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Focus on David Carr, MD

David Carr, MD is an associate professor of medicine and neurology, and clinical director for the Division of Geriatrics and Nutritional Science. His areas of specialty include geriatric medicine and Alzheimer’s disease.

Dr. Carr evaluates patients at the Memory Diagnostic Center, 4488 Forest Park, Suite 160.

FOR AN APPOINTMENT, PLEASE PHONE 314 286-1967.

Dr. Carr is medical director at The Rehabilitation Institute of St. Louis (TRISL), which provides inpatient and outpatient rehabilitative care for patients with stroke, brain injury, spinal cord injury, amputations, deconditioning, orthopedic and other neurological conditions. For more information on the rehabilitation hospital, please call 314-658-3900.

Dr. Carr also provides primary dementia care at Parc Provence, a long term care facility, 605 Coeur De Ville Drive, Creve Coeur, MO. Call 314 542-2500 for information on the facility.

What led you to choose geriatrics as your specialty?

I volunteered as a certified nurse assistant (CNA) in a nursing home during my first two summers of college—while I was working on my undergraduate degree in chemistry. Back then we were called “orderlies.” I did a lot of hands-on physical care -- getting people out of bed, feeding during meals, changing their clothes, giving showers – so it was a very intimate, close contact experience with older adults. I was often told by the nursing staff and the administration --“You need to go on to medical school and become a doctor, because we can’t find doctors to come in to our nursing homes and take care of our patients.”

I enjoyed my geriatric rotation in medical school. Working in the nursing home really helped shape my desire to specialize in geriatrics. I can
Dr. David Carr and driving assessment patient
’t say I was born to be a geriatrician, but I quickly realized it was the place for me. I like working with older adults. It’s definitely more of a “care” than a “cure” field.

Unfortunately, we’re training fewer people to go into geriatrics now, than when I entered the field 20 years ago. Despite aging demographics, a lot of people just aren’t choosing this profession. It is job security for me, but it’s not what we want for the future of our aging society.

What brought you to Washington University?

Even though I considered an academic profession when I finished my geriatric fellowship at Duke University, my first position was with St. John’s Mercy Medical Center here in St. Louis, in their division of geriatrics. I was there for four years where I was able to take care of patients in a primary care practice and the nursing home, and teach students.

Because I enjoyed the research I did at Duke, I knew I wanted to be more involved in the science and research of aging. I eventually interviewed with Washington University and took a position here fifteen years ago, in 1994.

Which aspect of your practice do you find most interesting?

My dementia care practice is very interesting. I enjoy evaluating the variety of patients with memory loss -- from mild to moderate to advanced stages of dementia. I like making the diagnosis of the cause of dementia, prescribing the right medicines and educating the family members.

The Alzheimer’s disease and dementia research, along with my involvement in our driving assessment program, are all very satisfying. In the process I’ve become an Alzheimer’s specialist. I really have enjoyed my collaboration and mentorship with my colleagues in the Division of Geriatrics and the Alzheimer’s Disease Research Center.

Can you briefly explain your driving assessment program for older adults?

Washington University has partnered with The Rehabilitation Institute of St. Louis (TRISL) and Independent Drivers, LLC to offer a driving assessment program called Driving Connections. As we age, our physical and mental abilities may decline, affecting our skills behind the wheel of a vehicle. Because these changes can be so gradual, we might not be aware we are no longer a safe driver.

The program includes off-road testing and a 45-minute road evaluation in a car with dual brakes. It’s a thorough course that starts in a parking lot and builds its way through more dense traffic and complex driving situations. We believe it to be a reliable and objective measure for driving assessment.

Following the assessment, driving recommendations are provided to the patient, their family and doctor in a sensitive manner.

Most of us know someone affected by Alzheimer’s, are there any new developments that you are excited about?

We’re now into Phase 3 trials of several different drugs that appear to either block production or assist with the elimination of the amyloid protein, a compound we believe acts as a neurotoxin -- causing a lot of the brain damage which is a hallmark of this disease. We are working on two immunization studies, where we provide an antibody, which eliminates or helps clear the abnormal amounts of protein in the brain.

