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| ### GERIATRIC RESEARCH, EDUCATION AND CLINICAL CENTER    |   |   |   |   |
|                                                          |   |   |   |   |
| ### *Annual Report: Fiscal Year [2007]{.underline}*      |   |   |   |   |
|                                                          |   |   |   |   |
| ######## Part II: Accomplishments                        |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **NOTE:** The **GRECC Annual Report** reflects status    |   |   |   |   |
| and accomplishments of **[GRECC Core Staff]{.underline}  |   |   |   |   |
| \*** (as defined below) [only]{.underline}. The          |   |   |   |   |
| **"Report Year"** is from [October 1, 2006 through       |   |   |   |   |
| September 30, 2007]{.underline}.                         |   |   |   |   |
|                                                          |   |   |   |   |
| You are welcome to use this report format for your own   |   |   |   |   |
| internal reporting purposes,                             |   |   |   |   |
|                                                          |   |   |   |   |
| in which case you may exceed the recommended limits of   |   |   |   |   |
| numbers of responses and their length                    |   |   |   |   |
|                                                          |   |   |   |   |
| ("list no more than..." "Describe the three most         |   |   |   |   |
| important..." "limit your response to five lines or      |   |   |   |   |
| fewer")                                                  |   |   |   |   |
|                                                          |   |   |   |   |
| ***\-\--BUT\--***                                        |   |   |   |   |
|                                                          |   |   |   |   |
| [Please limit **to ten pages or fewer** the version      |   |   |   |   |
| **SUBMITTED TO VACO** **.**]{.mark}                      |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **\*[GRECC Core Staff ]{.underline}**is limited to       |   |   |   |   |
| either **Primary Core**, **Affiliated 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.              |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **[IMPORTANT:]{.underline} Throughout this report,       |   |   |   |   |
| please AVOID/MINIMIZE JARGON. Each response is much more |   |   |   |   |
| likely to be included in secondary communications        |   |   |   |   |
| derived from the Annual Reports if it can be readily     |   |   |   |   |
| understood by a non-technical readership.**              |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **1. GRECC NAME/LOCATION**                               |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| a.  **GRECC Name:** VAPSHCS GRECC                        |   |   |   |   |
|                                                          |   |   |   |   |
| b.  **Location** *(facility, VISN)*: Seattle, WA, VISN   |   |   |   |   |
|     20                                                   |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **2. CONTACT PERSON**                                    |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| a.  **Name: Chris Foster**                               |   |   |   |   |
|                                                          |   |   |   |   |
| b.  **Position:** Administrative Officer                 |   |   |   |   |
|                                                          |   |   |   |   |
| c.  **Phone, e-mail:** (206) 764-2308,                   |   |   |   |   |
|     chris.foster@med.va.gov                              |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **3. GRECC FOCUS AREA(S)**                               |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **NOTE:** Please succinctly list your GRECC's Focus      |   |   |   |   |
| Area(s), one per line below. After each focus area       |   |   |   |   |
| listed, please indicate with a check mark (****) which  |   |   |   |   |
| of the research type(s) suitably describes the work      |   |   |   |   |
| conducted (including planning, implementation, analysis, |   |   |   |   |
| and dissemination/publication) within that focus during  |   |   |   |   |
| the Report Year. Add additional lines by positioning     |   |   |   |   |
| your cursor at the lower right side of the table and     |   |   |   |   |
| striking the "Tab" key.                                  |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **GRECC Focus Area**                                     | * |   |   |   |
|                                                          | * |   |   |   |
|                                                          | R |   |   |   |
|                                                          | e |   |   |   |
|                                                          | s |   |   |   |
|                                                          | e |   |   |   |
|                                                          | a |   |   |   |
|                                                          | r |   |   |   |
|                                                          | c |   |   |   |
|                                                          | h |   |   |   |
|                                                          | T |   |   |   |
|                                                          | y |   |   |   |
|                                                          | p |   |   |   |
|                                                          | e |   |   |   |
|                                                          | * |   |   |   |
|                                                          | * |   |   |   |
+----------------------------------------------------------+---+---+---+---+
|                                                          | > | > | > | > |
|                                                          |   |   |   |   |
|                                                          | * | * | * | * |
|                                                          | * | * | * | * |
|                                                          | B | A | H | R |
|                                                          | a | p | e | e |
|                                                          | s | p | a | h |
|                                                          | i | l | l | a |
|                                                          | c | i | t | b |
|                                                          | > | e | h | i |
|                                                          |   | d | > | l |
|                                                          | B | > |   | i |
|                                                          | i |   | S | t |
|                                                          | o | C | e | a |
|                                                          | m | l | e | t |
|                                                          | e | i | r | i |
|                                                          | d | n | v | o |
|                                                          | i | i | i | n |
|                                                          | c | c | c | * |
|                                                          | a | a | e | * |
|                                                          | l | l | s |   |
|                                                          | * | * | * |   |
|                                                          | * | * | * |   |
+----------------------------------------------------------+---+---+---+---+
| ***Neurobiologic and Neuroendocrine Aspects of Aging***  | * |   |   |   |
|                                                          | * |   |   |   |
|                                                          | X |   |   |   |
|                                                          | * |   |   |   |
|                                                          | * |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| ***Metabolic Diseases and Cognitive/Sensory              |   | * |   |   |
