Mild cognitive impairment: What questions to ask the neurologist?

Wow, this is an interesting thread for a very difficult situation!
Sympathy and commiseration to all here.

Adding to cmb1 's comments, I want to thank "tall guy," too.

Two additional points:

1. About right-brain/ left-brain theory:
When I left teaching about 3 years ago, there was a growing debate about the accuracy of the theory. I haven't followed the debate since leaving the profession (due to disability from Covid on top of pre-existing conditions).

2. About lowered comprehension when someone reads to you vs. reading to yourself: This may be due to an "auditory processing deficit," which I have dealt with my entire life.

I take copious notes of all information that I HEAR (not see/read), including at doctor's appointments. I usually inform the doctor of my audio processing deficit and explain my note taking to him/her before the doctor begins to answer my questions or to explain anything. The doctors usually are understanding.

Sometimes, the mere act of writing down the fact and seeing it in writing are enough to set the fact in my memory.

[Tallguy, were you an English teacher? Your use of the subjunctive mood was a refreshing delight! Actually, all of your prose here has been elegant and lucid-- so uncommon nowadays! My own has suffered in retirement...]

Tallguy, may I share your definition of "resilience" in the Mayo thread about "inspiring quotes"? I found it very useful.

Everybody, good luck and let's keep sharing coping strategies!

The speech therapist route is the one that I've taken 1 year post-brain-tumor radiation. She's the one who is teaching me various tools for strengthening memory and cognition. Short-term memory is where I have a "close to disabled" level (82) whereas the other brain measurements are very very good (98+)

Hi Laurie, That's a journey for sure. I do feel I need some cognitive practical skill therapy. I did have a previous brain MRI about 15 years ago and white matter showed up then (in my 40's). Now at 64 the MRI is showing progression of WML due to small vessel disease. I also have an inflammatory demyelinating polyneuropathy that he is also treating me for but that is affecting motor neurons not anything to do with the brain. I very much appreciate your input. I have been using notes and calendar on my device but I'm sure if I get rehabilitation there is more I can do.

@sb4ca
I don’t have the knowledge to answer your questions about a viral ocular infection other than the ocular nerve is a nerve that controls eye movements. Likewise, I cannot answer about herpes eye infection or aseptic meningitis without guessing. I would say, however, that I wonder how any of these eye infections would cause white matter lesions that would occur in the brain itself. This is a question for your neurologist or perhaps a specialist in eye diseases.

I thought it would be a good idea to explain what white matter is and what it means when there is a diagnosis of “white matter lesion”. The nervous system has white matter and grey matter and all of us (animals) have both grey matter and white matter in the peripheral and central nervous systems. Grey matter refers to brain cells, and some of the connections between among and between brain cells (connections called dendrites and some axons). White matter is made up of axons that are covered in a pearly white coating called myelin. White matter forms large tracts in the brain that connect one region of the brain to another region of the brain. White matter lesions refer to injuries that affect the white matter and so the conduction of nerve impulses from one place to another in the brain is affected when there is a white matter lesion. Some of the white matter injuries can be caused by a stroke, multiple sclerosis. or other diseases.

When someone is diagnosed with mild cognitive impairment (or dementia) this means that could be changes in the brain that show up on the MRI. This does not always happen, by the way and sometimes the MRI doesn't show anything unusual.

Here are some links to this information:

White matter and grey matter:

-- https://www.simplypsychology.org/what-is-grey-matter-in-the-brain.html

Mild cognitive impairment:

--https://www.alz.org/alzheimers-dementia/what-is-dementia/related_conditions/mild-cognitive-impairment

What did you learn from your appointment with the neurologist today? What are the next steps?

This is very helpful, thank you. I keep a diary but yesterday when talking to my cardiologist’s nurse I couldn’t find blood pressure readings from one month ago. I realize now that since I have an Apple phone , I can take notes and write documentation anywhere I am. What app do you use? Thank you so much for this nudge.

It was very disappointing for me but my husband looked at it as good news. The bottom line is that the neurologist felt the progression of WML were not reflective of the level of impairment I'm experiencing. He said even the odd presentation of the herpes infection and ocular involvement could be related to all this. He believes something else is going on and even suggested I might go to Mayo because I present very atypical. Personally I feel crushed not knowing what is going on and complete apathy about pursuing another course of diagnostics. I feel so done with all this.

Hello @sb4ca - I'm so sorry you are struggling with MCI and ocular disruption. Naturally you feel "done with this" out of frustration, exhaustion, fear. Understandably, it's a lot. I'm happy you have this community to seek support from. Your post caught my eye because I just went to my mom's neurology follow up appointment last week to discuss her being diagnosed with MCI, after an MRI showed no signs of Alzheimer's or Dementia, thankfully. As I'm sure you have been doing, I've researched MCI. Here's what Mayo has to say about MCI:

Mild Cognitive Impairment - diagnoses and treatment -

- https://www.mayoclinic.org/diseases-conditions/mild-cognitive-impairment/diagnosis-treatment/drc-20354583#:~:text=Health%20care%20providers%20often%20use,the%20degree%20memory%20is%20impaired.

For the past year or so, my mom has described what you say - losing words, thoughts, spelling. She had been having TIA's as well and scans proved a stroke at some point. She has a small brain tumor that is watched annually for growth, and suffers from ocular migraines for many years. Plus, she lives in chronic pain from a traumatic accident years ago which is "managed" and I say that loosely, with opioids. A mixed bag of mitigating factors. Sound familiar?

Has your neurologist suggested memory medication? My mom has been taking one and swears it has made a change in her reciting of words and thoughts. While I don't know specifically about your diagnoses, I know that when faced with a plethora of symptoms and challenges, the CNS can go a little haywire and the overwhelmingness of it all causes an uptick in symptoms. At my Mom's appointment, her neurologist handed her a packet about "Curable".

Curable: A Different Approach -

- https://www.curablehealth.com/?gad=1&gclid=EAIaIQobChMIvP3s7aiHgAMVVROzAB1fqgJ4EAAYASAAEgKhzfD_BwE

Curable is a site that has been spoken highly of by Connect members who have chronic pain. It offers a different approach to pain management and I was very pleased to see my mom's doc was acknowledging the need for self-help and self-management, in addition to meds, etc. Maybe it could be helpful as you and your doctors navigate your current health conditions.

Here is a Connect discussion about Curable -

- https://connect.mayoclinic.org/discussion/amazing-websiteapp-in-dealing-with-chronic-pain-curablehealth-com/

I sure wish you the best in your journey. Try to stay positive and keep your chin up. You got this! When might you know if you will apply to Mayo Clinic?

Where is the HABIT program? Is it something you can participate from home? Does insurance pay for it?

juliesheff5 | @juliesheff5

Check out this flyer for additional info and contacts. It also mentions insurance coverage.
https://mcforms.mayo.edu/mc2800-mc2899/mc2815-10.pdf
I think it is at all Mayo locations (MN, AZ and FL)

Laurie

Thank you so much!