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My Mom has mild to medium dementia - depending on the day. She is on Galantamine and Memantine which was prescribed by her primary care physician. Should I get a screening from a neurologist? Are different drugs prescribed for different kinds of dementia? Or should I just leave it alone?

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Are the meds she’s on helping? If you don’t feel they are, call her PCP and tell them. What tests were originally done for Mom? Did she have any scans, like an MRI? If so, the neurologist probably won’t do anything different. If it would set your mind at ease and Mom is on board with it, go ahead.
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Hugemom, The Memantine was helping but was reduced because of severe Diarrhea. No other option was offered. The comment about the MRI was that it was typical for someone her age (88). What is that supposed to mean?
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I just had a brain MRI (for hearing issue) and part of the findings were "consistent with mild to moderate chronic small vessel ischemic changes." Goodness! What does that mean? (I haven't talked to the doctor yet.) I looked it up and apparently it can be linked to a number of cognitive problems, but it is extremely common in my age bracket, whether there are cognitive issues or not. I take it this is what "typical for someone her age" means.

Would it be useful to know what kind of dementia your mother has? At this point it would be useful to science if she were enrolled in a study. It MIGHT be useful in coming up with a treatment plan or in understanding her symptoms. But we know so little about how to treat the various kinds of dementia that being able to differentiate among them may not be as valuable as we wish. This will change as research progresses, but right now even if you knew that mother had XYZ type dementia, there aren't likely to be any specific treatments for XYZ in any case.

There are very few biomarkers that allow for diagnoses of type of dementia in non-intrusive ways. Autopsy is often the only way of identifying what was going on in the brain. While that is very useful for research, it is of no practical value to the patient or family. (My husband donated his brain for this kind of research.)

Here is an important consideration: The different kinds of dementia have different symptoms and progress in different ways. Even within the same kind of dementia, individual cases vary a lot. So if the care center or day care program or hospital staff -- anyone who deals with a "dementia" patient expects all patients to match some predefined "typical" case, that will be a problem. But if they are better educated and flexible in their approach then the exact diagnosis isn't so important.

Case in point: A nursing home staff was sure a resident was being manipulative and "faking" symptoms, because they seemed to come and go. Something he could do in the morning he claimed he couldn't do in the afternoon. None of their other dementia patients had this much and this frequent variation. But that is a core identifying feature of Lewy Body Dementia (which is what he had). So in a way it would be good to identify what type of dementia people have. But for now it would be cheaper and more convenient to simply treat each person as a unique individual and deal with the symptoms they have, without regard to some supposed "typical" dementia pattern.
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Anerus, “typical for her age” means nothing alarming stands out, no tumors, lesions, etc.
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I agree with most of what jeannegibbs has said, BUT I still wish I had had a definitive diagnosis for my mom, or any kind of diagnosis at all. I spent a lot of years trying to figure out what was going on with her and making decisions based on the belief she was much closer to the end of her life than she turned out to be. Maybe it wouldn't have made any difference in her life, but it might have spared me a lot of frustration and self doubt.
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Cwillie,
You probably could have saved Mom from a diagnosis that would have led to many medications, that (in some people's opinions), would have led to a more rapid deterioration. I think for you, and for your Mom, you did good, really good!
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Is you mom seeing a geriatrician? Or a family type PCP. You need a geriatric specialist or a neurologist.
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cwillie, I do believe that one benefit of a specific diagnosis is for the caregiver. I knew that my husband had Lewy Body Dementia, and that led me to join a specific support group, and also to learn a lot about that disease. I think that indirectly helped my husband because it made me a better caregiver.

We never did know what kind of dementia our mother had. By observing the symptoms I would say it was not ALZ, and I'm definitely sure it wasn't LBD. It might have satisfied my curiosity to know, but I doubt it would have made any difference at all in my mother's care.

If it were easy to get a differentiated diagnosis, why not? But it is not easy, not inexpensive, not highly accurate. I don't think that putting my mother through more tests, interviews, etc. would have been worth the effort for her. As diagnostic techniques become refined, and as effective treatments become available, this will all change.

