Turning Brain Health on Its Head

What if new technology could help doctors keep patients with Alzheimer’s at home rather than in a hospital? What if early intervention replaced ERs for people in need of mental health care? David Paydarfar and Steve Strakowski are asking those questions.


Frank — not his real name — was diagnosed with Alzheimer’s disease two years ago. He is happiest when he is at home with his wife in familiar surroundings. But even though he keeps up with his regularly scheduled doctor visits, Frank is at high risk for hospitalization.

Every day, thousands of people with Alzheimer’s disease are rushed to the emergency room, often due to simple health issues. Dehydration. Urinary tract infections. Problems resulting from medication errors. Most are admitted to the hospital. Many never return home, but instead end up in assisted living or nursing homes.

People with cognitive impairment report more than three times as many hospital stays as individuals who are hospitalized for some other condition.

Alzheimer’s Association

Developing a system of care that helps Alzheimer’s patients stay healthy at home is one of the first orders of business for David Paydarfar, M.D., and Stephen Strakowski, M.D. The two have worked closely together since relocating to Austin last year to capitalize on new opportunities to improve the way we care for people with neurological disorders.

“Neurology has been shifting over the last several decades from a field of diagnosis to early intervention that can really change the trajectory of diseases,” explains Paydarfar, head of neurology at Dell Medical School, new to the campus of The University of Texas at Austin. “We are beginning to apply the knowledge we have learned to help people with Alzheimer’s and other memory disorders live independently as long as possible.”

The Mulva Clinic for the Neurosciences

Last year, Dell Med began planning a cognitive impairment clinic, one of the first programs of the Mulva Clinic for the Neurosciences, to focus on developing better ways to care for people with memory disorders. Soon, the clinic will treat patients at a Dell Med facility on campus, adjacent to the new Dell Seton Medical Center at The University of Texas.

“We see a real opportunity to improve the quality of care for people with memory disorders while reducing costs associated with emergency room visits and hospitalizations,” explains Paydarfar.

One of the ways Paydarfar and Strakowski, Dell Med’s psychiatry chair, plan to slow the trajectory of diseases like Alzheimer’s is by creating and deploying a home-based early detection system for persons with mild cognitive impairment. The technology, being developed in partnership with the Cockrell School of Engineering at UT Austin, will enable physicians to remotely monitor their patients’ cognitive function in real time by analyzing how they use their smartphones. When the technology shows that a patient is exhibiting signs of cognitive decline, caregivers are notified and can intervene before the patient deteriorates further, preventing stressful and costly hospitalizations.

Rethinking Mental Health Care

Dell Med is also in the process of establishing a new patient care program through the Mulva Clinic for persons living with bipolar disorder, a serious but treatable mental health condition. “Bipolar disorder is a dynamic and complex illness that clinicians of all types struggle to manage successfully,” says Strakowski, one of the country’s leading experts on the disorder. It affects 2% to 3% of Americans.

State and local efforts to transform the region’s outdated and inefficient public mental health care system are another area of focus. Strakowski leads a team that includes lawmakers and experts from Integral Care, the local mental health agency; Central Health, the county health district; the Department of Health and Human Services; UT System; and others charged with working to develop a plan and secure funding.

The undertaking includes developing a comprehensive strategy to replace the Austin State Hospital with a modern facility that can serve as a national model for providing cost-effective, multidisciplinary mental health care. In 2015, the Texas Health and Human Services Commission determined that the 150-year-old hospital, one of 10 public psychiatric hospitals in Texas, was beyond repair. State Sen. Kirk Watson (D-Austin) has called for its replacement with what he labeled the “M.D. Anderson of the brain.”

Strakowski envisions a system that focuses resources on early intervention and caring for patients closer to home, in outpatient programs, rather than providing the lion’s share of care in expensive settings like emergency rooms, hospitals and jails.

“I came to Austin to do something big,” says Strakowski, who relocated to Texas from Ohio last summer. “Working alongside the people of this community, providers and consumers alike, to redesign the way we structure and deliver mental health care — especially for people with lesser means — is a huge opportunity to make a difference on a large scale.”