posted
I did several searchs here and didn't find anything.
I was relating many cognative issues and burning type pains, with my Rheummy who suggested I go see the Neuro.
Well, that was a joke! She Kept telling me I was chronically depressed, in rather loud tones. She is very arrogant. It has been abt 7 yrs since my last brain mri, so she is sending me for one of those and a new WB lyme test{ But she doubts I have this} and I was rather surprised to see the third script for a "Pseudodementia test".It was written on the back of the script to go to Kessler Inst for this test.
A google search shows this: PSEUDODEMENTIA
Term applied to apparent cognitive impairment associated with psychiatric disorders, most often depression (50-100%).
Four criteria proposed by Caine (1981) for diagnosis:
1) intellectual impairment in a patient with a primary psychiatric disorder
2) features of impairment are similar to those seen in CNS disorders
3) the cognitive deficits are reversible
4) there is no known neurological condition to account for the presentation
PREVALENCE: Of patients referred for dementia evaluation, reports in the literature have ranged from 2% to 32% found to have a pseudodementia, with most reporting about 10%.
There also is suggestion of overdiagnosis of degenerative dementia, with some studies reporting 20-50% of patients being misdiagnosed who really have a pseudodementia. Most cases occur in later life, with few reports in early or midlife.
PSEUDODEMENTIA FEATURES:
depressed affect/mood
neurovegetative signs
slow, aspontaneous, monotonous speech
long response latency
frequent "I don't know" responses
quick to give up, but persists with encouragement disorientation
impaired attention/distraction
incomplete responses
forgetfulness - particular deficits in learning new information, although memory may be patchy
poor abstraction
typically make errors of omission, vs. errors of commision
awareness of cognitive difficulties may have concern over deficits - "Do I have Alzheimer's? See, I can't remember anything!"
if psychosis, delusions typically nihilistic, self-deprecatory, paranoid
no signs of aphasia, apraxia, or agnosia greater similarity to subcortical dementias, such as Parkinson's
~~~~~~ Has anyone here been tested for this?
Waste of Time & money??
Does anyone know what this test consists of?
Any thoughts or advice on this? Thank you, Dakotasmom
-------------------- Take Care, DakotasMom01 Posts: 371 | From NJ | Registered: Dec 2007
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lymie tony z
Frequent Contributor (1K+ posts)
Member # 5130
posted
Hi Dakota's mom,
Now let's try and figure this out shall we?
Pseudodementia right?
Is this like being pseudopregnant?
What I mean is...by definition Pseudo means false.
Pseudodementia is(per my Taber's cyclopedic medical dictionary), Exaggerated indifference to
environment without impairment of mental capacity.
So exactly how do you feel about this?
I'm wondering exactly how one tests something that is false???
Your neurologist is obviously wrong and should be slapped about the head and shoulders.
Get a new neurologist,however, unless a new one would be lyme literate, that decision, would be useless.
I have never had this test suggested for me by any duck or llmd.
If you don't want to change neuro's then try to convince this one that you present with dementia
like symptoms but there is probably no typical physiological evidence of dementia.
This is because your symptoms are just mimicking dementia, you don't actually have this psychological disease.
However if you don't get some ABX to address the infection(encephalitis or
encephalomeningitis), caused by a TBD, this immitation of dementia may turn into the real thing.
Is the test a waste of time and money. I would say yes! However as we all do from time to time,
especially early on with our TBD's. We have to patronize our ducks and hold their hands thru
this disease, just to make sure we DON'T have, what they think we have.
Your neuroduck probably does'nt have the slightest idea of what you are suffering from nor it's poly-psychophysiological manifestations.
The next time this neuro-duck yells at you or treats you in any way that is
condescending...give me a call and Ill personally come there and give him/her a spanking!
If, for nothing else, but to punish him/her for not keeping up on diseases that come under, his/her PSEUDOSPECIALTY!
zman
-------------------- I am not a doctor...opinions expressed are from personal experiences only and should never be viewed as coming from a healthcare provider. zman Posts: 2527 | From safety harbor florida(origin Cleve., Ohio | Registered: Jan 2004
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Michelle M
Frequent Contributor (1K+ posts)
Member # 7200
posted
What TONY said!!
