Which specialist to see

When memory or thinking changes worry you, it can be hard to know which doctor to call. Many different kinds of doctors and clinics can help, and each one brings something a little different.

This page explains who does what, when a specialist makes sense, how to find one, how to handle long waits, and when to ask for a second opinion.

Start with your primary care doctor

For most people, the first stop is the regular doctor. A primary care doctor often leads the whole evaluation. They look at your overall health and check for other problems that can affect thinking, such as medicine side effects or thyroid trouble.^1,2

It is fair to ask your doctor two questions:^1,2

• How much experience do you have diagnosing dementia?
• When would you send me to a specialist?

If you have Medicare, your yearly Wellness Visit includes a memory check. Medicare also pays for a longer visit to make a diagnosis and care plan. See the first doctor visit about memory for what to bring and what Medicare covers.

Bring a family member or close friend if you can. Experts say a care partner should be part of the process for most people, because it can be hard to take in a lot of information alone.⁵

Who does what

Source for the table: Alzheimer's Association.²

Geriatrician

A geriatrician is a good fit for someone who is older, has several health problems, or takes a lot of pills. They tend to look at the whole person, not just memory.² Geriatrics care often helps most when a person is frail, manages many conditions, or when family caregivers feel worn down.⁶

Neurologist

Your doctor may send you to a neurologist when memory changes are clear.⁷ Neurologists usually have training in Alzheimer's and other dementias. But some focus on other problems, like epilepsy or headaches. Before you book, ask the office: "Does the doctor see people with memory problems or dementia?"²

Some neurologists focus only on memory and thinking. They often work in memory clinics or university hospitals.

Geriatric psychiatrist

Depression, anxiety and grief can cause memory and focus problems that look like dementia. A geriatric psychiatrist can help tell these apart.² They can also help later if a person with dementia has hallucinations, agitation or deep sadness. See depression in later life and treatable conditions that look like dementia.

Neuropsychologist

A neuropsychologist gives longer, more detailed thinking tests than the short ones done in a doctor's office. Results show which thinking skills are strong and which are weaker.² This can help when short office tests do not give a clear answer. See memory and thinking tests.

If English is not your first language, ask whether testing can be done in your language or with a trained medical interpreter. Test scores can be affected by language, culture and schooling.

Memory clinics and research centers

A memory clinic (sometimes called a dementia diagnostic center) usually has at least two kinds of specialists on the team. Many also have nurses and social workers.² Some do research and can tell you about studies you might join.²

Alzheimer's Disease Research Centers (ADRCs) are funded by the National Institute on Aging (part of the NIH). There are more than 30 across the country, mostly at major medical centers.³ They can:³

• Help with getting a diagnosis and managing care
• Share information about services and resources
• Offer chances to join studies and clinical trials
• Run support groups and programs for families

With only about 30-some centers, many families live far from one, and services vary. Call ahead to ask what they offer. To find the nearest one, use the directory on alzheimers.gov or call NIA's Alzheimer's and related Dementias Education and Referral (ADEAR) Center at 1-800-438-4380.³ See also joining a dementia clinical trial.

Your local Alzheimer's Association chapter can also give you a list of dementia specialists in your area.¹ You can reach the Alzheimer's Association at 1-800-272-3900.²

When to ask for a specialist

Your primary care doctor may be able to handle everything. But ask about a referral if:^1,2

1. Symptoms started before age 65. Younger people may need more than one specialist to reach a clear answer.
2. The picture is unclear. For example, the main changes are in personality, behavior, language, vision or movement rather than memory.
3. Things are getting worse fast, over weeks or a few months. Ask for an urgent visit. See dementia that gets worse fast.
4. Depression, anxiety or other mental health problems may be part of the picture.
5. You want to know about new Alzheimer's drugs. These need special tests and close follow-up. See are anti-amyloid treatments right for us?

Getting a referral and checking insurance

How you get to a specialist depends on your coverage.

• Original Medicare: You can see any doctor who takes Medicare, anywhere in the U.S.⁸ Many specialists still want a note or records from your regular doctor.
• Medicare Advantage HMO: In most cases you need a referral to see a specialist, and you usually must use doctors in the plan's network. Care outside the network may not be covered.⁹
• Other plans: Call the number on your insurance card. Ask if you need a referral and which memory specialists are in network.

If you are a veteran, VA health care includes dementia care. A VA social worker can help you get started, and families can call the VA Caregiver Support Line at 1-855-260-3274.¹⁰ See VA benefits for dementia.

Handling long wait times

There are not enough dementia specialists. More than half of primary care doctors say their area does not have enough. In rural areas, about 7 in 10 say so.¹¹ The country would need more than four times as many geriatricians by 2050 to meet the need.¹¹

A large study of Medicare patients looked at how long people waited after a referral to a neurologist. The average wait was 34 days. About 1 in 5 people (18%) waited more than 90 days. Going to a neurologist outside your local area added about 11 days.⁴

If symptoms get worse while you wait, call the clinic and your regular doctor. A change can move you up the list.

Second opinions

Asking for a second opinion is normal. A good doctor will not be offended. Consider one when:

• The diagnosis does not seem to fit what you see at home.
• You were told "it's just aging," but changes keep getting worse.
• Symptoms started before 65, or are unusual. People with unclear symptoms may need two or more specialists to reach an answer.^1,2
• You are making a big decision, such as starting a new Alzheimer's drug.
• You feel rushed or your questions were not answered.

How to do it. Ask the first doctor's office for copies of your records. This includes visit notes, test scores, lab results and brain scan reports. Ask for the scan images on a disc or by secure link. Bring everything to the new doctor so tests are not repeated without need.

Cost. Medicare Part B clearly covers a second opinion before non-emergency surgery, and a third opinion if the first two differ. You usually pay 20% after the deductible.¹² For a second opinion about a diagnosis, Original Medicare pays for specialist visits as it does for other medically needed care, but Medicare Advantage plans may need a referral or an in-network doctor.^8,9 Call your plan first.

If the answer is still "not sure," that is common early on. Your doctor may suggest checking again in several months. Changes over time help make the picture clearer.

Questions to ask a specialist

• Do you see many people with memory problems or dementia?
• What tests do you plan, and why?
• Will you send results to my primary care doctor?
• Who do I call with questions between visits?
• Do you offer research studies or know of any?
• Do you have a social worker or care navigator?

After you get an answer, read after the diagnosis: the first 30 days. For the full set of steps and tests, go back to getting a dementia diagnosis.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.