Dementia Doctors: Choose the Right Specialist

dementia doctors

If you suspect that someone has dementia or you already know a person with the neurodegenerative illness, they must see the right dementia doctors.

One of the main reasons for this is the fact that it is usually not easy to diagnose or manage dementia.

For this reason, an ill individual needs to consult with a specialist. He or she has the knowledge and experience to effectively deal with the disease.

People who have dementia may have to visit different types of specialists to get a proper diagnosis.

This will help them get the right information on how to go about living with the illness that has no cure.

Best Dementia Doctors

Some of the professionals that can help individuals with dementia include:

A General Physician

a general physician
Any individual who has concerns about changes in memory, mood, thinking, and behaviors, should first contact their primary care physician.

After discussing the symptoms, the doctors will mostly probably diagnose dementia using tests to determine cognitive ability, brain scans, neurological evaluations, and mental health evaluations.

The professionals use a combination of various diagnosis methods because there are no blood tests that confirm whether a person has dementia or not.

It is important because it helps determine whether other underlying medical conditions are behind the symptoms that a person has.

When need is, the doctor can recommend other specialists that a person who has dementia can see to lighten the burden of the illness.

Neurologists

neurologists
Neurologists also belong to the category of dementia doctors who help persons with the illness. These are professionals who specialize in abnormalities of the central nervous system and the brain.

They have the technical know-how to interpret brain scans to see if any changes are as a result of dementia.

Geriatricians

These are specialists who manage health care for seniors. Geriatricians are aware of how the body changes as a person grows older and can detect some of the symptoms that are not a normal part of aging.

Gerontologist

This is a professional who deals with gerontology, like social, biological, and psychological aspects of aging.

Although they are not medical professionals, they can be instrumental when it comes to offering essential support services to people who have different types of dementia.

Geriatric psychiatrists

They are professionals who focus on the emotional and mental problems of the elderly. They can also assess thinking and memory.

Neuropsychologists

These are experts who are responsible for conducting tests that relate to memory and thinking.

Now that you have an idea of some of the dementia doctors that persons with the disease can see, let’s jump into some of the tips you can use to choose the right specialist.

Seek Referrals

seek referrals
When dealing with dementia especially for the first time, you may not know who to turn to. This is why it is important to look for referrals.

Your primary doctor can help you with this when you need to see a specialist.

Alternatively, if you know a person who is dealing with dementia, they can direct you to a specialist they trust to offer proper treatment and care.

Other resources you can take advantage of include dementia care centers, and reputable senior living communities in your region.

While working with referrals, it is important to get a few contacts.

This way you will be in a position to compare the services that different doctors have to offer so that you can pick the ones that you feel will serve your needs best

Experience with Dementia

experience with dementia
No offense to doctors who are just starting, but it is usually recommended that you look for a specialist who has been in the industry for a couple of years.

These are well-trained and competent individuals who can properly deal with dementia.

Other than being professional, the doctor should give individuals all the time they need to listen and address any questions and health concerns that a person may have.

Before a person commits to seeing one doctor, it is important to research the professional beforehand.

This is where you get to find out about the credentials of the professional, office policies, and any other details you would like to know about the professional before working with them.

Checking board certifications can also help determine the skills a particular doctor has in a specific area of medicine.

You can make a cold call to the office to determine how they run things. If this impresses you, schedule a one-on-one meeting to see if you will finally seal the deal.

Accessibility

accessibility
Naturally, you do not want to deal with dementia doctors who are miles away. This can prove to be rather unhelpful when you want their services.

It is best to find a doctor who is easily accessible so that you can see them anytime you want without too many complications.

The doctor’s office should have open communication lines so that you do not have to struggle when you want to consult the doctor.

Cost Implications

cost implications
When looking for a good doctor, you must also think about the cost implications. If you are using insurance, make sure the professional accepts the insurance you are under or else it will create problems later on.

When using cash, it is important to find a doctor whose services are within your budget.

This way, you will not end up in debt simply because you are walking with a professional that you cannot afford.

Trust your Gut

trust your gut
Your gut feeling can be helpful when it comes to choosing the right dementia doctors.

If something does not sit well with you, it is better to continue with your search. It is worth investing extra time until you find a doctor that you are confident with.

