Losing a loved one is an emotional and personal experience for friends and family members. You are not alone in your grief and confusion. With recent changes in the health care industry, you may have more questions than answers about the actual cause of death and course of illness. An autopsy can help bring closure during a very difficult time, or provide valuable information about inheritable problems to assist other family members in early diagnosis and treatment.
Since 1974, Pathology Support Services, Inc. (PSS) has been providing accurate, high quality autopsy services to families, funeral homes, hospitals, forensic-based pathologists, institutions, government agencies and law firms. We perform thousands of autopsies every year and provide an organ recovery and tissue collection service for both research and litigation. PSS is independent. We are not affiliated with any hospital or health provider.
PSS is sensitive to the needs of families when a loved one passes away. Working with your funeral home, we tailor our services to your specific requirements and personal wishes.
Dementia: Changes & Choices
The term “dementia” instills a fear of the unknown. How can a system as complex as the brain completely shut down a personality, a person, or a past? Is it some environmental exposure? Is it accidental? Has it always been present in some latent form? Can we all expect to develop it as we age? Our nervous system is extremely complex: it is estimated that over fifty per cent of all human genome codes are nervous system specific. Neurons (primary nerve cells) can greatly differ from one another in properties, functions, and within a given region of the brain. Healthy interconnections and neurotransmissions depend upon a carefully balanced multitude of chemical and electrical elements in our bodies. Because neurons are incapable of cell division, they cannot replace themselves. Destruction of even relatively few neurons responsible for a specific function may leave a person with severe clinical neurological deficits.
Unfortunately, this degenerative process is usually a long-term, gradual, condition with irreversible results. Dementia is characterized by a progressive loss of neurons. These changes may be selective, only affecting one or more groups of neurons while leaving other associated groups intact, or the disease may arise in patients without any clear evidence of trauma, ischemia (stroke), or other neurological indicators.
It is important to remember that dementia is not a part of the normal aging process and almost always signifies a disease. The following is a brief clinical and pathological overview of common dementias. Please use these as guidelines with prospective clients, especially those struggling with decisions over loved ones. Keep in mind that while clinical assessments and CAT scans can contribute to diagnostic accuracy, only a microscopic examination of brain tissues can confirm diagnostic suspicions. A brain autopsy is the final answer.
Most common clinical diagnosis of dementia in the elderly. Clinical onset includes alteration of mood and behavior, progressive disorientation, memory loss, inability to perform simple mathematical skills, aphasia (inability to speak), muteness and immobility. Rarely occurs in patients younger than fifty years. Most cases are random, although five to ten percent are familial. Death is usually caused by pneumonia.
Dementia characterized by rigidity, jerking movements of limbs, and language deficits and inability to reason.
A rapidly progressive dementia with worldwide incidence of one per million
people. Familial forms exist, with the majority of cases inflicting people in their Sixties. This disease can be transmitted to other humans and is usually fatal within seven months of onset. Clinical signs include involuntary jerking muscle contractions on sudden stimulation, ataxia (inability to stand), and subtle changes in memory and behavior.
Dementia with genetic origin. Clinical signs are progressive movement disorders, jerky spasms affecting all parts of the body, difficulty in breathing, writhing, and forgetfulness. Onset is most commonly when people are in their thirties or forties. These patients have a clinically high risk of suicide. Infection (pneumonia) is the most common cause of death.
A dementia associated with movement disorders including rigidity, abnormal posturing, diminished facial expression, slowness of voluntary movements, shortened, accelerated steps, and tremors. May be due to metabolic toxins or other known underlying etiology. This dementia condition increases with age.
Progressive dementia brought on by an early onset of behavioral changes and personality alterations with language deficits.
Post Traumatic Dementia:
This is not a disease but a condition that originates from brain trauma (accidental) resulting in hemorrhage and swelling. Causes of dementia include increased cerebrospinal fluid build-up and pressure, thinning of the ventricles, seizures, infections (pneumonia), and psychiatric disorders.
Progressive Supranuclear Palsy:
Clinical signs include rigidity with an inability to stand, abnormal speech, ocular disturbances including a vertical gaze, and eventually a loss of all eye movements. Onset is usually between the fifth and seventh decades, twice as frequent in females, and lethal within five to seven years.
Parkinson-type dementia with hypotension (low blood pressure), impotence in males, excessive sweating and salivating, dilated, unequal pupils, and possible joint stiffness.
Clinical hypertension. Can be caused by a vessel occlusion with blood clot or tumor. Usually due to arteriosclerosis (narrowing of the arteries). Symptoms include severe headaches, vomiting, convulsions, and inability to walk.
Pathology Support Services (PSS) is available to assist concerned families by performing the brain only autopsy. The autopsy is not a disfiguring procedure, so no facial alteration occurs. Depending upon the site and location of the body, the autopsy can be performed within twenty-four hours of notification. The autopsy is usually finished in less than an hour. Once the autopsy authorization form is complete, PSS coordinates the time with the hospital or mortuary of choice. A detailed report from a board certified neuropathologist specializing in dementia cases will be issued within 60-90 days.
