Behavioral neurology treatments

[NeuroKlitch]

Are behavioral neurologists essentially diagnostician. Most are 2/2 tbi , so I feel like ther isn't really much to do. I imagine it's mostly an academic field filled with the Oliver sacs type who just love the presentation .


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[Thama]

Behavioral is mostly dementia, not TBI. I don't know a single person in that field who isn't primarily a researcher.

 

[typhoonegator]

There are strong connections between behavioral neurology and related fields like neuropsychology, neuropathology, and neuroradiology from a diagnostic and research perspective. As Thama noted, TBI is not something that most behavioral neurologists even deal with. There is a growing interest in behavioral neurology towards successful aging and harm mitigation, as lifestyle modification and various forms of physical and mental activity are increasingly considered for cognitive impairment and dementia. Vascular cognitive impairment (VCI) contributes to the presentation of many other neurodegenerative processes, and early secondary prevention could improve outcomes. So, while there will always be a strong component of behavioral neurology that establishes diagnosis and prognosis, there are current and future opportunities for treatment, both in secondary prevention and in symptom management.

Also, a lot of neurodegenerative disease has a strong neuropsychiatric component, and behavioral neurologists are very valuable in assisting in managing mood disorders, psychosis, etc. in diseases with neurodegenerative etiology.

 

[Nonphysiologic]

I used to be a huge hater of this field and in some ways I still am because I get frustrated when I feel like I'm wasting time and not helping.

Our behavior neurology specialist used to spend like 90 minutes per patient with a tedious thorough and monotonous exam and I felt like the social workers did most of the work. I always felt like when I saw dementia patients as a resident they would take so long and at the end I wouldn't really do anything.

But honestly often setting expectations and coordinating care is really therapeutic and when I did my formal behavioral neurology in a specialized dementia clinic with a specialist and social workers all under one roof and office visit I saw the clinical value in being a specialist. Idk if you need a fellowship though to specialize in it clinically maybe you do if you want to do research or be an authority or something. I think it's something if you're interested you can learn on your own in residency and maybe take mentorship from faculty that are interested


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[neglect]

Behavioral/cognitive neurology can be the worst thing in the world when it concerns 3 hours of clinical time and nothing but an alphabet soup of differential diagnoses at the end: DLB, CBGD, FTD, PCA, SNAP - whatever. Or it can be off putting in localization - which has been superseded by things like head CTs BTW. If you ever make the mistake of going into one of their conference rooms, get ready for a bunch of phenotype/anatomy/tracer ligand/CSF proteinopathy talk. It is boring and has no clinical applicability as far as I can see.

But it doesn't have to be like this and from what I see the field is moving entirely into AD and other dementia trials. Hopefully we'll have a DMT for AD in the next few years, which will change everything. At that point it'll be important to have people understanding early AD/MCI, present and emerging biomarkers and treatments. Sadly many behavioral neurologists will stay in the caves they take as towers and talk about what an interesting apraxia this is.

 

[RenegadeSynapse]

Behavioral Neurology & Neuropsychiatry (BNNP) can be synonymous with dementia in practice, although a number of programs do a good job of exposure to a broader perspective in the field. This is especially true of those that have a history of taking both neurologists and psychiatrists. My program, for instance, sees a good bit of TBI (mostly mild-moderate TBI, persistent post-concussive symptoms, etc) and spends (very limited) time seeing consults at a state psychiatric hospital. Other programs (WashU, Mayo, UCSF) are, as far as I know, purely dementia programs. I chose to apply to programs that are broad due to my interests and desire to learn the neuropsychiatric aspects of the subspecialty. There's no right or wrong, just different program with different training paradigms.