Professional profiles

In this section, you can find interviews with professionals describing their role in the care team. The occupations illustrated below are:

General physicians (GPs) are usually the entry point to dementia diagnosis and care. In most countries they are also considered as the gatekeeper to service provision. Tasks on the GP (or primary care) level include the identification of cognitive impairment, behavioural alterations, and detection of physical causes or contributors to cognitive and / or behavioural changes (e. g. impairment of hearing or vision). An important diagnostic role of primary care is to identify potentially treatable or even reversible causes of the complaints, e. g. depression, vitamin deficiency or thyroid disturbance.

To confirm the suspicion of dementia and identify the underlying cause the GP usually refers the person to the secondary or tertiary care level (neurologist, memory clinic, university department). Here, more extensive neuropsychological tests and diagnostic questionnaires are administered. People who would particularly benefit from referral to the secondary care level:

• younger people with suspected cognitive impairment or dementia
• people showing atypical presentations which may indicate a rare form of dementia or brain tumour
• high-risk situations such as changed behaviours or psychotic symptoms
• safety issues

Social workers have the important role of assisting physicians in the coordination of services. Social work in general has the tasks of identifying individual needs, preferences and resources; initiating, organising and providing support; coordinating services; creating networks; and removing disadvantages and barriers.
The main responsibilities of a social worker in dementia care include:

• Education about nursing homes, special care units, day centres, end-of-life care, hospices
• Referral for concrete services (transportation, home assistance, meals, non-pharmacological therapies)
• Assistance with transition to alternative care settings
• Referral to support programs for people with dementia and carers
• Collaboration with local agencies and organisations
• Provision of educational materials and resources
• Advice on legal (advance directives, insurance, liability) and financial issues
• Identifying personal goals, assistance with life planning
• In a more formal way, social workers - but also specialised nurses - may take on the role of case managers.

The focus of an occupational therapist is to support a person in all areas of life, perceiving them in their environment with their strengths and vulnerabilities. The tasks of occupational therapy include prevention, intervention, health promotion, counselling, rehabilitation, maintaining and improving strengths and skills, and providing support where needed. Occupational therapy is provided in individual or group format. Specifically, the role of occupational therapists in dementia involves:

• searching for the most appropriate individual solutions and developing problem-solving strategies
• assessing the ability of a person to perform activities of daily living and provide interventions to support independence
• applying therapeutic techniques such as art therapy, bibliotherapy, drama therapy, music therapy, psychomotor therapy, occupational therapy and game therapy, focusing on preserved abilities
• informing about assistive technologies and environmental modification at home or in a care facility
• leading carer support groups or engaging in psychoeducation otherwise.

As members of a multidisciplinary team occupational therapists contribute information about the person’s abilities and limitations in daily life, needs, preserved competencies and areas of possible intervention. Thus, occupational therapists have a significant role in defining individual care plans. They may also be involved in the training of other professionals working with people with dementia.

Dementia is often associated with communication difficulties for people with dementia, carers, and professionals. Dementia can also cause problems with chewing, drinking and swallowing. Specifically, speech and language therapists contribute to dementia care by:

• assessing communication deficits related to dementia
• identifying of cultural and environmental factors that interfere with communication
• analysing of language impairments as an aid to the accurate diagnosis
• advising on food modification and feeding tools
• educating carers about communication techniques
• setting up an individual treatment plan.

The therapeutic portfolio of speech and language therapists includes oral exercises that strengthen the muscles of the mouth as well as exercises in naming, describing objects or memorising objects. Speech and language therapists use various forms of tools to support communication in people with dementia, including low-tech techniques such as signs, labels, calendars, communication boards, timers and other visual symbols that provide cues for interaction.

Neuropsychologists apply psychological methods such as interviews, test and standardised questionnaires to detect, evaluate and analyse deficits as consequences of brain disorders. Based on their knowledge about brain structure and functions neuropsychologists can recommend and conduct appropriate non-pharmacological treatment of cognitive and behavioural impairments. Specifically, the contributions of neuropsychologists to dementia care include:

• confirming cognitive and behavioural complaints and changes.
• assessing impairments in a broad range of cognitive domains in detail.
• defining the pattern of preserved and impaired cognitive abilities as an aid to diagnosis.
• making assumptions about the underlying brain pathology which can direct the diagnosis process.
• evaluating individual resources and preserved strengths.
• suggesting and providing non-pharmacological interventions such as training or adoption of compensatory strategies as part of the treatment plan.
• participating in follow-up assessments to determine the effectiveness of treatments and adapt the treatment plan.
• counselling and support of carers.

