Behavioral Neurology and Neuropsychiatry Fellowship Program

 Fellowship Title: Behavioral Neurology and Neuropsychiatry Fellowship Program

Our Program: 
The field of Behavioral Neurology constitutes a distinctive subspecialty within neurology, concentrating on the clinical and pathological intricacies of higher mental functions. These encompass cognition, affective responses, and behavioral facets of brain activity. Behavioral neurologists undertake the crucial tasks of diagnosing, managing, and conducting research on neurological disease, pertaining to intellectual disorders, including but not limited to memory, language, executive function, and behavior.

This specialized domain rests upon a robust framework grounded in functional neuroanatomy/imaging, neuropsychology, cognitive neuroscience, and neuropathology. Augmenting this foundation is an extensive understanding of epidemiology, nosology, genetics, pathophysiology, and molecular biology.
The realm of behavioral neurology is concerned with both diffuse and focal brain conditions that impact higher mental functions. This paramount role encompasses the diagnosis and treatment of various cognitive impairments, notably including Alzheimer’s disease. As our awareness grows regarding the prevalence and significance of such cognitive ailments, coupled with the recent advance in disease modifying therapies and exciting diagnostic modalities, a pressing scarcity of proficient behavioral neurology experts is anticipated.

In this context, the Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Disease is dedicated to helping cultivate future leaders in behavioral neurology and dementia care. It is the site of an NIA designated Alzheimer’s Disease Research Center (the only one in Texas) and is associated with our department’s Parkinson’s Disease Center of Excellence. The Institute houses a cohort of distinguished professionals encompassing behavioral neurologists, neuropsychologists, neuropathologists, neuroimaging specialists, epidemiologists, geneticists, and geriatricians. We offer precision medicine, comprehensive multidisciplinary care, caregiver-related support, and person-centered management to our patients and their families.

We offer both one- and two-year fellowships. The one-year program is designed to train exemplary clinicians with skills applicable to the entire neurological disease spectrum.  The two-year program applicants can choose from leadership, education, or a research track. We extend an earnest invitation to individuals driven by a passion for advancing the frontiers of behavioral neurology to consider joining our distinguished community at the Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Disease. Your involvement can play a pivotal role in shaping the future of this dynamic and indispensable field.

Highlights:

• Faculty status:  Faculty Development Position
  Program length: 12 months or 24 months.
• Fellowship salaries are funded by the Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases.
• UTHSA campus houses world class facilities related to neurodegeneration including Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, Barshop Institute for Aging, and Research Imaging Institute.

Goals/Objectives – Our program aims to graduate fellows with:

• High levels of clinical skills in the assessment and management of:
  o   Dementias, including vascular and neurodegenerative dementing illnesses.
  o   Prodromal stages of disease including mild cognitive impairment
  o   Focal and lesional neurobehavioral syndromes.
  o   Major neuropsychiatric disorders.
  o   Cognitive, emotional, and behavioral consequences of neurological and medical disease.
• Expert knowledge of core literature related to:
  o   Behavioral neurology
  o   Neuropsychology
  o   Neuropsychiatry
  o   Cognitive neurobiology
• Understanding of research methodology in both clinical and basic science research through exposure and didactic teaching.
• Scholarly experience tailored to the fellow’s preferences and career tract.

Great interpersonal and communication skills to counsel, console, inform, educate, and relate to patients and their family.

These will be achieved by practice-based learning, participation in case conferences, direct mentoring, didactic lectures, clinicopathological correlation sessions and research seminars.

For the two-year program, additional goals are considered:

• Training in research design, data collection, and analysis. Depending on the research project, the trainee receives training in design of clinical trials, epidemiology, genetics, imaging, or immunology. The fellow will complete a research project with a member of the faculty and set the groundwork for future funding.
• Fellows may receive training in management, communication, and advocacy.  They may contribute, under the supervision of a member of the faculty, to the establishment of a new program related to clinical leadership, quality control, advocacy, or outreach.
• Fellows interested in education will attend formal didactics related to teaching offered by the University, co-edit a textbook within the scope of Behavioral Neurology, apprentice as an associate editor at a related journal, and or develop a curriculum.  Additionally, they will be familiarized with research techniques in neurology education.

General Competencies

• Patient care:
  o        Competent and compassionate care which involves the patient and the family in the decision-making.
  o        Interpretation of principal testing modalities including imaging, genetics, biomarker studies, and neuropsychological assessment.
  o        Administration of screening cognitive instruments and familiarity with neuropsychological test types.
  o        Promotion of health outcomes by pursuing preventative and lifestyle measures.
  o        Awareness of the high risk of psychiatric comorbidity and appropriate treatment or referral.
  o        Treating the patient-caregiver as a dyad and being sensitive to the possibility of caregiver distress.
• Medical Knowledge:
  o        Mastery of clinical semiology of cognitive disorders.
  o        Understanding of biological processes underlying cognitive, emotional, and behavioral impairment.
  o        Understanding the neurochemical basis of drug therapy in behavioral neurology and an ability to appropriately prescribe the medication.
  o        Good working knowledge of literature and common paradigms.
• Professionalism:
  o        Demonstrated commitment to completion of professional responsibilities.
  o        Understanding and abiding by ethical principles, including understanding capacity.
  o        Understanding of cultural factors that play into cognitive disorders.
• Interpersonal Communication
  o       Communication with patients and family in a non-technical manner.
  o       Ability to present patient histories to colleagues in a concise and efficient manner.
  o       Written communication with colleagues, patients, and family, including clinical notes and letters.
• Systems-based Practice
  o       Understanding the broader context of any disease in terms of social, economic, and biological terms.
  o       The ability to call on appropriate system resources to mitigate harm, improve quality of life and reduce co-morbidities.
• Practice-based Learning and Improvement
  o       Demonstrated ability to assimilate new information into the diagnosis and management of cognitive disorders.
  o       Demonstrate the ability to seek information on his or her own to complement the base of knowledge.
  o       Willingness to learn from non-neurologists on the road to clinical competence.

