Faculty Bibliography

In February 1996, George Shultz went to visit his old boss, Ronald Reagan, at the former president's home in the Bel Air neighborhood of Los Angeles. He drank tea with Reagan and his wife, Nancy, and talked a little politics. In all, he stayed perhaps an hour. At one point in the visit, Reagan had left the room briefly with a nurse. When they came back, Mrs. Reagan went on, 'he said to the nurse: `Who is that man sitting with Nancy on the couch? I know him. He is a very famous man.' ' Reagan 'absolutely' did not 'show any signs of dementia or Alzheimer's,' said Dr. John Hutton, who cared for him from 1984 until the end of his presidency and remains a close family friend. Extensive mental status tests did not indicate evidence of Alzheimer's until 1993, more than four years after Reagan left office, Hutton said. Even in hindsight, Reagan's friends and former aides said that they, too, had seen no hint of the deterioration to come. And while they acknowledged that he had occasional memory lapses as president, especially when it came to names, many said he had had these problems for years, certainly since he was governor of California, from 1967 to 1975. Reagan is believed to be the first president or former president to have Alzheimer's. But the disease -- a form of dementia, or senility, that strikes with increasing frequency as people advance beyond their 60s -- is a growing public health problem in an aging society

IN FEBRUARY 1996, George Shultz went to visit his old boss, Ronald Reagan, at the former president's home in the Bel Air neighborhood of Los Angeles. That night Shultz, the former secretary of state, received a call from Mrs. Reagan, who told him that 'something poignant happened today that you would like to know about.' At one point in the visit, Reagan had left the room briefly with a nurse. When they came back, Mrs. Reagan went on, 'he said to the nurse: `Who is that man sitting with Nancy on the couch? I know him. He is a very famous man.' '

He drank tea with Reagan and his wife, Nancy, and talked a little politics. In all, he stayed perhaps an hour. At one point in the visit, Reagan had left the room briefly with a nurse. When they came back, Nancy Reagan went on, 'he said to the nurse: `Who is that man sitting with Nancy on the couch? I know him. He is a very famous man.' ' It has been almost three years since Reagan disclosed that he had the memory-destroying neurological illness known as Alzheimer's disease. And if, at age 86, the former actor still looks the image of vigorous good health, the truth is that the man behind the firm handshake and barely gray hair is steadily, surely ebbing away

In February 1996, George Shultz went to visit his old boss, Ronald Reagan, at the former president's home in the Bel Air neighborhood of Los Angeles. He drank tea with Reagan and his wife, Nancy, talked a little politics, then left. That night Shultz, the former secretary of State, received a call from Mrs. Reagan, who told him that 'something poignant happened today that you would like to know about.' At one point in the visit, Reagan had left the room briefly with a nurse. When they came back, Mrs. Reagan went on, 'he said to the nurse: `Who is that man sitting with Nancy on the couch? I know him. He is a very famous man.' '

In February 1996, George Shultz went to visit his old boss, Ronald Reagan, at the former president's home in the Bel Air neighborhood of Los Angeles. He drank tea with Reagan and his wife, Nancy [Reagan], and talked a little politics. In all, he stayed about an hour. Just when the Alzheimer's began can never be known. But though the line between mere forgetfulness and the beginning of Alzheimer's can be fuzzy, a matter of gradation, Reagan's four main White House doctors say they saw no evidence that he had crossed it as president. They saw and spoke with him daily in the White House, they said, and beyond the natural failings of age, never found his memory, reasoning or judgment to be significantly impaired. Reagan 'absolutely' did not 'show any signs of dementia or Alzheimer's,' said Dr. John Hutton, who cared for him from 1984 until the end of his presidency and remains a close family friend. Extensive mental status tests did not indicate evidence of Alzheimer's until 1993, more than four years after Reagan left office, Hutton said

When former President Reagan disclosed in November 1994 that he had Alzheimer's disease, many people could not help suspecting that the illness had begun to rob him of memory while he was in the White House. 'There was never anything that would raise a question about his ability to function as president,' said Dr. Lawrence C. Mohr, one of Reagan's physicians in his second term. 'Ronald Reagan's cognitive function, belief structure, judgment, ability to choose between options, behavior and ability to communicate were totally and completely intact.' Dr. John Hutton, the chief White House physician during Reagan's last two years in office and a close family friend, said he was speaking out with the permission of the former president's wife, Nancy, chiefly to rebut published statements questioning Reagan's mental status in office

At one point in the visit, Reagan had left the room briefly with a nurse. When they came back, Nancy Reagan went on, ``he said to the nurse: `Who is that man sitting with Nancy on the couch? I know him. He is a very famous man.''' It has been almost three years since Reagan disclosed that he had the memory-destroying neurological illness known as Alzheimer's disease. If, at 86, the old movie actor still looks the image of vigorous good health, the truth is that the man behind the firm handshake and barely gray hair is steadily, surely ebbing away. Reagan still plays a little golf, works out lightly in his basement and walks amid eucalyptus and day lilies in parks close to home. He puts on a suit and is driven to his office in nearby Century City. As he rides the elevators or walks the corridors, he remains the perfect gentleman, sweeping a hand through the air to let a woman pass by. Well-wishers are ushered into the office, and the 40th president of the United States obliges them with a warm welcome and a photo op

OBJECTIVE: To characterize the susceptibility to levofloxacin of clinical isolates of Mycobacterium tuberculosis (MTB) obtained from patients with HIV-related tuberculosis and to characterize the molecular genetics of levofloxacin resistance. DESIGN AND METHODS: Isolates from culture-positive patients in a United States multicenter trial of HIV-related TB were tested for susceptibility to levofloxacin by minimum inhibitory concentration (MIC) determinations in Bactec 7H12 broth. Automated sequencing of the resistance determining region of gyrA was performed. RESULTS: Of the 135 baseline MTB isolates tested, 134 (99%; 95% exact binomial confidence interval, 95.9-99.9%) were susceptible to levofloxacin with an MIC < or = 1.0 microg/ml. We identified a previously unrecognized mis-sense mutation occurring at codon 88 of gyrA in a levofloxacin mono-resistant MTB isolate obtained from a patient with AIDS who had received ofloxacin for 8 months prior to the diagnosis of tuberculosis. CONCLUSIONS: Clinical MTB isolates from HIV-infected patients were generally susceptible to levofloxacin. However, the identification of a clinical isolate with mono-resistance to levofloxacin highlights the need for circumspection in the use of fluoroquinolones in the setting of potential HIV-related tuberculosis and for monitoring of rates of resistance of MTB isolates to fluoroquinolones

By 1998, a Medicare prospective payment system for home care is expected to be in place. Physicians must become more involved in home care, because they will be held accountable for the patients they refer and the services they order.