xt7bg7374186 https://exploreuk.uky.edu/dips/xt7bg7374186/data/mets.xml University of Kentucky. Office of the Vice President for Research and Graduate Studies Kentucky University of Kentucky. Office of the Vice President for Research and Graduate Studies 1989 volumes. Call Number: LD2762.9 .K38c. Accession Number: 2018ua049 journals LD2762.9 .K38c English Office of the Vice President for Research and Graduate Studies  Contact the Special Collections Research Center for information regarding rights and use of this collection University of Kentucky Odyssey Magazine Research -- Kentucky -- Periodicals Education -- Research -- Periodicals Research -- Kentucky Odyssey: The Magazine of University of Kentucky Research, Winter 1989 text images Odyssey: The Magazine of University of Kentucky Research, Winter 1989 1989 1989 2026 true xt7bg7374186 section xt7bg7374186 _ ”is!“ : A
WSECRETS QF ACNC

THE SCIECN *

 

  

he University of Kentucky, the Commonwealth‘s

graduate education and research institution, exists

to provide opportunities for the education, personal
growth and development of individuals and to contribute to
the improvement of soctety,

With this mission as its prerruse, one goal of the Univer—
sity is to conduct programs of basic and applied research
which support graduate and professional education, provide
for the advancement of knowledge, and seek solutions to the
acute problems of society.

The University's research mission also acts as a magnet
for attracting tap graduate students who want to participate
in nationally competitive research projects. This research
experience can offer them a significant advantage in their
education while laying the foundation for future research
and development. ODYSSEY Magazine, through are
ticles about various research projects and graduate educa»
tion programs, reflects the breadth of the University’s search
for new knowledge and the myriad of research endeavors unr
derway. The progress that the University has made toward
achieving its research mission and securing the extramural
funds required to support these types of endeavors would
have been impossible without the talents and dedication of
our researchers,

The goal of ODYSSEY Magazine is to offer the
reader the opportunity to share in some of the excitement,
curiosity and creativity evident in the research underway at
the University of Kentucky.

 

 

 

Va
sea

SANDERS/BROWN
CENTER ON AGING FOUNDATION

IT’S NOT HOW OLD YOU GROW
BUT HOW YOU GROW OLD.

r7 The SanderSeBrown
Center on Aging
Foundation is dedicated ,
to developing
SanderSeBrown into
the finest center for the
study of aging in
the United States.

 

 

Dr William R. Marlcesbery, director of
the Sanders—Brown Center on Aging,
works with an electron microscope which
is used in geriatric research.

3‘1? In recent years private gift support has
helped us make progress toward this goal.
However, much more needs to be
accomplished to establish and maintain
excellence in this field.

L‘ Asking others to join us in our efforts is not
difficult. The determination to improve the
quality of life for our senior citizens is an
endeavor from which we all will benefit.

I For further information, please contact:
Mr. Jack Hillard, University of Kentucky,
Sturgill Development Building, 450 Rose
Street, Lexington, KY 4050670015,

(606) 2335374.

This message is sponsored by Ashland Oil, Inc. Ashland.
'
and by

Cornelius E. Hubbuch
in memory of his wife, Mary Louise Hubbuch,
who died of Alzheimer’s disease May 1988.

 

 

 

 

  

 

ODYSSEY

Volume VII, No. l

 

 

University .‘Mchévm

Margaret i 3 in; 3:1; ,, 5.333%
CONTENTS J
lhvinrrfiq— Y""'l" 'izu iii-ngzfv“
u! .v 3 .

 

 

"AID Living a Hundred Years .7.
Plastic

amines

 

Faster Healing with Electricity 14

 

3051mm
Faster Healing, p. 14

 

“I Can’t Read” 18

 

Sleuthing Through the Stables Z5

 

Steroids and Sexuality Z8

 

Research Briefs 31

 

Research Results 35

 

 

ODYSSEY is a magazine published by the Office of the Vice President for Research and Graduate Studies.
Each issue of ODYSSEY describes only a few of the many University of Kentucky research projects underway in
a variety of areas.

Requests for permission to reprint material and reader's comments regarding ODYSSEY are welcome and
should be sent to the Editor, Research Communications, University of Kentucky, Lexington 40506—0057
(Phone 606’25748297li

The publication of ODYSSEY is not financed by state—appropriated funds.

