Who should be on the care team?

JMack88

So a while ago now, my mother's geriatric doctor diagnosed her with "mild cognitive impairment."  He diagnosed donepizil.  Since mom is very healthy otherwise for her 83 years, we only see him twice a year and he's always astounded how well she's doing other than her mind.  According to him, mom's dementia is "proceeding as expected."  My sister and I watch out for her and I work from home so I can be with her most of the time.  She has eye doctors and a dermatologist and a dentist in addition to her primary care geriatric physician.  She is a cancer survivor and has had back surgery twice in her life due to a disc that collapsed.

She has arthritis which she complains about at home but as soon as the doctor asks her, she denies having pain.  

I'm wondering if a neurologist, rheumatologist, or any other type of physician should be added to our care team.

Marta

What would be your goal in adding someone else to the team?  Once you articulate that, it would steer you in the direction you should go. 

There is no “should” as far as who should be on the team/ it depends on the individual. 

One person you may add if behaviors become unmanageable is a geriatric psychiatrist. 

Quilting brings calm

As long as her symptoms are being managed by the present team, you are good.  At some point her PCP might not feel comfortable managing her symptoms and  then you might add a neurologist and a psychiatrist.   Mom’s NP in the Neurology area has her on donepizel  ( which you’ve already done).  Otherwise she just gives her an MMSE test and checks her balance each visit.  Mom goes to a psychiatric clinic and gets medication for anxiety and depression. The PCP might do that for your mom if you mom exhibits those symptoms.  Those symptoms can make the cognitive decline seem worse than it is  

Mom’s neurology NP only does memory issues,  and Mom has been diagnosed with neuropathy - which may be a symptom of the cognitive decline. So she now has a neuropathy specialist.  

Elio52

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harshedbuzz

JMack-

There is no one-size-fits-all team. It will depend a great deal on your LO's overall health and how their dementia presents. Dad was seen at a well regarded memory center that had no more to offer him beyond the initial diagnosis than what my friend's mom got from her PCP. For us, the geripsych was the most important part of the team aside from my mom. 

With the progression on the dementia, it may be time to rethink medical care. As dad progressed to the mid-stages where he (aged 82) needed more supervision, we moved to a more palliative model of care. We jettisoned some of his specialists-- his retinal specialist, the derm's annual skin checks, cardiology but kept others-- his pulmo and urologist. We kept the pulmo because dad had COPD and mild pulmonary fibrosis and needed a specialist to keep his breathing as comfortable as possible. We kept the urologist because dad had a recurrence of prostate cancer and we were hoping treatment would avoid it moving to his bones and risking a fracture; this was a twice yearly injection so small potatoes really. We looked to preserve quality of life rather than prolong it. 

With dad, we didn't automatically agree to any testing. I found it useful to consider what we would do with the information obtained from testing and procedures before agreeing to even minimally invasive screenings. 

HB

Jack90

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serenac

Hi JMack88! 

It's a great question - I have struggled myself in getting the right folks on my friend's care team. I came across a great resource last month and thought it might be helpful to you as well: https://remo.health/learn/articles/18/getting-the-right-players-on-your-dementia-care-team

It's important to know who does what and this helped me without being overwhelming.