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My wife has been suffering from some memory loss and difficulties with organization, navigation, and problem solving. A recent MRI report states "The diffusion-weighted sequence ins negative. The Ventricles are normal in size with no mass effect or midline shift. The FLAIR and T2 sequences demonstrate small multifocal hyperintensities scattered in the deep white matter regions and a larger focus of hyperintensity approximately 1.8 cm i size in the left paraventricular region at the mid to posterior frontal lobe. These all are confined to minor white matter zones and considering the patient's age (68) and overall appearance are most suggestive of changes related to underlying small vessel disease. The individual age of these is not determined but the diffusion sequence indicates no acute ischemic infarct event....There is no evidence for hemorrhage."

We will have our first visit with a neurologist on April 20th. My research into the above suggests early stage vascular dementia. Most of the material I could find on vascular dementia related to stroke induced dementia. I am interested in being in communication with people who have experience with non-stroke vascular dementia and locating neurologists who specialize in this form of dementia.

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We see so many abnormalities in brain scans that it can be hard to know if they are what are causing symptoms. It may be that your wife has a vascular disease that is affecting the small blood vessels and delivery of oxygen and nutrients to the brain. Has your wife been screened for other problems, e.g. diabetes, kidney or liver disease? Are there any abnormalities in her blood panels? I hope that her doctors can look at the whole picture and figure out what might be wrong. If it is a vascular disease, I hope they can find a way to slow down any damage that might be caused.
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How do you find a good neurologist and PCP that are experienced in the care of elderly and dementia and Parkinson's disease?
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Richie, is this MRI part of a comprehensive neuropsych workup? If not that's what you might look into.

I think the bigger picture here is the clinical one, i.e., what does this mean for day to day functioning, and, what is the future going to look like. Those are questions for the neurologist who specializes in dementia. Speak to her/him both with your wife present and privately. See if there is a social worker or Nurse practioner you can be in touch with on a regular basis as changes occur. You want followup at least once a year to see if there is progression.
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Any other health problems that you already know about?
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"small multifocal" says mini strokes to me. Now about the 1.8cm hyperintensity, I would definitely ask the MD to put the picture up on the screen and give me a full explanation. Bring your laser pointer so you don't touch the screen and ask LOTS of questions. I always ask for a CD copy of MRI's. The Neurologist might order a PET scan with amyloid tracers if your insurance covers that.
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