My Annual Evaluation

On July 1, I had my annual evaluation with my neurologist.  Normally my evaluations are preceded by a couple of hours of intensive psychometric testing, but she had decided to forego it this year.  She made that decision last year because I had been tested so frequently and intensely for the SNIFF (insulin) study.  Taking a year off seemed to be a very good idea.  The purpose of the testing is to track progress (or decline) and it would be unlikely that any particular results would change what I've been doing or change any treatment plan.

However, I told her that I believed I had a marked "hiccup" in my cognition during the first two weeks in May.  While my brain seemed to have adjusted some, I doubted that I had regained more than 85% of what seemed to have been lost.  I prefaced that by saying I believed that, had I been tested in April, I would have done at least as well as I had done for Harborview's testing last summer -- 2018.  But not after early May.

Concurrently with that, I seemed to have a new balance problem on top of the original one, but my perception of it is subjective.  Also, I've been having increasing difficulty with sleep.  I get little more than 5 hours per night, often significantly less.

I had prostate surgery in January in the hope I'd be able to sleep all night without trips to the bathroom, but that hasn't worked out.  It's not unusual for me to get up 5 or more times/night, and it's a struggle to get back to sleep after each one ... a struggle I often lose. 

She was very concerned about the sleep, and she may have connected it with the renewed cognition problem.  We discussed Tamsulosin, and I told her I had stopped using it when the correlation was found between Tamsulosin and dementia.  She said that the research on Tamsulosin was inconsistent, and I needed to put priority on getting better sleep.

Regarding the balance, she said that my vestibular system should be tested again.  The previous two times the tests found nothing, suggesting to me that the balance problem is in my brain, not in my ear.  My primary care provider went ahead and ordered some new testing for my vestibular system.

Sleep is important, but sedatives to aid sleep, like Ambien, are very much contraindicated with AD.  She said, however, that I should consider getting a prescription for Trazodone when I got home -- but only if Tamsulosin doesn't correct my sleep problem.  Trazodone is an older antidepressant used in cases of serious depressive and other psychological disorders.  In recent years it has rarely been used for anything other than insomnia, and it appears to be the go-to sedative for elderly people, especially with AD.  Or so I've read.

For a while, there was excitement that Trazodone had actually improved cognition in mice with AD-type disease, but I read a recent study from the UK that correlated Trazodone more strongly with dementia than other sedatives.  So I definitely want to see if the Tamsulosin doesn't help before more seriously considering Trazodone.

But, one way or another, it will be really great to be able to consistently get a good night's sleep.