Brain experts share insight about dementia

Published on Friday, 8 September 2017 13:28 - Written by JACQUE HILBURN-SIMMONS, jasimmons@tylerpaper.com

Prev  1 of 8  Next

Dr. Allison Hennigan works as a neurologist, but she seems more an artist than a student of the brain.

She works from an office flooded with natural light, surrounded by colorful accents, children’s artwork and random knick-knacks.

Barefooted, and with a comfy sweater close at hand, the mother of three sits cross-legged behind her desk to discuss with visitors the powerful, extraordinary potential of the human brain.

Eyes twinkling with delight behind trendy eyewear, she speaks with great passion and wonder about her chosen field and the one part of the anatomy that gifts people with a sense of identity and self.

“It’s fascinating, the brain is just so awesome,” she said. “It’s my job to narrow down and deal with a diagnosis - not because anybody is curable.”

But because, she added, in some cases treatment makes it possible for people to eek out as much quality of life as their circumstances will allow, for as long as possible.

“Essentially, what I do is deal with things I can’t fix,” she said.

EVERY CASE IS DIFFERENT

Dementia seems almost a general term to describe a variety of brain-related ailments, such as Alzheimer’s, Lewy body, Parkinson’s and Creutzfeldt-Jakob disease.

Cures continue to elude science, but hopes are high that could one day change.

These afflictions of the brain happen for varying reasons that continue to captivate neurology specialists like Dr. Hennigan, who stays on a constant prowl for information to improve the patient experience.

The neurologist sees a lot of people who suffer from migraines and those who are dealing with complications of strokes, heart attacks and other health conditions, such as Parkinson’s, a type of dementia.

Dementia cases represent a sizable amount of her patient caseload, with the youngest being in their 40s.

Dr. Hennigan never seems to tire of studying ways to help them all, which includes constant evaluations of how the brain functions and reacts when something goes awry.

“Not everyone fits (the) textbook,” she said. “You take a patient’s story and figure how what applies. Collecting the stories of people, you’re trying to figure out who they are. People who do best with dementia are those with a purpose … you try to help families figure out what they can do.”

Sometimes patients want nothing more than to putter with a hobby, live independently or revisit things familiar to their childhood.

“Dignity is huge,” she said. “If I could give a gift to each patient, it would be to let them choose, if no harm can come from the decision.”

It’s critical after a diagnosis to coordinate with a primary care physician to ensure a multi-prong, team approach that addresses the whole person, not just the brain.

Patience is critically important because changes in the brain can affect judgment and demeanor.

Her thirst for clarity about dementia dates back to childhood. A grandmother exhibited signs of the disease, but no one realized it until it was too late.

“It’s always in the back of my head,” she said. “The wheels are constantly turning … I always think, ‘How would I want my family treated?’”

Dr. Hennigan’s philosophy is frequently tested in hospital settings, as she takes turns being the on-call expert in cases in which a patient’s brain health is affected.

During a recent visit to her office, she receives a text message indicating a possible stroke victim was on the way to a local hospital.

Fearing a reduction of oxygen to the brain, she orders an MRI, grabs her sweater and heads to the facility.

It may be several minutes before she meets the patient, but they won’t be strangers long as Dr. Hennigan begins to pick through and contemplate the components of their lives.

“Sometimes work goes home with me, especially when I’m on call,” she said. “That is part of the practice of medicine.”

ASSESSING THE SYMPTOMS

Across town, a colleague who often refers patients to Dr. Hennigan is dealing with a different urgency that’s a key aspect of the disease: detection.

Dr. Andrew Schmitt, a professor at the University of Texas at Tyler, helps run an off-campus clinic, the Memory Assessment and Research Center, which assesses and identifies symptoms of the disease.

Assessments are free, thanks to generous donors, and there is a waiting list of people wanting to be tested. The clinic also provides free counseling to caregivers.

Graduate students who study the disease assist in these herculean efforts.

“Dementia is a neurological degeneration,” he said, noting Alzheimer’s represents roughly 60 or 70 percent of the dementia cases.

Experts like Dr. Schmitt, a licensed psychologist, who study the disease say it creates cellular changes in the brain that change over time.

“You lose who you are,” he said. “And we are our memories. Our memories are built on who we were yesterday.”