For now, the biggest benefit is probably for the caregiver.
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Does it matter in the long run...probably not.
Does it matter during the course of their lives?...maybe.
A person with Lewy Body Dementia can not take certain types of medications. But Lewy Body is usually in people with Parkinson's so if she does not have Parkinson's It probably doesn't matter.
Vascular Dementia on the other hand is different. The Dementia is worsened by small strokes. And at some point there may be a major stroke that you may have to deal with. Either the person (and caregiver) is lucky enough to not survive or unlucky enough that it is one that they do survive and are left with not just the result of more decline but more physical problems as well.
The "normal" decline of one with Alzheimer's is a slow and steady decline. (Like walking down a ramp)
The "normal" decline of someone with vascular dementia is sudden drops. (Like walking down stairs.)
My Husband never got an "accurate" diagnosis and I think he had both Alzheimer's and Vascular Dementia's. His decline was slow and steady like walking down a ramp with sudden steep declines just like he came to a landing on the ramp that forced him to take a step down to another ramp of decline.
Did not knowing make a difference? Not really. I would not have changed what I did and it would not have changed the ultimate outcome.
So the ultimate person to answer this is you and you knowing your Mom.
Can she withstand the testing?
Can she cooperate during the testing?
Will she have to be sedated during any of the testing and how will she react to the sedation?
Is she otherwise healthy?
Have you discussed the outcome of any testing and whatever it may uncover?
If she has Alzheimer's or other form of dementia and problems are discovered during any testing what will you do with the results? (example: during a full physical the doctor suggests a colonoscopy? would you elect to do it? If you do it and the results show cancer will you elect to treat or not?)
Do you/she have a P.O.L.S.T. (used to be a DNR) in place? A P.O.L.S.T. is more detailed than a DNR
All very tough discussions but these are conversations that are best had as early as possible or you will be left making the call.
And if you have siblings they need to be kept in the loop and be made aware of decisions that your Mom makes.
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Jeannegibbs, can you tell me where & how much it cost to donate alz brain to research?
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I found that the diagnosis of my husband's vascular dementia with possibility of future major stroke very important. It caused us to move back to our hometown where both his children and his sister lived, as did my two children from a former marriage. Twelve months after the move he suffered a major stroke and died in hospice three weeks later. If he had been diagnosed with Alzheimer's I might have put off the move for several more years as we were managing relatively well and I didn't want to move from the city where we had lived for 25 years and had a lot of activities and friends.
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My mom has some sort of dementia. It has been helped a little with aricept. She has had some cognitive testing and passes parts of the test with flying colors. If you ask her to draw a clock face and then put hands at 1:00, she can't do it. Sometimes she is confused about the day, time of day or things on her calendar. At the same time, she can use an iPad and send me text messages. She is 86. I think if she had been exhibiting signs of mental decline years ago I would have suggested testing. I'm not going to put her through it now. She seems happy and functions at assisted living. I feel like I don't need to know what kind of dementia it is at this point.
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There are a lot of good answers here. As the neurologist/author of the book “Grain Brain” would tell you, the current drugs for Alzheimer’s do not work, and it is a shame they are prescribed. Dr Dale Bredesen of California has reversed Alzheimer’s in nine people and is now, along with his team, working with 100 more patients. However, he is doing it through nutrition. For example, as we age, the brain has trouble processing sugar. It is glucose (sugar) that the brain uses to function. If the brain cannot use sugar, then we have problems such as Alzheimer’s. However, the brain can still use keystones. Keytones can be introduced to the body via coconut oil and MCT oil. Fortunately, both can now be taken in powder form and purchased at GNC. Each come with a measuring spoon, and I take one measuring spoon each three times a day. You can put it in a smoothly, which I do from time to time, though that is time consuming. So, I generally just mix it in pomegranate juice or orange juice. It does not mix that well, but it still tastes good. So, that is one idea of treating dementia via nutrition. It takes more work but it works. Knowing what kind of dementia your mom has will possibly help if a nursing staff knows how to handle each type, ie what to expect from each kind. My advice is 1) make sure you are the medical and financial power of attorney, 2) prepare yourself emotionally and physically for what could be a challenging journey, and 3) consider what I have stated about the GNC products. To learn more about what you can do for your mom nutritionally, get the new video series “Awakening to Alzheimer’s” or at least get the book “Grain Brain”. And keep in mind that 1) the medical community has spent $600 billion dollars on Alzheimer’s research and they are still chasing their tales and getting nowhere and 2) it can all be prevented in the first place via nutrition...but, the drug companies don’t want you to know that and 3) much of Alzheimer’s starts in the gut and not the brain, so get Mom’s eating turned around...promptly! I wish you all the best.
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I agree with 20Eagle16.
The book 'Brain Grain' is an incredible understanding of how to prevent ALZ. It is too late for my Mom as she is 96 with a long history of non-appropriate eating and in mid to advanced ALZ, but it is not too late for many of us; and it may not be too late for an ALZ patient who is only in the mild stage. It is a great breakthrough. I DO suggest everyone gets that book and begins to make changes in their diet according to their ability.
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There are so many forms of dementia, and so many causes, that a GP doctor should never continue to prescribe drugs without first getting a proper assessment from a neurologist. It is scandalous if this does not happen. Whether or not Aricept or Domezapil is prescribed thereafter, you should know that many prescription drugs cancel each other out, and if the brain is in a fragile state, the time of day for taking any drug may be crucial.

