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Working with your Doctor - Specialist Referrals - DementiaGuide.com
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Working with Dementia

Specialist Referrals

After the diagnosis of Alzheimer's disease , many people wonder whether or not they should see a medical specialist . For the most part, a family physician is able to effectively manage and treat the disease, but there are circumstances when the expertise of a specialist is recommended.

Rockwood et al. (source: Who should be referred for dementia consultation? Geriatrics Today: Journal of the Canadian Geriatrics Society 2005; 8: 8-12). suggest the following circumstances for when to see a specialist:

1) Atypical presentation

  • Showing symptoms or signs are not common for most typical cases of dementia
  • When there are symptoms to suggest another important illness (normal pressure hydrocephalus , Creutzfeld-Jakob disease, dementia with Lewy bodies )

2) Counselling family members when familial Alzheimer's disease is being considered

  • Early onset of Alzheimer's disease runs in families
  • A high risk for heritability may prompt the need to inform the rest of the family

3) Potentially reversible dementias

  • Uncommon
  • Has recognizable characteristics

4) Concern about co-existing depression in dementia and other behavioural and
psychological symptoms

  • In the early stages , depression and dementia can occur at the same time and telling them apart can be difficult
  • Family physicians may want a more detailed follow-up with depressed patients, so they refer them to an expert in the field
  • Failure to respond to an antidepressant also warrants a referral to a specialist

5) Treatment problems or failures

  • Early experience with treatment demonstrates that the signs and symptoms do not get better
  • Some symptoms improve while others worsen
  • Failure to respond to anti-dementia treatment

6) Assessment of competence , including driving

  • A specialist can determine whether the person you care for is able to make a decision when making a will, executing financial decisions or making decisions about future health care and living arrangements
  • Issues are better addressed ahead of time
  • A specialist such as an occupational therapist can provide driving assessments
  • Specialists protect society's safety by deciding whether the Alzheimer's patient is capable of driving without causing harm

7) The opportunity to enroll patients in research studies

  • Referred to specialist memory clinics for enrollment in research studies
  • Some evidence suggests that patients can benefit from participation in research studies

If none of the circumstances described above are present in the person you care for, it is likely their family doctor will be able to successfully manage their disease. If some of these circumstances are present, there are four main types of medical specialists that the person you care for may be referred to: Family physicians who have a special interest in the care of elderly, psychiatrists, neurologists and geriatricians. They are able to give advice when the family doctor needs additional information on the diagnosis of the disease. Psychiatrists are most interested in patients with both dementia and depression. Neurologists are involved when a patient has dementia as well as signs and symptoms of other cognitive impairments such as Parkinson's disease . Geriatricians deal with patients with dementia and co-existing medical problems.

See Also:
About Dementia > Types of Dementia > Dementia with Lewy Bodies
About Dementia > Types of Dementia > Creutzfeldt-Jakob Disease
About Dementia > Working with your Doctor > Specialist Referrals
About Dementia > Working with your Doctor > Getting Involved in Research
About Dementia > Alzheimer's Disease > Early Onset versus Late Onset
Symptom Library > Everyday Activities > Driving
About Dementia > Treatments for Dementia > Counselling
About Dementia > Types of Dementia > Normal Pressure Hydrocephalus
Symptom Library > Everyday Activities > Financial Management
About Dementia > Alzheimer's Disease > Depression
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Last updated December 7, 2018
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