What type of neurologist is consulted for testing and preventive measures of Alzheimer's disease?

Dementia Subspecialist Neurologist for Alzheimer's Disease Evaluation

For testing and preventive measures of Alzheimer's disease, consult a dementia subspecialist, specifically a behavioral neurologist or geriatric neurologist, who has advanced training in comprehensive cognitive-behavioral assessment and interpretation of complex biomarker testing. 1

Types of Dementia Subspecialists

The most appropriate specialists for Alzheimer's disease evaluation include:

• Behavioral neurologists – subspecialists with expertise in detailed neurobehavioral assessments and cognitive syndrome characterization 1
• Geriatric neurologists – specialists focusing on age-related neurological conditions including dementia 1
• Neuropsychiatrists or geriatric psychiatrists – when prominent neuropsychiatric symptoms are present 1, 2

These dementia subspecialists perform methodical and nuanced evaluations that go beyond standard neurological examinations, using specialized neurobehavioral assessments to identify subtle patterns of brain dysfunction that narrow the differential diagnosis. 1

When Subspecialist Referral is Essential

Refer immediately to a dementia subspecialist for: 1, 2

• Atypical cognitive presentations – aphasia, apraxia, agnosia, or non-amnestic presentations 1, 2
• Early-onset symptoms – cognitive decline before age 65 requires comprehensive subspecialist assessment 2, 3
• Rapidly progressive symptoms – deterioration within weeks or months is an urgent medical problem requiring prompt subspecialist evaluation 1, 2
• Prominent sensorimotor dysfunction – cortical visual abnormalities, movement disorders, or gait disturbances 1
• Severe neuropsychiatric features – profound anxiety, depression, apathy, psychosis, or personality changes 1, 2
• Diagnostic uncertainty – when history and examination findings are incongruent or when office-based testing is normal despite reported functional decline 1

What Dementia Subspecialists Provide

Comprehensive diagnostic evaluation includes: 1

• Detailed behavioral neurologic examination – identifies key symptoms and signs of abnormal brain function to narrow differential diagnosis 1
• Advanced biomarker testing interpretation – CSF analysis for Aβ42 and tau/phosphorylated tau profiles, FDG-PET imaging, and amyloid PET scanning according to appropriate use criteria 1
• Neuropsychological testing coordination – referral for formal neuropsychological evaluation when office-based assessment is insufficient 1
• Genetic counseling coordination – for patients with suspected autosomal dominant family history 1
• Tiered diagnostic approach – judicious selection of Tier 2-4 laboratory tests based on individual clinical profiles rather than shotgun testing 1

The dementia subspecialist uses clinical formulation to set prior probabilities on likely etiologies and guides selection of appropriate diagnostic tests and their interpretation. 1

Role in Preventive Measures

For individuals seeking preventive assessment: 1, 2

• Dementia subspecialists evaluate patients with subjective cognitive concerns who perform normally on standard testing but report functional changes in daily life 1
• They coordinate access to clinical trials and emerging disease-modifying therapies 2
• Subspecialists provide genetic risk assessment and counseling for individuals with family history 1

Neuropsychological Evaluation

Neuropsychological testing is recommended when: 1

• Office-based cognitive assessment is not sufficiently informative 1
• Patient or caregiver reports concerning symptoms but examination is normal 1
• Complex demographic characteristics (limited or advanced education, language limitations) confound interpretation 1
• Detailed characterization of cognitive strengths and weaknesses is needed for care planning 1

The neuropsychological evaluation must include normed testing of learning and memory (particularly delayed free and cued recall/recognition), attention, executive function, visuospatial function, and language. 1

Common Pitfalls to Avoid

Critical errors in referral patterns: 2, 3

• Delaying subspecialist referral for atypical or rapidly progressive symptoms leads to worse outcomes and increased patient/family distress 1, 2
• Failing to obtain collateral history from reliable informants misses important functional and cognitive changes 2, 3
• Attempting complex biomarker interpretation without subspecialist expertise leads to misdiagnosis 1
• Using broad-based "shotgun" testing rather than personalized, judicious diagnostic approaches wastes resources and delays diagnosis 1

Access to Subspecialty Care

Specialist memory clinics provide: 2

• Comprehensive multidisciplinary evaluations with earlier diagnosis (up to 4 years earlier than primary care) 2
• Access to clinical trials and disease-modifying therapies 2
• Coordinated care planning with interdisciplinary teams 1, 2

The dementia subspecialist coordinates an interdisciplinary team approach that may include neuropsychologists, genetic counselors, social workers, and other specialists to address the complex needs of patients with atypical or early-onset presentations. 1, 2