Do NOT subject yourself to such an idiotic test.
Do you have an LLMD? An LLMD would never recommend a test like this.
Ask this idiot instead for a SPECT scan. (Assuming he knows what that is.) From a good facility well versed in lyme. It will show hypoperfusion in your brain which likely accounts for your "dementia."
Failing that, ask for neuropsychogical testing. Takes 1-2 hours. When you're lyme-brained, it can be quite accurate at identifying deficiencies (for me, short term memory in the toilet, executive function, etc.)
Sounds like THIS particular test is already weighted heavily against you. Refuse it. Please find an LLMD. Your rheumatologist is a danger to your health. Not to mention, an insult. No joke.
Michelle
Posts: 3193 | From Northern California | Registered: Apr 2005
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Michelle M
Frequent Contributor (1K+ posts)
Member # 7200
posted
From the Lyme Times... maybe your duck should read more. But they never do --- it's a lot easier to just mock their patients than actually bother to learn anything.
Michelle ______________________________
Distinct Pattern of Cognitive Impairment Noted in Study of Lyme Patients
Marian Rissenberg PhD & Susan Chambers MD, The Lyme Times, Vol. 20, Jan-Mar 1998, pp. 29-32
I. Cognitive Characteristics of Chronic Lyme Encephalopathy
On the basis of both a formal neuropsychological study of 49 patients (APA 5/96) and on clinical observation and comprehensive neuropsychological examination of well over 100 patients, a distinct pattern of cognitive impairment occurring chronic Lyme disease can be described.
These patients consistently demonstrate deficits in directed, sustained and divided attention, planning and organization of responses, temporal ordering, verbal fluency, abstract reasoning, speed of processing, and motor programming.
The overall pattern of intellectual impairment is not unlike that seen with diffuse brain injury, and it most often results in some degree of work-related disability.
Although performance is impaired on measures of cognitive functions associated with specific brain regions -- receptive and expressive language, visuospatial problem solving and memory -- the quality of performance is not suggestive of focal lesions in these areas. Rather, deficits are secondary to impairment of higher level integrative functions, likely mediated by complex neuronal systems. Specifically, the receptive language deficit is secondary to impaired auditory tracking and slowing of mental processing. The expressive language deficit is secondary to impaired word retrieval and response planning, The visuospatial problem solving deficit is secondary to impairment of mental flexibility, conceptualization and the ability to compare and contrast necessary in decision making.
Finally, deficits on test of memory function are most often secondary to impairment of the encoding or initial processing of information, which depends on attention, and the retrieval of stored information. The storage of new information, or memory per se, is rarely impaired.
This pattern suggests that cognitive dysfunction in chronic Lyme, while expressed variably across individual patients, results from a common factor -- the breakdown of diffusely represented processes involving both integration and activation, and impacting primarily on attention and reasoning.
The fluctuation of impairment over short periods of time suggest that a physiologic rather than a structural mechanism is responsible.
II. Neuropsychological deficits in chronic Lyme disease (A study presented at the annual meeting of The American Psychiatric Association , May 1996)
The neuro-psychological characteristics of 49 patients with Lyme disease were examined. The study set out to answer three questions:
1) Do all patients with subjectively perceived cognitive dysfunction have measurable intellectual impairment on objective testing?
2) In those without measurable impairment, does depression account for the perception of cognitive dysfunction?
3) What is the nature of the cognitive impairment in Lyme disease when it does occur?
Subjects were patients seen consecutively between 1990 and 1994 in a private neuropsycological practice with complaints of cognitive dysfunction and a symptom complex consistent with Lyme disease. Diagnosis was based on former CDC criteria. Mean duration of illness, defined as the time from the onset of general symptoms to the neuro-psychological exam, was 4.7 years (range: 3.3 to 14 years). Mean age was 39.9 years (range: 21 to 58 years) from 18 to 60 years. Mean level of education was 15.3 years (range 12 to 20 years).
Subjects were interviewed and administered a comprehensive battery of tests, including the complete WAIS-R and WMS-R, and additional test of language, attention, reasoning, visuospatial processing and complex motor function. They also completed the Beck Depression Inventory and a symptom checklist. Tests were divided into seven groups based on the cognitive functions they are presumed to measure: Attention, Memory, Language, Visuospatial Processing, Reasoning, Verbal Fluency and Motor programming.
