Which Specialist to See for Memory Issues and Mood Changes?

Dementia? Depression? Hypothyroidism? Which department(s) should I consult?

Hello Doctor, my mother is 55 years old and slightly overweight.
She has a history of hypothyroidism and cardiovascular issues (she has a lack of temperature sensation in her left hand and elevated blood pressure, and was diagnosed with a mild stroke).
After receiving treatment, her symptoms have improved, and she hasn't taken medication for several months.
Recently, our family has noticed that she seems unusual; she often calls family members by the wrong names during conversations (the content of the conversation is normal, but she confuses family member A with family member B).
Her mood, mental state, and energy levels appear to be very low; she frequently lies down to sleep and has little interest in eating.
My sister, who is a nurse, believes we should consult a neurologist to check for signs of dementia, while I suspect it may be related to her hypothyroidism or possibly depression.
Since my mother has always been reluctant to seek medical attention, I would like to ask the doctor which specialty would be more appropriate for her situation.
Thank you!

Kevin, 30~39 year old female. Ask Date: 2006/04/23

Dr. Xu Li'an reply Family Medicine

Dear Kevin, I suggest you take your mother to see a neurologist; some hospitals refer to this as the Department of Neurology.
At the same time, you should also visit an endocrinologist, which some hospitals call the Department of Metabolism.
It would be best to find a facility where both specialties have outpatient services available, so you can complete both visits in half a day.
Wishing your mother a speedy recovery.
Best regards, Hsu Li-An, Hualien Hospital, Family Medicine Department.

Reply Date: 2006/04/23

More Info

When it comes to memory issues and mood changes, especially in a patient like your mother who has a history of thyroid dysfunction and cardiovascular problems, it is essential to approach the situation with a comprehensive understanding of potential underlying causes. Given her symptoms—such as calling family members by the wrong names, experiencing low mood, lethargy, and a lack of appetite—there are several specialists you might consider consulting.

1. Neurologist: Given your mother's recent memory issues and the concern about possible dementia or cognitive decline, a neurologist would be an appropriate specialist to see. Neurologists can conduct a thorough evaluation of cognitive function, including memory tests, and may order imaging studies like an MRI or CT scan to rule out structural brain issues, such as strokes or tumors. They can also assess for neurodegenerative conditions like Alzheimer's disease or other forms of dementia.

2. Psychiatrist: Since your mother is also exhibiting signs of low mood and lethargy, it would be prudent to consult a psychiatrist. Depression can significantly affect cognitive function and memory, often leading to what is termed "pseudodementia," where memory issues arise from mood disorders rather than true neurodegenerative processes. A psychiatrist can evaluate her mental health status, provide a diagnosis, and recommend appropriate treatment, which may include therapy or medication.

3. Endocrinologist: Given her history of hypothyroidism, it would be wise to consult an endocrinologist as well. Thyroid dysfunction can lead to cognitive impairment and mood changes. If her thyroid levels are not adequately managed, it could contribute to her current symptoms. An endocrinologist can assess her thyroid function through blood tests and adjust her medication if necessary.

4. Primary Care Physician (PCP): Starting with her primary care physician can also be beneficial. The PCP can perform an initial assessment, review her medical history, and coordinate referrals to specialists. They can also evaluate for other potential causes of her symptoms, such as vitamin deficiencies (like B12), electrolyte imbalances, or other systemic issues that could be affecting her mood and cognition.

Additional Considerations
- Comprehensive Evaluation: It is crucial to conduct a comprehensive evaluation that includes a detailed medical history, physical examination, and possibly cognitive testing. This will help in identifying whether her symptoms are primarily due to a neurological issue, a psychiatric condition, or a combination of factors.

- Family Support: Encourage your mother to engage with family members during this process. Having a support system can help her feel more comfortable seeking medical attention, especially if she has a history of avoiding healthcare settings.

- Lifestyle Factors: Consider discussing lifestyle factors that may be contributing to her symptoms, such as diet, exercise, sleep patterns, and social engagement. These can all play a significant role in both cognitive function and mood.

- Follow-Up: Ensure that whatever specialist she sees, there is a plan for follow-up. Memory issues and mood changes can evolve, and ongoing monitoring is essential to adjust treatment as needed.

In summary, a multidisciplinary approach involving a neurologist, psychiatrist, endocrinologist, and possibly her primary care physician will provide the best chance of identifying the underlying causes of your mother's symptoms and developing an effective treatment plan.

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