Best type of doctor

Lgb35 · July 19

we are in the earlier stages of this journey and as I read messages from those of you much further along, I wonder what kind of doctor is your go to when things come up? Do most of you use your primary, a neurologist or geriatric psychiatrist?

jfkoc · July 19

All three. Together, with you, you are a team.

HollyBerry · July 19

It depends on what you have access to and what the person needs. We're in a city with a University Hospital with a geriatrics clinic. We could shift primary care to someone in that group if we wanted to, but haven't, so primary care/internal med takes care of most health problems, geriatrics manages AD, and the geriatric psychiatrist is connected with both. My mom, who also had dementia and lived here at the end of her life, only had a primary. When she moved here, we decided to wait and see what she actually needed and it turned out that opthamology was the only specialty that internal med couldn't handle.

trottingalong · July 19

We live in a remote area, with few doctors, no specialists and a small hospital. We have to rely on a GP who knows little about dementia of any kind. There are no geriatric psychiatrists within hundreds of miles. The nearest neurologist is 130 miles away on difficult roads.

jfkoc · July 19

Wow…how did you even get a diagnosis?

I imagine the internet is especially helpful to you.

Bill_2001 · July 19

I use our primary care physician and this forum. In general, the medical community is not nearly as helpful as you all here.

FTDCaregiver1 · July 19

I eventually settled on a geriatric psychiatrist and meet via zoom.

SDianeL · July 20

initially I contacted my husbands PCP & asked for a referral to a Neurologist. He also referred him to a Neuro Psychologist for testing. The Neurologist ordered the scans. After the diagnosis I kept both his PCP & Neurologist updated at least monthly online with his new behaviors. When it was time to start medications for hallucinations & agitation, the Neurologist referred him to a Geriatric Psychiatrist who is better able to manage medications for Alzheimer’s & Dementia.

harshedbuzz · July 20

I live in an area that is well served medically. With dad, we relied on the team at the university memory center for the diagnostic piece. His situation was that mom was in denial and waited for the shoe to drop to allow addressing dad's cognitive shift. Our initially access point was the ER in a psychotic episode.

Since dad had significant behavioral symptoms, he saw a geriatric psychiatrist who was probably the most important person on the team after mom. Once he had the comprehensive evaluation, the MC appointments seemed pointless— they were an hour away, the docs had nothing to offer and the visits triggered dad's agitation. His PCP managed most of his care. We did drop the majority of dad's specialists (retinal specialist, cardiologist, allergist, gastro) within a year of his diagnosis keeping only urology (prostate cancer) and pulmonology (COPD and OSA).

I'm starting the process of evaluating my mom. She's more cooperative, so we're able to start with her PCP who ordered bloodwork and imaging. The imagining shows some atrophy and small infarcts but nothing "remarkable" given her age. The bloodwork did show Lyme Disease which can cause cognitive issues. It's been treated and things seem a bit improved around memory but not word finding and executive function (she has ADHD, so her EF baseline is not typical to begin with). We have a referral to the MC and are waiting for an appointment in about 6 months.

HB

mrahope · July 20

As many have said, we began with our PCP. He was able to rule out many other potential causes of my DH's memory/cognitive issues. We also saw a neurologist, who ordered neuropsychological testing and confirmed the presence of mild dementia Then we moved to our current location (more rural) and encountered long waits to see all types of specialists. It took over 3 months to see a neurologist and 6 months (plus two referrals) to see a geriatric psychiatrist. By the time we saw the geriatric psychiatrist, I was very close to placing him. The best help we got was from the neuro and geripsych being willing to sign the forms to activate his admission to MC. Moral of the story: if these professionals are easily available, by all means use them, but if not, trust your gut and your day in-day out experience, too.

Crkddy · July 20

Started out relying on a very good neurologist, who made the diagnosis and prescribed the first meds. Then got passed around to a couple of different neurologists in the same clinic, and really was not getting any benefit. Got a referral to a geriatric doctor by her PCP but was unable to get an appointment due to availability of resources. After about 5 years, just decided to see only the PCP and let her handle all the meds previously prescribed by neurologists. This has worked out ok thus far. She is very responsive and easily accessible via email. DW has been hospitalized and been under hospice care (though no longer) and was prescribed meds on these occasions as well.

midge333 · July 20

I think your PCP is really important. I would start with a good general internist. Neurologist for the diagnostic work up and geriatric psychiatrist for antidepressant/antipsychotic medication management. Toward the end stages, a palliative care doc can be very helpful. Obviously, all these practitioners may not be available to those living in a more rural setting which makes having a good general internist even more important.

Jazzma · July 20

https://alzconnected.org/discussion/69942/best-type-of-doctor

We worked with his PCP for about 7 years, then were referred to a neurologist who made the diagnosis. After reading comments on here I tried to locate a geriatric psychiatrist but there are few in this area and I couldn't even get a call back from their offices. We tried another neurologist who turned out to be fantastic, she spent a lot of time talking with both of us and explaining options, encouraging us to try different timing for dosages to address his behavior. When she moved on, she gave us some recommendations but also explained that many neurologists will not address behavioral issues — they will ask you to see a psychiatrist. Hoping for the best for you.

LaneyG · July 22

we initially started with a neurologist who did or ordered all the testing. Once that was done and we had a diagnosis, she prescribed a couple of meds which might slow down progression. She has been pretty useless since. I’m seriously considering just dropping her. I agree that a geriatric psychiatrist is most helpful for management of the disease from a behavioral perspective. BUT make sure the doctor has plenty of experience with managing dementia.

Sherry LD · July 22

https://alzconnected.org/discussion/comment/216613#Comment_216613

We are in the Same position. Neurologist did work up and prescribed medication. Now wants to see my DH every six months…. Why? They aren’t doing anything else for him.

Anna2022 · July 22

We are in Central Texas. We have a geriatric psychiatrist (who did the MOCA, MRI, PETScan yet can't give a definitive diagnosis but offered meds - DH refused) and a PCP (who has access to the Geriatric Psych records via a written release).

CindyBum · July 22

We have had a neurologist, a GP and a geriatric psychiatrist on board. And, in where we live, a neuropyschiatrist is who does the assessment for a dementia/or not diagnosis.

The neurologist has largely been unhelpful and annoyed to have to deal with us. The GP was able to manage depression meds and is kind. I've leaned in a bit more with the geriatric psychiatrist, but truly only for medications. There is absolutely no talk therapy happening or other kid of support. Most have been for medications. I'm most grateful for the antidepressants from the GP and the anti-anxiety meds from the geriatric psychiatrist.

Sherry LD · July 22

https://alzconnected.org/discussion/comment/216675#Comment_216675

same- We have a PCP that he has been going to for about 40years. Will have her refer for any other doctors we need

Lgb35 · July 22

thank you all for the input. We have seen a neurologist for work ups and initial prescription for aricept. Our pcp has taken over that med and we were thinking of not going back to the neurologist since they are a 4 hour drive from home. My main concern was what happens down the road if we run into behavioral problems. I didn’t know if I should get established with a Geri psych now or not

M1 · July 23

Lgb, i would definitely pursa referral for geri psych sooner rather than later. There may be a long wait, and that way at least you'll have an established relationship. Chances are better than 50% that you'll need it at some point.

LaneyG · July 23

I totally agree with M1.

Best type of doctor

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