Subjects were grouped into three levels of impairment based on their neuropsychological performance: Intact (N=11; 22%), with no functions impaired, Moderate (N=31; 63%) with two functions impaired, and Severe (N=7; 14%) with three or more functions impaired. Subjects in the Severe group met diagnostic criteria for dementia. The correlation between depression and cognitive impairment was nonsignificant, but the trend was positive, rather that negative. Anxiety by self report was significantly greater in the impaired groups that the Intact group. Duration of illness was greater in the Severe group (nonsignificant).
Of the 38 subjects with cognitive impairment, deficits of attention were most common, occurring in 26 subjects (68%) Deficits of memory storage were least common, occurring in 8 subjects (21%), Motor, Verbal Fluency, Visuospatial, Language and Reasoning deficits occurred in 24, 26, 29, 36 and 36% of the subjects respectively.
III. Possible Pathophysiologic Mechanisms of Cognitive Impairment in Lyme Disease
Based on these findings and on patients' reports, two characteristics of Lyme Encephalopathy arise which provide insight as to possible neurophysiologic mechanisms:
One, the nonfocal nature of the cognitive functions affected, and
Two, the subtle fluctuations and reportedly abrupt and global shifts in cognitive function from one day to another in a given patient.
Four broad categories of possible neurophysiologic mechanisms might be compatible with this pattern:
1) Diffuse cerebral diffusion abnormalities -- Single photon emission computerized tomography (SPECT) scans of the brain in Lyme disease often display a diffuse pattern consistent with heterogeneous areas of hyperfusion and/or diminished neuronal metabolism.
Note: I think this is a typo and should read hypOperfusion.
While vasodilators are often capable of reversing these abnormal patterns on SPECT scan, this reversal does not consistently correlate with a symptomatic improvement in cognitive function.
2) Alterations in cellular metabolism at the cortical level -- Evidence of alterations in neurotransmitter function is suggested by clinical evidence of cognitive improvement following treatment with selective serotonin reuptake inhibitors (SSRI's) which appears to be independent of their antidepressant effect. Systematic studies of the impact of SSRI's on cognitive function, as well as the role of other transmitters, are required.
3) Neuro transmitter abnormalities (imbalances of synthesis and/or receptor activity) -- Neurotoxic substances may well play a role in Lyme Encephalopathy, given the neurotropic nature to Treponema pallidim, and the close parallel between syphilis and Lyme disease, it is possible that Borrelia burgdorferi could produce intracellular or extracellular neurotoxins which we have yet to identify.
4) Neurotoxic substances produced endogenously or possibly exogenously -- Endogenous neurotoxins have been identified as by-products of the humoral immune response. Among these is quinolinic acid, a product of the interleukin cascade system, which accumulates as a result of the humoral response to acute infectious agents and functions as a neuronal excitotoxin. As there are many similarities between Lyme Encephalopathy and the nonspecific mental dysfunction of acute systemic infections, such as influenza, it is quite possible that continued stimulation of production of quinolinic acid and other cytokines plays a role in the pathophysiology of Lyme encephalopathy.
IV. Clinical Impressions and Implications for Diagnosis and Treatment in Chronic Lyme Disease
This study demonstrates that for the majority of chronic Lyme patients with cognitive complaints, there is in fact a measurable and significant decline in intellectual acuity. The nature and severity of the cognitive impairment is such that it interferes with all aspects of normal functioning: employment, home, marriage, social interactions, and general emotional well-being. Rather than the cognitive complaints being secondary to anxiety or depression, as is sometimes suspected, depression and anxiety increase with, and are apparently secondary to, cognitive impairment and the emotional and practical impact of a loss of competence. Thus, while patients with chronic Lyme disease can present a confusing and "psychiatric" picture to the clinician, it is important that their concerns be properly investigated and addressed.
