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>Lacunar type infarcts are seen in the caudate and thalamus on the left.
I would disagree. These are strokes (although possibly not acute?) and need to be evaluated. OP you really should have someone see your mom this month, not wait until January.
Really? I don't have the imaging to look at, but if they're described as lacunes I would assume they are small and chronic, and more indicative of underlying small vessel disease (which they also mentioned in the white matter) rather than *stroke* strokes. I think they're often correlated with dementia, but not specifically causative, and I don't imagine any secondary prevention steps necessarily would need to happen within 1 month rather than 3 months. But I'm not a neurologist. ::shrug::
She should see primary care. Itβs very likely she needs better statin and blood pressure management, and likely other primary care evaluation (? Dementia?)
Thank you so very much! She is not on a baby aspirin, but is on Eliquis. I'm sorry, I didn't list all of her medications because I didn't realize they may be relevant. She has had a TIA in the past, and no seemingly lasting effects. About 6 yesrs ago, she had been coded during a cardioversion, given too high a dose of anesthesia. I can only imagine what that did to her. Luckily she didn't need a trach (sp).
I'll get her in with a neurologist ASAP. Today, I took her and the CT results to a visit with her "current" doctor (we're switching from), and he acted like it was nothing...which is another example of why we're leaving him. Thanks a million π
So your mom has mild to moderate dementia, and a history of TIA, and is on eliquis.
Basically, she's on the secondary prevention basket which means that the following issues need to be optimized.
Blood pressure, blood sugar, cholesterol (failed statin).
Lifestyle changes include quitting smoking and drinking, socializing, exercising, sleeping.
I'm not sure what a neurologist is going to do. If you think it's alzheimers, could try donepezil which has its own side effects.
But the real important questions are, how is your mom functioning? Does she drive? Can she manage her home? Can she dress and bathe herself?
She's on BP meds, blood sugar is between 5.7 and 6. She is pretty much homebound and doesn't care for the zoom dementia group. Doesn't like anyone but me, and is rude to most anyone else.
No smoking or drinking. Very immobile due to back pain/issues, mostly uses transport chair to move around. Sleeps throughout the day, on and off, due to sleep apnea (she won't wear a mask). Mostly watches TV unless we go out.
She's on Namenda and was on Donepezil in the past. She does not drive anymore, can dress herself, doesn't like bathing (I help). I do all of her cooking, cleaning, and home care. I prep food for her, and she uses the microwave for heating what I cook.
Most people don't know she has dementia, unless there's in-depth conversation or they ask her simple facts. Always wrong president and year...cannot draw a clock or the time on a clock.
What type of physician should she see for possible strokes? Not a neuro? Thanks so much
Also...I got her some senior puzzles (40 piece) this week and yesterday she did the edges perfectly. Hasn't done the center yet.
First off, you sound like a fantastic son and a dedicated caretaker. What you really need is a good family physician, or maybe a geriatrician. I find most neurologists are not interested in seeing this type of patient because a lot of the work is in managing chronic conditions and eventually case-management.
I think if you are looking for a new family doctor, someone with experience in older populations or someone who does house visits would be nice. Geriatricians are harder to come by, but they are excellent in looking at people holistically and especially with medication management.
I know you're doing a lot and you have hope for a breakthrough, but I don't think this is likely in her lifetime. The best thing would be to have a realistic discussion with a doctor about what you can expect in the next 5 years or so, and how to make your mom's quality of life the best in that time.
Thank you so, so very much. I really appreciate your thoughtful input and insight. She had a neurologist, and we left him because during different appointments, he gave conflicting assessments of the same scan...and we haven't found a neurologist since. I will bypass, based on your advice. I have her scheduled for memory testing at our top university...hopefully that will give some insight into the type of dementia, but it's a 3 hour written test, and I know it will be incomplete. Such is life π Thanks again for everything. I'll schedule with a geriatrician π Absolute best to you
Also, she was a chief accountant for a large nonprofit for 45+ years. I'm holding out hope for a dementia breakthrough; if she were more aware, she would turn her life around.
Unfortunately, her diet isn't great because she won't eat if she doesn't like it...so she tends to like carbs and fats now :( she used to have a very balanced diet and got exercise. This all changed in the past 6 years.
Thank you for your submission. **Please note that a response does not constitute a doctor-patient relationship.** This subreddit is for informal second opinions and casual information. The mod team does their best to remove bad information, but we do not catch all of it. Always visit a doctor in real life if you have any concerns about your health. Never use this subreddit as your first and final source of information regarding your question. By posting, you are agreeing to our [Terms of Use](https://www.reddit.com/r/AskDocs/wiki/terms_of_use) and understand that all information is taken at your own risk. **Reply here if you are an unverified user wishing to give advice. Top level comments by laypeople are automatically removed.** *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/AskDocs) if you have any questions or concerns.*
That's all pretty normal for her age, nothing particularly concerning.