| Impairment***                                            |   | * |   |   |
|                                                          |   | X |   |   |
|                                                          |   | * |   |   |
|                                                          |   | * |   |   |
+----------------------------------------------------------+---+---+---+---+
| **Bioethical Aspects of Medical Decision Making and      |   |   | * |   |
| Palliative Care: Ethical Issues in palliative and end of |   |   | * |   |
| life care.**                                             |   |   | X |   |
|                                                          |   |   | * |   |
|                                                          |   |   | * |   |
+----------------------------------------------------------+---+---+---+---+
|                                                          |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+

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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 specific       |
|     impact on **host VAMC's** research, staff education, program      |
|     evaluation, or clinical care improvements for elderly veterans    |
|     (i.e., how the GRECC has "made a difference" in these areas       |
|     within the entire host VAMC) during the Report Year. **Please     |
|     limit your response to [5 or fewer]{.underline} "ways"; and       |
|     please limit your description of each of the five "ways" to [five |
|     lines or fewer]{.underline}. ***                                  |
|                                                                       |
| -   GRECC investigators invested research dollars to purchase         |
|     laboratory equipment in collaboration with the host VAMC for use  |
|     by all VAPSHCS researchers.                                       |
|                                                                       |
| -   GRECC Director served as chair of the R&D Committee               |
|                                                                       |
| -   The GRECC increased its consultative services for the host VAMC,  |
|     by providing cognitive disorders, memory disorders and geriatric  |
|     psychiatry services for primary care patients.                    |
|                                                                       |
| -   GRECC Clinical Director serves as Director of the Clinical        |
|     Research Unit and Chair of the Conflict of interest committee.    |
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| b.  **GRECC Impact on VISN in the Report Year:** *list **the** **most |
|     important ways** in which the GRECC has had specific impact on    |
|     the **host** **VISN's** research, staff education, program        |
|     evaluation, or clinical care improvements for elderly veterans    |
|     (i.e., how the GRECC has "made a difference" in these areas       |
|     within the entire host VISN) during the rating period. **Please   |
|     limit your response to [5 or fewer]{.underline} "ways"; and       |
|     please limit your description of each of the five "ways" to [five |
|     lines or fewer]{.underline}. ***                                  |
|                                                                       |
| -   GRECC Associate Director, Suzanne Craft, PhD appointed to VISN    |
|     Primary Care Committee.                                           |
|                                                                       |
| -   **Ethics:** The GRECC continues to have a major role in the VISN  |
|     Ethics Advisory Board , providing key input and consultation to   |
|     the Network Director and VISN Executive Leadership Council.       |
|                                                                       |
| -   GRECC Investigator **Dr Cyrus Zabetian** collaborates with the    |
|     VISN PADRECC on several Parkinson related research programs.      |
|                                                                       |
| -   GRECC investigator Gerry Schellenberg collaborated on several     |
|     Research Grants with the Northwest MIRECC located at the Portland |
|     VAMC                                                              |
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| c.  **GRECC Trend-Setting Innovations since October 1,                |
|     [2002]{.underline}**: *list **the** **most significant** GRECC    |
|     research, education or clinical innovations in the past five      |
|     years. For each item, provide date or date range, GRECC core      |
|     staff responsible, and a description. **Please limit your         |
|     response to 5 or fewer innovations; and please limit each of the  |
|     five innovation descriptions to five lines or fewer. ***          |
|                                                                       |
| -   **Ethics Program:** Completed pilot- and field-testing of a Staff |
|     Survey on Clinical and Organizational Ethics for the National     |
|     Center for Ethics in Health Care (VHA). This staff survey         |
|     assesses clinicians' and managers' perceptions of local ethics    |
|     practices, knowledge of ethics standards, and perceptions of      |
|     institutional factors that influence ethics practices. The survey |
|     will be incorporated into a new initiative from VACO in FY 05 to  |
|     promote integrated ethics programs in VHA facilities. The staff   |
|     survey is intended to provide information to facility leadership  |
|     so that quality improvement initiatives are targeted to improve   |
|     ethics practices.                                                 |
|                                                                       |
| -   **Electronic Informed Consent**. Dr. Pearlman and his Ethics      |
|     Program staff have been working with Ethics Center (VHA) staff    |
|     and Dialog Medical in pilot testing an electronic consent         |
|     software package at five VHA facilities. The software program     |
|     aids the informed consent process by (a) providing guidance to    |
|     the process, (b) ensuring that the process and documentation      |
|     matches VHA policy and ethical standards, (c) providing           |
|     standardized educational materials for patients, (d) permitting   |
|     electronic signatures, and (e) simultaneously developing a        |
|     progress note that accompanies the consent form. The results of   |
|     the pilot testing will be sent to the National Leadership Board   |
|     in early 2004 and help determine whether VHA institutes a         |
|     national electronic informed consent program.                     |
|                                                                       |
| -   **Memory Disorders Clinic/Memory Wellness Center.** GRECC         |
|     Associate Director for Operations, Suzanne Craft, PhD, has been   |
|     instrumental in establishing the GRECC Memory Disorder Clinic     |
|     (MDC). The MDC is located at the American Lake campus and         |
|     developed as part of Dr Crafts clinical research memory           |
|     disorders. The MDC provides Gero-psychology consultation to the   |
|     VAMC and provides a platform for continued clinical research by   |
|     Dr Craft and associates.                                          |
|                                                                       |
| #                                                                     |
|                                                                       |
| -   **Diagnosing Dementia using Telemedicine Technology:**            |
|                                                                       |
| The GRECC conducted a pilot study to see if telemedicine could        |
| provide reliable, accurate geriatric consultative services to         |
| evaluate veterans for dementia who were residing at remote sites at   |
| Veterans Homes. We found that the telemedicine examination was as     |
| accurate as an in-person clinical examination in establishing the     |
| diagnosis of dementia. Moreover, the subjects reported a high degree  |