Editor: Susan H. Donohew. Asst. Editor: Jeff Worley. Designer: Shear & Shear. Publications Asst.:
Sharon ]. Turner. Contributing Writers: Elizabeth Hansen‘ Gary Pierce, Michal Smith, Linette Wheeler.
Printing: Merrick Printing, Inc. Typesetting: Maury Boyd St Associates.

Credits: photos on cover and p. 5 by Mark Zerof; photos on pp. 3‘ ll‘ 17, 26, 27, 2*), and 33 by Ken Goad;
photos on pp. 6, 9, 24, and 35 by Bill Wlells; photos on pp. H, 18‘ and 34 by Lee Thomas; photos on pp. 2‘3
and 27 by Bill Straus.

Cover: Lucy Powell, one of over 500 Kentucky centenarians who have taken part in a University of Kentucky study of
the state’s oldest old.

 

 

 

  

 

 

O
O

LIVIN A HDUNDRE YEARS

GENETICS, PHYSIOLOGY,

OUTLOOK AND OTHER SECRETS

ODYSSEY 2

 

  

 

by Jeff Worley

r. David Wekstein, associate director
D for the Sanders~Brown Center on

Aging, remembers the day when the
invited speaker, a white’haired woman named
Mary Cross, presented a lecture to first~year
medical students at the University of Ken~
tucky. After she had stood in front of them
for an hour, she asked if there were any ques—
tions. “How is your health?" asked a student
in the second row. Mrs. Cross, age 101,
looked directly at the young man, reached
over without bending her knees and put the
palms of her hands flat on the ground. “One
final note for all of you to take with you,"
she said from her new position—“when you
graduate, don’t you overcharge. It's the wrong
thing to do!H

The oldest old have always fascinated and
intrigued us. They are a tangible link to a far—
away past we can only vaguely imagine. They
are a living history: one centenarian describes
the severe, determined face of Carrie Nation
as she marched into the town’s only saloon;
another recalls watching the portly Grover
Cleveland strolling on the White House lawn;
and another clearly remembers, on December
31, 1899, listening to her father’s clock on the
mantel tick into the new century.

Partly because so little was known about this
special group, Wekstein, a professor of physiol~
ogy and biophysics, is now involved in a study
of Kentucky centenarians, a project that
seemed to grow naturally from an earlier idea
to recognize and honor IOO—yeapolds living in
Kentucky. “This current project resulted from
our idea of sending certificates to centenarians
throughout the state. We started doing this
about five or six years ago through the gover—
nor’s office and the president’s office here.
We've sent one to every name reported to us—
about 500 so far,” Wekstein says.

As new names came into his office, and
more and more certificates left in the mail,
Wekstein realized the potential for a fascinat~
ing project. “I thought, ‘Why don’t we pull
together people from various parts of the uni—
versity, look at this unique group, and see
what we can learn from them.Y ” Wekstein
says that in the beginning the focus of the
project was to describe a phenomenon, not to
attempt to answer any questions. “There was
so little information available about people of
this age, we wanted, first, to describe them

 

 

David Wekstein

‘ ‘One centenarian in Western

Kentucky told me that when she
dies she wants her body to go to a
university for research—and that
her 104vyear~old brother feels just
the same way. How many people

have a 104ryear~old brother! ’ 5

continued on page 4

 

3 ODYSSEY

 

  

ODYSSEY 4

 

accurately. Our goal was simply to find out
what 1007year’olds in Kentucky had in
common."

Funded by the Sanders’Brown Center and
two private sources, the Beverly Foundation
and the Andrus Foundation, the centenarian
project was initiated in 1984 by a time
consuming, but necessary, first step. With a
listing of the telephone numbers of those who
had made referrals, Wekstein and research
associate Ms. Charli Kirkpatrick began to
interview this group to find out how func—
tional the centenarian was. Those who were
characterized as “quite functional" were con—
tacted in person. If the researchers were sat;
isfied that the centenarian was mentally
competent, they described the project and
asked him to participate. All participants had
to then sign an “informed consent" document.

At this point the researchers got a wide
range of responses. “Quite a few were happy
to participate, pleased to be asked,” says
Wekstein. “But there were some that wanted
no part of it. One man in Louisville—we'd
been warned by his niece that he was ‘mean
and nasty’—said he was too involved with his
stocks and bonds portfolio. Another hundred
year‘old, who had just come home from get—
ting his driver’s license renewed, said it would
interfere with his social lifel’y

—
Persons 85 years of age and over
now constitute the most rapidly
growing segment of the population.

