UAB opens the third clinic in the world for patients with transverse myelitis

By Bob Shepard
UAB Media Relation

UAB has established the third multidisciplinary comprehensive clinic in the world for transverse myelitis, a rare spinal cord disease.

mike jezdimerPhysical therapist Melissa Daniel works with Mike Jezdimir, a transverse myelitis patient at UAB.Mike Jezdimir knows firsthand how hard it is to get appropriate medical treatment for his condition, a disease of the spinal cord called transverse myelitis. He has had it for 48 years, since he was 17. TM is fairly uncommon, and many physicians rarely encounter it. Treatment options are limited.

There were only two comprehensive clinics in the world for TM until the University of Alabama at Birmingham recently opened the third multidisciplinary, comprehensive clinic for transverse myelitis at UAB’s Spain Rehabilitation Center.

Jezdimir is a patient at UAB and the creator of the Mike L. Jezdimir Transverse Myelitis Foundation, raising money for UAB TM research. Amie (Jackson) McLain, M.D., the chair of the UAB Department of Physical Medicine and Rehabilitation, directed him to Tara DeSilva, Ph.D., a scientist in the department who studies multiple sclerosis, a disease similar to TM.

Jezdimir sparked her research interest in transverse myelitis and connected her with the Transverse Myelitis Association, where conversations about the necessary components for a designated transverse myelitis clinic at UAB began.

“This is a game changer for those of us with transverse myelitis and for UAB,” Jezdimir said.

The clinic joins two others — at Johns Hopkins University and the University of Texas Southwestern — as the only comprehensive clinics for treating TM. It will combine physicians and other medical professionals from multiple disciplines, including physical medicine and rehabilitation, neurology, neurosurgery, urology, and pain management, in caring for patients with TM, which can cause loss of motor function or paralysis.

“The mission of our multidisciplinary clinic is to provide the best care possible to patients living with transverse myelitis,” said William Meador, M.D., assistant professor in the Department of Neurology. “We also combine excellent clinical care with research efforts to better understand and treat this illness.”

The clinic offers immediate access to a number of rehabilitation specialists, such as physical, occupational and speech therapists, orthotic specialists, and many others. The clinic also serves as an educational tool to expose medical students and residents to transverse myelitis in a constructive and meaningful manner.

In the United States, up to 10,000 people will develop TM annually. Although it can affect people of all ages, it typically strikes people in their teens and early 20s, or in their 30s and 40s. About half of all TM patients experience significant recovery, but the other half have profound loss of motor skills or experience some level of paralysis.
In the United States, up to 10,000 people will develop TM annually. Although it can affect people of all ages, it typically strikes people in their teens and early 20s, or in their 30s and 40s. About half of all TM patients experience significant recovery, but the other half have profound loss of motor skills or experience some level of paralysis.

“Those patients require a multifaceted approach, and the comprehensive nature of our clinic creates a synergy among the diverse branches of medicine involved, leading to outstanding medical care,” McLain said. “The UAB TM clinic provides one-stop shopping, so each patient can see all the medical professionals who have a role in their care at one time and in one place. For patients with mobility issues, this is a tremendous benefit.”

“We are blessed in Alabama to have an academic medical center such as UAB with the expertise and knowledge to provide the depth of care needed by patients with TM,” Jezdimir said. “This is only the third clinic of its kind in the world, and the combination of outstanding patient care with UAB’s robust research efforts gives me hope that new therapies, or even a cure, can someday be found.”

UAB’s transverse myelitis research efforts are spearheaded by DeSilva along with Chander Raman, Ph.D., a professor in the Division of Clinical Immunology and Rheumatology, and Hui Hu, Ph.D., associate professor in the Department of Microbiology.

Their collaboration seeks to understand how inflammation can damage or destroy myelin, the fatty insulating substance that covers nerve cell fibers.

