Psychiatric pioneers
By Natalie Christenson
Joshua Gear, MD, left, and William Mautz, Ph.D., are the co-founders and supervising clinicians of the Brichel Center for Neurodevelopment in Portsmouth. (Photo by Rich Beauchesne)
When you have an 8-year-old who has attention problems in school, is disruptive at home and is not responding to anything the primary-care physician is recommending, seeking out a psychiatrist or neuropsychologist could be the next step.
On the other hand, maybe you are misplacing things, experiencing changes in mood or have a general loss of initiative - these are also problems in which a physician might recommend a psychiatrist or neuropsychologist.
These services in tandem are routinely offered to provide answers to more than just struggling children and adults. Children and adults who have difficulties with attention, anxiety, moods, learning, behavior and memory have sought out advice from psychiatrists or neuropsychologists for years.
What is new to the Seacoast is a center co-founded by a psychiatrist and a neuropsychologist who reached a point in their careers in which they wanted to take their work to the next level by offering one place for patients needing a psychiatrist, a neuropsychologist or both.
Memory focus
Both Joshua Gear, MD, and William Mautz, Ph.D., opened the Brichel Center for Neurodevelopment in downtown Portsmouth, believing their collaboration would be the key to the success of their practice and their patients.
"The both of us felt that together we could provide better treatment than either one of us individually could provide," Gear said. "We had said so many times before if we came together that our patients would benefit from us being able to work more closely together."
Dr. Gear, a board-certified child, adolescent, adult and addiction psychiatrist, has worked in downtown Portsmouth since 1997.
Mautz and Gear met because Mautz was a Massachusetts-based neuropsychologist whom Gear often referred patients to for brain-related issues.
"There is nothing like this on the Seacoast," Gear said. The new center has two neuropsychologists, one clinical social worker and a psychiatrist.
Gear’s professional background previously involved working with children, but he has expanded his services to include adults. One specialty area the Brichel Center is focusing on is memory.
Mautz’s professional specialty in assessing and interpreting tests related to functions of the brain. This has allowed for the clinic to explore memory difficulties and treatment options.
The memory clinic at the center, however, goes beyond the traditional offerings of memory screenings and ful* work-ups" for those suspected of having Alheizmer’s disease. Healthy patients can also receive services.
A booming problem
Alzheimer’s affects 10 percent of those older than 65 and nearly 50 percent of those older than 85.
With the national office of the Alzheimer’s Association in Chicago, Ill., saying it expects Alzheimer’s disease to grow to "pose perhaps the greatest threat to our health-care system," many agencies are brainstorming about what the future needs will be for this growing population.
According to U.S. Census data, the size of the older population (65 and older) will double during the next 25 years, growing to 70 million by 2030, when the youngest of the post-World War II baby boomers will be more than 65 years old.
Because age is a known risk factor for Alzheimer’s, the association said the United States could realize a 70 percent increase in the prevalence of Alzheimer’s, with an estimated 7.7 million people affected.
According to a report issued by the organization in 2004, New Hampshire should expect a 37 percent increase in Alzheimer’s patients by 2025. In Maine, that growth figure is 12 percent, compared to an expected 17 percent increase in Massachusetts by 2025.
Realizing Alzheimer’s will become a reality for many Seacoast adults approaching their golden years, the Birchel Center’s memory clinic is offering a memory test for "well" adults with a family history for dementia.
Base-line testing
The test is called a "base line" and is designed for healthy patients who want a thorough evaluation of their brain-based memory functions because they are concerned one day they might have memory-related difficulties.
The idea is the same as getting a healthy X-ray of someone with a history of breast cancer; if doctors can see what the patient looked like prior to developing a condition, the diagnosis and treatment process are expected to be faster.
Mautz emphasized the test isn’t going to keep people from getting anything, but it can help a doctor at a later date see what the patient’s normal functions looked like.
The Alzheimer’s Association said it couldn’t support some base-line tests because of insufficient evidence that the tests work on a large segment of the population.
In a statement prepared by the organization for the Herald Sunday, the group said, "The U.S. Preventive Services Task Force found that there is insufficient evidence to recommend for or against routine screening for dementia in older adults. Because of a lack of published research on the topic, the task force was unable to determine whether the benefits of screening for dementia outweigh the harm. They found that current evidence does not support routine screening of people in whom cognitive impairment is not otherwise suspected."
It did, however, recommend doctors test for Alzheimer’s or other dementia when "cognitive impairment or deterioration is suspected based on direct observation or report by the person, a family member or caregiver."
Mautz said he expected such a response from the association.
"I don’t expect this to take off immediately. It could take five years or it could take 10," he said.
That, according to Mautz, is part of breaking ground in a field.
The procedure is also costly, with services provided by the memory clinic ranging from $600 to $1,800.
Nevertheless, Mautz says the investment, for some, could become part of boomers taking steps to maintain a healthy lifestyle, which includes taking care of both mind and body.
"This isn’t for everyone," Mautz said. "We want to offer it and see what happens."