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| ### *GRECC Annual Report: Fiscal Year [2005]{.underline}*             |
|                                                                       |
| ######## Part II: Accomplishments                                     |
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| This GRECC Annual Report covers [October 1, 2004-September 30,        |
| 2005]{.underline}: **the "Report Year"**.                             |
|                                                                       |
| This GRECC Annual Report reflects status and accomplishments of       |
| [**GRECC Core Staff \***only]{.underline}.                            |
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| **\*[GRECC Core Staff ]{.underline}**is limited to either **Primary   |
| Core**, **Affiliate Core**, or **Research Core**:                     |
|                                                                       |
| -   **Primary Core =** positions authorized by the original GRECC     |
|     allocation plus any addition in ceiling from VA Central Office    |
|     specifically designated for GRECC.                                |
|                                                                       |
| -   **Affiliated Core** = Staff who work full- or part-time in        |
|     [direct support]{.underline} of the GRECC's research, education   |
|     or clinical activity.                                             |
|                                                                       |
|     -   May be either "contributed" by the VA Medical Center or       |
|                                                                       |
|     -   May have been acquired through centralized                    |
|         enhancements/awards for programs\                             |
|         (e.g., Home-Based Primary Care, Geriatric Evaluation and      |
|         Management Program, etc.)                                     |
|                                                                       |
|     -   To be considered Affiliated Core, staff must be               |
|         organizationally aligned under the GRECC or specifically      |
|         identified by the Medical Center as **"GRECC-affiliated       |
|         staff."**                                                     |
|                                                                       |
| -   **Research Core** = Full-or part-time staff who devote 51% or     |
|     more of their total time to GRECC research and whose salaries are |
|     supported by research funds (either VA or non-VA). Includes all   |
|     GRECC staff whose salaries are paid from research funds, e.g.:    |
|                                                                       |
|     -   Associate Investigator                                        |
|                                                                       |
|     -   Assistant Research Scientist                                  |
|                                                                       |
|     -   Senior Research Career Scientist                              |
|                                                                       |
|     -   Research Career Scientist                                     |
|                                                                       |
|     -   Advanced Research Career Scientist.                           |
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| **1. GRECC NAME/LOCATION**                                            |
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| a.  **GRECC Name:** William S. Middleton Memorial Veterans Hospital - |
|     GRECC                                                             |
|                                                                       |
| b.  **Location** *(facility, VISN)*: Madison, WI; VISN 12             |
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| **2. CONTACT PERSON (if there are questions about this report)**      |
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| a.  **Name:** Ce Doskocil                                             |
|                                                                       |
| b.  **Position:** Administrative Officer                              |
|                                                                       |
| c.  **Phone, e-mail:** 608-280-7000; <cecilia.doskocil@med.va.gov>    |
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| **3. GRECC FOCUS AREA(S)**                                            |
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| GRECCs are required to conduct research in a basic biomedical area,   |
| an applied clinical area, and either a health services or             |
| rehabilitation topic. The number of specific research foci in each    |
| perspective should be limited to two or fewer.                        |
|                                                                       |
| Please enter a succinct phrase that best characterizes the focus      |
| area(s) recognized for your GRECC in the first two and either the     |
| third or fourth (or both) category below:                             |
|                                                                       |
| a.  **Basic Biomedical**: 1) Nutrition/Oxidative Stress;              |
|                                                                       |