| of satisfaction with the telemedicine experience and that they would  |
| like to have further care through telemedicine in the future. Another |
| benefit of the project was that the medical staff at the Residential  |
| Veterans Homes had improved communication and increased accessibility |
| to physicians at the VA Puget Sound Health Care System                |
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| **5. RESEARCH**                                                       |
+-----------------------------------------------------------------------+
| **a. Key Findings Published in the Report Year on projects for which  |
| GRECC Core Staff was PI or Co-PI:\                                    |
| ***list **five or fewer;** for each item provide GRECC Core Staff     |
| name(s), journal reference, and description of topic/                 |
| method/results/clinical significance.* *Please limit each response to |
| [5 lines or fewer]{.underline}.*                                      |
|                                                                       |
| ADAPT Research Group, Lyketsos CG, **Breitner JC**, Green RC, Martin  |
| BK, Meinert C, Piantadosi S, Sabbagh M.  Naproxen and celecoxib do    |
| not prevent AD in early results from a randomized controlled trial.   |
| Neurology. 2007 May 22;68(21):1800-8.                                 |
|                                                                       |
| **GRECC CORE STAFF: John Breinter**                                   |
|                                                                       |
| Initial results on efficacy of non-steroidal anti-inflammatory drugs  |
| for prevention of AD dementia, from a randomized placebo-controlled   |
| primary prevention trial.  Normal elderly who were treatmented with   |
| naproxen or celecoxib showed no reduction in rates of dementia AD.    |
| There was some evidence to suggest that these conditions were more    |
| common in those receiving the treatments.  These results show that    |
| individuals who are on the verge of developing AD dementia will not   |
| benefit, and may be harmed, by the regular use of non-steroidal       |
| drugs.                                                                |
|                                                                       |
| Li G, Larson EB, Sonnen JA, Shofer JB, Petrie EC, Schantz A, Peskind  |
| ER, Raskind MA, **Breitner JC**, Montine TJ.   Statin therapy is      |
| associated with reduced neuropathologic changes of Alzheimer          |
| disease.  Neurology. 2007 Aug 28;69(9):878-85                         |
|                                                                       |
| **GRECC CORE STAFF: John Breitner**                                   |
|                                                                       |
| In a large community-based cohort of elderly, we looked for           |
| neuropathological features of Alzheimer's disease in autopsied brains |
| of non-demented individuals, and we then looked for a relationship    |
| between severity of those changes with the deceased participant's use |
| during life of "statin" cholesterol-lowering drugs.  Statin users had |
| a reduced frequency of neurofibrillary tangles -- one of the two      |
| classic hallmarks of Alzheimer's -- but there was no such             |
| relationship between statin use and presence of the other classic     |
| Alzheimer lesions, amyloid plaques.                                   |
|                                                                       |
| **Zabetian CP**, Hutter CM, Factor SA, Nutt JG, Higgins DS, Griffith  |
| A, Roberts JW, Leis BC, Kay DM, Yearout D, Montimurro JS, Edwards KL, |
| Samii A, Payami H (2007) Association analysis of MAPT H1 haplotype    |
| and subhaplotypes in Parkinson\'s disease. Ann Neurol 62:137-144      |
|                                                                       |
| **GRECC Core Staff: Zabetian CP**                                     |
|                                                                       |
| Discovering genetic risk factors for Parkinson\'s disease (PD) could  |
| lead to the development of improved treatment strategies, but has     |
| proved very difficult thus far. We examined variants within one       |
| promising gene (MAPT) in 1,762 PD patients and 2,010 controls. We     |
| found a strong association between one of these variants (\"H1        |
| haplotype\") and PD risk. These findings represent a major step in    |
| establishing a common genetic risk factor for PD-only the second such |
| risk factor identified to date.                                       |
|                                                                       |
| **Shores MM**, **Matsumoto AM,** Sloan KL, and Kivlahan DR.  Low      |
| Serum Testosterone and Mortality in Male Veterans[\                   |
| Arch Intern Med]{.underline}, Aug 14/28, 2006; 166: 1660 - 1665.      |
|                                                                       |
| **GRECC Core Staff: Shores, MM and Matsumoto AM**                     |
|                                                                       |
| In a VA-clinical database study, older men with low testosterone had  |
| an 88% increased mortality risk compared to men with normal           |
| testosterone levels in analyses controlled for age and medical        |
| morbidity. To minimize the effect of acute illness on the results,    |
| men with first year deaths were excluded from the analysis and low    |
| testosterone continued to be associated with a significant increase   |
| in mortality risk.                                                    |
|                                                                       |
| **Vig EK**, Starks H, Taylor JS, Hopley EK, Fryer-Edwards K.          |
| Surviving Surrogate Decision-Making: What Helps and Hampers the       |
| Experience of Making Decisions for Others. J Gen Intern Med 2007; 22: |
| 1274-1279.                                                            |
|                                                                       |
| **GRECC CORE STAFF:** **Vig EK**                                      |
|                                                                       |
| There are a number of factors that contribute to surrogate            |
| decision-makers having an easier or harder time making medical        |
| decisions for loved one.  Many of these factors can be modified by    |
| the way that health care providers interact with surrogates when they |
| are making these decisions.                                           |
|                                                                       |
| **Brian Kraemer** and **Gerard Schellenberg**.  2007.  SUT-1 enables  |
| human tau-induced neurotoxicity in C. elegans. Hum Mol Genet.         |
| 16(16):1959-71.                                                       |
|                                                                       |
| **GRECC CORE STAFF: Kraemer B, Schellenberg GD**                      |
|                                                                       |
| Using our C. elegans model for Tauopathy, we identified a gene called |
| SUT-1 that when knocked out, suppresses tau neurotoxicity.    SUT-1   |
| is part of a conserved pathway that participates in regulation of the |
| actin cytoskeleton to modulate tau neurotoxicity                      |
|                                                                       |
| Leverenz JB, Fishel MA, Peskind ER, Montine TJ, Nochlin D, Steinbart  |
| E, Raskind MA, **Schellenberg GD, Bird TD**, Tsuang D. Lewy body      |
| pathology in familial Alzheimer disease: evidence for disease- and    |
| mutation-specific pathologic phenotype. [Arch Neurol]{.underline}     |
| 2006 Mar;63(3):370-6                                                  |
|                                                                       |
| **GRECC Core Staff: Schellenberg GD, Bird TD**                        |
|                                                                       |
| Lewy body pathology was common in familial Alzheimer's disease cases  |