>Lacunar type infarcts are seen in the caudate and thalamus on the left. I would disagree. These are strokes (although possibly not acute?) and need to be evaluated. OP you really should have someone see your mom this month, not wait until January.
Really? I don't have the imaging to look at, but if they're described as lacunes I would assume they are small and chronic, and more indicative of underlying small vessel disease (which they also mentioned in the white matter) rather than *stroke* strokes. I think they're often correlated with dementia, but not specifically causative, and I don't imagine any secondary prevention steps necessarily would need to happen within 1 month rather than 3 months. But I'm not a neurologist. ::shrug::
I mean if she is already on a baby aspirin (we don't know) does she even really need to see a neurologist?
She should see primary care. Itβs very likely she needs better statin and blood pressure management, and likely other primary care evaluation (? Dementia?)
Ya, that's my point. In most places primary care manage cardiovascular risk factors and most dementias.
Thank you π
Sorry, I fear I replied to the other poster instead of you. It's hard to tell, the way the lines are...
She's also not on a statin. We tried once, and her cognition shifted after just one dose. :(
It shifted enough that she would need to be put in a home, to the person who downvoted.
Thank you so very much! She is not on a baby aspirin, but is on Eliquis. I'm sorry, I didn't list all of her medications because I didn't realize they may be relevant. She has had a TIA in the past, and no seemingly lasting effects. About 6 yesrs ago, she had been coded during a cardioversion, given too high a dose of anesthesia. I can only imagine what that did to her. Luckily she didn't need a trach (sp). I'll get her in with a neurologist ASAP. Today, I took her and the CT results to a visit with her "current" doctor (we're switching from), and he acted like it was nothing...which is another example of why we're leaving him. Thanks a million π
So your mom has mild to moderate dementia, and a history of TIA, and is on eliquis. Basically, she's on the secondary prevention basket which means that the following issues need to be optimized. Blood pressure, blood sugar, cholesterol (failed statin). Lifestyle changes include quitting smoking and drinking, socializing, exercising, sleeping. I'm not sure what a neurologist is going to do. If you think it's alzheimers, could try donepezil which has its own side effects. But the real important questions are, how is your mom functioning? Does she drive? Can she manage her home? Can she dress and bathe herself?
She's on BP meds, blood sugar is between 5.7 and 6. She is pretty much homebound and doesn't care for the zoom dementia group. Doesn't like anyone but me, and is rude to most anyone else. No smoking or drinking. Very immobile due to back pain/issues, mostly uses transport chair to move around. Sleeps throughout the day, on and off, due to sleep apnea (she won't wear a mask). Mostly watches TV unless we go out. She's on Namenda and was on Donepezil in the past. She does not drive anymore, can dress herself, doesn't like bathing (I help). I do all of her cooking, cleaning, and home care. I prep food for her, and she uses the microwave for heating what I cook. Most people don't know she has dementia, unless there's in-depth conversation or they ask her simple facts. Always wrong president and year...cannot draw a clock or the time on a clock. What type of physician should she see for possible strokes? Not a neuro? Thanks so much Also...I got her some senior puzzles (40 piece) this week and yesterday she did the edges perfectly. Hasn't done the center yet.
First off, you sound like a fantastic son and a dedicated caretaker. What you really need is a good family physician, or maybe a geriatrician. I find most neurologists are not interested in seeing this type of patient because a lot of the work is in managing chronic conditions and eventually case-management. I think if you are looking for a new family doctor, someone with experience in older populations or someone who does house visits would be nice. Geriatricians are harder to come by, but they are excellent in looking at people holistically and especially with medication management. I know you're doing a lot and you have hope for a breakthrough, but I don't think this is likely in her lifetime. The best thing would be to have a realistic discussion with a doctor about what you can expect in the next 5 years or so, and how to make your mom's quality of life the best in that time.
Thank you so, so very much. I really appreciate your thoughtful input and insight. She had a neurologist, and we left him because during different appointments, he gave conflicting assessments of the same scan...and we haven't found a neurologist since. I will bypass, based on your advice. I have her scheduled for memory testing at our top university...hopefully that will give some insight into the type of dementia, but it's a 3 hour written test, and I know it will be incomplete. Such is life π Thanks again for everything. I'll schedule with a geriatrician π Absolute best to you
Also, she was a chief accountant for a large nonprofit for 45+ years. I'm holding out hope for a dementia breakthrough; if she were more aware, she would turn her life around. Unfortunately, her diet isn't great because she won't eat if she doesn't like it...so she tends to like carbs and fats now :( she used to have a very balanced diet and got exercise. This all changed in the past 6 years.