| 2\) Bone & Mineral Metabolism;                                        |
|                                                                       |
| 3\) Alzheimer's Disease                                               |
|                                                                       |
| b.  **Applied Clinical**: Alzheimer's disease & related dementias     |
|                                                                       |
| c.  **Health Services**: None                                         |
|                                                                       |
| d.  **Rehabilitation**: Dysphagia                                     |
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| **4. ADMINISTRATION**                                                 |
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| a.  **GRECC Impact on Host VAMC in Report Year**\                     |
|     *(list the most important ways in which the GRECC has had         |
|     positive impact on the host VAMc\--i.e., how the GRECC has "made  |
|     a difference"locally. **Please limit your response to five ways   |
|     or fewer.** Please be as succinct as possible but specify the     |
|     GRECC contribution, what the impact was and whom it benefited,    |
|     where it occurred, and why it was important. **Please limit the   |
|     description of each bullet item to 5 lines or fewer**)*           |
|                                                                       |
| -   VA research studies significantly enhanced VERA earnings due to   |
|     increased research dollars.                                       |
|                                                                       |
| -   A recent graduate of the GRECC-sponsored Geriatric Medicine       |
|     Fellowship Program was hired as a Hospitalist and Director of the |
|     Palliative Care and End-of-Life Program.                          |
|                                                                       |
| -   The current Palliative Care Program was expanded from an          |
|     inpatient consult service to include an additional outpatient     |
|     clinic component.                                                 |
|                                                                       |
| -   Due to unfortunate circumstances resulting in the medical         |
|     retirement of a VA faculty member (Dr. James Skatrud), Dr. Steven |
|     Barczi assumed oversight of the VA Sleep Program in July 2005.    |
|                                                                       |
| -   Veterans now have access to novel treatment and diagnostic tests  |
|     in research studies related to dementia.                          |
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| b.  **GRECC Impact on VISN in Report Year** *\                        |
|     (list the most important ways in which the GRECC has had positive |
|     impact on the host VISN\-- i.e., how the GRECC has "made a        |
|     difference" regionally. **Please limit your response to five ways |
|     or fewer.** Please be as succinct as possible but specify the     |
|     GRECC contribution, what the impact was and whom it benefited,    |
|     where it occurred, and why it was important. **Please limit the   |
|     description of each bullet item to 5 lines or fewer**)*           |
|                                                                       |
| -   Dr. Steven Barczi has made administrative changes in the referral |
|     system for Sleep Evaluations of veterans referred from several    |
|     medical facilities including the Iron Mountain, Tomah, and        |
|     Milwaukee VAs.                                                    |
|                                                                       |
| -   Madison GRECC Memory Clinic is unique within VISN 12 and          |
|     continues to support patients from several northern tier sites    |
|     (Tomah; Iron Mountain; Baraboo).                                  |
|                                                                       |
| -   Madison GRECC research programs are conducting                    |
|     nationally-recognized work that has enhanced the reputation of    |
|     the host facility as well as that of VISN 12.                     |
|                                                                       |
| -   The Madison GRECC successfully competed and was awarded the       |
|     NIH-funded **T**raining and **E**ducation to **A**dvance          |
|     **M**ultidisciplinary Clinical Research (**TEAM**) Program. This  |
|     will be a mechanism to support junior faculty at both the VA and  |
|     University. This Program provides the opportunity for VISN-based  |
|     physicians and health care professionals to develop necessary     |
|     knowledge, skills and experiences to be a clinical researcher as  |
|     well as train in areas necessary to work effectively as a member  |
|     of a multidisciplinary clinical research team.                    |
|                                                                       |
| -   Dr. Michael Siebers, GRECC GEM Director, continues to serve on    |
|     the VISN Long-Term Care Committee via participation in the        |
|     established phone conferences and Gail Gunter Hunt, GRECC GEM     |
|     Social Worker, is a member of the VISN 12 Women Veterans Program  |
|     Managers Committee.                                               |
