- What Type of Doctor Treats Patients With Alzheimer’s?
- Which Doctor Should I See for Cognitive Decline and Dementia?
- Who Treats Alzheimer’s Disease?
- Geriatric Psychiatrists
- Physical Therapists
- Occupational Therapists
- Physicians with Alzheimer’s: What Happens When a Doctor Forgets?
- How Is Alzheimer’s Disease Diagnosed?
- What Are the Benefits of Early Diagnosis?
- An Alzheimer’s Doctor Reveals His Most Powerful Technology
- Understanding Alzheimer’s Disease
- What Is Dementia? Symptoms, Types, and Diagnosis
- How is Dementia Diagnosed?
- Checklist for Visiting a Neurologist
- Preparing for a Neurologist Appointment
- What Does a Neurologist Do on Your First Visit?
- Questions to Ask a Neurologist About Dementia
- What to Do After the Neurologist Visit
- How should one approach care for a dementia patient?
- Can dementia lead to death?
- Can dementia be prevented?
What Type of Doctor Treats Patients With Alzheimer’s?
You can search for “memory assessment clinics” or Alzheimer’s centers on the Internet. You can also contact your local Alzheimer’s Association chapter for a list of physicians near you who do this kind of work. The national Alzheimer’s Association (1-800-272-3900) can direct you to your local chapter.
Q2. My dad was diagnosed with Lewy body dementia two years ago. The most prominent symptom was the visual hallucinations. Since the diagnosis, he has been on Seroquel. It has been increased from 50 milligrams to 150 milligrams over the past two years. During this time, his cognitive and physical ability has declined dramatically. I know this is partly due to the disease, but I’m also concerned that the Seroquel may very well be causing a lot of his problems. Is it unusual for a doctor not to try Exelon or Reminyl first?
I do not recommend the use of atypical anti-psychotics (such as quetiapine/Seroquel, olanzapine/Zyprexa, or risperidone/Risperdal) for management of visual hallucinations in Lewy body dementia. There is no good evidence to support the use of Seroquel, or any other antipsychotic drug, for visual hallucinations of Lewy body dementia.
In addition, there is evidence that atypical anti-psychotics can worsen cognitive and functional decline – particularly in Lewy body dementia because these patients are very sensitive to such drugs. I would encourage you to think carefully about whether or not the visual hallucinations actually need to be treated. Many hallucinations are not distressing to the dementia patient. If your dad is not particularly threatened or disturbed by the hallucinations, then the risks of attempting to treat them with a drug outweigh the benefits. Just because the hallucinations are not “normal” doesn’t necessarily mean that we have to make them go away. This is especially true if the treatments we have are not particularly effective (fact), have potentially serious side effects (fact), and the problem itself is not particularly distressing.
That said, there is a significant cholinergic deficit (a lack of a neurotransmitter called acetylcholine) in Lewy body disease and, thus, a rationale for treating that deficit with drugs called cholinesterase inhibiters, such as donepezil (Aricept), rivastigmine (Exelon), or galantamine (Razadyne, formerly called Reminyl). While these drugs are not FDA-approved for use in Lewy body dementia, there are randomized controlled trials to support their use in this disease, showing benefit not only on cognition and function, but also on the visual hallucinations. I would consider them first-line therapy in Lewy body dementia.
Q3. My 77-year-old mother was fine one year ago. Then she fell down and broke her hip. She was rushed to the hospital to have hip surgery. After her surgery the family noticed that she did not seem to be the same mentally. The doctors said that this condition was caused by the anesthesia and she would be okay in a couple of days. After a few days, her condition did not improve and we were told that this happens sometimes, but was still told that it was being caused by the anesthesia. About a week later, she was diagnosed with Alzheimer’s (early stage). Have you ever heard of anesthesia causing or triggering Alzheimer’s?
There isn’t good evidence to link anesthesia to Alzheimer’s. In a recently published review of 18 randomized controlled studies (considered the best evidence), the data consistently showed that general anesthesia did not cause post-operative cognitive dysfunction, particularly when compared to regional anesthesia, such as a spinal block.
