Help… please, with MRI findings

[Undrugged]

please could someone who knows about gerontology or neurology provide some advice?

my very elderly parents are currently managing a slightly younger relative who is showing signs of dementia. There is an NHS referral somewhere in the system but it doesn’t appear to be moving so they paid for a private MRI.

The reports have just been supplied and they allude to:

Moderate frontotemporal small vessel ischaemia with two right occipital haemorrhages
Severe bilateral medial temporal atrophy (graded MTA3)
The letter accompanying says marked memory and cognitive impairment with a “fronto temporal flavour”. It also notes the patient was slightly disinhibited (understatement - he’s normally much more like this) and sometimes argumentative (he had fallen out with everyone for the best part of 20 years)…

They’ve been offered an NHS GP appointment in 3 weeks time 😳 but are naturally wondering what this all means.

Can anyone medical please shed any light on what this might mean?

Thank you!

You are unlikely to come across a medic here.

Occipital haemorrhage is bleeding at back of head

temporal atrophy is linked to Alzheimer’s

sounds like Alzheimer’s.

disinhibited behaviour etc

PP - there's loads of medics on here!

I'm a radiologist who reports dementia imaging. Findings suggest a specific kind of dementia called frontotemporal dementia, which is separate from Alzheimer's disease or vascular dementia, the two commonest types. But that will need to be taken in the clinical context, and please note I obviously can't give you medical diagnosis or advice here. There's also reference made to ischaemic change, and imaging may not be able to exclude vascular dementia. With reference to the occipital haemorrhages - has your relative ever had significant head injuries? Does he/she have any visual problems?

This all needs to be taken in clinical context, which is why paying for the MRI in isolation doesn't necessarily help with diagnosis. Hassle for a referral to old age psychiatry (even if your relative doesn't quite fit the age group, they are the dementia experts), and make sure your family have a copy of the private scan images as well as the report.

I do dementia imaging because I lost my mum to Alzheimer's, so I'm very sorry your family are going through this OP x

Thank you - appreciate your reply: maybe I should post in health or something as well.

Why do you think you won't find medics here, banned?

I'm not one myself, but I am medical adjacent and I agree with Seaside. Sounds like they suspect dementia with possible involvement of other factors that have caused brain damage. Multiple areas of the brain are showing damage to the blood vessels (ichaemia and haemorrhage) or shrinkage (atrophy).

@Undrugged I don't think anyone can give you more information than this from the report alone. Imaging is only part of assessment, your relative really needs to go to memory clinic or psychiatry for full assessment

Sorry to hijack but @Seaside1234 what role does psychiatry play in dementia diagnosis?

Dementia is considered to be a mental health issue and it's generally diagnosed by a psychiatrist specialising in older persons mental health.

My mum had fronto temporal variant dementia, and it is different to classical Alzheimers though the end result is the same. There's two initial types of way it presents - one is behavioural and the other is speech (which my mum had, though the behaviour issues did come along), and it is usually diagnosed in those younger than the 'normal' age for dementia.
It sounds like your relative may have this type unfortunatly

OP, a scan alone can’t tell you what you or your family want to know, namely I assume whether there is or is not a dementia diagnosis. People can have normal scans but the clinical history and cognitive assessments tell us they have dementia. Conversely people can have abnormal findings on scan but present with no dementia symptoms.
As a pp said you really do need a specialist assessment!

I wanted to thank you all for your responses💐

Sorry, it’s been one of those weeks, and I apologise for not responding to you all individually.

Totally get the needing someone who can look at the big picture. The frustration for my family is, that seems to be at an indeterminate point in the future.

It feels like the consultation with the memory clinic/ a geriatrician/ a psychiatrist could take some time.

Meanwhile, my parents have their own significant health issues, and the affected relative is threatening to go out in the SORN-ed car, has tried to buy another one from a dealership, etc, plus a few other expensive and totally unnecessary purchases :(

Relative can’t recognise someone they’ve known for the last 30 years. Still ok with people they’ve known since early childhood though …

@Seaside1234 its so meaningful that you’re using your skills to help others, inspired by your Mum. Thank you for your vital work.

@Undrugged sending you all the best for your relative 💐

Frontotemporal dementia is one of the most difficult types. Sorry. Your relative needs a referral to neurology or psychiatry.

They do have the referral but there’s no date for when it might happen and in the meantime they are probably not particularly safe living alone. Plus they are ringing my aged and also unwell mum multiple times each day…. It seems you have to be at complete crisis point to get any kind of immediate help. Suspect this might have always been the way but it’s hard as I can see the stress it’s causing my folks :( I just want them to enjoy their own older age. My mum has been caring for relatives for the best part of 30 years :(

Do they have the keys for their car? I would see if I could take those away or doable the car in some way?

Does anyone have LPA for them?

Could you email their GP? I've done this with a couple of relatives. You need to make it really clear that you don't want any information but you want up make them aware of what is going on and that you want to avoid a hospital admission.

If you think that they have delirium you can call 111 and ask for advice. We did this when DMIL developed Delirium. She already had a diagnosis of vascular dementia but the delirium was new.

We were advised to take her to A&E, from there she was admitted and from there she went to a very caring home.

You san also call Adult SS?

I’d also add at slight tangent, if at all possible in terms of mental competency, get them to do LPOA immediately. You’re ( or the attorneys more specifically) are going to need to use that potentially and not having it is a massive problem.