There are multiple types of doctors and other medical professionals involved in the diagnoses of, and ongoing treatments for Alzheimer’s and other dementias. This article explores the types of doctors and therapists with whom a family should expect to interact as well as their roles and how they change as dementia progresses.
The initial doctor the vast majority of individuals see about their memory concerns and other symptoms is their primary care doctor / general practitioner. This is as much about convenience, habit and the realities of medical insurance billing practices as it is about medical expertise.
With this initial appointment, a patient’s medical history, and current medical state are discussed. From there, one’s primary care physician begins to perform tests and assessments. These can range from invasive to non-invasive. That means that before saying your loved one has a probable diagnosis of dementia, they need to be evaluated from the outside in. A common first step in diagnosing Alzheimer’s is to give a cognitive exam. Various tests assess a person’s immediate and short-term memory and brain function. While different exams exist, they generally all ask questions about:
– Orientation demonstrating knowledge of time and place
– Short-term memory
– Attention and ability to solve problems
– Language and the ability to identify things by name
– Comprehension skills that show how well something is understood
– Motor skills
These types of tests are not relied upon alone to make a diagnosis. Normally, there are other tests that need to be done like blood and urine samples. Another important step for your loved one’s is that other medical conditions will be ruled out. Through a process of elimination of medical conditions that can present similar characteristics to dementia, a doctor will check for vitamin deficiencies, depression, medication cross-interactions, different infections, or thyroid disease.
In some cases, at this initial appointment, a dementia diagnosis is made. But that is not normally the case. For the most part, a diagnosis is not a simple process to achieve. A general practitioner is the first step in the medical community. Normally they will refer a patient to a specialist. That happens to determine what kind of dementia someone has and at what stage of the disease they are at. Also, people who are younger than “normal” or have inconclusive tests from their primary care doctor will need to see a professional who specializes in the brain.
Most persons with dementia will continue to meet regularly with their primary care doctor as their condition progresses.
The specialist most patients will see for a more definitive diagnosis is a neurologist. Although to be clear, not all neurologists are specialists in Alzheimer’s and dementia. However, given it often takes a referral to meet with a neurologist, most patients can be confidence that the neurologist to whom they were referred will be a specialist in Alzheimer’s and dementia (as opposed to, for example, a neurologist who specializes in seizure disorders).
Further exams and tests will be performed that solidify a patient’s diagnosis and often help to identify the type(s) of dementia such as Alzheimer’s, vascular, FTD or surprisingly common a mix of these dementias. The additional tests will examine the results from neurological exams, cognitive exams, and imagining of the brain. From there an individualized treatment plan is formed that can include a combination of medication and different therapies.
As dementia progresses, they will be continued interaction with the patient’s neurologist, but these visits may occur once or twice a year, relatively infrequently when compared to visits with a primary care doctor.
Following a diagnosis, many patients will meet with a geriatrician. Geriatricians are doctors focused on the elderly and a geriatrician visit is often about treating dementia in relation to other conditions the aging individual has. For example, how a patient’s dementia and its progression may impact a heart condition, diabetes, high blood pressure or other ailments common to the aging.
As dementia progresses, there can be some overlap between a geriatrician and a primary care doctor. Some patients will choose to continue with one or the other, as it may not be necessary to continue with both of these physicians.
While not every person with dementia with meet with a Psychiatrists or Geriatric Psychiatrists, it is common for other mental health conditions to co-exist with dementia or to develop because of dementia. For example, depression is common among people diagnosed with Alzheimer’s.
Different therapies can help patients at all stages of dementia and there are many different types of therapists that might be appropriate including mental health therapists, occupational therapists, physical therapists, cognitive therapists, and speech therapists.
Mental health therapists help a patient’s emotional health. By focusing on how well a person is feeling, a psychologist, counselor or psychotherapist can help patients by helping them process what they think and feel about their dementia diagnosis and treatment plan. Benefits can be seen with patients having less stress, anxiety, and depression regarding their medical condition.
Occupational therapists are specialists who help with activities that are done every day in order to be able to live independently without extra support and care services. That means that they can help patients find methods for safely doing activities of daily living and successfully interacting with other people. Occupational therapists also offer help with medical improvement suggestions like dementia-friendly locks and grab bars in bathrooms. They can also aid caregivers by advising with different types of care.
Physical therapists are professionals in the medical field who are experts in how the body moves. They are able to help with balance and mobility. As Alzheimer’s and dementia progresses, these become two major characteristics of the disease. Through different exercises, patients are moving around as long as possible. By doing this, mobility and independent living are not lost as quickly. Different exercise programs for dementia patients can include taking walks and seated stretches.
Cognitive therapists help patients who have Alzheimer’s or another form of dementia with their cognitive abilities. This means how someone understands and participates in the world around them. It is how the brain is able to solve everyday problems. This set of brain skills focuses on how things are understood, learned, and done. These are involved with how the brain interprets something, its ability to pay attention, its memory, motor skills, language skills, and visual and spatial processing. Exercises are given to help keep and build on these skills. Patients can do a combination of games, puzzles, and activities or have relevant discussions to aid and improve memory, mood, mobility, and thought processes.
Speech therapists are language experts. As dementia breaks down the brain processes at a cellular level, your loved one can undergo many changes in their behavior. These differences are noticed in how they talk, think, and act. Speech therapists use voice and speech exercises to help your loved one pay attention, listen, and communicate. This improves your loved one’s quality of life by helping how things are understood and practicing techniques to improve them. Speech therapists have the added benefit that they can help with exercises to improve swallowing. As dementia progresses through to its end stage, eating and swallowing becomes difficult. This varies from patient to patient but happens because the person forgets to swallow the food or drink in their mouth.