That said, delirium (acute confusion) occurs in about 50 percent of older adults after hip fracture repair. There are many factors involved, including pain, pain medicines, poor sleep, and many others. People who have underlying cognitive impairment, like very early Alzheimer’s, are at the highest risk for delirium. It is not uncommon for families to say “mom was fine until she went into the hospital with a hip fracture (or pneumonia or heart attack).” Subtle signs of Alzheimer’s often go unnoticed, even by family, until a patient is “pushed over the edge,” so to speak, with an episode of delirium – which is usually very noticeable. Then as the delirium resolves, everyone is paying closer attention and other deficits become more apparent, prompting the evaluation and diagnosis of Alzheimer’s.
If you look back, and think very carefully, ask yourself if your mother was really 100 percent as sharp the week before the hip fracture as she was five years earlier. I’d guess that you can find examples of times when her memory wasn’t as good and perhaps other very subtle differences in thinking skills, but they weren’t bad enough that anyone thought anything was wrong.
Q4. My mom recently had a shunt inserted. She has had Alzheimer’s for about six years. She seems to have improved with the shunt, but I am wondering if this is just a temporary improvement. Is it possible to improve Alzheimer’s permanently with a shunt? I understand that there was fluid, but was it from Alzheimer’s or hydro? The doctor seems to think that is was a combination of the two. I am afraid that the family might be in for a disappointment when the results are only temporary. It has only been a month and she just recently showed improvement.
I’m guessing that your mother had normal pressure hydrocephalus and therefore got a brain shunt to help drain excess fluid. Normal pressure hydrocephalus(NPH) results from a build-up of excess cerebrospinal fluid in the brain. The classic symptoms of NPH are cognitive impairment, gait abnormality and urinary incontinence. People with NPH may be misdiagnosed as having Alzheimer’s disease, but NPH does not cause Alzheimer’s.
Treatment with a shunt may improve or resolve the symptoms, depending on how early the fluid build-up is found and treated. So if she has both Alzheimer’s and NPH, then draining the fluid with a shunt may help the symptoms that were caused by the NPH – however, it won’t help the Alzheimer’s. If she truly does have Alzheimer’s, then her cognitive decline will continue to progress over time. If all of her symptoms were related to the NPH, then she may stay quite stable at her new, improved level of function.
Q5. I was wondering if the herb ginkgo biloba is a good thing to help with Alzheimer’s disease. I have taken it for memory and for function and it works great. I have used it for studying, and it has made a difference in my focus of things. What do you feel about this herb?
Ginkgo biloba, an herb that is widely used in Europe for dementia treatment, contains antioxidants and improves blood flow to the brain. It may be helpful in the prevention and treatment of Alzheimer’s disease, but we currently don’t have enough good clinical trial evidence to say one way or the other. There is a large study of ginkgo in 3,000 people over the age of 75 that has been going on for five years. When the results of this trial are available, I think we’ll have a much better idea about whether ginkgo is useful in the prevention of Alzheimer’s in older adults.
I would not recommend it for Alzheimer’s patients who are on blood thinners (including medicines such as aspirin, Plavix and warfarin) since it increases the risk of bleeding.
Learn more in the Everyday Health Alzheimer’s Disease Center.
Which Doctor Should I See for Cognitive Decline and Dementia?
4. Psychiatrist, Psychologist and Social Worker
Many people struggle upon receiving a diagnosis of cognitive decline or dementia. A psychologist or social worker can “provide counseling and support” and also help to address behavioral issues. They can also offer support to the family unit in order to best support the newly diagnosed individual. As mentioned above, the University of North Carolina School of Medicine suggests visiting a geriatric psychiatrist because they focus solely on “the emotional and mental needs of older individuals.”
If you suspect that you or a loved one is experiencing cognitive decline or dementia then starting with your Primary Care Physician is the best first step. But, don’t feel restricted by their opinion.
U.S. News suggests that if you are not happy with the results of your PCP appointment, or “if the doctor does not seem to feel that an evaluation for diagnoses and treatment of the cognitive problem is that important, then it’s time to get a second opinion.”
Have you seen one of the healthcare professionals listed above about cognitive decline or dementia? We’d like to hear more about your experience in the comments below.
