Sierra Pacific (VISN 21) MIRECC - MIRECC / CoE
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Sierra Pacific (VISN 21) MIRECC

Education
Education Overview

Education and Dissemination provides the most current information related to dementia and PTSD and evidenced-based practices. The goals are:

  1. to disseminate the latest evidence-based practices and peer-reviewed research to Veterans, family members and clinicians,
  2. to address the education needs of VA clinicians in VISN 21, and
  3. to support the VA Office of Mental Health in the national implementation of evidence-based practices.

 

Dementia

PTSD

TMS

Psychotherapy

Dementia

Dementia Education Overview 

Tau PET image

Contacts

Director: Allyson Rosen, Ph.D., ABPP-CN

Other Educators: Sherry Beaudreau, Ph.D. ABPP

What is the Alzheimer's Neuroimaging Initiative (ADNI)?

The Alzheimer’s Disease Neuroimaging Initiative (ADNI) is a longitudinal multicenter study designed to develop clinical, imaging, genetic, and biochemical biomarkers for the early detection and tracking of Alzheimer’s disease (AD).

How could we use this information clinically?

This information is already being used to study therapies to treat Alzheimer’s disease.  Whereas clinicians have frameworks for diagnosing Alzheimer’s disease (i.e. DSM 5, ICD 10, Consensus Guidelines) they rarely use Alzheimer’s biomarkers and genetics. We believe this information will be used to improve the accuracy of diagnosis.

Ongoing Community Outreach

Advisory Group on Risk Evidence Education for Dementia (AGREEDementia.com)
ADNI revealed some brain changes leading to dementia begin decade before symptoms and there are now brain scans and blood tests as well as treatments clinically available in part due to ADNI. AGREEDementia is a collaboration with Stanford’s Alzheimer’s Disease Research Center and is national partnership between scientists, clinicians and the community to help people learn about this dementia risk information and help guide how it is used and shared. We meet monthly and there are lectures.
Contact: Allyson Rosen

Geriatric Education Rounds:
An ongoing lecture series with faculty and internationally recognized presenters and collaboration with Stanford’s Department of Psychiatry and Behavioral Sciences.
Contact: Sherry Beaudreau

Hospital Dementia Committee
The Dementia Committee is an inter-professional committee which increases awareness of issues related to dementias, and promotes collaborative efforts regarding clinical activities, education, and research activities in this area. The committee reports to the Medical Executive Committee (MEC) and the VISN Dementia Committee.
Palo Alto VA contact: Allyson Rosen, Dat Hoang-Gia (GRECC Partner)
Request a Presentation

Annual Updates on Dementia
For more than 20 years, we have provided continuing education on the latest developments in dementia diagnosis and care in partnership with the Alzheimer’s Association, GRECC, Family Caregiver Alliance, the Ombudsman of Santa Clara, and the Stanford Alzheimer’s Disease Center among others.
Coming May 12,2022 Virtually
Contact: Allyson Rosen

Major Initiatives Supporting Research Cores

Implementation: Improving Brain Stimulation with Imaging (IBSI)
Repetitive pulse TMS (rTMS) is a major focus of our center and an important therapy that enhances brain functioning. Our center applies it to dementia and mild cognitive impairment. Unfortunately, most clinical rTMS clinics do have access to MRI’s and hence use scalp landmarks to direct rTMS therapy to a selective brain region. This program applies multi-site fMRI to study variations in brain targeting which relates this information to clinical outcome.
Contact: Allyson Rosen

Protecting Progress: Ethics Review Description and Publications
As innovations in dementia develop, there are often concerns about how they are best applied.  Ethics review focuses on solutions to barriers to implementation through work with the Journal of Alzheimer’s Disease. Learn more

Epidemiology: Aging Women Veterans
The Women’s Health Initiative represents a large, longitudinally studied, group of women Veterans and civilians who participated in a study of hormone replacement. The group is special because they have been very carefully described in terms of their health and cognition. The attached link has multiple papers describing how older women Veterans have different outcomes from civilians as they both age. Contact: Julie Weitlauf
Learn more

Preventing Dementia: Exercise
Exercise supports brain health in many ways. This research program involves exercise to improve cognitive functioning.
Contact: Kaci Fairchild

Preventing Dementia: Reducing Substance Use
Smoking and use of alcohol and other substances can reduce brain integrity. This research program focuses on study of how to reduce use to avoid brain degeneration.

Products

Amyloid PET Decision Tool to support informed decisions about whether to learn brain amyloid
Geriatric Depression Scale (GDS)
Receiver Operator Characteristics (ROCS)

Collaborating Organizations
Center for Imaging of Neurodegenerative Diseases
Stanford Alzheimer’s Disease Research Center (ADRC)
Stanford VA Alzheimer’s Center
Geriatric Research Education and Clinical Center (GRECC) Palo Alto
GRECC Geri Scholars

 

PTSD

PTSD Education Overview

Contacts

Director: Leanne Williams, PhD

Other Educators:Joseph Ruzek, PhD, Julie Weitlauf, PhD

What is PTSD?

