Brief Answer:
That is an unusual diagnosis for a 55 year old woman- Recommend VERIFY

Detailed Answer:
Good morning. I'm sorry you're not feeling well.

I've read your introductory information and as a neurologist and one who sees many patients with Alzheimer's dementia that are in all sorts of stages of development I can say that it is a RARE occurrence in my practice and indeed the medical literature to find someone as young as yourself complaining of TRUE AD with what to be a strong set of side effects from the medication who is able to very clearly explain those symptoms on a background of extreme anxiety.

I would like to suggest 2 things:

1. You speak with your doctor about switching your medication to something more tolerable than Aricept. I have not found very much benefit from that medication in terms of actually TREATING AD is concerned compared to the unsavory side effects compared to simple single agent treatment such as Namenda or memantine or Razadyne.

2. However, more importantly than that I am always very skeptical of a diagnosis said to be DEFINITE AD in someone of your gender and age with the number of red flags having to do with what appears a strong backdrop of anxiety which should not be taken to be equivalent a loss of cognitive function...especially as it relates to memory function.

I would highly recommend having the doctor who diagnosed you offer you a 2nd opinion with a behavioral neurologist or a referral to a NEUROPSYCHOLOGIST who is trained in applying a battery of much more sensitive and specific tests that can distinguish between memory and other cognitive impairments due to anxiety, depressive mood disorder, or even metabolic disease such as HYPERTHYROIDISM, HYPOTHYROIDISM, vitamin deficiencies (B12, D, D2, D3), alcohol related cognitive dysfunction, and even heavy metal intoxication which is likely more prevalent than we think but just never tested for since everybody feels that such environmental exposures could only happen in places outside the U.S.

The way you present your case with the grammar and vocabulary you use make me very suspicious that there isn't another more overriding process going on which is causing you to have neurocognitive dysfunction but which needs to be clearly distinguished from other conditions and pathologies before labeling you with AD. That could be significant when it comes to either Health Insurance or even Life Insurance considerations and if it were me or a loved one...I would want to be absolutely certain that was the diagnosis.

Therefore, again, I would recommend the following:

1. Speak to the doctor about reducing if not eliminating Aricept. I think there are much better options to try including NO MEDICATION right away before having a SOLID diagnosis in hand through much more rigorous testing and even imaging by at least functional MRI imaging if not AMYLOID imaging.

2. If medication absolutely must be used in this case and if the diagnosis remains that of AD despite more in-depth and confirmatory testing then, I would recommend a switch to NAMENDA or MEMANTINE.

3. At the same time I would look for much more robust neuropsychological testing and even a 2nd opinion with a BEHAVIORAL NEUROLOGIST at an academic center who is more likely to work you up thoroughly and obtain adequate labs and other testing before agreeing to such a diagnosis since the implications are quite far reaching both from a medical as well as from a psychosocial and family social point of view.

If the doctor you saw is doing any screening testing at all then, check to see which test they are using. Chances are they may be using something like the Folstein XXXXXXX Mental Status Exam (MMSE). This is considered antiquated by most practicing neurologists anymore an the test of choice when screening for any dementia is the Montreal Cognitive Assessment (MOCA). I also occasionally use the St. XXXXXXX University Mental Status exam (SLUMS) but mostly I use MOCA.....it is a pretty good screener for neurocognitive dysfunction but then, in any case may still need to be followed up by something more hard core such as the neuropsychology battery done by a seasoned expert.

And make no mistake....I'm not saying Neuropsychologist meaning that it's the same as PSYCHOLOGIST, PSYCHIATRIST, etc. etc. I am specifically saying NEUROpsychologist due to the specificity of the battery of tests, the training these folks have which is completely different from a psychiatrist or general psychologist.

If I've adequately answered your questions could you do me a huge favor by CLOSING THE QUERY and being sure to include some fine words of feedback along with a 5 STAR rating if you feel my suggestions have helped? Again, many thanks for posing your questions and please let me know how things turn out.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 23 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

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