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- 5 Tips for Finding the Right Therapist for Seniors
Who Treats Alzheimer’s Disease?
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Managing and treating Alzheimer’s disease can be complex and often requires a team of healthcare professionals. Your primary care doctor can help coordinate your care and refer you to other healthcare providers. Some of these providers might include the following:
Geriatricians are doctors who have special training in how the body changes with age. Most geriatricians are either internists by training or family practitioners. They can help when there are many health problems to address.
Geriatric psychiatrists specialize in the mental and emotional problems of older adults. They can create a care plan that addresses and considers:
- Any medical, emotional and behavioral issues including agitation
- Social concerns
- Your home environment
Neurologists specialize in diseases of the brain and nervous system. They diagnose, treat and manage common neurological disorders, including Alzheimer’s disease.
At Your Appointment
What to Ask Your Doctor About Alzheimer’s
Psychiatrists have special training in disorders that affect mood and how your mind works. They can help diagnose Alzheimer’s disease, as well as identify and treat depression, which is common among people with Alzheimer’s disease.
Unlike psychiatrists, psychologists are mental healthcare professionals, not medical doctors. Rather, they have advanced degrees in psychology. Many psychologists are experts in testing memory and other mental functions.
Physical therapists are licensed healthcare providers who provide guidance on how to stay physically active.
Occupational therapists are licensed healthcare providers who evaluate your ability to carry out daily tasks and teach you ways to function better.
Some dentists have experience caring for people with dementia. It may be helpful to find one in your area who has worked with people with Alzheimer’s disease.
Physicians with Alzheimer’s: What Happens When a Doctor Forgets?
The Association of American Medical Colleges estimates that by 2030, the United States will face a shortage of 42,600 to 121,300 physicians due to increasing demands and physician retirement. Given the looming shortage of physicians, nurses, and other health care professionals, the medical field cannot afford to lose or ostracize clinicians who are still capable of providing care to their patients.
When working with a patient, Devi first determines whether they have dementia or just MCI. Physicians with mild cognitive impairment are more likely to be able to continue working. But it’s not always her executive decision. She emphasized that choosing which course to follow is a joint effort with each patient. “If it’s dangerous , I’ll say ‘no you can’t do that,’” she said, but adds that she has never had a patient refuse to agree with her recommendations for protecting their patients. Generally, the physician-patients Devi treats are deeply concerned about the safety of their patients.
With each of her cases, Devi must determine whether the physician she is treating can continue to function well in their position. She imagines herself in the place of a patient considering that doctor. “Would I be comfortable having this person as my physician or internist?” Devi asks herself. “It’s surprising how often this answer is yes.”
A Judgement Call
The answer to that question isn’t always a “yes,” but it’s not always an unequivocal “no” either. Devi’s patient, the surgeon, ended up deciding to close his private practice, but continuing to work with residents for a few more years. “It was more hands off, a team-based approach,” she said of his teaching work. “We decided that he was no longer able to continue in his practice, but he continued to teach and supervise.” He returned to her clinic for 3 years after his diagnosis with Alzheimer’s disease for ongoing monitoring.
Though some are, other situations aren’t as clear cut. In the surgeon’s case, Devi isn’t sure whether the measures they took were entirely necessary given how mild his symptoms were. “Perhaps it was an overreaction to have him give up his practice,” she said.
Like the physicians she treats, Devi keeps the patients’ best interests in mind. At times a doctor must stop practicing in order to protect patients. At other times, patients benefit from a doctor continuing to provide care, despite early symptoms of cognitive impairment or Alzheimer’s disease.
How Is Alzheimer’s Disease Diagnosed?
What Are the Benefits of Early Diagnosis?
Early, accurate diagnosis is beneficial for several reasons. Beginning treatment early in the disease process may help preserve daily functioning for some time, even though the underlying Alzheimer’s process cannot be stopped or reversed.
Having an early diagnosis helps people with Alzheimer’s and their families:
- Plan for the future
- Take care of financial and legal matters
- Address potential safety issues
- Learn about living arrangements
- Develop support networks
In addition, an early diagnosis gives people greater opportunities to participate in clinical trials that are testing possible new treatments for Alzheimer’s disease or in other research studies.
