Need some advice. My wife is 32 yrs old and is experiencing difficulty remembering things. This began last june and since then the memory has deteriorated a little more.

She was diagnosed with moderate depression at that time and started undergoing counselling sessions along with medication (mild anti-depressants. All other depression related symptoms such as lack of sleep, mood swings, palpitations, lack of concentration, lack of interest in activities etc have today disappeared. Memory remains the only problem. Even in memory she recollects 99% of all the forgets if she is prompted and given the right context.

She has met a neurologist, psyciatrist and a clinincal psychologist. She has gone through MRI, blood tests, MMSE and other clinical psychological testing and all the results / reports are normal. She has however has a weight gain of 6 kgs in the last one year which can be attributed to depression or medication.

All other cognitive skills etc are functioning normally and she has no difficulty in cooking, reading, driving and doing really intricate art and craft work which is her hobby.

Based on the above is this MCI (amnestic) or EOAD or plani simple depression? What further tests should we get done to arrive at a conclusive and definitive diagnosis? Pls advise.

Ritesh Jain

Ritesh, I just wanted to let you know that I just answered your personal e-mail to me.

Tracy

Ritesh, you might want to have her seen by an endocrinologist. I'm wondering if she might have a problem with her thyroid that hasn't been detected by the standard tests.

Hello Ritesh, my name is Tom and I woul like to join the others extending a warm welcome to this board. The reason you came to us is not pleasent! We all wish you and your wife the best!
From this distance, probably whatever Tracy told you in her email is the best advice.She has extensively dealt with dementia in young people.

I would suggest she be checked out by a good gynecologist or other women's health specialist who understands hormones. This included thyroid.

Try to find a specialist in bio-identical hormones. They take a more specialized look at the hormone panel. Many MD's just use a shotgun approach when they see any deficiency. Bio-identical hormones can be used to treat any specific deficiency, addressing each hormone individually.

The best testing is done by testing the blood. Saliva testing is not as accurate. With follow up visit, it can take a while to get the levels correct.

Well, the good news is that it doesn't resemble any of the progressive, terminal dementias.

Bad news is, there's something persistently wrong and undiagnosed. She's had all the "horses" tests, perhaps it's time for the "zebra" tests?

All things considered, I'm in agreement with Mark, that a good gynecologist would be a good next step.

And please, keep in touch, let us know what's discovered.

thank you for your responses.

Have already done the thyroid / b12 testing and that's normal. even the brain mri scan is normal.

think we will be now required to do EEG and PET Scan.

In the psychological testing, we have done wechsler memory scale, bender gestalt test and rorschach ink blot test and MMSE and all are normal.

Any suggestions on what other tests we should do?

Hello Ritesh, welcome to this message board. I developed fairly sudden memory loss at age 37, along with fatigue and sleep deprivation. I was diagnosed and treated as anxiety/depression for 6 years, then my diagnosis was changed to systemic lupus after evaluation by a rheumatologist. I still have the memory loss and other cognitive deficits. Depression, memory loss, and cognitive dysfunction are major symptoms of lupus. So have the doctors check her ANA titer and evaluate her for lupus.

Iris L.

Hi Ritesh, when we did the EEG it picked up that I was having seizures I had no clue about. It is called Frontal Lobe Epilepsy that goes along with the Frontal Temporal Lobe Dementia. You also mention that all of her scans were normal. Was there ANY mention of atrophy in her MRI? Because atrophy in a 31 year old IS NOT normal. If that be the case I would definitely seek a second opinion. The Pet Scan will provide the most definitive answers as it is the most accurate test that can be done for dementia. Keep your fingers and toes crossed and I'll keep you in my prayers.

Dear Ritesh: I also wish to extend a warm welcome to you and am very glad you have found us. You are a wonderful advocate for your dear wife and you are to be commended for continuing to look for a concrete answer to the challenges you and your wife are facing.

Certainly, there are many conditions which could cause such an outcome. You are utilizing your instincts in continuing toward a diagnosis, and those instincts should be trusted.

Next to come; the MRI, PET Scan, a second opinion with another Neurologist after all tests are done; definitely an Endocrinology consult, and if her hormone panel has any irregularities, then a consult with both Endocrinology and Gynecology. Would a SPECT Scan add anything that a PET Scan would not? That is something to ask.

I understand that a T3, T4 and TSH have all been done and are normal for thyroid function? That is one elimination. Her B12 levels are doing well, so another cause has been eliminated.

Sometimes the onset of a particular condition can begin so slowly and so subtly, that it is difficult to "see" what is happening. Has your wife traveled to any out of the way places where she could have been exposed to any vectors such as birds or insects, etc., which could have affected her?

Has she been exposed to any environmental factors in earlier life or now which could be manifesting it's results at this later date?

Has there been anything similar in any members of her family going back to earlier generations?

I am dreadfully sorry you are facing such a medical puzzle. If this were me, I would take the path that you are; Neuro, Internal Med, then Endocrinology and even perhaps, Infection Control/Epidemiology. I would advise, "no stone left unturned." And I suppose, I would look for a large medical center with a formal Neurobiological Department that is active with a multidisciplinary approach to the patient and have her examined and medically worked up there even if some tests are repeated. Second opinions are always welcome.

I would also like to extend the invitation for you to also access the Caregiver's Forum site here on this Online Community. Just click on the Caregiver's Forum and write your question there anew. You will get MANY additional responses as that is where the majority of the caregivers and family members communicate. Most of them have been through very rigorous medical diagnostics for their loved ones.

It is a blessing for your wife to have you by her side throughout this challenging time. We certainly wish you well. If you feel you can do so, please let us know how you and your wife are doing and what you are finally able to find out from all the medical workup.

I wish the very best outcome for both of you and we will be thinking of you.

Johanna C.
Peer Volunteer

I am confused. If she has normal scores on the Wechsler and MMSE, what are her memory difficulties? Are they more long term memory than short (delayed) or immediate term memory problems. The Wechsler tests for short and immediate memory function, not long term. The cued recall sounds like it could be a long term memory problem.

An EEG will only show seizures. Do you have access to a QEEG? Quantitative EEG? It can find
small blips in the brain's processing.

At the risk of sounding offensive, has she been tested for syphilis? It can be the cause of brain malfunction.

Does she breath properly when she sleeps? Sleep apnea can cause memory difficulties by interrupting the brain as it transfers information from short term memory to long term memory. This is done during sleep.

Has she undergone any stressful situations? PTSD can effect memory functions sometimes.

How about a fMRI, functional MRI? It can watch the brain as it processes.

Have you journaled her memory problems? Having a good record of her memory failures will help with understanding them.

Sounds like you need to become a real detective in charting symptoms.

Good luck to you.

Ritesh: Johanna mentions "other environmental factors...."

Please read my post on Caregivers' threads under "On Insight News this morning." 3-24-09

Call or email with questions. Also review my website (access below sign-off).

Best wishes and take care - Joanne