Dementia from a Neurologist’s Perspective

Transcript of Interview: “Dementia from a Neurologist’s Perspective”

Mike Barnes:

You know, when you encounter something like dementia in the family, I think it’s always good to get a doctor involved. A specialist like a neurologist is really, really important. 

Kim Barnes:

Today, we are glad to have Dr. John Bertelson, who is a behavioral neurologist and specializes in all sorts of cognitive disorders. Thanks so much for being with us today.

Dr. John Bertelson:

Thank you, Kim and Mike. Thank you both.

Kim Barnes:

Let’s just start with our parents. As we are with our parents and might be noticing some changes, what are the most common signs that we should be looking for that there might be some dementia that we need to address?

Dr. John Bertelson:

Right, so red flags for dementia or a precursor to dementia—there are many, but I think one of the big ones is a change in thinking, especially worsening or increasing forgetfulness. Repeating oneself more than one used to, maybe not being aware that someone is saying the same thing or asking the same question repeatedly. Struggling to think of names of people that they used to come up with pretty well, close family, even close friends. Maybe someone you haven’t seen for a while and the holidays are a perfect time because you see people you might not have seen for six months to a year. If you used to get their names pretty well and now it’s difficult, then I’d consider that a concern.

Certainly, if you’re noticing new difficulty with driving, bills not getting paid, medicines not being taken correctly—these are also significant red flags that something may be going on. None of these by themselves are diagnostic of dementia or mild cognitive impairment, but they are commonly seen, especially when those disorders are caused by Alzheimer’s disease, and they certainly would warrant further investigation.

Kim Barnes:

I think there are a couple of big problems that a lot of adult children have with their parents trying to see a neurologist. The first one is that a lot of parents say, “I don’t need to go to the doctor.” What should we do about that?

Dr. John Bertelson:

Yeah, that’s tough because, as I was sort of alluding to, people who have Alzheimer’s disease or Alzheimer’s dementia often don’t know how much of a problem they’re having. They sincerely feel that they are fine or that it isn’t that big of a deal. There may also be defensiveness due to fear of the unknown or fear of what might be happening. There are a number of reasons why someone might behave that way. Every family is different, every circumstance is different. You’ve got to be prepared to try many different options.

Sometimes it helps to start with primary care, with a doctor the patient already knows very well, making it less threatening than seeing a specialist they’ve never met before. Maybe bring it up with that primary care doctor. Another tip might be to say, “Hey, there are new medications available,” which is true. There are things that have come out that we didn’t have a few years ago. You might also express your own worry, saying, “I’m worried about you. If things get worse, it’s going to be harder on me as the adult child. So do this for me—help me help you better because it’s going to make everyone’s lives easier.” Not that you want to guilt someone, but if it’s the honest truth, it can help.

Mike Barnes:

I think the other big problem is that when they do agree to go, doctors like you are so popular that they can’t get in for three or four or five months. Do we need to worry about that?

Dr. John Bertelson:

It’s different in different markets. In some markets, there is less of a shortage, but here in Austin, while there are plenty of excellent neurologists, the demand is so high that even if you have a headache or something different, it may be hard to get in timely. Start with primary care—they can do screening quizzes and order basic tests. By the time you get to a neurologist, a lot has been done already, so you’re not starting from scratch. Advocate for yourself, be flexible, and get on a wait list if possible. Cancellations happen all the time, and being available on short notice can help.

Kim Barnes:

What’s the benefit or importance of actually getting a diagnosis? A lot of times, parents may not want to face the fact of what it might be. What are the benefits of having a specific diagnosis, and the importance of knowing which type of dementia it is?

Dr. John Bertelson:

First, if the forgetfulness is due to a hormone deficiency or depression, you don’t want to miss something treatable. Depression can mimic dementia in serious cases. You can improve thyroid deficiency with a supplement, and depression is often very responsive to treatment. Identifying a neurologic disorder like dementia is important because different types progress differently. We can sometimes predict what might happen and help patients and families plan for the future. For Alzheimer’s, especially in early stages, there are new medications available that are only appropriate in the early stages. There are many reasons to know if it’s a neurologic problem and what type it is.

Mike Barnes:

You brought up a good point—would it be helpful to let our parents know that if this is what we’re facing, like Alzheimer’s, to get treatment, we need to know earlier than later for it to be effective?

Dr. John Bertelson:

Absolutely. We can generally do more if we know things as soon as possible. It’s easier for someone to help plan for the future if they have awareness. If the condition is caught before insight is lost, the parent can meaningfully contribute to the discussion about their future.

Kim Barnes:

Do you see or are there even more promising treatments coming?

Dr. John Bertelson:

Yes, I do. We have medications that target amyloid protein in the brain, which many neurologists believe is a critical component of Alzheimer’s disease. There are two FDA-approved medications in this family, and there may be more coming soon. We may eventually treat Alzheimer’s like we treat cancer, with many different drugs simultaneously targeting different parts of the disease process.

Kim Barnes:

Any suggestions for adult children interacting with parents who have dementia? It can be frustrating trying to communicate as they progress through the process.

Dr. John Bertelson:

Frustration is normal. Recognize that these are normal human reactions. When you recognize your limits, you can identify when you’re approaching them and take steps to avoid crossing the threshold. Take breaks if things get difficult, step out of the room, end the phone call, and resume later. Distract your parent if needed. Every situation is different, so be patient and flexible. Also, recognize what worked before. If a way to diffuse conflict worked 5 or 10 years ago, it might still work.

Mike Barnes:

How do we know when it’s time to get a neurologist involved?

Dr. John Bertelson:

It depends on the availability of neurologists in your community. Not everyone with dementia needs to see a neurologist. Start with primary care and see if you’re getting what you need from them. If the primary care doctor seems uncomfortable or uncertain, ask them about it. Have an honest, open dialogue with primary care before assuming that a neurologist must be involved.

Mike Barnes:

Great words of wisdom. Dr. Bertelson, thanks so much for joining us.

Dr. John Bertelson:

My pleasure. Thank you for having me.

Mike Barnes:

We really appreciate it. You used the word “overwhelm” earlier. We talk about it all the time. You get overwhelmed, but you gave us some great tips about how to get through it, how to survive, and how to accept what’s going on.

Kim Barnes:

Absolutely. 

Mike Barnes:

Hey, if you have any other topics you’d like us to discuss, please let us know. Parenting Aging Parents.

*This transcript is auto-generated. Please excuse any typos or mistakes.