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Alzheimer's Disease

Myasthenia Gravis and Alzheimer`s disease

09/20/2006

Question:

My grandmother was diagnosed in August with moderate alzheimer`s disease by her family doctor. Since then we have seen a gastroenterologist which concurred with this diagnosis and a speech therapist for a swallowing problem also. A few years ago (approx. 5 yrs.) a neurologist diagnosed her with myasthenia gravis, which was also agreed upon by the gastro doctor.

She has, in the past month, had a ct of the head which read as an impression: no acute problems noted. Atrophy and white matter disease....also, she had normal upper gi`s and egd`s. Now, we went to the neuro doctor today and he said that she had mini strokes when he saw her back in 1998, wouldn`t that have shown up in her ct? He also said she does not have alzheimer`s, she is 82 y.o. and has something that sounded like microarterialurgic dementia. He is going to have a ct of the chest done for thymus/myasthenia gravis and also: striated muscle antibody, acetylcholine rec bind ab, striated muscle ab titer, acetylcholine rec bloc ab, and acetylcholine rec modab. She has hypothyroid and high blood pressure also.

What is he saying/looking for that is differing his opinion with the other two because hearing it is not alzheimer`s disease really got her hopes up and I don`t want her to face that disappointment if there is no chance of reversal. These are well known doctor`s and I don`t know who to believe or what to do.... I must sound like a mess, but I am now officially confused, if you can, please help me... thank you so much!!!

Answer:

“Mini-strokes” is a widely used term I have heard other doctors use to explain anything from unexplained memory loss to white matter changes on CT or MRI to actual small strokes. When I hear the term, I start over from square one because I don’t know what was intended. An MRI is more sensitive than a CT, so that could explain one discrepancy, but if you want to sort out to the best of your ability what is going on from a cognitive standpoint, I would recommend evaluation by a fellowship trained specialist on Cognitive Neurology and Dementia, and continue following through with the other medical/neurological issues.

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Response by:

David Q Beversdorf, MD David Q Beversdorf, MD
Formerly
Assistant Professor of Clinical Neurobehavior and Neurology
College of Medicine
The Ohio State University