Dr. Robert Lynn Horne, MD

I suggest doing a MMSE exam It is not very sensitive re High IQ individuals, but if the score is <30 it is significant and medication (Aricept if Alzheimers) should be started. Studies show, if no intervention, a 3 point/year deterioration. Dose should be increased from 5 mg to 20 by day 61. Studies have shown if a patient is continued on 20 mg for 34 years, decrease in MMSE may be as little of 3 points, but if then stopped, within 3 months scores drop another 9 points in 3 months. That is to score expected if Aricept was never used. There are multiple causes of dementia, eg Pseudodementia due to depression, not just Alzheimer's disease. Some are treatable and reversible, such as Vitamin B-12 deficiency which is reversible if treated early, and Wernicke's encephalopathy due to alcohol, which untreated with Thiamine 100 mg tid for 3 months, become irreversible (Korsakov's syndrome). Hope this helps.

Sincerely, Robert Lynn Horne MD

Yes, the psychiatrist will be able to help distinguish between Pseudodementia due to an episode of Major Depressive Disorder and Dementia and also treat the depression and, if necessary, make an early intervention with medication to slow the progression of dementia if she does have early dementia.

She should be slowly tapered off Xanax which is already impairing her memory. She should NOT be placed on any other benzodiazepine. Alternative medications could be selected after evaluating her history and what other meds she has taken for treatment of anxiety and any medical problems she may have and current concomitant medications. Possible alternatives include Cymbalta, Lexapro, Neurontin (all for preventing chronic anxiety) or "rescue, non-addictive medications" which start to work in 20 minutes, full effect in 2 hours and last 6-12 hours, including Vistaril, Atarax and Inderal. There are certainly other alternatives, depending other history

She needs to be assessed by a psychiatrist who could look at all of her current medications and determine if any are likely to have a side effect of depression and if so, what are safe alternatives and which could be stopped without any substitution being needed