My father in law is diabetic and he has been showing dementia symptoms for quite some time. His doctor (a cardiologist) ordered an MRI to see if he had dementia. He says that the MRI came back normal, I'm not sure if it did or not, he does lie about things. Even so, is it conclusive evidence? Will an MRI show dementia?
Thanks for any help.
Lizzie
I'm no expert, but the way it worked with my Mom was this: an MRI was done to rule out any OTHER causes of her forgetfulness and personality change. Tumors, aneurisms, etc can be diagnosed this way. I was told that Alzheimers can only be definiteley diagnosed by autopsy after death -- but this was a few years ago.
Mainly, Dementia is diagnosed by oral tests such as asking the patient to name the date, day of the week, year, the current president, how many children he has, what time of year it is, etc. Sometimes they are asked to count forwards or backwards by 6 or 7, and other things. Oh yes, often the examiner will start by saying, "I am going to tell you three words, try to remember them ... example Bird, Fish and Tree." Later after all the questions on time and place, the person is asked, "do you remember those three words?"
That's how cognitive memory is tested .. and the doctor gets some idea whether or not it is Dementia. Usually the patient manages to fake the test 2 or 3 times before ''getting caught." My Mom fooled the doctor several times, just by changing the subject, making a remark about his taste in wallpaper and the fine rug on the floor, and distracting him from his line of questioning. Flattery worked also - he seemed to think, "this woman thinks so highly of my taste in furnishing the office that she MUST be brilliant, not suffering from dementia". (they do not lose intelligence, just memory!) In fact she didn't get diagnosed until one day the older doctor was not in the office and his son asked Mom the memory questions. Result, she was already in late middle stage Dementia; he recommended a nursing home! I kept her at home another year, but was probably wrong to do so, since she adjusted to the NH very well and was happy there for the 2.5 remaining years of her life. She died on Dec 29 2007, one year ago.
I don't tend to put much in the three word to remember. Reason: I have gone with my husband and I forget them by the time the doctor comes back to it!!! Makes me wonder about my memory. Am I having problems? Don't think so = I just remember those things I feel are important. I have been one to multi-task and unimportant things are not remembered. I do remember them later when I am more relaxed. I guess I am just concentrating on remembering all the important stuff the doctor has to say about my husband.
What Martha described is what they call a mini mental evaluation. All, you might not remember the three words but you can count by 5's. There are several questions that test several different areas of cognition. But, to truly diagnose dementia it takes a much more extensive battery of cognitive testing which also includes other information about your education, employment etc. This way they compare you to others of your same intellegence level. Mom's cognitive testing lasted from 9 in the morning until 3 in the afternoon with a break for lunch. We received very specific information about her deficits such as her inability to process auditory information. She does much better with visual input. Like Martha's Mom she fooled the GP and his mini mental until she was moderate/sever (depending on the cognition skill) stage consistent with ALZ. They diagnosed the dementia... but not the actually ALZ.
The MRI is used to check for any other possible reason for the symptoms as is a complete physical with all necessary blood work. The MRI is also used to determine if there is shrinkage of the brain which may indicate dementia. It is not a definitive diagnosis but an indication. If there is a previous MRI for comparison it is helpful.
It takes a combination of test to determine dementia. No one simple test can determine if it is present of not. Cognitive testing is being developed by the facility Mom was tested at in hopes to diagnose it sooner. Right now they rule out everything else, and then check for what symptoms they know.
Lizzie, if you don't trust your FIL's doctor to tell you the truth then take him to a geriatric neurologist or a cognitive testing center.
Welcome to both of you. Hope you will find the forum helpful in many ways. I have found a wealth of information here from the experience of other and it is great to talk to those who have have the same experiences to talk to. They definitely understand!! Again.... welcome
I definitely pursue testing through a different doctor rather than the cardiologist. Does your father in law have a good family doctor who can refer you?
