At the window with Dementia - Episode 24 "What you need to know when asking for a memory evaluation"

Going to see you doctor to ask for a memory evaluation can be a scary and intimidating process. Let me tell you what you need to do and what you need to ask for before going in.

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Today's topic is making sure that your concerns are validated and heard. What I mean by that is too often people are going in, to their healthcare provider and there expressing concerns about something. And it seems to me that too often, when the healthcare provider doesn't themself recognize that there's an issue, then that person's concern is dismissed. It's not validated, it's kind of poo-pooed a little bit. Maybe the patient is reassured that everything is fine, they're just overly concerned. Well, let me tell you whether you're the patient or you're the family member of someone, and you're expressing concern about their memory, you need to make sure that your concerns are heard and acted upon.

As I've mentioned in previous podcasts, when someone is 65 or older, and they go for their regular wellness visit, having their memory evaluated is part of that evaluation. It's not often being done, but it is something that CMS, which is Medicare, Medicaid services, require. It's so important that your health care provider, check not only your blood pressure, your blood sugar, and your cholesterol level, but also, evaluate your memory.

Now, as I've mentioned in the past, sometimes people are very aware that they're having some memory difficulties, and not all memory problems are attributed to dementia. Sometimes it's due to another cause like medication, but what's happening is, sometimes, when people themselves don't recognize that they're having a memory issue, and the healthcare provider asks the question, "Are you concerned?" perhaps the individual is answering "No, I'm not." And that's where the evaluation stops. But that's not good enough.

I want to share something that happened recently with my mother.
My mother is 78 years old, and for those of you who've listened to previous podcasts know my mom is struggling with memory loss, in part, I believe it is due to an organic type of dementia, but I also think there are some other variables in play. So we talked about it, and I don't treat my mom, I think that that's not in her best interest or in mine, I'm too close. I'm absolutely biased.

So, we talk about things, and then she goes to her primary care doctor and has a more in-depth discussion. So my mom's been having memory problems, specifically word-finding difficulty, Some judgment issues, and some sequencing difficulty she has trouble following along with the series of events. And she talked to her primary care provider, and her primary care provider didn't seem too concerned. Or at least that's the story I'm getting, and I have to believe that my mother is reporting accurately with that.

So my mom trying to be proactive, said she was concerned, and that she talked to me. And at this point, I don't believe that her primary care provider knows that I'm a neurology nurse practitioner, and my mom asked for Aricept. Aricept is a cholinesterase inhibitor; it's a mild to moderate level of memory supporting medication, and what I mean by that is, it's indicated when someone's in the earlier moderate stage it's not typically a medication that started for advanced dementia.

So my mom asked about that medication she wanted to see if her doctor thought she would benefit from it. And I was quite disappointed to hear the response. The response was that her doctor doesn't really believe in that medication. It doesn't really find it to be helpful. And I find that to be problematic. And what really bothers me about that is twofold number one. She's already set the expectation that there is no benefit for this medication, so why bother trying. But for whatever benefit, placebo-type benefit it may have. She's just wiped that out because my mother does trust her doctor, which is important; you have to have a trusting relationship in order to really be treated effectively, in my opinion.

So when her doctor said she doesn't think it's effective. First of all, she's disputing data that shows it is. True, it's not beneficial for everybody, but for many, it is. And what if that might have involved my mom. What if she was one of the many that would benefit from it?
And then when it comes to the placebo aspect, the fact that the doctor said she doesn't believe in it. I think already set the stage for my mom to doubt the benefit of it. So my mom pushed back a little bit, which I was really happy to hear and said well my daughter thought maybe I would benefit from it, and she's a nurse practitioner, and she specializes in dementia. So with that, her doctor agreed. She said, "Okay, I'll go ahead, and I'll prescribe it, and we'll touch base in six weeks."

Again that is appropriate. I'm glad that she's going to touch base with my mom. She also ordered an MRI of the brain. Okay. Agreed, that's appropriate as well. But she didn't do a memory assessment. She did not apply a simple memory assessment that would give a raw score. True, That alone is not diagnostic to be able to determine whether or not someone has dementia or early-stage cognitive impairment. But she didn't even go ahead and give the assessment. Now, what the assessment would do is it would pick up whether or not there were some memory problems. It would be a piece in the puzzle, just like an MRI. And I'm so disappointed. Again, my mom is 78. And so for my mom to go to her and say I'm concerned about my memory, and really not even have assessments done or the opportunity for a referral made. I just can't see beyond that; there is no justification in my mind for that. I've said this many times that I believe that dementia is the pandemic that nobody's talking about. So if we're not talking about it, and we're not making our voices heard, then there's no action being done, we're not making progress in finding a cure. I don't know, is it possible that the doctor just dismiss my mom she's 78, what are you going to do about it anyway?

Well, gosh, I sure hope not. But you know what, I find that a lot of people have that attitude, a lot of people in positions where they could actually make a difference. And I find that completely unacceptable. What if I wasn't my mother's daughter? What if I didn't know anything about dementia? What if my mom didn't feel empowered to push back a little bit?

 Well, let me tell you what would happen. My mom, at some point, would probably be referred to a neurologist, when she started having issues that the primary could no longer manage, or when a family member would accompany my mom to one of her wellness visits and say we need some help here. And at that point, she would probably be in the moderate, perhaps even advanced stage. And then when someone shows up at a neurology visit and they're at that stage, we're limited in what we can do. It's managing expectations, making sure that all safety precautions are in place. But the utility or benefit of memory supporting medication may have already been lost. Perhaps that time frame had already come and gone. And there's no excuse for that. Again, my mother has full faith in her doctor, and I'm glad she does. But I'm so disheartened that this is how that visit went. Now I'd like to believe that the doctor did ask some other questions, maybe about her sleep pattern, perhaps about other medications over the counter or prescribed by other providers. I don't know if that conversation happened, so I'm not going to place judgment on that. But from what I heard, and again, I have no reason to believe that more than what my mother tells me actually happened did happen.

I find this to be completely disappointing, unacceptable, and something that needs to stop. So I tell all of you who are listening: If you're concerned about your memory, or if you have a family member and you're concerned about their memory, and you go to your healthcare provider, and you raise concern, and your concern is dismissed. Then push back, in if you don't get the results that you want, and when I say the results that you want, what I mean is a more in-depth evaluation. Then you ask for it. And it's; still, there's pushback, and sometimes there is, then perhaps you need to really re-examine whether or not you are with the right healthcare provider.

Anyway, those are my thoughts, as you can tell, I'm pretty upset about it, and you should be too. Because although we can't stop dementia. We can't reverse it. Not yet, at least. What we can do is we can intervene. We can find out what actions we can take to reduce our risk, what things we can do to promote good brain health. And if there is some dementia going on. We know that early diagnosis, early intervention. Certainly, it provides a better support system, and I don't want to say a better experience, but perhaps a less difficult experience than someone would otherwise have.

Anyway, those are my thoughts. I hope you enjoy my podcast, please subscribe if you haven't already, I release new episodes every Tuesday. You can also check me out on Instagram, and my website, CompassionateEducation.com. 
On my website, you can find lots of brain-stimulating activities, things you can do to reduce your risk factors. I hope you check it out. Thanks again, and have a good day.