UK Albert B. Chandler Hospital

KNI Stroke Center awarded for high-quality patient care

UK HealthCare’s Kentucky Neuroscience Institute (KNI) has received the Get With The Guidelines – Stroke Gold-Plus Quality Achievement Award by the American Heart Association/American Stroke Association for maintaining nationally recognized standards for the treatment of stroke patients.

KNI also received the association’s Target: Stroke Honor Roll Elite for meeting stroke quality measures that reduce the time between hospital arrival and treatment with the clot-buster tPA, the only drug approved by the U.S. Food and Drug Administration to treat ischemic stroke.

Over 12 months, at least 75 percent of the hospital’s ischemic stroke patients received tPA within 60 minutes of arriving at the hospital (known as door-to-needle time). Stroke patients who receive tPA within three hours of the onset of symptoms may recover more quickly and are less likely to suffer severe disability.

This year marks the sixth year that KNI has received Gold Plus designation. KNI has been named to the Target: Stroke Honor Roll the past three years and repeats for the ‘elite’ level that was introduced last year.

Kentucky patients aren’t the only ones benefiting from this achievement.

“By participating in the Get With The Guidelines-Stroke program, we are able to share our expertise with other member hospitals around the country, including access to the most up-to-date research, clinical tools and resources, and patient education resources,” said Dr. Jessica Lee, medical director of the KNI Comprehensive Stroke Center.

Dr. Larry Goldstein, chair of the UK Department of Neurology and co-director of KNI, said that “Comprehensive Stroke Center status reflects our capability to provide the most advanced care for patients with stroke. These awards further underscore the hard work of our multidisciplinary team of neurologists, neurosurgeons, emergency physicians, nurses, therapists and others to optimize care delivery for stroke patients right here in Lexington.”

According to the American Heart Association/American Stroke Association, stroke is the number five cause of death and a leading cause of adult disability in the United States. In Kentucky, cardiovascular disease (which includes stroke) is the leading cause of death.  On average, someone suffers a stroke every 40 seconds; someone dies of a stroke every four minutes; and 785,000 people suffer a new or recurrent stroke each year.

The KNI Stroke Center is also also certified as a “Comprehensive Stroke Center” by The Joint Commission – its highest honor.

Research shows exercise may prevent Alzheimer’s

A group of researchers led by Nathan Johnson, Ph.D., of the University of Kentucky College of Health Sciences, found a positive correlation between fitness and blood flow to areas of the brain where Alzheimer’s disease is usually first detected. This suggests that exercise might provide some measure of protection from Alzheimer’s and other dementias.

Thirty men and women ages 59-69 were given treadmill fitness assessments and ultrasounds of the heart. Then they received brain scans to look for blood flow to certain areas of the brain.

“We set out to characterize the relationship between heart function, fitness, and cerebral blood flow, which no other study had explored to date,” Johnson said.  “In other words, if you’re in good physical shape, does that improve blood flow to critical areas of the brain? And does that improved blood flow provide some form of protection from dementia?”

The results showed blood flow to critical areas of the brain was higher in those who were more physically fit. This means that the supply of oxygen and vital nutrients is also higher. Essentially, this study indicates that regular exercise at any age could keep the mind young, said Johnson.

“Can we prove irrefutably that increased fitness will prevent Alzheimer’s disease?  Not at this point,” Johnson said.  “But this is an important first step towards demonstrating that being physically active improves blood flow to the brain and confers some protection from dementia, and conversely that people who live sedentary lifestyles, especially those who are genetically predisposed to Alzheimer’s, might be more susceptible.”

Since people who exercise frequently often have reduced arterial stiffness, Johnson and his team believe that regular physical activity maintains the integrity of the “pipes” that carry blood to the brain. Their study is taking great steps in the right direction. And that’s what it’s all about – taking proactive measures to combat diseases like Alzheimer’s and other forms of dementia.


Next Steps

Epilepsy

13-year-old boy enjoys being “normal kid” again after epilepsy surgery

Anyone who’s 13 years old – or who was once 13 – can relate to the embarrassment of a parent insisting on sitting in the room while they showered.

Unfortunately, that was the reality for 13-year-old Joey Maggard until a delicate surgical procedure eliminated his epileptic seizures this past January.

