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Dr. Thomas, MD
Dr. Thomas, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 55835
Experience:  Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
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My husband is 72. Over the last 4 years, since his retirement

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My husband is 72. Over the last 4 years, since his retirement as a draftsman in bolted tank manufacturing, we have seen little change in him other than 'normal' aging. Forgetting a name now and then or misplacing keys, etc. In the last 4 months his health has left him incapable of caring for himself. Originally, his memory was the first marker, then he wasn't following thru on simple task. He would say okay I am getting up and not. Okay I am coming yet not make any effort to stand up. This progressed to lack of appetite, diagnosed at one time as failure to thrive, no short term memory, including not able to recall a series of words said to him, further progression went to aphasia, incontinent, weakness on left side, stiffness in his muscles identified by therapist as 'tone'. Nuerologist hasn't any answers. He has remained about the same for 2 months. He current speech is garbled, yet at times he will say entire sentences in communication. He can't walk yet he will take steps with support from others on each side. He sleeps alot. I mean like 18 hours a day. He communicates with difficulty, yet he does communicate. Testing includes CAT, EEG, Thyroid, Thyroid serum, B12. He has a pacemaker/defib. so no imaging is possible. We have had his heart medications reviewed, no diabetes. This is either terribly simple or very obsure. Any ideas what to look for?
Submitted: 8 months ago.
Category: Medical
Expert:  Dr. Thomas, MD replied 8 months ago.
Hello
Thank you for requesting me.



I am Dr. Thomas, double board certified physician with over 20 years of clinical experience. I will help you with your question and any follow up questions you have.

Simply put, this is progressive dementia.

Unfortunately, there is no definitive lab test or scan to say that this is Alzheimer's or frontal dementia, but you have ruled out normopressure hydrocephalus. You might have ruled out multi infarct dementia as well.
I am surprised he has not had an MRI as this generally gives a bit more information than a CT scan, an MRI/MRA particularly.

However, the diagnosis of most dementia is based on clinical examination.

It sounds like the neurologist has been reluctant to do this for whatever reason; I therefore think a second opinion hands on with another neurologist would be wise. You have not even mentioned his mental status exam score, for example, which is one of the first steps in assessing dementia.

Use reply to let me know if you have further questions.
Please do not forget a positive rating.
Customer: replied 8 months ago.

As I previously said, he has a pacemaker/defib. and since he is dependent on the pacemaker it makes magnetic imaging impossible. He has has many CT's, read by many drs. The outcome has been consistent. Normal vascular, normal age related atrophy. His inability to walk, aphasia, choosing not to eat by mouth and his moving in and out of periods of alertness has remained fairly unchanged for 2 months. Also remaining unchanged is his ability to, when alert, walk ( move his legs and feet with intent), speak meaningful sentences in relationship with to the conversation, eat and drink things that bring him pleasure (beverage or sweets). His memory has improved to the extent that he remembers the people that he sees through the day. When alert he can repeat a sequence of items.


 


Still puzzling is this constant tightening of his arms, jaw, neck and back. This is not present when sleeping soundly. It begins to calm down as he falls asleep. It is present until he reaches a deeper sleep. As soon as he wakes up it starts again.


 


All professionals agree it is not Alzh. Other things such a CJD and Hashimoto's Encephalopathy have been ruled out. There are some symptoms of stroke but not enough. I have cared for family members who had dementia and this is not even close to that. I will check for the normopressure hydrocephalus, although the symptoms sound familiar.


 


Was looking for, hoping for, symptoms to sound familiar enough to lead me/us to another direction. It takes 10 to 14 months to get into a university hospital neurology dr. The local guys just don't see much beyond the normal.

Expert:  Dr. Thomas, MD replied 8 months ago.
2 months is not enough time to assess progression or the lack thereof.

Fronto temporal dementia presents differently from alzheimers.

Stiffness and rigidity of course is typical of Parkinson's and some varients can present with exactly these mental and physical symptoms, so this needs to be considered as well.

In fact I don't think it is normopressure hydrocephalus, as this would show up on CT typically.

The CT findings are quite consistent with dementia, as often that is all that is seen.

you might discuss PET or SPECT scanning, not definitive, but can give more indications of typical dementia patterns.

Again, I don't think the neurological assessment has been aggressive enough.

If I were your doctors, I would be talking personally to leading dementia/parkinson's docs, if that is at the university, and pushing to help you get an earlier assessment.

Since, I assume that thyroid, B12, and other metabolic problems have been ruled out....Dementia, from parkinson's, or other cause..FT dementia, multi infarct, etc...still seems on the top of the list.


I am assuming of course, he has not had any toxic exposures...heavy metals for example.

Use reply to let me know if you have further questions.
Please do not forget a positive rating.

Customer: replied 8 months ago.

Future plans are as you described. PET and another EEG. What 'other' metabolic problems should we have looked at. Yes to Thyroid and B12 tests, normal ranges on both.

Expert:  Dr. Thomas, MD replied 8 months ago.
thyroid and B12
Addison's, Cushings
B1 deficiency.


Please do not forget a positive rating.
Dr. Thomas, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 55835
Experience: Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
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