Success Story Shows Physical Therapy Can Help Both Body and Mind

When a woman experiencing cognitive decline showed up for her first physical therapy appointment with Christy Ross, PT, DPT, GCS, at Cleveland Clinic Lou Ruvo Center for Brain Health, this geriatric specialist knew she could help not only with the physical complaints of increased falls and chronic back pain, but also with the patient’s difficulty completing daily activities due to memory deficits. In fact, the resulting gain in cognitive function was remarkable enough that the case study and its results were published in 2021 in GeriNotes, a journal of the American Physical Therapy Association.

Here’s a synopsis.

Have goal, will try
Ms. Bach, 79, was repeating questions, misplacing items and having difficulty managing complex tasks as reported by her daughter. With a score of 16 out of 30 on the MoCA (a standard cognitive screening) and a hippocampal volume at the 27th percentile compared with her age peers (based on images acquired via MRI), Ms. Bach was diagnosed with mild dementia — specifically, cognitive impairment due to cerebrovascular disease.

Yet, she remained goal oriented. A retired nurse who lived alone in an active adult senior community with daily support and visits from her daughter, Ms. Bach wanted to return to participating in the social clubs and community exercise programs that she had enjoyed prior to a stroke and to decrease her back pain and increase her endurance. Improved balance was another goal. Compared to individuals without cognitive impairment, those with cognitive impairment experience two to three times more falls.

The intervention
Dr. Ross prescribed a home exercise program with simple written instructions and accompanying pictures for exercises Ms. Bach could do by herself, as well as supervised aerobic walking and stationary biking with “dual tasking” (performing a cognitive task while exercising) to be aided by her daughter or personal care assistant. The plan encompassed a total 30 minutes of moderate-intensity exercise five days a week, supplemented by twice-weekly, one-on-one PT sessions at the Lou Ruvo Center for Brain Health.

The result? Based on a battery of standardized metrics such as timed sit-to-stands, a six-minute walk test and Berg balance assessment, Ms. Bach showed physical improvement. Perhaps more surprisingly to her daughter, at Ms. Bach’s six-month neurology appointment, her MoCA score had improved 37 percent, from that baseline of 16 to 22 of 30.

“Families often ask if it’s worth the time and effort to bring someone with dementia to physical therapy,” says Dr. Ross. “However, with modification of the communication process and utilization of best-practice, evidence-based interventions, specialized clinicians can effectively serve this rapidly growing population of individuals with cognitive impairment.”

Physical therapy at the Lou Ruvo Center for Brain Health is available upon referral from our neurology providers. To make an appointment with a neurologist, call 702.483.6000.

Photo: Christy Ross, PT, DPT, GCS with patient; courtesy of Cleveland Clinic Lou Ruvo Center for Brain Health.

Pediatric Access Line Expands Mental Health Services for NV Children, Teens

THROUGH PHYSICIAN-TO-PHYSICIAN PROGRAM

With mental health problems in youth a growing concern worldwide, here, in Southern Nevada, the lack of mental health care for children and teens is particularly alarming for Dr. Lisa Durette, assistant professor at the Kirk Kerkorian School of Medicine at UNLV Department of Psychiatry and Behavioral Health, who also serves as director of the Child and Adolescent Psychiatry Fellowship. 

According to Dr. Durette, Nevada consistently ranks last for quality of mental health services, especially for youth. “In Nevada, we only have six child and adolescent psychiatrists per 100,000 kids as compared to a national average of 14,’ said Dr. Durette. “It’s no wonder our kids and teens who need mental health services are suffering.”

In 2020, Dr. Durette helped to establish the Pediatric Access Line (PAL), a statewide child psychiatry access program that builds capacity for mental health diagnoses and treatments for a number of conditions, including but not limited to Attention Deficit Disorder, learning disabilities, anxiety, self-destructive behaviors, eating disorders, and autism.

