UnwBPD Brain MRI shows White Matter Disease, but no change since MRI 10 yrs ago

[JazzSinger]

My uhwBPD had a brain MRI, ordered by a doctor of ours who is trying to help, based on my sharing about my H’s behavior. 

My H had a TMI (mild stroke) 10 years ago, and the brain MRI at that  time  showed white brain matter disease, consistent with a stroke.  However, I read it can also be a sign of dementia, mood swings, and other ailments.  Nevertheless, since there’s been no change in the MRI results from 10 years ago,  and because my husband always tells the doctor that apart from mild memory loss, he’s fine, there will be no treatment plan.

I was disappointed.  I sat down at dinner and told my husband that his forgetfulness and mood swings have intensified, and have occurred with greater frequency, over the past two years.  I begged him to tell the doctor the truth about what’s been going on, and to ask for meds, because he’ll only get worse. He took it well, and didn’t deny anything. But he asked for specifics. I was vague, for fear he’d blow up if I described his scary behavior in great detail. I also told him he probably doesn’t remember any of the episodes.  He said he didn’t.  But I did scare him. He feels he might get worse over time. 

I then asked him to send a note to the doctor, telling him  the truth about the mood swings and forgetfulness.  I told him to ask for help. He said he would, and asked me to write the note for him.  I did it.

Of course, by the next morning, he was blaming his memory loss on me, and he said he’s moody because he hates our home, etc. He took no responsibility for his behavior, and told me to send the note myself — he wouldn’t do it.  So I asked if I could tell the doctor he approved of my sending it, and he agreed to that.  Then, I briefly restated my husband’s symptoms, in writing, explaining that My HUSBAND ASKED ME TO SEND THIS TO HIM. I  pleaded for help. Then I hit SEND.  That was a few days ago.  I’ll see how it goes.

Meanwhile, my H is walking around making jokes about dementia and mood swings, and saying he’s not “crazy,” a word I never used. 

This is where we are. And I’m planning another getaway for October. 

I pray the doctor can help.  I pray he can prescribe medication. I pray my husband will take it.  I don’t know how this will work out, because he really needs therapy, But he’s still in denial.

Guess all I can do is wait and see. 

Any light anyone can shine on this, or any comments at all, are welcomed. 

[Pook075]

That's a really tough situation and I don't have much practical advice.  I will share though that when I brought my dad to our doctor for mild dementia a few years ago, she told me that the best medicines out there can only slow dementia a tiny bit at best. 

You're talking about BPD though, which is a completely different "memory loss/memory re-writing" type of thing since it stems from disordered thinking.  There are meds that can help there, but they're reliant on a diagnosis and active participation from your H.  In short, if he doesn't think he needs them, then the rest of the process is useless.  He has to want to actively change to see results. 

The mood stabilizers also take a good 4-6 weeks to fully kick in and make a difference, so it's not a quick fix.  The problems a lot of us have here is that the pwBPD takes the meds for a few months, feels great (aka manic), then decides they don't need the meds anymore...so they're in a psych ward 1-2 months later.  Some also have decent side effects, including weight gain (which is a great excuse to not take the meds).  So it's an uphill battle for sure.

[Notwendy]

 Many older people will have some age related changes on an MRI but it doesn't always correlate with behavior and cognition.

"Dementia" is a category of conditions- not just one of them. My BPD mother has had episodes of confusion where dementia has been considered but these seem to be in episodes- and then she's lucid again. She has the expected age related changes on her MRI but so does one of her siblings who, other than occasional forgetfulness, is as sharp and functional as ever and doesn't have BPD.

I have been told my mother would need full psychological testing for that diagnosis to be made and since she's gone in and out- this hasn't been recommended.

With my mother, while she has some age related behaviors- it's a confusing situation. Sometimes she's sharp as a tack, sometimes she's forgetful, and sometimes she's "forgetful" on purpose when it suits her. Sometimes what she "remembers" is her distorted thinking. When she's had her confusion episodes, they seem to be related to a medication change or an infection- and so not dementia.

My sweet, usually calm, mother in law would get snippy in her elder years at times but we knew it wasn't "her" doing it. With my mother though- there is BPD+ the behaviors of older people and that is a very puzzling picture to try to figure out. I am not sure it's entirely possible to do that.

Your H's doctor can look for medical causes- the MRI, a physical exam- which it seems he is doing. Your H can try medicines for depression or anxiety and see if that helps. You have expressed your concerns to his doctor so hopefully the doctor will take it from there.

[JazzSinger]

Many older people will have some age related changes on an MRI but it doesn't always correlate with behavior and cognition.

Your H's doctor can look for medical causes- the MRI, a physical exam- which it seems he is doing. Your H can try medicines for depression or anxiety and see if that helps. You have expressed your concerns to his doctor so hopefully the doctor will take it from there.

Thanks so much, NotWendy.  This is quite helpful. My H is an older gent, and the signs of dementia are mounting, along with more intense and frequent outbursts. There’s no correlation with the unchanged brain MRI.

It’s tricky.  My H will not full-throatily say that he has some problems, and he needs help.  The only ray of home is that he wanted me to tell the doctor about the behaviors I’m witnessing — unbeknownst to him, I’d been doing it behind his back, for about a year.   But now that he sort of acknowledges a problem, perhaps he’ll agree to take meds. On the other hand, the doctor might order more tests, and I doubt my husband will comply.  . Also, any mention of mental illness will cause him to back away, because he’s “fine.”