Patients with Lyme encephalopathy complain of problems with memory and concentration, word retrieval, confusion, problems with thinking, "mental fogginess", a decline in job performance, difficulty with calculations, directions, and judgment. Decreased initiative, manifest as difficulty getting started with or following through with projects is often noted. Mood disturbance is common with complaints of irritability, explosiveness or "a short fuse," sadness, hopelessness or guilt, increased anxiety or mood swings. Sleep disturbance is also common, and can present as initial, middle or terminal insomnia or some combination of these. Fatigue is universal. Headache is common, and of course joint and muscle pain. Increased sensitivity to light and noise, visual disturbance, and tingling in the extremities are also common.
On interview, patients with Lyme encephalopathy tend to be vague and disorganized in the presentation of the history of their illness. This is despite their close attention to their symptoms and having recounted them many times before. Although in most cases memory of discreet events - tests, dates, diagnoses, responses to medications - is intact, the patient is unable to recall them spontaneously or organize them in temporal order. They may be unclear as to their chief complaint. They may completely lose track of what they were saying, sometimes repeatedly, or of what the question was. They may get off on a tangent and have trouble re-orienting themselves. Frequent prompting and refocusing will be necessary; beginning the interview with an open-ended question like "Tell me what the problem is" will allow these qualities to become clear.
Often patients with chronic Lyme disease will seem overly focused on their illness, or overly concerned with convincing the clinician that they are ill. The clinician may be tempted to interpret this as evidence of a primary psychiatric disorder. It is important to understand that the frustration many of these patients experience is real, and results from the general attitude of doubt toward Lyme disease as a serious and chronic illness, the invisibility of their symptoms, the difficulty in getting a definitive diagnosis and getting approval for extended treatment from insurance carriers. Many have been accused of hypochondriasis or malingering. As with head injury, the patient may "look fine" though they are having difficulty with very basic work, social and day to day functioning.
The cognitive deficits in chronic Lyme disease involve primarily attention and arousal mechanisms. Patients have difficulty keeping track of external and internal events, retrieval of information from memory and with planning and sequencing, as occurs in attention deficit disorder. However their experience is different from that of ADD, in that rather than having the experience that there are many thoughts competing for attention, the Lyme patient has difficulty bringing any thought into clear focus. They experience difficulty thinking. One patient described it as the universe ending six inches from his face. He can't process information that is not immediately apparent, immediately experienced. Another said that when he tries to think about something, or figure something out, all he can do is repeat the question -- he can't get to the meaning. This is like the idea of "surface" versus "deep" processing in cognitive psychology. Reading a passage for typing errors would be surface processing, while reading for meaning is deep processing. One patient, a physician, described it as a "mental intention tremor" -- the more she tries to focus on something the more out of focus it becomes.
The clinician should proceed with empathy and reason. Specific cognitive complaints in previously high functioning individuals are unusual and indicative of serious illness, either psychiatric or neurologic. Comprehensive neuropsychological evaluation will most often differentiate the two.
Where the neuropsychological exam is normal or there is a significant psychiatric component, a psychiatric evaluation is advised. Psychiatric symptomatology is not uncommon in Lyme and the presence of depression, anxiety, obsessive compulsive symptoms, flat affect and so on may cloud the issue of significant cognitive decline. Both the cognitive and psychiatric symptoms would be expected to improve with antibiotic treatment in Lyme encephalopathy. However sometimes concurrent treatment with psychotropic medication is necessary.
Unfortunately for some patients, significant cognitive impairment persists even after years of antibiotic treatment. These patients may never be able to return to their premorbid level of employment, or be gainfully employed at all. Cognitive remediation can help them learn strategies for improving memory and concentration and relieving stress. Support and advice in regard to living with a chronic condition is equally important. Strategies include reducing work hours when possible, taking regular rest periods during the day, limiting the number of outings in a week, and using a calendar to stay organized and structure their time.
V. Cognitive impairment in Lyme disease: specific functions and the impact of deficits
1. Attention and mental tracking. Includes directed and sustained attention: the ability to direct and maintain one's focus on a particular event or idea, whether in the environment or internally; and divided attention: the ability to simultaneously attend to two events, or do two or more things at a time, or to retain awareness of one thing while doing another.
Impact: difficulty functioning effectively in many situations, remembering what one was doing before a distraction, keeping track of conversation, taking notes while someone is speaking, remembering that someone is on hold, or what you were about to say.
