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Dementia is a clinical syndrome marked by the insidious onset and slow progression of cognitive impairment. Alzheimer’s disease is the most common dementia and the fifth leading cause of death in Americans over age 65. It affects more than 5 million Americans and millions more worldwide. Based on the aging population, these numbers are predicted to double every 20 years. John Dougherty, M.D., associate professor of Medicine and the director of the University of Tennessee Medical Center Cole Neuroscience Center, along with his clinical and research colleague, Monica Crane, M.D., clinical assistant professor, are part of a very active multidisciplinary, multi-institutional team investigating many aspects of Alzheimer’s disease. The symptoms of Alzheimer’s usually begin with short-term memory problems that eventually affect job skills and daily life at home. Problems with using and understanding language develop. Further complicating the illness are confusion about time and place, problems with abstract thinking, personality changes such as apathy and withdrawal from social situations, mood swings and behavioral difficulties. Some medical researchers believe Alzheimer’s disease is caused or complicated by amyloid, a proteinaceous material that forms hair-like fibrils that deposit in the brain causing devastation and eventual death. The devastation is not confined to the person with the disease. Since the disease gradually renders patients unable to care for themselves, the burden of caregiving usually falls on the spouses or other family members. These unpaid caregivers suffer unmeasured financial and

emotional damage in work lost, careers abandoned and lives put on hold. The cost of medical and institutional care for patients with Alzheimer’s disease is estimated in billions of dollars per year. Identifying the problem at an early stage is pivotal to realistic management and meaningful research. “Up to

60 percent of patients with early indicators of Alzheimer’s disease go undiagnosed in the primary care setting” says Dougherty. To facilitate earlier diagnosis, Dougherty has developed a computerized test that may be self-administered or administered by physicians, caregivers or family members to screen for cognitive deficits. He and his research team recently completed a project correlating driving skills and cognitive function that resulted in a poster presentation at the International Alzheimer’s Conference in July 2012 entitled “Turning the Keys Over in Alzheimer’s Disease.” According to Crane, accurately diagnosing Alzheimer’s also is important but can be difficult. Diffuse Lewy Body, Vascular Dementia, Frontotemporal Dementia and Parkinson’s Dementia may be confused with Alzheimer’s disease. Depression, vitamin deficiencies, hypothyroidism and chronic subdural hematoma can cause symptoms easily mistaken for dementia. “It is important to diagnose these accurately since they are treatable,”

Academic medical centers are at the core of scientific innovation and discovery. Mankind has immensely benefited from scientific discoveries that have improved health care. Vaccines have eradicated dreaded diseases, such as small pox; others such as polio are at the brink of eradication; and antibiotics effectively treat highly fatal infections. We also have an unparalleled ability to diagnose diseases at an early stage with biochemical tests, ultrasound, x-rays, magnetic resonance and radiopharmaceutical imaging.

Exciting findings of the ENCODE project provide a vast wealth of knowledge about gene regulation that could unlock vexing mysteries of common diseases that have remained resistant to all scientific inquiry. Society expects academic medical centers not only to train excellent physicians but also provide new knowledge and discoveries to enhance human health. We embrace this responsibility, because through our efforts trainees will receive instruction in the latest technology and the most up-to-date, advanced scientific knowledge. If the past is our guide, we can imagine the day when dedicated efforts of medical researchers will lead to lasting cures for cancer and other diseases that currently take an enormous toll on human life. The health and well-being of future generations depends on our ability to build on the achievements of our predecessors in academic medicine.

Alzheimer’s Disease: What’s in a Name?

Points of View

Rajiv Dhand, M.D., Chair

John Dougherty, M.D., and Monica Crane, M.D., are investigating many aspects of Alzheimer’s disease.

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Department of Medicine

Connect ing Technolog y, Educat ion and Discover y with Humanism in Medicine Vol. 2 Issue 1 Jan. 2013

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Brian Reed, M.D.