Martha and Deb are correct about how Alzheimer's is diagnosed. It hasn't changed. We have our final appt with MIL today for the results of the battery of tests she had, but I was told at the first appt that it was Alzheimer's, simply because the doctor (a neuropsychologist) asked a lot of questions to her and to me and ruled out other possible dementias. We had already done tests to rule out other causes, like tumors, etc. It was very clear to the doctor in the first few minutes that MIL has some form of dementia. It was just a matter of what type. But we did the whole battery anyway, just to be official.
On the last test, she took a bathroom break and I was told it would be about another hour. They brought her back to me about two minutes later, which I took to mean that she couldn't do anything on the last test. It doesn't surprise me, seeing what she can and can't do with us.
If you can get a different cardiologist for your father in law, I certainly would. You need to be able to trust his doctors!
I had the same experience as you did with Mom's last cognitive testing Emily. Mom was back in the waiting room with me much sooner than expected. She walked off with my daughter and the doctor told me she was doing so poorly that there was no use in annoying her further by continuing the testing. She had reached the outter limits of their research window as well so there was no follow up. Now it is a matter of follow ups with her geriatric physician and psychologist to keep the mental and physical health as stable as possible. We know the extent, cause, and direction of her dementia.
I think knowing a proper diagnosis is more or our benefit than theirs. Mom is clueless that there is even anything wrong with her at this point. The diagnosis is irrelevant in her world... but it definitely tells us what is going on and why. It also gives is validation and a direction. It is what it is and knowing is better than guessing or denying. Finding a doctor that is informed in dementia treatment and that you are comfortable with and you trust is so very important!
I'm no expert, but the way it worked with my Mom was this: an MRI was done to rule out any OTHER causes of her forgetfulness and personality change. Tumors, aneurisms, etc can be diagnosed this way. I was told that Alzheimers can only be definiteley diagnosed by autopsy after death -- but this was a few years ago.
Mainly, Dementia is diagnosed by oral tests such as asking the patient to name the date, day of the week, year, the current president, how many children he has, what time of year it is, etc. Sometimes they are asked to count forwards or backwards by 6 or 7, and other things. Oh yes, often the examiner will start by saying, "I am going to tell you three words, try to remember them ... example Bird, Fish and Tree." Later after all the questions on time and place, the person is asked, "do you remember those three words?"
That's how cognitive memory is tested .. and the doctor gets some idea whether or not it is Dementia. Usually the patient manages to fake the test 2 or 3 times before ''getting caught." My Mom fooled the doctor several times, just by changing the subject, making a remark about his taste in wallpaper and the fine rug on the floor, and distracting him from his line of questioning. Flattery worked also - he seemed to think, "this woman thinks so highly of my taste in furnishing the office that she MUST be brilliant, not suffering from dementia". (they do not lose intelligence, just memory!) In fact she didn't get diagnosed until one day the older doctor was not in the office and his son asked Mom the memory questions. Result, she was already in late middle stage Dementia; he recommended a nursing home! I kept her at home another year, but was probably wrong to do so, since she adjusted to the NH very well and was happy there for the 2.5 remaining years of her life. She died on Dec 29 2007, one year ago.
Love,
Martha
Hi Martha,
First thanks for your answer, it was helpful. Here is where my problem starts. My FIL has been telling his doctor about how he fishes and plays raquetball all the time, his doctor thinks he's fine. Actually, what I think has been going on is the doctor is leading him with small talk and he is agreeing. Anyway, my husband has gone with his father and told the doctor but it took a LOT of convincing for the Dr. to order the MRI! I am really at a loss as to what to do. He does have Parkinsons-like symptoms (hand tremors) but no one wants to do anything. I can't tell you how frustrated I am! Actually, I am sure you all know
Another problem is that I don't know how to get him to another Dr. He thinks his Dr. is God, so if HE told my FIL to go to a certain Dr. he would go. I would like to call his Dr. and tell him that he really needs to see another Dr., but there is the H.I.P.P.A. laws that prevent him from speaking to me.
Its so perplexing!
Klattsoe, my mother's cause of death was that her body shut down as a result of Dementia. Her body forgot how to process food, so basically she starved. Her body also stopped processing the many heart medications she was on - none of them showed up in her blood stream, nor did the nutrients we get from food.
