Nov 3 • General discussion
"I've diagnosed 1,000+ dementia cases. You don't need a neuropsychologist."
After diagnosing over 1,000 dementia cases, I've developed a system that primary care doctors can use.
You don't need a neuropsychologist.
You don't need a 6-month wait for specialty referral.
You don't need advanced imaging.
Here's my clinical approach:
The 15-minute assessment that catches what traditional tests miss:
- History from an observer is more valuable than history from the patient
↳ Spouse or adult child notices changes first
↳ Patient often minimizes or doesn't recognize deficits
↳ Ask: "What activities have they stopped doing?"
2. Digital cognitive testing reveals patterns traditional tests miss
↳ Standardized digital tests eliminate administrator bias
↳ Normative data adjusted for age and education
↳ Qualifies for CPT 96132 reimbursement
3. The questions that reveal more than any test
↳ "Do you still handle finances independently?"
↳ "Have you gotten lost in familiar places?"
↳ "Are you repeating questions or stories?"
↳ "Have family members expressed concern?"
The diagnostic framework I use:
Rule out dementia imitators first
↳ Sleep apnea
↳ B12 deficiency
↳ Depression
↳ Medication side effects
↳ Thyroid dysfunction
↳ Hearing loss
Establish pattern of decline
↳ Slow and steady suggests neurodegenerative process
↳ Stepwise progression points to vascular dementia
↳ Fluctuating symptoms may indicate Lewy body dementia
Assess functional impact
↳ Mild: Independent with complex tasks becoming difficult
↳ Moderate: Needs help with some daily activities
↳ Severe: Requires supervision for safety
The diagnosis conversation I have:
"Based on everything we've reviewed together, I believe you have early-stage dementia. This means your brain has changes affecting memory and thinking that are beyond normal aging. Here's what we can do about it."
Then I create an immediate care plan:
Start medications that work better early
↳ Acetylcholinesterase inhibitors add quality years
↳ Side effects minimal if started properly
↳ Benefits appear over years, not days
↳ Earlier start means better outcomes
Address modifiable risk factors
↳ Treat cardiovascular disease aggressively
↳ Optimize diabetes control
↳ Manage sleep disorders
↳ Address hearing loss
↳ Encourage physical activity
Connect to resources
↳ Alzheimer's Association for education and support
↳ Adult day programs for socialization
↳ Caregiver support groups
Specialists are overwhelmed with complex cases
↳ 6-12 month wait times when most cases are straightforward
PCPs have longitudinal relationships and know patients best
The tools now exist to make this practical
↳ Digital testing is standardized and billable
↳ Care planning has CPT code 99483
The barrier isn't knowledge or skill.
It's believing that dementia diagnosis belongs in primary care.
It does. with the right support.
⁉️ Primary care providers: what stops you from diagnosing dementia in your practice?
1
1 comment
"I've diagnosed 1,000+ dementia cases. You don't need a neuropsychologist."
skool.com/dementia-lifeboat
Dementia Care Support & Expert Guidance.
Leaderboard (30-day)
1
+3
2
+2
3
+1
Powered by