MRI's for dementia patient

Specialties Private Duty

Published

Hi Everyone,

Not sure if this post belongs here but I will pose the question and hopefully get some feedback:

I'm a private care nurse of a dementia/ALZ patient. The patient's daughter is hyper-vigilant and always wants diagnostics run on her father. The daughter is particularly fond of MRI's. The patient receives an annual MRI of the brain. However, we have had several other MRI's done over the course of several years for various injuries of various body parts. Even against medical advice, she demands and MRI and will state that a Xray is not enough. I've done my best to explain when an MRI is appropriate. Aside from the fact that it is totally traumatic for her father to undergo one, I was told by a doctor that MRI's can exacerbate dementia symptoms. I wanted to know if any of you know about the risks of multiple MRI's for a dementia patient and if, in fact, it can clinically worsen symptoms. If you can direct me to any journal articles or studies, I would be very grateful.

Thank you so much in advance

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Specializes in HH, Peds, Rehab, Clinical.

Why are MD's being bullied into ordering them?

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Yeah, I hear this all the time in the hospital in which I work, and I'm always puzzled; if the client, or family, is demanding something that is not considered medically appropriate by the professional providers involved, why don't they just suck it up and say, "No." (And explain why, if they really feel like it). I'm as big a fan of client rights and autonomy as anyone, but autonomy means you (the client or substitute decision-maker) have the right to refuse any treatment that is offered to you; it doesn't mean you get to demand, and get, treatments and interventions that are considered inappropriate by the healthcare professionals treating you.

I'm on the large psychiatric consultation and liaison service of a major academic medical center and now based in a small, community hospital, and I'm rather shocked at how often I see situations here in which a client is demanding something that is considered medically inappropriate or unnecessary (like someone demanding that he receive pain medications IV instead of po, or demanding additional tests be run that no one else thinks are indicated), and the response of many of the physicians here is to give the individual what s/he is demanding, that no one thinks is a good idea, and, at the same time, order a psych consult on the person (because, obviously, the fact that s/he is demanding something medically inappropriate must mean s/he has some sort of psychiatric problem, right??) instead of just refusing to do what the person wants. Drives me crazy.

Back on topic, though, I've never heard anything about MRIs exacerbating dementia sxs. Have you done a lit search, OP?

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Hey, thanks for the input. Yes, I've done a lit search and have not seen anything regarding MRI's exacerbating dementia. At least directly. I'm wondering if the doctor is suggesting that that the trauma the pt feels by going through the process of having medical procedures performed increases her emotional/behavoral sxs in such a way that is damaging. I'm going to be in touch with him next week so I will get to the bottom of this. Hes out of the country. I really was just putting it out there to you all on the off chance that you had some insight. I really appreciate you responding in any way!

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Specializes in PACU, pre/postoperative, ortho.

How are they justifying the MRI's to medicare/insurance for payment? Perhaps the daughter would be less insistent if unnecessary testing had to paid out of pocket (like it should be).

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If the pt wants to pay for the test, no reason that it shouldn't be done. It's not like an MRI is a craniotomy. Not very invasive, but probably not being paid for by the pt or family. Send them a bill. If they pay it, call them to schedule next years MRI

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I suppose the crux of the matter is that as a patient advocate, I do not want him to undergo unnecessary medical procedures or diagnostics to pacify his daughter. It's a compliated family dynamic. Trying to be non-judgemental...

When I get a hold of the doctor who made the original comment tome, I will ask for some data and I will present it here.

Thanks again everyone for the convo.

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