EEG and neuropsych test results: what next steps would be prudent?
58-year-old female with history of depression, which is currently being treated with venlafaxine; no depressive symptoms at present. History of ECT; last session 05/16, total of 17 treatments over approximately 8 months. Mild REM sleep behavior disorder. Memory/cognitive complaints for past approximately 5 years, which are becoming more frequent and worsening. Family history of Parkinson’s and/or dementia among mother’s siblings; two of the five with dementia were early-onset, one likely vascular. Nothing abnormal in most recent blood work, other than total cholesterol (236). Blood pressure is normal. History of breast cancer in 2012, treated with bilateral mastectomy; no chemo or radiation. Fatty liver disease (non-alcoholic). No alcohol/drug use; no current tobacco use. Early macular degeneration (dry type).
Formerly worked as a systems analyst/programmer and project manager, computer systems trainer, network administrator. 14 years’ education, as well as avid pursuit of a wide variety of interests and hobbies. Lives alone; recently requires assistance with some activities such as bill-paying.
CT performed subsequent to fall 06/16. Mild cerebral atrophy and ischemic changes.
Underwent neuropsychological testing in 07/16. Dementia Rating Scale -2 result: 134/144. Report states that “This pattern of performance is suggestive of very subtle frontal and subcortical system involvement” and “Given the presence of REM sleep behavior disorder and her family history, the possibility of underlying disorder such as Parkinson’t disease should be ruled out, and should continue to be monitored. Similar cognitive findings can be observed with Parkinson’s disease.” Repeated testing to be conducted in one year.
EEG was performed in 08/16 at Mayo in Rochester. Verbatim report follows:
CLINICAL INTERPRETATION: The short-term video EEG shows a moderate degree of intermittent focal slowing over the left frontotemporal head region. This finding is consistent with a moderate disturbance of cerebral function or focal lesion involving this region. No clear epileptiform discharges are seen.
EEG CLASSIFICATION: SPECIAL STUDY – Short-term video EEG. Dysrhythmia grade 2: left frontotemporal (awake and asleep). EKG monitor.
REPORT: This short-term video EEG recording during wakefulness contains 9-10 Hz background activity. Intermittent, moderate amplitude, polymorphic 1-2 Hz delta slowing is present over the left frontotemporal head region. No abnormal activity occurred during photic stimulation. Hyperventilation was not performed due to concerns about ischemia. During the recording, the patient fell asleep spontaneously. No additional activation was seen during sleep. The EKG was unremarkable.
What, if anything, should be done to follow up on this EEG? If there’s a neurologist reading this, what would you suggest for this patient? What questions should she ask of her providers?