For physicians who continue to practice into their senior decades, cognitive impairments like Alzheimer disease can become a serious concern.

According to a study published in the New England Journal of Medicine, around 4600 of the 95,000 actively-licensed American physicians age 70 years or older have Alzheimer disease, and an even greater number have some type of dementia.1 When diagnosing or treating Alzheimer disease in a working physician, the challenge lies in assessing professional competence and the physician’s ability to continue to work. For the physician being treated, however, one main concern is facing the stigma associated with cognitive impairment.

An Alzheimer diagnosis does not necessarily indicate the end of a professional career. Study author Gayatri Devi, MD, of the Department of Neurology at the State University of New York Downstate Medical Center and the Departments of Neurology and Psychiatry at Lenox Hill Hospital, shared the story of a physician who was diagnosed with Alzheimer disease at 76 years of age. Following cognitive testing, the physician was cleared to continue working, and she did so until her originally planned retirement age of 80.

Dr Devi stressed that because Alzheimer disease affects the brain, variability in severity and thus in appropriate treatment is common. Patients can live for years with apparent preclinical markers of the disease and fail to show symptoms until long after those markers are identified. Because every brain is unique, there is no universal path of progression for the disease, which is why cognitive testing is so necessary to monitor disease progression over time. Currently, working physicians with Alzheimer disease can participate in programs in which they are periodically evaluated and overseen as they work, ensuring that they are mentally fit enough to continue their jobs.

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In contrast, another physician — a well-respected university professor — shared her Alzheimer disease diagnosis with her department chair and was asked almost immediately to leave on disability. Many other actively working professionals experience distressing effects of the stigma around a cognitive impairment diagnosis. As such, physicians may be hesitant to seek testing or help for a condition like Alzheimer disease because they fear a positive diagnosis and the stigma that comes with it.

Dr Devi concluded that if the nuances and variability in Alzheimer disease were better understood, some of the stigma surrounding professionals who have a received a diagnosis could be eliminated. “We’re just learning more about the different subtypes that fall under the umbrella of Alzheimer disease,” she explained in an audio interview.2

References

  1. Devi G. Alzheimer’s disease in physicians — assessing professional competence and tempering stigma. N Engl J Med. 2018;378(12):1073-1075.
  2. Morrissey D. Dr Gayatri Devi on assessment and support for physicians with Alzheimer’s disease . March 2018. Accessed April 2, 2018.