Are continued neuro-psych evaluations necessary?

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Are continued neuro-psych evaluations necessary?

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Are continuing neuro-psych evaluations of any benefit to the alzheimer's patient? My wife's primary physician already had her on Aricept, Memantine, and Rosuvastatin at the time the neurologist and neuro-psychologist diagnosed early onset AD. My DW's primary is taking good care of her health. I see periodic neuro-evaluations only as updates that the disease is progressing and they cause my wife additional stress. Am I wrong to not want to continue seeing the neurologist that has already said there is nothing that can be done to stop or reverse the disease?

Alzheimer's & Dementia Care Decisions Medical Care

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The deterioration in dementia, is due to the chemical changes that occur in the brain tissue, which destroys the neurons and interrupt or blocks communication among them. It has nothing to do with psychology. Therefore, with stress or without stress the rate of brain deterioration will remain unaffected. Dementia is not a psychiatric illness, it's a neurologic illness like ALS. A purely structural problem affecting the brain tissue, totally independent from psychologic issues. The caregivers are the ones who suffer the psychological consequences.

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Ok-then why is this disease so inconsistent from patient to patient? The rate of brain deterioration may change-because of genetics, pre-existing conditions and age of patient when first diagnosed, family history and patient's own history. Yes, it is a structural problem, problem is, the type and kind of structure is so inconsistent from person to person, that we currently do not have a consistent treatment plan to deal with the deterioration of the neurons, synaspses and associated chemical and structural changes that happen with this disease. For, if what you've postulated is true, then, this forum would not exist, and treatment would be resonable and routine for dementia.

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The doctors have said: "Not everything can be fixed".

Seeking small improvements and suggestions from a support system (several people or family familiar with issues) has helped us both cope.

I remember the psychiatrist saying: "Just be kind to each other". AND,
"When you leave here, take a drive to the beach".

Still, there are times when it surprises me-a new behavior-a new road block to normal as possible functioning.

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IMO if wife has been tested and found what type of Dementia she is suffering thats all you or they need to know. Meds will be given based on the type of Dementia the person is suffering from. A neurologist can give meds and adjust as needed but there is no idea for additional testing unless its labs. It doesn't matter how they are progressing. I would not rely on a PCP to handle meds for a person suffering from Dementia. They know a little about everything and a lot about nothing. Keep with a neurologist. There will be a time that Meds for cognitively will not work.

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The exact type of dementia can only be determined in an autopsy. Clinical identifications are only approximations. In many cases there are combinations of various types. In practice, identifying the exact type is irrelevant. They all end up the same way.

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Once diagnosed what is the point? There is no cure, nothing will get better so why stress your wife out?

IMO you are not wrong.

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Thank you.

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I'm all for it. Perhaps you could talk to the neurologist ahead of the appointment and descibe your wife's stress, it may be possible to try a different approach. I think that the more people are seen, examined, patient notes written, there is going to be a viable body of evidence to use and help with long term research. This is an extremely individualistic disease, and what ever blips that might be recorded into the medical record could be of use one day down the road to a researcher mining the evidence of the effects of Alzheimer's. Perhaps improving the evaulation tests too.
Of course-as with the disease, each and every caregiver is different, and you know your situation best.

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My LO’s dosage has been changed every several months, with good results.

The changes are made based on periodic observation and reports from her caregivers.

A full neuropsychiatric evaluation? Probably not, but updates on medications? In our situation a useful tool.

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The only evaluations that matter, are the ones to confirm the diagnosis of dementia. Once diagnosed, any future neuro-psych evaluations will only show the progression of the disease. You have to understand that the disease will only go downhill. There is no cure for it, it's like ALS or Lou Gehrig disease. The speed in which the disease advances is unpredictable. At times it may appear to go very fast, then it may go slow and even take a break. Then it may crash in a hurry. There is no way to tell, you have to play by ear. The medications that have been prescribed, are the standard ones. They do not cure dementia, its value is debatable. But doctors don't want the patients to leave empty handed. What's is really important, is to plan ahead for the worse that will be coming. There is going to be a time when caring at home won't be possible anymore.

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Thank you.

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Anything at all that causes your wife stress should be avoided, in my opinion. As long as you can call the doctor for medication refills/updates/changes, that's all you really NEED from him or her. All the testing is not going to do one darn thing to stop or reverse Alzheimer's anyway, just as you said, so what is the POINT? No point. It was like that with my mother; she had a neurologist while in the hospital who was 'looking after her' for neuropathy & dementia, neither of which she could do anything to help her with, admittedly. Yet she was on me like white on rice, asking when I was bringing mom back to her for a follow up? I said never. She was shocked. I didn't care. WHY would I drag my wheelchair bound 92 year old at the time mother clear across town, God knows HOW, for a follow up appointment with a neurologist who did nothing FOR her to begin with? No thanks.

Do as you wish; as her husband, in reality, you know her and her needs best.

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Thank you.

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I think it is important with early Alzheimer's that you have measurement on how quickly the disease is progressing, est. with early onset. I myself would want this done.
This really is more a "choice" than anything else for you at this point, and for the MDs this can fall under measurement, and progression, and information regarding the disease in general itself.
I certainly wouldn't do this more than once a year, and perhaps would stretch that to one and one half years.
Discuss this with your primary. Ultimately, like many diseases, you have some choices you have to make for yourself. I surely do wish you good luck in making them. They aren't easy decisions. I am glad you DW is getting good care, and has your support.

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Thank you.

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Are continued neuro-psych evaluations necessary?

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