Minneapolis VA Health Care System
GRECC Clinical and Education Programs
The Geriatric Research, Education and Clinical Center (GRECC) Clinical Program seeks to distinguish, define, and disseminate the best ways to identify and treat dementia. We manage a clinical service, conduct clinical studies, and train other health care professionals in geriatric-focused medicine and research. The clinical staff includes three neurologists, including one behavioral neurologist; three internists, including one geriatrician; a social worker, and an occupational therapist. Affiliated staff includes geriatricians, neuropsychologists, and geriatric clinical pharmacists.
Memory Clinic - GRECC operates a half-day clinic on Thursdays, evaluating patients referred from Primary Care. GRECC uses a multi-disciplinary approach to patient care, so each new patient is seen by a physician and pharmacist, and, if needed, a social worker and occupational therapist.
The entire appointment lasts about two hours. The physician takes a medical history and performs an exam focusing on memory and mental ability. The pharmacist reviews the patient's medications and makes recommendations if medication concerns are noted. The social worker discusses the home environment with the patient and caregiver to determine personal safety, family functioning and coping skills, and makes referrals to community agencies if needed. The occupational therapist assesses the patient’s needs for assistance with everyday tasks.
For the new patient, a typical treatment plan includes these sessions, as well as brain MRI and possibly neuropsychological testing. Patients are referred to an Occupational Therapy driving evaluation if there is concern about driving safety. Since GRECC is a specialty clinic, patients with other medical problems are referred to the appropriate service within the VA or to their private physician.
Occupational Therapy Clinic - In this clinic, Veterans are evaluated with the Cognitive Performance Test (CPT), a standardized assessment that measures cognition associated with daily living activities. The CPT uses seven common tasks (Medbox, Shop, Wash, Toast, Phone, Dress and Travel), where the information-processing demands are systematically varied to assess functional capacity levels. CPT scores predict capacity for managing medications, meals, finances, driving, and independent living. Caregivers observe the assessment to educate themselves about their loved one's capabilities and needs.
Family Meeting Clinic - Once a work-up has been completed, GRECC staff review the results at a multidisciplinary consensus diagnosis conference. After a consensus diagnosis is made, a meeting is scheduled to discuss the diagnosis and next steps with the patient and family. The patient's physician and social worker attend the meeting to answer any questions raised by the Veteran or family.
Service Connected Clinic - Since the GRECC Clinic operates just one day a week, an intermittent clinic is offered to enable service-connected Veterans to be seen within the 30 day window prescribed by the VA. Physicians from GRECC staff the clinic; other appointments are made to ensure that Veterans are seen by GRECC affiliates including Pharmacy, Social Work, Occupational Therapy and Psychometry.
Research Clinic - GRECC conducts clinical research studies and appropriate patients may be invited to participate. Participation is not a requirement for treatment in GRECC; study participation is strictly voluntary. It is our hope that GRECC research will help Veterans and their families assist us in educating other health care professionals about memory loss and its treatments. Contact Margaret Miller at 612-467-3345 if you would like more information about research studies that involving Veterans. For aging-related research studies for non-veterans, contact the Alzheimer's Association at www.alz.org/research/clinical_trials/find_clinical_trials_trialmatch.asp
The GRECC clinic offers training opportunities for fellows, residents, and allied health trainees. A cognitive disorders rotation for neurology residents provides clinical contact in several memory clinics, as well as experiences with palliative care, adult day health care, and behavioral neurology. Another rotation for internal medicine residents connects trainees with the CLC, spinal cord injury, and palliative care clinics.