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| c.  **GRECC Trend-Setting Innovations since October 1,                |
|     [2000]{.underline}**\                                             |
|     *(list the most significant research, education or clinical       |
|     innovations originating in your GRECC in the past five years.     |
|     Please limit your response to five innovations or fewer. For each |
|     item, succinctly describe the innovation, specify the time frame  |
|     of its earliest impact, whom it benefited, where it occurred, and |
|     why it was important. **Please limit the comments concerning each |
|     innovation to 5 lines or fewer**)*:                               |
|                                                                       |
| -   GREEC investigators initiated and established a unique registry   |
|     (i.e., Wisconsin Registry for Alzheimer's Prevention -- WRAP).    |
|     This is the first Registry of its kind in the country to enroll   |
|     adult children of individuals diagnosed with Alzheimer's disease. |
|     This Registry is the basis for recent funding of at least three   |
|     NIH-funded grants as well as serving as the foundation for the    |
|     recently-submitted Alzheimer's Disease Core Center (ADCC)         |
|     application. (PI: Sanjay Asthana, MD)                             |
|                                                                       |
| -   Dr. Weinduch's research has employed microarrays ("gene chips")   |
|     to provide a global view of the effects of aging and caloric      |
|     restriction (CR as state of aging retardation) on gene expression |
|     in mice. Prior to the development of this technology, the         |
|     activities of genes were largely determined for one gene at a     |
|     time. Microarrays allow one to monitor the activity of thousands  |
|     of genes in a single experiment. Work is now forcused on using    |
|     this technology to determine critical shifts in the expression of |
|     genes underlying the retardation of aging by CR. (PI: Richard     |
|     Weinduch, PhD)                                                    |
|                                                                       |
| -   Dr. Johnson, GRECC Research Scientist, has demonstrated for the   |
|     first time the important interaction between family history and   |
|     ApoE genotype as a potential risk factor for developing           |
|     Alzheimer's disease. (PI: Sterling Johnson, PhD)                  |
|                                                                       |
| -   Historically solutions used in videofluoroscopy swallowing were   |
|     not standardized. Madison GRECC has developed standard methods    |
|     that have lead to intellectual property that has been licensed    |
|     through the Wisconsin Alumni Research Foundation (WARF) and has   |
|     resulted in diagnostic barium materials used nationally. (PI:     |
|     JoAnne Robbins, PhD)                                              |
|                                                                       |
| -   As a result of the VA RR&D funding received by the GRECC/UW       |
|     Swallowing Laboratory, an intra-oral exercise program has been    |
|     developed and disseminated to Speech and Language programs        |
|     throughout the country. (PI: JoAnne Robbins, PhD)                 |
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| **5. RESEARCH**                                                       |
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| a.  **Most Noteworthy Findings Published in Report Year by GRECC Core |
|     Staff as PI or CO-PI\                                             |
|     ***(Please list five or fewer. For each noteworthy finding,       |
|     include the GRECC Core Staff name(s), journal reference, and a    |
|     JARGON-FREE description of the finding and its clinical or other  |
|     significance. Please limit your description of each noteworthy    |
|     finding to five lines or fewer.)*                                 |
|                                                                       |
| -   Bowen RL, **Atwood CS**. Living and dying for sex: A theory of    |
|     aging based on the modulation of cell cycle signaling by          |
|     reproductive hormones. *Gerontology* 50(5):265-290, 2004. The     |
|     basic premise behind the theory included in this publication is   |
|     that reproductive hormones act in an antagonistic pleiotrophic    |
|     manner via cell cycle signaling, promoting growth and development |
|     early in life in order to achieve reproduction, but later in      |
|     life, in a futile attempt to maintain reproduction, become        |
|     dysregulated and drive senescence (dyosis).                       |
|                                                                       |
| -   Kuthjoth GC, Hiona A, **Pugh T**, Someya S, Panzer K, Wohlgemuth  |
|     S, Hofer T, Seo AY, Sullivan R, Jobling WA, Morrow JD, VanRemmen  |
|     H, Sedivy JM, Yamasoba T, Tanokura M, **Weindruch RH**,           |
|     Leewenburgh C, Prolla TA. Mitochondrial DNA mutations, oxidative  |
|     stress and apoptosis in mammalian aging. *Science*                |
|     309:481-484, 2005. Mitochondria, the main source of cellular      |
|     energy, play a central role in a variety of cellular processes.   |
|     Mutations in mitochondrial DNA (mtDNA), however, are thought to   |