The program is funded by a mental health block grant from the Nevada Department of Public and Behavioral Health and administered by Chicanos por la Causa (CPLC) Nevada in partnership with the Kirk Kerkorian School of Medicine at UNLV and the Center for Community Solutions. Since the program started, more than 250 consultations have been completed for Nevada families.

How does it work? PAL provides pediatricians and general practitioners statewide with access to a cadre of child and adolescent psychiatrists via tele-video consultations who review patient cases and weigh in with diagnoses and suggested treatments.

Not to be confused with a crisis line that can be used by general consumers and patients, PAL provides physician to physician services, giving pediatricians and primary care providers access to highly specialized psychiatric professionals who help refine diagnoses and recommend evidence-based treatments for better outcomes.

For children, teens and families who benefit from this service, there is no additional charge for their doctors to access this expertise on their behalf.

For information, visit www.center4cs.org, or call 702-559-4528.

Photo: Dr. Lisa Durette, assistant professor at the Kirk Kerkorian School of Medicine at UNLV Department of Psychiatry and Behavioral Health and director of the Child and Adolescent Psychiatry Fellowship

UNLV’s Neuroscience Research Capabilities Expand with New Lab

With the incidence of Alzheimer’s and neurodegenerative disease on a sharp rise, including right here in Nevada, UNLV’s department of brain health within the UNLV School of Integrated Health Sciences is addressing two critical areas: the need for improved detection and treatment, and the need for more doctors and researchers who specialize in this area of neuroscience.

Dr. Jeffrey L. Cummings, director of the Chambers-Grundy Center for Transformative Neuroscience at UNLV, along with professor Jefferson Kinney of the Pam Quirk Brain Health and Biomarker Laboratory, which was recently endowed by Ted and Maria Quirk in honor of Ted’s sister, Pam, explain how work at UNLV is connecting researchers around the globe in their quest to address brain health.

UNLV Chambers-Grundy Center for Transformative Neuroscience
The principal activity of the UNLV Chambers-Grundy Center for Transformative Neuroscience is the study of the drug development pipeline for Alzheimer’s disease treatment. These observations provide a better understanding of the science of clinical trials and the science behind new drugs and biomarkers being assessed in clinical trials.

Biomarkers
A biomarker is a measure of disease or a response to treatment. For example, if cholesterol is detected in blood, treatment is initiated to prevent a heart attack or stroke. According to Dr. Cummings, we are in an exciting period of growth in the availability of biomarkers for Alzheimer’s disease, including a blood test used for detection, with more blood tests under development.

Biomarkers are critical to success in clinical trials and help to detect side effects of drugs as well as the development of new treatments.

Pam Quirk Brain Health and Biomarker Laboratory
This recently endowed lab will allow UNLV to accelerate its efforts to develop new biomarkers, provide a biobank resource for UNLV researchers and measure known biomarkers critical to research. The endowment also helps to encourage worldwide collaboration with the global scientific community.

In addition to groundbreaking research, the Lab provides a hands-on opportunity to participate in critical research for post-doctoral students from the School of Integrated Health Sciences and students from the School of Medicine. Through their work, students have an opportunity to publish, which helps to advance their careers.

Photo: Biomarker Lab at UNLV Chambers-Grundy Center for Transformative Neuroscience; courtesy of UNLV School of Integrated Health Sciences

Packed-House Town Hall Features “Envisioning the Future of LVMD”

The Las Vegas Medical District (LVMD), one of the most exciting development opportunities in the city of Las Vegas, was the featured topic of packed-house town hall at Las Vegas City Hall on August 23. Titled “Envisioning the Future of Las Vegas Medical District,” the event was hosted by Las Vegas City Councilman Brian Knudsen whose passion is ensuring access to quality healthcare for all Southern Nevadans. Orchestrated by staff of the city’s Economic and Urban Development Department and the Downtown Vegas Alliance, the event featured lively discussion with Southern Nevada healthcare leaders and private developers. 

Centrally located within the heart of the valley near US 95 and I-15, the LVMD is an emerging center of excellence for academic medicine that has already benefitted from nearly $500 million in actual and planned private and public investment since 2018.