Learn more about Alzheimer’s disease from MedlinePlus.
An Alzheimer’s Doctor Reveals His Most Powerful Technology
Asayo Sakai, a former nurse and housewife who was diagnosed with Alzheimer’s disease almost 10 years… ago, walks on a road, followed by her daughter Akiko Sakai, near their apartment in Osaka, Japan, on Aug. 6, 2014. Photographer: Noriko Hayashi/Bloomberg
I am an Alzheimer’s doctor. I practice at a “university-based memory center.” I care for patients with failing brains, and I also care for their families, because you cannot have one without the other.
Technology surrounds me. Beneath me, in a basement encased in concrete, a 220-ton cyclotron spins hydrogen atoms to near light speed, creating a beam of protons to shoot at a cancer. Around me, infusions suites house intravenous pumps delivering powerful medications. There are devices to monitor, pace and even resuscitate hearts. The building itself testifies to invention, a multi-storied glass-and-steel-framed atrium, a kind of crystal palace.
Technology surrounds me, but my exam rooms are barren. My technology is limited, almost pre-modern. In fact, a better word to describe what I use is “tools.” A clipboard with plain white paper, a pen for me, a pencil for the patient, a box of tissues. I’ve come to see that my most powerful technology is not technology in the strict sense of that word. My most powerful technology is a four-word question : “What’s a typical day?”
“What’s a typical day?” inaugurates a conversation that achieves several important diagnostic and therapeutic goals. The stories of day-to-day life are real-world, detailed accounts of brains in the world, or, in a word, the mind. They tell me the severity of memory problems and so guide me to a diagnosis. Even more fundamentally, a family member’s ability to answer the question is data as well. The more detailed and vivid the story, the more confidence I have that the history I gather is accurate because I know someone else knows what’s going on.
The question is also transformative. A family member answering this question is among the earliest enactments of a new and important role she is about to take on, a role we call the “knowledgeable informant.” This is the person who reports on the health and well-being of a patient with cognitive impairment. It is among the roles that collectively create “the caregiver.”
Caregivers are of course critical to making the case for the size and scope of the problem of Alzheimer’s in America. Eighty-four percent of the disease’s $215 billion-a-year costs are attributed to caregiving. If there were no caregivers to label, count and ask questions to, Alzheimer’s wouldn’t be so costly.
The stories of what’s a typical day as told by the patient and by their informant provide a personalized narrative that opens up a precise assessment of the patient’s quality of life. A day that is busy, engaged and safe is arguably better than one that begins and ends with sitting on a couch before a TV, punctuated only by three meals, a snack and a nap.
My profession is not simply engaged in diagnosing diseases of the brain. We’re dedicated to measuring a problem of the mind and to help patients and their families reconcile differences over what this problem is and how they are going to live with it.
“I go to work,” said one long-ago retired man with moderate-stage dementia. His wife slowly shook her head.
Much of my practice is about prompting the patient and family to arrive at a coherent and vivid story of how they’re living with Alzheimer’s disease. Why is this important? Because short of a cure, that is what each of the five million or so patients with the disease will have to do.
My technology has downsides. I encourage so much talking that one husband bitterly remarked to me that it seems that all we do at the memory center is tell each other stories. He wanted treatment, aggressive treatment, for his wife who he said was falling apart before him. One day, he found her lost in her closet. All I offered him was the telling of stories, a practice of narrative medicine.
“How long,” I asked him, “was she in the closet?”
I understand his frustration. The histories of the other killers of 20th century America are war stories. A massive therapeutic armamentarium is deployed. The walk to my memory center takes my patients and their families past well-endowed cancer and cardiovascular centers, endowments that testify to the value society places in their centers where patients do brave battle with the 20th century’s great killers. My colleagues arm their patients with powerful technologies–pacemakers, implanted defibrillators, portable catheters into which drugs are infused, some so powerful they turn people hairless, yellow and bloated, or pink and shiny.
And I sit in my exam room with my pen and clipboard, pressing a daughter for details about the movies her mother watches and whether her mother really follows the plot or merely sits and watches.
