A diagnosis of Alzheimer’s disease is daunting. You and those close to you will undoubtedly have a lot of questions about how to proceed and what kinds of specialists you will need to see going forward. Your healthcare team may evolve over time and you'll want to build a team that can support you as you move through the various stages of the disease.
Primary Care Doctor
In addition to being the first person you should see if you are having memory issues, your primary care doctor is usually the point person coordinating your treatment following a diagnosis of Alzheimer’s disease.
Historically, the diagnosis of Alzheimer’s disease is a diagnosis of exclusion, meaning your doctor will first want to rule out other medical conditions that could be causing memory problems. These include thyroid disorders, stroke, and brain tumor. Emotional problems such as stress, anxiety, or depression, can be mistaken for dementia so your doctor will want to check for these as well.
It’s not unusual for a primary care practitioner to order vitamin B12, thyroid, and magnetic resonance imaging (MRI) testing that can help rule out certain other conditions.
By ruling out other conditions, doctors or other specialists can obtain a diagnosis of probable Alzheimer’s disease with approximately 90 percent accuracy.
Importance of Getting an Early Diagnosis
Some people may be reluctant to go to the doctor when they notice problems — they may wonder if there’s any point in getting a diagnosis for a disease that has no cure. Or maybe they worry about losing their independence or fear not being able to care for themselves.
Today there is no cure for Alzheimer’s disease, but there are benefits to early detection.
To start with, the medications currently approved by the U.S. Food and Drug Adminsitration (FDA) are more likely to be helpful early in the disease process.
“Early intervention can delay progression to dementia if you have mild cognitive impairment,” says Marwan Sabbagh, MD, director of Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas. “We know that you can actually slow the rate of progression of the disease with aggressive multitargeted interventions, including traditional pharmacological therapies and lifestyle interventions, and we also give mild patients early access to clinical trials and research,” Dr. Sabbagh adds.
For many, getting a diagnosis can also be a relief. “In my experience, the vast majority of patients want to understand what is going on,” says Jonathan Graff-Radford, MD, a behavioral neurologist at Mayo Clinic in Rochester, Minnesota. “It’s important to get a diagnosis as soon as you can so you can make plans for what might happen in the future,” Dr. Graff-Radford adds.
The Alzheimer’s Association advises you to see your primary care physician as soon as you notice certain early warning signs and symptoms, including:
- Memory loss that disrupts daily life
- Difficulty completing familiar tasks
- Misplacing things and losing the ability to retrace steps
- Trouble following or joining a conversation
The Office of Disease Prevention and Health Promotion recommends seeing your primary care practitioner (PCP) at least once a year to screen for things such as high blood pressure, blood sugar, or cholesterol. Some primary care doctors might also perform cognitive impairment assessments as part of their examination but this is not always the case. This is why it’s best for you to be sure to alert your doctor if you are experiencing cognitive issues.
As gatekeeper to your healthcare and medical history, your primary care doctor initiates diagnostic workups, refers you to specialists when necessary, and coordinates treatment going forward for your Alzheimer's disease and any other medical conditions that you may have.
RELATED: Early Signs and Symptoms of Alzheimer's Disease
Neurologist and Neuropsychologists
Your primary care physician may refer you to a neurologist. A neurologist is a medical doctor who specializes in diagnosing, treating, and managing disorders of the brain and nervous system, such as epilepsy, migraine, stroke, Parkinson’s disease, and Alzheimer’s disease.
If your primary care doctor sends you to a neurologist as part of an evaluation to determine a diagnosis, he or she will test your mental status, vision, speech, strength, sensation, coordination, and gait.
As part of your standard medical workup for Alzheimer’s disease, your neurologist may order brain imaging or tests, such as MRI or computerized tomography (CT). These tests are primarily used to rule out other conditions that may cause symptoms similar to Alzheimer's but require different treatment. These tests can reveal tumors, evidence of large or small strokes, damage from severe head trauma, or buildup of fluid in the brain.
