DIMENSIONS Summer 2000


by Julie Cleveland

The UW ADRC public forum on May 17th drew an audience of over 100 caregivers and geriatric professionals. Activities included informational lectures by Drs. George Martin and Soo Borson, as well as booths exhibiting ADRC research, The Friends of Alzheimer's, Dimensions, and the de Tornyay Center on Healthy Aging.

Dr. George Martin received his MD degree from the University of Washington in 1953, and was appointed to the faculty in 1957 as an instructor in Pathology. He is currently professor of Pathology and adjunct professor of Genetics. He was founding director of the UW Alzheimer's Disease Research Center (ADRC) and served in that capacity from 1985, when it was first funded by the National Institute on Aging, until December 1998, when he transitioned into the role of co-director of the Center. He has received many prestigious awards for his work in geriatrics, pathology, and genetics, and was honored as the UW Distinguished Alumnus in 1989. Dr. Martin's research has focused on the genetics of Alzheimer's disease, Werner syndrome, and on DNA changes associated with aging. In addition to his own distinguished research career, he has served as a mentor for countless students, fellows, and faculty colleagues.

Dr. Martin's talk was entitled "Biological aspects of aging and Alzheimer's disease (AD)". He discussed the biological and genetic changes that occur in AD patients. There are two main changes that occur in the brain of someone with AD--neurofibrillary tangles, and plaques (both of which are abnormal protein accumulations). Three genes are associated with early-onset AD: 1) The amyloid precursor protein (APP) gene located on chromosome 21; 2) the presenilin 1 (PS1) gene on chromosome 14; and 3) the presenilin 2 (PS2) gene on chromosome 1. When individuals have mutations in the APP and PS1 genes, AD will develop. However, mutations in the PS2 gene may not necessarily lead to AD. The mutations in these three genes are thought to be involved in abnormal processing of the amyloid precursor protein, creating a toxic fragment known as beta amyloid that makes up the characteristic plaques of AD. A different type of dementia called Frontotemporal dementia (FTD), is caused by a mutation in the "tau" gene located on chromosome 17. Researchers at the University of Washington have been responsible for discovering several of the genetic mutations responsible for AD and FTD.

Dr. Soo Borson graduated from Stanford University Medical School in 1969 and joined the UW faculty in 1981, specializing in Geriatric Psychiatry. She is currently professor of Psychiatry and Behavioral Sciences, divisions of Geriatric Psychiatry and Neuroscience. She directs the Geriatric and Family Services Clinic at UWMC and the ADRC Community Minority Outreach program, and mentors medical students, residents, and fellows in geriatric clinical care and research. Her clinical work and teaching emphasize diagnosis and treatment of late-life mental disorders in the context of family care, particularly Alzheimer's disease and rarer dementing disorders. Dr. Borson's Alzheimer's disease research program focuses on improving detection and treatment of dementia in community populations and addressing ethnic disparities in dementia care. She is immediate past president of the American Association for Geriatric Psychiatry and current president of the Geriatric Mental Health Foundation.

Dr. Borson's talk was entitled "The growing prevalence of dementia: the challenge for primary care." She described the increasing prevalence of dementia and unmet needs for care in the primary care setting. Many people with dementia are not being effectively diagnosed or treated in primary care settings Dr. Borson proposed that a brief dementia screening tool developed in her research program, the Mini-Cog, could improve the detection of dementia in community settings. Standard diagnostic tools such as the Mini Mental Status Exam and Cognitive Abilities Screen Instrument take 7 to 20 minutes to administer. The Mini-Cog, consisting of a three-item recall and clock drawing, takes only three minutes to administer, and is at least as sensitive (i.e. accurately detects dementia in more people) as those longer tests She also discussed the effectiveness of pharmacological treatments for dementia, including the use of medications to improve cognitive functioning (such as Aricept), and to reduce mood and behavioral disturbances (such as antidepressants, antipsychotics, and other drugs used in psychiatry). Dr. Borson concluded by summarizing the challenges that need to be met in primary care: 1) dementia needs to be detected before a behavioral or family crisis develops: 2) treatments for cognitive impairment and behavioral problems need to be initiated; 3) patients with complex diagnostic and psychiatric problems need to be referred to appropriate specialists: and 4) caregivers need referral and counseling to address their unmet needs for support, future planning, and amelioration of caregiving stresses.

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