Hello everyone. I posted a thread a couple of months ago, and I appreciate the responses I received. This topic is similar, but a little more specific.

Mom is 68 and since Dad passed away, almost 5 years ago, her memory issues have gotten worse. I found a list of all of the stage symptoms on this board, and stage 1 and 2 describe Mom to a tee.

My brother and I spoke to her internist together after a friend recommended a neuropsychological assessment. Mom's Doc made these comments:

"The only problem with neuropsych reports is just that...they give you this long report, but very rarely do they follow up with any treatment recommendations."

"Your Mom meets symptoms for clinical depression, so let's put her on depression meds and if the symptoms go away, we know it's depression. If nothing changes, then it sounds like the beginning stages of Alzheimers. And if that's the case, there's not a damn thing we can do about it."

When my brother and I told her that we wanted to have the evaluation simply because we wanted to know, she said "So what if you know. What are you going to do about it? What happens with the neuropsych reports is that it gives families a false hope. It's not like there's a magic pill out there that can cure Alzheimers."

If this were me or my wife, we would get a new doctor, but Mom loves her doc and would never leave her. When we decided as a family to move forward with the neuropsych testing, I spoke to Mom's doctor and made it clear that she needs to deliver the message to Mom in a positive way, which she did. She wrote the referral and sent over Mom's history the same day.

So, my question is this. Do any of you have any experience with neuropsychological evaluations, and did you find them useful?

Also, if you have any other thoughts or comments, please share them with us. This is totally new to us, and we are learning as we go.

Steve

Well, xrays and lab reports don't come with treatment recommendations either! But they're still worth doing.

Making recommendations is the job of the primary physician. For someone with dementia, the best primary physician is usually either a neurologist experienced in diagnosing and treating dementia, or a geriatric psychiatrist experienced in treating dementia.

There are several causes of memory issues. Some are reversible and treatable. Has your mom had a full workup to rule out thyroid, MRI to rule out other neuro issues, drug review to rule out medication interactions, etc.? Usually the best doc to do this is a neurologist who specializes in dementia.

Next, there are different kinds of dementia. Alz is just one. You need to know which one she has with as much certainly as possible, because the symptoms can be wildly divergent as it progresses. Certain psychiatric meds that work well for Alz are disastrous in frontal-temporal dementia, for example.

And if she does have Alz, there's evidence that starting cognitive meds sooner rather than later may help her hang on a bit longer to the cognitive function she still has.

Plus, eevn if she does have Alz, different people with Alz have different cognitive issues depending on where the brain damage occurs first and worst. They're not all identical. The neuropsych testing helps you understand more about the KIND of confusion a person with dementia is experiencing or likely to experience. And the more you know, the better you can support them and be prepared.

I agree, a neurologist or psychiatrist who works with AD patients is a good idea.
It is the job of the internist to follow up with the treatment recommendations in many cases or you could continue to take your LO to a psychiatrist or neurologist. Based on the attitude of the internist I think that it's fine to continue seeing the internist, but also meet regularly with the specialist every few months or how ever often is recommended. Aricept, Exelon, Namenda etc can slow the progression and improve quality of life. Or, possibly antidepressants can be added to the mix if it's AD and depression.
Being that the doctor seems to think it may be depression and not AD (from your post), I think I'd go with a psychiatrist instead of a neurologist, personally. But, either way, I'd definitely get your LO for an evaluation with a specialist.
Good luck.

In my experience, a neuropsychological evaluation was done where the chief complaints were word finding problems, memory deficits and attention and concentration difficullties. The intake/interview was one session, testing took place over two sessions, and the results were discussed weeks later after tests were scored and report was completed. Tests included the DSM-IV Problem Checklist, Neuropsychological History Questionnaire, Wechsler Abbreviated Scale of Intelligence, Wechsler Memory Scale-Third Edition, Repeatable Battery for the Assessment of Neuropsychological Status, Delis-Kaplan Executive Function System and Millon Behavioral Medicine Diagnostic. These tests offered insights into patient's capacity for forming short-and long-term memories as well as flexibility of thinking, multi-tasking, simutaneous processing, divided attention, and abstract reasoning. The neuropsychologist concluded by offering specific strategies and concrete recommendations.

In general, it is my understanding that neuropsychological evaluations are batteries of tests that can be tailored to a specific patient and finding the answer to their particular situation or circumstance. You should feel free to ask as many questions of the neuropsychologist prior to testing as you'd like. Here are a few I came up with...How experienced working with elders? How many visits for tests? Which tests? What specifically will he/she look for? (memory?, cognitive functioning?, depression?)

