has changed at times if she was not doing well, but it seems she has been taking these for a long time.
Just in the last year she has started having symptoms such as short term memory loss, having trouble putting a key in the door sometimes but other times not having as much of an issue.
One day she forgot how to put her car in reverse. The shifter is down in the middle like most new vehicles but she was looking for it on the steering wheel column.
Some days she seems better. The medicines really do help her to feel good. She is almost always in a good mood. About a year ago my brother had taken a bunch of her medicine so she ran out and it really affected her mood.
She did not feel well until we were able to get another prescription filled. Both looked good and they said nothing acute appeared on the MRI. I asked the doctor if the medications she has been taking for a long time could be a cause and if cutting the size of the doses in half Under the care of a psychiatrist would possible be helpful. She said no, she does not think moms symptoms are coming from the medications and that we need to continue trying to find what is the cause.
Any advice would be very much appreciated. We are located in St. Louis, Missouri. Also if you know of a practitioner here in the area that is along your lines of thinking, that would be great as well. Thank you for listening! In general, we would not expect bupropion brand name Wellbutrin or venlafaxine to cause the kinds of symptoms you describe. If your mother decides she wants to reduce the dose, she should work closely with a healthcare provider.
Cutting the dose in half may be too big a jump, some people need more gradual tapers. For challenging cases related to memory and thinking problems, it can be helpful to look for a specialized memory clinic.
There may be one at the major academic medical centers in the St. Louis area. It seems as though every health related writer feels the need to include smoking as one of the causes of whatever problem is being discussed. Inhalation of any kind of smoke causes problems. But some people assume that the problem is nicotine, even though several scholarly articles exonerate it.
Newhouse, K. Kellar, P. Aisen, H. White, K. Wesnes, E. Coderre, A. Pfaff, H. Wilkins, D. Howard, E. The results are not conclusive.
But it has been an uncontrolled test. I plan to start monitoring her cotinine level. Perhaps more important is REM sleep and its effect on the Glial cells and clearance of waste products. I welcome your comments. Sleep is indeed important to brain health although the problems is that many problems affecting the brain also tend to disrupt sleep, and sleeping pills make brain function worse.
Kernisan, I am a 34 years old woman based out of Delhi, India. There after I developed multiple symptoms, most of which got alright. I have mild issues with remembering tasks to be done, recalling names and tasks.
Consulted neurologists, physicians,psychiatrists, no one seems to have heard of this problem at my age. Tried homeopathy, ayurvedic herbs like Bacopa, others like Ginko biloba, Dr. Recently heard of HBOT tretament, do you feel it could help with my kind of an issue?
Looking forward to hearing from you. Given your age of 34, I am not sure how much of what is in this article can be applied to you.
I would recommend you try to get help from a health provider with experience addressing cognitive issues in people of your age. Dear Dr Kernisan I am most grateful for your reply. Would you know of any other treatment or a Practitioner who could help with cognitive issues at my age.
It affects my functioning and efficiency. I had a 4-hour memory test in Psychiatry. He thought I had brain CA. But did not.
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