Brief Answer:
Dementia needs full blown assessment

Detailed Answer:
Good morning. My name is Dr. Dariush Saghafi and I am a neurologist in the XXXXXXX OH area. I have extensive experience with patients suffering from dementia and am sorry your husband is having problems. I am interested in giving the following thoughts in answer to your questions.

Your husband's MRI shows a loss in brain volume which is commonly seen in cases of dementia. This "brain shrinkage" automatically makes more room inside the head for fluid to reside. That is what the term "hydrocephalus" means (water in the cranium). "Hyperintensities" is a radiographic term used when looking at MRI's that describes what appears to be areas or small "spots" or "lesions" on or in the brain that represent some form of neuronal deterioration.

Now, here's the crazy part of that MRI picture. You can see virtually see all those findings mentioned in a person WITHOUT DEMENTIA or cognitive issues (I've seen this same picture in perfectly healthy and robust 25 year old hard working kids!). So the only reason this picture has significance for your husband is because it goes together with the fact that he's having difficulties from a mental capacity point of view.

In other words, what I'm saying is that the MRI picture is not nearly as sensitive a marker of how ADVANCED THIS DISEASE is compared to the results from a good neurological or better yet, NEUROPSYCHOLOGICAL point of view. This is where you can gain a much better sense of how deficient he may be (i.e. mild, moderate, severe) in certain areas of thinking such as calculations, abstract and logical thinking, short term memory, speech/language usage and his ability to have insight into what's going on, etc. Knowing these things, in my opinion are infinitely more important and useful than saying that he has a 25% loss in volume (which frankly I may question since volumetric measurements that are precise are not routinely done for patients in the clinical setting so I question that number to begin with).

So, knowing HOW he is performing according to certain measures and standards of testing could allow for a treatment plan or interventional strategy to be established and launched. And in the end that's what your interest probably is...not so much whether or not he's got hyperintensities and excess fluid compared to brain volume, right?

I would say that going forward in terms of testing that would really be helpful or necessary would be laboratory findings which could be important to make sure he is not suffering from some type of metabolic derangement which could also LOOK like a dementing illness such as thyroid disease, vitamin B12, folate, and Vitamin D deficiencies, calcium overloads, cortisol deficiencies, urine specimens, and a blood count, etc.

If your husband is being seen by a neurologist then, I would almost guarantee that these lab tests have been performed and read out as either normal or insignificant. But just in case, you could mention them to his doctor and see how he answers you.

I wish you the best with your husband. If it is dementia that you and he are facing then, contact the Alzheimer's Association right away and get some resource information on how to go about helping him especially when it comes to safety issues in the home and such.

They have great resources and there may even be programs in your area that they can direct you to for his benefit (AND YOURS!). Make sure all his legal stuff is in very good order otherwise, doing it later can be very costly and time consuming and depending on the circumstance, HARROWING! The probate court system in our country is unfortunately very broken and corrupted by people not interested in the welfare of patients, their families, or proper and fair treatment of estates. So I recommend you have a trustworthy attorney check over all paperwork and nail things down now so you can avoid getting involved into complications.

Otherwise, if you feel this information answers your questions well enough I'd very much appreciate some written feedback so I can know how well I did for you and your husband. Also, if you have no further questions would you please CLOSE THE QUERY on your end. That would also be greatly appreciated.

I will also give you another piece of information and tell you that if you would ever like me to give you a WEBCAM LIVE consultation where I can actually see and speak with your husband you can reach me on the network called HealthTap at www.HealthTap.com. You can look me up by doctor name (DARIUSH SAGHAFI, MD). I am in the state of OHIO and my hours (as you can see) are rather crazy.....Wed-Sat 3a-6a, Eastern Standard Time. I will also be picking up an extra shift on the network beginning Sept. 3 from 11p-3a if that any better.

Be well!

This query required 60 minutes physician specific time to review, research, and document for final draft and envoy.

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