2. Memory: Retaining new information.
Impact: secondary to impaired attention, slowing of processing and the retrieval of stored information, but not storage per se; a tendency to lose or forget things; miss appointments; repeat oneself.
3. Receptive language: understanding spoken or written language
Impact: secondary to impaired attention and speed of processing; difficulty participating in meetings or social conversation; difficulty with reading comprehension.
4. Expressive language: Using spoken or written language to express ideas
Impact: difficulty finding the right word; using the wrong word and not noticing; not being able to express oneself or communicate.
5. Visuospatial Processing: Efficient scanning of the visual field, making sense of how things are related in space; visuospatial conceptualization and problem solving.
Impact: a tendency to get lost; difficulty with reading comprehension.
6. Abstract reasoning: The ability to generalize from the particular; to identify the common factor between related concepts; to compare and contrast two things or ideas; to see the "big picture"; to identify the critical factor in a situation; to anticipate consequences and make inferences regarding cause and effect.
Impact: difficulty with decision making, planning, and problem solving.
7. Speed of mental and motor processing: The ability to think and respond quickly; critical to understanding speech which occurs at a fairly constant rate.
Impact: difficulty understanding or keeping up a conversation; functioning in a timely manner in day to day situations; meeting deadlines.
A PDF version of this article is available for easier printing.
The Lyme Times is published quarterly by the Lyme Disease Association.
Posts: 3193 | From Northern California | Registered: Apr 2005
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adamm
Unregistered
posted
Seriously--there's no need for that test, unless you
need to produce some objective evidence of your impairment
to obtain something. YOU know whether or not you're losing
Tony, Thank you for your support & input. You asked how it made me feel?? During the whole ov, I had all I could do to keep the "Lyme Rage" in check, by NOT slapping the smug, smirk off her face.
You really don't want to know HOW I FELT when I saw that script after I left the office. {I would be banned for sure.}
Every issue I was bringing up with her, rashes, memory, vision disturbances, she kept telling me "she was a neuro", NOT an eye dr or a derma, go see them!! I plan on writing to the head of her practice, then Dumping "her"! Michelle, Thank You, I am keeping the info. I am not having this done, I feel its just more of her condisending attitude, then anything of real value. I will look into the SPECT Test that you mentioned. I am trying to connect with an LLMD.
Adamm, Thank You for your support!
Take care, Dakotas mom
-------------------- Take Care, DakotasMom01 Posts: 371 | From NJ | Registered: Dec 2007
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lymednva
Frequent Contributor (1K+ posts)
Member # 9098
posted
If you were to have any type of testing done for cognitive impairment it should be neuro-psych testing by a practitioner who is familiar with Lyme and related issues.
I had that done as part of my SSDI process, by the psychologist recommended by my attorney.
I see no reason for you to pursue this, unless it may help in getting assistance for your son in school. It's rather expensive and my insurance didn't cover it.
If you need help with school issues post separately and some of the moms who have gone through this can help you.
I'm a retired teacher (due to Lyme) and it's been a few years since I did referrals, so I'm not as up to date as I once was.
Finding a LLMD is the most important thing you can do. Try to get in touch with Dr. J, the famous Lyme pediatrician. Post in Seeking a Doctor Forum to get his info.
-------------------- Lymednva Posts: 2407 | From over the river and through the woods | Registered: Apr 2006
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posted
Michelle, Wow! What a great article! Thanks for posting it.
Going to have to print that out and hand it to a few people (with highlights).
-------------------- If you don't know where you are going, any road will take you there. - Lewis Carroll Posts: 356 | From Body-PA, Mind-elsewhere | Registered: Dec 2007
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Greatcod
Unregistered
posted
How about pseudo-scientific...pretty much what psychiarity is all about. They used to call MS "hysterical paralyisis"--the old "its all in your head game". Now that Chronic Fatigue Syndrome is recognized as a real medical condition by the CDC, the shrinks have invented this one to keep the bucks rolling in, as well as letting their ignorant collegues in other specialities off the hook. We don't know what it is, so it's all in your head. Right up there with Demonic Possesion as an explanation.
