Barak Gaster, MD, on Improving Dementia Care in the Primary Care Setting

Barak Gaster, MD, recaps his presentation on improving dementia care for the primary care provider from our Practical Updates in Primary Care 2021 Virtual Session on May 13.

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Barak Gaster, MD, is a professor of medicine from the Division of General Internal Medicine at the University of Washington in Seattle, WA. 


Barak Gaster:  Hi again. My name is Barak Gaster. I hope you enjoyed the talk on improving dementia care in primary care. As I have gone through the process of figuring out how we can do a better job of identifying dementia in the primary care setting, the big light bulb moment for me was how important it is to have an observer of the patient there in the exam room with you. You can't really evaluate somebody's cognitive function without being able to ask somebody questions who's spending time with that person in their lives. And so, that observer input, cannot stress enough just how important, and valuable, and essential that is for evaluating cognitive function.

In terms of how to do an efficient job of assessing cognitive function, it's so crucial to have that quick checklist to use, like I reviewed, of the labs to order and the comorbidities to ask about and evaluate.

And then really, if I was to have one takeaway in terms of when do you need to refer somebody to a neurologist is when somebody is describing visual hallucinations. If somebody's having visual hallucinations, it does raise the concern that they could have Lewy body disease, which is a very significant clinical impact in terms of how to manage their illness. It's not an easy diagnose to make. Visual hallucinations should make you think about the possibility of Lewy body disease and should increase, in a significant way, the value of referring somebody to a neurologist to help make that diagnosis.

If you take away nothing else, it's how important advance care planning is for this disease in terms of giving people better care, which is care that's better aligned with the care that they would have wanted. Consider using a dementia‑specific advance directive to elicit people's preferences and values before they develop dementia. That's something that can help you as a primary care doctor do a better job of taking care of your patients.

Thanks again for listening, and stay well. Take care.