She just wasted away. In the end some minor infection, maybe a bad cold, weakened her so much that she just stopped breathing. She was 99 years old, so no heroic measures were taken to prolong her life. Mom had told us many months before that she was ready to 'go home.' The doctors also told us that a stomach tube or intravenous feeding would not be processed by her organs either. 'Organ failure' is probably the correct expression for her cause of death.
But she had lived a long and happy life before she got dementia, and in many ways it was a blessing for her and all of us to see her suffering come to an end.
I do understand your delima Lizzie. My Mom had convinced her long time family doctor that she had caregiver depression from taking care of my Dad who has had vascular dementia for years. Many of the symptom of dementia and depression are the same. If we saw anything out of the norm she would tell us that either Dad did it or it was due to her depression. When her doctor finally "caught on" she changed doctor's and had her new doctor convinced of the same.
We went with her to the doctor. During the visit we ask her, with him present, if it was ok for him to talk to us. What could she say but yes! That was how we ended up on her HIPPA form. From there I called and ask for the referal to the Memory Assessment Research Service where she was finally diagnosed. Her physician didn't think it was "that bad" but agreed to appease me. She was already moderate/sever dementia consistent with ALZ by the time she was diagnosed. The doctor was shocked but hopefully he learned something from it. As you said, he lead the conversation and Mom would nod and smile without truly understanding a word he said. Her answers seemed appropriate to him but he didn't have background that we knew to dispute what she was telling him.
So if you can manage to get a referal from his doctor, then it was not your idea but the doctor's idea and then it's ok.
I do understand your delima Lizzie. My Mom had convinced her long time family doctor that she had caregiver depression from taking care of my Dad who has had vascular dementia for years. Many of the symptom of dementia and depression are the same. If we saw anything out of the norm she would tell us that either Dad did it or it was due to her depression. When her doctor finally "caught on" she changed doctor's and had her new doctor convinced of the same.
We went with her to the doctor. During the visit we ask her, with him present, if it was ok for him to talk to us. What could she say but yes! That was how we ended up on her HIPPA form. From there I called and ask for the referal to the Memory Assessment Research Service where she was finally diagnosed. Her physician didn't think it was "that bad" but agreed to appease me. She was already moderate/sever dementia consistent with ALZ by the time she was diagnosed. The doctor was shocked but hopefully he learned something from it. As you said, he lead the conversation and Mom would nod and smile without truly understanding a word he said. Her answers seemed appropriate to him but he didn't have background that we knew to dispute what she was telling him.
So if you can manage to get a referal from his doctor, then it was not your idea but the doctor's idea and then it's ok.
Love, deb
Hi Deb,
I do appreciate your (and everyone's) help and support. Things aren't going well at all. Since his MRI and blood work came back "fine", my husband acts as though everything is fine now. Its just his low blood sugar that is causing all his problems. So I said to my husband, just a few minutes ago, 'Did the doctor ever send him to the neurologist?" Hubby said no, everything came back 'fine'. I said, 'Well what about his shaking hands?' He just shrugged and looked at me like 'what can I do?'. This is sooooo FRUSTRATING! I can do nothing, absolutely nothing. I can't contact his doctor (tried that before and he never got back to me). The HIPPA laws prevent me from doing anything. So I guess we just leave it like this?
One good thing, the doctor gave him a new way to take his insulin so at least he hasn't been seizing on us. For a while he was taking too much insulin every night and several times a week my husband had to revive him. Maybe I was wrong. Of course the problems have been obvious since he has lived here and I think that his sugar may have been ok once in a while, but I could be wrong... Its only been two years.
Sorry for going on but I am getting really aggravated.
Why can't you go to the doctor's visits with your husband and his father? If your husband is stopping you, put your foot down and say "hey your father is living here with us and I have as much right as you!".
If there are other reasons, try to get your father to put your name on the medical documentation that gives you the right to talk to them. This is only if you really, really want to be dragged into that nightmare.
