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What kind of specialist should I go to about my husband's confusion and movement disorder?

A fellow caregiver asked...

My 62 yr old husband has developed stroke induced Parkinson's...the movement disorder neurologist believes. He will soon take the psychological battery testing (3rd time) to try to identify what type neurological disease he actually has. I know PD meds, depression, and many things can cause his progressive cognitive decline. However, lately he is much more confused, frustrated with himself, and gets easily agitated, especially when asked any questions that requires him to think. It has been 5 yrs since the significant brain bleed and 2 yrs since the PD diagnosis. Once these tests are evaluated, what should I do or ask to get my husband to the correct expert? Our primary dr, former neurologist, and movement disorder dr. don't seem to know what to do with his mental state even after those previous tests. I don't want to "try out" drs. anymore; what type specialist should I ask for?

Expert Answer

Graham A. Glass, MD, is the co-founder of PEAK Neurology and Sleep Medicine, LLC with multiple locations across Alaska. Previously, he was deputy director of the San Francisco Parkinson's Disease Research, Education, and Clinical Care Center PADRECC and assistant clinical professor of neurology at the University of California, San Francisco (UCSF). Glass received his medical degree from the University of Texas Health Sciences Center at the San Antonio School of Medicine and completed his neurology residency at Tufts-New England Medical Center. He subsequently completed a fellowship in movement disorders at the Mayo Clinic.

This is a difficult situation as "vascluar parkinsonism", "vascular dementia" and other "structural causes of Parkinsonism" are very difficult to treat. My sense is that a very thoughtful memory expert (sometimes called a behavioral neurologist) may be helpful in some regards and may help with confusion and agitation, although honestly, no matter how much the specialist tries, there are limits to what physicians can do and we often struggle to make "game changing" medication adjustments in this type of situation. My guess is that this is why a movement disorders specialist and a neurologist have struggled to help much. I wish that I had a better answer to this question.