Neurological problems

Hello,

I'm a retired medical professional from the U.S. who specialized in neurodegenerative disease and movement disorders and noticed that there were no initial replies to your inquiry and that your original posting is nearly as delayed as the wait period to see a neurologist. If you'd like, you can respond by bringing matters up to date and provide your current status. If you choose to do so, I'd like to know your age and any medications that you were taking at the time of the original posting and any medications presently being taken. In the meantime, I'll provide a cursory response.

The key to determining whether neurodegenerative disease of some type exists is illuminated by symptoms and the particular company that they keep in the way of other particular symptoms. From your comment, you describe experiencing dysarthria in the form of slurred speech and stuttering, aphasic and apraxic speech in the form of misuse of certain words and incorrect word choice along with anomia in the form of word-searching. I also see reference to bradyphrenia, which is the slowing of cognitive performance and function, lack of concentration or focus and recent or functional memory difficulties. We'll speak about the physical symptoms following my comments relevant to cognitive function.

While it is true that intense anxiety and clincal depression can indeed produce the inconsistencies and difficulties you describe, it is important to consider the constellation of difficulties to determine whether consideration to neurological pathology should be further contemplated. One of the key components is timeframe of onset. If the speed at which these collective disparities took place is within 90 days from onset then it tends to lead us away from neurodegeneration in some form because such disease most always presents in a most insidious progression over a period of years as it becomes worse.

The other major key is how these cognitive events are related to specific areas of the brain and whether other elements associated with those brain areas are being expressed as well. In other words, if certain targeted areas of the brain relative to speech and semantics appear to demonstrate negative impact then it would follow that all factors guided by those specific or targeted areas of the brain would likewise be expressed. Neurodegenerative disease that arises in specific areas would express difficulty in all aspects of function in those areas rather than anything selective or sporadic. While your description may simply not be complete or constitute a summary of sorts, there does appear to be an absence of certain dysfunction that should accompany those specific difficulties mentioned in your post. While this inconsistency does not exclusively rule out true neuropathology, it does suggest consideration of a broader scope of possible causes because your specificities lie outside what is normally encountered with neurodegenerative disease in that while targeted to some extent, is incapable of extremely finite diminished capacity absent other closely related aspects of function that cannot be separated. Neurodegenerative disease is incapable of such precision.

Lastly, with reference to the cognitive difficulties, is your present status and to what specific extent matters have expressed change. If any single portion of your described deficits have demonstrated improvement to any extent then it would lead us away from neurodegenerative disease because such disease is a one-way direction toward increasing deficit and broader scope to other areas of brain function with no ability under any circumstance to exhibit improvement.

With respect to your hand and body tremor, I would be interested in knowing whether this aspect of your difficulties began with muscle weakness, diminished coordination and any signs of muscular atrophy. I would also like to know if the tremor is steady in its presentation or is expressed in a relapse and remission sort of pattern, or in other words here today and gone tomorrow sort of pattern or any timeframe that may constitute greater periods between better versus worse.

Clear MRI findings would also suggest an inconsistency between what is being experienced versus any abnormalities observed on MRI imaging studies. Most typical of neurodegenerative disease is progressive atrophy of the cortex. Its absence in your imaging study would tend to suggest a cause other than degenerative disease. Of equal importance is the performance of neuropsychometric tests that are designed to examine the actual presence and measurement of cognitive performance relevant to specific regions of the brain.

I'd like to pause here and allow you to take into consideration the points discussed and if possible, provide response along with your present status. Aside from my comments regarding generalized impressions, these impressions in the absence of direct examination admittedly constitute limitations based more solely in experience with neurodegenerative disease. So the passage of time and greater information in the context mentioned would help draw nearer to diagnostic considerations to discuss with your primary physician or neurologist.

Lastly, clinical depression is also known as pseudo-dementia because of its ability to demonstrate sometimes striking symptoms mimicking those of true neurodegenerative disease. Intense anxiety, particularly arising from a significant life event or psychological trauma can likewise produce striking somatic features that can easily result in contemplation toward the presence of neurodegenerative disease.

I would look forward to hearing back from you or otherwise hope that you have been able to undergo formal evaluation by a neurologist and your circumstances brought under treatment in some form.

Best regards