| with Presenilin 1 and 2 mutations.                                    |
|                                                                       |
| Brickell KL, Steinbart EJ, Rumbaugh M, Payami H, **Schellenberg GD**, |
| Van Deerlin V, Yuan W, **Bird TD**. Early Onset Alzheimer's Disease   |
| In Families With Late Onset: A Potential Important Subtype Of         |
| Familial Alzheimer's Disease. [Arch Neurol]{.underline}, 63:1307-11,  |
| 2006                                                                  |
|                                                                       |
| **GRECC Core Staff:** Schellenberg GD, Bird TD                        |
|                                                                       |
| Early onset Alzheimer's disease may occur in families with generally  |
| late onset and may indicate a distinct genetic subgroup.              |
|                                                                       |
| **Schellenberg, G.D**., Dawson, G., Sung Y.J., Estes, A, Munson, J.,  |
| Rosenthal, E., Rothstein, J., **Yu, C.E**., Stodgell, C., Rodier,     |
| P.M., Spence, M.A., Minshew, N., McMahon, W., Wijsman, E.M. Evidence  |
| for multiple loci from a genome scan of autism kindreds. 2006. Mol.   |
| Psychiatry 11:1049-1060.                                              |
|                                                                       |
| **GRECC Core Staff: Yu, CE, Schellenberg TD**                         |
|                                                                       |
| This study applied the whole genome linkage analysis on a large       |
| collection of autistic families, and identified several linkage       |
| signals through out the genome. Each of these signals could be        |
| associated with a candidate gene for autism.                          |
+-----------------------------------------------------------------------+
| **b. Key Findings Published in the Report Year on work in which GRECC |
| Core Staff served as Co-Investigators to a Non-GRECC PI:** *list      |
| **five or fewer**; for each item provide GRECC Core Staff name(s),    |
| journal reference, and description of topic/method/results/clinical   |
| significance. Please limit each response to [5 lines or               |
| fewer]{.underline}.*                                                  |
|                                                                       |
| Hayden KM, Zandi PP, Khachaturian AS, Szekely CA, Fotuhi M, Norton    |
| MC, Tschanz JT, Pieper CF, Corcoran C, Lyketsos CG, **Breitner JC**,  |
| Welsh-Bohmer KA; Cache County Investigators.  Does NSAID use modify   |
| cognitive trajectories in the elderly? The Cache County study.        |
| Neurology. 2007 Jul 17;69(3):275-82.                                  |
|                                                                       |
| **GRECC CORE Staff: Breitner JC**                                     |
|                                                                       |
| In observational studies (not randomized trials) non-steroidal        |
| anti-inflammatory drug (NSAID) use has been associated with reduced   |
| risk of Alzheimer's disease.  It is unknown whether "normal"          |
| cognitive aging is in fact a very early change in people whose brains |
| are already affected by Alzheimer's changes, even though they are     |
| several years or even decades away from the development of            |
| Alzheimer's dementia.  In a large population-based study, we examined |
| whether NSAID use was associated with a reduction in cognitive        |
| decline in non-demented people.  We found this effect particularly in |
| individuals who have a gene that places them at high risk of          |
| Alzheimer's dementia.                                                 |
|                                                                       |
| Kay DM, Moran D, Moses L, Poorkaj P, **Zabetian CP**, Nutt J, Factor  |
| SA, Yu CE, Montimurro JS, Keefe RG, Schellenberg GD, Payami H (2007)  |
| Heterozygous parkin point mutations are as common in controls as in   |
| Parkinson's patients. *Ann Neurol* 61:47--54                          |
|                                                                       |
| **GRECC Core Staff: Zabetian CP, Yu CE, Schellenberg TD**             |
|                                                                       |
| We performed a comprehensive sequence analysis of parkin in 302 PD    |
| patients and 301 controls; findings were replicated in 1,260          |
| additional patients and 1,657 controls. Thirty-four variants were     |
| detected; patients and controls did not differ in the frequency,      |
| type, or functional location of the variants. This study cast doubt   |
| on the commonly held belief that heterozygous parkin sequence         |
| variants are risk factors for PD and has important implications for   |
| genetic testing and counseling.                                       |
|                                                                       |
| Curtis JR, Engelberg RA, Young JP, **Vig EK**, Reinke LF, Wenrich MD, |
| McGrath B, McCown E, Back AL. An approach to understanding the        |
| interaction of hope and desire for explicit prognostic information    |
| among individuals with severe COPD or advanced cancer. J Palliat Med  |
| 2007 (in press).                                                      |
|                                                                       |
| **GRECC CORE STAFF: Vig EK**                                          |
|                                                                       |
| In a study of seriously ill patients, their loved ones, their         |
| physicians, and their nurses, we found four ways that patients think  |
| about the interaction between their hope and their desire for         |
| prognostic information.  By being aware of these 4 models for the     |
| interaction of hope and prognostic information, health care providers |
| can use different approaches for talking to patients about their      |
| prognoses                                                             |
|                                                                       |
| Jarrett, M.E., **Kohen, R**., Cain, K.C., Burr, R.L., Poppe, A.,      |
| Navaja G.P., Heitkemper, M.M. Relationship of SERT Polymorphisms to   |
| Depressive and Anxiety Symptoms in Irritable Bowel Syndrome.          |
| Biological Research for Nursing, 2007; 9:161-169                      |
|                                                                       |
| **GRECC Core Staff: Kohen, R.**                                       |
|                                                                       |
| This study investigated the influence of serotonin transporter        |
| polymorphisms on psychiatric comorbidity in patients with chronic     |
| gastrointestinal disease (irritable bowel syndrome, IBS). IBS         |
| patients were more likely to suffer from depression if they were      |
| homozygous for the short allele of the 5-HTTLPR polymorphism or       |
| carried the STin2.9 variant.                                          |
|                                                                       |
| Sanders NM, Taborsky GJ Jr, **Wilkinson CW**, Daumen W, Figlewicz DP. |
| Antecedent hindbrain glucoprivation does not impair the               |
| counterregulatory response to hypoglycemia. Diabetes. 2007            |
| Jan;56(1):217-23.                                                     |
|                                                                       |
| **GRECC Core Staff: Wilkinson**                                       |
|                                                                       |
| Recurrent hypoglycemia impairs hormonal counterregulatory responses   |
| to further bouts of hypoglycemia, a serious problem for diabetic      |
| patients attempting to regulate blood glucose. Hypothalamic, but not  |
| hindbrain, glucose sensing sites were implicated in the development   |
| of defective counterregulatory responses.                             |
|                                                                       |