—

The next step for Wekstein and Kirkpatrick
involved a bit of detective work—verifying the
age of the centenarians. Since Kentucky didn’t
keep any birth certificates before 1917, no one
born before that date can prove date of birth.
The investigators, therefore, turned their
attention to census data, knowing that after
70 years this information is part of the public
record. H\We’d go back to the 1900 census, for
example, to see if the person was 11 or 12
then,” Wekstein says.

“If we found that age reported in 1900, we
were satisfied, since there’s no reason to
believe that anybody at age 12 would exagger—

 

ate how old she was. It's a perfectly acceptable
way of verifying age.H The oldest participants
in the study have been 106.

So far, the researchers have interviewed
over 500 centenarians, over 40 of whom have
participated in in’depth, personal interviews
and clinical work. “We have done a great deal
of clinical chemistry with this group,” VUek~
stein says, “as well as CAT scans and cardit»
vascular work to get some fundamental kinds
of information." One of the problems the
researchers are focusing on is dementia, loss of
intellectual function, in the older population.

”We know that thirty percent or more of
the population 85 and older have Alz~
heimer's—some studies say up to two—thirds of
this group—so you could predict that in the
centenarian population most of them would
be demented, which is not the case," says
Wekstein. “In our group, in fact, only about
40 percent were demented." He cautions that
this is not a study of every centenarian in
Kentucky: uThese people were all self’reported
in some fashion, so if someone is demented
and living alone or no one cares about him,
we wouldn't know he exists. So the study is
skewed in that way.H

There are no accurate numbers to tell us
how many centenarians live in the United
States, though Wekstein estimates that one of
10,000 people are 100 or older. Of Kentucky's
3.5 million people, then, there would be 300 to
400 centenarians at any one time. \Xlekstein
says that although the study doesn’t include
all of them, 70—80 percent are contacted.
“From one perspective," Wekstein says, ”that’s
not at all problematical. In almost any study
of a group, you want to exclude those who are
sick. We are interested in looking at only
healthy centenarians.”

What traits do these centenarians share.7
One common characteristic among the group
is a reported history of longevity in the imme~
diate family. The centenarians’ mothers and
fathers lived well beyond the time their peers

continued on page 6

 

 

  

 

Lucy Powell: Mackville’s Oldest Citizen

 

 

 

hen we arrived at the
Medco Center of Spring—
field, Kentucky on a windy

day in November, Mrs. Violet Elliott,
Medco Administrator, assured us
that Lucy I’owell was looking forward
to the visit.

“There's just one thing," Elliott
said. “Lucv wanted me to let you
know that she can't chat past 4:00.
Friday‘s her bingo day."

I had driven from Lexington along
the Bluegrass Parkway, the wind pick—
ing the maples and hickories bare,
with Lisa Burgess, senior research as—
sistant at the Sanders-Brown Center,
and Mark Zerof, a photographer who
accompanied us. \Ve had come to see
Mrs. Lucy I’owell, one of over 500
Kentucky centenarians participating
in a University of Kentucky study of
the state's oldest citizens.

Mrs. Powell—Lticy—\vas clearly
delighted to see us, and seemed espev
cially pleased to see the two cameras
Mark carried over his shoulders.
“Now don’t you take my picture
when my mouth's open," she warned
Mark after we had been introduced
to her by Lisa, “the last one that did

 

 

Lucy Powell

that made me look like an old fish!"

And before any photos could be
taken, Lucy wanted to pin on the
corsage she received on her 100th
birthday in 1987. In the middle of the
flower arrangement was a blue ribbon
showcasing the number 100 in gold
script.

Lucy was born on the family farm
about five miles outside of Mackville,
Kentucky where she was raised with
her brothers, Carter and Charlie,
and a sister, Sarah Elizabeth. She at—
tended school from the time she was
six until age 13. Although her school,
ing was brief, one memory stands out.

“I remember being punished at the
old White Oak Schoolhouse,” Lucy
said. “The teacher kept me in during
recess and wouldn't let me have notha
ing to eat."

“What had you done that was so
bad?" I asked.

”I bit a girl, right on the wrist."

Asked why she’d done this, Lucy
replied, uMeanness probably.”

