I took dad to see the neurologist this week. It was very cold – 30’s and lightly snowing though not sticking to the ground. I got out dad’s winter jacket for the first time this year.
Also dad didn’t have socks on, so I pulled out socks from his drawer and made him put those on. It was just too cold to let him continue with bare feet inside his slippers. He never wears shoes anymore because the slippers are more comfortable. Last winter I bought him rubber soled slippers since he was using them as shoes.
I stopped at the office and picked up the envelope prepared for dad’s medical visit. It contained the list of his current medications and a form for the doctor to write a diagnosis.
After we arrived, we spent the first 30 minutes waiting while I filled out more forms. I had already completed the 4 page form they sent to my house which had questions on his medical history and family medical history. In addition now I had to complete insurance information and sign that we would be responsible for charges not paid by insurance.
Dad asked a few times why we were going to a doctor. I told him it was just for a checkup and nothing to be concerned about. When the doctor introduced himself, he said he was a neurologist and specialized in memory issues.
First the doctor asked dad if he had any memory problems. Dad said “No.” He did not have any memory problems. “Wow!” I thought. No wonder dad doesn’t worry! He isn’t aware of any memory problems. Mom used to worry all the time the last year before she died because she couldn’t remember my children’s names, or later, because she couldn’t remember if I even had children.
Dad’s lack of worry makes life so much easier for him. He takes each day as it comes and doesn’t worry about the next one. I should learn from him!
The doctor then asked him what year it was. Dad said “2012”. What season? Dad said “winter” which wasn’t too far off considering the weather and the coat he was wearing. “What month is it?” asked the doctor. Dad said “December”. The doctor asked the day of the week, but dad didn’t have an answer for that one.
Next he asked dad to spell the word “world”. Dad did fine. Then he asked dad to spell “world” backwards. Dad was a little off on that one. He told dad 3 words and asked him to repeat them. Dad did fine on that. He asked dad to write a sentence on a piece of paper. Dad wrote: “What is your name?” The doctor told him his name and a little about himself. Then he showed dad a drawing of 2 overlapping pentagons and asked dad to copy the drawing. Dad did pretty well.
Then the doctor asked dad what the 3 words had been (that he repeated before). Dad didn’t remember. I wondered if I would remember either!
The doctor asked about previous medications like Aricept and Namenda. I said dad had taken them in the past but I guessed they didn’t help much as he had been taken off both.
Then the doctor did a little physical exam, looking in dad’s eyes, testing his reflexes, etc. He took a tuning fork and hit it to make it vibrate. He held it to dad’s head, chest and arms and asked if he could feel the vibration. Yes, dad could. Then he held it to dad’s feel and legs. Dad couldn’t feel that at all. I guess that must indicate poor circulation, but the doctor didn’t say anything.
He then commented that dad does have memory problems but he would also like to obtain the brain scans from 5 years ago to see if dad’s stroke could have some impact on his current memory problems.
I also mentioned that dad’s poor hearing made conversation difficult and makes his memory seem worse than it is. The doctor agreed and said it was too bad dad doesn’t wear hearing aids as it would help in his communication skills. As it is, dad has about given up television and even listening to his music tapes. He might forget he has them, but I suspect it is hard to hear them too.
After the exam, the doctor asked us to make another appointment for dad to do some paper and pencil tests. He told dad they were easy. I asked if it really took 3 hours, and he said the whole appointment takes 3 hours with the testing, doctor reviewing the test and then doctor discussing results with us.
He also decided not to add any new medications today but may in the future after he reviews the records from dad’s previous doctor.
For the ALF paperwork, the doctor just wrote “dementia” on the form. He said dad’s geriatric doctor had written “advanced Alzheimer’s” on the paperwork she sent over. The neurologist didn’t consider dad to have “advanced” Alzheimer’s. And he wanted to evaluate how much of the memory deficit might be due to the previous stroke.
I would agree that dad’s dementia isn’t “advanced” as there are so many things he can still do. However, I do think it is getting worse over time, so it must be more than just the old stroke. I am very glad I arranged for dad to have this assessment, and wish I had arranged it sooner.
I also wonder if the doctor will send feedback to dad’s geriatric practice. I think they tend to ignore his Alzheimer’s disease and just treat any physical symptoms that come up. This should be a good way to keep the geriatric office informed about dad’s needs as well.
In addition, I hope this assessment informs dads’ ALF on dad’s abilities. I think the fact that he doesn’t hear questions and instructions make them presume he doesn’t understand them.