When Dr. Margot Savoy notices memory loss in patients, she knows she has to rule out a few possibilities before she can issue a diagnosis.
She conducts blood work and other tests to see whether a patient had a stroke, a vitamin deficiency, or a brain tumor. Sometimes, memory loss is tied to depression. But other times, she knows patients have dementia, which includes Alzheimer’s disease.
“I look at my role as being both the person who should be able to pick it up and the one to treat it,” said Savoy, a family doctor who mostly sees patients in Philadelphia. “I have been taking care of you ideally all your life, and this is the next stage in our relationship.”
Many other primary care doctors aren’t so comfortable making a diagnosis of dementia. A report from the Alzheimer’s Association released in March found that while 82% of primary care doctors saw themselves as being on the front lines of providing care for dementia, 39% said they were “never” or only “sometimes” comfortable making the diagnosis.
But having enough doctors to diagnose Alzheimer’s is becoming exigent. Five million people in the United States have Alzheimer’s, and that number is expected to increase nearly threefold, to 14 million, by 2050.
Alzheimer’s advocates hope that government policies can help scale up the workforce before it’s too late. Until then, more responsibility will fall onto primary care doctors.
One of the reasons some primary care doctors are uncomfortable diagnosing Alzheimer’s is because they haven’t had enough training, the Alzheimer’s Association report found. An estimated 22% of doctors didn’t train on dementia diagnosis when they were in residency, and the majority of those who did said they had very little training.
Savoy, who completed a postdoctoral fellowship in geriatric interdisciplinary care, will sometimes send her patients to the Memory Center. Still, she finds it’s hard for them to get an appointment because there aren’t enough neurologists. When Savoy works with patients, she discusses their plans for a living will and power of attorney with them. She encourages patients to exercise or do crossword puzzles or prescribes medication.
There isn’t any cure or treatment for Alzheimer’s, but discussions with doctors help patients gain some control and help families plan too.
“What feels like a heavy thing to be diagnosed with can turn into an action-motivating kind of conversation, because now there are things we can do that can help,” Savoy said.
Primary care doctors help fill the gap left by a shortage of specialists. To be able to meet the future demand in specialists that will be needed to care for people with Alzheimer’s, the U.S. would need to triple the number of geriatricians, who focus on care for older adults. In 14 states, the number of geriatricians will need to increase fivefold. The Alzheimer’s Association says that scholarships and loan forgiveness programs could help, but it also wants to boost the training available to primary care doctors.
“They know an individual and their family best,” Dr. Joanne Pike, chief program officer at the Alzheimer’s Association, said of primary care doctors. “That’s who you go to if you have a question and who you go to on an annual basis.”
States are making their inroads on scaling up the workforce. Last year, Connecticut lawmakers approved a bill that provides more dementia training to doctors and registered nurses, and Texas boosted funding to develop educational resources about dementia for doctors. A bill to increase the number of geriatricians through loan forgiveness has been introduced in New Jersey, and California has a bill that would help educate doctors in rural parts of the state.
At the federal level, the Alzheimer’s Association backs the bipartisan Improving HOPE for Alzheimer’s Act, which would have health agencies make more doctors aware that Medicare will reimburse them for the time they spend diagnosing patients with Alzheimer’s and helping them learn about the resources available to them. It would also have federal agencies report back on how many people are using the benefit and whether they face barriers.
Savoy does think primary care doctors are getting more comfortable than they used to be when she first started practicing. Part of that is because now people covered by Medicare qualify for an annual wellness exam in which doctors are also supposed to ask about cognition.
Doctors can try to get a sense of how patients are doing by just asking them. They can have patients take paper questionnaires that ask them to do mind games and assess their ability to recognize pictures and count items in order. Doctors will also ask any caregivers questions and observe patients. From there, they can order more tests or refer to a specialist.
During the earlier stages of the disease, people forget information they’ve just heard or ask the same questions repeatedly. As the disease progresses, they have a harder time concentrating and take longer to do things than they did before. They might forget where they are or how they got there or use the wrong names for objects.
“It’s not typical aging,” Pike said of doctors diagnosing dementia. “This is more than just forgetting where you left your keys. This is memory loss that impacts daily living.”
Savoy said when she first started her career, patients or their families would come to her with their concerns. Now that she screens for it, she’s able to pick up on signs before patients approach her. The American Academy of Family Physicians, an organization where Savoy is on the board of directors, created a toolkit doctors can use to help families and patients with dementia.
“A lot of people who say they’re not comfortable, it’s because they can’t find the resources, but once you show them, they tend to do a little bit better,” Savoy said.
