I've been amazed at the number of different doctors and meds that some of our spousesseem to require. I mean, sometimes the list of meds is rather lengthy, I can't imagine how anyone can afford that? Anyway, I digress. My chief curiousity is about psychologist visits, I can't imagine what a psychologist will do for our spouses at this stage of the game. What am I missing? I'm not trying to be critical, I'm just curious.
Mothert, I felt the same way when my DH was in the beginning stages, however as he progressed I felt his neuropsychologist was able to understand the progression of AD, rather than his primary care dr. And therefore would know which drugs would be most appropriate. Also, if one is trying to obtain Disability benefits, the more Docotors that have verification of LO disease, the better.
Hmmmm, I never thought about the drug issue. My husband's PCP does have experience with AD as she took care of her father who had AD. However, I don't know if she lived with him and was primary caregiver or not, I'll have to ask - it makes a difference. We just changed PCP's and the last doc pretty much let me decide on the drugs, but, as this disease progresses, medicating becomes more complex and a bit above my pay grade :-). I'll see how it goes with his new PCP before I go find another doc. She did prescribe Lorazapam for him when I complained about his drinking and how aggressive he gets if I challenge him about the drinking. The Lorazapam puts him right out so I rarely give it to him. And, because of his drinking I'm a bit apprehensive about giving him the drugs, anyway. Sure hope he forgets about the drinking real soon - it adds another $200/month to the grocery bill, too.
mothert--a Neuro-Psych Dr. is going to know more about available meds for Alz than a PCP will, even if she did take care of her parent. The Specialist wll probably also know ways to help curb the alcohol, which will definitely make problems with any meds. Anything you can do to reduce his consumption will help. Maybe let him start with full. strength and then substitute diluted for any additional? Maybe the Dr. can prescribe an additive that will put him to sleep (slip him a Mickey). The Lorazapam (ATIVAN) quells agitation and aggression.
When nursing home recommended a neuropsych for hb because of his wanderings and sometimes refusal to cooperate w/staff (held an aide's wrist a couple times so sh couldn't give him meds), neuropsych said he didn't fit his criteria for intervention or seeing him. Probably wasn't aggressive enough. I, too, have wondered about a person with dementia seeing a psych because at least my hb wouldn't be able to answer questions or converse w/one.
My husband has been treated by neuropsychiatrists since his diagnosis. I see his doctor as a "specialist in dementia". He sees strictly patients with dementia; does research on dementia; and has more experience with the medications, supporting the caregiver, etc. than a PCP would. Perhaps if a LO is the rare dementia patient that does not require medications for behavioral issues, then it seems to me, a PCP may suffice. However, sooner or later, most dementia patients will require some sort of psych drugs to help them and the neuropsyschs have the edge on that. Also, a good neuropsych doctor will guide the family on when to bring in help, when to consider placement, etc.
BTW, there is a world of difference between a "regular" psychiatrist and a neuro. It's not the cliche scenario one imagines with the patient lying on a couch answering a lot of the psychiatrist's questions about feelings or their upbringing. The conversation centers around the MMSE and general social interaction, mainly for the neuro to gauge the stage of the disease the patient is in. I believe they rely as much on input from the caregiver in terms of describing behaviors and the big picture. They also keep an eye on the caregiver's mental state and a good doctor will let you know if you are overtaxing yourself. They cannot "save" the patient, but they can "save" the caregiver.
The issue of which doctors to see ... and how often ... just came up again in my weekly support group. Some take their AD spouses to see doctors every 3 months, some every 6 months, etc. I only take my wife once a year to see a geriatric psychiatrist at the hospital where she was first diagnosed, and we both go once a year to our PCP for annual physicals. That's it.
I would think the freqency of doctor's visits would depend on how stable the patient is and how much medication that are on. My husband was/is on a lot of medication; his doctor wanted to see him every 2, 3, or 4 months, depending on how many difficult behaviors were occuring at the time. acvann, if your wife only goes once a year to each doctor, she must be pretty stable?
My hb was going to a psychologist and it did no good. For the money he charged he would tell my hb what he wanted to hear. He was of no use to us. He was just there to collect his fees. I wouldn't do it if I were you, but that is your choice. It was a waste of money. There is nothing these doctors can tell a person with dementia/alz that will make a difference. Half the time my hb couldn't even remember what was discussed. Good luck
I so agree with you.Some doctors are there just to collect the fee's.I find it hard to get back to the office,when we leave I find myself wondering why we went.Other doctors are a true blessing.
From reading the post here the last few years, I do agree it needs to be a neurop psych doctor, not a regular psych unless the specialize in dementia. Next visit to his neurologist I will have to touch on the subject if he should have behavioral problems where drug intervention will be necessary to find out if she will prescribe or will he have to be referred to a neuropsych doctor.
My hb was going to his neurologist every 6 months, but with his last visit in October she gave us the choice of 6 months or a year. I took the year with the option of sooner if needed.
I also think the frequency depends on other medical conditions. Many here have spouses that have multiply medical problems besides dementia. I commend them for all the additional problems and accountability they have. It is hard enough dealing with the dementia.
There is a big difference between a psychologist and a neuro-psychologist. A regular psychologist is useless for someone with AD. Their job is to get to the root of the patient's psychological problems by talking through the issues and giving them strategies to follow. That's a no go for Alzheimer patients, who have no reasoning, no judgment, and little to no memory.