Lucy added that later in the
schoolday the girl sitting next to her
gave her a piece of cake from her
desk. “Oh, they loved me, really. I

 

was a little bitty fella . . . they just
loved me."

At age 27 Lucy married Will Poww
ell. They lived on a ZlZ~acre farm in
the Mackville area and raised crops
and livestock. Will, with hired help,
would tend the tobacco and corn
crops and Lucy cooked for everyone.
She never smoked any of the tobacco
herself, but did admit to one short!
lived “terrible bad habit"—-drinking
coffee.

“I didn‘t drink coffee when I marv
ried \X’ill, but he wanted his coffee
three times a day—breakfast, dinner,
and supper. I got tired of making it
that long. I got to pouring a little on
a saucer and then into a teacup. But
it didn’t agree with me so I quit."

When Lucy talked about their life
together on the farm, her words
seemed lighter, even more sure of
themselves. “We had big times, good
times," she said. “We didn't have any
children, but I had lots of pets. My fa—
vorite was Buster, my pet pig. I could
hold him in my arms at first, but
then he got big~over 300 pounds.H

After her husband died in 1958,
Lucy remained on the farm for ten
years before moving into a home in
Mackville. In the 19705, she broke
her hip and her freedom was restrict;
ed, but she didn‘t let her accident
slow her down. Instead, she took up
the art of quilt making and found she
was extremely good at it.

“I pieced 7.5 quilts and quilted
them,” she said, “and I’ve sold every
one." She had planned to keep the
last one, but a man who had already
purchased one was so insistent, she
sold the last one to him too.

On her 100th birthday, Lucy was
named a Kentucky Colonel and re
ceived correspondence from President
Reagan and Governor Martha Layne
Collins. “I got all kinds of presents,"
Mrs. Powell told us, “over 230 cards
and letters."

But now she was suddenly distract—
ed—perhaps, I thought, by another
memory she wanted to share with us.
She was looking beyond me to the
opposite wall. It was 3:45, time for
us to shake her hand and be on
our way.

Jeff Worley

 

5 ODYSSEY

 

 

  

Lisa Burgess, senior research
assistant at the Sanders-
Brown Center, and Sumner
Davis, a participant in the
UK centenarian project.
Davis, 103, lives with his
daughter Jane Davis.

ODYSSEY 6

 

lived, and had brothers and sisters who also fit
this pattern. “One centenarian in Western
Kentucky," Wekstein says, “told me that
when she dies she wants her body to go to a
university for research—and that her 104—year~
old brother feels just the same way. How
many people have a 104’year‘old brother!"
The second commonality is that the meme
hers of this select group have lived a lifestyle
that is consistent with longevity. None has
had any significant history of smoking (though
two were tobacco chewers), they were not
heavy drinkers (though some occasionally
took something for “medicinal purposes"),
none was obese (defined by Wekstein as ten
percent above ideal weight), they drank very
little caffeine, and most weren’t red—meat

eaters.

“I won’t say they read the book and knew
what to do," says Wekstein, “but they pretty
much stayed within the American Cancer

 

Society guidelines. That’s basically how these
people have lived."

Another important shared attribute is that
these centenarians are very future~oriented.
One of the men in the study who is 102 years
old is writing his autobiography. He is cur,
rently up to the time (1916) when he was
thirty. He has every intention, Wekstein says,
of finishing it. “All of these centenarians had
definite plans for the months ahead. They
weren’t just sitting around waiting to die."

Although these findings weren’t particularly
surprising, Wekstein says that they are valu’
able because now some hard data have been
gathered to support them. There have been,
though, a number of surprises. “l was amazed,
for one thing, how easy it was to identify these
people. i never in my wildest imagination
thought that we would have hundreds of
them. A second surprise for us was the num~
her not living in long/term facilities. Vie

 

 

 

  

 

envisioned the vast majority to be in institu—
tions and that wasn’t the case for about half
of them."

Although the immune systems of the cente«
narians had “gone downhill about the way we
expected," he thought that there would be a
much higher percentage that were demented
by this age. ”In terms of CAT scanning of the
brain, they most certainly did lose brain tissue
as they grew older. But they didn’t lose it at
the rate we would have predicted. They didn't
seem to lose themselves as quickly as the rest
of their peer population. So although they
weren’t immunologically spared, the loss of
brain tissue didn't go downhill that way,"
Wekstein says.

