If you or a loved one is showing potential signs of age-related cognitive decline or dementia, you may want to seek help but not know the right type of health care provider to choose.
That’s partly because there’s more than one.
In fact, diagnosing and treating cognitive decline, Alzheimer’s disease and other forms of dementia requires an interdisciplinary approach, says Hayley Kristinsson, a neuropsychologist with UCI Health in Orange, California. This means that many patients will need support from more than just their primary care physician or a neurologist.
Here’s what you need to know about finding the right mix of health care providers to help you or a loved one live better with dementia.
Seek Providers With Expertise in Dementia
Dementia is more than just occasional absentmindedness. It’s a very real, progressive brain disease that currently has no cure.
If you suspect that you or a loved one may be in the early stages of dementia, your primary care physician should be your first point of contact for testing and diagnosis, according to Dr. Mark W. Albers, assistant professor of neurology at Harvard Medical School in Massachusetts.
Once you or a loved one is diagnosed with a type of cognitive impairment, you’ll want to start building a multidisciplinary care team that may include several of the following specialists:
— Geriatrician. This type of doctor focuses on treating the needs of older adults. Some offer primary care and may be referred to as a geriatric primary care provider, while others focus on specific issues that are common among seniors, such as dementia and cognitive decline.
— Neurologist. This specialist focuses on treating diseases based in the brain and nervous system. Some treat only a specific type of dementia, while others treat a wider range of disorders and conditions. “Neurologists are often the primary diagnosticians” in cases of dementia, Kristinsson says.
— Neurodegenerative disorder specialist. Doctors who specialize in the treatment of neurodegenerative diseases such as Parkinson’s, ALS or Huntington’s disease may also be key players on your care team. Diseases such as Parkinson’s can trigger dementia-like symptoms, and getting to the root cause of the problem can lead to better outcomes.
— Sleep specialist. Sleep disruptions often arise with dementia, so a sleep specialist can test for this and provide a treatment plan to improve sleep.
— Physical therapist. A person experiencing cognitive decline or dementia might experience balance issues or a loss of confidence in their physical abilities, which leads to an avoidance of exercise, Albers says. “So, I end up having some people see a physical therapist to try to help them with their walking so they feel more confident.”
— Occupational therapist. These therapists can conduct formal driving evaluations, as the patient’s ability to drive and perform other tasks of daily living decline. They can also help patients learn to manage mobility issues or loss of function related to activities of daily living.
— Mental health professional. A social worker, clinical psychologist, licensed therapist, psychiatrist, neuropsychologist or related mental health professional can address mood disruptions and other behavioral concerns that often accompany dementia. They can help you or your loved one learn new coping strategies or otherwise come to terms with the changes you’re experiencing if they’re troubling you. A psychiatrist may be able to offer medications for depression or anxiety to further support mental health.
— Dietitian or nutritionist. Because lifestyle factors have been shown to be effective in slowing the progression of cognitive decline and dementia, you may want to seek out a dietitian-nutritionist to help you adjust your diet. “A physician can cover (nutrition and dietary changes) at a high level, but to sit down and go through what you eat in a week and make concrete suggestions about helpful substitutions — that’s a nutritionist,” Albers says.
— Other health care professionals. Depending on the diagnosis and prescribed treatment plan, you may also encounter a range of nurses, therapists, social workers, counselors and other related health care professionals. The entire team is intended to help people with dementia age better and slow or stall the progression of their disease.
[Related:8 Questions to Ask a Geriatrician at Your First Appointment]
With a dementia care team, bigger is better
Large health systems or university-based hospitals may offer a broader network of specialists to work with than smaller hospitals or private clinics, says Dr. Douglas Scharre, director of the division of cognitive neurology at the Ohio State University Wexner Medical Center in Columbus. Bigger, more integrated facilities can also provide greater access to clinical trials and newer treatment options, which can be a positive for patients.
“Physicians involved in clinical trials for cognitive disorders are often at the cutting edge for diagnosis and treatment,” Scharre says.
The National Institutes of Health provides a searchable list of all ongoing clinical trials.