The history of my profession’s efforts to discover treatments for Alzheimer’s disease is a history of decades of failed experiments. Our few successes discovered drugs that increased the level of cholinergic neurotransmitters. Their modest effects on symptoms created the cholinergic hypothesis of Alzheimer’s and so a business model to promote the disease, but then the drugs’ patents began to expire and so the field looked up to scan the event horizon to discover better treatments.
And we need them. The promise of our current experiments is that brain scans and genetic tests will more precisely label the disease and drugs will treat the underlying pathologies that cause cognitive decline. Colleagues speak of the coming of “Alzheimer’s infusion centers,” reflecting how many of the drugs under study are delivered by intravenous infusion.
These centers will be a welcome addition to memory centers, but I fear the unintended consequences of the technologies they’ll house. Technologies don’t just do things, they change things. Look at how the car, electric light bulb and cell phone have changed the American family.
The coming Alzheimer’s technologies will arguably change my profession as technologies have changed fields like oncology and cardiology. Alzheimer’s doctors will pass less time talking with the patient and family about the patient and how they’re living with and making sense of the disease, and more time talking about the technologies. The Alzheimer’s doctors who run the centers will not be doctors like me who like to ask questions to write vivid narratives about a typical day. I’ll be replaced by different and probably younger doctors who like talking about the scans and the drugs.
I fear one side effect of these technologies is that we’ll stop caring about our patients’ days.
Understanding Alzheimer’s Disease
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We all forget where we kept that box of firecrackers, or the bill that needs to be paid. But there is a more serious loss of memory that progressively begins to disrupt one’s normal day-to-day functions. Alzheimer’s disease is the commonest form of dementia, a disease of old age, and becomes increasingly frequent with every passing decade after 60 years.
Over the age of 80, more than 20% of people have mild dementia. Currently, over 3 million people suffer from dementia in India alone. In about 20 years time, the numbers are expected to double, thanks to a greater life-span and to better identification of patients in large areas of our country.
Many elderly couples live alone these days. They are frail and particularly vulnerable. Their children may not live close by and could even be in a different country altogether, finding it difficult even to come down for Diwali. What would be the impact of Alzheimer’s disease in such a couple?
Imagine the pain of seeing your partner slowly forget everything that was once special and precious to you. Forgetting all likes and dislikes, friends and relatives, or how to be happy or sad. And one day, even forgetting who you are! Imagine your helplessness on being left alone, caring for the one you care for most, but not knowing how to care. And then there is the grocery, the banks, the pension, the medical bills, all that for you to sort out. You are old and frail yourself but there is no time for all that. Medicines help a bit, but for you there are no balms of comfort. Such is the impact of Alzheimer’s disease. It affects two people – the patient, but enormously more, the caregiver.
Alzheimer’s is not an obscure illness but an ailment affecting real people in real families like yours and mine. I want you to learn to recognise the signs of Alzheimer’s disease, but at the same time be reassured that all forgetfulness is not dementia.
We all forget things, all the more as we age. A certain degree of forgetfulness is normal for every age group, especially in the elderly. That is not dementia. Some people are naturally bad with names, telephone numbers or addresses, as the case may be. That is ‘normal’ for them and is not dementia either. Ask their families and you will find that they have always been like that.
The worry is, when the memory loss exceeds what is normal for the person’s age, education or nature. In such situations, a decline in dayto- day function may also be noticed. Appointments may be forgotten and memos may need to be kept. Shopping lists may be difficult to remember. Things may be misplaced and lost a bit too frequently. There may be difficulty remembering names and even recognising people not seen for a few years. Objects that have not been used recently may also be forgotten. Wrong names may be used. Some may start losing their way, initially in unfamiliar and later in familiar places. They may have great difficulty in locating their seats in a train or in flight, for example.
And gradually, even forget the way to their own home. Conversation may be affected in many. Some cannot stop speaking while others sit quietly by themselves with almost nothing to say. Some speak with stutters and trip over words. Finding the right words may be difficult for many of them. Reading and handwriting may be affected; pronunciation and spelling errors may be prominent. Signing a cheque could become a harrowing experience. Dressing, cooking, handling a remote control, a mobile phone or a push-button telephone may become difficult.