I don't know what I'd be anxious about; being involved in it, or being denied involvement. After dealing with all the bull about my husband's illness and taking his venting that 'this is happening to ME!!!!, not you" and me screaming back "excuse me!, but the kids and I hear you throwing up every single blessed morning, and see you barely able to walk to the chair in the living room!, don't tell me that its only happening to YOU. Who the hell do you think is suffering right along with you, taking notes, getting test results, assembling them in a binder, being able to provide any doctor with immediate access to your records. Getting up in the middle of the nights for the emergency runs to the hospital after getting your blood results!".
I had to fight to be involved, blow him off and just forced myself into his doctor appointments and stay strong to hold it all together!. I lost myself to his illness, its like a second or part-time job. When it was over, I just laid in bed for weeks not knowing what I was suppose to do now.
So sit quietly, comtemplate if you really want to be involved in it and if the answer is yes, bully your way into the doctor visits as well! let everyone know that when they talk about the Dad, they better talk to both of you and not just to your husband. Men are sometimes in more denial than woman when it comes to bad things.
Take a deep breath Lizzie. This is your husband's father. He ultimately has the responsibility. You have done what you can to facilitate your father in law's care. At some point something will happen that will make it necessary for your husband to move from his denial. No, they can not tell from blood test or an MRI if someone suffers from Dementia. Ask your husband if the doctor gave his Dad a Mini Mental test and how did he do on that? That will be the best indication of dementia in the examination.
You can print out web sites that say, ALZ can only be diagnosed medically from an autopsy. Neurological testing, cognitive testing, and some other methods can give you an indication of ALZ but the only true way to disgnose it medically is to physically examine the brain. So the fact that the MIR was normal only shows that he has not had a stroke or has brain tumors. My Mom's MRI was within normal ranges and she was already a stage 4/5.
I do wish you luck and keep typing. I know you are frustrated and with good reason. But remember, you can only do what they are willing to let you do...
We had a little difference with the MRI. The national AD research center that DH went to, showed us distinct changes in the brain related to AD on his MRI. They were not significant changes when he was first diagnosed, but they did exist. The usefulness of the MRI may depend on both the equipment and the expertise of the doctor reading it. This is another area of medicine that is changing rapidly. Be careful not to rely on stuff in books, brochures etc. too heavily, since it takes time for them to be written, published and distributed (copyright date is an indicator of course). You may be getting information that is 2+ years out-of-date from the info that Doctors receive in their medical journals and conferences.
I agree with you totally beginning. Printed information is outdated by the time we get it. My comments about the MRI were basically concerning the very beginning of ALZ. Yes, there are certain areas of the bain that do shrink as the disease progresses but most times, at the beginning of the disease, there are no noticeable changes, especially if there is not a previous MRI to compare... and as in Mom's case there was not evident well into the diasease. I would not stake a diagnosis on an MRI unless there was definitive evidence. The absence of evidence doesn't mean an absence of the disease at the early stages.
caringsister,
I agree with you on everything! Do I want to be involved? Well, yes and no. My husband has never said, hey this is my dad, but I try to respect that he may feel that way. I don't think I would want him interfering at ALL if it was my dad. But he and I are very opposite. I really like your argument though that he lives with all of us. Its true. He did set our backyard on fire after blowing up a full 5 gallon can of gasoline. He was burning twigs in our fire pit and used gasoline as fuel. We have an elementary school behind our house, the children were screaming and basically traumatized by the whole incident, my daughter who lives a few houses away calls me and says, why is the fire company at your house? I'm like, you are there why are you asking me!?!? Anyway, that was almost two years ago. But to answer your question, do I really want to get involved? I think I have to. I don't know if I am strong enough though. I am not a confrontational person. I will confront when I have to, its just not first nature with me. For me to be as outspoken as I have been lately is highly unusual. So I suppose I am somewhat ready. Maybe I can see if I can go to an appointment. If nothing else, saying that I want to, may make my husband decide he needs to be more proactive. I may have to do that.