| Züchner S, De Jonghe P, Jordanova A, Claeys KG, Guerguelcheva V,      |
| Cherninkova S, Hamilton SR, Van Stavern G, Krajewski KM, Stajich J,   |
| Tournev I, Verhoeven K, Langhorst CT, de Visser M, Baas F, **Bird     |
| T**, Timmerman V, Shy M, Vance JM. Axonal neuropathy with optic       |
| atrophy is caused by mutations in mitofusin 2. [Ann                   |
| Neurol]{.underline}, 59(2):276-81, 2006.                              |
|                                                                       |
| **GRECC Core Staff: Bird TD**                                         |
|                                                                       |
| Optic atrophy is often found in subjects with Charcot-Marie-Tooth     |
| disorder and mutations in MFN2.                                       |
|                                                                       |
| Zabetian CP, Hutter CM, Yearout D, Lopez AN, Factor SA, Griffith A,   |
| Leis BC, **Bird TD**, Nutt JG, Higgins DS, Roberts JW, Kay DM,        |
| Edwards KL, Samii A, Payami H. LRRK2 G2019S in families with          |
| Parkinson disease who originated from Europe and the Middle East:     |
| Evidence of two distinct founding events beginning two millennia ago. |
| [Am J Hum Genet]{.underline}, 79:752-8, 2006.                         |
|                                                                       |
| **GRECC Core Staff: Bird TD**                                         |
|                                                                       |
| At least two founding mutations have occurred in LRRK2 causing        |
| familial Parkinson's disease.                                         |
|                                                                       |
| Keene CD, Sonnen J, Swanson P, Kopyov O, Leverenz J, Bird T, Montine  |
| TJ. Neural transplantation in Huntington's disease: long-term grafts  |
| in two patients. [Neurology]{.underline}, 68:2093-2098, 2007.         |
|                                                                       |
| **GRECC Core Staff: Bird TD**                                         |
|                                                                       |
| Embryonic neural transplants may survive for many years in            |
| Huntington's disease patients but may not interact with the host      |
| brain                                                                 |
|                                                                       |
| Sieh, W., **Yu, C.E**., **Bird, T.D., Schellenberg, G.D.**, and       |
| Wijsman, E.M. Accounting for linkage disequilibrium among markers in  |
| linkage analysis: impact of haplotype frequency estimation and use of |
| molecular haplotypes for a candidate Alzheimer's disease gene. 2007   |
| Hum Hered. 63:26-34.                                                  |
|                                                                       |
| **GRECC Core Staff: Yu, CE, Schellenberg TD, Bird TD**                |
|                                                                       |
| This study applied the molecular haplotyping analysis to assess a     |
| late-onset Alzheimer's disease candidate region on chromosome 19      |
| short arm. It assessed several novel molecular and statistical        |
| approaches to address the genetic signals of complex disease.         |
+-----------------------------------------------------------------------+
| **6. EDUCATION**                                                      |
+-----------------------------------------------------------------------+
| **NOTE**: **DO NOT** list trainee and conference data                 |
| here**\--**those data are reported in the GRECC Electronic Database.  |
|                                                                       |
| **NOTE:** You may list educational activities here even if they were  |
| supported by funds that qualified for inclusion in the ePROMISE       |
| (RDIS) database if you wish.                                          |
+-----------------------------------------------------------------------+
| a.  **Innovations in Educational Activities Implemented during the    |
|     Report Year** *(list five or fewer. Please limit each item to [5  |
|     lines or fewer]{.underline} and include clarification of how each |
|     activity is innovative.)*                                         |
|                                                                       |
| b.  During FY 2007, the VAPSHCS GRECC continued to make educational   |
|     outreach programs available to all eight VISN 20 medical centers  |
|     through the use of VTels. The October 2007 VTEL was the first in  |
|     a joint partnership with other facilities and programs and was    |
|     cosponsored and broadcast by the Portland VA MIRECC and PADRECC.  |
|     The GRECC education staff worked closely with EES and             |
|     representatives here at the Seattle VA to reestablish Category I  |
|     CME, as well as CEUs for nursing, social work and psychology.     |
|                                                                       |
| c.  During FY 2007 the VAPSHCS GRECC moved to a comprehensive, online |
|     evaluation system that provides equivalent and congruent          |
|     assessment of the diverse educational and clinical training       |
|     activities provided by GRECC staff. This system is being used to  |
|     evaluate the VTEL, training grant lecture series, research        |
|     lecture series, and medical and allied health trainee experience  |
|     in GRECC clinics.                                                 |
|                                                                       |
| d.  The VAPSHCS GRECC continued to present a Fall and Spring seminar  |
|     series, hosting several prominent researchers and clinicians in   |
|     the field of Alzheimer's and other Neurodegenerative diseases.    |
|     The VAPSHCS hosted 22 educational seminars and provided local     |
|     continuing educational hours to 757 VAPSHCS, University of        |
|     Washington and VISN 20staff.                                      |
|                                                                       |
| e.  The redesigned GRECC national newsletter increased it's focus on  |
|     more in-depth coverage of outstanding research, clinical and      |
|     education accomplishments of individual GRECC members, as well as |
|     coverage of issues of general interest to all GRECC's. The        |
|     newsletter underwent further revisions as a result of a survey on |
|     readership and interests, which was sent to 1000 recipients       |
|     across the country in the Fall 2006 edition.                      |
|                                                                       |
| f.  VAPSHCS GRECC continued to strengthen partnerships with local,    |
|     regional, and national health care organizations by sponsorship   |
|     and hosting of conferences and lectures. These events include an  |
|     Ethics Forum presented once per quarter, co-coordination of Grand |
|     Rounds and research seminars (i.e., Parkinson's disease) at       |
|     several area teaching hospitals, and 26 community presentations   |
|     with over 850 attendees.                                          |
+-----------------------------------------------------------------------+
| g.  **Exportable Educational Products First Available for             |
|     Distribution in Report Year** *List five or fewer of the most     |
|     important products. For each item, limit the response to five     |
|     lines summarizing content, target audience, format, and product   |
|     evaluation plan and results. **Include educational products       |
|     developed in previous years ONLY if this is the [first            |
|     year]{.underline} they have been available for distribution.***   |
|                                                                       |
| -   In conjunction with the University of Washington, the VAPSHCS     |
|     GRECC offered a seminar series on Translational Research in       |