While any or all of these symptoms may be seen in Alzheimer’s disease, loss of memory is typically the most prominent. Very often it is this loss of memory that draws the attention of the caregivers and other close relatives. At other times, a worried patient himself rings the doctor first.
There are tests we can do to screen for Alzheimer’s disease. Some of these are simple questionnaires that take around 10 minutes to finish. More detailed memory tests can be done later. Screening tests are easy to administer, require minimum training for the tester and can be performed at almost all settings like screening camps for Alzheimer’s disease, general outpatient clinics and special clinics exclusively set up for memory disorders.
Besides picking out those with Alzheimer’s disease or other forms of dementia, memory tests help us separate those who do not have dementia from those who have very mild memory impairments (mild cognitive impairment or MCI). This last group is particularly important. Most people with MCI will be forgetful – but only some will develop Alzheimer’s disease. Others may have mild but significant forgetfulness for several years, while a few may even improve and be back to normal. Identifying patients with MCI and trying to treat them early is an area of major interest in Alzheimer’s disease research today.
Until now, much of the treatment of Alzheimer’s disease has been symptomatic and not really geared to treat the root cause. This is now changing. Current international research is looking to find molecules that can act against the very proteins that cause Alzheimer’s disease. Many such drugs are now in the pipeline and could be expected to hit the shelves over the next few years. These drugs seem to work best on patients with early and mild Alzheimer’s disease. A heightened awareness and an early diagnosis of the disease are therefore essential.
Lowering the risks
Can you reduce your risk of having Alzheimer’s disease? Researchers have been finding links between the occurrence of Alzheimer’s disease and diseases of the small blood vessels of the brain. MRI scans of the brain can sometimes pick up patchy, mini-stroke like areas in the brains of patients with Alzheimer’s disease. This has led to the suggestion that good food, lots of green vegetables and an otherwise healthy lifestyle could reduce the chances of having Alzheimer’s disease much as it reduces the risks of brain strokes and heart attacks. Turmeric, frequently used in Indian food, is also believed to be one of the protectors against Alzheimer’s disease.
Looking after the caregivers and their needs is as much a part of Alzheimer’s disease care as is looking after the patient. In this regard our social service systems leave a lot to be desired. The Alzheimer’s disease and Related Disorders Society of India (ARDSI), in its own way, is trying its best to fill this vacuum. One day, drop in at one of their offices, share a thought, and show them that you care. Who knows how long you will remember the ‘forgotten ones’?
What Is Dementia? Symptoms, Types, and Diagnosis
How is Dementia Diagnosed?
To diagnose dementia, doctors first assess whether a person has an underlying treatable condition such as abnormal thyroid function, normal pressure hydrocephalus, or a vitamin deficiency that may relate to cognitive difficulties. Early detection of symptoms is important, as some causes can be treated. In many cases, the specific type of dementia a person has may not be confirmed until after the person has died and the brain is examined.
A medical assessment for dementia generally includes:
- Medical history. Typical questions about a person’s medical and family history might include asking about whether dementia runs in the family, how and when symptoms began, changes in behavior and personality, and if the person is taking certain medications that might cause or worsen symptoms.
- Physical exam. Measuring blood pressure and other vital signs may help physicians detect conditions that might cause or occur with dementia. Some conditions may be treatable.
- Neurological tests. Assessing balance, sensory response, reflexes, and other cognitive functions helps identify conditions that may affect the diagnosis or are treatable with drugs.
What Tests are Used to Diagnose Dementia?
The following procedures also may be used to diagnose dementia:
- Cognitive and neuropsychological tests. These tests are used to assess memory, problem solving, language skills, math skills, and other abilities related to mental functioning.
- Laboratory tests. Testing a person’s blood and other fluids , as well as checking levels of various chemicals, hormones, and vitamins, can help find or rule out possible causes of symptoms.
- Brain scans. These tests can identify strokes, tumors, and other problems that can cause dementia. Scans also identify changes in the brain’s structure and function. The most common scans are:
- Computed tomography (CT), which uses x rays to produce images of the brain and other organs
- Magnetic resonance imaging (MRI), which uses magnetic fields and radio waves to produce detailed images of body structures, including tissues, organs, bones, and nerves
- Positron emission tomography (PET), which uses radiation to provide pictures of brain activity
- Psychiatric evaluation. This evaluation will help determine if depression or another mental health condition is causing or contributing to a person’s symptoms.