Included in this investment is an infrastructure upgrade in excess of $130 million that includes significant roadway improvement projects that are enhancing pedestrian safety, traffic capacity and utility reliability; upgraded sewer, water and storm drains; widened sidewalks; outdoor lighting; and landscaping. Additionally, the Bearden Family Paseo was completed in 2018 to provide an outdoor gathering and respite space offering LVMD workers and students a place to rejuvenate; and new signage throughout the area is helping to create a sense of identity for the district.

GoMed, Las Vegas Medical District Circulator & Connected Pedestrian Safety Program, is a comprehensive mobility program that includes autonomous transit vehicles, smart transit shelters, and traveler wayfinding information to improve pedestrian access and safety throughout the area. The system is fully designed, with work expected to begin in early 2023.

Aligned with the 2045 Downtown Master Plan, the LVMD is being planned to create a mixed-use hub with supporting uses that will include transit linkages to the downtown core, a bike network, greenway spaces and public art.

Development in the LVMD is more easily facilitated by the city’s adoption of form-based code that makes it easier for developers to more quickly design and build suitable and complementary projects. The plan also calls for building that is appropriate in scale relative to nearby residential neighborhoods; urban design that supports walkability; appropriate transitions from auto-oriented sites to transit-oriented design while still protecting vehicular access; and a streamlined entitlement process that makes development in the LVMD even more user-friendly and attractive.   

Located within an Opportunity Zone and within the city’s Redevelopment Area, the LVMD offers developers many tax and financial incentives.  

“With hundreds of millions of dollars of investment already in progress, and our region’s desperate need to improve healthcare, the LVMD remains one of the most important and attractive opportunities today for developers,” said Councilman Knudsen.

For more information about development opportunities at the Las Vegas Medical District, contact Tabitha Pederson at tpederson@lasvegasnevada.gov or 702-229-2411. A new informational video is also available on the home page of the LVMD website.

Photo: Drone photograph of the Las Vegas Medical District

New Endowment Establishes the Pam Quirk Brain Health and Biomarker Laboratory

The UNLV Foundation is honored to recognize the generosity of Ted and Maria Quirk, who recently established an endowment to create the Pam Quirk Brain Health and Biomarker Laboratory (Quirk BBL) within the Department of Brain Health in the UNLV School of Integrated Health Sciences. The gift was made in memory of Ted’s sister, Pam, who tragically succumbed to Alzheimer’s disease last December.

The Quirk BBL, co-directed by Jeffrey Cummings MD, ScD, and Jefferson Kinney, Ph.D., is devoted to the banking, measurement, and discovery of biomarkers (such as blood tests) indicative of brain disease. Biomarkers provide insight into the biology of brain disease and provide an essential foundation for diagnosing and treating Alzheimer’s disease and other neurodegenerative disorders.

“My sister was the most generous person I’ve ever known, and I wanted to do something meaningful in her memory,” shares Ted. “Jeff Cummings is a world-renowned leader in Alzheimer’s disease research. We are excited to support the extremely important work that he, Dr. Kinney, and their Brain Health team are performing at UNLV.”

UNLV Vice President of Philanthropy and Alumni Engagement and UNLV Foundation President Rickey N. McCurry says that “laboratories across UNLV are engaging in life-changing research, and when donors like the Quirks support their work, it allows these teams to move more swiftly towards developments that make the lives of those within our community, and the world, better.”

The brain health team will use the laboratory to advance research into biomarkers for Alzheimer’s Disease and other neurodegenerative diseases, accelerate treatments for these devastating disorders, and help millions of patients and their families.

“The Quirk BBL is poised to make important advances in brain health,” explains Dr. Cummings, the Research Professor and Director of the Chambers-Grundy Center for Transformative Neuroscience. “Thanks to the generosity of the Quirks, we are one step closer to translating novel biomarker discoveries made in our lab into improved diagnosis and treatment of Alzheimer’s disease and other neurodegenerative disorders.”

