i frequently get messages like this via facebook email
messenger or texting
folks asking for help deciding what to do for
themselves or a loved one with memory issues
this person a former patient
no i consider them once a patient always a patient
messaged me
asking for help with her parent who lives with the family
my parent is having memory issues
my parent had an episode of several minutes where
they didnt know who they were or where they were
they were confused
then it cleared up
i dont know what to do
so i went into my doctor mode
my alzheimers disease memory loss mode
from hearing the story i knew this patient would eventually
end up at a neurologists office for definite care
however
knowing the system like i do it can take awhile for someone
to get into see a neurologist
so enter the primary care provider
the entry road to the healthcare system
i knew that there were possibilities causing this
some of them real bad
some of them that couldnt wait that long to see the neurologist
like a brain tumor a stroke a hematoma from a fall an aneurysm
too much fluid in the brain
things that really needed to be ruled out sooner than later
things like vascular dementia alzheimers disease could be
diagnosed at a slower pace with no rush in doing the workup
i recommended a primacy care provider appointment as soon as
possible
if before the appointment the episode occurred again
the parent should go to the emergency room
eg i remember my mom had slipped and fallen
when she was taken in a ct scan was done which showed
a subdural hematoma from the fall
luckily it was small and nothing had to be done about it
a larger one that continued to bleed would have required surgery
if i was the primary care provider for this patient
i would do a careful history and examination to look for causes
of thier memory loss and confusion
an irregular heart beat eg atrial fibrillatin can cause clots
to be sent up to the brain causing these symptoms
a fall uncontrolled blood pressure uncontrolled cholesterol
uncontrolled diabetes
medications that would affect the memory
symptoms of depression or severe anxiety or lack of sleep
on exam i would look for signs of neurological deficits
like drooping of face or eyelids or muscle weakness or
increased or decreased reflexes gait problems
confusion in answering questions
i would probably do a brief mental exam to generally find out
what the memory level was
my priority for this visit would be to find an acute cause
that could be life threatening that needed to be addressed
then based on what showed up in the history and exam
i would do screening labs like cbc chemistry profile thyroid level
vitamin b12 and probably add a vitamin d level while i was
drawing blood and add an urinalysis
elderly patients especially females can get confused from utis
then i would do an mri on this patient to rule out most of the
bad things that could be going on that would need sooner
treatment
other things to consider would be a carotid ultrasound to
check neck circulation
so a primary care provider could and should do all this workup
then fine tuning the care can be done by them
or referral to an appropriate specialist
on her parent the mri showed some brain shrinkage
and what sounds like white matter hyperintensities
although i dont have the mri to look at
these are areas that start showing up in folks who may
have eventually have a stroke or have alzheimers
its associated with high blood pressure high cholesterol diabetes
i think of them as microscopic strokes in some cases
from either hemorrhage or ischemia
eg i have two of these on my scans but over five years there have
been no new ones
so she is left with a parent who has some mild atrophy of the
brain with memory loss
there is an upcoming neurology appointment
this parent should not let the parent go to any of their appointments
alone
so whats left to do
maybe more labs
carotid ultrasound
memory test probably in office or neuropsychological test to see where
the patient is with their memory and to act as a baseline
so if nothing else is found
this parent may have memory loss from vascular causes
ie vascular memory loss
the idea is to maximize a persons health
good control of blood pressure and diabetes and cholesterol
maintain good sleep habits
watch for anxiety and depression
be careful with medications
avoid excessive alcohol
do exercise even if its walking around the block once a day
be active
make sure the person is active socially
dont let them isolate themselves get them involved in something
make them stay mentally active reading writing using the computer
if possible
dont let them get stagnate
sometimes aspirn is added
sometimes based on what the memory loss looks like
aricept or (donnepezil) like i take is added
then
they and their family need to be ready for the future
start planning now
make sure these documents are done now
will power of attorney power of attorney for healthcare living will
no cpr form for when things get worse
families wait too late sometimes to do this and it takes
the legal system and courts to get these done
please dont wait on these
i have all these forms done
then be ready as someone in this family will become
a caregiver
a tough tough job sometimes
then do all this
but
enjoy each day as much as you can with this person
sometime in the future you and your family will
be glad that you did
thats what i would tell her and others that ask me
enjoy the moment
october 31 hays county in san marcos
team organicgreendoctor
november 7 bell county in temple
team organicgreendoctor
i will be the honorary chair for this event
the organicgreen doctor
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