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Memory Disorders Clinic serves individuals, families (11-30-99)

"Johnís" family didnít notice the subtle signs that something was wrong: the car keys misplaced, the stove left on, the appointment missed. But as situations occurred over several months, John grew frustrated. Quietly, his loved ones and friends began to question his ability to remember things.

Johnís primary doctor served as a sleuth, sifting the clues for answers. He could not rule out the possibility of Alzheimerís disease or other "dementia"óthe loss of intellectual capabilities and life knowledge. Was Johnís disease the result of Alzheimerís, a degenerative brain disorder for which the cause is not known, or was it due to a vascular injury such as a stroke? Johnís doctor needed the help of a specialized diagnostic and treatment clinic, such as The University of Texas Health Science Center at San Antonioís Memory Disorders Clinic opening today (Nov. 30) at Villa Serena, 4455 Horizon Hill Blvd. in San Antonio (telephone: 210-530-5005).

Dementia disorders affect an estimated 4.5 million people in the United States. They increase with age, occurring in nearly half of all Americans 85 and older. The annual cost of dementia treatment and care in this country is about $100 billion. Incidence of the disorder is expected to double to 9 million Americans by 2030.

The Memory Disorders Clinic will feature an emphasis on stroke, which triggers dementia in many patients, said neurologist Gustavo Román, M.D., clinic director and professor of medicine at the Health Science Center. Dr. Román, staff physician at University Hospital and the South Texas Veterans Health Care System, is an internationally recognized expert on treating and researching all forms of dementia, in particular vascular dementia, which involves memory impairment with stroke.

"We are building on Health Science Center faculty expertise developed over many years in the field of neurology and specifically in the subject of stroke," he said. "The data clearly link vascular disease with dementia. Research in patients age 85 or older has shown that those who had small strokes were the ones who exhibited symptoms of dementia, including the type of dementia known as Alzheimerís disease. If we can prevent small strokes, we can prevent the development of dementia."

The clinic will help with the early diagnosis of dementia and explore new ways to treat it. Dr. Román and his colleague, psychiatrist Donald Royall, M.D., will conduct clinical trials of drugs targeting dementia and its symptoms. Current drugs slow progression of dementia but are not cures. Dr. Románís research also will include a study of hyperbaric oxygen treatment for dementia.

Dr. Royall, associate professor in the departments of medicine, psychiatry and pharmacology at the Health Science Center and staff physician at University Hospital and the South Texas Veterans Health Care System, is a recognized expert on early diagnosis of dementia. His studies focus on diagnostic tests for assessing "executive function"óbrain functions that involve decision making, planning and sequencing of steps toward a goal, all strongly associated with activities of daily living.

Memory is a cognitive behavior. So are wandering, restlessness, anxiety and irritability, all associated with dementia. Though drugs are available to address the latter, memory disorders and executive function problems require other treatments.

The Memory Disorders Clinic will address the needs of families and individuals. "Older people may lack access to specialty care or not know it is available to them,"

Dr. Román said. "We encourage people to call for specialty information so we can help them get a referral if necessary. If a family wants something more comprehensive for their family member, they might need to look to a place like the Memory Disorders Clinic.

"This memory clinic is an outpatient program available to anyone in the city.

Dr. Royall and I will see patients on consultations in the clinic by referral through the patientsí health care providers. Clinical trials of drug therapies will be offered without cost to eligible subjects and with free medical monitoring."

Anyone with questions may call the clinic at (210) 530-5005 or through Villa Serena, (210) 344-2664. Villa Serena is a clinical affiliate of the Health Science Center with specialized capacity to care for dementia patients.

John and his family eventually came to grips with a diagnosis of vascular dementia. Even with excellent care in a friendly environment, Johnís spiral continued. He lives on through the memories of his family and friends.

"The worst thing people can hear is, ĎThereís nothing we can do,í " Dr. Román said. "The Memory Disorders Clinic is here to provide some options."