Tomorrow I have a call with the neuropsychologist that diagnosed Mom and I’m nervous … Is there anything else I should ask?

UPDATE: Just to update everyone … the call with the neuropsychologist went so much better than expected. Despite being told my his assistants that he would only have 15 mins, he stayed on the phone with me for 30, answering all my questions and explained everything in clear and thorough detail. He also very compassionate and patient which made it so much easier. He also offered to answer as many follow up questions as I had. I feel very fortunate b/c I know that not all providers are this personable. I was not expecting that. 

I feel I now have a much better understanding of my Mom’s results. The outcome is that although it was a dementia diagnosis and there was no specified cause (which I already knew), it was worth exploring treatment for the depression since this could be considered a “reversible” cause. I explained the home life situation and he acknowledged that there could contributing factors there but said ultimately a psychiatrist could comment on that. 

He did say, however, that even although there are notes on her history (e.g. her struggling with independence / ADLs) which would come from a verbal discussion, these are not what is factored into the scoring. It’s the cognitive tests that are designed to to check the “circuitry” and the diagnosis comes that.

He confirmed that meds (esp anti depressant to see if it improved symptoms) and neurologist would be prudent next step. However, he did agree that the NP/GP should have followed through with this from the start w/out my asking. Another issue to address at another time (I am not letting them get off easy).

So in short, we don’t know for sure what’s causing her symptoms (other than a ‘general’ diagnosis of dementia) so we have to wait for the neurology scan see if there are any visible issues in the brain and if nothing comes from that, it’s a “wait and see” situation. 

In the meantime, I’ll focus on the depression - have urged her to try the Zoloft for a while, find her a therapist, get her away from her husband more often and see if these all help. She still doesn’t actually quite “know” about the diagnosis - I’ve told her but it’s not really sinking in (she’s blocking it out) - so it’s a conversation I need to have with her again. I’m dreading it. I don’t want it to make her “worse” from worrying.

This has been hard so far, there is so much to think about and do and it feels like I’ve had to go from 0 to 100 in less than a week. But without the support of all of you and resources on this site, I would be utterly lost. 

Thank you all again for your helpful input (and will probably have more questions soon).🙏🏽

Wonderful to have your updates Heidi and so thankful you have a clinician who will listen and answer. I had an oncologist who said re my cancer years ago "I don't know; it's anything but an exact science", told me he could tell me this because I was a nurse; other people wanted "answers" so he "gave them answers".
It IS anything but an exact science. It worries me that your Mom is a bit in denial as that makes it so much more difficult. My brother was not in denial where his diagnosis of probably early Lewy's dementia was concerned (diagnosed mostly by his symptoms). He was he said, very sad and concerned about his future as it would mean loss of control,and he and I are BOTH somewhat control freaks. He said he was happy to know there were REASONS for what he was experiencing and he could learn more. He died before he could descend further into his disease, and in fact once he made me Trustee of Trust, sold his last little home, moved into Assisted Living and had me paying all bills, doing financials and sending him a monthly statement he did nothing but improve. The hallucinations involved almost completely disappeared. He was so much more relaxed and we would sit by the hour discussing how he "saw" the world differently. He would have been a marvelous study subject.
I love how you are there for your Mom, and it reminds me of me and my bro, having been Hansel and Gretel to one another in the woods of life, as I describe it.
Don't force anything onto your Mom but do continue to say what the docs found, and how less anxiety will help her, how she is an individual, not a diagnosis, and how she may be doing nothing but IMPROVING with good loving care. Just keep stressing how important it is for her to have LOVE and SUPPORT now, and how you will be there for her when she needs you to help with what she needs help with.
You are a pleasure to have on the Forum and I hope you will stay, update, and help others here.

I think that you're terrified that your mother might have Alzheimer's. So you wish the diagnosis should be anything but Alzheimer's. Also you expect that whatever or mother has it will be reversible. The only reversible conditions that resemble dementia, are acute delirium and severe depression. Since your mother is depressed, it's logical to think that her mild cognitive impairment is due to her depression, since there is no evidence that she is undergoing an acute delirium. So the thing to do is the focus in relieving her depression with medicines and to expect an improvement in her mood and cognition within 3 to 6 months. If there is no improvement in such time or if the cognition worsens, then the diagnosis of dementia will become more real. All types of dementias are incurable. The most common is Alzheimer's. It affects more women than men and it can produce depression and anxiety too. Medications are supposed to improve some of the dementia symptoms but they won't stop the process. Be prepared that reality does not always follow our wishful thinking.

You are clearly thoughtful and articulate… and on the clock.

You give the impression you want to control/micromanage the call with wanting to discuss each area of every report. If you trust him, you don’t need granular details. If you don’t, he could explain til the hogs come home and you won’t be convinced.

I suggest ultra concise wording designed for concise answers - not let’s discuss and rehash.