Photo: Left to right – Dr. Jeffrey Cummings, Maria Quirk, Ted Quirk, Dr. Jefferson Kinney, and UNLV School of Integrated Health Sciences Dean Ronald Brown celebrate the naming of the newly endowed UNLV Pam Quirk Brain Health and Biomarker Laboratory.

Brain Health Month: Tips for Women to Help Prevent Alzheimer’s Disease

Two-thirds of Americans with Alzheimer’s are women

Alzheimer’s disease is a brain disorder that rapidly declines ability to think, learn, organize, carry out daily activities and remember important details. It’s the most common form of dementia. According to the Alzheimer’s Association, 6 million Americans are living with the disease — a number that’s expected to grow to 12.7 million by 2050. And almost two-thirds of Americans with Alzheimer’s are women. Although there’s no current cure or treatment for Alzheimer’s, thankfully, there are ways you can reduce risk.

Neuropsychologist Jessica Caldwell, PhD, helps break down the reasons why women may be more affected by Alzheimer’s than men and offers tips that may help prevent the disease.

How Alzheimer’s affects women differently
It’s not exactly clear why women are more affected by Alzheimer’s than men, but there may be several factors at play. According to Dr. Caldwell, women tend to decline faster than men after receiving a diagnosis for Alzheimer’s. Women typically live longer than men, too, and while the No. 1 risk factor for Alzheimer’s is aging, that may not be the whole story.

“Some of the reasons might be artifacts of our diagnostic systems,” says Dr. Caldwell. “For example, we know women tend to have better verbal memory than men, and our tests rely on verbal memory. So, it is possible that women don’t get diagnosed as early because our tests miss those important verbal memory changes.”

In addition, menopause and estrogen loss are a huge area of investigation for Alzheimer’s because estrogen supports an area of the brain (the hippocampus) responsible for forming new memories. It’s this part of the brain that’s first targeted when Alzheimer’s develops, so as women age, they may be even more affected. Plus, women have a greater increase in Alzheimer’s risk, compared to men, when they carry a gene associated with late-onset Alzheimer’s. But on the other hand, there is a line of research that suggests having two X-chromosomes might put women at an advantage.

“There’s not a simple, straightforward story,” says Dr. Caldwell. “We are going to have to look at Alzheimer’s as involving our genetics, our environment as well as our own behaviors.”

For more information, the entire article is online at the Cleveland Clinic website.

Photo: Courtesy of Cleveland Clinic – during an Alzheimer’s Friends Walk

One of the Most Exciting Development Opportunities in the City of Las Vegas

The Las Vegas Medical District (LVMD), home of the Kirk Kerkorian School of Medicine at UNLV, University Medical Center (UMC), Valley Hospital Medical Center, and other ancillary medical facilities and providers, is, today, one of the most exciting development opportunities in the city of Las Vegas.

According to Bill Arent, Deputy Director of Economic and Urban Development for the city, the recent evolution and expansion of the Medical District is putting the area on the map in a big way for potential developers.

“Located within an Opportunity Zone and within the city’s Redevelopment Area, the Las Vegas Medical District offers developers many incentives,” said Arent. “With the growing number of faculty and students at the Medical School, along with hospital workers, there is an increased need for a variety of neighborhood services such as retail and dining, as well as residential development including apartments that provide walkability to work and school.”

Centrally located within the heart of the valley near US 95 and I-15, the LVMD has already benefitted from approximately $400 million in actual and planned private and public investment since 2018, an investment that speaks volumes about the area’s potential, according to Arent.

Recently completed or ongoing public infrastructure improvements include the Bearden Family Paseo that provides an outdoor gathering and respite space offering LVMD workers and students a place to rejuvenate; signage throughout the area that creates a true sense of identity for the district; and significant roadway projects that are improving pedestrian safety, traffic capacity and utility reliability.

