Essential Tests for Stroke and Dementia in Elderly Patients

Examination items for stroke/dementia in the elderly?

Hello, my mother is 73 years old.
Last month, she had a cold and visited a clinic near our home for medication.
The following afternoon, she went out as usual but did not return home for a long time.
In the evening, family members found her in a nearby park, and she said she forgot how to get home.
The next day, her personality changed dramatically; she began to cry and accuse my father of stealing her money, showing clear hostility towards him.
Her memory has significantly declined, and her language skills have worsened, with some stuttering.
Sometimes she reports tinnitus and seeing shadows.
There is no numbness in her limbs, but her movements have become very slow.
We are concerned that she may have dementia, so we took her to a neurologist for evaluation.
A psychiatric consultation was also arranged, and she underwent two MRI scans.
Currently, the doctor indicates that she has indeed deteriorated significantly, with three possible conditions: 1.
Stroke 2.
Inflammatory infection 3.
Tumor metastasis.
The MRI did not reveal a clear cause, and the doctor recommended hospitalization for further tests, including an EEG, a full vascular ultrasound, and a lumbar puncture.
The doctor also candidly mentioned that even after these tests, the cause might still not be identified.

At present, my mother's language skills seem to have returned to her pre-illness state.
Taking her for walks nearby, her physical condition appears better than when she first became ill, but her memory is still noticeably impaired; she may forget something she just did, like cutting an apple and later not recalling who did it.
She can manage some daily activities, such as brushing her teeth and washing her hair, independently.
However, her appetite has decreased, and she seems more depressed, expressing feelings of psychological distress but unable to specify what is troubling her.
Previously reported tinnitus and blurred vision have not recurred, and she has not experienced headaches or other pain.
The earlier incident of crying about her money being stolen occurred once recently but was very sudden and resolved quickly (she just cried out "Dad stole my money" and then acted as if nothing had happened).
After the first MRI, she became very dependent on my father, which is puzzling.
I would like to ask the doctor if a "lumbar puncture" is a necessary examination in my mother's case.
I have reviewed other stroke evaluations, and this test was not mentioned, plus it is an invasive procedure.
I would appreciate the doctor's opinion.
Thank you.

Meimei, 40~49 year old female. Ask Date: 2017/01/19

Dr. Hong Weibin reply Neurology

Hello, thank you for your inquiry.
Your concern for your mother is truly touching.
Based on your description, it seems that your mother is experiencing acute altered mental status (personality changes, slowed movements).
Your neurologist is correct; potential causes could include a strategic stroke, encephalitis, and other issues.
Therefore, an MRI has been arranged.

As for the lumbar puncture, it is used to rule out encephalitis (which involves inflammation or infection of the brain) and is not intended to diagnose a stroke.
An EEG is also performed to assess brain function and check for abnormal wave patterns (such as epileptiform activity).
Some types of encephalitis may present with epileptiform activity, but the presence of such waves does not necessarily indicate that seizures are occurring.
Additionally, aside from the acute issues, it may be worth considering whether your mother had been experiencing any subtle symptoms prior to this episode, such as frequently asking the same questions, difficulty with household tasks, confusion about how to use certain items, changes in her daily activities (like shopping), or occasional delusions.
Sometimes, degenerative dementias (such as Alzheimer's disease or Lewy body dementia) can present with acute and more severe symptoms, but there may have been earlier, more subtle signs that we overlooked.
Wishing her a speedy recovery!

Reply Date: 2017/01/19

More Info

In evaluating the symptoms and medical history of your mother, who is 73 years old, it is crucial to consider the potential underlying causes of her cognitive decline and behavioral changes. Given her recent episodes of confusion, memory loss, personality changes, and the possibility of a stroke, a comprehensive diagnostic approach is warranted.

Essential Tests for Stroke and Dementia
1. MRI (Magnetic Resonance Imaging): This is a non-invasive imaging technique that provides detailed images of the brain. It is essential for identifying structural abnormalities such as strokes, tumors, or signs of neurodegenerative diseases. Since your mother has already undergone two MRIs, it is important to review those results carefully with her neurologist to determine if any abnormalities were detected.

2. CT Scan (Computed Tomography): Similar to MRI, a CT scan can help identify strokes and other brain abnormalities. It is often used in emergency settings to quickly assess for acute strokes.

