Dolly Gonzalez left the curtains open at night so she could see into her elderly parents’ home next door.
But soon after helping her father into bed, Gonzalez often would see him through the window creeping over to his wife’s room, where he would sit next to her bed all night long.
“He was worried,” Gonzalez said.
When her mother died from complications of Alzheimer’s in 2018, her father, Jesus Flores, began to sleep again. His health improved.
Then he, too, began to forget things and show other signs of dementia. Sudden blindness following cataract surgery and later a COVID-19 infection seemed to precipitate his failing health, Gonzalez said.
Flores is one of an estimated 6.5 million Americans age 65 and older who are living with Alzheimer’s or dementia in 2022, according to data from the Chicago Health and Aging Project.
About 1 in 9 people age 65 and older in the U.S. has Alzheimer’s.
Care and research into preventing and treating the brain disorder and other kinds of dementia, a medical specialty established in San Antonio within the last 10 years, is the primary focus of a new $100 million building planned for the UT Health Science Center of San Antonio campus.
Everything in one place
The Center for Brain Health is a major project set to get underway in April.
When construction is complete and doors open in 2025, more than 50 research studies, departments and centers that make up the institution’s many brain health initiatives will operate under one roof rather than spread across the South Texas Medical Center.
“It will let everything happen in one space so that it’s more efficient for the patients and for the providers,” said Dr. Sudha Seshadri, founding director of the Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases at UT Health San Antonio. “It will be linked to the [Medical Arts & Research Center] where all the other specialties are and it will be linked to the new hospital as well.”
The Center for Brain Health will house the only 7-Tesla MRI in San Antonio. The high ultra-frequency magnetic imaging equipment is capable of reducing the blurring between gray and white matter on scans of the brain, and is critical for research.
The center also will feature infusion beds, Seshadri said, which could be used to treat patients when the federal Food and Drug Administration approves new treatments for Alzheimer’s disease. Other space will be devoted to physical and occupational therapy, counseling, social work — and room to grow.
“We need to recruit more people, because we have a waiting list of people to be seen,” Seshadri said.
‘I’ll do the remembering’
Arturo and Mary Lou Rodriguez were sweethearts at Edgewood High School in 1960 and 1961. In April, they will celebrate their 60th wedding anniversary with three children, four grandchildren, one great-grandchild and another on the way.
The couple retired about the same time over 12 years ago, he from a job with the Air Force and she from the City of San Antonio, where she worked during Henry Cisneros’ terms as mayor and in the city clerk’s office. “I’m sure you’ve heard of proclamations,” Mary Lou Rodriguez said. “I wrote those.”
But “our main focus was raising the family,” said her husband.
They marked their 50th anniversary with a trip to Hawaii. Then, about five years ago, Mary Lou began to forget birth dates and anniversaries and things people had told her.
Both suspected something was wrong. A doctor confirmed: She has Alzheimer’s disease.
“There’s a lot that I can’t do anymore,” she said. “I used to go to programs or things that were coming up with the city and, of course, as my illness increased, everything else was taken back.”
But on Wednesday, the couple ventured from their Northwest Side home to attend a community event during the annual South Texas Alzheimer’s Conference at UT Health San Antonio.
A panel of experts answered questions from patients and caregivers, and singer-guitarist Clifton Jansky closed out the session with a performance of the song he wrote, “I’ll Do the Remembering.”
It made Mary Lou sad, she said, not for herself but for others with a disease that robs them of their memories — and sometimes their dignity.
“For the most part, people don’t know how to deal with people with Alzheimer’s,” she said. “The worst thing that you can do … is to say ‘I’ve already told you’ or ‘I already answered the question for you.’ How do you think that makes us feel?”
Brain health equity
It is an “illness that deprives us of our narrative,” said Dr. Ihsan Salloum, founding chairman and professor in the Department of Neuroscience and director of the Institute for Neuroscience at the University of Texas Rio Grande Valley School of Medicine.
In Starr County, one of the nation’s poorest, nearly 1 in 4 older people had Alzheimer’s or a related dementia in 2021, according to a report by Public Health Watch. Through the National Institute on Aging, UT Health San Antonio is partnering with the Rio Grande Valley institution to study why so many cases are concentrated in South Texas and what can be done to bring down the numbers.
Drs. Salloum and Seshadri opened the recent conference attended by physicians, researchers and others working in the field of neuroscience from around the world.
“Difficult questions are best answered by many minds working together,” Seshadri said. Bringing together experts helps UT Health expand its reach “in terms of care and what we can provide in terms of clinical trial opportunities.”
Presentations at the two-day conference centered on dementia research in disadvantaged populations and also how to approach the detection and management of dementia with a culturally informed approach.
“It’s a great responsibility that we have to be sure that the test is appropriate for the culture that the individual being tested to belongs to,” said Monica Rivera-Mindt, a professor of psychology at Fordham University and Icahn School of Medicine at Mount Sinai.
In addition to racial and cultural differences in patients with dementia, researchers are looking into bilingualism as it plays into both disease prevention and diagnosis.
This is important as the population grows older and more diverse, said Monica Rosselli, professor and associate chair of psychology at Florida Atlantic University. Estimates show the percentage of the U.S. population over age 65 who are Hispanic will increase at a faster rate than other racial groups, she added.
“Research does suggest that Black and Latinx adults are up to twice as likely to develop Alzheimer’s and related dementias compared to non-Latinx whites,” Rosselli said. “These are populations that also have high rates of cardiovascular comorbidities.”
Other research suggests that Black and Latino people are more likely to be diagnosed at an earlier age, she said, and experience more severe symptoms early on in the disease process.
For those reasons, Rosselli is an advocate for fairness in brain health studies and care.
“If we’re really going to center on brain health equity, we need to prepare providers to care for these diverse populations of older adults because it’s coming — this big wave,” she said. “Second, we really need to focus on increasing diversity in our dementia care. And third, we need to increase diversity of participants in the [clinical] trials.”
‘Next tsunami’
Those issues are particularly relevant to the region served by UT Health, said Seshadri, who leads the institute named for Glenn Biggs, a prominent figure in local economic and medical development initiatives.
“There are parts of South Texas, unfortunately, that have faced some of the same challenges as many of the developing, lower middle-income countries,” Seshadri said. “There are half a million people in Texas who live in colonias along the Rio Grande Valley and sometimes their access to care is not what you would expect in the richest country in the world.”
After struggling to find care after his own Alzheimer’s diagnosis, Biggs and his wife Ann helped establish the institute, the only such place in the state recognized as a National Institute on Aging-designated Alzheimer’s Disease Research Center.
Biggs died in 2015, two months shy of the couple’s 60th wedding anniversary.
Ann Biggs said during the recent conference that she hopes researchers will make progress at finding treatments and a cure for dementia diseases for the sake of the next generation.
“The next tsunami is Alzheimer’s,” Ann said. “So we need to be prepared.”
In the meantime, it’s the day-to-day caregivers who are the front-line heroes against the disease, Seshadri said in 2020.
Dolly Gonzalez said she was fired from her job several years ago when she missed work because both parents were sick and needed her help.
She is still looking after her dad. But now, with the help of Veterans Affairs benefits and Medicaid, she has assistance from in-home health aides. She is watching him slowly deteriorate, as she did her mom.
“He used to sing, now he just kind of dances,” she said. “He doesn’t sing anymore.”
