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July 25, 2014

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Your brain in 10 years

Breakthroughs in cognitive health are coming, and Las Vegas researchers are behind the push

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If the dreams of doctors at the Cleveland Clinic Lou Ruvo Center for Brain Health come true, the brain will be at the top of people’s mind in 10 years.

We’ll wake up at dawn to hit the gym for an hour before packing up a healthy lunch and heading to work. We’ll make sure to get brain scans, even if we show no symptoms of disease, to check for toxic proteins that can fuel debilitating diseases such as Alzheimer’s. We’ll teach our kids about the brain and how important it is to maintain.

For the past five years, the minds at the Ruvo Center have been committed not only to treating illnesses such as Alzheimer’s disease, Huntington’s disease, Parkinson’s disease and multiple sclerosis but to researching their causes and cures. The end game? A world where fatal brain diseases no longer exist.

“Our goals are to deliver the highest quality of care to our patients and their families and to develop effective new therapies,” said Dr. Jeffrey Cummings, director of clinical trials. “We aspire to be the organization that defines how the best care is delivered and to be a model for others. We aim to transform clinical trials and drug development to bring more treatments to patients faster.”

CLINICAL TRIALS

It’s 2024, and you’re suffering from Alzheimer’s disease. Your doctor prescribes you a drug your grandfather used a decade ago to treat skin cancer.

Doctors today at the Ruvo Center are working to repurpose such drugs, the newest twist in the fight against Alzheimer’s.

Click to enlarge photo

The Cleveland Clinic Lou Ruvo Center for Brain Health.

Releasing a new medicine is a long and expensive process. From dreaming up a drug to testing it in clinical trials to getting it approved by the Food and Drug Administration, the process typically takes about 12 years and $2 billion.

The last new Alzheimer’s drug hit the market more than a decade ago in 2003.

So Ruvo researchers are taking a new route to speed things along: testing drugs approved by the FDA for other diseases to treat Alzheimer’s patients. One such trial focuses on a drug called bexarotene, which doctors until now have prescribed to treat skin cancer.

During a recent study on mice, scientists discovered the drug also removed proteins built up on the rodents’ brains.

Within days of taking bexarotene, the mice showed a substantial reduction in amyloid proteins. Before long, the mice showed improvements in cognition and behavior.

It was a light-bulb moment for doctors. Toxic amyloid proteins are the culprits in Alzheimer’s disease.

Led by Cummings and Dr. Kate Zhong, the center’s director of clinical research, the trial was the first time anyone experimented with bexarotene to treat Alzheimer’s.

If only the drug could have the same effect on human beings. That study is being conducted now.

Dubbed BEAT-AD, the eight-week study includes 20 patients with mild to moderate Alzheimer’s disease who will take bexarotene orally twice a day. Scientists will inject them with a radioactive compound called florberapir, a biomarker, to highlight and make glow red amyloid proteins during a brain scan.

Positive results would represent a major breakthrough in brain health. While oral medications and vaccines to control amyloid proteins are in development, a drug has never been able to eliminate the proteins altogether.

Bexarotene also is a perfect pitch because its dosing, side effects and manufacturing methods are established for treating skin lymphoma.

EARLY DETECTION

It’s 2024, and you’re in a doctor’s office receiving your regular brain checkup. The doctor asks: Do you want to know your chances of getting Alzheimer’s?

Those doctors of the future will most likely be able to provide that answer thanks to the work Ruvo researchers are doing today to identify a specific gene that often pops up in Alzheimer’s-prone patients.

Today, Alzheimer’s is virtually undetectable until sufferers began displaying symptoms. But the Ruvo Center’s doctors hope soon to uncover it in its earliest formation with a blood test.

One of the center’s research topics involves using a simple blood test to look for specific genes, or biomarkers, that predict a patient’s risk of Alzheimer’s. Doctors offer a similar test to detect Huntington’s disease, one of the few diseases for which such a test exists.

Researchers also are preparing to test an approved diabetes drug on patients predisposed to Alzheimer’s to see if it helps doctors detect the disease as it’s developing.

The five-year study focuses on the drug pioglitazone, which also could reduce brain inflammation.

The Ruvo Center hopes to use 120 people in the study; the Cleveland Clinic hopes eventually to include 5,800 patients worldwide.

Participants must be between 65 and 83 years old and can’t have any symptoms of memory impairment. They must get a blood test so scientists can see if they’re predisposed to developing Alzheimer’s disease. Low-risk subjects will get a placebo, while high-risk participants will get the drug.

A FIGHTING CHANCE

It’s 2024, and you’ve suffered a head injury. Will you be susceptible to Parkinson’s or other chronic diseases?

Today, that’s unclear. But Ruvo doctors are hard at work trying to understand how injuries affect the brain. Boxers are helping with the effort.

The Ruvo Center has spearheaded the Professional Fighters Brain Health Study, with a mission to answer questions such as: “Why does Muhammad Ali suffer from Parkinson’s disease, while George Foreman doesn’t?”

Over the past decade, head trauma has been a recurring headline. Aging, retired athletes who experienced repeated head trauma on the field or in the ring have been showing signs of neurocognitive diseases, such as Parkinson’s. Some fighters’ brains look astoundingly similar to Alzheimer’s patients’.

“The protein in a fighter’s brain is the same protein that occurs in Alzheimer’s,” Cummings said.

Doctors hope the Brain Health Study can detect pugilistic dementia, Alzheimer’s, Parkinson’s and other disease in fighters and help treat them. The four-year study could include as many as 625 people; more than 400 fighters have signed up since it began in 2011.

The center gives fighters free access to tests they need to get a fighting license. In return, the fighters return annually for MRI brain scans to measure connectivity, scarring and blood flow.