- Genetic tests. Some dementias are caused by a known gene defect. In these cases, a genetic test can help people know if they are at risk for dementia. It is important to talk with a genetic counselor before and after getting tested, along with family members and the doctor.
Checklist for Visiting a Neurologist
In addition to finding a physician considered to be an expert in dementia, it is also important that the physician you work with is someone you and your loved one feel comfortable around. You and your loved one should feel respected and free to ask questions. You may want to consider interviewing a neurologist to see if he or she is a good fit for your family before making an appointment.
Preparing for a Neurologist Appointment
Your loved one will get the best care possible if you prepare for your appointment ahead of time. The American Academy of Neurology (AAN) recommends caregivers of people with known or suspected dementia do the following before visiting a neurologist:
- Write down all the questions you would like to ask, like the ones listed in the section below. List your most important questions first. It may be helpful to carry a small notebook or download a smartphone app that will include all your loved one’s pertinent care information in one place.
- Make a list of all medications – including prescription, over-the-counter and supplements – your loved one takes and their dosages.
- Bring along his or her medical history and other paperwork including diagnostic test and lab results, as well as imaging scans like X-rays and MRIs.
- Bring a list of your loved one’s other physicians who should have access to their neurology records.
- Ask the neurologist if there are any forms you can complete prior to your visit so you can focus, as much as possible, on keeping your loved one calm and stress-free for the appointment.
What Does a Neurologist Do on Your First Visit?
It can take a week or several months to secure an appointment with an expert dementia neurologist. When it comes time for your senior loved one to visit the neurologist for the first time, what can you expect?
Office visits average around 30 to 45 minutes, so ensure your loved one has had plenty of rest prior to the appointment.
The neurologist may conduct a variety of evaluations for dementia and other neurological conditions. They typically include:
- A mental status exam, which tests your loved one’s abilities to recall current events and perform routine activities
- A cranial nerve evaluation, which may include an eye test and an evaluation of their hearing and sense of smell
- A motor system exam to assess muscle tone and strength
- A sensory system exam, which tests their sensory response to things like temperature, pain and pressure
- A deep tendon exam, which measures reflex activity and assesses how tendons move
- A gait and coordination evaluation to test balance and walking abilities
Your loved one’s neurologist may also order diagnostic tests, such as a CT scan or MRI, along with blood and urine tests.
Questions to Ask a Neurologist About Dementia
It is important to work closely with the neurologist and other members of your loved one’s care team to make the best treatment and lifestyle decisions. Asking the right questions ensures you will understand your loved one’s diagnosis, all available treatment options and the benefits and risks of each, and what to expect as the condition progresses.
Here are some questions you may want to ask a neurologist at your loved one’s first appointment, or first few appointments:
- What tests will you be performing, what do they involve and what will they tell you about my loved one’s condition?
- How soon can you share the results of these tests?
- How did you arrive at your diagnosis of dementia, and is there any possibility these symptoms could be triggered by a reversible cause?
- What type and stage of dementia is this, and how quickly does it usually progress?
- What treatment options are available for my loved one’s Alzheimer’s disease or other form of dementia? Are there any clinical trials available?
- Which treatment option(s) do you believe best fit our situation? Are there non-drug approaches that could be helpful?
- How will you determine if a treatment is effective, and how soon will you be able to evaluate the treatment’s effectiveness?
- What side effects are possible with this treatment, and how can we monitor those potential effects at home?
- When should we call you about potential treatment side effects or an apparent worsening of dementia symptoms?
- Is one treatment option more likely than another to interfere with medications for my loved one’s other conditions?
- What are the concerns with stopping one treatment and beginning another?
- At what stage of the disease would you consider it appropriate to stop using the drug?
- Is it safe for my loved one to continue to live at home/work/perform everyday activities?
- What resources can help us manage this condition?
