Who's Who on the Care Team: Alzheimer's Disease

They might be clinicians, such as neurologists, geriatric psychologists or nurse-practitioners. Or, they might serve a support role, as social workers or geriatric care managers. Confused about who does what and why? Read on.

Geriatrician: Geriatricians are medical doctors certified in either family or internal medicine who have additional training in treating, diagnosing and preventing disease among those over age 65. You may want to seek one out if your loved one's primary practitioner does not specialize in the health of older adults.

Why: Nine out of 10 adults age 75 and older have at least one chronic illness, and about 1 in 5 have five or more chronic conditions, according to AARP. In addition to Alzheimer's, your loved one may be battling heart disease, Parkinson's disease, diabetes, or other conditions which require ongoing care and monitoring. The geriatrician is the "point person" who manages your loved one's overall health and coordinates care provided by other care team members. Geriatricians help you and your loved one evaluate goals of care and develop a care plan that encompasses the things that matter most to the individual.

It's important for the family caregiver to help the geriatrician stay on top of health issues — but communication may not always be optimal, said Mara Botonis, of Ft. Myers, FL, a family caregiver and author of When Caring Takes Courage. Use a checklist or keep a log to monitor medical and behavior issues; review it regularly with the provider to identify areas of concern.


Neurologist: A neurologist is a medical doctor trained to diagnose and treat disorders of the central nervous system, including the brain. He or she may help the primary physician diagnose Alzheimer's or other dementias through an examination of the nervous system and brain functioning. Neurologists may perform diagnostic tests such as CAT scans, MRIs, or spinal taps.

Why: A referral by the primary care provider is common if Alzheimer's or other dementia is suspected. The neurologist will take complete medical and psychological history and perform a variety of physical, cognitive and lab tests to pinpoint probable Alzheimer's – such as testing motor skills and cranial nerves, and conducting a standardized a mental status evaluation. Neurologists can diagnose the likelihood of Alzheimer's with about 90 percent accuracy by eliminating other conditions, say experts at the University of Miami. However, the only way to actually confirm that diagnosis is through autopsy.

Geriatric Psychiatrist: Geriatric psychiatrists are trained to treat patients with AD and to counsel caregivers. They perform clinical assessments, provide comprehensive behavioral treatment and management, advise and educate individuals about mental health issues of older adults. Geriatric psychiatrists also help family members cope with the psychological toll of caregiving.

Why: Behavioral problems become more common as the disease progresses, according to the Geriatric Mental Health Foundation. These symptoms may be the result of a treatable problem such as pain, infection, or discomfort and managed through non-pharmacological and pharmacological approaches. The primary goals of treatment are to improve the quality of life of the patient and caregiver and to maximize function by enhancing cognition, mood and behavior.

Nurse Practitioner and Geriatric Nurse: A nurse practitioner (NP) is a registered nurse with advanced education and training in the diagnosis and management of common medical conditions, including chronic illnesses. Nurse practitioners provide a wide range of health care services — including some of the same care provided by MDs — and maintain close working relationships with physicians. An NP may serve as someone's regular health care provider, although regulations and "scope of practice" vary by state. The Family Caregiver Alliance calls the role of nurse practitioners "pivotal" in early diagnosis of Alzheimer's and in managing disease progression.

Geriatric nurses care for the elderly, focusing on creating and carrying out treatment plans for chronic illnesses, including diabetes, hypertension and respiratory disorders. They also educate and counsel families of elderly patients who suffer from acute and chronic conditions.

Why: Nurse practitioners are part of many medical practices, hospitals, and clinics and may treat your loved one for routine care. "Many people believe nurse practitioners are better listeners and often have more time to spend answering questions and offering support." said Susan Reinhard, Ph.D., R.N., Director of AARP's Public Policy Institute. Nurses can talk about the day-to-day topics that they weren't always comfortable talking to the physician about, like "how do I get him to the bathroom? How do I prevent those falls at night?" explained Liz Capuzeti, Ph.D., R.N., Hearst Foundation Chair in Gerontology at Hunter-Bellevue School of Nursing, City University of New York.

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About this article: Who's Who on the Care Team is one of  an 8-part series provided to the ajc.com by Alzlive.com - a distinct voice in the online caregiver landscape, devoted to family who are caring for those with Alzheimer's or other dementia.

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