|     contribute to aging.   This study provides evidence indicating    |
|     that accumulation of mtDNA mutations may be a central mechanism   |
|     contributing to mammalian aging by triggering programmed cell     |
|     death.  We created a genetically engineered mouse strain that had |
|     proofreading-deficient version of the enzyme needed to repair     |
|     damage to mtDNA.  These mice accumulated more rapidly than normal |
|     mice and showed many signs of accelerated aging including loss of |
|     hearing and muscle mass. They also lived only about one-half as   |
|     long as normal mice.                                              |
|                                                                       |
| -   **Robbins J**, Gangnon RE, Theis S, **Kays SA, Hewitt A, Hind     |
|     J**. The effects of lingual exercise on swallowing in older       |
|     adults. *JAGS* 53(9):1483-1489, 2005. The objective of this study |
|     was to determine the effects of an 8-week progressive lingual     |
|     resistance exercise program for swallowing in older individuals,  |
|     the most "at risk" group for dysphagia. Findings indicated that   |
|     lingual resistance exercise is promising as a treatment strategy  |
|     for dysphagia (swallowing disorder) and potentially for           |
|     preventing dysphagia in older, frail individuals.                 |
|                                                                       |
| -   **Binkley N**, Kiebzak GM, Lawieck EM, Krueger D, Gangnon RE,     |
|     Miller PD, Shepherd JA, **Drezner M**. Recalculation of the       |
|     NHANES database SD improves T-score agreement and reduces         |
|     osteoporosis prevalence. *J Bone Min Res* 20:195-201, 2005. The   |
|     major findings of this paper suggested that the GE NHANES III     |
|     software update leads to lower femoral neck and trochanter        |
|     T-scores than those obtained with Hol or prior GE software.       |
|     Recalculation of the young-normal SD reduces this difference and  |
|     is recommended. Clinicians are advised to avoid using the TR for  |
|     diagnosis or, at a minimum, use caution when making treatment     |
|     decisions based solely on T-score at this site.                   |
|                                                                       |
| -   **Constantini C**, **Weindruch R**, Della Valle G, **Puglielli    |
|     L**. A trkA to p75^NTR^ molecular switch activates amyloid        |
|     -peptide generation during aging. *Biochem J* 391:59-67, 2005. In |
|     this paper, we report the identification of the first molecular   |
|     link between normal aging of the brain and Alzheimer's disease    |
|     (AD). We also show two novel approaches (dietary and              |
|     pharmacologic) for the prevention of some of the AD-associated    |
|     phenotypes in mice.                                               |
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| b.  **Most Noteworthy Findings Published in Report Year -- GRECC Core |
|     Staff as Co-Investigators on Projects with Non-GRECC PI\          |
|     ***(Please list five or fewer. For each noteworthy finding,       |
|     include the GRECC Core Staff name(s), journal reference, and a    |
|     JARGON-FREE description of the finding and its clinical or other  |
|     significance. Please limit your description of each noteworthy    |
|     finding to five lines or fewer)*                                  |
|                                                                       |
| -   **Puglielli L**, Friedlich AL, Setchell KDR, Nagano S, Opazo C,   |
|     Cherny RA, Barnham KJ, Wade JD, Melov S, Kovacs DM, Bush AI.      |
|     Alzheimer's disease -peptide activity mimics cholesterol oxidase. |
|     *J Clin Invest* 115:2556-2563, 2005. In this paper, we identified |
|     and characterized a novel enzymatic activity of the amyloid       |
|     -peptide (Ab), which accumulates in the brain of AD patients.     |
|     This report can potentially help us understand the mechanisms of  |
|     AD-associated neuropathology.                                     |
|                                                                       |
| -   Cherrier M, Matsumoto AM, Amory JK, **Asthana S**, Bremner WJ,    |
|     Peskind ER, Raskind M, Craft S. Testosterone improves spatial     |
|     memory in men with Alzheimer's disease (AD) and mild cognitive    |
|     impairment. *Neurology* 64(6):2063-2068 2005. This intervention   |
|     study for the first time indicated that testosterone therapy      |
|     improved spatial memory in patients with Alzheimer's disease.     |
|     These findings will form the basis for larger definitive studies  |
|     employing testosterone for the treatment and possible prevention  |
|     of AD.                                                            |
|                                                                       |
| -   Hansen K, Binkley N, Vallarta-Ast N, Krueger D, **Drezner MK,     |
|     Blank RD**. The inter-observer reproducibility of criteria for    |
|     Vertebral Body Exclusion. *J Bone Min Res* 20:501-508, 2005. The  |
|     findings of this study indicated that contrary to common belief,  |
|     there can be significant differences in interpretation of DXA     |
|     scans between experienced interpreters. These differences         |
|     resulted from differing thresholds for recognition of FSD and the |
