Behavioral Neurology & Integrated Brain Medicine

Our Approach

The Division of Behavioral Neurology & Integrated Brain Medicine at Massachusetts General Hospital diagnoses and treats patients with brain disorders that affect language, memory, problem-solving, and other cognitive functions. We also treat patients with neurological conditions that impact emotions and behavior.

Our division specializes in diagnosing and treating patients with various conditions, including:

• Alzheimer's disease and other degenerative dementias
• Degenerative neurological disorders affecting walking, coordination, and movement (e.g., Cerebellar Ataxias)
• Strokes and closed-head injuries resulting in cognitive and behavioral problems
• Functional neurological disorder, including functional (nonepileptic) seizures, functional movement disorder, functional speech disorder, persistent postural perceptual dizziness, and functional cognitive disorder
• Persistent symptoms following a concussion or mild traumatic brain injury
• Aphasia and other language disorders
• Other memory disorders
• Attention deficit hyperactivity disorder (ADHD) and attention deficit disorder (ADD)

What to Expect

Patients can schedule an appointment with us directly or request a referral from their primary care physician or another specialist. During the first appointment, the patient will meet with one of our physicians, who will conduct a physical examination and gather details about the patient's medical history.

From there, the physician may schedule additional tests and exams, including:

• Cognitive and behavioral testing (e.g., neuropsychological testing)
• Brain imaging, such as magnetic resonance imaging (MRI), computed tomography scan (CT), positron emission tomography scan (PET).
• Blood/cerebral spinal fluid tests

These tests help the team gain a comprehensive understanding of the patient's condition and tailor treatment accordingly.

After evaluating the patient's condition, a clinician may prescribe medication and provide information on how the medication works, how to take it, and any precautions to be aware of. When appropriate, we refer patients to different departments within Mass General for additional tests and examinations, such as psychology, psychiatry, neurosurgery, chronic pain, physical therapy, occupational therapy, speech, and language pathology. In these cases, we often work together with other specialists or the primary care physician. If a patient is seeking a second opinion while maintaining care with a community physician, we strive to collaborate with their physician rather than take over the care entirely.

Complex brain diseases and disorders can affect daily activities like work or family life. We encourage family members to actively participate in the development of the treatment plan. For long-term conditions, we work with families to help them understand the associated challenges and participate in the care of their loved one effectively.

Fast, Accurate Diagnosis

Our patients are often in the early stages of a disease. They and their families may sense that something is wrong but may not have a clear understanding of the issue. This is common, as cognitive behavioral conditions can be challenging to diagnose accurately.

Our team excels in diagnosing conditions with a high level of specificity due to several key reasons:

1. Access to Latest Research: As part of an academic medical hospital, our clinicians are constantly updated on the latest research, diagnostic methods, and treatment advancements in behavioral neurology, neuropsychiatry, brain medicine, and brain health. This commitment to staying informed and collaborating across disciplines enables us to effectively differentiate between various conditions.
2. Multidisciplinary Approach: We embrace a multidisciplinary and interdisciplinary approach to patient care, involving neurologists, psychiatrists, psychotherapists, neurorehabilitation experts, and neuropsychologists. Our close collaboration with other divisions in neurology and psychiatry, such as memory, epilepsy, movement disorders, and neuropsychiatry, enhances our ability to provide accurate diagnoses.
3. Advanced Diagnostic Capabilities: Mass General's advanced diagnostic capabilities, including neuroradiology, provide valuable insights that contribute to the certainty and accuracy of our diagnoses.

Managing Symptoms & Manifestations

While it’s currently challenging to halt the progression of many cognitive behavioral conditions, our team specializes in managing their related symptoms and manifestations.

Some patients find relief through medications or adjustments to their environment. Others benefit from our multidisciplinary approach to patient care. For example, speech and language pathology often plays an influential role in treating certain conditions. Additionally, conditions like strokes, epilepsy, multiple sclerosis (MS), and Alzheimer’s disease are linked to mood and anxiety issues which can be addressed by affiliated psychiatrists.

Our unique expertise in treatment and long-term management aims to reduce the symptoms associated with these conditions, such as agitation, pain, and sleep difficulties, leading to improved quality of life.

Major Contributions to Our Field

Two esteemed pioneers, C. Miller Fisher, MD and Raymond Adams, MD, sparked the Mass General Department of Neurology's interest in cognitive and behavioral neurology. Over the years, a number of clinics that specialize in thinking and emotion disorders emerged within the department.

In 1990, the department consolidated these various subspecialties into one cohesive entity: the Division of Cognitive Behavioral Neurology. David Caplan, MD, PhD, a world-renowned neurologist specializing in language disorders, was named founding director.

Over the past two decades, members of our division have made significant contributions to the field. For instance, Jeremy Schmahmann, MD, pioneered the identification of the cerebellum’s role in cognition, including characterizing the Cerebellar Cognitive Affective Syndrome. Dr. Schmahmann also founded the Ataxia Center, one of our specialized pathways.

Another notable expert in our group is David Perez, MD, MSc, who is dually trained in neurology and psychiatry and chief of the division since 2023 (now known as the Division of Behavioral Neurology & Integrated Brain Medicine). Dr Perez pioneered the development of specialized diagnostic and treatment pathways for functional neurological disorder, leading to the establishment of the FND Unit, which he continues to lead with Sara Finkelstein, MD, as the associate director.

We are at the forefront of redefining team-based patient care, including innovative pathways for integrating psychiatric consultations, led by Caitlin Adams, MD.

We collaborate closely with other divisions and units within the Mass General Department of Neurology, such as the Memory Disorders Division, McCance Center for Brain Health, and the Frontotemporal Disorders Unit.

Our Team

Neurologists:

• David Caplan, MD, PhD
• Sara Finkelstein, MD
• Lauren Moo, MD
• Bruce Price, MD
• Jeremy Schmahmann, MD

Dual-Trained Neurologists-Psychiatrists:

• Zeina Chemali, MD, PhD
• David Perez, MD, MSc

Psychiatrists/Neuropsychiatrists:

• Caitlin Adams, MD
• Joan Camprodon-Gimenez, MD, PhD, MPH

Psychotherapists:

• Ellen Godena, EdM, MSW, LICSW (Social Worker)
• Dan Millstein, PhD (Psychologist)