At the time of his surgery, Joey’s seizures were so frequent and unpredictable – about 20 to 30 per month – that his mother, Erin Smith, would sit in the bathroom in case he seized while showering.

“It was so frustrating for him and heartbreaking for me,” Erin recalls. “He wanted so much to be ‘just a kid,’ but the reality was that being ‘just a kid’ could have been dangerous for him.”

Adding to the disappointment were the other restrictions imposed upon Joey. He could no longer play his beloved sports or have sleepovers with friends. He was forced to follow a restricted diet and reduce Xbox and electronics use. After his seizures increased in frequency, his school district asked that he be tutored at home for the last half of his sixth grade year.

A very understanding doctor

“Epilepsy is often misunderstood by the lay public, and epilepsy patients are often teased or shunned, particularly when they are younger,” said Dr. Meriem Bensalem-Owen, director of the Epilepsy Program at the Kentucky Neuroscience Institute at the University of Kentucky. “As a result, they often isolate themselves for fear of losing control in public, and depression and anxiety commonly go hand-in-hand with the stigma of epilepsy.”

Bensalem-Owen considers it part of her responsibility to reassure patients that they are not alone in their journey.

“More than 150,000 Kentuckians are living with epilepsy today,” she explains. “I think many patients are surprised when I tell them that.”

Even more reassuring, Bensalem-Owen believes, is the fact that she has a personal experience with epilepsy.

“My son had seizures few years ago, and I literally told myself ‘OK, so now I have to be as brave as the parents of my patients and do what I tell them to do.’ So I understand, not just as an epileptologist but as mom, what Joey and his family were going through and I can reinforce with them that there is a team with them step of the way.”

An epilepsy center to get the job done

Joey’s odyssey began when he was 9. Erin said that while Joey’s birth was stressful, otherwise “he was great, he hit every milestone.” With no family history, his first and second seizures – about six months apart – were a shock to his family. After Joey experienced a grand mal seizure – considered the most violent and dangerous of all seizures – a CAT scan at a hospital close to their Lincoln County home found a lesion in his brain. He was referred to Dr. Qutubuddin G. Khan, a pediatric neurologist at the Kentucky Neuroscience Institute (KNI).

The Epilepsy Program at KNI is accredited by the National Association of Epilepsy Centers (NAEC) as Level 4 Center — its highest designation. A Level 4 center provides more extensive medical, neuropsychological, and psychosocial treatment, including thorough and highly technical evaluation for a wide range of surgical treatment for epilepsy. Since 2003, US News and World Report has included NAEC Level 4 adult epilepsy centers as a part of its ranking criteria.

“Level 4 epilepsy centers have the professional expertise and facilities to provide the highest-level medical and surgical evaluation and treatment for patients with complex epilepsy,” said Dr. Larry Goldstein, chair of the UK Department of Neurology and KNI co-director. “To achieve this designation is an apt reflection of our institutional commitment to provide the best subspecialty care to the people of Kentucky and beyond.”

At first, Khan tried a variety of medications, alone and in combination. Each time, says Erin, they would work for a while, but Joey’s seizures would eventually return.

“One of the things I loved most about Dr. Khan was how candid he was,” said Erin. “After each setback, he’d sit with us and explain patiently what our next options were and the pros and cons of each option.”

Based on initial testing to determine what areas of the brain Joey’s seizures came from, Khan felt Joey was a good candidate for surgery, and referred him to Bensalem-Owen for further evaluation.

A crucial step in the process of assessing Joey’s seizures — and a hallmark of centers with NAEC Level 4 accreditation — is invasive brain monitoring, where the skull is opened and a delicate web of electrodes is placed directly on the brain. Over a period of days Joey was monitored and brain mapping was performed to pinpoint exactly which parts of his brain controlled essential functions like speech, and those points were compared to the areas were his seizures arose. It’s a painstaking and uncomfortable process.

“I asked Joey if he was ready for this, and he looked me straight in the eye and said YES,” said Bensalem-Owen. “He said he was tired of missing school and having poor grades. I was impressed by how determined and brave he was.”

Brain mapping indicated three small areas that were leading to Joey’s seizures. Two areas were perilously close to the part of Joey’s brain that controlled vision and motor function; Bensalem-Owen knew that precision was critical to a successful outcome for Joey.