|     choice of excluding the upper or lower vertebral body for the     |
|     criteria requiring comparison between adjacent vertebrae.         |
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| **6. EDUCATION**                                                      |
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| a.  **Innovations in Educational Activities Implemented During Report |
|     Year**\                                                           |
|     (*Please list up to five. For each, describe the innovation and   |
|     the context in which it was innovative. Please limit your         |
|     description of each innovation to five lines or fewer):*          |
|                                                                       |
| -   The Wisconsin Geriatric Psychiatry Initiative (WGPI) consists of  |
|     geropsychiatry and geriatrics professionals working with state    |
|     and local government staff in developing systems to enhance       |
|     mental health services for older adults in Wisconsin. This group  |
|     has developed the "WI STAR" method, which provides a simple way   |
|     to map complicated clinical situations, shift between linear and  |
|     ecological perspectives, avoid premature closure and enhance care |
|     that is comprehensive as well as sensitive and specific to each   |
|     unique individual.                                                |
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| b.  **Exportable Educational Products First Available for             |
|     Distribution in Report Year**\                                    |
|     (Please list your most important products. Please limit to five.  |
|     Your description of each item should succinctly summarize the     |
|     content, target audience, format, and product evaluation results  |
|     if any. You may include products developed in prior years ONLY IF |
|     THIS IS THE FIRST YEAR they have been available for distribution. |
|     Please limit each description to five lines or fewer):            |
|                                                                       |
| -   Wisconsin Geriatric Psychiatry Initiative (WGPI) -- WI STAR       |
|     Method: Given the statewide shortage of expertise in how to       |
|     address the mental health and substance abuse problems of older   |
|     adults, the WGPI is dedicated to widely disseminating basic       |
|     principles of geriatric psychiatry to health care providers,      |
|     long-term care and aging network providers. The WI STAR method    |
|     provides a simple way to map complicated clinical situations,     |
|     shift between linear and ecological perspectives, avoid premature |
|     closure, and enhance care that is comprehensive as well as        |
|     sensitive and specific to each unique individual. The STAR method |
|     is readily adaptable to audiences with different levels of        |
|     knowledge, skills, and attitudes, and consists of evidence-based  |
|     teaching through case-based consultations, and a social           |
|     entrepreneurial approach to the networking of already existing    |
|     resources.                                                        |
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| **7. CLINICAL INNOVATIONS**                                           |
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| **NEW DEFINITION:** A "Clinical Innovation" is an untested,           |
| GRECC-initiated clinical effort that ideally is related to one of the |
| GRECC's research foci. A Clinical Innovation may be a wholly original |
| clinical program or an original aspect of or variation on an          |
| established program. A Clinical Innovation must incorporate an        |
| evaluation plan for assessing the innovation's efficacy so that, if   |
| the innovation is demonstrated to be an improvement over an existing  |
| approach to care, there is a basis on which it can be exported for    |
| implementation elsewhere.                                             |
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| a.  **Clinical Innovations Underway in Report Year**\                 |
|     *(list all Clinical Innovations underway during the report year.  |
|     For each, indicate whether the innovation is [N]{.underline}ew or |
|     [O]{.underline}ngoing in the report year. Please describe each    |
|     innovation in five lines or fewer)*:                              |
|                                                                       |
| -   Several geriatricians spearheaded the development and enhancement |
|     of cancer and non-cancer related palliative care services at the  |
|     host VA. The Palliative Care Consult Team (PCCT) was developed as |
|     a collaborative effort between the GRECC and oncology. Staff and  |
|     trainees from both services participate in the Team that includes |
|     the spectrum of other interdisciplinary team members. A           |
|     GRECC-directed outpatient clinic that focuses on the management   |
|     of chronic diseases in their most advanced stages was initiated   |
|     in July 2005 with a structured training component for residents   |
|     and fellows. (New)                                                |
|                                                                       |
| -   The Madison GRECC has developed the STAR method, an ecological,   |