A neuro-psychologist - one who specializes in dementia - treats the AD patient's behavior problems with medication. A good one will listen to the caregiver spouse and take seriously their observations and concerns related to behavior, agitation, depression, hallucinations, and whatever else your spouse is experiencing.
It is not easy to find a good one. I had horrible experiences with the one Sid saw. She was as bad as everyone else - thought there was nothing wrong with him - that I was over-reacting. When she told him that she couldn't see any reason why he couldn't drive, I stopped going to her. His neurologist now prescribes the Risperdal that keeps his rages under control.
I think the Drs. are kinda like our LOs---if you've seen one----you' ve seen one, when it comes to quality of care. We dumped the one that ignored my input; disparaged "old" meds that worked; and then wanted all kinds of tests done--some just because it'd been a year since the last one. He'd been told, test would be event driven.
At our first appointment, his replacement told me, I am the most valuable tool he has in treating DH. He can't possibly get in an Office Visit what I can tell him from my 24/7/365 perspective. We started with him each 6 months, b ut now it's a cross between once a yearand when needed.
(Hi all, haven't posted in long time, but still reading. Glad so many new people have found Joan's place.)
My DH sees a geriatric psychiatrist. It works very well for us, as he understands dementia as well as the psych. meds. It still means trying something to see if it helps, but he understands the pros, cons and potential interactions of the meds. He does talk briefly to DH, judges his levels of depression, anxiety, etc. and I add my view of things. He'll either suggest a time frame or ask what I think is necessary for appointments.
I think I will contact the original neuro-psych who diagnosed dh and see if she can give us a referral, as we are at a different clinic now - the original clinic gave all their medicare patients a choice of going on medicare advantage program or going to another clinic , so we found another clinic. Dh really isn't much of a problem right now (except for the drinking), but I don't expect this to last for much longer and I want to be prepared when the time comes. Thank you all for your comments, they are very helpful.
My husband, who is in the early stages of Lewy Body Dementia, does see a psychologist for counseling. My husband likes having someone to talk to about his problems; it helps him feel that he has some control. I hope the psychologist will discourage paranoid thinking. And the psychologist affirms to me my frustration with my husband's refusal to try things that would help him. I don't believe my husband is capable of insight any more. But between Medicare and his medicare supplement it doesn't cost us much.
marilynMD ... I'm not sure how one defines 'stable' when discussing AD. Clare's declines follow an erratic pattern of falling off a cliff, reaching a plateau, experiencing a slow but steady decline, reaching a plateau, etc. She is at a plateau now after a slow but steady decine these past few months involving her gait, aphasia, and agnosia. She's been on aricept (actually the generic, donezepil) and namenda this past year. Since my take on the research is that no AD med can possibly be effective for more than 18-24 months, if effective at all, I'll discuss ending both meds with the geriatric psychiatrist at the end of next year. Fortunately, there have not been emotional overlays with my wife's 'brand' of AD as of yet, so I don't need to watch carefully with seroquel or other similar meds that can have major side effects where dosage levels can be critical. I imagine those whose spouses are on those kinds of meds may need to visit doctors more often. I also email the ger. psych. each time Clare has another fall off a cliff or declines further in any area and we exchange emails readily. In addition to the annual visit with the ger. psych. and our PCP, Clare also has a serious heart condition so we see her cardiologist every 3-4 months. That's it for docs!
acvann--my last post was confusing--sorry. By stable, I meant stable emotionally--i.e., little anger, aggression, refusing to cooperate with care, etc. I can understand a patient who is on the AD drugs only (Aricept, Namenda, etc.) being fine with a once a year visit. My husband is the opposite end of the spectrum; in addition to Namenda, he is on 6 other drugs to control behaviors. It took 2 stays in geripsych wards to come up with a successful combination; consequently, I moved him to an ALF, where he is under constant medical supervision. Although the slow, steady decline is certainly heartbreaking, you cannot imagine how challenging it is to handle that in addition to extreme "emotional overlays" as you called them. Usually, I believe that type of thing happens with FTD more than AD, by in my husband's case, he is one of the few AD patients that presents with both the 4 A's and lots of behavioral symptoms. I hope the rest of your wife's illness continues in the same manner it has been, without the difficult behaviors.
marilyn, what a nightmare it has been to finally get your DH under control. you are so right that finding the right combo of drugs is crucial. so happy to hear hes compliant and adjusting so well. its these cases that are so very difficult to manage when they rage and are so aggitated all the time. i think you are also right FTD i think bluedaze calle dit AD on steroids. divvi
You've got that right, Nora, re the black box warnings! It's a shame that they confuse so many families and put added pressure on making a decision as to whether to use them. (I felt the choice to be obvious, Steve would have absolutely no quality of life without them.)
Yes, Divvi, what a relief that things are under control--hope it stays that way. I never take it for granted when I see him content and smiling, his old personality coming through! He even tells jokes--you cannot understand what he's saying, but I can tell by the delivery. He will say a couple of sentances, then stop and look to see if I'm laughing. I say "Did you just tell a joke?" and he will nod or say yes, and then I laugh uproariously.
My husband has FTD/Alzheimer's and has only been to a neuropsych once and that was for help in diagnosing him. The first diagnosis wasn't the correct one but it did diagnose dementia. We are going for another neuropsych visit, a 5-6 hour visit, with neuropsych testing being done to show the doctors what changes he has been going through. He is on psych meds and without them he probably wouldn't be home now, having a good quality of life. His memory has been going downhill though.