Mild cognitive impairment: What questions to ask the neurologist?

Oh I’m aware. But the drugs get to the infusion room via a central pharmacy in the hospital. In a Doctor’s office in my experience there is a mini pharmacy - same kind of controls. Particularly as it relates to opposing drugs.

My mistake. I didn’t grasp that from initial read.

@pb50 do you take Methotrexate or Rituximab for your RA?
I’ve done both for a rare autoimmune condition I have. The rheumatologist had to take me off Methotrexate because it was damaging my lungs. My blood oxygen levels got low, and test results showed ground glass opacity in my lungs.
Now I take Hydroxychloroquine.

I took methotrexate when I was on Humira but it had to be lowered to the point where I developed antibodies to Humira. Switched to Enbrel and injected the methotrexate but continued to have liver impact. So I had to stop it altogether and switch to infusions of Remicade four years ago.

I have minimal cognizant impairment. They started me out with a cognizant test which appeared slightly lower than average, but I am 67 years of age. The neurologist suggested I needed a psychiatrist for further studies - I did see him, but thought it was uneventful. I did fore go through an MRI of the brain and it did show a mass. So I decided to look into that and had laser surgery to have it removed. It was normal studies until about one year, and it returned. So I decided to go to a specialized oncologist -he went over several possibilities for treatment. I decided with his suggestion to go through a high dosage of chemotherapy . I have had a normal MRI for four years. Just goes to show you more studies are important. Good luck.

Within the last week, I've gotten a couple of "likes" to a comment that I posted almost 3 yrs ago. Random, I'm sure, but maybe an update is in order. For reasons stated below, I doubt my experience will be of much help to others, but maybe there is someone out there who is on the same weird journey, who will find more of use or at least hope from my remodelling of my neuro-endo-immune-metabolic systems.

In some respects, my cognition has improved, tho it remains mildly impaired, so I continue to practice everything in the comment like decluttering and using Google notes and a centrally located gourd to collect keys, eyeglass cases, my wallet and other things that tend to lose themselves. I still rely on Google maps in unfamiliar places to navigate, rather than rely on my impaired navigational skills. I still support my parasympathetic (rest and relax) nervous system by humming, walking slowly, sliding in my socks along our uncarpeted floors, and generosity--e.g., I tip contractors and overtip restaurant servers and buy several (salient) books every week with which to stock the free book box in front of my house.

I don't think that I drove my cognitive improvements as much as I stayed out of the way as my brain slowly recovered. I followed closely what was going on in my neuro-endo-immune metabolism and tried to support the processes that seemed to be leading to remodeling themselves so as to regain function. But I suspect that my recovery of cognition and other functions, such as enhanced healing, are somehow a product of the fact that I experienced an abrupt neuro-immune/metabolic event 5 yrs ago.

Anyway, for what it's worth, I've found that the 4 pillars of (my) health are diet, exercise, rest and play. Diet is Mediterranean plus whole fat, grassfed dairy--and, alas, no red wine-- but lots of water, coffee (I'm immune to the effects of caffeine), yogurt and kefir, wild blueberries, walnuts, olive oil, wild salmon, cod, tuna, cruciferous veggies, etc. Exercise is lots of cycling--5000 miles/yr--in zone 2 (about 2/3 of capacity) and lots of freeform yardwork. Rest includes sleep, but also mind-emptied states during the day. Play (the Dick Van Dyke factor) is child's play, not working on a tennis stroke or a golf game or other competitive forms of "play." I play while cycling (always varying the ratio of grinding to spinning), working in the yard (mostly weeding around my many native plants), wrangling my 4 ridgebacks, and reading. Diet and exercise are more prominent, I suppose, but rest and play inform exercise and even diet!

I don't meditate (or pray). A proponent of meditation, Prof Richard Davidson, suggests that meditation is a means to relax, tame overthinking, become mindful, and essentially enter a state of being and feeling (I prefer "sensing"), rather than thinking and doing. I'm mindful of my body and mind all the time, such that this is now my default state. I'm generally in a being-and-sensing state--aided partly by my MCI and also by not overworking the slowly improving tier-one elements of cognition: attention and memory (which support the many tier-two elements of cognition, such as learning, reasoning and problem-solving).

I suppose 2 more caveats are in order, besides the one mentioned above about the abrupt decline in function perhaps setting the stage for a (slow) recovery of function. First, even at 75, I am (otherwise?) in excellent health. I take no drugs, vitamins or supplement. Second, altho my neuro-immune/metabolic event necessitated my retirement, I am financially secure--and believe that my report would not be as positive if, over the past 3 yrs, I had been trying to work with my MCI.

My final suggestion is to read relevant material. I read a lot about neurology, endocrinology, immunology and metabolism. Useful science aggregators include sciencedaily.com, nature.com/news, and sciurls.com. Weekly, I do a Google search, limited in time to the past week, of various items of interest like bdnf, fibroblasts, glymphatic, delta waves, microglia, astrocytes, neurogenesis, and so on. At first, when reading technical articles (often on the NIH site; BTW, always try the DOI link, even when the article seems paywalled), read only the introduction and the discussion at the end--and scan the charts, references and citations.

Don't be intimidated by doctors or other health care providers. Neurology is in its infancy. Imaging neurotransmitters, neuromodulators, hormones, peptides, etc remains a difficult task due to the size of the target, its brief lifespan (e.g., the half life of exogenous adenosine is 10 seconds), and its ever-varying levels (e.g., growth hormore or the hormone releasing growth hormone). Science needs to write large and must proceed cautiously with replicable demonstrations to prove causal relations. But, if he or she listens to his or her body, the patient senses what is happening and recognizes correlations. The doctor has science of the large group, and the patient has knowledge of him or herself. Anytime a doctor is unreasonably dismissive of a patient's knowledge, remind him or her that science used aspirin for a century w/o understanding its mechanism of action--and a recent editorial in the prominent journal, Nature, complained that researchers were moving too fa , too fast w/o understanding mechanisms of action!!!

Peace. And I wish each of you with an MCI or any other neuro-endo-immune-metabolic deficit the very best. Carry on!!