Misplacing keys, forgetting names or conversations and getting lost can happen to all of us.
It’s often due to stress, overwork, lack of sleep or generally feeling overwhelmed. But as we age, these may also signal the early stages of cognitive decline and dementia.
If you think you or a loved one may be displaying more than the usual signs of forgetfulness, it may be time to consult a doctor. But what kind of physician is best able to evaluate your cognitive abilities?
Your primary care physician is an obvious first choice, especially because they are familiar with your medical and family history, medications and general health. You may also want to consult a neurologist or geriatrician with expertise in cognitive and neurodegenerative disorders, says UCI Health neuropsychologist Hayley B. Kristinsson, PsyD.
What is cognitive decline?
Cognitive decline refers to a reduction in mental capabilities. It can happen with age but may also be caused by strokes, heart disease, kidney disease, liver disease and even some medications. Metabolic conditions such as diabetes and exposure to environmental toxins like heavy metals and solvents can also play a role.
Cognitive decline can sometimes progress to dementia. Dementia isn’t a single disorder but a term that indicates a person’s loss of memory, language, problem-solving or other thinking abilities that are severe enough to affect their daily life. Dementia can strike as early as age 50 and some symptoms resemble mental illness.
The World Health Organization (WHO) says about 55 million people worldwide have dementia and while it is common among older people, the WHO does not consider it a normal part of aging.
Of the five common types of dementia, Alzheimer’s disease (AD) accounts for 60% to 70% of cases globally. As the degenerative brain disorder advances, symptoms worsen and may include disorientation, confusion and behavior changes. Eventually, speaking, swallowing and walking become difficult. Although most people with AD are at least age 65, about 200,000 Americans under 65 are living with the disease.
How to find a specialist
“Most medical centers have information on their websites about providers and their specialties,” says Kristinsson, whose specializes in neuropsychological testing and cognitive markers to predict dementia. “If you are not sure who to make an appointment with, the neurology department can assist you in finding the most appropriate provider.”
You can also visit the websites of nonprofit organizations such as the Alzheimer’s Association for resources to help find the most appropriate services or providers. Another avenue may be reaching out to academic medical centers with expertise in treating cognitive disorders.
“Many of the providers at academic medical centers also do research, so you know you are getting the most up-to-date information and treatment,” she says.
Preparing for your doctor’s visit
One of the most important things you can do to prepare for your cognitive consultation is to line up a family member or friend to accompany you.
“Diagnosing dementia often requires a detailed clinical interview and if you’re having memory difficulties, it is helpful to have someone with you who knows you well and can offer information about your current functioning,” Kristinsson says.
You will also want to:
- Complete questionnaires or paperwork requested beforehand to help the doctor make the most of your consultation
- Bring any neuroimaging scans or other recent test results
- Write down any questions you may in advance to ensure you don’t forget to ask them during your appointment
Diagnosing whether a person is experiencing a decline in cognitive ability often requires neurological imaging and neuropsychological tests to assess various facets of cognitive and psychological functioning.
Kristinsson says people should be prepared to be asked lots of personal questions and may need to repeat their story to various providers.
“Questions may seem irrelevant at times, but dementia impacts all areas of your functioning and your provider needs sufficient detail to render an accurate diagnosis,” she says. “These types of evaluations are extensive but they are used to distinguish between different types of dementia and to aid in treatment planning.”
Treatment for dementia requires a multidisciplinary approach.
A patient’s care is generally led by a neurologist who specializes in memory disorders, but may also involve a primary care doctor, a physical therapist if balance or falling is a concern, as well as a neuropsychologist, sleep specialists and even occupational or other licensed therapists.
Depending on the type of dementia and where a patient is in the disease process, treatment may involve medications to slow progression of the disease and lifestyle changes.
“Neurodegenerative disorders are irreversible, so most treatment strategies are aimed at slowing the decline and helping the individual adapt to their current level of functioning,” Kristinsson says. “Treatment may also involve modifications of the patient’s living environment to ensure their safety or arranging for the help of caregivers.”
Patients diagnosed with dementia should also be cautious about trying alternative remedies without first consulting with their doctor, especially untested dietary supplements, which don’t require approval by the U.S. Food and Drug Administration (FDA).
“Many of these remedies have not undergone sufficient scientific research,” Kristinsson says. “A supplement may be called ‘natural’ but still contain powerful substances that have not met FDA standards. This can lead to adverse reactions when combined with prescription medications so make sure to check with your doctor before starting anything new.”
Patients and loved ones who care for them should also avail themselves of information and resources to help them better understand and prepare for further declines.
“Caregivers take on a great deal of responsibility and have to cope with watching their loved one decline as the disease progresses, which can cause significant stress,” Kristinsson says.
“I recommend seeking out caregiver support groups. The Alzheimer’s Association provides essential information for caregivers on their website that can help you locate local resources.”