You'll probably start by seeing your family doctor or general practitioner, who may refer you to a neurologist, psychiatrist, neuropsychologist or other specialist for further evaluation.
Because appointments can be brief and there's often a lot to discuss, prepare before your appointment.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance. Ask if you need to fast for blood tests.
- Write down any symptoms, including any that may seem unrelated to the reason for scheduling the appointment. Your doctor will want to know details about your concern for your mental function. Try to remember when you first started to suspect that something might be wrong. If you think your difficulties are getting worse, be ready to explain why, and be prepared to discuss specific examples.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins or supplements that you're taking.
- Make a list of your other medical conditions, including those you are currently being treated for, such as diabetes or heart disease, and those you've had in the past, such as strokes.
- Take a family member, friend or caregiver along, if possible. Sometimes it can be difficult to soak up all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
Preparing a list of questions will help make the most of your time with the doctor. Prioritize questions from most important to least important. Some basic questions to ask the doctor include:
- What is likely causing symptoms?
- Are there other possible causes for symptoms?
- What kinds of tests are needed?
- Is my condition likely temporary or chronic? How will it likely progress over time?
- What's the best course of action?
- What are the alternatives to the primary approach being suggested?
- I have other medical issues. How can they be managed together?
- Are there any clinical trials of experimental treatments I should consider?
- Are there any restrictions?
- If medication is being prescribed, is there a potential interaction with other medications I am taking?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend?
- Do I need to see a specialist? What will that cost, and will my insurance cover it? You may need to call your insurance provider for some of these answers.
If you've had a concussion, some basic questions to ask your doctor include:
- What is the risk of future concussions?
- When will it be safe to return to competitive sports?
- When will it be safe to resume vigorous exercise?
- Is it safe to return to school or work?
- Is it safe to drive a car or operate power equipment?
Don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
The doctor may ask you a variety of questions.
Questions related to symptoms:
- What symptoms are you experiencing? Any trouble finding words or remembering events, focus, personality changes, or getting lost?
- When did symptoms begin?
- Are symptoms steadily worsening, or are they sometimes better and sometimes worse?
- How severe are symptoms?
- Have you stopped doing certain activities, such as managing finances or shopping, because of difficulty thinking through them?
- What, if anything, seems to improve or worsen symptoms?
- Have you noticed any changes in the way you tend to react to people or events?
- Do you have more energy than usual, less than usual or about the same?
- Have you noticed any trembling or trouble walking?
Questions related to health history:
- Have you had your hearing and vision tested recently?
- Is there a family history of dementia or other neurological disease such as Alzheimer's, ALS or Parkinson's disease?
- What medications are you taking? Are you taking any vitamins or supplements?
- Do you drink alcohol? How much?
- What other medical conditions are you being treated for?
If you've had a concussion, your doctor may ask questions related to events surrounding injury:
- Have you had any previous head injuries?
- Do you play contact sports?
- How did you get this injury?
- What symptoms did you experience immediately after the injury?
- Do you remember what happened right before and after the injury?
- Did you lose consciousness after the injury?
- Did you have seizures?
Questions related to physical signs and symptoms:
- Have you experienced nausea or vomiting since the injury?
- Have you been experiencing headaches? How soon after the injury did the headaches start?
- Have you noticed any difficulty with physical coordination since the injury?
- Have you noticed any sensitivity or problems with your vision and hearing?
- Have you noticed changes in your sense of smell or taste?
- How is your appetite?
- Have you felt lethargic or easily fatigued since the injury?
- Are you having trouble sleeping or waking from sleep?
- Do you have any dizziness or vertigo?
Questions related to cognitive or emotional signs and symptoms:
April 20, 2016
- Have you had any problems with memory or concentration since the injury?
- Have you had any mood changes, including irritability, anxiety or depression?
- Have you had any thoughts about hurting yourself or others?
- Have you noticed or have others commented that your personality has changed?
- What other signs or symptoms are you concerned about?
- McKee AC, et al. The spectrum of disease in chronic traumatic encephalopathy. Brain. 2013:136;43.
- Evans RW. Concussion and mild traumatic brain injury. http://www.uptodate.com/home. Accessed Jan. 29, 2016.
- Concussion: Mayo's multidisciplinary approach. Mayo Clinic Neuroscience Update. 2013;10:2.
- Malec JF, et al. The Mayo classification system for traumatic brain injury severity. Journal of Neurotrauma. 2007;24:1417.
- Small GW, et al. PET scanning of brain tau in retired national football league players: Preliminary findings. American Journal of Geriatric Psychiatry. 2013;21:138.
- Daroff RB, et al., eds. Frontal lobes. In: Encyclopedia of the Neurological Sciences. 2nd ed. Waltham, Mass.: Academic Press/Elsevier; 2014.
