Remote Alzheimer's Monitoring for Choctaw Nation

We have many, many users in Oklahoma. Everywhere, really. There is a guy in Oregon that lives on a mountain top in a cabin, above 7,000 feet. He has no phone. He has a propane generator and satellite internet access and a Skype account. What will we see tomorrow?

Doctors in UT Southwestern Medical Center's Alzheimer's Disease Center are using telemedicine for follow-up appointments with patients in the Choctaw Nation, an American Indian population in southeastern Oklahoma. The Alzheimer's Disease Center is the only one in the country studying the clinical and scientific aspects of dementia in the American Indians.

"After finding out that the Choctaw Nation had a video-conferencing setup, we thought this might be a better way to serve the population," said Dr. Myron Weiner, professor of psychiatry and neurology and a specialist in age-related dementia.
Dr. Weiner said this is the first time the Alzheimer's Disease Center at UT Southwestern has used telemedicine as a way of seeing patients for periodic checkups. It's also one of the first of 32 National Institutes of Health-funded Alzheimer's Disease Centers across the United States to use telemedicine.

The National Institute on Aging has funded research at UT Southwestern since 1991 - examining patterns of Alzheimer's disease and other forms of memory loss in American Indian populations. In one of these, patients are more than 200 miles away from their doctors.

"After the initial diagnosis is made, it is not necessary to have follow-up, face-to-face meetings with patients, which is why the telemedicine link has made it very efficient for us to track patients' progress. We think this is a model that other Alzheimer's Disease Centers could be able to use across the country," said Dr. Roger Rosenberg, director of UT Southwestern's Center, and holder of the Abe (Brunky), Morris and William Zale Distinguished Chair in Neurology.

UT Southwestern doctors visit Talihina, Okla., four times a year to diagnose any new cases of Alzheimer's-related memory loss or other types of dementia within the Choctaw community. Dr. Weiner first used the satellite link in January to see patients.

The health-care connection is made using equipment in Dallas linked to satellites located where patients in the Choctaw Nation live. Patients' family members bring them to one of the four Oklahoma locations including the primary memory disorders clinic in Talihina, Broken Bow, McAlester and Hugo.

"They can see me, and I can see them," Dr. Weiner said of the teleconference linkup. "We can assess any side effects of psychotropic medications and get an estimate of disease progression."

Dr. Weiner, who holds the Aradine S. Ard Chair in Brain Science and the Dorothy L. and John P. Harbin Chair in Alzheimer's Disease Research at UT Southwestern, also conducts interviews with patients' caregivers to assess the progression of memory loss or other neurological deficits. For people suffering from dementia or other memory disorders, shortening travel time for checkups is another positive outcome of telemedicine, Dr. Weiner said.

Because of the three-hour travel time to the Choctaw Nation Health Care Center in Talihina, Okla., it had not been possible for UT Southwestern staff to see as many new patients or to follow patients as closely as they would like. Telemedicine reduces doctors' travel time and increases convenience for Choctaw tribal members because satellite hookups are available at several locations in southeastern Oklahoma.

In 2004 UT Southwestern received a grant from the National Alzheimer's Association to look at cardiac risk factors affecting Alzheimer's Disease in the American Indian community. Telemedicine is another way of using existing technology to increase research capabilities and reach more people.

In addition, Dr. Weiner said, similar telemedicine setups could be used in any remote location, enabling doctors to better serve patients living in primarily rural areas.

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