So there's your answer: a neurologist, not a general practitioner, is the only person who can diagnose the present state of your mother's brain and say if it's Alzheimer's or another clear form of dementia requiring a different level of personal care. They will also know the latest treatments. True Alz patients have many periods of complete lucidity, and hate being treated like morons when they are perfectly capable of rational conversations.  But such patients may desperately need  anxiety-depressors to get them through the first stages until they reach acceptance that their mental state will never improve but only get worse.

Good diets are fine to halt a disease's progression but I have yet to find a food diet that wil replace lost useful brain tissue.

And dementia may cover up other serious medical conditions (eg urinary tract infection). Dementia patients are not medically articulate. Alzheimer's patients may struggle to articulate due to their memory lapses and they expect a doctor to diagnose them by thought transfer!! . My friend had a prolapsed anus, but because she was too shy to tell anybody about "the trouble with her bottom" and because she was paralysed with fright during a consultant with a specialist doctor, (I was not there) and even refusing an examination, she suffered for several more weeks before I dragged her to a clinic we knew and insisted on a thorough health check up. The problem was identified, surgery booked and done. It had to be redone more thoroughly 3 years later but this time at least we were on the lookout.
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I'm a RN, and your loved one needs to be seen/followed by a neurologist, rather than a primary care provider. There are many different types and subtypes of dementia, and they are NOT all treated the same. In fact, some medications for one dementia would not be advised for another (i.e. drug for Alzheimer's given to FTD patient can cause Dystonia, which causes extreme stiffening/pain of neck and shoulders, difficulty moving head). My father has (FTD) frontal temporal dementia. A proper work up by neurologist with imaging is the best way to provide best care for your family member and provide best education and resources for you. This is one of the most cruel and heartbreaking conditions, you will need all the tools possible to help them and yourself.
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@ALG1447 Difficulties with the clockface, the counting down by 7s from 100, the memory game with 3 key words are all part of the Alzheimer's regular testing of different mental abilities. They can be used for general testing, and repeating them at regular intervals serves to monitor the rate of decline of cognitive ability.
People in their mid-80s do not necessarily want to live for ever, but they do want to be comfortable. So if they are in a heavily structured environment like assisted living, where they don't have to worry where the next meal comes from, nor bills to pay, and there's always somebody to ask if they have a problem, then they can live quite happily at a superficial level. Knowing the exact date matters very little in this context, so old people often don't bother.
I would speculate that your mother has very mild form of Alzheimer's but that her brain has reprogrammed itself a bit to be able to handle the ipad.
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My friend who had no children or close relatives except her elderly husband was diagnosed with frontal temporal dementia. I read about it on-line to get a clue about what that meant and what to expect. Shortly after this diagnosis, I was made power of attorney for my friend and her husband and given complete control to make decisions over their lives. As her dementia progressed, I was able to get support help and find a place for them with good care. The head nurse at the Assisted living/MemoryCare facility was very astute and clued me in on changes they noted and what to do next. Not all people with FTD follow the exact same path of deterioration, of course, but the variations were explained which were useful to me and the support staff there so they could better help with her care. That was why knowing the specifics as best they could tell became useful in her care.
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The only reason to know type of dementia is for caregivers to be able to know how to follow the progress - my mom has it from a stroke & acquired brain injury so we don't expect too much deteriation physically but mainly mental whereas some like Altzimers has some physical effects -

This means that when they are going into care you know all issues & can effect your choice because moving at a later stage can be harmful to their orientation as they don't accept change well

