Expert: Mary Gordon - 9/18/2011

Question
Hi Mary:  I'm back after a follow-up visit to my husband's visit to his primary care Dr.  I wrote you about 4 months ago saying that his Neurologist had left her practice and we had a visit with her replacement.  Neither of us cared for him.  At that time I spoke with his pcp and asked if she could monitor his health and medications without going to a Neurologist and she agreed. During his visit Friday she stated that she might refer him to a neurologist after seeing him in January to be sure that he is getting "state of the art" treatment.  He is on Aricept 23 and takes 10mg. of Namenda twice daily.  She did indicate that she did see some changes since last visit, but isn't that what we expect?  In your last reply (May) you also felt that pcp care was adequate.   He's been going to her for 15+ years and she knows him better than anyone else (other than me).  Please let me know your feelings as I value your opinion.  Thanks,  Lorraine

Answer
Hi Lorraine,

The good news is that his doctor at least recognizes that she may not be totally current on the latest dementia treatments. However, there isn't any big news on the research front, and he is on the combination therapy that seems to be the best medicine has to offer at the moment.
Having a doctor who knows both you and your husband is a HUGE advantage, since she will be tuned into to subtleties that someone else would be oblivious to. She's also going to be concerned with the whole package of his overall health, mood and behavior and  and the impacts on you as caregiver.

You are right that you will see deterioration even with the medication - the Aricept/Namenda combo doesn't stop the illness, it just seems to slow it down somewhat and makes the best of whatever function he has left. Changes are to be expected, although some people will plateau for a time. It is really unpredictable.

I guess what you could do is wait until January and see how things go. If she wants him to see a specialist at that point, have a frank talk about what she thinks seeing a new neurologist might achieve. The thing is, a new neurologist won't know him, so will not really have a feel for the changes he has been through. I'd only bother to see a new neurologist if he had developed some new concerns that you and his pcp aren't sure what to do about, like behavioral or sleep problems, or even neurological based physical issues like balance problems.

Hope this helps.

Mary