The sun had barely risen over Austin, Texas, on a brisk February morning, but Gladys Maestre’s mind had been at work for hours. She’d spent the night — and the flight from her home in the Rio Grande Valley — rehearsing what to tell state lawmakers about the epidemic of Alzheimer’s disease sweeping through Texas.
The day before, Maestre had spoken to Lt. Gov. Dan Patrick alongside a team of biomedical researchers from the Texas Medical Center. The state’s 89th legislative session was in full swing and the researchers’ continued pitch to Patrick, a three-term Republican who controls the Texas Senate, was a big one: Make Texas the nationwide leader on dementia research.
As director of the University of Texas Rio Grande Valley’s Alzheimer’s Disease Resource Center for Minority Aging Research, Maestre was on a more specific mission. She was at the Texas Capitol to demand greater state investment for early prevention and care in the Rio Grande Valley — a four-county region along the Texas-Mexico border that’s become the epicenter of a nationwide Alzheimer’s spike.
One in nine adults over 65 in the United States is living with Alzheimer’s, the most common form of dementia, a fatal and progressive neurodegenerative disease that causes memory loss and cognitive decline. In 2025 alone, Alzheimer’s will account for $384 billion in health care spending across the country. That doesn’t include the economic cost of unpaid caregiving — an estimated $413.5 billion last year, according to the Alzheimer’s Association.
Texas ranks second in the nation for Alzheimer’s deaths and third in prevalence: 460,000 people have the disease and 1.1 million more are their caretakers. But the state’s lack of funding for memory care and support, along with its ongoing refusal to expand Medicaid, is making matters worse.
Over the past two years, Texas has only allocated a total of $5.5 million to dementia care and support, despite having a nearly $33 billion budget surplus. That’s a strikingly low investment compared to other states facing Alzheimer’s crises. Florida spends $80 million on the disease annually. New York spends $33 million. Even Georgia, a state with less than half as many dementia cases as Texas, spends $10 million a year. And, unlike Texas, these states invest heavily in direct services for Alzheimer’s patients and their families, including training and respite programs for caregivers.
Things are especially dire in the Rio Grande Valley, a medically underserved region even by Texas standards. One in four people over 65 has Alzheimer’s in Starr County, the heart of the Valley’s dementia surge. Seniors there are three times more likely to develop the disease than the national average. Two of the Valley’s four counties, including Starr, don’t have a public health department. The region has no public hospitals and lacks community and senior centers. Roughly half of its residents live in food deserts and one in four households lives in poverty.
Maestre had seen these disparities up close. She’d watched people, desperate for treatment or a diagnosis, wither away on long waitlists to see specialists like neurologists and neuropsychologists. And she’d witnessed caretakers, many of whom spend years of their lives looking after loved ones, crumble under the relentless pressure that comes with navigating an underfunded medical system.
That’s why Maestre was at the Texas Capitol for a second straight day: To urge all 11 state senators and representatives from the Valley to step up for their districts. During the meetings, some of the lawmakers asked Maestre questions that only people with firsthand experience with dementia would think to ask. Others became emotional when discussing the disease. At least four cried, Maestre said.
“I was surprised at how passionate some of the representatives were,” she said. “In my impression, all of them have someone nearby with the disease. They were very sensitive.”
Following her final meeting of the day, Maestre walked out onto the grassy Capitol grounds. It had been a grueling six-hour stretch, but it felt like progress. She felt “mucha esperanza" — a lot of hope.
One step forward, one step back
Nearly four months later, Maestre was back at her office in Harlingen when she heard the news: The Texas Legislature had adjourned its biannual session without delivering the funding changes she’d fought for.
She felt deflated. Sure, legislators had sustained the state’s investment in dementia public awareness campaigns and resources for health care providers, but they’d done nothing to directly help patients or their caregivers. The $2.71 million they’d approved for dementia care over the next year was less than 1/25th of what Florida will spend in 2025.