“This damage causes nervous system scars that interrupt communications between the nerves in the spinal cord and the rest of the body,” DeSilva said. “We will employ advanced imaging techniques and novel approaches in epigenetic research on immune cells to further our understanding of transverse myelitis. This information will help facilitate our pre-clinical studies in animal models to develop future clinical therapies.”

The most common causes of TM are inflammation, infection and stroke, although in many cases the cause is never determined. Symptoms can vary greatly depending on which portions of the spinal cord are affected. The most common symptoms include numbness in the extremities, weakness of the legs or arms, loss of bladder and bowel control, inability to walk, and impaired balance.

The transverse myelitis clinic is held the third Thursday of each month at the Spain Rehabilitation Center, 1717 Sixth Ave. South. Appointments can be made at 205-934-4179.



BrightFocus Foundation grant to fund new UAB and Southern Research Alzheimer’s research

By Bob Shepard
UAB Media Relations


Research to identify a new approach to treat Alzheimer’s disease gets new funding after a pilot grant from the Alabama Drug Discovery Alliance.  

   alzheimersResearchers at the University of Alabama at Birmingham and Southern Research are launching a new study to identify a novel therapy for treating Alzheimer’s disease. Funded by a grant of $250,000 from the BrightFocus Foundation, the new study grew from preliminary work funded by the Alabama Drug Discovery Alliance.

Principal investigator Erik Roberson, M.D., Ph.D., associate professor in the Department of Neurology and co-director of the Center for Neurodegeneration and Experimental Therapeutics at UAB, and co-principal investigator Corinne E. Augelli-Szafran, Ph.D., director of the chemistry department at Southern Research, will lead this program focusing on targeting the interaction between tau and fyn, two proteins in the brain that are involved with Alzheimer’s disease.

“We’ve long known that the protein tau is associated with Alzheimer’s disease,” said Roberson. “Fyn is a protein involved in learning and memory, and has more recently been implicated in neurological conditions such as Alzheimer’s and epilepsy. There are now considerable data suggesting that blocking the interaction between tau and fyn could be protective against Alzheimer’s.”

Roberson says previous research has shown that lowering tau in the brain in animal models seems to prevent Alzheimer’s disease, and the tau/fyn linkage is an intriguing target for blocking tau’s function without having to reduce tau levels, which may be difficult in human patients.

“The interaction seems to be key,” Roberson said. “But we can test this only by finding drugs that block that interaction. The BrightFocus Foundation grant, following on the heels of our ADDA funding, will fund the next step in this process.”

The UAB School of Medicine and Southern Research began the Alabama Drug Discovery Alliance in 2008, with crucial contributions from the UAB Center for Clinical and Translational Science and the UAB Comprehensive Cancer Center. The ADDA’s objective is to use the resources available at these institutions to facilitate drug discovery and development.
The UAB School of Medicine and Southern Research began the Alabama Drug Discovery Alliance in 2008, with crucial contributions from the UAB Center for Clinical and Translational Science and the UAB Comprehensive Cancer Center. The ADDA’s objective is to use the resources available at these institutions to facilitate drug discovery and development.

“This is an excellent example of taking groundbreaking basic research to the next level, and it demonstrates the unique capabilities within the ADDA,” said Mark J. Suto, Ph.D., vice president of drug discovery at Southern Research.

The first phase of this work, funded by the ADDA, used the state-of-the-art high-throughput screening facility at Southern Research to look for compounds that acted upon the interaction of tau and fyn. More than 100,000 compounds were screened, from which about 30 compounds showed a positive response. The new grant from BrightFocus will allow the research team to further evaluate the active compounds with the goal of identifying the top two or three candidates for a potential drug that could interfere with the tau/fyn connection.

Those candidates will then be tested in animal models of Alzheimer’s disease with the ultimate goal of entering into human clinical trials for the treatment for the disease.

“This is an exciting and novel therapeutic approach for the treatment of Alzheimer’s disease,” Augelli-Szafran said. “Having been able to identify potential chemical matter from our high-throughput facility at Southern Research gives us an edge moving forward with this research program. With our drug discovery talent here at Southern Research and our research and clinical expertise at UAB, we anticipate that this program will have an impact on the Alzheimer’s disease community.”