Posttraumatic stress disorder (PTSD) can occur after someone goes through a traumatic event like combat, assault, or disaster. Most people have some stress reactions after a trauma. If the reactions don't go away over time or disrupt your life, you may have PTSD.

Additional patient information

Dissemination of Best Practices

We provide webinars and talks as needed on topics of relevance to our community of clinical professionals and Veterans. We hold an annual “Updates on PTSD” webinar conference. This webinar also incorporates emerging topics of relevant to clinical professionals and Veterans, including precision medicine and implementing approaches for improving outcomes for PTSD and comorbid disorders. To ensure cutting-edge information is disseminated widely beyond the day of the webinar itself we host a video of the webinar online whenever possible. We partner with educators at Stanford University and the University of California San Francisco in order to provide the highest quality education and insights.

Supplementing these webinars are more specialized presentations on topics initiated by VA health professionals and educators or by our community. For example, throughout 2020 through to the present we have hosted a case series focused on novel therapeutics such as transcranial magnetic stimulation for PTSD and related disorders such as major depressive disorders.

Links for webinars, presentations and materials they refer to are provided below:
2021
2020

Major Resource

Our major resource for integrated information for the public and for professionals is the National Center for PTSD. http://www.ptsd.va.gov

Ongoing Community Outreach

Learn more

Major Initiatives Supporting Research Cores

In support of the clinical dissemination of research, we are developing a new program focused on precision medicine approaches for PTSD and comorbid disorders in Veterans. Under this new program, we address the goals of the “Precision Medicine for Veterans Initiative”, as outlined in the Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019. We are using functional brain imaging, electroencephalogram, and behavioral clinical measures to develop innovative diagnostics that identify which Veterans will benefit most from different therapeutic options. We also develop the clinical translational understanding of innovative interventions spanning TMS, ketamine, and exploratory therapeutics. This initiative is anchored in the understanding of brain circuits and cognitive functions and the daily functions they implicate. The goal is to tailor recovery in a more precise way based on the capacity and needs of each Veteran, to optimize daily social and vocational function, and minimize disability and risk for suicide.

TMS

TMS Education Overview

Click  the map for specific clinic contact information.

Contacts

Please contact the Director of the National Clinical rTMS Program, Michelle Madore, PhD, Clinical Neuropsychologist: Michelle.Madore@va.gov or Program Specialist L. Chauncey Green: Laroman.Green@va.gov

Others Providing TMS Education: Mark George, MD, Allyson Rosen, Ph.D., ABPP-CN

What is transcranial magnetic stimulation (TMS)?

TMS is a clinical tool used to change activity in the brain without drugs. TMS therapy works by placing a special coil on the head that delivers magnetic pulses which, over several sessions, cause those stimulated regions to function better. A great description of TMS may be found on the NIMH website here.

Additional patient information

Dissemination

The National Pilot Program is a Mental Health Funded pilot project which began in FY 2017 to expand access to TMS. The effort is based upon the work of Dr. Yesavage as PI of Co-operative Study (CSP 556) in treatment resistant major depression disorder (TRMDD) in Veterans. rTMS is FDA approved for treatment resistant major depressive disorder. This effort focuses on starting TMS clinics in the VA and includes purchase of rTMS equipment, assisting in staff training, aiding in developing VA documentation including credentialing and hospital center memoranda, clinical consultation, and evaluation of national Veteran response to TMS Therapy.

Program Goals

  • Open and Support TMS Clinics in the VA
  • Coordinate Purchasing TMS Machines through a National Bidding Process
  • Educate TMS Prescribers and Operators
  • Evaluate Veteran response to TMS through Outcome Data Collection as part of Program Evaluation
  • Provide Ongoing Continuing Education
  • Assist with Credentialing and Administrative Set-up
  • Develop Model Memoranda and Procedures


Products and Education

TMS studies references list

Information for VA Professionals (VA Intranet only)

Lecture on rTMS basics

Past Continuing Education Webinars

Psychotherapy

Psychotherapy Education Overview

Contacts

Edward Wakabayashi

Dissemination

About the Dissemination. MHS has continued to disseminate Acceptance & Commitment Therapy (ACT) for Depression, Cognitive Behavioral Therapy for Depression, (CBT-D), and Cognitive Behavioral Therapy for Insomnia (CBT-I) in VHA. VISN 21 MIRECC works as local coordinator with MHS to implement these programs offered to VA clinicians nationwide. Over 2000 VA clinicians have attended in-person trainings for these initiatives.

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