Dear Dr. Garcia, You have been very kind to answer many questions for me in recent years. I am writing now with a general medical question that I hope you can help me with. My incredibly sweet, gentle, and unfailingly kind husband is 81 years old. A retired professor, he is physically active and extremely fit, conitnuing to work 35 hours/week as a grocery clerk. He also volunteers as a literacy tutor in prisons and at a homeless shelter. He has begun to experience understandable cognitive deficits, particularly with short-term memory and sequential tasks. He had an MRI last week and I just received the radiology report. We won't see his physician again for another 5 weeks, following a standard geriatric neuro-psych evaluation in a few weeks. Meanwhile, I am hoping that you can help me to interpret the radiology results. (I know that my husband is not your patient and that you have not assessed him; nor are you a neurologist, a radiologist, or a geriatrician. I would simply appreciate your professional medical opinion on this report.) It seems to me that it confirms the organic changes underlying his symptoms, indicating a decrease in oxygen to his brain due to the ischemic small vessel changes and due to the diffuse atrophy--particularly of his hippocampus, which governs memory. What I am wondering if you can tell me is this: Are these organic changes likely to be the early stages of a progressive dementia like Alzheimers, or are these neurological changes simply typical of/consistent with advanced age, indicating that he might simply retain his current level cognitive deficits without experiencing significant progression of them? The report follows. Thank you ever so much for any insight you can offer us, Dr. Garcia. We appreciate your generosity greatly, especially in the face of the inevitable, heartbreaking an incalculable losses of aging and death.
FINDINGS: There are prominent ventricles and cortical sulci. There is moderate atrophy of the apical Campbell formations--right greater than left. No intracranial mass lesion, hemorrhage, abnormal extra-axial fluid collection or evidence of acute or territorial infarct. No restricted diffusion. Mutiple discrete foci within the deep and subcortical and confluent areas within the preventricular white mattter and of the cerebral hemispheres and brainstem are identified. The pituitary gland, clivus, cervial medullary junction are normal. The calvarium skull base, mastoid air cells and orbits are normal. The visualized paranasal sinuses are unremarkarble.
IMPRESSION: Mild to moderate chronic small vessl ischemic changes. Diffuse atrophy. Moderate atrophy of the hippocampal formations, right greater than left.