Private investment in the LVMD is led by the ongoing development of the Kirk Kerkorian School of Medicine at UNLV for which its first medical education building will be completed this summer; an expansion of Valley Hospital Medical Center’s emergency room; and the completion of Optum Care Cancer Center located at the gateway to the LVMD.

Currently in the pipeline for future growth and expansion are several projects that will contribute to the area’s ongoing revitalization, including a rehabilitation of nine buildings on the UMC campus; a development of the Women’s Cancer Center on the corner of Pinto Lane and Tonopah Drive; future apartment development of more than 200 rental units; and a $60 million investment by G2 Capital Development for a 150,000 square foot medical building and a 75,000 square foot hotel.

For more information about development opportunities at the Las Vegas Medical District, contact Tabitha Pederson at tpederson@lasvegasnevada.gov or 702-229-2411.

Photo: Las Vegas Medical District Monument

Why Southern Nevada Needs an Infectious Diseases Society

By Dr. Luis Medina-Garcia, UMC.

As the COVID-19 pandemic tightened its grip on the world last year, it crystalized an idea I had long been pondering:  the need for an infectious diseases society in Southern Nevada. In times of crisis, information, collaboration and sharing of resources is everything. At no time in recent history has this been more apparent, especially in the early days of COVID when the world was grappling with a highly infectious disease whose fallout would change almost everything in our daily life.

As an infectious disease specialist at UMC, I was acutely aware that our region did not have an organization that brought together physicians, advanced practice providers, pharmacists and other health care professionals to share critical information and brainstorm solutions, advocate for research, interpret data and support others to pursue careers in infectious disease. Most states with large metropolitan areas have infectious disease societies that help prepare communities to fight public health challenges today and in the future.

Through this turbulent time and with the help of many, especially Las Vegas City Councilman Brian Knudsen, who has generously provided meeting space, resources, encouragement and support, the Southern Nevada Infectious Disease Society was born and continues to grow. As the first professional society for infectious disease practitioners in Nevada, we are still in our infancy but are meeting regularly and actively recruiting medical professionals to join us.

A major goal of the Southern Nevada Infectious Disease Society is to promote the formation of the state’s first infectious diseases fellowship training program. By encouraging more medical professionals to become infectious diseases specialists, we can help meet the dire need for these services both locally and nationwide. To that end, we plan to establish scholarships and provide financial support for the trainees through our nonprofit and philanthropy. Currently, there are only about 20 practicing infectious disease doctors in Clark County. Given our growing population and our huge influx of tourists, the need is far greater.

It takes a community of experts to deal with the societal scourge of infectious diseases like influenza, tuberculosis, sexually transmitted diseases, HIV/AIDS, hepatitis, pneumonias and many common preventable infections for which vaccines are readily available, including measles, mumps and chickenpox; and of course, COVID-19. And that’s just scratching the surface of a long list of infectious diseases that have the potential to disrupt both personal lives and impact public health.

Las Vegas leads the nation as the city with the highest number of syphilis cases, which sadly means we also see a commensurate number of syphilis cases in newborns. Because of our large global tourist population, we have a fair number of tuberculosis cases, and the Las Vegas area is endemic for an infection with a fungus called Coccidioides. These are just a few examples outside of COVID that illustrate the need for more infectious diseases doctors and specialists. Sadly, there are just not enough of us to meet the need.

An important issue within the infectious disease universe is antibiotic resistance: bacterial diseases where the organisms mutate to become resistant to antibiotics. This is often a result of these drugs being commonly overprescribed. That’s why antibiotic stewardship programs inside our hospitals and nursing homes are critical to guide health care professionals in the appropriate use of antibiotics. By including pharmacy specialists in our society, we are better positioned to leverage improved physician-pharmacist relationships to choose the best medicine for patients, especially in difficult cases.

Now is the time to strengthen our public health workforce which includes those who specialize in treating infectious diseases. Pandemics haven’t occurred that often, but with globalization, they are going to become much more common. We are working hard toward growing our society to become affiliated with the Infectious Diseases Society of America, one of the world’s most prestigious ID societies, an important step that will give us even greater access to resources and information to protect Southern Nevada.

