OpenHealth Q&A

Should We Seek a Second Opinion on Alzheimer’s/Dementia Diagnosis?

I need some advice! To summarize a lengthy situation briefly, my father (71 years old) has exhibited troubling signs for roughly two years. His cognitive difficulties include a substantial decline in vocabulary, frequent forgetfulness of names, places, and tasks, repetitive questioning with no memory of prior inquiries, decreased logical reasoning, an inability to summarize movies or events immediately after experiencing them, increased aggression, a decline in his previously good math skills, poor spatial awareness (evidenced by numerous dings and scratches on the car), and difficulty maintaining conversations. We consulted with a neurologist who ordered an MRI, CT scan, and lumbar puncture, and I’ll outline the findings below. We had our concluding appointment today, and the neurologist stated, "Given that amyloid levels are over 600, he does not have Alzheimer’s and shows no signs of dementia.” Although I am not a healthcare professional, the results seem concerning, and I am puzzled as to why a 71-year-old man is struggling to function in everyday life. Considering the findings detailed below, should we pursue a second opinion? Or is the neurologist correct in their assessment that everything is normal? **MRI Findings:** The examination revealed lesions in the periventricular and subcortical white matter, suggesting chronic ischemia. Additionally, small areas of tissue damage were noted in the external capsules bilaterally and in the right basal ganglia, potentially due to small infarcts. A minor area of tissue loss was also present in the left thalamus. There were no acute changes, hemorrhages, or microbleeds, nor any space-occupying lesions observed. A subsequent arterial angiography of the intracerebral vessels indicated no significant stenosis. The ventricular system’s size and shape remain unchanged, as does the sulcal pattern. **CT Scan Summary:** The CT images exhibited low-density areas in the periventricular and subcortical regions, indicative of chronic ischemia. Tissue loss was also seen in the external capsules and the right basal ganglia, possibly from previous infarcts. There were no obvious acute changes or any space-occupying lesions. However, the ventricular system appeared enlarged, suggesting mild central atrophy, but no signs of mesial temporal atrophy were noted. Some cortical atrophy was documented, primarily in the parietotemporal areas on both sides (GCA 2). The bone window showed no abnormalities. **Lumbar Puncture Results:** - Amyloid beta 1-42: 624 ng/L in CSF - Amyloid beta 1-42 / 1-40 ratio: 0.072 - CSF Phosphorylated tau (p-tau): 232 ng/L - CSF Total tau protein: 1110 ng/L

Answers (1)

7/3/2025, 5:20:41 AM

OpenHealth AI

It sounds like you are deeply concerned about your father's cognitive decline and the neurologist's interpretation of the tests. Your instinct to seek clarity is completely valid, especially given the symptoms and findings you described. A second opinion can provide further insight and reassurance.

Main Points

1. Symptoms vs. Diagnosis: Your father's troubling cognitive symptoms are concerning and deserve further exploration, especially since the neurologist's interpretation may not fully explain his decline.
2. Pursuing a Second Opinion: Seeking a second opinion could help clarify your father’s condition, confirm the neurologist’s findings, and potentially explore other underlying causes.

Explanation

The symptoms you've outlined—like forgetfulness, repetitive questioning, and difficulty with everyday tasks—are indeed significant. While the neurologist has indicated that the amyloid levels suggest he does not have Alzheimer's, the presence of chronic ischemia and minor tissue losses raises questions about other potential neurological issues. Cognitive impairment can arise from various conditions, including vascular dementia, which is connected to chronic ischemia, as well as other issues that may not have been fully explored.

Next Steps

1. Seek a Second Opinion: Look for another neurologist, ideally one who specializes in cognitive disorders. Bring all previous test results and notes from the past consultations to provide them with a complete picture.

2. Document Symptoms: Keep a detailed journal of your father’s symptoms, noting when they occur and their severity. This will help the new neurologist make a more informed recommendation.

3. Explore Other Assessments: Inquire about additional tests or evaluations, such as neuropsychological testing or evaluations for other conditions (e.g., vitamin deficiencies, thyroid dysfunction) that could contribute to cognitive decline.

4. Supportive Environment: While you navigate these medical decisions, ensure your father is in a supportive environment. Help him maintain routine activities that stimulate his cognitive function, while also being patient with any frustrations he may experience.

5. Seek Support for Yourself: Caring for someone with cognitive decline can be very challenging. Consider looking for local support groups for caregivers or counseling services to manage your feelings effectively during this time.

Remember, it's essential to advocate for your father's health and get the answers you need. Your proactive approach is beneficial in navigating his care.