The researchers will employ the BrightFocus Foundation grant to help support the necessary work to find the strongest contenders for a new potential drug candidate — work that got its start with the ADDA.

“This grant illustrates how we are leveraging institutional investments by both UAB and Southern Research to attract outside investment in our programs,” said Maaike Everts, Ph.D., director of the ADDA and an associate professor in the Department of Pediatrics. “I think the funding of this proposal illustrates the quality of the science and the approach we have here in the Alabama Drug Discovery Alliance, and how the strengths of both institutions complement each other, making for a very attractive partnership for external investment.”

BrightFocus Foundation is a nonprofit organization supporting research and providing public education to help eradicate brain and eye diseases, including Alzheimer’s disease, macular degeneration and glaucoma.



UAB awarded Comprehensive Stroke Center designation

By Bob Shepard
UAB Media Relations

UAB has received prestigious designation as a Comprehensive Stroke Center from the Joint Commission and American Heart Association.

stroke2“Designation as a Comprehensive Stroke Center means that UAB is prepared to offer immediate access to state-of-the-art stroke care every minute of every day.”The University of Alabama at Birmingham has been named a Comprehensive Stroke Center by the Joint Commission and the American Heart Association/American Stroke Association. UAB met the Joint Commission’s standards for Disease-Specific Care Comprehensive Stroke Center Certification. The designation means UAB is part of an elite group of providers recognized as industry leaders and responsible for setting the national agenda in highly specialized stroke care.

“Designation as a Comprehensive Stroke Center means that UAB is prepared to offer immediate access to state-of-the-art stroke care every minute of every day,” said David G. Standaert, M.D., Ph.D., professor and chair of the Department of Neurology. “We provide advanced and potentially lifesaving services that are available nowhere else in Alabama, as part of our continuing commitment to offer the best possible care to residents of our state, the surrounding region and beyond.”

Comprehensive Stroke Center certification recognizes those hospitals that have the staff, training and infrastructure to receive and treat patients with the most complex strokes. The Joint Commission recognized UAB’s advanced imaging capabilities and 24-hour availability of specialized treatments, along with staff who possess the unique education and competencies to care for complex stroke patients.

UAB, which is the first hospital with Comprehensive Stroke Center certification in Alabama, has eight expert stroke physicians and the most board-certified vascular neurologists in the state, along with 350 nurses specially trained in stroke care. UAB’s Neurosciences Intensive Care Unit is one of the largest in the United States, and UAB Hospital also boasts a dedicated stroke unit. UAB treats over 1,100 strokes a year.

UAB, which is the first hospital with Comprehensive Stroke Center certification in Alabama, has eight expert stroke physicians and the most board-certified vascular neurologists in the state, along with 350 nurses specially trained in stroke care.
“Comprehensive Stroke Center certification is a reaffirmation of the exceptional stroke care we provide for our patients,” said Mark R. Harrigan, M.D., associate professor in the Department of Neurosurgery and interim director of the UAB Comprehensive Stroke Center. “Stroke is a medical emergency, and this recognition by the Joint Commission and AHA shows that UAB is well equipped to be a leader in stroke management through education, research and enhanced patient care.”

A stroke occurs when a blood vessel either is blocked by a clot or bursts, which interrupts blood flow, depriving brain cells of the oxygen and nutrients they need to survive. An American has a stroke every 40 seconds, and someone dies from a stroke every four minutes. Strokes are the fifth-leading cause of death and the leading cause of adult disability in the U.S.

“By achieving this advanced certification, UAB has thoroughly demonstrated the greatest level of commitment to the care of its patients with a complex stroke condition,” said Mark R. Chassin, M.D., president of the Joint Commission. “Certification is a voluntary process, and the Joint Commission commends UAB for successfully undertaking this challenge to elevate the standard of its care for the community it serves.”