But she saw a silver lining. Legislators passed a law that aims to do for dementia what the state has done for cancer since 2007: lure the best specialists, researchers and biotech companies to Texas, in this case to search for a cure to dementia and related diseases.
The Dementia Prevention and Research Institute of Texas, or DPRIT, proposes pulling $3 billion from the state’s current budget surplus — $24 billion — to fund dementia research. If created, the institute will award $300 million in research grants to medical and educational institutions annually over the next decade.
State Sen. Joan Huffman, a Republican from Houston who co-authored the bill, pointed to the $6 billion Cancer Prevention Research Institute of Texas — which has made the state the second-largest public funder of cancer research — as the model for tackling Alzheimer’s.
“DPRIT will help Texas become a leader in combating these diseases,” Huffman said in a written statement to Public Health Watch. “DPRIT is specifically designed to accelerate research, attracting top talent to our state and creating high-quality jobs, but most importantly, improve the health and quality of life for Texans impacted by dementia and related disorders."
All 11 members of the Rio Grande Valley delegation Maestre met with — including State Sen. Juan “Chuy” Hinojosa, a Democrat who co-authored the bill — voted for Huffman’s legislation. But DPRIT still isn’t a reality, even though it’s been signed into law by Gov. Greg Abbott. Instead, Texas voters will determine the institute’s fate in the upcoming November elections. If passed, the research fund will take effect on January 1, 2026.
Even if voters approve it, many experts have reservations about DPRIT.
DPRIT could boost medical research and business in Texas, but it does little for patients and caregivers in need of immediate help. And because Huffman’s legislation doesn’t allocate money to specific regions with greater need, Valley researchers worry that most of that $3 billion will be funneled toward universities and research institutions in bigger cities like Houston or Dallas — exacerbating the current circumstances in rural parts of the state, especially the Valley.
“This is an issue that’s tearing our communities apart,” said Rep. Erin Gamez, a Democrat whose district includes the Valley’s Cameron County. “My every hope is that we utilize and send [DPRIT] funds to the communities most in need.”
Disparities in the Valley
In addition to having high uninsured rates and extreme poverty, the Valley has a shortage of neurologists, occupational speech therapists and neuropsychologists. Maestre’s Alzheimer’s center in Harlingen is the only memory clinic in the entire 4,000-square-mile region. The clinic’s waitlist has more than 600 people on it, many of whom will have to wait as long as 18 months for treatment or a diagnosis.
If approved by Texas voters, DPRIT could shorten that waitlist by funding more specialist positions. But there are larger systemic and infrastructural problems at play, too. As Public Health Watch has previously reported, there is no cure for Alzheimer’s and scientists don’t fully understand what causes this devastating form of dementia. The research is clear, though: Lack of education, air pollution and other social and environmental factors leaves people more vulnerable to the disease.
The Valley’s older, crumbling infrastructure is of special interest to Maestre. Her team of researchers has studied how cities’ designs and architecture play a role in people’s cognitive and psychological health. For instance, because cities in the Valley largely look alike, it’s difficult for aging people to recognize where they are. A study by Texas A&M University found that dangerous metals like lead and arsenic are common contaminants in the Valley’s water and soil. Both have been found in residents’ blood samples and urine samples.
“There are still areas in the Valley where lead is a problem. Lead in the houses, in the paint, it shouldn’t be there,” Maestre said. “Once lead enters the body, it never goes out and it can go to the brain.”
DPRIT wouldn’t solve these issues. In fact, it would widen the gap between the haves and the have-nots in the Valley and elsewhere. Research efforts overwhelmingly benefit Alzheimer’s patients whose illnesses are addressed in their earliest stages, Maestre said — a privilege that low-income residents without insurance, access to care or higher education levels are afforded far less often.
To close this gap, community-based organizations like El Faro Health and Therapeutics, a small Alzheimer’s clinic located in the Starr County border town of Rio Grande City, are stepping up. The understaffed clinic offers treatments and diagnoses to patients. It also offers nutritional support, financial literacy classes and community health fairs.
