Associate clinical professor of neurology, UAMS

Mark A. Pippenger, MD, a behavioral neurologist has 20 years of experience in treating patients with Alzheimer’s Disease (AD) and other forms of dementia. What he would most like to communicate to healthcare providers in the state is that there are a lot of ways to help their behaviors without using drugs.

“There are all kinds of reasons that doctors think a prescription drug will help with the behavior of someone with dementia,” Pippenger said, who sees patients at the Walker Memory Clinic in the University of Arkansas for Medical Sciences (UAMS) Center on Aging. “They might have started a patient on a drug and their behavior got better. But most likely it was not a result of the medicine. There are no real medicines that are effective for managing dementia.”

Pippenger has a mission to educate caregivers and doctors about the best ways to take care of people with AD and related diseases. The non-profit group Alzheimer’s Arkansas is a good resource for family caregiver support programs.

“That is the most important thing, supporting the caregiver,” Pippenger said. “We can do more good by educating caregivers than with any type of pill. For example, rather than try to explain things to them, correct them and tell them they are wrong, you have to be able to change the subject to something more interesting. It is something that is not very intuitive to learn to leave it alone when a person with dementia is saying things that aren’t so.”

The strategy can be similar to what some parents use with a toddler. Instead of trying to argue or persuade, distract them with something else more positive.

One possible distraction is music.

“Music is generally very useful in managing people with AD,” Pippenger said. “Musical memory preserved beyond other forms of memory. People might remember songs better than anything else. A lot of work being done is finding a major benefit for regularly playing music for people with AD, especially if they can participate by singing or playing an instrument.”

While working with dementia patients is challenging, Pippenger said it is rewarding at the same time because a lot of times they can make a big difference.

Pippenger grew up in Jonesboro, and got his undergraduate degree in zoology where he developed a special interest in dragonflies. While attending UAMS medical school, he became very intrigued with behavioral and cognitive neurology, and was able to interact with some of the big names in the field including Jeffrey Cummings, MD, at UCLA – where Pippenger completed a fellowship in behavioral neurology and dementia

“Seeing them and how they evaluated patients was an inspiration,” Pippenger said. “It was elegant the way they could do an evaluation and localize disease processes to certain parts of the brain just by their exam, not a lab test. It was almost like a detective case, much more than other fields of medicine. We can tell where the pathology is even without neuroimaging.”

Recent studies have indicated that AD may be the third leading cause of death in the U.S. Although the failure to find a cure is leaving millions of people with suffering that can last from three to ten years, Pippenger said there has been great progress made understanding the disease.

“We know a lot more than we used to know,” he said. “When I was starting out 20 years ago, we only knew about this vague protein amyloid in the brain. We still don’t know why people have it, but we are getting to that. There have also been improvements in treatment. We have introduced the first drugs that have been found to be actually effective in slowing down the symptoms of AD. They aren’t terribly effective, but they have some benefits. There has also been progress in finding which drugs for behavior are not effective.”

One positive factor is that the incidence of new cases has slowed down in recent years. There are more people with AD because of the nation’s aging population. But the incidence has slightly decreased – which Pippenger hopes is related to people taking prevention measures such as exercising more, and eating healthier diets.

“Some of that may be starting to work,” he said. “It is at least hopeful that those measures might be having some effect. My advice for doctors is to tell patients that keeping mentally active is also helpful, but probably not as important as physical exercise. Better to get on an exercise bike than sit doing crossword puzzles and word games.”

Observational studies clearly show people with more curcumin– an ingredient in the spice curry – have lower rates of AD.

“Why not use more turmeric?” he asks. “Get it in your food. Besides which, the food is pretty darn tasty.”

As for keeping his brain active, Pippenger has a big interest in Irish traditional music. He is a founding member of the Arkansas Celtic Music Society, and plays the traditional drum called a bodhran. He has helped bring Irish bands in for concerts in Little Rock, and is working to learn Irish – which is a challenge because there aren’t a lot of people who speak Irish these days.

Pippenger also retains his special interest in dragonflies that he developed as an undergrad studying entomology.

“There are a lot more species than you might think,” he said. “There are more than 200 species of dragonflies and damselflies in Arkansas. I’m not collecting anymore, but I like to keep up with the research.”