|     Alzheimer's Disease and Neurodegeneration. This series was        |
|     professionally videotaped and is currently available a            |
|     stand-alone educational product consisting of DVDs, PowerPoint    |
|     lecture slide decks, readings, resources, and evaluation forms.   |
|                                                                       |
| -   The VAPSHCS GRECC website is fully on-line and offers access to a |
|     number of education-related materials, including streaming video  |
|     of the VTEL lectures previously only offered to the VISN. The     |
|     website also offers links to other area, regional, and national   |
|     resources and connects users to current research, educational,    |
|     and clinical services. This site also hosts the evaluation forms  |
|     for clinical and educational activities.                          |
+-----------------------------------------------------------------------+
| c\. **Educational programs offered by your GRECC during the report    |
| year that were evaluated for impact, as described in                  |
| <http://vaww1.va.gov/grecc/docs/2007Measuresinstructions102506.doc>   |
| for Performance Measure 7.** *.*                                      |
|                                                                       |
| -   The VAPSHCS, in conjunction with the University of Washington,    |
|     offered its biannual seminar series on Translational Research in  |
|     Alzheimer's Disease and Neurodegeneration. The goals of this 9    |
|     session series are: 1) to provide a common knowledge base and     |
|     language for researchers in the area of Alzheimer's disease       |
|     (AD); 2) to present the most recent evidence in critical areas of |
|     investigation; and 3) to foster ability to carry out              |
|     translational research that will integrate clinical and basic     |
|     science approaches to the study of AD. Background, methodology    |
|     and research findings from clinical, biological, genetic and      |
|     neurological approaches were covered. The series was required for |
|     all MD and PhD fellows currently being supported by the NIH       |
|     training grant "Neurogenetics, Neuroendocrinology, and            |
|     Neurobehavior of AD," and was also attended by other faculty and  |
|     staff from within the VAPSHCS medical center and University of    |
|     Washington. The confidential, on-line evaluation form was         |
|     available on the course website and was accessed via a link       |
|     provided during registration or at the individual lectures.       |
|     Participants were also sent a reminder email to complete the      |
|     follow-up evaluation to gauge impact after attendance and return  |
|     to their clinical or research worksite. Evaluation forms were     |
|     based on EES materials and assessed relevance, quality, and       |
|     congruence with overall program objectives as well as those for   |
|     individual lectures. Based on the results of the evaluation       |
|     forms, it was determined that the relevance and quality of the    |
|     lectures was high, as was the overall expertise and level of      |
|     knowledge of the presenters. Quality and applicability of the     |
|     readings and other handouts were variable, and with little        |
|     perceived relevance for select readings/lectures. Participants    |
|     identified individual presenters who were more or less helpful in |
|     conveying information, as well as supplementary topics that would |
|     be important for inclusion for the next series to be held         |
|     in 2009. The conclusions from the evaluations are that the series |
|     continues to effectively develop a common knowledge and language  |
|     base for integrative, translational researchers in the area of    |
|     Alzheimer's disease. Based on the evaluations, modifications to   |
|     presenters, materials, and scope of topics will be made for the   |
|     upcoming lecture series to be held in 2009.**\                    |
|     **                                                                |
|                                                                       |
| -   The VAPSHCS GRECC, in conjunction with the Alzheimer's            |
|     Association Western Washington Chapter, offered a seminar on      |
|     clinical and research updates in Alzheimer's disease. This event  |
|     was held in Vancouver, WA and was led by a core GRECC staff       |
|     member. Attendees included providers from the Portland and        |
|     Vancouver VA campuses but consisted of providers from other area  |
|     hospitals, community agencies, and caregivers (both family and    |
|     professional). The intervention included a brief overview of      |
|     Alzheimer's disease and related dementias, assessment, treatment, |
|     and ongoing research in the neuroendocrinology of Alzheimer's     |
|     disease as it relates to insulin resistance and metabolic         |
|     dysfunction. Participants were provided with opportunities to     |
|     interact with staff from the VAPSHCS GRECC and the Alzheimer's    |
|     Association and were given paper-and-pencil evaluation forms to   |
|     complete at the end of the seminar. The evaluation form was       |
|     congruent with EES materials and assessed relevance, quality, and |
|     degree to which the overall program objectives were met. Similar  |
|     domains were measured for the faculty. Outcomes indicated that    |
|     the program was highly successful, with the vast majority of      |
|     participants rating the quality of the lecturer and the content   |
|     in the "very good" to "excellent" range. All participants         |
|     indicated that they increased their store of knowledge and        |
|     learned new material by attending and on follow-up, over 90%      |
|     stated that they had applied what they learned. Outcomes also     |
|     revealed that revisions should be made as regards the site and    |
|     the materials, with relatively fewer participants rating these    |
|     dimensions as highly as overall content. Future editions of this  |
|     series will account for this by increasing availability of        |
|     handouts and other educational reference materials. It should be  |
|     noted, however, that scores on all domains of evaluation were     |
|     above average and that participant satisfaction was within the    |
|     upper quartile of the scale.                                      |
+-----------------------------------------------------------------------+
| **7. CLINICAL DEMONSTRATION PROJECTS**                                |
+-----------------------------------------------------------------------+
| **NOTE:** A clinical demonstration [program]{.underline} is defined   |
| as:                                                                   |
|                                                                       |
| -   an ongoing, clinical, cooperative collaboration between the GRECC |
|     and host VA medical center;                                       |
|                                                                       |
| -   that carries out and evaluates assessment strategies, management  |
|     approaches and/or specialized investigations                      |
|                                                                       |
| -   of a targeted or focused group of elderly patients                |
|                                                                       |
| -   with the intention that findings will be disseminated for the     |
|     advancement of the field.                                         |
|                                                                       |
| A clinical demonstration program is comprised of one or more clinical |
| demonstration [projects]{.underline}, each of which is defined as     |
|                                                                       |
| -   a set of one or more clinical activities                          |
|                                                                       |