Patients rarely show advancing signs of dementia before the fifth decade. The progressive incidence of disease has given rise to major medical, social, and economic modifications within the growing number of elderly individuals. PSS is dedicated to maintaining a personal approach.
Please keep Pathology Support Services in mind as part of the death protocol. It is better to know than wonder why.
- Complete Autopsy – $2,500.00 to $4,500.00 (includes travel)
This includes a gross description of all organ systems and microscopic examination by a board certified pathologist, diagnosis and cause of death if different than that stated on the death certificate. A comprehensive report with a case summary in non-medical terms will be completed in approximately forty-five working days.
- Neuropathology Consult – add $700.00
This includes the above plus a detailed examination of the brain by a board certified neuropathologist. This examination is only needed if there are questions regarding the mental or neurological status of the individual, such as seizure disorder or dementia.
This increases the report completion time to approximately ninety working days.
- Toxicology – add $400.00
This includes the examination of blood and urine for specific prescription drugs.
Toxicology is normally not needed. This increases the report completion time to approximately ninety working days.
Brain only Autopsy – $1,800.00 to $3,500.00 (includes travel)
This is an acceptable choice if the only questions involve the mental status of the individual, such as the type of dementia involved.
This examination includes a detailed description of the brain with diagnosis and clinicopathological correlation by a board certified neuropathologist. A comprehensive report will be completed in approximately ninety working days.
Tissue collection and partial autopsies for toxic tort cases are time driven. Technician’s time is billed at $140.00/hour plus expenses with a $600.00 minimum and $1400.00/a day maximum. Pathologist time for case review is billed at $350.00/hour plus expenses (two hour minimum) civil court testimony is billed at $450.00/hour (two hour minimum).
The above prices are as of January 1, 2005 and may be subject to change without notice. Please call for confirmation.
What is an autopsy? An autopsy is the systematic detailed external, internal and microscopic examination and description of the body and its organ systems after death, in which a qualified pathologist (a medical doctor trained in the study of disease) forms opinions and conclusions as to cause of death and course of illness.
Why should an autopsy be done? The primary purpose of an autopsy is to put to rest, any questions the family or physician may still have about the illness, cause of death, and/or any coexisting conditions. Establishing an exact cause of death can be a source of comfort to families. The autopsy may also determine whether there are inheritable problems and help other family through early diagnosis and treatment. Furthermore, what is learned through an autopsy on one patient may help save the lives of others with similar conditions.
Who can request for an autopsy? An autopsy can be requested either by the patient’s physician or by the family. The autopsy cannot be performed without the consent of the legally designated next-of-kin or responsible party. When giving consent, the family may make any restrictions, limitations, or special requests that will be honored.
Where is the autopsy done? The autopsy will be performed in the funeral home you have chosen. Most funeral homes are happy to be able to assist families in this process.
How does the family benefit from the autopsy?
- Finding a specific cause of death may simply ease the stress of the unknown.
- Finding that diagnosis and treatment was appropriate may be comforting to the family.
- Discovering inherited or familial diseases may help families through early diagnosis and treatment and in family planning.
- Discovering an infectious disease, for example tuberculosis, may lead to early diagnosis and treatment of other family members and close contacts.
- Uncovering evidence of a work-related disease may lead to compensation for the family.
- Providing crucial evidence for the settling of insurance claims or death benefits.
- Knowledge that the death of a loved one has helped someone else to live longer may ease the profound sense of loss experienced by families.
- The families medical history has become more and more important as new information is learned about many illnesses. You, your children, others in your family may want to know what medical conditions have occurred in the family. With an autopsy, you can know for sure
Will an autopsy affect funeral arrangements? No. There is no change in the appearance of the body following autopsy. Working with your funeral director PSS will attempt to schedule the autopsy so as not to affect funeral arrangements.
Is it possible to have a brain only autopsy? Yes. If the only questions you have can be answered by examining only the brain, this is a good option. Your doctor probably explained to you that with Alzheimer’s disease and other dementias, the diagnosis cannot be established with complete certainty during life. It is only through an autopsy that doctors can establish for sure what the cause of your relative’s dementia was. With an autopsy, you can know for sure.
How long does an autopsy take? It takes approximately thirty working days to issue a report to the family. The actual examination of the body takes from two to four hours, after which the funeral home can begin preparing for the funeral. The remainder of the time is taken up in the histology laboratory preparing tissue samples for microscopic examination and reviewing medical records. Some complex cases may take longer. Cases to establish the type of dementia are very complex and may take approximately ninety working days to complete a report.
Will there be a report? Yes the report that the next of kin receives will be a detailed description of each organ system with a list of anatomic findings, pathological diagnosis and cause of death. In addition there will be a summery explaining the pathological findings and course of illness in none medical terms.