James Falcon, El Faro’s co-founder and lead investigator, said his clinic is a “game changer” for people who otherwise wouldn’t have access to resources like free memory tests and medication. A funding influx from DPRIT could bolster his staff and help families across the Valley, he said.
“Every day that you’re seeing patients in your clinic… you’re having to take care of them and their families, because it has a lot of ripple effects,” Falcon said. “It affects the whole community.”
Caretakers left behind
Isabel Alanis moved to Brownsville from the northwestern Mexican state of Durango in 1977. By day, she supported her eight children by working at a factory making electrical switches. By night, she fed them traditional Mexican delicacies like chicken tamales with homemade masa. She loved to embroider, making blankets for her grandchildren and slips for her daughters’ sofa pillows.
But Isabel, now 86, can’t spread masa on corn leaves or hold a needle anymore. She doesn’t recognize most of her 31 great-grandchildren, their parents or her own daughter, Maria, when she sees them, either.
In 2018, Maria took her mother to the doctor after she began misplacing things and accusing family members of stealing them. But she didn’t get a medical referral until her symptoms grew more severe, and she had to wait another year to see a neurologist to confirm she had dementia. By then, the disease had advanced so much that doctors couldn’t slow its spread. Now, all they can do is treat her behavioral symptoms by prescribing sleep medication.
Isabel’s memory is failing. She looks at her daughter, whom she calls Concha, and thinks she’s slimmer and has darker hair than she actually does — because she’s picturing Maria, who is 62, when she was 18. Isabel’s behavior is often erratic. Staying awake for four days straight. Acting aggressively or stubbornly. Unable to control when or where she uses the bathroom.
Taking care of a loved one with dementia is a traumatic, life-enveloping experience, Maria said. She wakes up at 4 a.m. if her mother doesn’t sleep through the night. She tries to stay patient, even when her mom hits her and throws temper tantrums.
“One time, she told me this wasn’t her home, that she didn’t want to be here,” Maria said in Spanish. “The truth is, I can’t take it anymore.”
Even if DPRIT takes effect next January, it won’t help Maria. She spends 40 hours a week watching over her mother but doesn’t receive state benefits for being a caretaker because most respite care programs are only eligible to Medicaid recipients. There’s a workaround — Maria works part-time at a home health company, which assigns her to work with her mother — but that pays her only about $200 a week after taxes. It’s not nearly enough, but she’s trying to survive on the money she and her mother get from Social Security.
“I always try to avoid debt. I don’t have credit cards,” Maria said. “Somehow, someway, you have to keep going,”
One resource that’s helped Maria is a “stress-busting class” at the WellMed Charitable Foundation’s Senior Activity Center in Brownsville. The class hosts caregiver workshops, exercise classes and Caregiver SOS services. It also offers free support for families and caregivers of people with any chronic disease, including Alzheimer’s.
But other caregiver programs that are run by the state are in jeopardy.
In March, the Trump administration halted the National Institutes of Health’s grant approval abilities, freezing $65 million in funding for Alzheimer’s disease research centers. Proposed cuts to Medicaid also threaten existing caregiver programs like respite-care services that accept Medicaid waivers or pay qualified caregivers — a blow that would exacerbate Texas’ failure to significantly fund Alzheimer’s care during the recent legislative session.
Already, the Brownsville senior center has shut down its support group for dementia caregivers, a blow to Maria. Amid all of her pain is the fear that her mother’s dementia could be hereditary. She has signed up for a free memory test with a clinic, but she’s on a waitlist for that, too.
For now, all Maria can do is wait and look to God. She can’t attend Mass in the mornings anymore, but she prays in her room when her mother sleeps. She imagines her mother’s brain as a Christmas tree: beautifully adorned with colorful lights that flicker and eventually burn out. She wants her mom’s life to be as bright as possible until the last light finally dies.