Expert: Mary Gordon - 5/10/2011

Question
Hi Mary:  You were kind enough to respond about 1-1/2 yrs. ago when my husbanc was first diagnosed with AD.  He is currently on Aricept 23 and Namenda.  His condition is much the same, lack of energy, emotion and interest in most things.  Physically, he has more difficulty with stairs and walking as a means of exercise.  His Neurologist has just left the clinic and we saw the new Dr. this week.  Neither of us cared much for him; he had little to say other than give my husband a script for refills and "see you in four months."  My question is this:  Does he really need to continue seeing a Neurologist or can he be cared for by his primary Dr.  He has been under her care for approx. 15 yrs. and is familiar with the changes in his health.  Her own mother is an AD patient.  I would appreciate your input.  Thank you.

Answer
Hi Lorraine

I think you are right - given that this is a progressive illness with no cure, and a reasonably predictable course, I'm not sure why you would need to see the neurologist every few months. Your husband has been expertly diagnosed, and that is about you really needed the neuroligist for - unless your husband happens to develop some alarming new symptoms or behaviors. I could even see going back for a medication change if you feel the meds are no longer doing much for him, or you want to try something else - but that would not be a routine thing.

I can't see a reason why the primary would not be able to look after him and monitor his situation. After all, the family doctor will know your husband as a person much better, and would be much more likely to be able to assist with him. He's not just a nervous system. He's a full human being with a family who needs someone who understands him in the context of his overall health and his relationships - and the stresses on his caregivers. I think a good GP may be much better at providing the supports you need.

You can always go back to the neurologist if in the future either you or the GP thinks there is a benefit.  

Thinking of you. My mother in law only saw a specialist when she was diagnosed. After that, it was the family doctor or the doctors in assisted living.

Mary