For many adult children and spouses, it’s difficult to convince a parent or mate to stay current with the medical appointments needed for checkups and medication renewals. If specialists are required, that generally means more waiting, more testing, and more visits. All of these appointments are time-consuming and frequently frustrating, which all too often leads to delaying the appointments themselves.
Then we have issues involving the brain. The stigma of any health problem connected to the brainmay have improved over the years, but it has yet to disappear. The attitude that there is something particularly bad about diseases that affect the way a person thinks is particularly evident in the older population, yet the older population is where most dementia is found. For this reason, caregivers are often advised to take the loved one who may be having some potential cognitive issues to his or her primary physician as a first step.
The primary physician can often determine if medications or infections that can mimic dementia are present. Sometimes a physician will tell a patient that he or she likely has Alzheimer’s disease — and the doctor may be right. Family doctors may even prescribe medications. Often, however, they will refer the person to a specialist.
Why would someone need a specialist to diagnose dementia?
The Alzheimer’s Association definition of dementia helps to explain the need for a specialist to diagnose dementia:
"Dementia is a general term for loss of memory and other mental abilities severe enough to interfere with daily life. It is caused by physical changes in the brain. Alzheimer's is the most common type of dementia."
Alzheimer's disease (AD) may be the most common type of dementia, but AD is followed closely by vascular dementia, dementia with Lewy bodies (DLB), mixed dementia, frontotemporal dementia and many more types. Therefore, while your family doctor may correctly diagnose dementia, he or she may not have the background to correctly target treatment for a specific type.****
This is important because some treatments that are helpful for one type of dementia may actually be harmful with another. A specialist is likely the best person to determine if dementia is present and what type of dementia that may be.
Why are diagnostic mistakes made?
It's widely known that dementia is often misdiagnosed. Daniel C. Potts, M.D., fellow, American Academy of Neurology, told HealthCentral via email about the challenges of diagnosing dementia and determining the type:
Misdiagnosis and under-diagnosis are persistent concerns, particularly with lesser known conditions like Lewy Body Disease and Frontotemporal Dementia…. Early psychiatric and behavioral symptoms (such as psychosis, depression, and disinhibition) rather than the early short-term memory loss seen in Alzheimer's disease, contribute to the diagnostic challenges encountered with these diseases. I think we need to do a better job in our training programs for medical students and residents to both educate future providers about these diagnoses and grow empathy in trainees for the unique challenges encountered by persons with these conditions and their families and caregivers.
Dr. Potts makes it clear that even specialists can have a difficult time diagnosing dementia and determining which type exists. That being said, your primary physician does have some tools to help determine whether or not your loved one may have a cognitive disorder. These tests can help a family doctor decide whether or not further tests are necessary. If more testing is needed, then the doctor is likely to refer the patient to a specialist.
What tools can a primary physician use?
Examples of tools that are fairly simple to administer in the office setting are:
Self-administered geocognitive examination (SAGE): SAGE is a free pen and paper test that can be administered by your doctor or even taken in private by downloading it from the Ohio State University Medical Center website.
Number naming test: The King-Devick (K-D) is a two-minute test that has been used to determine the level of cognitive impairment for a number of diseases such as Parkinson’s and multiple sclerosis.
The person who is exhibiting dementia-like symptoms must see a doctor. Often the least stressful thing to do is make an appointment with this person’s personal physician. This is true not only because of the emotional factor that goes along with dementia stigma, but also because this doctor can test for issues that may cause symptoms that mimic dementia but which can be reversed. If the person's personal physician determines that more cognitive testing needs to be done, then a specialist should be the next step.