Even after picking a doctor, there is space to change your mind if you discover that he or she is not the person you are looking for to meet your medical needs.

You might also want to look for a doctor who speaks your language and is sensitive to your religious and cultural convictions.

It is one of the ways to create a friendly working relationship with the specialist.

Do Neurologists Treat Dementia?

do neurologists treat dementia

The common question that arises amongst the general public is whether or not do neurologists treat dementia.

While there are various specialists who can diagnose dementia, many patients are referred to a neurologist who determines the type of dementia, as well as treatment options.

What is dementia?

Dementia is a neurologic disease affecting cognition, involving the different aspects of cognitive function (memory, language, attention, social life, planning, and motor skills).

Dementia represents a decline that is severe enough to interfere with daily life and independence. When people think of dementia, Alzheimer’s comes to mind, and that’s because Alzheimer’s Disease is the most common type of dementia.

Alzheimer’s is responsible for about 60-80% of all dementias in older adults. With an aging population, the overall prevalence of dementia is increasing worldwide.

what is dementia

Dementia is a progressive disease, meaning it gets worse over time. In the early stages, it may be diagnosed at mild cognitive impairment (MCI), which is an in-between stage between normal cognition and dementia.

MCI may progress to dementia.

What are different kinds of dementia?

what are different kinds of dementia
The most common dementia in older adults is Alzheimer’s Disease. However, about 20% of patients with dementia have another form of dementia.

The main dementia syndromes include Dementia with Lewy Bodies, Frontotemporal dementia, Parkinson disease dementia and variants, and vascular or stroke-related dementia.

Who can diagnose dementia and why a neurologist?

who can diagnose dementia
Dementia is a diagnosis made by a physician.

While it does not have to be a neurologist to diagnose dementia, many patients are referred to a neurologist to determine what type of dementia they have and to help with treatment options and symptom management.

A primary care physician can make a presumptive diagnosis of dementia if a patient fits certain criteria, and the symptoms are not explained by another mental disorder (such as major depressive disorder or another psychiatric condition).

A neurologist can help distinguish between the different types of dementia.

In some cases, advanced neuropsychiatric testing is done to better clarify the type of dementia.

How is dementia diagnosed?

how is dementia diagnosed
A full dementia evaluation cannot be done in a quick office visit; a family member or a close friend should accompany the patient to their primary physician or neurologist and be able to recount the history over the past several weeks, months, and even years.

The first steps include a complete history and physical examination, neurologic examination, and laboratory or imaging workup.

The history, or story of the patient’s symptoms, is crucial to the diagnosis.

A doctor might ask when the patient first noticed memory loss, how it has progressed, and what sorts of things he or she is not able to do anymore independently (activities of daily living, or ADLs).

Certain details are key, such as loss of vision or strength, prominent personality changes, behavioral problems, hallucinations, sleep problems, and risk-taking behaviors.

There are several tests available to help with the diagnosis of dementia, which will be discussed further below.

A full evaluation includes a physical and neurologic exam, laboratory testing, and most times imaging tests such as a CT scan or an MRI of the brain.

By official definition, dementia is diagnosed when there is cognitive impairment in at least one cognitive domain (memory, language, attention, executive function, motor function, social function) that is progressive and interferes with independence in every-day activities, that is not explained by another medical or psychiatric disorder.

Why refer to a neurologist for dementia?

why refer to a neurologist for dementia
A neurologist will be helpful in diagnosing dementia, especially in distinguishing between different types of dementia as their treatments differ.

Also, a neurologist will perform a careful history and exam including labs and imaging to make sure there is nothing else being missed that would otherwise explain the symptoms of dementia.

In addition, a neurologist trained in cognitive neurology will have special expertise on managing the symptoms of dementia including the newest medications, clinical trials, and symptom management.

Often times, a neurologist will be able to give a prognosis and help guide family members through this chronic, progressive illness.

What does a neurologist examine for a dementia patient?

what does a neurologist examine for a dementia patient
After taking a careful history of the symptoms, a neurologist will begin with a general physical examination.

Part of this includes the neurologic exam.

A neurologic exam contains six major components; mental status exam, cranial nerve exam, motor exam, sensory exam, reflexes, and cerebellar exam.

Abnormalities on the neurologic exam may give the neurologist clues as to what the diagnosis is.

