In January, the American Academy of Neurology (AAN) published a “position statement” on violence and abuse that encourages neurologists to routinely screen for current and past abuse and neglect with their patients. (To read the statement, go to aan.com/go/about/position.)
“We don't have any statistics on how often neurologists inquire about exposure to violence or abuse with their patients, but I believe it's very uncommon,” says Elliott Schulman, M.D., Fellow of the AAN, adjunct clinical professor of neurology at Thomas Jefferson School of Medicine in Philadelphia, PA, and professor with the Lankenau Institute for Medical Research, also in Philadelphia.
People with neurologic conditions are more vulnerable to abuse than the general population, Dr. Schulman says. “For example, people who have cognitive impairment, such as from Alzheimer's disease, are at higher risk not only for physical abuse but also for emotional and financial abuse. People who are physically impaired, such as those with Parkinson's disease or who have had a stroke, are at greater risk as well.” When cognitively impaired patients can't communicate for themselves, the neurologist may look for signs such as unexplained bruises or cuts or poor hygiene, nutrition, or medical care.
Abuse can also cause many neurologic conditions, such as headaches and traumatic brain injury (TBI). “There's a connection between headaches and abuse, and it's been suggested that pain conditions may also be linked to abuse,” says Dr. Schulman. (For example, people who report having been abused as children appear to have higher rates of migraine and other pain disorders; this may hold true for abuse in adulthood as well, some experts say.) “Neurologists are seeing a special kind of patient population that really calls for us to screen [for abuse] on a routine basis,” he adds.
Dr. Schulman and Anna DePold Hohler, M.D., Fellow of the AAN and assistant professor of neurology at Boston University Medical Center, co-wrote the new position statement. They will be leading a special educational program at the next AAN meeting (April 21–28, 2012, in New Orleans, LA) to prepare neurologists to become designated “abuse experts” with a clear understanding of what abuse is and how to look for it.
Caregivers should recognize that caring for a person with a neurologic disorder can leave someone feeling frustrated or exhausted enough to lash out. “It's important to be able to reach out for help when you're becoming frustrated so that you don't become an abuser yourself,” Dr. Schulman says. “Sometimes, when patients come in with dementia, I'm just as concerned about the caregiver as the patient. I don't want them to burn out, become frustrated, and neglect the patient. If you're experiencing that, it's not uncommon. Work with the neurologist to help you find a way to have some down time.”
Joining a support group is another way for caregivers to feel less isolated and avoid burnout. See Resource Central, page 35, for a list of patient advocacy organizations. Many of them run support groups for both patients and caregivers.