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“Finally, we have an answer – and a plan.” — Roy, 77, Hertfordshire
Before the Diagnosis
Roy, a 77-year-old retired estate agent, had been quietly struggling with short-term memory problems for over two years. Initially, the changes were subtle—repeating questions, forgetting conversations—but in recent months, his symptoms rapidly worsened. Concerned, Roy and his wife sought help through their local NHS memory clinic.
There, Roy underwent standard testing, including a CT brain scan and a cognitive screening. He scored within the ‘normal’ range and was diagnosed with Mild Cognitive Impairment—a label that offered little clarity and no treatment. He was discharged back to his GP, but his condition continued to deteriorate.
Feeling lost and increasingly anxious, Roy and his wife came to see Dr Singhai at the Memory and Brain Health Clinic. What followed was a turning point.
A More Comprehensive Approach
At our clinic, Roy received a far more detailed, specialist-led assessment. This included a full clinical history, an in-depth cognitive evaluation (Montreal Cognitive Assessment), and a more sensitive MRI brain scan. But the breakthrough came not from the imaging alone—but from connecting subtle pieces of his clinical picture that had previously been overlooked.
Dr Singhai identified key features pointing toward Lewy body dementia, a condition that often eludes detection on scans:
- Fluctuating cognition, with “good days and bad days”
- Anosmia (loss of smell) for the past six months
- Sleep fragmentation and excessive daytime sleepiness
- Parkinsonian signs, including a resting tremor and reduced arm swing
- Mood disturbance with long-standing anxiety and panic episodes
- A recent sudden deterioration in memory—shortly after his bladder medication, Solifenacin, had been doubled
Why the Previous Diagnosis Missed the Mark
Although Roy’s MRI and CT scans did not show classic signs of Alzheimer’s disease, this was not unusual for Lewy body dementia, which often presents without clear imaging changes. The previous focus on scan findings alone meant a critical diagnosis was missed.
Worse still, the increase in Solifenacin—a drug with anticholinergic effects known to worsen memory in vulnerable brains—had accelerated Roy’s decline. This drug-induced deterioration highlighted just how delicate the balance of brain chemistry is in neurodegenerative conditions.
A Treatable Condition – With the Right Diagnosis
Once the correct diagnosis was made, Roy and his wife finally understood what had been happening. More importantly, they learned that Lewy body dementia is a treatable condition.
Dr Singhai developed a tailored management plan:
- Gradual withdrawal of Solifenacin, with an option to switch to an alternative bladder treatment (Mirabegron) if needed
- Introduction of a Rivastigmine patch, a cognitive-enhancing medication
- A roadmap for future treatment to target sleep, mood, and motor symptoms—including melatonin, SSRIs, and dopaminergic therapy
- Lifestyle recommendations to support brain health, including structured physical activity and diet
Roy’s Reaction
“I finally feel like someone really listened. We understand what’s going on—and we know what to do next. That alone has lifted a weight.”
Roy left the clinic feeling relieved, hopeful, and empowered. His wife shared how much calmer he seemed—even before starting treatment—just from having a clear explanation and a plan in place.
Why This Story Matters
Roy’s experience highlights why accurate diagnosis matters—particularly in memory and neurodegenerative conditions. At our clinic, we don’t stop at ‘normal scans’ or ‘screening scores.’ We connect the dots—clinically, cognitively, and pharmacologically—to uncover diagnoses that others may miss.
Dr Singhai has particular expertise in Lewy body dementia, a condition that is often under-recognised but highly responsive to the right interventions.