[Related:Signs It’s Time for Memory Care]
When to See a Doctor for Changes in Cognition
Albers says the symptoms of cognitive decline can start subtly and may be noticeable only to the patient at first. This stage is called subjective cognitive decline, in which the person senses they’re having some issues with short-term memory and word-finding, particularly with proper names.
Visual perception problems, such as confusing similar-looking words or reversing letters or numbers, for example, may also emerge, Albers says. But many people can still work around these problems and carry on almost normally.
As cognitive impairment progresses, these symptoms become more problematic.
“Once the patient can no longer compensate and they’re having difficulty performing their daily functions either at work or at home, that’s where you’d cross over into what’s considered dementia,” Albers says.
This tipping point is highly subjective and often depends on the type of work a person does. Albers gives the example of a courtroom lawyer who must choose the right word at the right time while also being able to pivot arguments in an instant based on evidence that’s just been presented. People with those kind of cognitively demanding jobs may notice declines much sooner than people who can work from notes or use other strategies to work around cognitive shortfalls.
Regardless of the type of job you have, if you notice changes in cognition, it’s important to see a doctor before symptoms begin interfering with your life.
[See: Preventing Dementia and Alzheimer’s: 8 Habits to Reduce Your Risk]
How Do You Get a Dementia Diagnosis?
During your initial visit, your primary care physician will take a complete medical history, family history, social history and current medication list and review any loss of abilities to perform day-to-day activities, Scharre says. He or she will also perform a physical exam and administer a cognitive assessment.
Scharre has developed a self-administered gerocognitive exam called SAGE (gerocognitive refers to cognitive ability as one ages) that patients can take at home and bring in to the office for scoring. MoCA — the Montreal Cognitive Assessment — is another common test your doctor may use.
If there is evidence of cognitive impairment or cognitive decline by history and/or cognitive assessment, then the physician will likely order lab tests to look at levels of various compounds in your blood, such as cholesterol and B12, and markers that indicate how well your liver and thyroid are functioning, Scharre says. This helps rule out whether a condition like liver disease or a thyroid imbalance could be causing your symptoms.
Beyond those blood tests, your doctor may also order a CT scan or an MRI. These two noninvasive imaging tests offer a view of structures inside the brain that may indicate Alzheimer’s and other forms of dementia.
“These evaluations should result in a diagnosis,” Scharre says.
Sometimes, however, it’s not so clear cut. Your doctor may refer you to a neurologist or cognitive specialist for further testing and for care after a diagnosis has been made.
Come prepared for your visit
Before your first appointment, assemble a list of all your medications and their dosages and frequency. You should also fill out any questionnaires or paperwork the doctor has requested prior to your visit.
“The more information your doctor has, the better equipped they will be to treat you,” Kristinsson says.
When you’re seeking care for dementia, you’ll likely be asked many personal questions and need to repeat your story several times to different providers.
“Questions may seem irrelevant at times, but dementia impacts all areas of functioning, and your provider needs sufficient detail to render an accurate diagnosis,” Kristinsson explains.
Bring a loved one
Don’t go alone to the initial doctor visit.
“In our clinic we require patients to bring a caregiver or somebody,” Albers says. “The other word we use, which is kind of awkward, is an ‘informant.’ Often, it’s the spouse and/or kids. But somebody else who can provide an outside, independent perspective on what they’ve noticed over time.”
This individual is critical to helping doctors arrive at an accurate diagnosis because they can often provide more details and specifics about the cognitive problems than the patient can themselves.
“In this field, the story, the history is so important, and the patient is doing their best to give you the best history they can. But particularly among people with memory problems, it’s inherently going to be problematic,” Albers says.
Early Intervention Makes a Difference
Although many people assume that dementia or cognitive decline is simply part of getting older, it doesn’t have to be.
“Increasingly, with more research on aging, we are learning that successful aging really doesn’t involve this degree of decline,” Albers says. “I think we’re redefining what is considered normal aging and what our aspirational goal ought to be.”
Intervening early, at the first signs of cognitive decline, can make a big difference in your quality of life. While dementia is irreversible, there are treatments that can slow the progression of the disease.
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What Type of Doctor Treats Dementia and Cognitive Decline? originally appeared on usnews.com
Update 01/10/25: This story was previously published at an earlier date and has been updated with new information.
