Finding a memory doctor in India

Who you are looking for

A neurologist, or a psychiatrist who works with older people, or a geriatrician. Any of the three is the right door and in most Indian cities the neurologist is the easiest to reach.

Several of the large government and private hospitals in the metros run a memory clinic by name, which is the best possible starting point because the whole team is used to families like yours. NIMHANS in Bangalore, AIIMS in Delhi and the larger private chains in each metro are the usual first suggestions, and your parent’s own physician can refer you.

• Start with the family doctor if there is one. A referral gets a faster appointment and the physician already knows the medicine list.
• Ask specifically for somebody who sees older patients. Memory in a seventy year old is a different conversation from memory in a forty year old.
• In a smaller city, the neurologist at the largest hospital within reach is the right answer. Do not wait for a perfect option in a metro.
• Dementia India Alliance and ARDSI will tell you who is good near you, over the phone, today. This is the fastest route and almost nobody uses it.

Getting your parent through the door

The appointment is usually easier to arrange than to attend, because the person it is for does not think anything is wrong.

Do not present it as being about memory. Frame it as the ordinary check that everybody of that age has, or attach it to something already agreed, like the blood pressure review. This is not deception in any way that matters. There are genuinely several ordinary and fixable things the visit will rule out.

• Tie it to an existing appointment or a routine check rather than making it an event.
• Go with them. A person on their own will say everything is fine, and mean it.
• Write to the doctor separately, in advance, with what you have seen. Many will read a short note before you arrive, and it spares your parent being contradicted in front of a stranger.
• Book a morning slot. Everybody is clearer in the morning and the wait is shorter.

What to take with you

The appointment will be short and the quality of it depends almost entirely on what you bring. Half an hour of preparation is worth more than the choice of hospital.

• Every medicine in the house, in a bag, including the ones from other doctors and anything bought over the counter. This is the most useful single item.
• A dated list of specific things that happened, six or eight lines, events rather than impressions. "12 Aug: could not find the way back from the market."
• When you first noticed, and whether it has changed quickly or slowly. That one answer shapes most of what follows.
• Any past records, particularly a head injury, a stroke, thyroid trouble, diabetes or low B12.
• A written list of your own questions. You will forget them otherwise, every time.

What the visit gives you

Usually a conversation, some questions put to your parent, blood work and often a scan. It is not a single test and you may not leave with a complete answer on the first day.

What it reliably does give you is the other explanations ruled out, and that is the reason to go early rather than late. Thyroid trouble, low B12, depression, poor sleep, a urinary infection and the side effects of ordinary medicines all produce confusion in an older person, several of them are common, and several of them are reversible. Finding one of those is not a small outcome. It is the whole point of going.

You will also get, eventually, a name for what is happening, and families are often surprised by how much easier a named thing is to live with than an unnamed one.

Ask these before you leave the room

Doctors are rushed and will answer what you ask. The questions families most regret not asking are practical rather than medical.

• Which of these medicines can come off, and which could be making the confusion worse?
• What should we expect over the next year, in ordinary language?
• What do we do when this gets difficult at night, and who do we call?
• Is there anything about driving, money or living alone that we should change now?
• When do you want to see us again, and what should we write down until then?

Where else to look

These are other people’s pages, not ours. Our own published work and the neurologist who reviews it are on the research page.

• Cultural adaptation of Alzheimer’s disease assessment scale-cognitive subscale for use in India and validation of the Tamil version for South Indian population.
  The cultural adaptation of the same questionnaire for use in India.
• Hindi Version of Addenbrooke’s Cognitive Examination III: Distinguishing Cognitive Impairment Among Older Indians at the Lower Cut-Offs.
  A Hindi memory questionnaire validated for older adults in India.
• Alzheimer’s and Dementia Support, India
  The Alzheimer’s Association’s own pages for families in India.