Confirming the Diagnosis through MRI 11/5/13

So the next step to confirm the diagnosis we already knew was to get him in for a MRI and PET Scan.  The MRI would show possible atrophy or shrinkage of the brain.  The PET Scan would capture images as the brain is actually functioning, not just structural images as shown in the MRI.

The hard part would be getting him to cooperate.  The MRI sounded relatively easy and was only supposed to take 20 minutes.  But getting him to stay still, not want to fidget, pace or smoke, would be the challenge.  The PET Scan was the hard one.  It was supposed to take 1 1/2 hours and he wasn't supposed to eat or drink anything for four hours before the test.  That seemed impossible, as he would never give up his morning coffee.  Smoking was also not recommended, and another impossibility for him.  Not to mention we had not yet told him about the diagnosis or why he was having these appointments in the first place. 

I was hoping to get both tests scheduled for the same day, since I was afraid if he went to one, he would refuse going back for the other.  Scheduling back to back appointments in different departments at the VA, seemed to be even more of a challenge than getting my dad to the tests.  I'd get through to one department to make one appointment, and by the time I'd get to the second one (which required several voicemails or phone calls in which it would ring endlessly and no one would answer) the other time slot would be taken and I'd have to start over.  I also had to work between our work and kids' school schedules.  I ended up getting the appointments scheduled for 10/30.  But I had no idea how we were going to get this to work.  I remember many nervous, sleepless nights.  Looking back I see I created so much extra stress.  I don't know why I was so stuck on scheduling them on the same day.  And as usual, things had their way of working out.  Just not as I planned.

Turns out 10/30 I ended up with strep throat and I had to reschedule his appointments (again).  I got him in for the MRI 11/5, and scheduled the PET for a later date.  My Uncle took him to the MRI, and he cooperated pretty well.  We got the call a couple days later that there was no need for the PET Scan.  The MRI told them everything they needed to know.  There were visible black areas or "holes" in the right frontal lobe.  At the age of 64, my dad's brain was shrinking.  Diagnosis complete.

My dad's FTD case is pretty text book and the MRI explains why:

The cell damage caused by frontotemporal dementia leads to tissue shrinkage and reduced function in the brain's frontal and temporal lobes, which control planning and judgment; emotions, speaking and understanding speech; and certain types of movement.

patients with frontal lobe injury fail to adhere to social norms.  In behavioral terms, patients with damage to the OFC, particularly in the right hemisphere, show a pattern of behavioral dyscontrol that may involve

1. either emotional blunting and emotional liability, including an insensitivity to others emotions,
2. deficient decision-making, including poor social and non-social judgment, lack of self-monitoring, and/or inflexibility, and
3. deficient goal-directed behavior, including apathy, disinhibition, task impersistence, and general disorganization.

Unlike other types of Dementia or Alzheimer's Disease, his memory was fine.  You could hold a normal conversation with him and have no idea anything was wrong.  He seemed a little "off" with his behaviors, but still as sharp as ever.  He could recall trivia, politics, sports, regular topics of conversation like normal.  His memory seemed fine.  The more I read about other families' stories, and I see how many misdiagnoses they've gone through, I think we were fortunate to find the 2 amazing doctors we did at the VA who were able to help us.  (And from everything else I saw and experienced with the facility, they may have been the only 2 amazing doctors there!)