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BRAIN HEALTH

tau proteins in the brain. CTE is associated with a history of substan- • National Aphasia Association: https://aphasia.org
tial repeated head impacts, including concussions. It is most common- • The Association for Frontotemporal Degeneration: https://www.
ly associated with athletes in contact sports (like football, boxing and theaftd.org/
hockey), military veterans, rodeo participants and others exposed to • Concussion Legacy Foundation: https://concussionfoundation.org/
repetitive head trauma. Symptoms include personality changes and
impulsivity (“neurobehavioral dysregulation”), executive dysfunc- There are also several local resources for Bexar County residents:
tion, memory impairment, neuropsychiatric symptoms and/or motor • Multidisciplinary specialty clinical care: Glenn Biggs Institute
abnormalities. CTE symptoms typically appear years or even decades for Alzheimer’s & Neurodegenerative Diseases at UT Health San
after repetitive brain trauma and worsen over time. Treatment is pri- Antonio; 210-450-9960; https://biggsinstitute.org/
marily supportive care and symptom management, and biomarkers • Research opportunities (including AD, vascular, DLB, FTD,
and treatments are also an active area of research. CTE): Glenn Biggs Institute for Alzheimer’s & Neurodegenera-
tive Diseases, primary site for only NIA-designated Alzheimer’s
Clinical Approach to Patients Presenting with Cognitive Disease Research Center in Texas; 210-450-9742 (Research Navi-
or Behavioral Symptoms gator); https://biggsinstitute.org/research/
For the initial workup of a patient who presents with new cognitive • Caring for the Caregiver Program: A UT Health San Antonio
or behavioral concerns, the history is the most important component. program that supports caregivers of those with dementia through
Providers should ask about when the symptoms first began, symptoms education, resources, peer support, and wellness activities, like
displayed, symptom progression and current functional status. Family Memory Cafes, social opportunities and activities for families
members’ accounts of symptom progression are also important, and affected by dementia; 210-567-5831; https://utcaregivers.org/
often there are different perspectives. The bedside exam should include • Local Support Groups: Several disease-specific support groups for
a brief cognitive screening tool (such as MMSE or MOCA). Labs patients and their families can be found in Bexar County; https://
should assess for possible metabolic and infectious disease contributors biggsinstitute.org/patient-care/supportgroups
(complete blood count, comprehensive metabolic panel, B12, thyroid
disease, often ruling out HIV, syphilis or other risk factors). Structural Finally, there are several online resources that can be given to
brain imaging (MRI brain without contrast) should be obtained to patients and their families:
assess for neurodegeneration and other contributing factors. Patients • Communicating with a loved one with dementia: https://memory.
can be counseled on strategies to optimize brain health and reduce ucsf.edu/caregiving-support/tips#Communication
modifiable risk factors for cognitive decline, and cognitive supportive • Five ways to say sorry (Teepa Snow): https://www.youtube.com/
therapies offered when appropriate. watch?v=vasnp81x63E
The specialist evaluation includes a more detailed history and • Responding to new behaviors in dementia: https://www.ama-
examination, in-depth neuropsychological testing and review of struc- zon.com/Coping-Behavior-Change-Dementia-Caregivers/
tural brain imaging. Depending on the clinical diagnosis and evalua- dp/0692385444
tion, genetic and biomarker testing for AD (blood, cerebrospinal fluid • Book Guide to Caring with Patients with Dementia (The 36-Hour
and/or PET) and/or DLB (skin biopsy, cerebrospinal fluid, dopamine Day): https://www.amazon.com/36-Hour-Day-Alzheimer-Dis-
transporter imaging) may be offered. Patients with AD who are poten- ease-Dementias/dp/1421441713/
tially eligible for antiamyloid therapies (e.g., MCI/early dementia,
MMSE >22, AD biomarker positive, minimal bleeding risk factors) References:
will undergo an eligibility evaluation and discussion regarding thera- 1. https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/
trc2.70033
pies. Patients to consider referring to a specialty or sub-specialty clinic 2. https://news.uthscsa.edu/san-antonio-has-a-new-designa-
include those with challenging or atypical diagnoses (such as DLB, tion-dementia-friendly-city/
CTE), challenges in management, or those interested in biomarker 3. https://www.ncbi.nlm.nih.gov/books/NBK536956/
testing, antiamyloid therapies and/or research opportunities. 4. https://pmc.ncbi.nlm.nih.gov/articles/PMC6153625/
5. https://medicine.washu.edu/news/highly-accu-
Patient and Caregiver Resources rate-blood-test-diagnoses-alzheimers-disease-measures-ex-
Dementia is a life-long illness, deeply affecting both patients and tent-of-dementia/
their caregivers. Those who care for a loved one with dementia are 6. https://pubmed.ncbi.nlm.nih.gov/23390181/
7. https://pubmed.ncbi.nlm.nih.gov/19535999/
susceptible to caregiver burnout, a state of mental exhaustion that 8. https://pubmed.ncbi.nlm.nih.gov/26052687/
presents alongside depressive symptoms. Patients and their families 9. https://pubmed.ncbi.nlm.nih.gov/33704781/
should be made aware of local and national resources that can help 10. https://pmc.ncbi.nlm.nih.gov/articles/PMC4062551/
them navigate the challenges of this illness and support them through
the disease journey. Arush Shekar is a fourth-year medical student at the Long School
At the national level, patients and families can be referred to, of Medicine at the University of Texas Health Science Center
among others: of San Antonio (UTHSCSA). He completed his undergraduate
• Alzheimer’s Association: https://www.alz.org education at Rice University in 2020, where he received a
• Lewy Body Dementia Association: https://www.lbda.org Bachelor of Arts in Neuroscience. He will begin Neurology residency at
• Family Caregiver Support: https://www.caregiver.org UTHSCSA in 2025.
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