Once the doctors knew which parts of Joey’s brain to target and which parts to avoid, KNI neurosurgeon Dr. Thomas Pittman performed the surgery to remove the lesions that were causing his seizures. Then began the waiting game.

“Joey’s been seizure-free since his surgery,” said Amy. “He now can take showers and be alone outside without my constant supervision. I know we’ve got a ways to go before we’re out of the woods, but this has been a huge burden lifted.”

Furthermore, says Bensalem-Owen, Joey’s vision and other motor function have remained intact. “We couldn’t have hoped for a better outcome,” she said.

Surgery shouldn’t be treated as a last resort

Bensalem-Owen stresses that while surgery isn’t an option for everyone, there are large swaths of individuals with epilepsy who either don’t know about or are afraid of surgery, and those people are suffering needlessly.

“In the U.S., there are more than 100,000 patients who are candidates for surgery, and only about 2,000 people elect to have the surgery every year,” she said. “We need to educate patients and healthcare providers that surgery shouldn’t be treated as a last resort, that patients don’t need to suffer from the physical and emotional effects of epilepsy for ten or twenty years. If someone has uncontrolled epilepsy for more than a year, they should seek an opinion at an accredited epilepsy center.”

In a post-surgery appointment with Bensalem-Owen, Joey was bouncy and talkative. His hair was growing back, mostly covering the scar that extends from the top of his head to just behind his ear. His grades have rebounded since his return to school in March and he has been cleared to play sports in June. He will continue epilepsy medication as an added precaution, but Bensalem-Owen predicts a complete return to the life that allows kids to be just that — kids.

“On my first day back to school, as I was going down the hall teachers were shrieking and kids were hugging me,” Joey recalled with a smile. “I was back with my buddies again, and I was so happy.”


Next steps

Understanding the signs and symptoms of Alzheimer's disease

Know the signs of dementia and Alzheimer’s disease

Forgetfulness is something many of us will experience as we get older. It’s a normal part of aging. But when memory loss starts to interfere with daily life, it can be a sign of a more serious issue such as Alzheimer’s disease.

Alzheimer’s disease is a form of dementia, a group of conditions that affect mental capability and can cause memory loss. While there is no cure for Alzheimer’s disease, one way to limit its effects is to identify it as early as possible.

Alzheimer’s usually affects people who are 65 or older, so if there’s a senior in your life, be aware of these signs and symptoms.

  • Forgetting important information: It’s normal for someone to forget a date or a name but suddenly remember it later. However, pay attention if they ask for the same information repeatedly or struggle to recall important dates (like their own birthdate).
  • Lack of problem-solving skills: Are they having trouble following a recipe? Problem-solving skills can deteriorate in someone with Alzheimer’s or dementia.
  • Difficulty completing familiar tasks: Do they get lost when driving to a familiar location? If they have difficulty completing familiar tasks, it might be a sign of Alzheimer’s.
  • Using incorrect words: Healthy people can occasionally a struggle to find the right word, but using the wrong word – particularly if they call something by the wrong name – merits further scrutiny.
  • Poor hygiene. Is the person suddenly displaying odd behavior related to clean clothes, bathing, oral health or shaving? It’s not uncommon for a person with Alzheimer’s to lose interest in personal hygiene.
  • Personality changes: Are they suddenly irrational, fearful or suspicious?

If a loved one in your life is experiencing any of these symptoms, make an appointment with a doctor.

And be sure to check out our infographic below for more information about Alzheimer’s disease in Kentucky.

Alzheimer's infographic


Next steps:

Tom and Nancy Conley

Family takes action to help fight Alzheimer’s disease

Nearly 68,000 Kentuckians today are suffering from Alzheimer’s disease, but the emotional and financial tolls are much higher. That’s because, in the words of Linda Van Eldik, Alzheimer’s is a “family disease.”

“Alzheimer’s affects the patient, of course, but as the disease progresses, it is also devastating for the people who love and care for that patient,” said Van Eldik, director of the University of Kentucky Sanders-Brown Center on Aging.