You also need to give the doctor a chance to explain before you start questioning him - if you get answers as he explains, fill in the blank and ask for questions he didn’t answer.

I think this is what you are asking:
1. Do you have a prognosis? [dementia] and/or [something else]
2. Did the screening show spousal abuse? [yes/no]
3-4. How did her fear and depression influence her testing? [answer]
5. (Refer to “Activities of Daily Living” then frame the question)
6. What are the next steps (further evaluation, treatment)? [list them and who provides them]
7. What care does she need now? [care] [how long] [who provides it].

Then at the very end of the call, if you need to, read back the answers in the [ ]. A good recap can be done in 60 seconds.

Btw, if you have the reports, read them and highlight the top concern.

Good luck. Don’t self-sabotage with a trip to the weeds.

No matter what you do you will leave feeling "I should have said this" "I should have told him that" "I wish I had remembered to say this" "that".
All of that is just a given. I would let him first go over his findings. I would then ask if he had been made aware that Mom is in a difficult relationship in which you can only say her spouse "gaslights" her, making her feel she is "not right" and that she is made very anxious because of this.
I would ask him if an MRI is in order at all to rule out brain tumor or any possible measurement of gray of white matter, any evidence of stroke or other vascular problems.
You are right about the level of care issues.
I think that no matter what, this is difficult. You have your one chance. Tell him you feel a bit like Mom must have felt.........you need to get it right and get it quick or you are "out". And you would bet you are leaving with an assessment of anxious, because you ARE anxious.
I sure wish you good luck. So much depends on the "bedside manner" in these instances. And I am not saying that bedside manner equates with skill. The surgeon I chose when I had a dx. of cancer was the one in our institution with the LEAST good bedside manner, because he was the best at what he did.
I sure hope you get some more answers, or answers that are the least bit helpful. I found it was hard to "hear" and think and remember when I was meeting with MDs. You might ask if you can record, take a few notes, ask if there is any way you could be allowed to contact him if you think of something you believe to be crucial. Likely not, and I understand, but worth a try.
Sure do wish you luck! Hope you'll update when you come down off the ceiling after all this, and have a chance to recover yourself. (Maybe you will be lucky and not even have to HIT the ceiling; I sure hope you are.)

HeidiAnn, this sounds like a compassionate, caring clinician and a good guide for you and your mom.

My mom also "heard" her diagosis of Cognitive Impairment and apparently didn't take it in. She was concerned that they were going to tell her that she was "crazy" and since they didnt' say that, she was a happy camper.

I wouldn't force an acknowledgement from mom; just see if getting her away from toxic spouse and if taking the Zoloft consistently helps.

She DOES need to understand that the Zoloft is a long-acting med that is not going to have an immediate effect and that she doesn't take it/not take it dependent upon how she's feeling. She just takes it. Everyday.

Keep us posted!

To all the other excellent responses, I would just add - get a thorough review of all her medications, with an eye to any that could contribute to cognitive issues, in order to eliminate where possible or look for substitutes. That conversation can start with the neurologist but likely should be had with your primary care physician and a pharmacist, as well. Best wishes

Wow. The stars must have aligned in the universe because this is such a timely post for me and my husband, L. He just recently agreed to a neuropsychological evaluation. A brain MRI confirmed he has mild small cerebral vascular disease and an initial evaluation at our primary care provider's office rated him as having mild cognitive impairment. (Having been present for that test, all I can say is I'm not so sure I'd have done very well in a couple of areas!).
A friend, who is a psychologist, suggested I try framing the neuropsychological testing as "checking brain function for the purpose of intervening early with medication that might control or slow any impairment. L's radar is on quick alert if I dare mention anything close to dementia...for all the same reasons I've read here. This may have been an easier way for him to process since it was a delay in diagnosing his hereditary transthyrein amyloidosis (hATTR) that allowed the disease to advance further than it had to.
THanks to all for sharing similar journeys - we caregivers seem to offer the only road maps to follow in helping ourselves and our loved ones.

All great questions .
Perhaps print out and give the doctor a copy going line by line with each question.

Before the end of the session ask about
scheduling a follow up appointment.

Medication and dosage may need to be adjusted….ergo the follow up appointments

ask if they have any other recommendations.

we keep a daily journal
With Medication, food diary etc to check what works and doesn’t. When the medication is given can be significant as well.

I have appointments every 6 or 8 weeks
with my 99 yo Mom’s doctors.

You are on the mark, in my opinion. These are similar queries I have and will be asking. We just received my mother's summary yesterday along with a referral to her neurologist for further evaluation. Her interview was approximately an hour and I was in attendance. After that, her exam was about 7 hours and split into 2 parts with lunch in the middle. They said it could take anywhere from 4 to 8 hours. We found out there are some underlying medical issues she has no recollection of that were not taken care of as she didn't follow up through Covid situations and my father's illnesses.