- Chronic traumatic encephalopathy. Alzheimer's Association. http://www.alz.org/dementia/chronic-traumatic-encephalopathy-cte-symptoms.asp#symptoms. Accessed Feb. 1, 2016.
- Yi J, et al. Chronic traumatic encephalopathy. Current Sports Medicine Reports. 2013;12:28.
- Goldstein LE, et al. Chronic traumatic encephalopathy in blast-exposed military veterans and a blast neurotrauma mouse model. Science Translational Medicine.2012;4:1.
- Concussion: A fact sheet for coaches. Centers for Disease Control and Prevention. http://fs.ncaa.org/Docs/health_safety/ConFactSheetcoaches.pdf. Accessed Feb. 3, 2016.
- Heads up: Concussion in youth sports. A fact sheet for Coaches. Centers for Disease Control and Prevention. http://www.cdc.gov/headsup/youthsports/coach.html. Accessed Feb. 3, 2016.
- McCrory P, et al. Consensus statement on concussion in sport: The 4th international conference on concussion in sport held in Zurich, November 2012. Journal of the American College of Surgeons. 2013;216:e55.
- Concussion: What can I do to feel better after a concussion? Centers for Disease Control and Prevention. http://www.cdc.gov/concussion/feel_better.html. Accessed Feb. 3, 2016.
- Lakis N, et al. Chronic traumatic encephalopathy — Neuropathology in athletes and war veterans. Neurological Research. 2013;35:290.
- Stein TD, et al. Chronic traumatic encephalopathy: A spectrum of neuropathological changes following repetitive brain trauma in athletes and military personnel. Alzheimer's Research & Therapy. 2014;6:4.
- Report on the neuropathology of chronic traumatic encephalopathy workshop. National Institutes of Health. http://www.ninds.nih.gov/news_and_events/proceedings/201212_CTE_workshop_report.htm. Accessed Feb. 3, 2016.
- Hart J Jr, et al. Neuroimaging of cognitive dysfunction and depression in aging retired national football league players. JAMA Neurology. 2013;70:326.
- DeKosky ST, et al. Acute and chronic traumatic encephalopathies: Pathogenesis and biomarkers. Nature Reviews Neurology. 2013;9:192.
- Gavett BE, et al. Clinical appraisal of chronic traumatic encephalopathy: Current perspectives and future directions. Current Opinion in Neurology. 2011;24:525.
- Mez J, et al. Chronic traumatic encephalopathy: Where are we and where are we going? Current Neurology and Neuroscience Reports. 2013;13:407.
- Home. National Suicide Prevention Lifeline. http://www.suicidepreventionlifeline.org. Accessed Feb. 1, 2016.
- Baugh CM, et al. Current understanding of chronic traumatic encephalopathy. Current Treatment Options in Neurology. 2014;16:306.
- Iverson GL, et al. A critical review of chronic traumatic encephalopathy. Neuroscience and Biobehavioral Reviews. 2015;56:276.
- Caregiver's guide to understanding dementia behaviors. Family Caregiver Alliance. https://www.caregiver.org/caregivers-guide-understanding-dementia-behaviors. Accessed Feb. 1, 2016.
- Traumatic brain injury. Family Caregiver Alliance. https://www.caregiver.org/traumatic-brain-injury. Accessed Feb. 1, 2016.
- Abreu MA, et al. Chronic traumatic encephalopathy (CTE) and former National Football League player suicides. The Sport Journal. Jan. 29, 2016. http://thesportjournal.org/article/chronic-traumatic-encephalopathy-cte-and-former-national-football-league-player-suicides/. Accessed Jan. 29, 2016.
- Bieniek KF, et al. Chronic traumatic encephalopathy pathology in a neurodegenerative disorders brain bank. Acta Neuropathology. 2015;130:877.
- McKee AC, et al. The first NINDS/NIBIB consensus meeting to define neuropathological criteria for the diagnosis of chronic traumatic encephalopathy. Acta Neuropathology. 2016;131:75.
- Savica R, et al. High school football and risk of neurodegeneration: A community-based study. Mayo Clinic Proceedings. 2012;87:335.
- Brown AW (expert opinion). Mayo Clinic, Rochester, Minn. March 18, 2016.
- Mielke MM (expert opinion). Mayo Clinic, Rochester, Minn. March 18, 2016.
- Savica R (expert opinion). Mayo Clinic, Rochester, Minn. March 18, 2016.
- Graff-Radford J (expert opinion). Mayo Clinic, Rochester, Minn. March 18, 2016.
- Boeve BF (expert opinion). Mayo Clinic, Rochester, Minn. March 25, 2016.