As a new member of the BrainKey team, and a cognitive neurologist, I want to help explain one of the newest sub-specialties of neurology coming into prominence today.

With a population living longer than ever before, the burden of age-related diseases is growing, and expected to grow faster than the ability of healthcare systems around the world to adapt to it. For example, the number of patients in the United States with late-onset Alzheimer disease is expected to nearly triple by 2060, to approximately 13 million (1).

Source: Alzheimer’s Association. 2021 Alzheimer’s Disease Facts and Figures. Alzheimers Dement 2021;17(3).

And that’s just the most common of the neurodegenerative conditions. There are many more that the average person, or even the average general neurologist, may not be well aware of: variants of Alzheimer disease featuring early behavioral or language manifestations, dementia with Lewy Bodies, and several frontotemporal dementia variants, among numerous others. So, who is going to take care of these patients and their families?

The answer is complicated. True reversal of neurodegenerative disease is currently an incredibly active area of research, both in the basic sciences laboratory, and in the world of pharmaceuticals. What we do know, however, is that patients and families of patients with Alzheimer disease and other neurodegenerative conditions already need physicians and other professionals who are particularly well-versed in the conditions they face, in order to help direct care, symptomatic treatment, provide prognosis, as well as determine social and caregiving needs.

An idealized model of cognitive neurology in a healthcare system, featuring allied professionals

Enter the cognitive neurologist. This is a relatively new term in the clinical world; the term used by the main accrediting body for the sub-specialty remains ‘behavioral neurologist’ (2). Given the sub-specialty gained recognition in the late 20th century, it only somewhat recently began to exist as a sub-specialty with specific qualifications and programs for certification. The typical pathway now, at least in the United States, is the following:

Given that research is a very strong part of the field of neurology in general, and cognitive neurology in particular, most who complete a fellowship actually dedicate their time to academic research, rather than to direct clinical neurology. This is proving to be a difficulty for healthcare systems, as the population of patients in need now is growing beyond the ability of the few fellowship programs around the country to provide qualified cognitive neurologists.

That’s why I decided to dedicate myself to the more clinical side of practicing cognitive neurology, and working to develop practice methods processes that help patients and their families, even as the disease-modifying pharmacological treatments available to us for neurodegenerative diseases affecting cognition remain very limited.

As a cognitive neurologist, I’m excited to help develop tools for visualizing concepts about the conditions afflicting my patients, using technologies previously utilized almost exclusively in research settings. In the clinic, I envision BrainKey as a much-needed method of demonstrating in three dimensions the changes in the brain often hidden behind neuroimaging reports written in medical terms.

As further high-quality, peer-reviewed research develops on the clinical utility of these tools, including BrainKey, I anticipate new insights into preventative management and pharmacotherapies, as diagnostic uncertainty and early detection become less challenging and less restricted to academic settings. There may come a time when tools like these may enhance diagnostic ability, and it would be exciting to help usher in such an era.

References

1. Alzheimer’s Association. 2021 Alzheimer’s Disease Facts and Figures. Alzheimers Dement 2021;17(3).
2. Todd Bulson. Behavioral neurology & neuropsychiatry certification eligibility information. United Council for Neurologic Subspecialties. Available online at https://www.ucns.org/Online/Online/Certification/Behavioral_Cert.aspx [accessed 28 August, 2021].

Jakob Mrozewski, MD is a practicing cognitive neurologist in the mountain West of the United States. He completed his subspecialty fellowship training in Behavioral Neurology and Neuropsychiatry, as well as Epilepsy, at the University of Colorado.

As one of a handful of clinically-focused cognitive neurologists in his region, one of his goals is gradual process improvement for optimizing patient education, health care delivery, and integration of multiple disciplines in the care of patients with cognitive manifestations of neurodegenerative diseases.