| -   integrated and coordinated under a specified protocol             |
|                                                                       |
| -   designed to permit evaluation(s) of processes and/or outcomes.    |
|                                                                       |
| Evaluation of a clinical demonstration program may be a comprehensive |
| assessment of the activity and/or the clinical outcomes.              |
| Alternatively, evaluation may concentrate on a prioritized and        |
| feasible set of more focused or specific, project-related questions,  |
| e.g. related to improved diagnosis, quality of care, patient          |
| satisfaction, drug compliance, functional status, etc.  Ongoing and   |
| subsequent modifications of the care model may also be evaluated as   |
| may be the practicability and outcomes of exporting new clinical      |
| models or variations of models to general care settings and/or        |
| smaller, more resource-limited VA medical centers or outpatient       |
| facilities.                                                           |
+-----------------------------------------------------------------------+
| a.  **Clinical Demonstration Projects Underway in Report Year***:     |
|     list **all** GRECC Clinical Demonstration Projects underway. For  |
|     each item, indicate whether [N]{.underline}ew or                  |
|     [O]{.underline}ngoing in Report Year. You may include up to five  |
|     lines of descriptive text for each Project.\                      |
|     *                                                                 |
|                                                                       |
| > **NOTE:** The number of Projects listed should be equal to the      |
| > number of Clinical Demonstration Projects you have listed and named |
| > in the GRECC Electronic Database.                                   |
|                                                                       |
| -   **[GRECC Osteoporosis/Andrology/Renal Stones                      |
|     Clinic]{.underline}.** This is a multi-disciplinary (geriatric    |
|     medicine, endocrinology and nephrology) directed by the GRECC     |
|     AD/C to evaluate and treat osteoporosis and other metabolic bone  |
|     diseases; male hypogonadism and erectile dysfunction; and         |
|     recurrent nephrolithiasis. Status: [O]{.underline}ngoing.         |
|                                                                       |
| -   **[GRECC Clinic]{.underline}.** This is a multi-disciplinary      |
|     (geriatric medicine, geriatric psychiatry, social work, pharmacy, |
|     and geriatric medicine and psychiatry fellows) geriatric medicine |
|     primary care and geriatric psychiatry referral clinic directed by |
|     the GRECC AD/C to care for complex elderly patients with          |
|     undiagnosed and/or severe psychiatric disorders (primarily        |
|     dementia and depression) who also have multiple medical           |
|     co-morbidities and who can not be cared for effectively in        |
|     general internal medicine clinic. Status: [O]{.underline}ngoing.  |
|                                                                       |
| -   **[Memory Disorders Clinic]{.underline}.** This is a              |
|     multi-disciplinary referral clinic directed by AD/EE to evaluate  |
|     and manage patients with dementia and other cognitive             |
|     dysfunction. Status: Ongoing                                      |
|                                                                       |
| -   **[Neurogenetics Clinic]{.underline}.** This a referral and       |
|     research clinic directed by a GRECC Staff Physician, to evaluate  |
|     patients and families with neurodegenerative diseases (late-onset |
|     Alzheimer's disease, Huntington's disease, hereditary ataxia and  |
|     hereditary neuropathy), both clinically (phenotype) and           |
|     genetically (genotype). Status: [O]{.underline}ngoing.            |
|                                                                       |
| -   **[Palliative Care Program]{.underline}.** This is a newly        |
|     organized interdisciplinary program that is directed by a GEC     |
|     Staff Physician that provides consultative and case management    |
|     services and limited inpatient palliative care in newly renovated |
|     rooms on the Transitional Care Unit in order to relieve suffering |
|     and improve quality of life for terminal patients and their       |
|     families. A GRECC Staff Physician is involved in planning the     |
|     scope of palliative care program within the medical center.       |
|     Status: [N]{.underline}ew.                                        |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   **[Caregivers Support Group.]{.underline}** This is a program run |
|     by the GRECC Social Worker that provides a weekly support group   |
|     to caregivers of elderly patients. Status: [O]{.underline}ngoing. |
+-----------------------------------------------------------------------+
| b.  **Evaluation of Clinical Demonstration Projects:** *for each      |
|     GRECC Clinical Demonstration Project listed in 7a above,          |
|     summarize the evaluation activity. If no evaluation results are   |
|     available, be explicit as to the focus of the planned evaluation, |
|     and when it is anticipated to occur. If the project has been      |
|     completed during the Report Year, provide key findings and their  |
|     significance.*\                                                   |
|     \                                                                 |
|     **NOTE:** Do not list patient service use data here. Those data   |
|     are reported in the GRECC Electronic Database.                    |
|                                                                       |
| -   **[GRECC Osteoporosis/Andrology/Renal Stones                      |
|     Clinic]{.underline}.**                                            |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   Descriptive study of the adequacy or inadequacy of work up and    |
|     treatment for osteoporosis in patients with high-risk patients    |
|     with low-trauma hip fractures. This will serve as a baseline for  |
|     designing and testing strategies to improve the evaluation and    |
|     treatment of osteoporosis in an older population at high risk for |
|     subsequent fractures, morbidity and mortality. Status:            |
|     [O]{.underline}ngoing (analysis phase).                           |
|                                                                       |
| -   Development of clinical templates for the evaluation of patients  |
|     with osteoporosis, male hypogonadism and renal stones for primary |
|     care practitioners. These templates will be tested in the clinic  |
|     and modified as needed for use by primary care practitioners in   |
|     order to improve their work up of osteoporosis. Initial targets   |
|     for improvement will be the diagnosis of vitamin D deficiency and |
|     male hypogonadism in the older osteoporosis population. Status:   |
|     [O]{.underline}ngoing (development phase).                        |
|                                                                       |
| -   Testosterone Replacement And Dutasteride Effectiveness (TRADE)    |
|     Study. This is randomized, double-blind, single site study to     |
|     determine the effect of combined administration of                |
|     testosterone (T) plus the 5 alpha-reductase inhibitor,            |
|     dutasteride, versus testosterone replacement alone on prostate    |
|     size and lower urinary tract symptoms in older hypogonadal men    |
|     with mild to moderate benign prostatic hyperplasia. A sub-study   |
|     will assess the effects of T plus dutasteride versus T alone on   |
|     intra-prostatic T and dihydrotestosterone (DHT) concentrations,   |
|     histology and gene expression in epithelial and stromal cells     |
|     using laser capture microdissection and gene microarray analysis. |
|     This is an investigator-initiated study (PI, GRECC AD/C). Status: |
