Undiagnosed problem

My sister, 54, was recently hospitalized for 2-1/2 weeks on a psychiatric ward for depression and anxiety. The doctors discovered that she had a neurological problem that they could not diagnose. A neurologist saw her and did a brain MRI that he said was negative. Her symptoms are, to me, very strange. She cannot button her clothes, she has trouble dressing herself, and she has severe short-term memory loss. When I ask her to get me something from, say, a desk, she will go to the end table instead and look in there although sometimes she will just stand there. If I try to show her how to button her blouse by demonstrating on my own blouse, she will place her hands in a different location on her blouse, one not even near the buttons. She sometimes cannot problem solve. She sometimes cannot follow even simple instructions. These symptoms also change and are not always present. Sometimes she can put her clothes on okay, except for buttons, which are always a challenge. When I write a figure or a number on her hand, she has no idea what it is. If I ask her to point to her right finger or any finger, she cannot do it; her hand starts to move and then goes off and kind of wavers in the air. We were told she did not have Alzheimer's, stroke, or a brain tumor. All of this is made worse by her anxiety, which causes problems expressing thoughts in an orderly manner, as she will forget what she is saying or even what she has just said. We are not sure what is anxiety and what is neurological. We are all so very frustrated and discouraged. She has to live with one or another of us and wants to go home very much. She is on Lamictal b.i.d., Xanax q.i.d., Exelon b.i.d., and Paxil b.i.d. She is on Atacand for hypertension.

[Abhijeet Deshmukh, MD]

Hello.

From the description, it appears that she does have symptoms of cognitive impairment. I am actually surprised to know that Alzheimer's disease has been ruled out.

In my opinion, she must undergo the Neuropsychiatric Inventory (NPI), Clinical dementia rating scale and geriatric depression scale, to name a few tests.

Her symptoms are definitely not explained by depression.

Regards