Lauren Davis, coordinator, and Carol Ellis, M.D., director, are leading clinical research for the Department of Medicine.

Combining his passion for hiking and scholarly activity, Brian Reed, M.D., PGY-1 Internal Medicine resident, is working with Mark Rasnake, M.D., to study water quality along the Appalachian Trail. “I most often hear along the trail, ‘Is this water safe to drink?’” Reed said. “Using sampling sites we

established in the Great Smoky Mountains National Park, we culture water and monitor it for coliform growth.”

A Physician Medical Education and Research Foundation grant allows them to collaborate with scientists from Oak Ridge National Laboratory to detect the presence of other organisms that can be identified using 454 DNA pyrosequencing. The results will be available soon.

Carol Ellis, M.D., director of Clinical Research for the Department of Medicine, is moving quickly to incorporate research trials in a variety of clinical areas. Her goal is to study new drugs for a variety of indications and evaluate therapies for conditions and populations where they have not been used. There are plans to participate in multicenter Phase III studies sponsored by pharmaceutical companies as well as investigator-initiated studies within the department. “There are potential opportunities for research in any area where we have both investigator expertise and a large pool of potential patient participants,” Ellis says. “Dr. Dhand [chair of the Department of Medicine] brings a wealth of experience to the department in conducting trials in pulmonary medicine, so the first studies are likely to involve inhaled bronchodilator medications in COPD and asthma.” Lauren Davis recently joined the department as Clinical Research coordinator. Davis worked in South Carolina initiating clinical trials for oncology research. She will be responsible for shepherding protocols through the Institutional Review Board process, budgeting, enrolling patients and processing the trials. Ellis encourages those interested in participating in clinical research to contact her or Davis at 865-305-9340. Likewise, they welcome information on Phase III clinical trials in which the department might participate.

Resident Spotlight: Water Safety in the Smokies

Clinical ResearchDepartment of Medicine

Department of Medicine faculty, residents and fellows share their knowledge and experience by publishing and presenting across the world. For a list of our most recent accomplishments, visit http://gsm.utmck.edu/internalmed/scholars.cfm.

Presentations, Publications, Awards

Thank You for Your SupportFor information about philanthropic giving to the UT Graduate School of Medicine Department of Medicine, please contact the development office at 865-305-6611 or development@utmck.edu. If you would like more information about any of the information in this issue of In Touch, please contact the Department of Medicine at 865-305-9340 or visit http://gsm.utmck.edu/internalmed/main.cfm. We look forward to your input. Thank you.

Stay in Touch!Alumni, please update your contact information by completing the simple form at http://gsm.utmck.edu/internalmed/alumni.cfm or by calling the Department of Medicine at 865-305-9340.Thank you!

she says. Crane presented a poster at the 2012 International Conference on Frontotemporal Dementias entitled “Differentiating Frontotemporal Dementia from Early Alzheimer’s Disease with the Cognitive Self Test.” In collaboration with members of the UT Graduate School of Medicine basic science research division, Dougherty and Crane have tested imaging biomarkers in Alzheimer’s, a project that resulted in the Food and Drug Administration’s approval of Amyvid™ for use in PET imaging. Decades ago all renal failure was labeled as Bright’s Disease. Today, books have been written on the many types and subtypes of renal pathology. Now, the diagnosis of Bright’s is only historically significant. Someday, the same will be true of Alzheimer’s. For more information visit http://www.utmedicalcenter.org/brain-and-spine-institute/diseases-and-conditions/alzheimers-disease/.

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Jonathan Wall, Ph.D., directs the collaborative and diverse basic science research

at the UT Graduate School of Medicine.

Eric Edwards, M.D.

Asha Pathak, M.D.

Jonathan Suther, M.D.

Andrew Dake, M.D.