3. Cerebrospinal Fluid (CSF) Analysis: A lumbar puncture (spinal tap) can be performed to analyze the cerebrospinal fluid. This test is particularly useful for ruling out infections (like meningitis or encephalitis) and certain types of inflammation or malignancy. While it is an invasive procedure, it can provide critical information if there are concerns about infections or inflammatory processes affecting the brain.

4. Electroencephalogram (EEG): This test measures electrical activity in the brain and can help identify seizure activity or abnormal brain wave patterns, which may be associated with various neurological conditions.

5. Doppler Ultrasound: This non-invasive test evaluates blood flow in the arteries of the neck and can help identify blockages or narrowing that may lead to strokes.

6. Neuropsychological Testing: Comprehensive cognitive assessments can help differentiate between types of dementia and assess the extent of cognitive impairment. This can be particularly useful if the initial screening tools (like MMSE or SPMSQ) do not fully capture the cognitive decline.

Considerations for Your Mother's Symptoms
Your mother's symptoms, including memory loss, personality changes, and language difficulties, could be indicative of several conditions, including:
- Stroke: The sudden onset of confusion and memory issues raises concerns about a possible stroke, especially if there are risk factors such as hypertension or diabetes.

- Dementia: Conditions like Alzheimer's disease or Lewy body dementia could explain the gradual cognitive decline and behavioral changes.

- Infection or Inflammation: Given her recent illness, it is essential to rule out any infectious processes that could affect her cognitive function.

Is a Lumbar Puncture Necessary?
The decision to perform a lumbar puncture should be based on the clinical judgment of her healthcare provider. If there are concerns about infections or inflammatory conditions that could be affecting her brain function, a lumbar puncture may be warranted. However, if the neurologist believes that the MRI results and other non-invasive tests are sufficient to guide treatment, they may opt to avoid this invasive procedure.

Conclusion
It is essential to maintain open communication with your mother's healthcare team. Discuss your concerns about the necessity of a lumbar puncture and any potential risks involved. Given her complex symptoms, a multidisciplinary approach involving neurologists, geriatricians, and possibly psychiatrists may provide the best care. Early diagnosis and intervention can significantly impact the management of her condition, so it is crucial to pursue appropriate testing based on her symptoms and medical history.

Similar Q&A

Effective Strategies for Preventing and Managing Dementia

Hello, my mother is 46 years old and often forgets things, with the situation becoming increasingly severe. I would like to know what methods can be used in daily life to prevent dementia, and if there are any suspicions, how should we proceed with testing? Thank you.

Dr. Lin Zijing reply Neurology
Regular exercise, a balanced diet, maintaining a normal daily routine, keeping a positive and optimistic mindset, avoiding smoking and excessive alcohol consumption, and engaging in mental activities such as reading, doing math, playing chess, card games, and chatting with friend...

Understanding Dizziness in Seniors: Blood Tests and Beyond

Hello Dr. Ouyang, my mother is 61 years old this year. In recent years, she has frequently experienced dizziness. She has been to the hospital for examinations several times, but they all said there was no problem, and each time they only performed blood tests. I would like to as...

Dr. Ouyang Wenzhen reply Geriatrics
JERRY: Hello! Your mother is 61 years old and has been experiencing dizziness frequently over the past few years. She has undergone several blood tests at the hospital, all of which have returned normal results. I would like to know if there are any other symptoms, such as poor m...

Understanding Stroke Aftermath: Care and Recovery Strategies

Hello Doctor, my grandmother suddenly had a stroke this week. There was a blockage in the blood vessels in her left brain, which caused her right side to be completely immobile at first. Additionally, it affected her speech and swallowing, so a nasogastric tube was temporarily in...

Dr. Shen Zhengnan reply Geriatrics
Hello, Grandma had a stroke just a week ago, and it is currently difficult to predict whether it will lead to dementia in the future. The most important thing right now is to actively follow the medical team's instructions for treatment and rehabilitation. If the treatment a...

Assessing Stroke Risk: Are Neurological Tests Accurate?

Hello, Doctor. I have a few questions to ask you. 1. Recently, when I am working or talking to others, I sometimes suddenly speak with a regional accent or experience a slip of the tongue, similar to a verbal error. Could this be due to speaking too quickly, or is it a sign of ...

Dr. Jiang Junyi reply Neurology
Hello Ms. Lin, You mentioned, "Is slurred speech a sign of a stroke?" Acute stroke refers to a sudden neurological deficit caused by abnormalities in the brain's blood vessels. The symptoms resulting from a stroke are related to the area of the brain that is affec...