The mental status exam will assess for orientation, attention, memory, visuospatial function, and language. Some common tools are the MOCA (Montreal Cognitive Assessment) and MMSE (Mini-Mental State Examination).

These are a short series of tasks a neurologist may ask you to fill out, and based on how you score, can help in categorizing the types of deficits and hint as to the type of dementia.

What treatments might a neurologist prescribe for dementia?

what treatments might a neurologist prescribe for dementia
There are a few medications that are approved for the treatment of Alzheimer Disease. These include cholinesterase inhibitors (such as donepezil, rivastigmine, and galantamine).

These medications work by modulating neurotransmitters in the brain and have some modest symptomatic benefit in patients with dementia.

Another category of medication includes Memantine, which is an NMDA-receptor antagonist. This works by blocking a different neurotransmitter (NMDA) which may protect the brain.

This also has been shown to have very modest benefits.

Neurologists may prescribe medications to help certain symptoms of dementia, such as behavioral disturbances, hallucinations, sleep problems, depression, agitation, and aggression.

These may include antidepressants, antipsychotics and various other medications.

Nutrition, physical therapy and cognitive rehab are also things a neurologist may consider in the multidisciplinary approach to dementia care.

What conditions can be mistaken for dementia?

what conditions can be mistaken for dementia
There are certain conditions that can mimic dementia. It is essential to make sure these conditions are not responsible for the symptoms, as they are often reversible and treatable.

A good neurologist will rule out “reversible” causes and mimics of dementia.

There are certain “red flags” that should not be missed; these include young age, rapidly progressive dementia (ie someone getting much worse within days, weeks or a few months), or an abnormal or asymmetric neurologic exam such as weakness on one side of the body.

These will need an expedited and different type of evaluation than the standard dementia workup.

Many people confuse the signs of normal aging with dementia.

Normal aging does include a slight degree of cognitive decline including mild changes in memory and information processing. Some people visit their doctor for these symptoms, worried that they may have dementia.

Normal aging is quickly recognizable from dementia

However, normal aging is easily distinguishable from dementia.

It is generally not very progressive and does not affect daily function.

Examples include forgetting where one left the keys or some items on the shopping list at the grocery store.

There are other medical conditions that can mimic dementia. One is delirium.

Delirium is a condition of confusion and an altered sense of awareness of one’s surroundings.

Delirium is often associated with an underlying medical condition, such as an infection, metabolic issue, or prolonged hospitalization.

The time course of delirium (much shorter) and the fluctuations in attention are characteristic and distinguishable from dementia.

Vitamin deficiency, specifically of Vitamin B12 can contribute to dementia, so this should be checked and supplemented if low.

Thyroid tests, and sometimes HIV or syphilis testing is done to make sure symptoms are not due to these other treatable medical conditions.

Depression is an important mimic of dementia. In fact, depression causing dementia has been named “pseudodementia” or “dementia of depression.”

This is because people with uncontrolled depression may exhibit signs similar to dementia (physical and cognitive slowing, giving poor effort, being unable to function in activities of daily life).

It is crucial to recognize pseudodementia because it can be treated and reversed with appropriate psychiatric and psychological care.

Resources

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington 2013.

Knopman DS, DeKosky ST, Cummings JL, et al. Practice parameter: diagnosis of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001; 56:1143.

Knopman DS, Boeve BF, Petersen RC. Essentials of the proper diagnoses of mild cognitive impairment, dementia, and major subtypes of dementia. Mayo Clin Proc 2003; 78:1290.

Reisberg B, Doody R, Stöffler A, et al. Memantine in moderate-to-severe Alzheimer’s disease. N Engl J Med 2003; 348:1333.

Petersen RC, Smith G, Kokmen E, et al. Memory function in normal aging. Neurology 1992; 42:396.

Geldmacher DS, Whitehouse PJ. Evaluation of dementia. N Engl J Med 1996; 335:330.

Brauner DJ, Muir JC, Sachs GA. Treating nondementia illnesses in patients with dementia. JAMA 2000; 283:3230.

Howard R, McShane R, Lindesay J, et al. Donepezil and memantine for moderate-to-severe Alzheimer’s disease. N Engl J Med 2012; 366:893.

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