The Department of Medicine’s Basic Science Research enterprise is a collaborative effort comprised of three active programs with overlapping and complementary areas of research. It is directed by Jonathan Wall, Ph.D. “The Preclinical and Diagnostic Molecular Imaging Laboratory is a small animal imaging facility dedicated to the study of

disease and the evaluation and development of novel treatments and diagnostic

techniques,” Wall says. “Our focus is on amyloid-associated disorders, cancer, atherosclerosis and diagnostic veterinary imaging.” The Human Immunology and Cancer Program, he says, is a multifaceted basic and clinical scientific endeavor devoted to

advancing understanding of the pathogenesis of primary (AL) amyloidosis and developing innovative diagnostic and therapeutic methods. This program, directed by Alan Solomon, M.D., is internationally known for Solomon’s work using monoclonal antibodies to treat and detect amyloid. Valerie Berthelier, Ph.D., director of the Conformational Diseases and Therapeutics Research Laboratory, works on understanding the mechanisms of protein folding and misfolding to decipher how these processes are related to normal physiology and disease. Among other goals, Berthelier is studying mechanisms of protein aggregation in patients with Huntington’s disease and alpha-1 antitrypsin deficiency. “The Basic Sciences division collaborates widely,” says Wall. “We work with scientists from Oak Ridge National Laboratory, the departments of Surgery, Pathology and Radiology, UT College of Veterinary Medicine and others and have several active clinical trials under way.” Those trials include melanoma imaging and therapy, tumor growth inhibition by odontogenic ameloblast associated protein (ODAM) and the ability of heparin-binding peptides to inhibit the infection of cells by enveloped viruses.

Basic Science Research: Collaborations, Programs

At the Department of Medicine’s annual faculty awards reception in December, Rajiv Dhand, M.D., presented several awards, including two new awards in honor of the department’s original chair, Alfred Beasley, M.D., and long-time leader, Richard Obenour, M.D. The Beasley Pylon Award is aptly named, indicating the recipient has been a pillar of support to the department. This inaugural award was presented to Richard Obenour, M.D., professor and vice chairman. In addition to serving for 50 years, Obenour has acted as interim chair for the department on two occasions. The inaugural R.A. Obenour, M.D., Distinguished Alumnus Award was presented to John W. Lacey, III, M.D., assistant professor, Department of Medicine, and senior vice president and chief medical officer, University of Tennessee Medical Center. Lacey was recognized for outstanding career achievement in the field of medicine. In recognition of excellence in teaching, Ronald Lands, M.D., associate professor, was honored as the recipient of the London Award, and Dale Wortham, M.D., professor, Division of Cardiology, and program director of the Cardiovascular Disease Fellowship, received the R.A. Obenour, Jr., Award.

Faculty Announcements and Honors

Congratulations to these residents in the Department of Medicine:

Eric Edwards, M.D., PGY-2, won first place with his oral presentation, and Andrew Dake, M.D., PGY-2, claimed second place for his narrative medicine entry “Still Kickin’” at the 2012 Tennessee Chapter of the American College of Physicians annual meeting.

Asha Pathak, M.D., PGY-1, won second place for her recent poster presentation at the 2012 Southern Hospital Medicine Meeting in Atlanta.

Jonathan Suther, M.D., PGY-1, received a Guardian Angel award from a grateful patient and family.

Resident Awards

50 YearsRichard A. Obenour, M.D.

40 YearsAlan Solomon, M.D.Robert Overholt, M.D.Clark Julius, M.D.

25 YearsDaniel Ely, M.D.

Richard Obenour, M.D., (right) received the inaugural Beasley Pylon Award. Joining him are

Rajiv Dhand, M.D., (center) and Alfred Beasley, M.D.

John Lacey, III, M.D., (left) received the inaugural R.A.

Obenour, M.D., Distinguished Alumnus Award from Rajiv

Dhand, M.D.

Service Awards

Ronald Lands, M.D., received the London Award.

Dale Wortham, M.D., received the R.A. Obenour,

Jr., Award.

