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More medical questions re cognitive functioning

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Lionne posted 8/10/2014 21:37 PM

I would appreciate any medical advice anyone has to offer here.

SAFWH is diagnosed Bipolar 2 and ADD. He takes Effexor XR and ritalin. He was diagnosed by a respected neurologist at a teaching hospital after years of being treated as chronically depressed. His personality was always somewhat of an "absent minded professor" type, easily distracted, forgetful, etc. This affected his self esteem considerably. The ADD runs in the family, both sons, his father, etc.
Recently he was also diagnosed with Lyme disease. The only symptom he had was a thumb that was unable to hold his cello bow. He had the same symptom a year ago which was dismissed as nothing by a hand specialist. This year, he insisted on a Lyme titre which was "very high" according to the doctor.

The scary thing is that he seems to be losing some processing skills. He is slower, he is more forgetful. It isn't outwardly obvious, but it is noticeable to me. I don't know if it is Lyme or early dementia, or medication adjustment.

I do find myself getting impatient when I am explaining the same thing for the fifth time. I try hard not to sound condescending. Add to the mix, he is deaf, and uses hearing aids, when he forgets them, it is like the looney bin. Some of the things he thinks I've said are utterly ridiculous

He is only 63. Who do we see? A neurologist? An infectious disease doctor? If it is the ID doc, do we wait for six months to try to get a reliable read on the titre?

Getting old is not for the faint hearted...

Lionne posted 8/10/2014 21:39 PM

Oh, I forgot to mention that he is NOT without physical and intellectual pursuits to keep him going. He has hobbies, he teaches part time at a college, and he reads a lot.

But his driving scares me.

cinnamongurl posted 8/10/2014 22:32 PM

Scaredycat, where do you live? Different parts of the coumtry treat Lyme differently. Lyme is no joke! Definitely begin antibiotic treatment asap, do not wait!!! The longer Lyme goes untreated, the more devastating the result!

I would consult with both the neurologist AND the ID and if there is a lyme dr in your area, please see them!! I went undiagnosed for a long time because after the initial tick bite I was treated for only 10 days instead of the recommended 3-4weeks. I was told it was everything from rheumatoid arthritis, to ms. I lost all feeling in my right arm for nearly 3 months,and experienced crippling pain in my joints and muscles. My mood and brain and vision were in pretty bad shape.

I finally convinced my pc to test me almost 9 months later because no matter what we tried, I just kept declining. As soon as I got my dx, I called a local lyme dr, and was seen right away. Ive been lyme free for 3 1/2yrs now, but still frequently experience some of the symptoms. Ive been told by other people who have had long term lyme that they experience these symptoms as well.

cinnamongurl posted 8/10/2014 22:34 PM

Feel free to pm me. I can answer any questions you may have. I've done a lot of research on the subject.

purplejacket4 posted 8/10/2014 22:57 PM

Ask your PCP to refer him for neuro cognitive functioning testing.

Lionne posted 8/10/2014 23:33 PM

Yes, he was already started on a 3 week course of doxycycline. We are assuming this isn't a new infection, but I'm guessing that doesn't really matter?

Dr. PJ, are there differences in damage due to Lyme's vs early dementia? What kind of doctor would do this testing? Could it be a medication issue? I neglected to mention his high BP and cholesterol but of which are only controlled with medication. His diet isn't the best.

lynnm1947 posted 8/11/2014 08:36 AM

Just a quick question. Is he on cholesterol-lowering drugs? My S/O has ADD and Lipitor caused him to have cognitive problems. Really screwed him up. He stopped the Lipitor a few months back and he's getting back to normal.

tushnurse posted 8/11/2014 08:46 AM

Along with neuro for cognitive testing, see if you can see an OT for therapy and training. Speech therapy too, work with cognitive training, and they are good at it.

Along with Neuro, I would suggest seeing a Rheumatologist if you do not have someone in your area that is versed in treating lyme. It sucks, and it is difficult to treat. Proper treatment is key to good long term outcome.

sparklezombie posted 8/12/2014 11:58 AM

I would see a neurologist that specializes in seniors with cognitive impairments for the dementia test. I work with seniors for a living, most of whom have a cognitive impairment and not every Dr is created equal. I would seek out a specialist in that area.

Also, in our area, we have a driving simulator at the medical college's geriatric clinic. I recommend to my clients that they have their loved one take the simulation and if they pass, then they can keep driving. Sadly, most don't pass.

tushnurse posted 8/12/2014 12:23 PM

A Neurologist would be the one to do the testing.
An OT and a ST would also be able to do an in depth where are we functioning at level of evaluation that gives a jumping off point for therapy.
I have to agree about the statins. They can cause a fair amount of brain fog. I have seen it multiple times. Once fairly significantly to the point where the family though grandma had a miracle, because it was stopped after surgery, with a protracted hospitalization including time on a ventilator. When she finally started to turn the corner she was pretty witty, and the kids said she hadn't been like that in years, figured out it was the Lipitor there too.

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