In the world of mild cognitive impairment, there are the haves and the have-nots.
And the difference in the care they are getting absolutely galls me.
There is so much that can be done these days to address MCI, and to potentially slow it, halt it or perhaps even reverse it. I see some people getting this high level of care. But I see others getting virtually no treatment at all.
Some people get a high level of care, but I see others getting virtually no treatment at all.
Partly, that depends on the answer to this important question. Have you been referred to a specialist in cognition and memory care?
Hi, I’m Tony Dearing of GoCogno.com, the website for people with MCI and author of the book, “I Want My Mind Back: The Go Cogno Approach to Halt or Reverse Mild Cognitive Impairment.”
That conversation came from a Facebook Live she did with me in a private group for people with MCI. Today, what I have to share with you is some great guidance from Dr. Papka on why someone with MCI really needs to be referred to a specialist, and ways to get that expertise. Here’s that discussion:
Tony: Now there are specific treatment guidelines for MCI, and one of the most fundamental of those says that if a primary care doctor sees that you’re having some kind of cognitive problem that deserves more looking, unless that physician is an expert in cognition, neurology, those areas, and virtually no primary care physicians are, that the person should be referred to a specialist. But many people aren’t being referred to a specialist. And that primary care physician isn’t really equipped to give them what you can give them, so talk a little bit about who the specialists are, what their background is, what type of specialist this person might be referred to, and if someone is listening and saying, “I didn’t get any of those things,” how do they ask for those things?
Primary care physicians and other physicians may feel uncomfortable or not adept at talking about cognitive impairment.
Dr. Papka: “So one thing that a person can do is specifically ask their primary care physician or the physician they’re seeing to be referred to a specialist. Because it may be that the physician doesn’t know anybody, but it may be that they really do and they have some sort of reluctance or resistance to bringing it up. So that’s one thing I would say if you really do have a physicians who you’ve been going to and you’re comfortable with, there’s no harm in asking.
“We know from some research that has been done that often times, primary care physicians and other physicians may feel uncomfortable or not adept at talking about cognitive impairment, either because they’re not comfortable making the diagnosis, they don’t have enough time, they don’t have the resources and they may not want to bring it up because it may be like opening a can of worms that they don’t then have the time, resources or expertise to follow up on.
“But if the patient says, ‘You know, look, I’m a little concerned about my memory or my cognition and I would like to go to a specialist. If you have someone who you would recommend, that would be great, otherwise I will try to find someone on my own, but I would love a referral from you,’ and that may just give that doctor an opportunity to make a referral.
Geriatricians, I find, tend to be really knowledgeable about cognitive disorders as people get older.
“But the first part of your question though is, who should you go to? There are different types of specialists who deal with these issues. So you could go to a neuropsychologist like myself. You could go to a neurologist, whether it’s a general neurologist or somebody who specializes in behavioral neurology. So if you do have access to specialists, that would be a good place. Geriatricians, I find, tend to be really pretty knowledgeable about cognitive disorders as people get older, and psychiatrists, particularly a geriatric psychiatrist would be a good resource.
“If you have access to a center, so there are centers at different academic medical centers, that’s a great place to start because these diagnoses and evaluations are multidisciplinary, so whether it’s done by everybody under the same roof or a network of private people, private practitioners who work together, expect to see multiple different specialists.
“So people who come to see me will see my colleague, who’s a neurologist and/or will see my colleague who is a geriatric psychiatrist. We’re also sending them to an imaging center so it’s not a one-stop shop. So you know you’ve gotten a comprehensive evaluation when you’ve had more than one consultation, appointment or data point to help diagnose the problem.
It’s not a one-stop shop. So you know you’ve gotten a comprehensive evaluation when you’ve had more than one consultation, appointment or data point to help diagnose the problem.
“And sometimes that can be frustrating, right? We all want to just, you know, we all want to go in somewhere and then do what you need to do and walk out with a diagnosis but that’s not what will happen in a comprehensive evaluation. We need different pieces of information, different types of specialists and different types of data to really put it all together and to study the patient and what’s happening with them in order to formulate a diagnosis.
“Other resources too, in addition to the academic medical centers, private centers, would be to contact for example, like a local Alzheimer’s Association. They often do keep lists of local resources. So the Alzheimer’s Association and organizations like those tend to be good resources.
“And also word of mouth. You know, if you have friends who have been experiencing something similar, I that that those could be good resources as well.
“And you know Facebook groups like this and other pieces of information on the Internet that you can verify.”
Tony: Thanks again to Dr. Papka for sharing these insights. I hope you found them helpful, and I’ll see you again next week. Until then, as always, be kind to your mind.