While a diagnosis of Alzheimer’s or other age-related dementias brings an incredible amount of uncertainty to patients and their families, the Sanders-Brown Center on Aging (SBCoA) provides information, support and hope. So say Tom Conley and daughters Terri and Susie, whose wife and mother Nancy was diagnosed with Alzheimer’s in 2009. The Conley family hails from Louisville, but they found care for Nancy in Lexington at UK.

“The care Nancy got while she was at Sanders-Brown and the clinical trials she participated in, I think slowed the disease down,” Tom said.

Nancy passed away from breast cancer in November of 2014.  Looking back the Conley daughters feel grateful that their mother’s last years were full of good memories.

“I got my mother — my real mother — a few more years than I probably would have if she had gone untreated,” Terri said.

SBCoA was established in 1979 and is one of the original 10 National Institutes of Health-funded Alzheimer’s Disease Research Centers. It is internationally acclaimed for its work in the fight against age-related diseases.

Faculty and researchers work together within the framework of the Center’s mission to explore the aging process and its implications for society. Research spans bench to bedside, from defining disease mechanisms in the brain and exploring cellular changes that lead to AD, to studies exploring healthy aging and ways to lower risk of dementia, to clinical trials testing potential new therapies that slow or stop the progression of age-related diseases of the brain.

“We are trying to cure Alzheimer’s and we know that here at the Sanders-Brown Center on Aging we will be part of that cure,” said Dr. Greg Jicha, professor of neurology at the UK College of Medicine and SBCoA. “Whether it comes next year or comes five years from now or 20 years from now, we will be playing a central role in that ultimate goal.”

Tom Conley hopes he’ll have a role, too. He continues to volunteer at Sanders-Brown and encourages others to donate their time and resources, all in the name of providing support for patients suffering from Alzheimer’s and their families.

Watch this video to learn how Sanders-Brown helped the Conley family extend Nancy’s quality of life and why philanthropy is so integral to ensuring that UK researchers contribute to finding a cure for Alzheimer’s disease while also helping other Kentucky families.

As Tom puts it, “You have a jewel right here in little old Lexington and we need to keep polishing it.”


Next steps:

 

 

Forgetfulness or dementia? How to tell the difference in elderly loved ones

If you’re spending time with elderly friends and family members this holiday season, be aware of noticeable changes in their memory and behavior, as these can be early warning signs of dementia.

“If you haven’t seen your elderly loved one in a while, you might be more likely to notice changes in their memory and behavior that worries you,” said Dr. Gregory Jicha of the University of Kentucky Sanders-Brown Center on Aging.

Here are some early warning signs of dementia that you might notice in an older friend or family member:

  • It’s normal for someone to forget a date or a name but suddenly remember it later. However, pay attention if they ask for the same information repeatedly, or struggle to recall important dates (like their own birthdate).
  • Are they having trouble following a recipe? Problem-solving skills can deteriorate in someone with Alzheimer’s.
  • Do they get lost when driving to a familiar location? If they have difficulty completing familiar tasks, it might be a sign of AD.
  • Healthy people occasionally struggle to find the right word, but using the wrong word  ̶  particularly if they call something by the wrong name  ̶  merits further scrutiny.
  • Poor judgment: are they giving lots of money to telemarketers or charities?
  • Poor hygiene.
  • Personality changes: are they suddenly irrational, fearful or suspicious?

Memory infographic

If you see any behavior that worries you, talk to your doctor. To make an appointment with a UK HealthCare doctor, visit our Appointment page or call 800-333-8874 today.

More information:

The Memory Disorders Clinic at the Kentucky Neuroscience Institute

 

What women need to know about stroke

Commonly thought of as a problem primarily affecting older men, stroke is a woman’s disease. Approximately 60 percent of deaths related to stroke in the United States occur in women, and the lifetime risk of stroke is higher in women (about one in five) compared to men (about one in six) for those aged 55 to 75 years.

The good news is that stroke can often be prevented.

Although men and women have several modifiable stroke risk factors in common such as high blood pressure (normal less than 120/80 mmHg), diabetes, cigarette smoking, overweight-obesity, atrial fibrillation (an irregular beating of the upper chambers of the heart), excessive alcohol consumption, poor diet or lack of regular exercise,  several risk factors are unique to women.