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Cheryl Fassler, M.D. Ramesh Khanna, M.D.

Department of Medicine welcomed special speakers recently for its active Grand Rounds series.In September, William Finn, M.D., Department of Medicine, University of North Carolina, presented “Hyperuricemia and Gout: A Neglected Component in the Care of the Patient with Chronic Kidney Disease,” and Cheryl Fassler, M.D., UT College of Medicine, Baptist Hospital, Nashville,

gave a presentation titled “Management of Hyperglycemia in the Hospitalized Patient: 2012.” Ramesh Khanna, M.D., the Karl D. Nolph, M.D., Chair in Nephrology at the University of Missouri Health Sciences Center, presented “Acid-Base Analysis” in October. For information about Grand Rounds, visit http://gsm.utmck.edu/cme/boards.cfm.

Department of Medicine Grand RoundsJanuary 8: Transcutaneous Aortic Valve InsertionFebruary 12: Primary Immune DeficiencyFebruary 26: ID Cases from the ArchivesMarch 12: 2013 Update on the Diagnosis, Treatment and Prevention of Breast CancerMarch 26: Interstitial Lung Disease8:00-9:00 a.m.Morrison’s Conference Center, University of Tennessee Medical Center, KnoxvilleApproved for AMA creditVisit www.tennessee.edu/cme for a complete schedule.

Ninth Annual Hematology Conference: An Update on Selected ASH TopicsJanuary 19, 2013University of Tennessee Conference Center, KnoxvilleApproved for AMA, AAPA, ACPE credits and CEUswww.tennessee.edu/cme/Hematology2013The annual update occurs as soon as possible after the American Society of Hematology (ASH) international conference, while allowing time for the

featured speakers to develop unique presentations combining their areas of expertise with new information garnered from the ASH presentations.

Annual Medicine Conference: Optimizing Patient Care for a Changing PopulationMarch 1-2, 2013University of Tennessee Conference Center, KnoxvilleApproved for AMA, AAPA, ACPE credits and CEUswww.tennessee.edu/cme/Medicine2013Primary care providers are faced with caring for an aging and changing population with increasing rates of obesity, diabetes, cancer and drug use. They and other healthcare professionals manage progressively complex medical issues using new guidelines and techniques. The Annual Medicine Conference will equip healthcare professionals with strategies and skills to provide care for today’s changing population. Topics will include patient-centered medical home; HIV; diabetes and obesity; complications of drug use; sleep-related breathing disorders; guidelines for screenings, vaccines, anticoagulation techniques and more.

Finn, Fassler, Khanna Present at Grand Rounds

Continuing Education Opportunities

In Touch Volume 2, Issue 1: January 2013

Publishers James Neutens, Ph.D., DeanRajiv Dhand, M.D.

Managing Editor Amanda F. Johnson, APR

Editor Ronald Lands, M.D.

Administrative Director Susan Burchfield, CAP-OM

Contributors Susan Burchfield, CAP-OM Rajiv Dhand, M.D. Amanda F. Johnson, APR Ronald Lands, M.D.

Design J Squared Graphics

In Touch iproduced by the University of Tennessee Graduate School of Medicine Department of Medicine. The mission of the newsletter is to build pride in the Department of Medicine by communicating the accessible, collaborative and human aspects of the department while highlighting pertinent achievements and activities.

Contact Us In Touch UT Graduate School of Medicine

Department of Medicine

1924 Alcoa Highway, U-114

Knoxville, TN 37920

Telephone: 865-305-9340

E-mail: InTouchNewsletter@utmck.edu

Web: http://gsm.utmck.edu/internalmed/main.cfm

The University of Tennessee is an EEO/AA/Title VI/Title IX/Section 504/ADA/ADEA institution in the provision of its education and employment programs and services.

The University of Tennessee Graduate School of Medicine offers the following educational courses this winter and spring. To register or for more information, call 865-305-9190 or visit www.tennessee.edu/cme.