Dr. Janet Dawson on how to talk to your doctor about dementia

Dr. Janet Dawson is a member of the Dementia Network Calgary and a clinical assistant professor of medicine at the University of Calgary. A family physician with a focus on seniors’ health, Dr. Dawson is also interested in ethics, chronic disease and integration of medical problems. Here, she gives some examples of a conversation with your doctor about a potential dementia diagnosis.

That first conversation about possible dementia between doctor and patient can be difficult. Many people and families fear a dementia diagnosis and would rather ignore the problem; others may not know how to describe symptoms like memory loss or confusion. Talking to your doctor can help build understanding of what to expect.

Q  |  Is it possible that the symptoms are caused by a treatable condition?

A | There are several diagnoses that can cause cognitive impairment and, unlike dementia, might be treatable. Sometimes a medical condition such as depression or delirium can affect cognition. Patients should be assessed by a health practitioner who takes a medical history, does a physical examination and organizes tests before settling on a dementia diagnosis.

Q  |  What tests are available?

A | Lab tests are ordered to rule out conditions such as a low-functioning thyroid. Further investigation based on symptoms and signs, called the clinical presentation, may lead to diagnostic imaging—a CT scan or MRI—to look for structural abnormalities such as a stroke, tumour or normal pressure hydrocephalus (NPH). In a small number of patients, a PET scan or a SPECT scan might be ordered to look at patterns of abnormal neurological function which can assist with diagnosis. In some cases, neuropsychological testing is done.

Q  |  What kinds of changes should I expect to experience? How quickly will the dementia progress?

A | There are some common patterns, but in general doctors can’t predict exactly which brain functions will decline when. This can be frustrating for patients and families. We talk to patients and families about how dementia gets worse over time, but we don’t know how quickly that will happen, and we don’t know which cognitive abilities will be impacted most.

Q  |  Is there anything that can be done to slow the progression of symptoms?

A | Most people understand that there is so far no cure for dementia, but it’s important to have a discussion about what you can do to help. It is important to treat risk factors that might increase the risk of stroke, such as high blood pressure and diabetes. Exercise, social interaction and mental stimulation are helpful to mitigate symptoms. Avoid harmful substances to the brain such as alcohol. For some of the dementias, such as Alzheimer’s disease, medications called cholinesterase inhibitors are sometimes offered to help treat symptoms or stabilize the decline, which can improve quality of life for a year or so.

Q  |  What kind of support is available and how do I access it?

A | Your first contact should be with your family doctor. If indicated by the clinical presentation, your doctor can refer you to specialized services such as geriatric assessment services, neurologists or geriatric psychiatrists. Specialists usually do not provide continuing care. Helpful resources such as Home Care, support groups, day programs and educational services are available. The Alzheimer’s Society has a program called First Link for patients with a new diagnosis. Dementia advice is available through Health Link; dial 811.

Sometimes it’s uncomfortable to talk about cognitive concerns, but a trusting relationship with doctors and health care providers can lead to understanding. It is helpful to have a family member or significant other accompany you to discuss issues. “As a primary care physician, when people raise concerns you try to see what their worries and fears are,” Dr. Dawson says. “In practice, most of the time their family and friends are also aware of cognitive changes. One has to balance the autonomy of the individual, if they are not ready to share information, with safety concerns.” [ ]

Differentiating the Doctors

Gerontologist 

A specialist in the psychological, social and biological aspects of aging. Gerontologists may be caregivers, policy-makers or researchers.

Geriatrician 

A medical doctor specializing in the health problems of the elderly. 

Neurologist 

A medical doctor who specializes in the central nervous system, specifically the brain and the spinal cord. 

Neuropsychologist

Deals with how the brain influences cognition and behaviour.

GP, or General Practitioner 

Your family physician, who can refer you to any of the above specialists and services. Some GPs have extra training in care of the elderly.

Share your questions with us at feedback@dementiaconnections.ca.