do you mean dementia? neurocognitive disorder is this bizarre DSM-5 term that even a lot of psychiatrists shudder when they hear. it is not a term that has any cachet in any other medical specialty, certainly not in medicine or neurology, and those of us who spend much of our time working with these patients use the term dementia. "neurocognitive" is a particular ridiculous term as it conveys nothing that "cognitive" would not.//end of rant - sorry ignore my ramblings
Geriatric medicine is a growth area of course, however you will find that many geriatricians do not advertise the fact that they are because they make less money seeing geriatric patients. Geriatric patients have medicare (which is why geriatrics begins at 65 in this country) and they are complex patients with multiple medical comorbidities. It takes a great deal of skill and effort (and time) to effectively treat these patients and this is not reflected in renumeration. However you are not likely to be poor. Gerontologists make less than their internal medicine colleagues. As a result it really is those with a true dedication to the field and caring for older adults who go into it. Atul Gawande describes the challenges of working in this field in Being Mortal which is worth a read if you haven't read it. One can certainly have an emphasis on dementia as a gerontologist though from what I have seen they are better at managing patients with vascular dementia, those with complicated medical comorbidities, or where medical illnesses are believed to be contributing/causing the cognitive dysfunction.
Geriatric Neurology is a subspecialty of neurology and tbh I'm not sure it adds anything over general neurology training given many of the patients neurologists see with movement disorders, epilepsy, neurodegenerative disorders are geriatric but I suppose focusing on older adults again focuses on the skill of focusing on complex patients with multiple comorbidities, and situating these problems within both the biology of aging, and its social implications. Behavioral Neurology is a particular field that focuses on dementia but it is a highly academic field, and often includes young-onset dementia, which is very fascinating in itself (particularly if you are interested in genetics, autoimmune diseases, and neuropsychiatric manifestations of neurological disease). Psychiatrists do not usually have much role (if any) in the diagnosis of patients with young-onset dementias.
Geriatric Psychiatrists do not just see patients with dementia. They will see patients with chronic psychiatric illnesses who are now older, those dealing with depression for the first time, abnormal bereavement reactions, delirium, late paraphrenia, very late onset bipolar disorder (which is still more common than rare dementias), increasingly substance use disorders (including alcoholism beginning for the first time, and now patients with long histories of substance use disorder who are living into old age). There are many interesting forensic issues in the geriatric population including assessment of testamentary capacity, guardianship/conservatorship, coercion/undue influence and elder abuse, contractual capacity, quality of care in nursing homes/ALFs which can be exploitative. I have a particular interest in forensic geriatric issues and forensic neuropsychiatry in general including how dementia is managed in the criminal justice system. One does not need a fellowship in geriatric psychiatry if you spend enough time during psychiatry residency working with geriatric patients and getting exposure to these patients. Although the issues of medicare reimbursement applies in this population you will find that inpatient geropsych units (which are becoming more common) pay well though can be dangerous places, and nursing home contracts can sometimes favorably supplement one's income.
I actually had no particular interest in geriatrics when I was a medical student but I did a 4 month geriatric medicine rotation as an intern (in the UK) and loved it. I had no particular interest in geriatric psychiatry but I have increasingly found some of the most fascinating patients I have seen to be geriatric patients (for example late paraphrenia, bipolar dementia, othello syndrome), though I have a particular interest in young onset dementias in general, and fronto-temporal dementia in particular.