Comprehensive Stroke Center certification was developed in collaboration with the American Heart Association/American Stroke Association and was derived from the Brain Attack Coalition’s “Recommendations for Comprehensive Stroke Centers” and “Metrics for Measuring Quality of Care in Comprehensive Stroke Centers,” as well as on recommendations from a multidisciplinary advisory panel of experts in complex stroke care.

For more information on the Joint Commission and American Heart Association’s Advanced Certification for Comprehensive Stroke Center, visit www.jointcommission.org/ or www.heart.org/myhospital.



As Cognition Slips, Financial Skills Are Often the First to Go



                
Francis, 84, with his daughter-in-law, Helen Clark. He has mild dementia, and his family says his former wife took advantage of him.                      
WHEN Helen Clark brought her father-in-law, then 83, to the doctor last year, she knew his mind was slowing, but a mental status exam confirmed it. He knew the year, where he lived and the name of the president. But when the doctor asked him to count backward from 100, subtracting seven from each number — 100, 93, 86, 79 — a look of confusion washed over his face.

Studies show that the ability to perform simple math problems, as well as handling financial matters, are typically one of the first set of skills to decline in diseases of the mind, like Alzheimer’s, and Ms. Clark’s father-in-law, who suffered from mild dementia, was no exception. Research has also shown that even cognitively normal people may reach a point where financial decision-making becomes more challenging.

“A person can appear to have their wherewithal cognitively, but not have the ability to understand money in the same way anymore,” said Ms. Clark, a retired registered nurse and family therapist in Cottonwood, Calif.
The issue looms large, particularly as the number of older people continues to rapidly expand: There are 44.7 million people 65 and older, representing 14 percent of the population, according to the most recent census data, but, within 10 years, they will swell to an estimated 66 million. This group collectively holds trillions of dollars in wealth, but are often left to manage their own finances, even as they become increasingly vulnerable. About half of adults in their 80s either have dementia, or at least some cognitive impairment without dementia, researchers said.

“If you can detect emerging financial impairment early, you can also step in early and protect the person,” said Daniel Marson, a neuropsychologist and director of the Alzheimer’s Disease Center at the University of Alabama at Birmingham. “It may be if you step in two months from now, they won’t be in a position to make a poor decision or be exploited a year from now.”

For Ms. Clark’s father-in-law, Francis Taylor, the intervention came too late. At 80 years old, he married a woman 17 years his junior, who, over their three-year union, according to the family, cashed $40,000 in blank checks sent by his credit-card issuer and emptied the contents of his $123,000 annuity, leaving him with little more than a giant tax bill.

Mr. Taylor, a former diesel mechanic and Korean War veteran, gave his wife permission to make two annuity withdrawals over the phone. But his wife, who couldn’t be reached for comment, made 20 more withdrawals on her own by using her husband’s Social Security number and other identifying information, and signing papers to direct money into a joint account, according to documents provided by Ms. Clark. After an internal investigation, MetLife, the annuity provider, concluded that it had followed proper procedures.

Preventing these situations is often difficult. Knowing exactly when to get involved can be fraught, whether you are an adult child or a trusted adviser. There are a series of early warning signs of financial decline, which Dr. Marson identified in a recent study, which is being submitted for publication and was funded by the National Endowment for Financial Education and the National Institute on Aging.


The signs, while perhaps not surprising, are subtle, making them easy to miss: It may become more difficult for people to identify the risks in a particular investment, and they may focus too much on the benefits. Completing various tasks on a financial to-do list may start to take longer, such as preparing bills for the mail. Everyday math may become more laborious or prone to errors, whether that’s figuring out a tip in a restaurant or doing a calculation that requires two steps. Financial concepts, like medical deductibles and minimum balances required in savings accounts, may also become harder to grasp. Naturally, these behaviors should represent a significant change: If a person was never adept with personal finances, this won’t serve as much of an indicator.