Charli Kirkpatrick, who conducted all of the
telephone interviews during the project’s first
two years, emphasizes the importance of the
data that have been gathered, and adds that
the project was “intensely interesting." “it‘s
the closest thing I ever did to not working,"
says Kirkpatrick, now the coordinator of the
Memory Disorders Clinic at the Sanders~
Brown Center. “There were very few people I
didn‘t fall in love with. And even though I
have a new position, I‘ve been in contact in
the last month with the four of the 38 people
still alive that I interviewed four years ago. I’m
still trying to find out if another three are
living.“

Ms. Lisa Burgess, the project‘s current
research assistant, thinks of the job as an
important step in gathering information, but
she also thinks of it as an opportunity to hear
a wide variety of “life stories." ”These people
are very important historically~they‘ve wit~
nessed incredible changes in their lives, Listen—
ing to them is a wonderful way to learn about
Kentucky's past.H

Burgess, who has interviewed over 220 cen’
tenarians during the past year, is continually
surprised how many of them are alert and
physically capable of living on their own with
a minimum of care from others. HOne thing
the study has done is to break the stereotype
of the totally befuddled, bedridden 100—year—
old,” says Burgess. “Only 18 percent of those
I’ve interviewed fit that pattern."

The centenarian study, \X’ekstein mentions,
has been funded in a number of ways. “\We’ve
been lucky enough to get money from here

 

‘ ‘ One thing the study

has done is to break the stereotype
of the totally befuddled, bedridden

100~yearvold. ’ l

and there to keep the project going," he says,
and now the plan is to put together a grant
application for a “well’funded, five—year
study.H Major funding would allow the
researchers to test some hypotheses based on
information that has been gathered.

“One thing we’d like to do is a prospective
study," \Vekstein says. “If we could find peov
ple, say, in their 50s whose parents lived to a
rightful old age, and the people in their 30s
had a lifestyle similar to that of their parents,
we could study the sons and daughters over
time to determine a correlation.”

Wekstein has already collected a pool of
close to 5000 research volunteers, all over 60
years of age, in Fayette County. He currently
has a databank of information on these volun’
teers‘how many had grandparents, parents,
or siblings that lived to be 90 or older. “er
have the possibility to use this group in a
number of ways, as various kinds of control
groups,H he states.

Vlekstein believes that the oldest old in the
United States will be studied in much greater
detail than in the past, pointing out that per—
sons 83 years of age and over now constitute
the most rapidly growing segment of
population.

He cites television programming and advea
tising as indications of the attention now
being paid to older groups. “Look at ‘Golden
Girls,’ for example. The characters are in their
50s, and 60s, and the mother is eightx»
something. People over 65 now have the great‘
est amount of disposable income, so TV ads
are being aimed differentlywluxurv cars and

continued an page 8

 

7 ODYSSEY

 

  

Demographic Information about

the University of Kentucky
Centenarian Pool

ODYSSEY 8

 

vacations and expensive jewelry. There’s a
whole lot of new public exposure."

Wekstein adds that perhaps the most impor—
tant finding to emerge from the centenarian
study is that in Kentucky, as elsewhere‘ there
is a large number of very old individuals who,
as they begin their second century of life, look
forward to each new day and add immeasur~
ably to the lives of those around them. I

 

Some of the other researchers involved in the centenarian
study at the University of Kentucky include Dr. John
Thompson, chairman of the Department of Medicine; Dr.
Thomas Roszman, professor of microbiology and immunology;
Dr, Norbert Tietz, professor of pathology; Dr. Robert Straus,
professor of behavioral sciences; and Dr. Anthony DeMaria,
professor of medicine.

 

 

Percentage of

Participants Participants
Sex
MfllCS 152 30.290
Females 352 60.8%
Marital Status
Single 41 8.1%
Married 1 l 2.2%
Divorced 7) .691)
Widowed 449 89.1%
Living Arrangements
In own home 61 11.9%
Home of Family 101 19.7%
Long’Term Care Facility 336 65.6%
Other 14 2.8%
Vision
Excellent or good 99 20.4%
Fair 199 41.0%
Poor 157 32.4%
Blind 30 6.2%

 

 

  

 

 

 

Research on Brain’s
Self'Repair Mechanism
Holds Hope for

Alzheimer’s Victims

common belief about the

brain is that its circuitry is

fixed at birth and that dam’
age to this delicate circuitry is never
100 percent reparable. The idea is, to
make an analogy between the brain
and a car’s electrical system, the wir‘
ing is fine when the car leaves the
factory, but after years of wear will
inevitably short’circuit, or burn out.

