Erin Jackson

Independent Research
January 17, 2016

Dr. Conrad May

Associate Professor, Doctor
University of Maryland Medical Center
Interviewed November 30, 2016

Dr. May is a practicing psychiatrist who works with older adults with dementia. He also
works with many residents and graduate students. Being a psychiatrist who works with older
adults, he has patients who have vascular dementia (VaD) and is researching a particular subtype
of dementia with one of his residents. May was kind of enough to answer fourteen open ended
questions as well as follow up questions. First, he talked about his typical day when he worked
with patients, saying he first reviewed the patients he was going to see and on Mondays.
Wednesdays he conducted rounds with the fellows. He also mentioned that he sees new patients
as a team and the patients are often referred because they have problems with cognition. He was
then asked a follow up question of how he examines patients and said that he checks vital signs,
visits in with patients and will use various types of memory tests to determine if a patient has
dementia. May answered an introductory question of what his favorite part about his job was. He
said he liked working with and teaching fellows because they got to learn and get additional
help.
When actually diagnosing a patient and differentiating among the different types of
dementia, he uses the history of both the patients; as well as his experience as a doctor. He also
uses the different characteristics of the disorders and symptoms of the diseases. He also considers
whether the course of the progression of the disease had been rapid, slow or fairly stable. He
looks for patterns of cognition, as some dementias have a typical pattern. He excludes different
types of dementia to determine which type of dementia a patient has.
Professor May has been researching a type of VaD called Cerebral Amyloid Angiopathy
which is when proteins build on the walls of the blood vessels in the brain and cause a blockage
leading to VaD. He is focused on learning how to prevent the progression of the disease as well
as treat the damage.
In terms of treating VaD in general, the biggest challenge he observes is not in the patient
themselves, but the caretakers. In terms of caretakers, the biggest challenge is those who care for
patients with behavioral problems. One way to make caretakers jobs easier is to get more people
in adult day care. This allows the caretaker to have some relief and to have a break.
When actually treating a patient, the most important part is preventing the progression of
the disease. Exercise and dietary changes are very useful for preventing the progression of the
disease as it will help prevent substance buildup in the brain. When treating VaD, it is important
for doctors to find what the patient likes and use medications as a last resort. Like many other
doctors, he stated that he preferred to use alternative therapies instead of treating patients with
traditional medication. Alternative therapies can include music therapy if the patient likes music.
Talking about and using these therapies stimulate the brain. He will use medicines as a last resort
when a patients family wants to use medicines, but all medications have side effects. When
weighing the risks of the different types of medications with the benefits, May works with
pharmacists. He tries to use medicines with as little side effects as possible. However with VaD,
medicines do not usually meet this requirement. There are no medicines designed specifically for
VaD, so doctors may use medicines designed for Alzheimers disease. May said that the benefits
of cholinesterase inhibitors are very modest and he prefers not to use these medicines when
treating any type of dementia, but may use it at the request of loved ones. When weighing the
risks of medicines, he considers what other medicines the patient is taking, how well the patients
can walk, and if other interventions had worked or not.
When treating patients with less severe dementia, he recommends that they start
exercising to prevent the buildup of substances, doing chores around the house to stimulate the
brain and control their diet and weight to help prevent further progression of the disease. He
largely relies on the family to help evaluate the therapy of a medicine. The caretaker will be
spending the most time with the patient and will be able to tell the difference in a patients
symptoms and behavior. He relies on the nurses and caretakers to determine the effectiveness of
a therapy.
Patients rely on their family and loved ones to help make their treatment successful. In
fact, May said that families play a considerable role in a patients treatment, and this role can be
extremely successful. There are a few ways to alleviate this stress including using adult day care,
having other caretakers, and using support groups. Many hospitals, including the University of
Maryland Medical Center, will run their own support groups. When teaching fellows, he teaches
quite a bit about dementia. He finds that the biggest challenge is that the fellows probably know
about dementia and VaD but do not really think about them before going into the program, so
learning to understand how patient are affected and the disease may be the hardest part.
However, learning the different therapies tends to be very easy for the fellows. New research
generally has a time lag between when the research is conducted and when something gets
published. Doctors have to be very careful when using studies as some can be manipulated to
make a therapy seem more effective than it actually is. May says that he sees treatment changing
in the next ten years by having a more effective treatment for VaD and learning how to stabilize
VaD earlier in treatment. Also, he hopes to have more knowledge about prevention of the
disorder and learn how to effectively treat brain damage caused by VaD.

Reflection
I think the interview went very well. It was incredibly interesting and helpful. We talked
for a long time and I did not realize how long we talked. I asked follow up questions but wished I
would not have used so many fillers like um when I was asking follow up questions. I think I
could have done more to show how interested I was in the interview. I was a bit nervous and
wished I could have been more confident. The interview helped give me a new perspective of
VaD as I learned about it from a practicing psychiatrist and professor. The interview provided
evidence for using alternative therapies instead of using pharmacologic treatments and
challenged some previous perceptions I had about VaD. It also allowed me to learn more about
the families and how they are affected by a loved one having VaD. My audio was not good
enough to transcribe an interview. I wished I could have had better audio and planning to
transcribe this interview.