Stroke risk can be increased during pregnancy, in part leading to a higher stroke risk among women of childbearing age compared to similarly aged men. Migraine with aura (neurologic symptoms such as seeing sparkling or zigzag lights) is also associated with a higher stroke risk, particularly among women who smoke or use oral contraceptives. Women who have had eclampsia or pre-eclampsia associated with pregnancy (high blood pressure, protein in the urine, and in the case of eclampsia, seizures) are at increased risk of stroke up to 30 years later.

What can women do to reduce their stroke risk?

  • Follow a healthy diet such as the DASH or Mediterranean diet.
  • Get regular exercise such as walking at a brisk but comfortable pace for 20-30 minutes most days of the week.
  • No more than one alcoholic drink per day (no alcohol during pregnancy)
  • Don’t smoke and avoid exposure to tobacco smoke
  • Have your blood pressure checked regularly

In addition, talk to your health care provider about reducing your stroke risk if you:

  • Have migraine, particularly migraine with aura
  • Have ever had eclampsia or pre-eclampsia

Memorize some common stroke symptoms using the FAST acronym:

  • Facial droop
  • Arm weakness
  • Speech slurring
  • Time call 911 – Stroke is frequently preventable and treatable, but you need to get help quickly

Larry B. Goldstein, MD

 

Larry B. Goldstein, MD, FAAN, FANA, FAHA, is the Ruth L Works Professor and Chairman of the UK Department of Neurology and Co-Director, Kentucky Neuroscience Institute.

 

 

This column appeared in the Dec. 6, 2015 edition of the Lexington Herald-Leader.

Sundown Syndrome can be a sign of Alzheimer’s disease

Have you ever noticed that a family member becomes confused, irritable or restless as night falls? Or as the night progresses, they become agitated and pace throughout the house? This person could be showing signs of sundowning, a phenomenon commonly associated with Alzheimer’s disease and dementia.

Sundowning, or Sundown Syndrome, is the materialization of different symptoms that occur at a specific time of day. Symptoms present most commonly as the day changes from day to dusk, hence the name “sundowning.” Symptoms can vary and include restlessness, irritability, becoming disoriented or confused, pacing and mood swings.

While doctors are unsure of what causes sundowning, many think that someone’s internal body clock gets altered with the progression of Alzheimer’s and dementia. In people with Alzheimer’s, doctors know that the area of the brain that controls sleep patterns (waking up, falling asleep) deteriorates. This could also explain sundowning.

Though sundowning typically occurs late in the day, other “triggers” have been shown to cause symptoms. Lots of activity or noise and even nonverbal cues from another person can cause a shift in behavior.

Although sundowning can be frustrating for everyone involved, there are many ways to cope with and reduce the gravity of the symptoms:

  • Keep the house well-lit. Shadows can cause disorientation and can be frightening.
  • Maintain a sleep schedule and try to reduce daytime napping. Keeping a daily routine will emphasize sleeping at a certain time and will make it easier for he or she to sleep at night.
  • Avoid stimulants like caffeine.
  • Avoid alcohol, which can disrupt sleep patterns.
  • At night, try to stifle any background noise or stimulation that could be upsetting.
  • Maintain a familiar environment, which can be more soothing.
  • Try to avoid over-the-counter sleep aids and other medicines, such as Benadryl or Chlor-Trimeton, which cause drowsiness.
  • Research shows that a low dose of melatonin, a naturally occurring hormone that aids in sleeping, can be helpful. However, talk to a doctor before starting a melatonin regimen.

If a loved one is presenting with symptoms of sundowning, as a caregiver it is important to remain calm and not get flustered. Nonverbal indicators of frustration can further agitate an already irritated individual. Instead, approach your loved one calmly and reassure them that everything is okay. Ask if there is anything that he or she needs to be comfortable. If he or she needs to pace, let them do so but continue to supervise them. Try to avoid arguing at all costs, which could exacerbate the situation.

If you or someone you love is showing symptoms similar to sundowning, it could be a sign of Alzheimer’s disease. Sundowning usually presents during the middle phases of Alzheimer’s disease and goes away as the disease progresses. If you are concerned, contact your family doctor or neurologist.

Dr. Ronan Murphy

Dr. Ronan Murphy

 

 

Ronan Murphy is an assistant professor of neurology at the University of Kentucky Sanders-Brown Center on Aging.