Cognitive Thinking Deficiency

    
      Re: Cognitive Thinking Deficiency
    


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Posted by CCF Neuro MD on July 13, 1997 at 20:03:18:

In Reply to: Cognitive Thinking Deficiency posted by Linda Spurlock on July 06, 1997 at 18:28:08:

: I recently went through a battery of tests as part of a routine breast
  cancer follow-up appointment (five years).  My complaint was a significant
  decline in my thinking ability in the past year showing up with short-term
  memory loss and inability to resolve simple problems or to recall words.  
  I also have severe allergies and tend to correlate my bad thinking days to
  allergies, but there is no actual basis for this.  In the past, I was
  treated for one year for epilepsy due to an abnormal eeg, however current
  physicians question wether I have ever had epilepsy even though they have
  never reviewed eeg in question.  As part of my work-up, current eeg was
  normal.  The MRI I received was also normal.  As you can imagine, my
  concern would be brain metasis of my breast cancer, but since MRI was
  normal, is no longer a concern for the docs.  I was given a neuro
  psychiatric test which showed significant cognitive thinking loss.  
  The doctors were not able to explain this other than to attribute the
  poor test results to some form of ADD.  I felt this diagnosis was pulled
  out of a hat.  The only kind of follow-up that was suggested was to obtain
  another neuropsychiatric test in six months to see if there was further
  decline, but did not want to order any other tests at this time.  In fact,
  my oncologist seemed indignant when he was reviewing my chart to my
  questions. These tests were conducted at a major medical facility known
  for diagnostic problems.  Does the fact that I had a "normal" MRI, does
  preclude any other tests that could uncover a tumor or other disease
  state?  Any comments are welcomed and appreciated.

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Dear Linda:
Your congitive decline worries me. Besides metastses in the brain, there are numerous causes of cognitive decline. High on the list are medications, Alzheimer's disease, and multiple apparent or inapparent strokes, and depression. Less common are tumors, hydrocephalus, subdural hematomas, brain or meningeal infection, vitamin deficiencies, thyroid disease, metabolic disturbances, toxins, and the lesser known neurodegenerative diseases. If your neuropsychological evaluation shows cognitive decline, I strongly feel that you need a careful neurological assessment and tests to exclude a treatable cause.
An MRI is quite sensitive for picking up metastatic disease in the brain, but is not infallible. A normal MRI does not rule out metastatic disease in the brain, only make it less likely. At this time, however, we do not have a more sensitive test for addressing this question than the MRI.
In case you live in the Cleveland are and are interested in a second opinion, please do not hesitate to consult Dr. Richard Lederman, Dr. Patrick Sweeney, or Dr R.S.Burns from the department of neurology at Cleveland Clinic. They are neurologists with a special interest in cognitive and neurodegenerative disorders. The number you might want to call for an appointment is [phone], or (800)CCF-CARE (toll free).  
This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options of your specific medical condition.