History of Development of an Alzheimer’s Disease Core Center
at the University of Oklahoma Health Sciences Center
Dementia is the fourth leading cause of death in the population over age 65. The prevalence of Alzheimer’s disease, the most common cause of dementia, is 10-15% in the population over 65 years, 20-30% in the those over 80 years, and 50% of those over 85 years. In Oklahoma, about 500,000 individuals are over age 65 years. Based on very conservative figures, we estimate that at least 50,000 people statewide are afflicted with Alzheimer’s disease. With the prolongation of life span, it has been projected that Alzheimer’s disease will become epidemic as 72 million “baby boomers” begin to reach retirement.
While Alzheimer’s Disease is the most common cause of dementia, accounting for 70% of the cases, other etiologies exist. Consequently, evaluating a demented patient using a multidiscipline approach that includes clinical, laboratory and imaging assessments is required to be certain there is no treatable cause for the cognitive decline. In addition, patients with Alzheimer’s disease and other degenerative dementias require a great deal of medical care. Pharmacologic treatments to control behavioral symptoms are available but must be used judiciously to avoid unwanted cognitive side effects. There are also medications that may produce short-term improvement in memory, but again they must be used carefully. Families and caregivers need a considerable amount of psychosocial education so they can meet the needs of the patient and better manage the dementing illness to avoid severe behavioral disruptions. All of this disease management depends upon accurate diagnosis of the patient in the beginning. This will enhance functioning of the demented patient by treating other medical/psychological conditions such as depression, diabetes, cerebrovascular disease, etc., that make dementia symptoms more intense. Disruptive neurobehavioral symptoms present a major problem for families of demented patients. These include agitation, wandering, hallucinations, paranoia, jealousy, and confusion. Caregivers of demented patients need a considerable degree of psychosocial support and education when managing the patient at home. This is, perhaps, the most critical aspect of caring for patients with an incurable dementia. An appropriate patient-centered care program will significantly delay entry into a nursing home, resulting in better care for the patient, and decreased family caregiver turmoil and distress. In addition, delaying nursing home placement, with an average cost of $42,000 per year, produces considerable financial benefits for families, as well as for society.
In the mid 1980’s the National Institutes of Health (NIH), through the National Institute on Aging, began promoting basic science and clinical research in Alzheimer's disease (and related degenerative disorders) by providing funds to support Alzheimer's Disease Research Centers (ADRC) and Alzheimer’s Disease Core Centers (ADCC). A primary goal of the University of Oklahoma Health Sciences Center (OUHSC) is to develop a campus-wide core of competencies to obtain an NIH-supported ADCC and eventually an ADRC. In order to accomplish this, it will be necessary to establish the appropriate clinical infrastructure coupled with basic and clinical research productivity to demonstrate that we have the capability to meet the academic requirements for NIH funding. This document reviews our current resources and discusses additional resources needed to carry out our goal.
The Center for Alzheimer’s and Neurodegenerative Disorders (CANDO) was started at the Oklahoma City VA Medical Center in 1996 for treatment and management of patients with dementia and other neurodegenerative diseases. This program was funded by Congress through a line-item appropriation that was initiated and supported by the Senators and Representatives of Oklahoma to be a model, multi-disciplinary program designed for patient-centered care. CANDO follows over 500 patients. It has been extremely successful as judged by the only clinical program at the Oklahoma City VA to be cited as a “best-liked practice” by the Veteran Services Organization. More importantly, only 7% of the patients followed with Alzheimer’s disease reside in nursing homes compared to a national average of 30%. This clinical program has been duplicated and expanded to OUHSC as the Center for Memory Loss and Dementia (CMLD) to benefit the non-veteran elderly population with dementia in the State of Oklahoma. The CMLD is an outpatient diagnostic and management unit that has been in operation 2.5 years and serves approximately 400 patients. It includes a research database of medical and behavioral characteristics of those patients and their family caregivers.
A clinical center of excellence for the care of patients with Alzheimer’s and other neurodegenerative diseases positions the OUHSC for additional potential research monies. Pharmaceutical companies are looking for reliable venues for research in the area of aging and dementia. Consequently, a clinical center provides significant opportunities for carrying out studies of therapies funded by pharmaceutical companies, research/charitable trusts, and other agencies of the Public Health Services. Total grants awarded to a campus for aging and dementia research make it more competitive for an NIH-NIA funded ADRC or ADCC. The funding for these centers provides basic clinical and research monies ($4-6 million over 5 years), which enable the institution to develop highly sophisticated programs for research and clinical care. To be minimally eligible for these monies, OUHSC must have in place three basic components:
1. an established clinical center of excellence for the care of patients with Alzheimer’s disease and other dementias, including
neuropsychological assessment and research;
2. an established neuropathology unit that specializes in processing brains of demented individuals for basic science research;
3. established clinical and basic science research programs that can be funded at RO1 level.
This campus has a comprehensive clinical program with CANDO at VAMC and CMLD located in the Neurology Clinic in the Presbyterian Professional Building. Dr. Richard Leech and Dr. Roger Brumback established the Diagnostic Center for Alzheimer’s Disease at OUHSC in the early 1990’s for processing brains from autopsied patients with demented for diagnostic and research purposes. Dr. Leach currently heads the unit. We have on-going RO1-level basic science research in aging and dementia through the laboratories of Drs. Robert Floyd and Jordan Tang at OMRF and Dr. Paula Grammas at OUHSC. Also, new research activities associated with aging and dementia could easily utilize the OUHSC General Clinical Research Center, funded by NIH. Other elements that will make an application for an ADCC grant more competitive will be:
1. education of physicians and other health care workers in the area of dementia;
2. special population emphasis, such as dementia care for American Indians;
3. campus-wide collaboration on provision of clinical services and in research programs, indicated by a Dementia Seminar
that meets on a monthly basis to share information and research efforts among all concerned.
Item 3 is being addressed with the
initiation of a CMLD sponsored seminar series beginning
October 4, 2002, 8-9 am, BRC 109 for
individuals on campus who are working in the area of degenerative dementias.
The initial meeting will be with our consulting group, Khachaturian, Radebaugh
and Associates (KRA); who will be assisting the CMLD in the
preparation of an ADCC grant application. Drs.
Zaven Khachaturian and Teresa
Radebaugh spent most of their academic careers at the NIA and were instrumental
in conceiving, initiating and administering the ADRC and ADCC programs before
retiring from the NIA to start KRA. Everyone who wishes to be involved in this
new area of emphasis for the OUHSC campus should attend so diverse areas of
emphasis can be entertained for our application.
This seminar will take place once a month and will be a forum for networking among those on campus involved in the research and clinical aspects of aging and dementia. After the initial meeting, seminars will be an opportunity for participants to take an hour to present their current research and/or clinical practice efforts to others in the group. This cross-fertilization on our campus should result in some unique and interesting collaborations that will generate additional grant monies! You may also contact either one of us directly:
Elliott Ross, M.D. Marilee Monnot, Ph.D.
phone: 278-5796 phone: 271-4113; ext. 46046
e-mail: elliott-ross@ouhsc.edu e-mail: marilee-monnot@ouhsc.edu
CMLD Director and ADCC P.I CMLD Clinic Coordinator and ADCC Administrator