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Dr. Gupta
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Can vascular dementia be misdiagnosed? In other words, are

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Can vascular dementia be misdiagnosed? In other words, are there other mental health conditions that might give very similar symptoms of rambling confused conversation etc.?My father was diagnosed with vascular dementia two years ago. In my opinion, although he talks a lot of confusion a lot of the time, his condition has not actually worsened visibly over two years. In fact, when he came out of a temporary care home stay of several months duration, he was worse from a purely practical functional point of view, and has actually improved in that respect greatly (not just my opinion, a couple of friends say the same).Hence, given that this is supposed to be a chronic progressively worsening condition, might it actually be another mental condition altogether with almost identical symptoms. For instance, I have heard that nutritional deficiencies can cause severe mental confusion issues...He became a vegetarian at age 80, having been a meat eater his entire life before that. I am not convinced that this means he actually ate much vegetables, just stopped eating meat. He also lost a lot of weight in the last five years or so.Here is what the examining doctor involved in the original diagnosis said in 2018 (also see attachment regarding how the diagnosis was arrived at i.e. partly by talking with my uncle):The CT scan was suggestive of Alzheimer's dementia, (a possibility in view of the temporal lobes findings),
After the information given by your uncle during the discussion with Psychiatric team it was clear that his dementia is likely to be vascular one rather than Alzheimer's; to support this diagnosis is that fact that he has ischaemic heart disease (IHD) and also vessel of the brain can be affected.
MOCA score (8/30) is a test assess the gravity of the cognitive impairment (<26 is abnormal).
No Issues about his heart during this admission (he was not taking his heart medication for two years and because he was stable we will let the GP think about restarting them).
I have attached his renal profile (with us the best he has had for years).
Vitamin D was low (17) and therefore we have prescribed medication for replace it.
< 25 nmol/L : Deficient
25 - 49 nmol/L : Insufficient
50 - 75 nmol/L : Sufficient
> 75 nmol/L : OptimalAnyway, I would appreciate your thoughts. I have his CT scan results from 2018. I do not have them for his current stay in hospital but I could ask for them I would imagine. I have attached the medical opinion I received from them last Friday.

Hi,

Have the Vit B 12 levels been checked?
Meat eaters turning vegetarian can have these quite low..

Warm regards

Customer: replied 1 year ago.
Hello, thank you for your rapid and helpful reply. I shall check and get back to you from what documents I have at that time. I do not recall them being mentioned much. I DID try to get him to take B vitamins once he got out of the care home in 2018. He did for a while and then stopped, as with the D vitamins. Basically, he refuses to take much of anything!Thank you for this feedback. When I said I doubt if it meant that he ate much vegetables, it is because he has not had much interest in food all his life. For many years, he was just eating a Mars bar and a banana for lunch! So, his "vegetarianism" is very different from other people's!He was hospitalised in April with acute kidney disease and released in early May. I asked about alternative diagnoses then, but the doctor I spoke to did not seem interested in challenging the original one. He was hospitalised again on May 22nd, and I have not bothered to ask them about that diagnosis again.The thing is, it involved an interview with my uncle. My uncle is a chronically negative man. In fact, the reason my father did not know why he was in hospital is because my uncle, not receiving answers to his telephone calls (April 2018 during heavy snow so he could not go over) called the police, who broke the door, and took my father to hospital. However, he never told either my father OR the doctors in the interview that it was him who had made the call that put my father in hospital (probably frightened that he would be involved financially!). So, how was anyone, least of all my father, to know how he ended up in hospital?! Also, both then and now, he maintains the attitude that my father belongs in a care home. So, he would have answered questions asked of him in a way that gave my father little credit: it would have been rather one-way biased. They did not contact me to interview me because they did not have my telephone number here in Italy, and had finished the diagnosis by the time I heard from them. It was based in large part on the evidence of my uncle (who, admittedly, sees my father more often than I do). The CT results then did not seem to definitively indicate vascular dementia all by themselves.Any thoughts on all of that? I can ask for the present CT scans, done in April and now?
Customer: replied 1 year ago.
Attached is his discharge report in 2018, when the vascular dementia was first diagnosed. I see no reference to B12, only to D.

Hi,

You are quite correct, there is nothing specific in the findings of the CT scan,

I would recommend an MRI imaging, since CT may not be very accurate in picking up all the changes.

Also, I would agree that since your father had improved after coming home, a progressive condition appears less likely,

I hope I’ve provided the information you were seeking. If you are happy with my service, your 5-star rating at this time is appreciated. A TIP would be even better! If you need more help, please let me know so l can continue to assist you.
Warm Regards,
Dr. Gupta, MD

Customer: replied 1 year ago.
Dear Dr. Gupta,Thank you very much for this helpful reply. I shall relay it to the hospital and ask them to do an MRI imaging. You will definitely get a 5-star when we are done, and doubtless a tip too.Are you available in any way to interface with the hospital with regards ***** ***** specific matter? Or should I relay your findings to his GP and ask them to take up the matter?

Hi,

Unfortunately I am a practising physician in India,

I would hence be unable to interface in any meaningful way with the local doctors.

I can certainly connect on the phone with you using JustAnswer interface, but I don't believe that talking to anyone in the hospital services would be very useful,

All the best & Stay Safe,

Warm regards

Customer: replied 1 year ago.
OK.I communicated your recommendation to the hospital and also CC'ed the medical centre in case his doctor there needs to sign off on it or something. If I may, I shall leave this question open just a little longer in case they come back to me today with anything that I should run by you.Thank you for everything so far.

