Dementia Screening: Key Tests and Considerations

Q: Dementia Screening: Key Tests and Considerations

Hello： MRI contrast agents typically do not cause common allergic reactions unless there is impaired kidney function. <br>It is recommended to first perform an MRI without contrast to evaluate the lesions. <br>You may consider consulting a neurologist for discussion and examinati

Dementia Assessment Items

I have a history of type 2 diabetes for 8 years and depression for 15 years.
I have been taking tricyclic antidepressants DOXEPIN 50MG, LYRICA 20MG, and sleeping pills for at least 15 years.
I have suffered from insomnia for 15 years and do not sleep well.
I smoke and have a family history of dementia, as my grandmother passed away from it.
My symptoms include generalized weakness, weakness in all four limbs, unsteady walking, pain in all four limbs, and overall pain that I cannot determine if it is bone pain or muscle pain.
I experience hand tremors, finger tremors, palpitations, forgetfulness of my good friends' names, dates, and days of the week.
I often forget the names of familiar chain stores, the president, public figures, mayors, and even common celebrities.
I also experience mild auditory hallucinations, with voices becoming quieter and somewhat hoarse.
I have seen a neurologist, but they only agreed to schedule a brain CT scan and refused to order an MRI, stating it would be out-of-pocket.
Question 1: I have diabetes, and my kidney function tests are normal, but I am very thin and fear that blood tests may not accurately reflect kidney function.
I previously had proteinuria, but now I do not.
I also have asthma and am afraid that using a non-ionic contrast agent could lead to shock, sudden death, or chronic kidney failure.
What are the chances of this happening?
Question 2: After reviewing the consent form, I am hesitant to undergo a CT scan because I have a dental crown made of cameo material.
I inquired about the crown, which is made of porcelain, precious metals, and 30% gold, and I also have a filling in another tooth that contains silver powder.
Is it still safe to proceed with the CT scan?
Question 3: The out-of-pocket physician advised me to ask at the health check center which tests I should undergo.
Which specific test can assess for dementia? What are the costs associated with these tests, and which option is the correct one among the five listed?
Question 4: Will the contrast agent used in the tests cause shock or sudden death? Is the contrast agent the same non-ionic type used in CT scans? Here are the MRI examination items, explanations, and costs:
1.
Stroke screening: (Assessing for stroke conditions) - No contrast agent, approximately 20 minutes, $10,000.
2.
Cerebral vascular and brain perfusion: (Understanding brain vascular disease, showing early signs of cerebral ischemia, assessing the degree of cerebral ischemia, observing blood flow perfusion in brain tissue, measuring cerebral blood supply) - With contrast agent, approximately 40 minutes, $20,000.
3.
Brain tumor screening + cerebral vascular and brain perfusion: (Understanding brain vascular and tumor disease, showing early signs of cerebral ischemia, assessing the degree of cerebral ischemia, observing blood flow perfusion in brain tissue, measuring cerebral blood supply) - With contrast agent, approximately 40 minutes, $25,000.
4.
PET/CT scan for brain perfusion nuclear medicine examination ECD - Price not listed.
5.
The cost for a glucose PET scan is $26,000.

POPO346074, 30~39 year old female. Ask Date: 2020/09/28

Dr. Jiang Junyi reply Neurology

Hello: MRI contrast agents typically do not cause common allergic reactions unless there is impaired kidney function.
It is recommended to first perform an MRI without contrast to evaluate the lesions.
You may consider consulting a neurologist for discussion and examination.
Wishing you good health and peace.
Best regards, Dr.
Jiang from the Department of Neurology at Taoyuan Hospital.

Reply Date: 2020/09/28

More Info

Understanding dementia screening is crucial, especially for individuals with a complex medical history like yours. Given your background of type 2 diabetes, long-term depression, and family history of dementia, it’s essential to approach your symptoms and concerns with a comprehensive understanding of the available diagnostic tests and their implications.

Key Tests for Dementia Screening
1. Cognitive Assessment: The first step in screening for dementia typically involves a cognitive assessment. This can include standardized tests such as the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA). These tests evaluate various cognitive domains, including memory, attention, language, and visuospatial skills.

2. Neuroimaging: Imaging studies, such as CT (Computed Tomography) or MRI (Magnetic Resonance Imaging), can help rule out other causes of cognitive decline, such as strokes, tumors, or significant brain atrophy. While CT scans are quicker and less expensive, MRIs provide more detailed images of brain structures.

3. Laboratory Tests: Blood tests can help identify underlying conditions that might contribute to cognitive impairment, such as vitamin deficiencies (e.g., B12), thyroid dysfunction, or metabolic issues related to diabetes. Given your history of proteinuria, monitoring kidney function is also essential, as renal impairment can affect cognitive health.

4. Neuropsychological Testing: If initial screenings suggest cognitive impairment, a more comprehensive neuropsychological evaluation may be warranted. This involves a series of tests that assess various cognitive functions in detail and can help differentiate between types of dementia.

Considerations Regarding Your Concerns
1. Kidney Function and Contrast Agents: You expressed concern about undergoing CT scans due to potential risks associated with contrast agents, especially given your history of proteinuria and asthma. Non-ionic contrast agents are generally safer and less likely to cause adverse reactions. However, if you have a history of severe allergic reactions or kidney issues, it’s crucial to discuss these with your healthcare provider. They may recommend alternative imaging methods or pre-screening tests to ensure your safety.

2. Dental Work and Imaging: Your dental work, including crowns and fillings, should not interfere with CT or MRI scans. However, it’s always best to inform the radiology team about any dental work you have, as certain materials can sometimes affect imaging quality.

3. Choosing the Right Test: For dementia screening, the most appropriate tests would typically be a cognitive assessment followed by neuroimaging (CT or MRI). If you are specifically concerned about vascular issues or tumors, the second or third options you listed may be more relevant. Discussing your symptoms and concerns with your healthcare provider will help tailor the testing to your needs.

4. Risk of Shock or Death from Contrast Agents: While there is a risk of adverse reactions to contrast agents, severe reactions are rare. Most patients tolerate these agents well. If you have specific concerns, such as a history of asthma or allergies, make sure to communicate these to your healthcare provider, who can take appropriate precautions.

Conclusion
Given your symptoms—such as memory loss, weakness, and other cognitive difficulties—it is essential to pursue a thorough evaluation for dementia. While your history of diabetes and depression may contribute to cognitive changes, they do not preclude the possibility of dementia. Early detection and intervention can significantly impact management and quality of life.
Make sure to have an open dialogue with your healthcare provider about your concerns, the necessity of tests, and the implications of your medical history on your current health status. They can guide you through the process, ensuring that you receive the most appropriate care tailored to your unique situation.

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