 

Faculty:
Arash Salardini, MD
Alicia Parker, MD

Curriculum/Program Format – The core rotation for the fellow will be divided in 10 blocks of 4 hours every week, most of them at the MARC clinic staffed by specialized faculty.  The training blocks will be allocated as follows:

1. One-year program: Six continuity MARC clinic blocks. In addition, there are 1-2 blocks a month for subspecialty clinics/electives. One block for self-study and research development.
   2. Two-year program: Four continuity MARC clinic blocks.
   3. There will be training for performing lumbar puncture under ultrasound guidance.
    
   Clinical teaching and meetings: 
   a.     Didactic session at the Biggs: Weekly 1.5-hour presentations are given by the core faculty and invited guests.
   b.     Neuroscience Grand Rounds: This weekly meeting consists of a case presentation and a didactic session that reviews an important contemporary issue related to clinical neurosciences.
   c.     Case Presentation: A case is presented monthly by Dr. Parker.
   d.     Clinico-pathological Correlation Meeting: monthly, the neuropathologist pairs with a clinician and presents the pathological findings of a subject whose brain was donated to the Biggs Institute’s Brain Bank.
   e.     Journal Club: The fellow will lead a journal club monthly, starting with the reading list assigned by UCNS for continuous certification.

Scholarly activity required of the one-year fellow.
The program will try to accommodate the preferences of the behavioral neurology fellow. Projects include:
1.    A small research project: The Biggs Institute is a leader in research related to neurodegeneration and cognitive disorders.  It is less likely that a project in a ‘wet lab’ can be accommodated in the time available for scholarly activity, however there are a number epidemiological, imaging, and other clinical studies which may allow the fellow to participate in research and familiarize themselves with research methods and data analysis.
2.    The fellow may decide to do a chart review for a condition or write up case studies of patients seen in the clinic.
3.    The fellow may participate in writing review papers or a book chapter.
4.    Other reasonable projects will be considered.

Syllabus:
Didactics follow the following syllabus:
1.  Introduction to neurobehavioral assessment
2.  An overview of dementias as clinico-pathological entities
3.  Neuropsychological testing in cognitive disorder
4.  Imaging, genetics, and other biomarkers in behavioral neurology
5.  Neuropathology of neurodegenerative dementias
6.  Geriatric assessment including capacity, competence and driving.
7.  Assessment of Daily Function, Neuropsychiatric Symptoms & Staging of Dementia in Practice
8.  Alzheimer’s dementia and related disorders
9.  Mild cognitive impairment
10.  Memory systems and amnestic disorders
11.  Parietal lobe function, visuospatial cognition, praxis, posterior cortical atrophy
12.  The language system, aphasias, and primary progressive aphasia
13.  Frontotemporal dementias with a focus on bvFTD
14.  Attention and executive systems.
15.  Delirium and encephalopathies
16.  4R and rare tauopathies
17.  Synucleinopathies: LBD, PDD and MSA.
18.  Basal ganglia and cognition
19.  Vascular cognitive impairment and dementia
20.  Subcortical dementia: white matter tracts, thalamus, and the cerebellum
21.  Classic focal neuro-cognitive syndromes
22.  TBI, post concussive syndrome and CTE.
23.  Altered states of consciousness including sleep and coma
24.  Rapidly progressive dementias including autoimmune encephalitis.
25.  Psychosis, hallucinations, and delusions.
26.  Mood disorders in the elderly
27.  Cognition in general neurology: epilepsy, NPH and headaches
28.  Intellectual disabilities, autism, and communication disorders
29.  Tourette’s, OCD and ADHD
30.  Therapies and neuromodulation including ECT.
31.  Neurochemistry – neurotransmitters, neuropeptides, neurohormones
32.  Non-Pharmacological Approaches to Neuropsychiatric Symptoms
33.  Pharmacological Approaches to Neuropsychiatric Symptoms
34.  Neuropsychology of aging
35.  Mechanisms of aging
36.  Common pathways in neurodegeneration
37.  Models of dementias and clinical trials in AD therapeutics

Graduates:
-Dr. Camille Merhi, Assistant Professor, Chief Neuromodulation A&M University (2023).

Support Services:  Social Works, Caregiver Support, Support Groups, Counseller, Genetic Counselling, MRI (Prisma-3T), PET (amyloid, Tau, TSPO, radiochemistry facilities), physical/occupational/speech therapy, ADRC resources (outreach, informatics, epidemiology, genetics), Research Imaging Institute, in house research biomarker laboratory, and infusion services.