Sure,

Feel free to get back :)
Also, even if you give a 5 star rating & a TIP, the question still remains open till you say so,

Warm regards

Customer: replied 1 year ago.
Oh, I see. I did not know that. I am new to this JustAnswers thing. Thank you.
Customer: replied 1 year ago.
What hours do you do, if I did want to speak to you about this?
Customer: replied 1 year ago.
Here are some videos I took of my father. Three are from August 2019 and one is from December 2019 (talking on phone to his doctor, who rang to try to come and see him.https://www.dropbox.com/s/703bqykqlcqzmu0/MrSelvarajah.zip?dl=0August 2019 is six months after he got rid of his last daily care worker (hated them!), who are sent to the house by social services. It is also fourteen months after he left a care home, having had a serious issue in March 2018 and been taken to hospital/care home for a total of three months. From the care home time in March to end of May 2018, he was talking dementia confusion, and does so to this very day. YET, as you see from these videos, at the same time he also possesses high mental functioning. For example, the place we are eating at involves a walk from his home followed by a bus ride there and back. He was doing this every day by himself for lunch.By contrast, when he emerged from the care home, he had mild confusion issues even relating to the local crossroad near his home!He was basically looking after himself fine until April 12th 2020 when he was taken to hospital after collapsing from acute kidney failure. But even this, it can be argued, has nothing to do with dementia per se, and everything to do with the fact that the world closed down around him, especially all local shops and restaurants, just a few weeks before his collapse.If you will, please kindly review these short videos and let me know if they help confirm what I am saying about this so-called vascular dementia diagnosis. Thank you.

Hi,

I have gone through the videos, & I agree that this certainly does not appear to be a progressive dementia from what I have seen.

Certainly a review with the neurologist, and an MRI would be helpful in deciding how to proceed further :)
He seems like a very nice & gentle person !

Warm regards& All the best,

Stay Safe and keep him safe too ..

Dr. Gupta and 2 other Medical Specialists are ready to help you
Customer: replied 1 year ago.
Dr. Gupta, thank you SO much. This has been very helpful. Over in UK, nobody wants to take the time to really pay attention. I sent the link to those videos several times, and there was not even a response to say that they had been received, let alone any comments on them!I shall relay your feedback to the hospital as well.So, I shall close this out but hope to ask you more if need be, as you mentioned. Thank you again.
Customer: replied 1 year ago.
Dear Dr. Gupta,Well, today I had the online meeting with the medical team. They all confirmed their previous diagnosis, and discussed their extensive experience in these kinds of conditions etc. I asked if anyone had bothered to view the videos, and stated that it would be a matter of concern to me if nobody had, but got no reply about that. They say that they witness worsening, but upon further questioning state that it is of a qualitative and not quantitative nature i.e. based on observing him over these past three weeks. I asked if there are illnesses with nearly identical symptoms, but did not really get an answer. Also, I mentioned what you had stated, but there was not much of a response to that either. Apparently, no MRI scan has been done. Overall, I had to probe quite hard to discover that they had basically done nothing new but go along with the existing diagnosis and use their doubtless extensive experience to see it as the same thing. I think I was told that there are no other conditions that produce similar symptoms at one point. I mentioned that I had witnessed improvement since his release from the care home in 2018 but it met with little or no feedback.Why is it so hard to get doctors to look again at previous diagnoses?

I can understand and agree with your frustration,

No one likes to admit they are wrong, and ( guess doctors are no exceptions ...

What I would suggest is that you try to talk to them about getting an MRI done to just see the extent of the "vascular dementia" so that this can help in deciding how the injury is likely to proceed.

They may be willing to do this,
Warm regards

Customer: replied 1 year ago.
Thank you for this. The thing is, yesterday's meeting was a discharge meeting. They want him out and in a care home under 24 hour care. I am also looking at return to home options.I can certainly try what you say, but they seemed pretty set on not doing it. I plan to ring talk to his GP today, so perhaps I can ask that way too.What I am seeing is that they all live in their own world of emails, words, expert opinions, "worries", "concerns" etc., and study the person in a hospital environment like a lab rat, and draw their conclusions only from that. Nobody looked at the videos or even acknowledged ever receiving them (maybe there is some UK privacy law or something, I don't know) and when I said that I and several others noticed improvement in practical functionality after exiting the care home in 2018, it was greeted with silence. It seems like they have no interest in "real world" data, only what they can gather in the hospital, with a kind of "that was then, this is now" attitude. But you cannot study a person in a hospital like a lab rat and make long-range conclusions, any more than you can take a bee out of a beehive and study it in isolation in a glass jar.
Customer: replied 1 year ago.
I sent the email request! :-)
Customer: replied 1 year ago.
Interestingly, they eventually did the MRI! Here is the feedback, "As your request of MRI Brain was not that unreasonable (even though will not change management) we went ahead and did a MRI Brain. This MRI Brain rules out any other pathology and supports Dementia."

Hi,

The fact that an MRI was done is great news, and the fact that no specific problem was found is great too.

At least they were willing to admit that your request was reasonable :)

If there is 'just ' dementia, then it does not need specific therapy,

Continue to stimulate him with multiple activities, and he should remain in good spirits !
Warm regards

Customer: replied 1 year ago.
Hello Dr. Gupta,It is thanks to your specific suggestion (i.e. motive/reason) that they did it. I have to learn to be more sensitive to political realities like this, which I am not for the most part. I hope they really did it and not just telling me they did, which will be verified once his GP receives his records.Yes indeed. This sounds like the thing to do. Thank you again for your help with this. :-)

You are welcome ...

They would not just say it, I am fairly certain ...

Wait for the reports,

And take care,

Warm regards

Customer: replied 1 year ago.
Thank you so much. You have been very kind. I look forward to discussing other matters with you in the future.

Always a pleasure,

Take care & Stay Safe

Dr. Gupta M D