Notes

October 20, 2021
Dr. Ramsussen- Sage Rehabilitation Clinic
Nancy Walter
Attended-Nancy, Leslie and Tori

I. General Conversation-recap
a. Dr. Whitten- Diagnosis Frontal Lobe Dementia- does not agree with diagnosis of Fredricks Ataxia
b. original diagnosis-Fredricks Ataxia (no prognosis, wheelchair by 50, diet, exercise, healthy living)
c. Dr. Kauffman- another neuro, doesn't practice anymore but is now legal consultant for brain injury cases
d. Ramsussen ruled out frontal lobe dementia

Background- Ramsussen: /neuro pshychologist-private practice, consults for Sage and has 4 neuro facilities. Originally from Abbeyville.

II. Send copy of Brain MRI to Dr. Ramsussen fax-Leslie has number

III. Review from previous testing at Sage
a. Nancy has problems remembering past (long term) memory, word finding, sleepless nights-day sleep, socialization, depression etc.
***concerned about day sleep- heightens dementia, confusion during day, asked if on any anxiety sleep med. possible trazadone?(ask David....Tori looked at med list: must be Buspirone 1/2 am and 1 night) Dr. R- suggested melatonin also to help with sleep issues.

IV. Results given by Ross with Dr. R
a. measure of effort- she is fine
b. premorbid IQ- average to low
c. learning and memory- used a nine word test. They give 9 words and she could remember 1 word the first time. When repeated she was getting 2-3 words/9. There was a delay for 20-30 min and couldn't come up with any words. With hints she recalled 1/9.
d. words recognition-gave a few words and she gave false words.
***verbal memory and learning difficulty
Memory- 3 ways to use
1. in
2. storing
3. location
***In was an issue.... New tasks are hard. ex. used a new remote control, not old remote and cell phones
e. screening-basic attention ability, motor skills in-tact, multi-tasking issue-not a good idea
ex. a-b and then return to a
***relies on auditory trace-Ears (listening) ex. when we are given a group of things to remember or in a conversation... she only remembers the last 2-3 things. ( simular to when you think your husband isn't listening, bc he can only tell you the last thing you said.

Diagnosis
Alzheimer-older pathology, manifested @ 80yrs old, day to day difficulties
Recommends-
1. Incorporate: Brain Reminisce Therapy- listen to favorite music, watch favorite movie and look at old photos.
Nancy was asked what is your favorite song? She didn't know
2. focus on:
Sleep, anxiety, routine, calendars and notebooks to remember things. Be careful of too many notes. Also be cognizant of the home phone and being manipulated by calls. Screen them or get rid of all together. Paying bills do together and be each others checks and balance. Make easy on both parties involved.
(Memory- Mood- Sleep) important variables
Exercise- keep doing!! Go more to Spectrum for socialization and join Silver sneakers program. Ran by Coach Murphy nationally recognized. -kenilworth spectrum classes

***watch for Perceptual Disturbances**** seeing things in the room that aren't really there/ being paranoid

Prognosis- from date of diagnosis 6-8 years

****reviewed again-

Sleep- melatonin

diet- researched at pennington biomedical found focusing on "right gut bacteria".... red meat causes most inflammation in the body and brain. Take a probiotic, Mediterranean diet-do not eat microwave popcorn (chemical in bag is dangerous)

lack of movement- keep exercising, walking- physical tasks keep the brain healthy for memory

Intelligence- the smarter the individual, the longer time for decline.

***Nancy's Alzheimer is NOT hereditary
Believe it is a Frontal and Neurological combination

Dr. Ramsussen will send Whitten and Carver report. Leslie and Nancy will be given the report.

Therapy continued @ sage ( maintenance vs rehabilitation)
Nancy's speech therapist is Sarah. In discussion, it was brought up about talking and doing maintenance that Nancy will enjoy bc bored. Dr. R talked about playing cards etc.

Alzheimer website is a good resource

wine= one glass
tumeric and vitamin B12 suggested

Nancy's morning meds=
1000mcg b-12
COQ10
fish oil gummies
vit e
once a day vit
vit c
estradiol 1mg harmone