How can I best broach the subject of a misdiagnosis with out questioning a doctor's throughness?

1 answer | Last updated: Oct 03, 2016
Swbailey asked...

My step-mom has been diagnosed with dementia/Alzheimer's and though I may be clutching at straws I have read some information about Normal Pressure Hydrocephalus (NPH) and how it has symptoms similar to dementia/Alzheimer's. I have contacted her doctor and neurologist and though they did a CT scan there is no indication that she has had an MRI. How can I best broach this subject with her physician without questioning his thoroughness?

Contact with him has revealed the CT results but I am not sure how to proceed from here. The neurologist just asked my step-mom a few questions at one time and stated that she has dementia based on her answers.

Expert Answers

Jennifer Serafin, N.P. is a registered nurse and geriatric nurse practitioner at the Jewish Homes for the Aged in San Francisco.

Reading through your letter, I understand your concern about the neurologist. It sounds like you have a hard time believing that he could diagnose dementia only after asking her a few questions and doing a quick exam.

You are worried that the doctor may be missing the diagnosis of normal pressure hydrocephalus (NPH). I want you to understand that NPH has very specific symptoms, known as "Adams triad". In evaluating a patient for NPH, we typically look for:

1) Gait changes: obvious difficulty walking, can be shuffling (like Parkinson's disease) or wide-based (ataxia), or even look like the feet are "stuck to the floor".

2) Incontinence: with frequency and urgency.

3) Cognitive changes: impaired memory, reasoning, problem solving, and speech.

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If your stepmother doesn't fit the above triad of symptoms, then her chances of having NPH are low. You write in your question that she did have a CT scan of the head, but you do not mention the results. CTs cannot 100% confirm a diagnosis of NPH, but it will show ventricular enlargement or other changes that suggest NPH. Furthermore, a MRI is also not 100% diagnostic either. What I do know is that if the neurologist saw something on the CT that would look suspicious for NPH, then more testing would be ordered, as this is something that he would not want to miss.

What I would recommend for your stepmother would be to either take her to another neurologist for a second opinion, or take her to a memory clinic to have her tested for dementia. At a memory clinic, they will do lengthy testing of her memory and other mental functions, which will allow you to see what her cognitive problems really are. Good luck.