Where the magic comes from

Anna Moore and veteran

Emory neuropsychologist Anna Moore conducts exams to determine level of cognitive function and best treatment approach for patients with problems ranging from Alzheimer’s and traumatic brain injury to impairment caused by low B12 blood levels.

Nothing in his past—not wartime skirmishes, a car crash, or a health scare related to his diabetes—nothing filled Al Williams, 64, with as much gnawing fear as the thought of having Alzheimer's.

 

Reaching out to veterans

Emory and the Atlanta VA Medical Center

Returning (all the way) home

The key to a better recovery

At first, it was the usual misplaced car keys. Then he began to forget directions, birthdays, and conversations. I just told you that, his wife often insisted, with growing frustration. Lots of days he couldn't remember whether he had taken his diabetes and cholesterol medicines. He was depressed and slept poorly. Finally, he confessed his concerns to his primary care doctor at the Atlanta VA Medical Center, who referred him to the center's new clinic for mild cognitive impairment.

Emory neuropsychologist Anna Moore, who practices full-time at the VAMC, administered an intensive cognitive function exam. Williams had some problems, but his ability to learn new things was pretty good, especially if he had simple cues or reminders.

In the meantime, Emory/VA geriatrician Birju Patel reviewed Williams' medical records, finding that his blood sugar and cholesterol levels had gone up, along with his blood pressure and weight, probably because of his increasingly erratic use of medications, his minimal physical activity, and his lack of sleep.

Patel reviewed Williams' medications with his primary care doctor. A night in the VAMC's sleep lab confirmed this patient's suspected sleep apnea. Williams got his first good night's sleep in months on the night he wore his continuous positive-airway pressure mask. His newfound energy helped him resume the walking, bending, and other mild exercise that all his doctors agreed were essential in getting his weight, diabetes, and hypertension under control. Patel also gave Williams a series of B12 injections.

Moore started Williams on an eight-week training session focused on memory and organizational strategies geared to his specific weaknesses. Because he had trouble with multi-tasking, he now turned off the television when talking with his wife or paying bills.

As his memory improved, Al himself gave much of the credit to the B12 injections. "Those shots were magic," he told his buddies when they complained of their own forgetfulness. His wife suspected that her husband's improvement had more to do with his weight loss and diabetes control. Williams' primary care doctor took an even broader view. The real magic was in the interdisciplinary team in the mild cognitive impairment clinic who had the expertise and had taken the time to address all aspects of this patient's memory decline.

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