You don't say where you are - is getting a neurologist going to be financially hard? - maybe try a gerentologist - good luck
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I found that further pursuing information about my mom's diagnosis and the extent of her cognitive disorder was helpful. We went to both a neurologist and a neuropsychologist, who were very good and very helpful. We decided not to go with any meds, as someone above rightfully pointed out that the side effects are many. I'm glad that we made that decision at this point, and we now have baseline data on which we can build if her condition deteriorates. Right now she has been fairly stable for well over a year. My mom was NOT looking forward to going to see the neuropsychologist, but she liked him so much that she danced on the way out of his office. He got quite a kick out of it.
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ps -- I would NEVER let me mom go on meds for cognitive disorder based just on the suggestion of a PCP. Those meds are serious business....
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My thoughts are right along the same ones Teri4077 points out. My mom has probably had some mental decline symptoms progressing for a few years but not to any degree that encouraged us (her children) to push for addressing it with any testing or anything. Her mother had Alzheimer's so it's been in the back of her mind, all of ours, as a possibility for her but also a touch subject that she preferred to ignore. My mom had a stroke a year and a half or so ago however and while we were very lucky that she has no lasting physical deficit she does have lasting aphasia as a result. Both her speech and thought process are effected but it's hard to know what's coming into play now. She has had 2 Neuropsychological evaluations since the stroke and it's very hard to tell during the testing in many places if her speech issues are the problem or her memory is and it's almost impossible to know if things are attributed to stroke damage, aphasia or Alzheimer's/dementia in some areas. If she had had a Neuropsyc evaluation before the stroke for a baseline it would be a big help in many ways. The ability to compare a test prior to the stroke and then the first one after the stroke with subsequent tests would help a great deal in knowing what progress she is making or isn't from stroke damage. Her primary doesn't feel medication helps at all in Alzheimer's or dementia (something I was surprised to hear actually) and she didn't have a neurologist until the stroke (only treating the stroke) as far as I know so that isn't a factor here at all though seems like it could be if that were a consideration but as we have learned there are good reasons beyond medication for having some baseline testing. Medicare paid for both evaluations and will pay for one every year or more often even with certain guidelines. I think there are various reasons a primary or specialist can give for ordering a Neuropsyc eval that get it covered by Medicare.

As Teri4077 also eluded to the test can be a scary prospect, my mom really resisted the second one in particular. I think because she knew it was being used as a guide to some big decisions like when she could go back to living on her own at her house and if she could think about driving again by her medical team. It's also a long and grueling test for some (mom with her aphasia) and I think makes difficulties with certain basics, things it never occurred to her she had difficulties with, very obvious to the person taking the test. It can expose things to the person taking the test that might feel really scary I think. But also as Teri said the experience can be swayed quite a bit by the testers personality and abilities. My mom loved the first tester in particular as well!
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I agree with the statement, "Typical for her age." What you would be looking for is something that stands out as "atypical," such as changed behavior patterns in your LO.
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My Mom had dementia and her doctor did nothing about it.. I quit my job, hubby and I sold our house and we moved in with my Mom to take care of her.. It went from normal, to her yelling at me at all hours, to sleeping a lot, then not talking or recognizing me at all.. Mom passed 5 years later on October 24, 2016.. It didn't matter to me what kind she had, she had it and there was nothing I could do about it but be there for her. and I did by myself... In that 5 years, I learned what dementia was and how it affects a person. Its a terrible disease. A disease my Mom didn't deserve.. My Mom was everything. We buried her 1 year ago today :'(
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I think you might benefit from talking to someone at Alzheimer's Association. I wanted my mom to be tested when she showed major changes in her behavior; one of my sisters did not see the point. My mom finally relented just to make sure that she did not have something that could be "fixed." Turns out it was vascular dementia which did not make any difference in treatment, since there is no medicine for that. But it helped me and my dad to know what we were dealing with and where to go for support.

My mom passed away in April from congestive heart failure, and I regret the pressure I felt and put on her to know what was wrong, i.e. the dementia. Looking back, I think it would have saved a lot of tension if I had just met alone with her doctor to get advice on what it could possibly be and how to help her adjust to her new "normal." But this is a personal decision. There are meds for Alzheimer's that work at the beginning stages, only to slow down the progress. So that would be something to discuss with a doctor also. Please know I'll be praying for you and your mom. It seems like a lonely journey, but everyone on here has either gone through this or is going through this now and can offer support and definitely relate to what you are facing.
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Thank you everyone for your input. All of you have been very helpful.
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For my dad it was important, because he has Lewy Body dementia and there are certain medications that can make it much much worse. Seemingly innocuous medications like Advil PM and Benadryl can cause havoc. Also, some anti-psychotics like Haldol can even be fatal. LBD has some classic markers, such as acting out dreams (REM sleep disorder) and vivid hallucinations, yet it's still under diagnosed. I would vote for taking her in for some tests, even if all you accomplish is ruling out LBD. At least you'll know if she can take these meds safely or not.
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