Let’s do this together for Nevada!

The Society website details more about membership.

Photo: Aerial image of Las Vegas Medical District courtesy of city of Las Vegas

Does Someone in Your Home Have COVID-19? Here’s What to Do

How to care for them while protecting yourself and others

Your spouse develops a dry cough and says they feel feverish. Or your roommate starts feeling achy, exhausted and short of breath after finding out a coworker tested positive for COVID-19. As cases continue surging across the country and new variants emerge, more people are finding themselves in these situations.

So, what should you do if someone in your household starts showing COVID-19 symptoms or tests positive for the virus? Here’s some guidance on how to care for someone who has COVID-19 while limiting the chances that the virus will spread easily in your household.

“Right now, we’re seeing a lot of infectivity in homes, where someone who’s sick infects others they live with,” says James Merlino, MD, Chief Clinical Transformation Officer.

What to do if someone in your house has COVID-19

  • Isolate and quarantine the person who’s sick by placing them in a separate bedroom and have them use a separate bathroom if possible.
  • Caregivers should also isolate to protect the public. Both patient and caregiver should stay isolated for at least 5 days.
  • Create as much air circulation as possible and open the windows weather permitting.
  • Wear masks.
  • Watch for warning signs such as difficulty breathing, persistent chest pain, new confusion, trouble waking or staying awake, bluish lips or face, and seek emergency medical care immediately if these symptoms appear.
  • Trace and inform others who have been in contact with the person who is ill.
  • Offer emotional support.
  • Monitor temperature and use over-the counter cough, cold and fever-reducing medications.
  • Wash your hands frequently and avoid touching your eyes, nose or mouth.
  • Clean and disinfect frequently touched surfaces every day and ensure your household disinfectant is effective against the coronavirus.
  • Don’t share personal household items with the person who is sick. Wash all of their cups, dishes and eating utensils with dish soap and hot water (or in the dishwasher).
  • Avoid visitors to your home — especially anyone who’s at high risk for COVID-19 complications.

“COVID-19 often gets in through the back door — it spreads when someone loosens up on precautions or when a family member isn’t careful,” Dr. Merlino says. “So, we have to be very vigilant with these precautions.” For more information please refer to the full article on the Cleveland Clinic website.

Article and Image are Courtesy of Cleveland Clinic Lou Ruvo Center for Brain Health

Spirit of Children Donates $202,000 to UMC Children’s Hospital

Funds Support Improved Hospital Experience for Pediatric Patients

Spirit Halloween’s Spirit of Children program presented UMC Children’s Hospital with a record-breaking donation of more than $202,000 on February 4 to support valuable child life services. This is the largest annual donation UMC Children’s Hospital has ever received from Spirit of Children.

UMC CEO Mason Van Houweling and UMC Children’s Hospital Medical Director Dr. Meena Vohra joined local Spirit Halloween store owner Brinnon Scott for a check presentation event at UMC.

The funds raised by Spirit of Children make hospital stays easier for young patients and their families through non-medical treatment and healing play. Proceeds were collected at local Spirit Halloween stores, SpiritHalloween.com and from business partners. One hundred percent of local donations stay in the community.

The Spirit of Children program has raised more than $844,000 for UMC Children’s Hospital since 2010, supporting vital child life services to improve the hospital experience for young patients and their family members.

Previous funds from Spirit of Children allowed UMC Children’s Hospital to launch a groundbreaking virtual reality program and introduce new sensory equipment for the hospital’s Child Life Department. The hospital has also allocated Spirit of Children funds to support a large-scale remodel of UMC Children’s Hospital in the future. This project will create an improved care environment for pediatric patients.

Each year, Spirit of Children and local Spirit Halloween stores also bring Halloween to the young patients at UMC Children’s Hospital, providing costumes, activity books and other goodies to every child receiving care at the hospital.

Photo: 2021 Spirit of Children Halloween costume delivery to UMC; courtesy of UMC