What to Do After the Neurologist Visit
Review all information you receive from the neurologist’s office. If you can’t remember or don’t understand something you were told at the appointment, contact the neurologist to ensure you have a clear understanding of your loved one’s diagnosis and the recommended next steps.
Depending on your loved one’s stage of dementia or Alzheimer’s disease, you may need to begin to plan for expected changes. Exploring local senior care options such as in-home care or Memory Care in an assisted living community may help you create a plan that will support their unique needs now and into the future.
Geriatricians, who specialize in treating older adults, are also frequently familiar with the different forms of dementia.
Tips for Finding a Doctor Who is Knowledgeable About LBD
The LBDA Research Centers of Excellence program is a research network of 25 sites where you can find expert LBD clinical care. These clinics are at major academic research centers with a commitment to providing outreach and support to LBD families, and where you can find opportunities to participate in researach.
If you are not near an LBDA Research Center of Excellence, contact any hospital affiliated with a medical school. Ask if they have a clinic specializing in dementia or movement disorders. These clinics often offer a high level of diagnostic and treatment capability.
Neurologists make the vast majority of LBD diagnoses. The patient site for the American Academy of Neurology has an outstanding search engine for neurologists. Visit their site and use the “Find a Neurologist” tool. Enter your state and city to narrow your search results. Choosing sub-specialties such as these may help further refine your search results:
- Alzheimer’s disease
- Behavioral neurology
- Movement disorders
- Parkinson’s disease
- Sleep disorders (if needed for more complex sleep issues)
A geriatric psychiatrist is a medical doctor with special training in the diagnosis and treatment of mental disorders in older adults. These disorders include, but are not limited to, dementia, depression, anxiety, alcohol and substance abuse/misuse, and late-life schizophrenia.
How should one approach care for a dementia patient?
That’s a very broad question that really depends on the cause of the dementia, the stage of dementia, and the individual circumstances of the person and his or her family. Not everyone is the same. In Alzheimer’s disease, once a diagnosis is made, the early care is usually focused on starting medications (cholinesterase inhibitors, like donepezil) to address symptoms, plus antidepressants for depression, if necessary. The early care is also focused on helping the family set expectations for the future so they can address any legal and financial planning concerns. Driving safety may also need to be formally evaluated.
As the disease progresses, the care may involve more assistance with activities of daily living, such as eating and dressing. Home care, which has the added benefit of alleviating burden on the spouse and other family members, can be helpful at this stage. We may consider other medications such as memantine , which may be appropriate in the moderate stages of disease, or other psychotropic medications for specific behaviors, such as agitation. In the later stages of the disease, all of the above continues, but the care may also be focused on considering alternative living arrangements, such as assisted living, a memory care unit, nursing home placement, or hospice care. But, with appropriate services in place, many people with Alzheimer’s disease are able to live at home to the very end.
Can dementia lead to death?
This is a bit of a semantic question. Dementia doesn’t cause death. But the life expectancy of a person with Alzheimer’s is about 10 years on average, from the very earliest symptoms to death, and it does vary. So, it shortens life expectancy, but the immediate causes are likely to be things like pneumonia, dehydration, or falls. Neurodegenerative causes of dementia—like Alzheimer’s disease—shorten life expectancy more than vascular diseases that cause dementia—individuals with vascular dementia can be fairly stable over time.
Can dementia be prevented?
Again, it depends on the cause. If we are talking about Alzheimer’s disease, we don’t currently have a program or intervention for preventing it. You can prevent head injuries, and maybe reduce some risk. But you cannot prevent the biggest risk factor—aging. You cannot alter family history and genetics—at least, not yet. One of the big areas of research interest is lifestyle choices, like eating well and exercising. Aerobic exercise and Mediterranean diets, with an emphasis on fruits and vegetables and limited carbohydrates, are associated with a lower risk. But we don’t have studies that prove this. However, we are currently conducting randomized controlled trials on the effects of both aerobic exercise (EXERT study) and specialized diets. I don’t think we expect these things to prevent dementia, but they could help to lower the risk. There are also ongoing therapeutic trials that attempt to lower the risk of Alzheimer’s by, for example, lowering brain amyloid levels. So far, nothing has been proven to work, but this is an area of intense research, and I remain very hopeful.