The competencies of neurologists are in the fields of diagnosis and management of disorders of the nervous system using pharmacological, non-pharmacological and rehabilitative approaches along the course of dementia. They contribute to the quality of life of people with dementia and carers by providing an early and accurate diagnosis, choosing the appropriate medication, enabling access to research studies, and involving and guiding other members of the multidisciplinary team. Specifically, the contributions of neurologists to dementia care include:

• conducting a thorough physical examination for signs of neurological diseases than can cause dementia (e.g. Parkinson’s disease, multiple sclerosis)
• establishing the indication, performing and evaluating diagnostic procedures such as analysis of the cerebrospinal fluid (lumbar puncture), MRI or PET
• treatment of neurological diseases as causes or comorbid conditions of dementia.

While the focus of neurology is on motor and sensory changes associated with brain disorders, the perspective of psychiatry is more on changes of behaviour, mood and cognition. Psychiatrists have a special eye on carers of people with dementia with regard to signs and symptoms of burnout and depression and with the aim of rapidly introducing psychotherapeutic or pharmacological help. Specifically, the contributions of psychiatrists to dementia include:

• assessing the strengths and weaknesses of people in everyday living
• determining what can still be done with minimal assistance and tasks that are beyond remaining abilities and should therefore be avoided
• evaluating the legal competence of a person with a mention regarding the ability to provide informed consent, financial decision, or making a will
• assisting lawyers and courts when it comes to establishing legal guardianship or power of attorney
• recognising and treating behavioural disturbances such as agitation, wandering, socially inappropriate behaviour or repetitive activity
• suggesting environmental and behavioural modifications as part of the treatment plan

At all levels of care - in community centers, outpatient services, hospitals and nursing homes - caregivers contribute in a variety of ways to diagnosis, treatment and, most importantly, support in managing activities of daily living. Nursing staff, who often have much closer contact with people with dementia and their relatives than doctors, are in a unique position to recognize signs of dementia, incipient confusion or excessive demands. However, caregivers also make other contributions:

• explaining the use, expected effects and potential side effects of medications to people with dementia and carers as a basis of informed consent and decision making
• educating people with dementia and carers on where to find information and support
• advising people with dementia and carers about nutrition, appropriate fluid intake and physical exercise
• making sure that people with dementia use hearing aids and glasses
• providing basic care activities such as bathing or showering, changing clothes, using the toilet in the home or in care facilities.

Pharmacists are one of the healthcare professionals that older people in particular often come into contact with. As they see people regularly, they may notice the first signs of cognitive impairment or even be approached about memory problems. Pharmacists can reassure people and advise them to seek help and clarification in good time. There are a few things to bear in mind when treating dementia with medication. Many older people have physical health problems as well as dementia. It is therefore important to have an overview of all prescribed medication. Pharmacists look out for problematic drug interactions and draw attention to medicines that could worsen the person's state of health. Finally, pharmacists can refer people with dementia and their relatives to local services where they can find advice and support.

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• Brody AA, Galvin JE. A review of interprofessional and education interventions for recognizing and managing dementia. Gerontol Geriatr Edu34: 225-256, 2013
• Burns A, Twomey P, Barrett E, et al. Dementia diagnosis and management. A brief pragmatic resource for general practitioners. NHS England. 2015         
• Galvin JE, Lavois L, Zweig Y. Collaborative transdisciplinary team approach for dementia care. Neurodegen Dis Manag 4: 455-469, 2014
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• Onyike U. Psychiatric aspects of dementia. Continuum (Minneap Minn) 22: 600-614, 2016
• Robinson L. Dementia: timely diagnosis and early intervention. BMJ 350: h3029, 2015     
• Stephan S, Möhler R, Renom-Guiteras A, Meyer G. Successful collaboration in dementia care from the perspectives of healthcare professionals and informal carers in Germany: results from a focus group study. BMC Health Serv Res 15: 208, 2015
• Tibbs MA. Social work and dementia. London, Jessica Kingsley Publishers 2001.