The last section of the TEASC evaluation report on Lyn continues below:


1.  Along with strategies for managing her cognitive declien, Lyn could benefit from treatment of her anxiety.  One place to start would be desensitization and relaxation breathing.  With anxiety disorders involving fear of going out, the more the feared thing is avoided, the more the anxiety grows.  Therapy involves using relaxation techniques along with having Lyn take small risks and then increasing challenges as she's successful.  A psychiatrist or counselor could help Lyn and her family work on this.

2.  Because Lorazepam has been helpful in allowing Lyn to successfully manage stressful situations, we recommend using it on a regular basis to allow her to be out or cope with larger groups of people.  If it were too sedating, she could try a smaller dose.  The purpose of it would be to help Lyn do more things, and potentially, for her to be able to travel if desired.  In some individuals, Lorazepam can be disinhibiting or cause confusion.  This does not appear to be the case with Lyn.

3.  At the current time, there are no medications that significantly improve cognition in people with dementia.  The two types of medications used with dementia primarily slow progression.  In many people they have no side effects, but in others the side effects are problematic.  A consultation with a geriatric psychiatrist or with a neurologist who specializes in dementia (such as (suggested neurologist)) is recommended.

4.  Lyn indeed appears to have early onset dementia, which may occur in patients with underlying developmental disability.  Treatable causes have been ruled out with a normal MRI and EEG (although EEG was done a year ago), and unremarkable blood work including B12 and thyroid function studies.  A practice parameter from the American Academy of Neurology suggests no further workup is indicated unless specifically suggested based on the individual's history (Creutzfeldt-Jakob disease, tertiary syphilis).  The only question is whether an EEG should be repeated as Lyn has had a significant cognitive decline since last year when her EEG was performed.  Also, repeating the neuropsychometric testing might be considered in the next year or two to help monitor disease progression, however repeating the MRI scan is likely not of great benefit and is not recommended at this point; this question might be raised if Lyn is able to see a dementia specialist such as (suggested neurologist).

5.  Research has shown that exercise may be the best treatment for improving alertness and decreasing stress.  Because Lyn has some problems with weakness, we recommend continued P.T. as well as other physical activities.

6.  The Alzheimers Association can continue to provide both educational information and caregiver support.


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