Dementia: Which Doctors Should You See? And How Can Complementary Medicine Help?
Dementia is not diagnosed with a single test. The diagnosis emerges from conversation, observation, testing, and imaging — and often from cooperation between several specialties. This very interplay shows where complementary medicine makes sense: where medication naturally achieves little — in daily life, in routines, in sensory input, in sleep, movement, and social activation.
In this article, we untangle which specialties may be involved in dementia diagnostics, how diagnostics proceed, which medications exist — and what complementary medical concepts, in contrast, can actually achieve.
Dementia Diagnostics: Who Actually Does What?
The process typically looks like this:
- General practitioner: for basic laboratory values, initial assessment
- Neurology: for cognitive tests, neurological examination
- Psychiatry: in cases of hallucinations and to distinguish behavioral changes from possible depression
- Geriatrics: to assess, for example, motor function, mobility, medication, hearing, and vision
- Neuropsychology: for comprehensive test batteries
- Radiology: for MRI/CT (vascular damage,
patterns of atrophy)
Because there are several forms of dementia, the approach differs depending on the suspected diagnosis — for example, memory tests for Alzheimer’s, imaging for vascular dementia, or a detailed sleep history for Lewy body dementia (McKhann et al., 2011; Iadecola, 2013; Walker et al., 2015).
In practice, the workup often stretches over several weeks to months, because physicians must assess patterns and trajectories in addition to test results. Cognitive tests are snapshots and can be strongly influenced by day-to-day condition, nervousness, and hearing or vision problems. That is why they are often repeated or supplemented by more detailed neuropsychological examinations.
In addition, there are lab tests, imaging procedures such as MRI or CT, and observations from relatives describing changes in everyday life. These collateral histories are of great importance for diagnostics, because those affected often do not notice early changes themselves or interpret them differently. Relatives can often describe typical situations — for example, behavioral changes, confusion, noticeable sleep patterns, or motor changes — far more precisely than any test can capture. Only the interplay of tests, findings, and observations over several weeks allows for a reliable classification.
Medications: Useful, but Limited in What They Can Achieve
Cholinesterase inhibitors and memantine can partly stabilize cognitive symptoms, but they do not cure (Birks, 2006; McShane et al., 2019). In Lewy body dementia and Parkinson’s dementia, they also affect hallucinations and cognitive fluctuations (Walker et al., 2015).
But the key to well-being lies in the structure of everyday life: physical activity, social inclusion, stimulating activities, and good sleep are needed.
This Is Where Complementary Medicine Provides Holistic Everyday Support!
Large reviews show that modifiable factors play a substantial role (Livingston et al., 2020). Complementary medicine includes more than plant-based compounds. Of great importance are:
o Sleep hygiene: fixed times, morning daylight, darkness in the evening, reduced stimulation — especially relevant in the Lewy spectrum and in Alzheimer’s.
o Movement as multi-therapy: improves cerebral blood flow, balance, sleep, mood, vascular health — one factor, many levels of effect.
o Ensuring hearing: untreated hearing loss is an evidence-based, modifiable risk factor (Lin et al., 2011).
o Structure and routines: regular routines reduce cognitive overload.
o Social activation: isolation increases risk; inclusion has a stabilizing effect.
o Cognitive activation: conversations, games, music, or reading — the brain responds to stimulation.
Also in Dementia: Phytomedicine as an Essential Part of Complementary Medicine
The following substances should be integrated into the diet:
o Ginkgo biloba (EGb 761) has positive effects on cognition and everyday functioning (Gauthier & Schlaefke, 2014). Interactions must be considered, especially when taking blood thinners at the same time.
o Curcumin has antioxidant and anti-inflammatory properties (Hewlings & Kalman, 2017), but can also irritate the gastrointestinal tract.
o Omega-3 fatty acids (DHA), e.g., from fish, support neuronal membrane function (Yurko-Mauro et al., 2010). Interactions should also be considered here.
o Polyphenols support neuronal protective mechanisms. Anthocyanins (berries) and EGCG (green tea) show effects on oxidative stress, neuroinflammation, and experimentally on amyloid processes. Cocoa flavanols improve, among other things, central blood flow and contribute to vascular protection (Lamport et al., 2015).