If your Mom is one who puts on her "best face" for her doc and outsiders, then a neuropsych eval might be an invaluable assessment. It should be able to indicate the severity of her memory deficits and cognitive impairment and it may very well reveal or refute the depression that the internist has "diagnosed".

Considering the comments by the internist, it would definitely be a good idea for you and your Mom to consult with a neurologist who is more aware of and up-to-date in what is now the standard of care of patients who have AD.

Keep in touch, we are all learning as we go. For many of us, each day is often a new adventure!

If your Mom is one who puts on her "best face" for her doc and outsiders, then a neuropsych eval might be an invaluable assessment. It should be able to indicate the severity of her memory deficits and cognitive impairment and it may very well reveal or refute the depression that the internist has "diagnosed".

That was certainly the case with my mom! The neuropsych evaluation was helpful for lining up the Power of Attorney and other legal documentation I was trying to secure at the time. It was helpful (but sad) to show to mom, who insisted on seeing copies off all her clinical notes as she would not believe she had anything other than "normal aging" going on. It was yet another thing to show to out-of-state family members who thought I was exaggerating the behaviors mom was displaying, and it served as a baseline for tests we did with her as she moved further into her experience of AD.

Good luck!

Steve, I was diagnosed as cognitive impairment n.o.s. and depression after neuropsychological testing. The neurologist prescribed Effexor, which made me worse. Then he prescribed Exelon patch, which I've taken for six months with improvement in my cognitive functioning. I'm also taking Namenda.

As the others have said, it's crucial to rule out other causes of dementia that might be treatable. If the diagnosis is dementia, the type is important because the course of the disease varies and the treatments vary.

The trend in dementia care is towards early diagnosis. Your Mom's doctor sounds behind the times. I had an internist tell me the same thing when I complained to him about my memory: If it's Alzheimer's you can't do anything about it so why worry about it?

If the diagnosis is Alzheimer's there's a lot you can do about it.
The early stage patient can learn the diagnosis and be more involved in her own care and planning for her future.
Medications can be started to improve brain function and prolong the patient's ability to remain in the community.
Legal and financial affairs can be put in order.
Family members can spend more time with their Loved One before it's too late.

The average primary care doctor is clueless about early dementia. Too many patients spend years being symptomatic before diagnosis. How is your Mom in handling her checkbook, bills and other financial affairs? How is her driving? These are important signs that most doctors don't understand the significance of.
I'm a retired doctor myself and I was misdiagnosed as depression for years.

If your Mom can use the internet, please invite her to our boards, "I have Alzheimer's" or "I have Alzheimer's under age 65". We would like to meet and support her. There are several senior women who post.

Iris L.

My ADLO started taking Aricept almost 6 years ago, and Namenda about a year or so later. I didn't think he got any boost in memory function or any other improvement, and at first was discouraged. However, I really don't think he would be enjoying his life as much as he does without these meds. I think his functioning would have delined to a much greater degree. Of course, I have no way to verify this.
The neurologist tests for decreases in functioning every 6 months, and it's reassuring. I do feel that if something new comes up he will see it, and make adjustments accordingly. I know it's never going to get better. From reading other posts there can be behavioral problems that can sometimes be mediated by meds. This neurologist specializes in aging brains. And he does listen to me. That counts.

Namaste.

Steve, a large number of MDs are burned out, and I fear the MD you describe is very much a burn out.

Even the best doctors can get busy, but there's no excuse for giving up. You want a doctor that stays on the cutting edge of research, someone who's excited about what the near future holds.

Perhaps the local Alzheimer's Association has a list of doctors they enjoy working with?

Steve, my ADLO underwent the neuropsych evaluation and we found it useful. My ADLO, however, was totally unresponsive to the Dx of what was then mild cognitive impairment. That was four years ago and I'd say the likelihood that she was then in the early stages of AD is undeniable. The testing lasts for a few hours and we got a detailed narrative report and analysis of functioning. What I would caution you, however, is to request time to read the report before you have the face time with the Psy.D. who administers the test. The terminology is pure jargon that is impossible to decipher unless you have a laptop and can Google every term you don't understand. Highlight the portions you want explained in layperson's terms. The objective of the post-test consultation (and do it w/o your LO there, if possible) is to get a good handle on the kinds of everyday tasks that the tests indicate your LO is borderline or non-functioning on so that you and your family can start some realistic planning. And if you have not done so already, get your legal docs in order: the DPOA, living will, health care POA, named POA on bank accounts, investment accounts, etc. Best wishes, Beth in SC