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Cass A
Frequent Contributor (1K+ posts)
Member # 11134
posted
It looks like this "neuro" is setting you up for a psych dx instead of handling your Lyme.
Don't go there!!
Cass A
Posts: 1245 | From Thousand Oaks, CA | Registered: Feb 2007
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bettyg
Unregistered
posted
the article michelle posted, i included the whole thing in my 2nd SSDI, disbility app.
we just have a psychotherapist join; does that person do anything like you all are talking about? you can tell i have no expertise on this matter!
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posted
Thank you All, For the input, support and suggestions.
Please note,there are no small children involved. My kids are all grown. Thankfully, I was ok while raising them.
Its been the last 7 or so yrs that all h3ll broke loose on me and the downward spiral has been going on.
At times it felt like I was under demomic possession with the horrid mood swings, severe pms, etc.
All the drs kept telling me I was depressed, thats all that was wrong with me.I refused the drugs, cause I knew there was something else.
When I was dx'd with Fibro,they convinced me, the antidepressants would help with everything.
Any help was short lived and after 7 yrs of them, I stopped them, 2 yrs ago.
After 3 positive WB's, they are still blamimng depression and denying Lyme.
Thank you all,the advice, and opinions are appreaciated more than you know.
Dakotas Mom
-------------------- Take Care, DakotasMom01 Posts: 371 | From NJ | Registered: Dec 2007
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lymie tony z
Frequent Contributor (1K+ posts)
Member # 5130
posted
It's really too bad Dakotamom, that even some of the good doctors, think we can get relief from pain, with certain psychotropic drugs.
Yes....some of them may help SOME of us, sometimes. HOWEVER,
it's been my experience that, any pain killing effects,that the pharma companies or their
company/representatives, tell the ducks and docs, about this new drug or that one merely to
use, as selling points, and hinted at side
effects/benefits/alternatives, to the different medications they're trying to sell the world.
Because these are short lived benefits, if experienced at all.
We all, patients everywhere, not just we lymies, have to tell these docs/ducks...
look doc/duck;
If I tell you; I'm haveing seisures, give me something to prevent them;
If I have trouble sleeping, give me something to help me sleep and get my circadian rhythm back in order;
If I have weight gain, give me something to help me lose weight;
If I have chronic fatigue, give me something that will give me energy, physically, not
something, that just keeps my mind alert, like(provigil);
most of all, if I have pain, please doc, give me
pain killers, for both my chronic pain and the breakthrough acute pains I have.
Don't give me;
anti-inflammatories or anti-seizures or psychotropics, as pain killers, because when you do...you're
just peeing on my head, and telling me it's raining.
Another thing doc/ducks if you give me these pain killers and the side effects just happen to
get me off of the couch and doing things again so my physical body is'nt steadily wasting away.
If in fact these pain killers give me a "false sense of well being".
WELL, WHAT THE HECK IS WRONG WITH THAT??!
I have a dang bug/s, crawling around inside me taking my life away, by little and sometimes big
pieces at a time. What's wrong with giving me something that will make me forget about my
maladies and troubles with; fighting insurance companies and the IDSA and the Social Security
Disability people,etc., etc., and so on?
I mean, why the heck do ya make the stuff that, could potentially put a smile on our faces,
even if it IS a "FALSE sense of well being", and
then not prescribe them for people who, are going thru h3ll and who,
REALLY NEED THEM ???
After all doc/duck, if you won't live up to your hyppocratic oath. Deflate your heads and egos,
because when it all comes down to it,you're our employees...at least try to be a good employee
when we come to you to help us feel better. We're paying you, or our insurance is paying
your exorbitant fees, so we ARE after all your EMPLOYERS, paying you all to do SOMETHING to help us thru these illnesses.
Kindly do your jobs!
zman
PS: Sorry Dakota, I got on my soap box this morning!...lol!
[ 29. December 2007, 08:55 AM: Message edited by: lymie tony z ]
-------------------- I am not a doctor...opinions expressed are from personal experiences only and should never be viewed as coming from a healthcare provider. zman Posts: 2527 | From safety harbor florida(origin Cleve., Ohio | Registered: Jan 2004
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