When to pursue a specialist opinion?

jzela

My mother is 71 and has increased episodes of repetition-repeating questions and activites.  At first they were directly related to higher anxiety periods such as when she is preparing for visitors or just generally concerned about someone or something.  Now they can happen without those prompts.  In addtion, she struggles with change, numbers, and can't navigate using maps.  Her PCP has not yet advised her to see a specialist.  There was some minor test adminstered during her last visit upon her request but according to her she only struggled with spelling a word backwards.

My father and sister and myself have seen this increase over the last two years from infrequent episodes to daily ones.  While my mother does navigate life without significant help, the family wonders what will come next and when.   My father at 75 is in decent health but has a fair amount of physical issues.  Fortunately his cognitive abililties seem fully intact.  He has had conversations with my mother about her condition but apparently her fear about it makes those difficult.  For example, she did not want him to join her at recent PCP visit.

Is now the time to get a specialist opinion?  I think I could convince my mother to pursue this if she knew there was a benefit. 

Or, do we simply wait another year and get the PCP's opinion during her next physical.

What can the specialist offer us now that might help or slow progression?  I think she currently lacks hope regarding her condition.

Thanks in advance. 

Quilting brings calm

Have her husband call the PCP and inquire who is listed in the HIPPA form. If he is, they can discuss the results of her prior visits with him and his concerns .  That means they can tell him what her test scores  really were.  Even if he is not on the forms, he and or you can tell them your concerns. 

My parents are no longer computer literate, so  I have helped them with the patient portals. My email is the one attached to the  portal, as is my phone for text messages.  I’m on the HIPPA form too.  Since they no longer use their patient portals, I do.  Therefore I can read all the visit summaries, test results, messages etc,  I send messages to the doctor - always  identifying myself as their daughter, so that they know.  Since I have been with them at appointments, No one questions it at all.  

Someone should go with her to her next appointment- even if she won’t allow you past the waiting area.  There are always forms  to be filled out - which my parents don’t want to do.  So I do it, with verbal input from them.  Any new symptoms,  mom?  Ok, you’ve  got arthritis, etc? Here this is your emergency contact form/ I’m listing me.   Oh,  here’s the places you need to sign.  They don’t care what the forms  are for  and they don’t look. 

The long term doctors know they need a patient advocate. 

DrinaJGB

Her PCP can perform a MMSE on her in the office---a series of 30 questions to gauge memory, executive functioning. Then PCP can refer to neurologist if appropriate.

Vitruvius

It can be important to get a better diagnosis. There are several conditions that mimic dementia but are treatable.

If it is some form of cognitive impairment it can also be important to narrow down the type. Medication for one type of impairment/dementia is not always good for a different type.

As others will surely add, now is the time to make sure all of the necessary legal documents are in place while your mother can still sign them. Trusts, wills, DPOAs, social security representative payee designation, etc.

Also establishing a support system for your father. As a 70 year old caregiver for my 70 year old wife with dementia  I can tell you this is the most important thing should it prove to be the early stages of dementia. 

jfkoc

You need to rule out anything that is treatable. Go online and search alzheimers diagnosis....there is a protocol that needs to be adhered to and a short list of questions is not much help.

M1

Jzela, absolutely you ad family members should make your concerns known to the physician, families are far and away more likely to pick up on early dementia symptoms, and the sooner the diagnosis is made the better, if any medications are likely to help it’s with early disease. Even if the doctor cannot respond directly to you because of Hippa restrictions, you can report what you’re witnessing and insist on neurology referral now. Don’t expect your mother to necessarily cooperate; read up on anosognosia.  You can get her to the appointment by using excuses like it’s now required by Medicare, or whatever it takes. Good luck-