The Small Guide to Alzheimer's Disease. Gary Small

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СКАЧАТЬ to terms with the reality that a loved one may be losing their mental abilities.

Connecting with a Doctor

      For many people, overcoming such denial—one way or another—is the first step to getting help. Unfortunately, when patients and their families finally decide they do want help, many are uncertain where to find it. They may not be sure whether a psychiatrist, neurologist, geriatrician, or some other specialist is the best person for them, so they end up seeing numerous specialists and obtaining several unnecessary and repeated evaluations, scans, blood tests, and lumbar punctures. Many times a second opinion is helpful, but too often patients end up with too many conflicting opinions, and rather than focusing on a clear path forward, they can become unsure of who to trust and what to do.

      I believe that the best thing to do first is to discuss any memory concerns with a doctor you trust, who is often your primary care physician (PCP). It may be an internist, family practitioner, or any doctor you know and have faith in. Many different specialists and generalists know how to diagnose and treat Alzheimer’s disease and related conditions. However, in some circumstances, specific types of specialists are better equipped to deal with the problems at hand.

Doctors Who Care for Memory-Impaired Patients

      Because of the shortage of neurologists and geriatric psychiatrists, many primary care doctors have developed expertise in diagnosing and treating dementia. Then again, certain clinical situations are best addressed by particular specialists.

       • Primary care physicians. For typical cases that do not present in unusual ways, internists and family practitioners who have an interest in cognitive problems are able to effectively diagnose and treat patients with dementia.

       • Geriatric psychiatrists. These specialists are well equipped to care for patients who have symptoms of depression, anxiety, personality change, or psychosis that often develop along with their cognitive symptoms. Geriatric psychiatrists can also be helpful if psychological conflicts emerge among family members.

       • Neurologists. Any patient experiencing a cognitive decline along with a neurological condition such as Parkinson’s disease or Huntington’s disease might wish to seek a consultation from a neurologist.

       • Geriatricians. Patients with multiple medical problems or gait instability, as well as those aged 80 years or older, may benefit from seeing a geriatric internist.

      In addition to determining the kind of specialist who might be suitable, it’s helpful to come up with a list of the most important qualities you are seeking in a doctor. These may include age, background, clinical style, and other professional qualities. Keep in mind that even if you find a doctor who meets your qualifications, the two of you may not click when you meet in person. That personal connection is important since you will likely have lots of questions for your doctor and you will want to feel comfortable while communicating. Always ask yourself whether this doctor is the kind of person you could trust and who will take your questions seriously. Keep in mind that many doctor/patient relationships strengthen over time as mutual trust builds. However, if your doctor turns out to be unpredictable and inconsistent, it will be hard to develop trust.

      One of the best ways to find a doctor is to ask for referrals from people you already trust. If you are not comfortable with your own personal physician but you happen to know someone in the medical field, that person could be an excellent referral source. Friends and relatives who have dealt with patients with cognitive problems themselves can be good referral sources as well. Chances are they went through their own vetting process to find their doctor, and they may be able to enlighten you about who’s out there and who might be a good fit for you.

Organizations for Finding a Doctor for Cognitive Issues

      The websites of the following organizations include links that can guide you to doctors in your area:

       • Alzheimer’s Association (www.alz.com). This national organization provides information on services, programs, publications, and local chapters.

       • Alzheimer’s Foundation of America (www.alzfdn.org). A nonprofit foundation supporting strategies that help lighten the burden and improve the quality of life of Alzheimer’s patients and their caregivers.

       • American Academy of Neurology (www.aan.com). This professional organization advances the art and science of neurology, thereby promoting the best possible care for patients with neurological disorders.

       • American Association for Geriatric Psychiatry (www.aagponline.org). A professional organization that is dedicated to enhancing the mental health and well-being of older adults through education and research.

       • American Geriatrics Society (www.americangeriatrics.org). A professional association that provides assistance in identifying local geriatric physician referrals.

       • American Psychiatric Association (www.psychiatry.org). A medical specialty society that works to ensure that mental disorders are accurately diagnosed and receive effective treatments.

      Another important referral source is your local university medical center department of psychiatry, neurology, or medicine, particularly geriatric medicine. Doctors affiliated with reputable academic medical centers are generally accomplished individuals with excellent credentials and experience. Local or national branches of professional societies like the American Psychiatric Association as well as national advocacy groups like the Alzheimer’s Association can also be useful referral sources. Members of these groups usually agree to professional and ethical standards set by the organizations, and they often provide continuing education to their members.

What to Expect at the Doctor’s Office

      When patients and their families come to me for help with cognitive issues, I take a systematic approach. I try to assess the clinical issues at hand, but I also need to gain the patient’s trust if we are to move forward together with a treatment plan. Educating people at the outset about what to expect is an important first step to building that trust—with both patients and their families. Unless the patient has very mild memory complaints, family members usually accompany them to the first visit.

      Following introductions, I explain what I hope to accomplish with them at the initial appointment. I also ask patients and their family members about their expectations so I can better understand what they want to accomplish. I describe the type of information that I need to obtain in order to understand the patient’s particular cognitive problems and plan a treatment strategy.

Summary of Assessment Procedures

       • Obtain a history of the symptoms from patients, caregivers, and family members. This includes the date of onset of problems, other medical conditions, СКАЧАТЬ