|     [O]{.underline}ngoing (recruitment phase).                        |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -                                                                     |
|                                                                       |
| -   **[GRECC Clinic]{.underline}.**                                   |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   Frailty assessment and management. This is an unfunded,           |
|     randomized pilot study to assess the value of directed            |
|     multi-disciplinary (physical therapy, geriatric medicine and      |
|     geriatric psychiatry) intervention versus usual care on mobility  |
|     disability (gait speed), as a risk factor for frailty in elderly  |
|     patients. Status: [O]{.underline}ngoing (development phase).      |
|                                                                       |
| -   Assessment of caregiver stress. This is an unfunded pilot study   |
|     to assess the impact of using the Screen for Caregiver Burden     |
|     (SCB) on the clinical care of elderly patients. Status:           |
|     [O]{.underline}ngoing (development phase).                        |
|                                                                       |
| -   Testosterone and Subsyndromal Depression Study. This is a         |
|     randomized, double-blind, placebo-controlled study comparing the  |
|     effect of testosterone replacement versus placebo on the severity |
|     of depression and quality of life in older men with mild or       |
|     subsyndromal depression. This is an investigator-initiated study  |
|     (PI, GRECC Staff Physician). Status: [O]{.underline}ngoing        |
|     (analysis phase).                                                 |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   **[Memory Disorders Clinic]{.underline}.**                        |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   Development and testing of guidelines for use of cognitive        |
|     enhancing medications in patients with dementia. Status:          |
|     [O]{.underline}ngoing (development phase).                        |
|                                                                       |
| -   Use of neuropsychological tests as predictors of driving          |
|     impairment in patients with Alzheimer's disease. Status:          |
|     [O]{.underline}ngoing (analysis phase).                           |
|                                                                       |
| -   Building on long-term memory as an approach to supportive group   |
|     therapy for patients with Alzheimer's disease. Status:            |
|     [O]{.underline}ngoing (analysis phase).                           |
|                                                                       |
| -   Funded clinical research studies by GRECC AD/EE. Status: ongoing  |
|     (recruitment phase):                                              |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   Therapeutic effects of rosiglitazone in patients with Alzheimer's |
|     disease.                                                          |
|                                                                       |
| -   Dose-response effects of intranasal insulin on memory in patients |
|     with Alzheimer's disease.                                         |
|                                                                       |
| -   Effects of daily intranasal insulin on cognition, functional      |
|     status and cerebral glucose metabolism in patients with           |
|     Alzheimer's disease.                                              |
|                                                                       |
| -   Effects of rosiglitazone on cognition, plasma amyloid and brain   |
|     atrophy in patients with mild cognitive impairment.               |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   **[Neurogenetics Clinic]{.underline}.**                           |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   No clinical demonstration projects are ongoing at present.        |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   **[Palliative Care Program]{.underline}.**                        |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   No clinical demonstration projects are ongoing at present.        |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   **[Caregivers Support Group.]{.underline}**                       |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   No clinical demonstration projects are ongoing at present.        |
+-----------------------------------------------------------------------+
| c.  **New Clinical Models developed at your GRECC that were exported  |
|     in the Report Year** *(list up to five examples, up to two lines  |
|     each; provide name of new clinical model, name of VA or non-VA    |
|     facility to which it was exported, and method of export, such as  |
|     "Falls Clinic protocol sent to [X]{.underline} VAMC"):*           |
|                                                                       |
| -   There were no new clinical models exported this year.             |
+-----------------------------------------------------------------------+
| **8. CONSULTATION AND OUTREACH**                                      |
+-----------------------------------------------------------------------+
| NOTE: **Consultation** = GRECC staff going to sites **[within host    |
| VAMC]{.underline}** or having those staff come to the GRECC, to       |
| assist in development of research, education or clinical programs at  |
| those sites. **Outreach** = GRECC staff going to **[non-host VAMC     |
| facilities]{.underline}** or having those staff come to the GRECC (in |
| person or by video or other technology) to assist in development of   |
| research, education or clinical programs at those sites.              |
+-----------------------------------------------------------------------+
| b.  **Current Year Activity Outcomes** *(list up to five examples, up |
|     to two lines each; summarize specific outcomes realized from      |
|     current year **consultation**, e.g., "Host VAMC instituted a      |
|     Falls Clinic after consultation from GRECC staff;" or             |
|     **outreach**, e.g., [X]{.underline} VAMC instituted a Falls       |
|     Clinic after GRECC outreach via series of videoconferences):*     |
|                                                                       |
| -   [Consultation,]{.underline} Dr Craft and the Memory Disorders     |
|     Clinic teamed with Dr Sharon Falzgraf of GEC to develop a         |
|     clinical education program for geriatric fellows and residents on |
|     the treatment and diagnosis of Memory Disorders.                  |
|                                                                       |
| -   The GRECC is providing in-service outreach to the CBOC's on       |
|     geriatric cognitive treatments and has sought to increase         |
|     consults from CBOC's to the Memory Disorders Clinic.              |
|                                                                       |
| -   GRECC Investigator Dr. Molly Shores and Geriatric Psychiatry      |
|     fellow Lucy Wang M.D. have teamed up with Marcella Pascually MD   |
|     to implement a prazocin research protocol in the GRECC Clinic.    |
+-----------------------------------------------------------------------+
| b.  **Previous Years' Activities Outcomes** *(list up to five         |
|     examples, up to two lines each; summarize specific outcomes       |
|     realized from previous years' [**consultation** to host           |
|     VAMC]{.underline} or [**outreach** to non-host                    |
|     facilities]{.underline}, where results were first realized in the |
|     current year.)*                                                   |
|                                                                       |
| -   No new outcomes to report.                                        |
+-----------------------------------------------------------------------+