I guess it’s a wait and see.  But at least…

—He’s halfheartedly admitted that he has a problem.
—I can now get way for a couple of days, without him making
   a scene.
—Our doctor is trying very hard to help him, without agitating
    him. 

Hope springs eternal. 

Thanks again. 

[ForeverDad]

There may be another reason why your H's doctor hasn't responded (yet).  Many countries have privacy and confidentiality laws (in the USA it is HIPAA) where the professional is limited in what can be discussed with others, even a spouse, about a patient.  You, of course, can reach out to the doctor to provide information, but the doctor may need permission from the patient to respond.

[livednlearned]

Any thoughts on why he was relatively receptive when you raised the issue of his mood swings?

Sometimes the way we communicate things can create openings. I wonder if there is a repeatable moment there since he seemed open to hearing you.

[JazzSinger]

There may be another reason why your H's doctor hasn't responded (yet).  Many countries have privacy and confidentiality laws (in the USA it is HIPAA) where the professional is limited in what can be discussed with others, even a spouse, about a patient.  You, of course, can reach out to the doctor to provide information, but the doctor may need permission from the patient to respond.

Thanks, Forever  Dad. 

Were it not for me, the doctors probably wouldn’t know my H had a mental  health issues, because he’s “fine.” Out of frustration, I vented to two doctors I share with my husband, and one of them took action.  Neither, however, has given me any information on my husband’s appointments with them — that’s been kept private.

I was so upset when I vented to them, that one of them prescribed Xanax for ME, which I’ll probably never take. To me, taking it would mean that my H broke me.  The other doctor ordered the brain MRI, and has done some probing about memory loss, according to my husband. 

That’s where we are.  But I get it. There are privacy issues. And more and more, I’m seeing that if my H isn’t willing or doesn’t see that he has a problem, there’s not much more anyone can do for him.

I just have to keep busy, enjoy my friends, spend a couple of nights away from home when I can, and enjoy him when he’s not off the rails. 

[JazzSinger]

Any thoughts on why he was relatively receptive when you raised the issue of his mood swings?

Sometimes the way we communicate things can create openings. I wonder if there is a repeatable moment there since he seemed open to hearing you.

Hi LivednLearned,

I think the brain MRI results scared him.  And I scared him by telling him he’ll probably get worse.  I could see, at the time, that he’d listen to me.  The wall wasn’t up — he was frightened and curious. 

But by the next day, he was defensive and all over the place. I don’t see what more I can do. I think  It’s in the doctor’s hands, and in the hands of a higher power than me. 

I’m a senior lady.  I have to take care of myself.  I have to embrace my friends, my social activities, and my health.  I have to spend a couple of nights away from home, here and there. These are the things that help me.  Sadly, he’s almost impossible tot deal with at times, and he can be exhausting.

But I haven’t given up hope. Maybe one day, he’ll agree to take meds.  I don’t see him going for therapy or agreeing to more testing. 

Thanks so much.

[Notwendy]

Both of my parents have had the same doctor for years. I could call his doctor with any questions about my father and my father gave consent to speak to me. However, my mother did not - so oddly- I could ask about my father, but not her.

So I knew not to. However my mother's behavior was a guarded secret and when my father got ill, his medical providers assumed my mother was a good caregiver for him. My reason for speaking about her wasn't to be critical of her but to ask what other help might be available to him such as home health as I knew it wasn't something she could handle. I recall the puzzled expression when I spoke to his doctor. My parents presented a different picture.

I understand the wish for someone to do something and assume that the doctor has some power to intervene, but the doctor can only do so much as the patient agrees or discloses to them- this is a one on one relationship. Doctors can advise my mother- but she decides whether or not to agree or comply. It's also possible the doctor doesn't believe you. Although you understandably wish your H would agree to do something to help- this is still up to him to decide. You can continue to take care of you.

[JazzSinger]

I understand the wish for someone to do something and assume that the doctor has some power to intervene, but the doctor can only do so much as the patient agrees or discloses to them- this is a one on one relationship. Doctors can advise my mother- but she decides whether or not to agree or comply. It's also possible the doctor doesn't believe you. Although you understandably wish your H would agree to do something to help- this is still up to him to decide. You can continue to take care of you.

Thank you, NotWendy. 

The doctor believes me — that’s why he ordered the brain MRI.  He also tried to have a discussion with my H about sleep issues, based on info from me, so that me might prescribe something to help.  My H has rejected everything  — He’s “fine.”

You’re right — it’s MY time. I’ve done all I can.  If he doesn’t want help, I can’t make him get it.  All I can do is take care of me.  Hard lesson, but it’s my reality. 

[JazzSinger]

You're talking about BPD though, which is a completely different "memory loss/memory re-writing" type of thing since it stems from disordered thinking.  There are meds that can help there, but they're reliant on a diagnosis and active participation from your H.  In short, if he doesn't think he needs them, then the rest of the process is useless.  He has to want to actively change to see results. 

Thanks, Pook075. 

Clearly, he’s not going to fully admit that he needs help.  I guess I have to accept that. 

I’ve probably done all I can.  It’s time to focus on ME. I’m going to try to have compassion for him, ,but I’m also going to continue with my life, without pouring so much energy into him.

I’m in my mid 70’s.  He’s only a few years younger.  I’m going to enjoy my golden years in my own way, and he’s responsible for himself.  When he’s lucid, we’ll enjoy those moments. When he’s not, I have support. I have friends. I have family.  I have the ability to get away for a while.  I have noise cancelling earbuds.

I have to make the best of it, for ME. 


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