We also have other medicines, called gamma secretase inhibitors, that decrease the production of amyloid, and are working their way through Phase 3 clinical trials. I believe we’re going to know in the next year or two, whether these new drugs or new mechanisms are effective for the disease. It’s a very exciting time, so there is some cautious optimism in this field.

Where are you from?

I’m originally from Grand Rapids, Michigan. When I was seven, my father, who was in the insurance business, moved our family to St. Louis – so, I really consider St. Louis my home. Our family lived in South County and I attended Lindbergh High School. Go Flyers!

After going to medical school at University of Missouri, Columbia, I went back to the state of Michigan, and attended Michigan State for my internal medicine residency. Ironically, in the hospital ER during this time, I actually took care of some of my old neighbors from the neighborhood I grew up in!

Is there a particular award or achievement that is most gratifying?

I would say the greatest satisfaction for me at Washington University has been the growing relationships with my co-workers, the interdisciplinary teams with which I work, and my partnerships with The Rehabilitation Institute of St.Louis (TRISL) and Parc Provence. Over the last four years, we’ve developed a driving team that not only includes the Program of Occupational Therapy, but colleagues at St. Louis University and University of Missouri St. Louis. Plus, we have developed some regional, national and international contacts in this area. I think that is what is so fun about being in a niche area -- we have very focused mutual goals that we share with others and can achieve so much more when we work together as a team.
 
There are two other recent achievements of which I am very proud – I received one of the highest patient satisfaction ratings for the care provided in my dementia clinic. I was recognized along with about 40 other doctors in the Washington University system. I also recently received the Regional Medical Director Award from HealthSouth for my work as Medical Director at The Rehabilitation Institute of St. Louis. This was quite and honor to be recognized by my co-workers and colleagues, given there are approximately 25 facilities in our region.

What do you do when you’re not working?

I spend time with my wife – we enjoy roller blading and biking at Creve Coeur Lake and the Katy Trail. I’m in a little music group where I sing, play guitar and the harmonica (but not too loud). I also play tennis and basketball.

What is the best advice you have ever received?

The best advice I’ve been given was “not to sweat the small stuff”. I know it’s very simple and seemingly trite. But in academics, there are a lot of issues that have the potential to be stressful, and you just can’t change them. I’ve learned to let go and focus on what’s important. Thankfully, I have had wonderful support from my Division Chief Dr. Samuel Klein and Dr. John Morris in the Alzheimer’s Disease Research Center (ADRC), who have allowed me the flexibility to focus on those areas that bring me great satisfaction.

What do you recommend to your patients that would benefit their health?

There are four things I recommend -- I call them the four legs of the table that will hold you up across your lifespan.

Exercise is number one. There are studies that suggest regular physical activity can have positive effects on physical health, quality of life, and cognition. The activity that has been associated with some benefit may be as little as than 20 minutes of walking every day.

Cognitive and social stimulation are number two. There is simply not much stimulation if you stay home alone, be the coach potato, and watch TV. The brain is like a muscle – it needs to be used, stimulated, and pushed. Interacting with other people in social situations is crucial. It’s also important to keep your hobbies going – board games, puzzles, cards, playing a musical instrument, staying active in volunteer work a small business.

Nutrition is number three. A good heart healthy diet will probably also turn out be great for the brain. You should eat plenty of fruits and vegetables (natural antioxidants) every day and consume fish at least a couple of times a week.

Controlling risk factors for vascular disease is number four. We know the number one killer of the brain and heart is vascular disease or atherosclerosis. If you have high blood sugar, high cholesterol, or high blood pressure, you should see your family doctor for treatment, and keep those risk factors under control.

Finally, I’m convinced that high stress levels over the lifespan can have a very negative impact on our organ systems. So trying to keep stress under control is probably the 5th leg of the table. If you find a good way to do this, let me know…

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Copyright 2013 Washington University School of Medicine