Residents and fellows can make impactful changes in research, patient care and caregiver support as part of the Memory Care team.
By Rawan Tarawneh, MD

2 Key Skills Cognitive Neurologists Need—And How to Develop Them

Cognitive neurology is at the forefront of neuroscience. There are over 100 billion neurons in the human brain that communicate with each other through 100 trillion synapses. The depth and enormity of the synaptic connections that control our brain functions has been compared to a galaxy.

When a person’s brain cells are damaged by illness or injury, the cells stop communicating. The patient’s thoughts and behaviors begin to change. In many patients, these changes culminate in a cognitive condition that requires memory care, such as dementia, the most common form of which is Alzheimer’s disease.

The cause of these cellular connections breaks is still unknown, and research is a central focus of cognitive neurology—particularly in understanding the pathological processes that lead to neurodegeneration and how this eventually culminates into memory, cognitive and behavioral changes

This specific area is a priority at the UNM Health Sciences Center. Our Department of Neurology is in the final planning stages of a new behavioral neurology and neuropsychiatry fellowship program that will be accredited by the United Council for Neurological Subspecialties (UCNS).

Along with research, we emphasize with our trainees the importance of balancing analysis with empathy. To successfully navigate the complexity of cognitive conditions, neurology residents and fellows must express genuine empathy—balanced with analysis—to patients, families, and fellow colleagues.

Striking this balance requires a passion for research and bedside manner expertise—two key skills students develop through education programs within the UNM HSC Department of Neurology.

1. Sustained Interest in Research

There is currently no effective way to cure or prevent neurodegenerative disorders. This can be sad and disappointing for trainees and faculty—but the challenge to find a solution fuels our desire to constantly research diverse facets of cognitive care, including:

  • Molecular and pathological mechanisms that underlay neurodegenerative disorders
  • Evaluation and early detection of memory loss and cognitive impairment
  • Discussing potential new approved or investigational symptomatic treatments
  • Detection and management of behavioral complications of neurodegenerative disorders
  • Multidisciplinary care including speech, cognitive, physical and occupational therapy

Many of the patients our trainees care for have elected to join clinical studies that provide early access to novel therapies. Our goal in every study or research project is to ensure we’re doing the best we can for patients. The findings inform and enhance our care processes, which in turn inspire additional research.

Fellows and residents gain valuable clinical research experience at UNM HSC as part of the frontline care team. For example, trainees conduct:

  • Detailed patient assessments alongside our research faculty. In the clinic, trainees perform cognitive testing to help patients get to a diagnosis and treatment as soon as possible. Then, the research team and interested trainees co-conduct more detailed assessments for each patient. By measuring a patient’s brain function, trainees learn to identify patterns of cognitive change and make diagnoses.
  • Patient outreach through the Alzheimer’s Disease Research Center. In September 2020, UNM HSC received a three-year grant from the National Institute on Aging to provide patients with cognitive decline the latest clinical evaluations, treatments, and research. As part of this grant, our memory care teams will travel to rural areas of the state with a mobile MRI scanner to examine patients who are unable to travel. This flexibility will extend more care to underserved patients and ensure our research includes ethnically and racially diverse patients, which is vital in developing effective therapies and addressing disparities in health care.

Making a Difference in Patients’ Lives

The brain is a fascinating, mysterious organ. Even with advancements in our understanding of its processes over the last decade, we still have a lot to learn. Cognitive neurology is a field in which you can flex your diagnostic skills. Even if recommendations don’t lead to big changes immediately, we can make a big difference in families’ quality of life over time.

Here’s an example: A patient is showing early signs of Alzheimer’s disease, but you perform testing that shows the symptoms are due to a sleep issue or a medication they’re taking for an infection. Just pinpointing the problem—and offering an effective solution—can make a world of difference for a patient’s mood, function, and overall health.

While all cases aren’t necessarily that simple, if you love taking on complex challenges and are passionate about improving memory care, consider an Adult Neurology Residency or Behavioral Neurology as your next step toward a meaningful career.

UNM Health researchers testing vaccine for Alzheimer’s disease.

Our researchers have spent several years studying the effects a protein called tau has on cognitive decline. They recently developed a vaccine that reduces tau to improve cognitive function.

2. Genuine Compassion

It’s important to remember that we’re not just treating the patient—we’re also supporting their family members and caregivers who may be burned out, mentally and financially.

We mentor trainees to talk with the family and caregivers separately from the patients. This allows the family to feel comfortable sharing concerns without upsetting the patient and ensures the patient feels valued and respected.

Trainees also receive guidance in understanding the importance of balancing empathy with authority. This approach to care requires a lot of planning before talking with patients so we’re prepared to answer their questions. Conversations can be challenging, and trainees are never alone in them.

A diagnosis of dementia, for example, often triggers worry in patients. They’re afraid of losing independence and privileges such as driving or control of their finances. We must address their concerns clearly and compassionately. Social workers often help us navigate these discussions with both the patient and their family.

Honesty is essential when recommending treatment. There are two types of treatments for cognitive conditions:

  • Symptomatic treatment that slows down symptoms—we can offer many.
  • Disease-modifying treatment that alters the underlying disease process—one drug, aducanumab, was recently approved for mild cognitive impairment and mild dementia due to Alzheimer’s disease. However, there are medical, financial and logistical limitations to its widespread use and concerns about high risk of adverse events.

I stress the importance of telling patients their medicine is not going to work the way they might expect. Even if the drug doesn’t feel like it’s making a difference now, it is helping to stabilize the brain to reduce symptoms for the future.

Aducanumab: A Lesson in Balancing Research and Clinical Care
A frustrating—and motivating—aspect of research is that results don’t always meet expectations. An example of this is aducanumab, a new drug that received approval for the treatment of Alzheimer’s disease by the US Food and Drug Administration (FDA) in June 2021.

Aducanumab developers say the drug slows cognitive decline by reducing the amount of a protein called amyloid in a patient’s brain. Amyloid is believed to contribute to Alzheimer’s disease when large amounts accumulate in the brain.

However, clinical trials did not show that the removal of amyloid was significantly effective at slowing cognitive decline—possibly because levels of amyloid likely start accumulating 10 or 20 years before a patient shows symptoms of memory loss and plateau by the time symptoms occur.

The drug is also extremely expensive, as are the ongoing blood and imaging tests it requires. And there is no recommended timeframe for providing it to patients.

I recently co-authored an article examining concerns about the safety and efficacy of aducanumab and how to discuss it with patients. While the drug’s claim would be a wonderful benefit for patients, a lack of evidence leads me to question whether it’s the best we can do—which is what patients deserve.

Learning to balance the desire to apply research to clinical care with compassionate consideration for patients’ best interests will help you cultivate an impactful career in cognitive neurology.

Collaborative learning opportunities within our education programs are designed to help you develop the skills necessary to achieve career success while furthering a field of study that is on the verge of illuminating life-changing answers. And that positive change is buoyed by each wave of driven, passionate cognitive neurology trainees.

 Interested in learning more about our Neurology education programs?

Schedule a call with JJ Maloney, Medical Education Program Manager for the UNM HSC Department of Neurology.

Categories: Neurology