Another Alzheimer’s doctor you may also see is a neuropsychologist. While a clinical psychologist mainly focuses on behaviors and emotions and therapy for related concerns, a neuropsychologist is a psychologist who specializes in the brain’s cognitive functions, such as attention, language, and memory.
If you are experiencing difficulties or changes in thinking, memory, speech, personality, or other behaviors which are significant enough to interfere with your daily life, you may benefit from seeing a neuropsychologist.
During your appointment, you may be interviewed by the neuropsychologist and a psychometrist (a specialist who administers psychological and neuropsychological tests), who may ask you to perform a number of tasks to measure your memory, concentration, problem-solving, and language skills.
Generally, the neuropsychologist will interpret the test results in the context of your medical history, providing information about your abilities in different areas of cognitive functioning. The summary will be sent to your primary care doctor. Testing can provide a reliable baseline for tracking changes in your cognitive function over time. It can also be used to help guide further medical decisions such as whether you need other specialized tests or medication.
A geriatrician is a primary care physician who specializes in treating conditions that affect older adults. A geriatrician may be a valuable member of your Alzheimer care team because he or she can collaborate with your primary care physician to help manage age-related health issues, including ones that may or may not be related to an Alzheimer’s disease diagnosis.
Geriatric psychiatrists specialize in the emotional and behavioral conditions of older adults. A geriatric psychiatrist may be consulted to help manage behavioral symptoms associated with dementia.
These symptoms include sleep problems, anxiety, agitation, paranoia, depression, hallucinations, and anger. In general, geriatric psychiatrists are more focused on addressing specific symptoms than the long-term care of the disease.
A geropsychologist is a psychologist who provides counseling or therapy sessions to the geriatric population. Geropsychologists focus their practices on issues relevant to the psychological, emotional, sociological, neurological, physical, and mental health issues of the elderly.
Many older adults with dementia have anxiety and depression. According to the Alzheimer’s Association, up to 40 percent of people with Alzheimer’s disease experience significant depression. A geropsychologist may work with an individual one-on-one, or with the family members separately or work with the family and patient together.
What Are Memory Clinics and Centers?
Memory centers are essentially a one-stop shop for everything a patient and their family may need living day to day with Alzheimer’s disease. These clinics offer a multidisciplinary, comprehensive approach to care.
At these clinics you’ll find a number of specialists, including behavioral neurologists, neuropsychologists, and geriatricians. These centers provide comprehensive diagnostic and treatment services for Alzheimer’s disease and other types of dementia. These centers also offer access to physical and occupational therapists and social services.
Your primary care doctor may be able to refer you to a memory clinic in your area. Many large hospitals and medical centers have memory disorder divisions.
You might also find helpful information through the Alzheimer’s and Related Dementias Education and Referral Center (ADEAR), a service of the National Institute on Aging (NIA), which funds Alzheimer’s Disease Research Centers (ADRCs) at major medical institutions across the United States. The ADRCs offer help with obtaining diagnosis and opportunities to volunteer to participate in clinical trials in addition to other services. You can find a list of ADRCs on the NIA website.
How to Choose the Best Healthcare Team
Your primary care physician can help you assemble your healthcare team and refer you to specialists for further evaluation and treatment as needed.
There are many primary care doctors who are comfortable with treating dementia, says Graff-Radford, “This is especially true if they see a lot of older patients who have been diagnosed with Alzheimer’s.”
Questions to Ask as You Put Together Your Alzheimer’s Healthcare Team
Naturally, you and your family will have a lot of questions for your doctors when you’ve been diagnosed with Alzheimer’s disease. You’ll want to understand all the treatment options that may be available.
You’ll also want to learn about all the risks and benefits of each option as your treatment plan evolves.
The following are examples of questions you may want to ask your primary care doctor or any specialists you may see:
- What is the usual course of Alzheimer’s disease?
- How long can a person with Alzheimer’s disease expect to function normally?
- What treatment options are available?
- What do you suggest would be the best treatment for me?
- If I take medication for my symptoms, how will you evaluate if it is working?
- What are the side effects of the currently available medications?
- At what stage of the disease might you suggest I stop taking medication?
- What clinical trials are available and how can I find out if I am eligible?