Dr. Schmitt realized a passion for learning more about the disease when he was in his early 20s, working at the Veterans Administration in Dallas, studying anxiety and post-traumatic stress.

When the opportunity presented to work with the World War II population, he was hooked.

Assessment tests at his center are generally conducted within a day. Results are evaluated and later shared with the client.

There are limited opportunities across East Texas to obtain testing so there’s always a wait time, sometimes several months.

Donations are a critical need for the center, as is future demand for people schooled in helping conduct assessments.

There are several key donors helping keep the doors open: A.W. Riter Jr. Family Foundation, Rogers Foundation, Mildred Grinstead, Lynda Speak and Byron and Nita Meads.

He sees people in various stages of the disease, which tends to progress slowly over a series of years rather than weeks or months.

Some of the latest figures from the Alzheimer’s Association suggest there are roughly 5 million Americans living with that form of the disease, spiking to 16 million by 2050.

“I wouldn’t think the numbers are increasing with age, people are living longer and there is a higher incidence,” he said. “There are things we can do. Things like physical exercise – studies are pretty clear that physical exercise is helpful.”

Mental exercises that stimulate neurological activity - such as playing board games - can be helpful in possibly fending off the disease, as is social interaction, spirituality and nutrition.

Risk factors include behaviors and factors such as smoking, hypertension, obesity and high cholesterol.

A MOTHER WORRIES

There is an emerging trend among patients that both Dr. Schmitt and his colleague Dr. Hennigan find interesting – people ages 40 to 50, asking for a neurological baseline assessment.

A baseline average provides a point of reference for any changes that may arise over a series of years.

“It’s a terrible disease,” Dr. Schmitt said. “People are becoming more aware of it. What we don’t have are answers on what to do about it.”

A Tyler mom who asked to remain anonymous wants to know before everyone else if she’s among those targeted with the disease.

She’s just 49, but is keenly aware of the risks. Her grandmother and eight other relatives lived with Alzheimer’s before succumbing to related complications.

On the surface, she appears to be a typical professional who needs an extra set of hands and more hours in the day.

But internally, this mom grapples with the “what ifs.”

“Sometimes I know what I’m trying to say, but I just can’t find the words,” she said. “With my grandmother, it started with forgetting familiar things, like making beef tips and noodles. Her signature dish, forgotten.”

When other close relatives started spiraling in similar directions, she became frightened and wanted to know well in advance if she’s going to be like the rest of the family.

“I’d rather die than lose my mind,” she said.

Terrified that she could somehow be genetically predisposed to developing dementia, she sought out Dr. Schmitt and asked for a neurological assessment.

The battery of tests were challenging and mentally draining, but she emerged feeling satisfied with the efforts.

The results revealed nothing out of kilter, although she must return for another look every few years.

Some of her forgetfulness could be attributed stress, it seems.

She’s lost a child to a traumatic accident and several others are in her care. She also works outside the home in a professional position wrought with stress.

All of that amounts to hours on the road carting around young ones, grabbing dinners from drive-through windows, staying up late for complete last-minute projects and trying to stay on top of the mundane tasks of everyday life: laundry, cleaning, paying bills.

There’s little time for meaningful exercise and fewer moments for unwinding. 

It’s a worrisome reality that’s unlikely to change anytime soon, she said, acknowledging doctors advise her to reduce stress whenever possible.

“Stress can lead to Alzheimer’s,” she said. “I know I need less stress in my life.”

So, if job and life tension can play a role in the development of dementia, does that mean everyone can be at risk?

That is a question that keeps people like Dr. Schmitt going to work everyday.

“It doesn’t discriminate,” he said, noting that his mother, 83, is among the millions afflicted with the disease.

She was energetic and in good physical condition, but 20 years ago began to experience memory issues, eventually forgetting her sense of self, he said.

It’s been a difficult journey for the entire family, but the personal experience gives Dr. Schmitt a birds-eye view of the challenges and motivation to keep learning about it.

“Mom is gone, I can’t help her, but I can help the future, I can look at the 30s, 40s,” he said. “We are identifying it earlier now. What I see is moving toward a treatment model … I think it will take the pattern of cancer. We’ll learn to treat and manage.”

TWITTER @ TMT _ Jacque