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Carilion Section Chief Focuses on Study of Geriatrics

Aubrey Knight, MD, represents one of the benefits of having a medical school in Roanoke. He works as a section chief in geriatrics for Carilion Clinic and as an associate professor for the school.

“We consider ourselves partners with primary care physicians,” said Knight.

Anyone with a family member that has a form of dementia, such as Alzheimer’s, or suffers from the effects from stroke, can urge the patient’s regular doctor to call upon the expertise of Knight’s section.

Another benefit will take some years to come to fruition: an increase in the supply of geriatric physicians.

“There are not enough geriatricians to take care of our aging population,” said Knight, “so the ones we do have need to take a role in education, [as well as] in care by consulting.”

Many medical schools and residency programs have been preparing their students recently for an aging population. At the Virginia Tech Carilion medical school, “students will be exposed to cases from the beginning,” notes Knight. “There will be real cases and students will discuss them, asking questions such as how would you approach this and what could the diagnosis be and what would you do.”

The school, still under construction, can start admitting students and setting up classes because it has achieved preliminary accreditation, a necessary first step. A major fly in the geriatric ointment consists in the lack of treatments that work to stop dementia or reverse it.

“There are some medicines that show mild improvement in cognitive ability,” said Knight, “but we’re more focused now on keeping people as independent and safe as possible, and supporting the care givers.”

Knight believes more treatments will be available down the road: “there’s a lot of money being spent on research and lots of things on the horizon.” One example is an “exciting development” from a researcher who discovered how to detect Alzheimer’s in living patients. Before this work, only an autopsy could diagnose it.

The researcher is coming to the University of Virginia Medical School. Knight warned, however, that his diagnostic method requires a very costly cyclotron, so for now physicians must still rely on cognitive tests.

Knight’s own professional journey started at the University of Virginia Medical School, with a geriatric fellowship in Baltimore.

“I got interested in geriatrics as a family doctor because that’s an important component of what we do. And part of it is from my own comfort in dealing with older people. I spent my summers with my grandparents on their farm,” he said.

Knight filled the geriatric void in the practices where he worked, when others weren’t interested in that population. “Each year I’ve decreased my general medical practice so that now I do nothing but geriatrics.”

Knight concurs with data that shows it pays to stay engaged: “folks who have a higher degree of education or have engaged in mentally stimulating activities may have the same number of brain plaques and tangles [as people with Alzheimer’s do] but show no effects of dementia.”

In short, mental stimulation won’t necessarily prevent the disease – but may stave off the effects.

Alzheimer’s and dementia are diseases of aging, so the longer one lives the more likely dementia in some form may occur. The good news is that measures prudent people take to ward off heart disease can also help ward off brain diseases.

Only cancer is more feared, said Knight.  But temporary aphasia, such as occasionally forgetting a name, does not herald Alzheimer’s.

As Knight admitted, “I’ve never been good with names.”

For more information on Alzheimer’s and other brain diseases, and local resources, visit www.org/cwva.

By Priscilla Richardson
[email protected]

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