At the University of Kentucky, as—
sociate professors Stephen Scheff, in
the Department of Anatomy and
Neurobiology, and Steven DeKosky,
in the Department of Neurology, are
currently involved in research, fund’
ed by the National Institute of
Health, that has shown this belief to
be false. In experiments with labora—
tory rats, the researchers have found
that the brain directs and regulates a
self’repair process after sustaining an
injury. There is also some preliminary
evidence—and this has important
implications in Alzheimer’s research
Aof regenerative or compensatory ef—
forts by the brain in degenerate dis—
eases and in aging.

In their work Scheff and DeKosky
cut bundles of connections between
specific groups of brain cells in anes—
thetized rats. Using electron photomi—
crographs, the researchers are able to
count the number of connections be!
tween nerve cells, or synapses, in the
tissue per unit area and unit volume.
As they take more samples, they then
plot a time course of regeneration
back to the normal levels.

”One surprising finding," DeKosky
says, ”is that in one area of the brain,
before the synapses regenerate to
their normal level, they come back at
a greater'than—normal level. The old—
er animals have a greater overshoot,
whereas younger rats come up just a
little bit over normal and then drop
down. In other areas there is no oven
shoot, just a slow return to normal

 

Steven DeKosky and Stephen Scheff

numbers of connections; although
older animals do return to normal,
they do so more slowly."

DeKosky states that there are all
sorts of ”marvelous speculations" why
this is so. ”In the spinal cord, for
example, there are many more cells,
motor neurons, than you're going to
live with the rest of your life. In de’
velopment, they send out their ax—
ons or signalers to the muscles and
those that dont make connections
die or are removed. It’s a kind of sur«
vival of the fittest analogy which also
may hold true in the part of the brain
we’ve looked at."

In their work, DeKosky and Scheff
have been trying to determine what
mechanism controls the regenerative
response. So far, they have found a
number of hormones that slow or
impair the repair process, some of
them, DeKosky says, used routinely
in head‘injury cases. For example,
glucocorticoids—a type of steroid?
are used to reduce brain swelling in
patients after a head injury. These
steroids, however, clearly suppress
one aspect of the self-repair process of
brain tissue. “Now that has serious
implications for how we treat pa—
tients," he says.

The problem, he explains, is that
almost everyone with a head injury
needs steroid treatment in order to
prevent the brain‘s swelling inside the
rigid brain case. “The idez ,“ he states,
“would be to find out why glucoeorti:
coids suppress some reactive growth
and to give the patient medication
that would decrease sweliing with-

 

 

out interfering with the rebuilding
process.”

A consistent finding in their work
relates to the brain’s regulation of
synapses. “Our work clearly shows
that as synapses are lost, the ones
that remain get larger, and that might
be one of the ways people compensate
as they go downhill in their think;
ing process," DeKosky says. ”\Ve’ve
found evidence for a normal relation—
ship between the number of synapses
and increase in size as the number
drops. An important point is, the
brain is doing the regulating and no
one thought that happened before.H

DeKosky mentions that a number
of areas in the brain of Alzheimer’s
victims have shown a ”clear—cut DIESr
ticity or regrowth, not unlike the
kind of thing we've seen in our exper’
imental models in one of the memo—
ry areas of the brain. \Vhat happens
in degenerative diseases and aging, he
says, is that these degenerative proc~
esses eventually overcome efforts
at regrowth, or that these efforts
are weak compared to the patho—
logical process of a disease such as
Aizheimer's.

As far as longevity is concerned,
DeKosky says that “healthy genetic
predisposition" can be taken to mean
that a person is a healthy rejuvenator
or rearranger of circuitry. “If a man is
85 and in relatively good health,” he
says, “it may be that wear and tear
have occurred just as with everyone
eise, but that the person has repair
mechanisms and reconnection mech—
anisms that rage strongly against the
dying of the light,“

 

9 ODYSSEY

 

 

  

Does Dad Have Alzheimer’s?

 

 

he woman at the other end of
the line was obviously upset.
“Dad just hasn’t been right
lately," she said. “It’s hard to say just
how he’s changed, but he’s changed.
Could we come in and talk to
somebody?"

