Neuropsychologist

Yesterday, Jim had a 2.5 hour visit with a neuropsychologist for his confusion. The man is a Ph.D., not an MD.

Dr. King had not received a report on Jim's latest CT scan, but I told him that it was consistent with the April CT scan, which he did have access to.

Dr. King said that although Jim's brain is shrunken and has infarctions more than would be "average" for a person his age--likely because of alcohol abuse--there is no imaging or clinical evidence that Jim has suffered brain damage or has any kind of dementia from alcohol or a stroke. There is a remote possibility that Jim could have some sort of increased pressure in his brain that can only be tested through a spinal tap, but doing that diagnostic would be inappropriate at this point--given the unlikeliness of the condition.

The DR. definitely saw that Jim's problem is one of random, situational confusion, not one of memory loss. Although slow to pull up the memory, Jim knew what he had for dinner the previous night. The DR said that someone with alcohol dementia wouldn't have that memory, and would make something up.

During the first hour of the visit, while I was there, Jim did admit some instances of confusion, like not being able to remember Ennis the cat's name. He also told the DR that he retired in 1955 (instead of the 1995 it was). Jim stuck to that date even though challenged by me and by the DR. He finally started to show that maybe, perhaps, he had made a mistake.

The DR then sent me out so he could do a battery of tests on Jim. Jim told me they were things like "close your eyes and touch your nose with your left hand index finger" and "remember these 5 things." The DR cut the testing short because Jim got very tired.

The DR's opinion at this point is that Jim's mental confusion is associated with his liver failure. As the insult to the liver becomes more remote, and as the liver heals, the mental confusion also should improve. There is no reason to believe at this point that Jim can't get back to the mental capacity he had before the liver failure, but there is a need to be patient. Recovery from a medical condition as severe as Jim has could take many, many months.

We thought that was good news. Knowing that there likely is an end to this tunnel, we can travel it with much more patience than we might be able to if we had been told this was permanent. In fact, when Jim gets confused/stuck in a dream state as he did last night talking about how some guy on his construction crew was being a jerk, I can just go along with him and ask questions about the situation, rather than become involved in trying to convince his that what he is experiencing is not reality.

The neuropsychologist will see Jim again in 2 weeks to evaluate his progress.

Thank you al for your concern about Jim and me.