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Q: My mother is 73 and in good physical health. In the past few years, however, she has developed a worsening word-finding problem. This has progressed to the point where sometimes she can barely get a sentence out. Other times she is more fluent and can make herself understood or ask a question. She has also exhibited signs of confusion and forgetfulness. I suspect she may be depressed, but other than that I don't know what could be wrong. Her doctor cannot find any pathology responsible for this. She has not had a stroke. She is aware that she has this problem. Any thoughts?
You
have noticed that your mother has aphasia, a disorder in speech and language.
There are other worrisome symptoms, such as confusion and forgetfulness, and you
mention that this problem has developed over the course of a few years. The
major causes of aphasia in older adults include stroke and neurodegenerative
diseases, such as Alzheimer’s disease.
A complete history and physical examination to evaluate your mother for
subtle neurological abnormalities is necessary. Medications that your mother is
taking, including prescription and over-the-counter medications, must be
reviewed to make sure that she is not suffering from an adverse drug effect or
from an interaction between two drugs. Alcohol use must be reviewed honestly.
Certainly your mother’s mood must be evaluated as well. There is no specific
test for Alzheimer’s disease, but it can be diagnosed accurately by history,
exam, and by making sure that no medical problems such as B12 deficiency,
thyroid disorder, infection, or metabolic changes from kidney or liver disease
are contributing to the symptoms. A CAT scan with contrast, or MRI, can help
diagnose a stroke. In some cases, for instance if an infection is suspected, a
lumbar puncture is performed to examine the spinal fluid.
If your mother is living alone, then you and she may wish to speak your local
office of the aging, or a social worker, to determine if she needs more
assistance to live more safely at home for as long as possible. A neurologist
may help sort out the diagnostic issues. A geriatric clinic may be better
equipped to help you and your mother evaluate the need for social services, a
need that may increase with time. I hope you find these suggestions helpful.
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