Deb, thanks for your kind words, especially when I know you are struggling right now as well. Truthfully, I do think that its more than his blood sugar. People who have known him for a long time know how much he has changed in a short period of time. Its more than his diabetes. After all, he has had diabetes for almost 50 years.
Beginning, I wonder what the MRI was looking for? I really don't know. I recently had an MRI and found I have "grossly clear sinuses" ... so what does that mean? They were trying to figure out why I had hearing loss. So I know that an MRI most likely is not the most conclusive evidence.
Thanks all for your support!
Love ya!
Lizzie
Lizzie,
You say that you won't know if your strong enough. I think you are and I also feel you have to be involved in this case. You won't get all the information needed through husband that's for sure.
When my husband would be at a doctor's appointment by himself, and come home and I'd ask "how did it go?" he just grunt 'fine'. When I walked into the doctor's with him and doctor would ask "well Mike how you feeling?" he said "fine". I'd be the one to pop up and say "no that's not true. This past week he wasn't sleeping, he was eating or not eating . . ., " A lot of the feedback to the doctors came from my observations more than from Mikey who didn't want to admit that he was as sick as he was.
So hang in there. You can and should do this. Not just to support and help husband on the road he's walking but to help yourself and the life you had versus the life you have now.
When push comes to shove Lizzie we all suprise ourselves at how strong we really are. I don't like confrontation but when pushed I will stand up. You will do the same. If your gut feelings is that something is terribly wrong and that you can help in some way, you will stand up and do it.
It is possible that some is from the diabetes but more than likely the diabetes is out of whack because he is not doing what he should for his diabetes because of the possible dementia. Mom is glucose intolerant which is a little different but much the same as well. She did great for a few years and was even told by her doctor to just keep doing what she was doing and there would be no problems. It was well under control with just her eating and exercise habits. Then ALZ struck. 40 pounds, a mountain of chocolate, and no exercise later she is on diabetic medication.
I'm with Caring. Some are always fine and some don't truly "hear" what is said by the doctor. It might be worth your time to go with your hubby and father in law to the doctor and stick in your two cents worth and actually hear what is said.
The fire escapade sounds scary. You are right, if he lives with all of you then it is for you to be involved as well.
As for the MIR... they look for areas of the brain that have actually physical shrinkage to determine some types of dementia. Particular areas of the brain with actually look smaller. As for the grossly clear sinuses... I wish mine were just a little bit clear!!
Unfortunately Lizzie, God has decided that you need to help your father in law. We all have to step up to the plate at times whether we think we should can or want to. When my mom was bad, my father was also bad. I was fightly on both fronts. There were days that I literally had the phone on both ears. The good thing was that both mom and dad were in the same building. The bad thing was that it was two separate wings, staff, doctors, nurses. I felt like I was being attacked from both sides.
reading my comments now you would never think that I used to have a hard time standing up to other people. But I learned that I needed to to be able to take care of my parents who were the sun and moon in my families lives. So I took a very deep breath and I would say what I thought I needed to say. and if they didn't listen to me I would just say it a little louder. If that didn't work, I jsut changed the words some. If that didn't work, I would talk to someone else. I got smart, I would smile and I got my way.
You will too because it is your family and your husband and your marriage and your FIL. Trust me you can do this. There isn't any discussion about if you can because there isn't a choice. Your family's very existance will depend upon you being able to help with him. I know that it sounds drastic, but your hubby shutting you out of the care of FIL when he lives in YOUR house is just plain not right. That'e would be like my husband coming home and saying we are having a border move in and you'r taking care of him but you won't know anything about it. Not only is it foolish but it could damage your FIL health. You need to know all that is going on with him also.
Deep breath Lizzie and step into the battle. Here's your towel. You're going to need it. We will hold tight to the other end and give you support. That's what we're here for....
Last edited by ibake&pray; 01-10-2009 at 07:24 PM.
Am I having problems? Don't think so = I just remember those things I feel are important. I have been one to multi-task and unimportant things are not remembered. I do remember them later when I am more relaxed. I guess I am just concentrating on remembering all the important stuff the doctor has to say about my husband.
Re: Accuracy of MRI 