Dementia: Interdisciplinary Diagnostics, Daily-Life Structures, and Complementary Medicine for Cognitive Stability
Dementia requires interdisciplinary diagnostics, because cognitive tests, lab values, imaging, and collateral history together enable a reliable classification. Decisive for quality of life and cognitive stability is everyday-life design: structured routines, good sleep, regular movement, social activation, targeted cognitive stimuli.
Phytomedicinal approaches with Ginkgo biloba, curcumin, omega-3 fatty acids, and a polyphenol-rich diet can support these strategies.
Such a holistic approach allows patients, their families and friends to maintain a pleasant everyday life with positive experiences.
FAQ – Frequently Asked Questions About Complementary/Alternative Treatment of Dementia
1. When/with which signs should you see a doctor?
Always promptly when symptoms occur suddenly, because acute causes (e.g., infections, medication side effects) may be behind them. Also when relatives notice: “The symptoms are new and are occurring more and more often.”
2. What if those affected do not want to see a doctor?
People should not be burdened with the “label” dementia. Instead, you should first try to address problems acceptable to them, such as poorer hearing or vision, or poor sleep.
3. What should you prepare for the first appointment?
o A symptom timeline (since when, how often, how intense?)
o Examples of when symptoms occur
o A medication list including over-the-counter products (sleep aids, antihistamines, herbal products)
o Pre-existing conditions (vascular disease, diabetes, high blood pressure, depression, stroke)
o If possible, previous findings.
4. Which tests are useful even if they are not always standard?
o
Hearing test
o Vision test (poor vision also leads to less cognitive stimulation)
o Sleep diagnostics
o Medication review
o Nutritional status
5. How can gentle exercises be integrated in everyday life if those affected lack motivation or there is a risk of falling?
With small, fixed rituals, starting with a safe environment and a focus on balance and strength. If there is fear of falling, physiotherapy is often more effective than going on walks “aimlessly.”
6. When should you talk about organizational matters, such as caregiving support or powers of attorney?
As soon as there is a solid suspicion. Even if it feels distressing, the earlier authorities-related matters, medication administration, emergency contacts, or advance directives are arranged, the less burdensome these factors are as the disease progresses.
7. Can mistakes in communication worsen dementia symptoms?
Yes — for example, if you try to convince those affected that their perceptions are “wrong.” Instead, it is important to give them a sense of safety by not constantly trying to correct them. Use simple language, avoid “flooding” them with stimuli or questions, and offer simple choices for answers.
Our next article will also be about a condition that can be difficult to diagnose and is even overlooked sometimes, although it often brings massive limitations and burdens for those affected: migraine. Further information, including on many other topics, can be found alongside the blog in the volumes of our “Codex Humanus” and the “Medizinskandale” series. Feel free to visit our online shop.
Sources:
· McKhann, G. M. et al. (2011): “The diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National Institute on Aging–Alzheimer’s Association workgroups,” Alzheimer’s & Dementia.
· Iadecola, C. (2013): “The pathobiology of vascular dementia,” Neuron.
· Walker, Z. et al. (2015): “Lewy body dementias,” The Lancet.
· Birks, J. (2006): “Cholinesterase inhibitors for Alzheimer’s disease,” Cochrane Database of Systematic Reviews.
· McShane, R. et al. (2019): “Memantine for dementia,” Cochrane Database of Systematic Reviews.
· Livingston, G. et al. (2020): “Dementia prevention, intervention, and care: 2020 report of the Lancet Commission,” The Lancet.
· Lin, F. R. et al. (2011): “Hearing loss and incident dementia,” Archives of Neurology.
· Gauthier, S. & Schlaefke, S. (2014): “Efficacy and tolerability of Ginkgo biloba extract EGb 761® in dementia: a systematic review and meta-analysis of randomized placebo-controlled trials,” Clinical Interventions in Aging.
· Hewlings, S. J. & Kalman, D. S. (2017): “Curcumin: A Review of Its Effects on Human Health,” Foods.
· Yurko-Mauro, K. et al. (2010): “Beneficial effects of docosahexaenoic acid on cognition in age-related cognitive decline,” Alzheimer’s & Dementia.
· Lamport, D. J. et al. (2015): “The effect of flavanol-rich cocoa on cerebral perfusion in healthy older adults,” Psychopharmacology.