Since opening its doors in 1984, the
Memory Disorders Clinic, located in
the University of Kentucky’s Medical
Plaza, has handled hundreds of re
quests for information and for clini~
cal help.

“If someone is showing memory
changes, personality changes, we like
to see that individual and provide a
good work—up that would rule out the
possibility of any other health prob—
lem causing the memory loss,” says
Ms. Charli Kirkpatrick, Clinical Co—
ordinator. “If we can identify some
thing we can treat, such as a thyroid
disorder, that’s wonderful—we can fix
that—but if not we can do an intense
diagnostic study to assure the families
we’ve eliminated the possibility of
finding any reversible cause."

Kirkpatrick mentions that a signifi—
cant number of their patients, ap—
proximately 50 percent, come in for
second opinions; and some come in
for third and fourth opinions. “Local
neurologists and internists send us a
lot of people. Sometimes they have
conducted a thorough evaluation,
but feel that the history and pattern
of memory loss aren’t exact, so they
send the patient to us. We also see
quite a few patients brought in by
families who simply want to exhaust
every possibility, to get an opinion
from someone who does this exclu-
sively.”

The bulk of the Clinic’s patients
suffer from Alzheimer’s Disease, al-
though a few are diagnosed as having
Parkinson’s disease with dementia
and a handful have progressive supra—
nuclear palsy, which is usually accom~
panied by memory changes.

“We also have some cases that we
classify as ‘other,’ ” Kirkpatrick says.
“No matter how much we study them
diagnostically, we can’t identify the
specific disease process because the
physical changes and memory change
es don’t fit any classical pattern.”

 

 

 

Kirkpatrick characterizes the pa
tient's first visit to the Clinic as “an
intensive appointment.” During the
first hour Kirkpatrick or one of her
assistants talks with the patient alone
and administers a battery of three
“cognitive screening" tests that indi~
cate a level of impairment. While the
patient is taking these tests, Ms. Ma—
rie Smart, the Clinic’s social worker,
talks with the family to find out if
they have any concerns or needs that
she can address.

Next, a doctor gives the patient a
cursory general examination, does a
detailed neurological exam, and talks
with the family, sometimes for as long
as one and a half hours, about the
specific behavior patterns of the pa;
tient and the family’s reasons for
concern.

If the doctor believes that there is a
memory problem, the basic work’up
includes blood studies, an EEG and a
CAT scan. “We do these tests on an
out—patient basis," Kirkpatrick says.
“Then we call and generally have the
patient and family come back in to
discuss the diagnosis. We also send
the diagnosis and any recommenda—
tions we have to the referring physi«
cian if there is one.

“After the patient is diagnosed, the
family might be advised to do some
thing as simple as setting up 3 meals
on wheels program for the patient.
Or we may advise, in cases of ad—
vanced Alzheimer’s, that the patient
be hospitalized,” she says.

Kirkpatrick believes that the Clin—
ic’s most important service may be
that it provides support across time.
“In order to measure changes, it’s
necessary to take this approach. We
like to see the patient every six
months. We emphasize that this al—
lows us to learn more about the
disease.

continued on page I I

 

 

ODYSSEY 10

 

 

  

 

 

 

“It's not unusual for a family to call
us back a year or so after we do a
workrup and say, ‘We think Dad’s
condition has gotten a lot worse.’ So
we re—test and talk with the patient
and the family and can then say,
‘Yes, these are the areas we've found
to be in decline.'" Generally such
corroboration, she says, is a source of
relief for the family. Their concerns
are validated and they can be told
what to look for in the coming
months.

Has the Clinic been “successful" in
its four years of operation?

“It’s difficult to measure ‘success’
when you’re dealing with incurable
diseases,H Kirkpatrick says. ”But I
don’t think we’d have people calling
us and booking appointments and
continuing with us if we weren't do—
ing a good job. In 1984 we had about
100 patients. Now we have 430 and
that number grows every week.”

She adds that in addition to func—
tioning as a support group for families
in Central Kentucky, the three physi~
cians and support staff occasionally
get “an unexpected surprise.”

“A few months ago a woman came
in who had been diagnosed as having
Alzheimer's. Her family wanted a sec—
ond opinion. We found that her con;
dition was related to medications, so
we changed her medications and now
she's fin