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When it comes to cognitive decline, primary care physicians are the front lines of detection and patient education.
No one likes to talk about dementia. It encompasses disturbing images of the loss of control, the loss of self and, of course, the frightening endgame of fatality. But patients need to be encouraged to discuss dementia, and primary care physicians (PCPs) play a special role in normalizing that conversation. PCPs also have the opportunity to educate patients about the benefits of awareness and lifestyle changes.
Patients can experience extreme fear and stress when confronted with the topic of cognitive decline, especially if they’ve experienced its progression in a family member or friend. Unfortunately, misunderstandings and myths about the vast family of cognitive conditions abound, so PCPs need to be well-versed in how to respond.
The good news: Greater understanding and social acceptance has brought the topic of dementia to the fore in recent years, says Keith Fargo, director of scientific programs and outreach at the Alzheimer’s Association. “It’s getting easier to have these conversations.”
PCPs are the front lines in detecting and documenting cognitive decline. Even if patients are referred to a neurology specialist, it’s still important for the PCP to follow up with regular screenings every 6-12 months and speak to family members about the importance of ongoing observational notes in partnership with regular office visits.
Here are six myths about cognitive decline:
Although Alzheimer’s is by far the most common form of cognitive decline, it’s just one type. Most patients have little or no comprehension of the 100-plus other types of cognitive decline, including conditions caused by vitamin deficiency, excessive alcohol use, thyroid problems and head injuries, according to the National Institutes of Health. Other conditions also can cause symptoms that mimic dementia, such as adverse drug reactions and urinary tract infections.
Not so. Alzheimer’s-related dementia usually strikes patients aged 65 and older but several other types, including early-onset, can strike patients in their 40s or even earlier and is therefore often misdiagnosed, notes the Mayo Clinic. PCPs should never ignore patient-reported symptoms of memory loss or decision-making problems regardless of age, since any form of cognitive problem needs to be explored.
This is a tough one for clinicians to explain, because while simple forgetfulness can be a normal attribute of aging, forgetting other things are not. One of the most patient-friendly explanations comes from Nicole Absar, MD, neuropsychiatrist and behavioral neurologist at Integrace Copper Ridge Neurocognitive Clinic, who spoke on neurocognitive disorders at the Spring 2017 Memory Care Forum in Philadelphia. “If I forget where I put my car keys, that could be normal forgetfulness. But if I forget what my keys are for, that could be dementia,” she said during her presentation.
While this is true for many types of cognitive diseases, some types of cognitive decline have nothing to do with the memory center of the brain. Some, like frontotemporal disorder, involve the brain’s executive decision-making centers and have more to do with language aphasia than memory.
Actually, it depends on the exact diagnosis, which is why specialists often request brain imaging, cognitive testing and other diagnostics. Some manifestations of cognitive decline point to specific physical issues that may be reduced or even reversed though lifestyle changes. Other types can benefit from medications that can slow progression and/or improve quality of life. It all depends on an accurate diagnosis, and the PCP is often the first point of contact in that exploration.
Alas, the Internet is chock-full of sites that tout dietary and medicinal “aids” for cognitive decline. PCPs should explain to patients that most of these have not been approved by the FDA and may have no scientific support for their supposed benefits. The National Institute on Aging even offers an article that explains how the use of self-aids can actually thwart clinician-based treatment plans.
As researchers learn more about cognitive diseases, the connection between cardiovascular health and brain health is becoming more distinct. Meanwhile, advancements in testing are helping neurologists to detect and diagnose cognitive decline far earlier than in the previous decade. Since exercise and diet can impact overall brain health, PCPs are instrumental in engaging patients in lifestyle choices that help both the body and the brain.
Pamela Tabar, CADDCT, CDP, is a certified Alzheimer’s disease and dementia care trainer based in Medina, Ohio.