Expert: Michalene Peticca - 11/18/2006

Question
Dear Michalene,
My mom is 64 years old and over the past 3 years she has developed some progressive memory loss.  Initially she was forgetting what she was going to say or she would forget the correct name of something.  She is now forgetting people's names (ie: cousins, old friends who she doesn't see often but has been friends with for years) and forgetting things like what basil and baking powder are (my mom has cooked her whole life).  Today, she could not remember what a lamb was and when I described it she said "I just can't remember what that is."  She has seen a neurologist and had the standard battery of tests (ie: CBC, BMP/lytes, Vit B12, VDRL, head CT, she takes thyroid medicine so her T3, T4, and TSH get tested on a regular basis).  She had a neuropsych eval which came back as "inconclusive".  Her neurologist started her on Aricept but had to switch her to Namenda because the Aricept upset her stomach.  When she first started taking the Namenda we felt like the progression had slowed down but over the past 4-6 weeks we have started seeing a more rapid progression again.  My grandfather died in his late 60's and he "had memory problems" for probably the last 8-10 years of his life but I don't think he ever had a formal diagnosis other than "he was senile".  My question is what other tests should we be asking for?  What are your thoughts as to what this could be?  We know it could be Alzheimer's or another form of dementia.  As far as we know she has not had any TIA's but we are concerned that perhaps she is having unwitnessed TIA's and has developed multi-infarct dementia.  We just want to make sure we are doing everything we can to help mom and make sure she gets the appropriate care.  Any input will be greatly appreciated.
Thank you,
A.L.

Answer
Hello A.L.,

Thank you very much for writing.  It sounds like you are very well versed on your mom's health and are in the healthcare field yourself?

You certainly have been thorough with tests.  There is also the PET scan...although costly.... it is the most definative for detecting CVA prior activity (MI dementia) and Alzheimer's disease.   If your mom is having TIA's on a frequent basis, i feel this test would certainly show some level of deficiency or deterioration of the brain.   

I'm leaning toward your conculsion as to your mom's memory loss. Forgetting names is one thing, but not being able to visualize an animal or object from verbal descriptions..there is something not "connecting" within the brain.   

However, don't forget that Depression can also mimic many symptoms of dementia and i'd rather see a person started on an anti-depressant rather than immediately head toward the Aricept or Namenda.  You may have already went this avenue, but, reconsider if you have not.  

Another good resource of information is on the Johns Hopkins School of Medicine website or their dementia facility Copper Ridge Institute.

Might i also suggest another neurologist, or geriatric specialist, as a second opinion.  "Inconclusive" is just too broad to give up on!  

Keep up the great work and i wish you and your mom well.

Best Regards,
Michalene Peticca, MA