|     multifaceted approach toward managing older adults with           |
|     complicated medical and mental health problems. This clinic uses  |
|     dual staffing to allow quicker access to psychiatric services for |
|     individuals who may not otherwise agree to referral to the mental |
|     health clinics. Interdisciplinary team meetings model integrated  |
|     care to a multitude of health professional trainees. (New)        |
|                                                                       |
| -   The Geriatric Sleep Clinic employees use of newly developed sleep |
|     questionnaires, computerized screening and conventional sleep     |
|     diagnostic tests with special emphasis on the medical, medication |
|     and psychiatric causes of sleep disruption in later life.         |
|     Approaches are being developed for more efficient means to screen |
|     for sleep apnea, an increasingly prevalent condition that         |
|     afflicts older adults at higher rates than the general            |
|     population. (New)                                                 |
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| b.  **Evaluation Results of Clinical Innovations listed in the        |
|     preceding box\                                                    |
|     ***(for each clinical innovation listed in 7-a above, summarize   |
|     evaluation outcome(s) identified in the report year, in five      |
|     lines or fewer. Please specify "no evaluation results" for any    |
|     innovation for which that is the case)*                           |
|                                                                       |
| -   Palliative Care Continuum: Outcomes measures are still being      |
|     developed with intent to link the activities of GRECC's           |
|     NCI-sponsored Cancer and Aging Program with the activities of     |
|     this clinic. (No evaluation results to report)                    |
|                                                                       |
| -   STAR Method: Educational outcomes are beginning to be tracked     |
|     regarding the impact of the STAR method on residents and fellows  |
|     in caring for mental health issues in frail, older adults. (No    |
|     evaluation results to report)                                     |
|                                                                       |
| -   Geriatric Sleep Clinic: Outcome measures are being developed. (No |
|     evaluation results to report)                                     |
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| c.  **Clinical Innovation Exported in Report Year**\                  |
|     *(Please list up to five examples. In three lines or less for     |
|     each example, name or describe the innovation, identify the name  |
|     of the VA or non-VA facility to which it was exported, and the    |
|     method of export)*:                                               |
|                                                                       |
| -   A novel battery of cognitive tests for screening of memory        |
|     disorders was extended to the Meriter and Attic Angel facilities. |
|                                                                       |
| -   The Geriatric Psychiatry STAR Method (an innovative approach      |
|     toward managing older adults with complicated medical and mental  |
|     health problems) developed at the Madison GRECC has been extended |
|     for use through the Wisconsin Geriatric Psychiatry Initiative at  |
|     various sites (i.e., Aurora Sinai Medical Center, Milwaukee, WI;  |
|     Elder Care of Wisconsin Partnership Program, Madison, WI; CCO     |
|     PACE and Partnership Program, Milwaukee).                         |
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| **8. CONSULTATION AND OUTREACH**                                      |
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| **DEFINITIONS:**                                                      |
|                                                                       |
| **"Consultation"** for this section of the report has occurred when   |
| GRECC staff has materially assisted in the development of a non-GRECC |
| research, education or clinical program **[within the host            |
| VAMC.]{.underline}**                                                  |
|                                                                       |
| **"Outreach"** for this section of the report has occurred when GRECC |
| staff has materially assisted in the development of a non-GRECC       |
| research, education or clinical program **[at a facility other than   |
| the host VAMC.]{.underline}**                                         |
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| **Note:**                                                             |
|                                                                       |
| **for the 2005 Annual Report,**                                       |
|                                                                       |
| **Consultation and Outreach activity**                                |
|                                                                       |
| **will NOT be reported here.**                                        |
|                                                                       |
| **It will be reported via the Electronic Annual report Data Base.**   |
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