Dr. Marson said he identified these warnings signs as part of a study of 138 older adults over time who were initially deemed “cognitively normal” by a panel of four doctors when they joined the study (and after at least one annual follow-up visit). Participants were also timed as they completed financial tasks in a lab. Twenty-three members of the group later received a diagnosis of mild cognitive impairment, but when the researchers went back and looked at the original results of the financial capacity test — when the group members were deemed cognitively normal — there were already subtle signs of slowing and financial decline.

“The group that would later decline already had some emerging signs,” Dr. Marson said, though they weren’t glaring.

While many people continue to handle their finances with ease well into their later years, even people with healthy brains tend to experience cognitive decline. According to one study, which analyzed participants’ propensity to make financial mistakes, a person’s financial decision-making ability peaks at age 53, or, more generally, in their 50s. This is the sweet spot, the paper said, because they have substantial amounts of experience but they have had only modest declines in their ability to solve new problems.

There is a general tendency for our ability to solve new problems — known as fluid intelligence — to slowly decline over time, starting as early as age 20. But this is at least partly offset by our growing experiences and wisdom, known as crystallized intelligence.

David Laibson, an economics professor at Harvard and co-author of the research, said he believed that crystallized intelligence tended to plateau when people reached their 70s. That plateau, accompanied with declining fluid intelligence, might explain why older consumers made more financial mistakes than middle-age ones in his study.

“At that point, vulnerability increases,” Professor Laibson said. “Our nation’s wealth is disproportionately held by older adults, and they are exactly the group, particularly as they reach their 80s and 90s, that are most vulnerable. But our system has the fewest protections for those people.”
He said he wishes all 65-year-olds would start by simplifying their financial lives, reducing the money clutter to just a few mutual funds at a reputable institution.


Then there are the boilerplate tools, including wills, revocable living trusts, durable financial power of attorney, and health care directives. Financial institutions often want their own powers of attorney filled out, so it helps to put them in place before you need them. If ready access to more credit isn’t important, advisers suggested freezing elders’ credit files, so criminals cannot attempt to open accounts in their names. Automate bill payments.

If adult children suspect a parent needs watching over, they can also ask financial institutions to send duplicate statements or notices if a parent misses a long-term care insurance payment, for example. Monitoring can also easily be done from afar with online access to accounts, but that sort of access can be disastrous in the wrong hands. If the person does not have trusted family members or friends, a licensed fiduciary can be a good alternative to monitor accounts, said Carolyn Rosenblatt, an elder lawyer and author who counsels families on aging-related issues.

Another financial adviser asks his clients to assemble what he calls a protective tribe, or a handful of people who are willing to step in and assist if and when the need arises. “The protective tribe is important because senior abuse is often committed by a close relative or trusted professional,” said Jean-Luc Bourdon, a certified public accountant who specializes in financial planning in Santa Barbara, Calif. “A tribe is needed to have checks and balances.”

Many estate planning lawyers and financial planners ask their clients to name a person they can contact if they suspect their cognitive skills may be on the decline. Sometimes called “a letter of diminishing capacity,” the document typically authorizes the adviser to raise the issue with a trusted individual the client names.
124CommentsBob Rall, a financial planner in Merritt Island, Fla., said it came in handy when a widow with modest assets asked if he could send her $50,000 so she could host an 80th birthday party. “I immediately called her daughter, who the client had previously given me the authorization to speak with,” he said. “After a discussion, we decided to send her mom $15,000. She still had a pretty nice party.”

For many families, there isn’t much margin for error. Ms. Clark’s father-in-law still has the equity in his home; she intervened just as his wife was completing the paperwork for a reverse mortgage.

“Although this is tragic for my father-in-law,” Ms. Clark said, “what I am even more concerned about is the lack of accountability when fraud occurs across the board for elders in this position.”


version of this article appears in print on April 25, 2015, on page B4 of the New York edition with the headline: As Cognition Slips, Financial Skills Are Often the First to Go. Order ReprintsToday's Paper|Subscribe