Research has connected a combatant’s fighting schedule to his brain health. The more fights on a boxer’s record, the greater loss of brain fibers and the more trouble with cognitive ability. Doctors have found using brain scans that veteran fighters often lack emotional self-control and are inclined to act more impulsively. Researchers also have found that some fighters exhibit changes in the volumes of their brains while others don’t.

And while doctors have connected brain health and head trauma, the implications of the findings are unclear.

Technology is helping the cause. Scientists have developed a mouthpiece that measures the impact of blows to a person’s head and an iPad application that measures a fighter’s balance.

CHAIR OF THE FUTURE

It’s 2024, and Alzheimer’s has all but taken your brain’s ability to store and retrieve memories. Thankfully, there’s a machine to help fix it.

That’s the future the Ruvo Center is working toward with a 15-week clinical trial using the neuroAD chair. Designed and invented by Israeli company Neuronix, the device looks like a science fiction dentist’s chair. The company claims the neuroAD chair can restore an Alzheimer’s patient’s cognitive ability to what it was two years earlier.

The chair is equipped with a computer that uses magnets to stimulate the brain, zapping it with electromagnetic energy. Patients perform computer-based tasks, such as matching a series of shapes or identifying missing words from a sentence, to gauge their cognition.

Successful testing of the device at the Ruvo Center is one of the first steps to getting the neuroAD chair mass produced.

EDUCATION

It’s 2024, and your 5-year-old comes home from kindergarten explaining all that she learned about the brain – that it is involved in everything the human body does, from breathing to climbing stairs to processing food for energy. And to your surprise, she wants vegetables – brain food – for a snack instead of sweets.

Today, staff at the Ruvo Center are trying to spark an interest in brain health and research so that it becomes a part of Las Vegans’ consciousness.

How do you teach a kindergartner about something as complicated as the brain?

“You tell them it’s your brain that tells you how to throw a ball,” said Dr. Dylan Wint, the center’s director of education.

Wint’s mission is to inspire professionals, from lawyers practicing medical ethics to neurosurgeons performing complex operations, to contribute to advancing brain science. His campaign starts with education – and partnerships with schools such as UNLV, the University of Nevada School of Medicine, Touro University Nevada and Valley Hospital. The Clark County School District, for instance, sends K-12 students on field trips to the Ruvo Center. Students from Bishop Gorman High School can complete 100-hour internships.

The idea is to teach children and young adults about the connection between a person’s body and mind and the importance of living and eating well to preserve brain health.

But the center’s main focus is internships with older students from college campuses across the country. They get to work with neurologists, psychologists, physical therapists, social workers and brain imaging specialists.

“It’s a reality classroom,” said Susan Ferris, the center’s education coordinator.

Wint and Ferris work with 75 students every year. Ask how the duo pitch the Ruvo Center to students, and the answer might surprise you: They don’t.

The Ruvo’s Center’s reputation precedes itself. Its internship program is booked until 2016.

    • Brain foods

      Think of your body as a machine: Your brain is the engine, and your stomach is the fuel tank. You can’t use bad fuel if you want your engine to run well. Doctors and scientists have spent centuries stressing the importance of a well-balanced diet, and they’ve learned that antioxidants in foods help fight oxidation in the brain. Oxidation is what happens when handlebars rust and half-eaten apples turn brown. No one wants their brain to look that way. So what can you eat to stay sharp? Here are some suggestions from the Ruvo Center:

      Fish: Omega-3 fatty acid is good for your brain, but your body doesn’t produce it. Eat 5 ounces of fish twice a week to get your needed dose. Salmon, cod, haddock, halibut or tuna all provide a boost. Vegetarian? Choose walnuts, flaxseed or soybeans.

      Red wine: In moderation, resveratrol found in red wine can reduce damage to cells caused by aging and protect the brain from amyloid plaques that led to Alzheimer’s. Doctors recommend a glass a day for women and no more than two for men.

      Coffee and tea: Studies have shown that coffee improves memory and decreases a person’s chance for dementia. Doctors recommend up to three cups of black coffee a day. Tea also includes powerful antioxidants.

      Dark chocolate: The tasty treat not only packs flavor but flavonoids, some of the strongest antioxidants around. Flavonoids help blood flow to the brain and reduce inflammation.

      Eggs: Eggs help make your memory stronger. The vitamin B, D and E in the yolk also keeps cholesterol in check.

      Herbs and spices: Flavor enhancers such as turmeric, cinnamon and ginger have antioxidant powers that reduce inflammation of the brain.

      Vegetables: The greener and leafier, the better. That means kale, spinach and broccoli, which are rich in nutrients the brain loves.

      Fruits: Blueberries, raspberries and blackberries also are loaded with antioxidants, which slow down the aging of the brain.

    • Take care of your body

      It’s important to treat your body like a machine. That means proper food and exercise to keep it running at its best. Here are some factors that could lead to Alzheimer’s or dementia.

      Hypertension: High blood pressure puts stress on the brain.

      Solution: Stay active, cut sodium intake and keep weight down.



      Obesity: People with weight problems have a higher risk of developing diabetes, which can lead to dementia.

      Solution: Eat more fiber and protein, exercise at least 30 minutes five times a week and avoid white sugar, flour and saturated fat.



      High cholesterol: High cholesterol also contributes to a higher risk of dementia.

      Solution: Take medications prescribed by your doctor, exercise and eat healthy.



      Depression: Doctors say depression makes a person more likely to develop Alzheimer’s disease.

      Solution: Strive for an active, social life.



      Head injuries: Scientists have proven there’s a connection between brain injury and developing dementia and Alzheimer’s.

      Solution: Wear a seat belt while driving and helmet while playing sports.



      Smoking: Smokers are twice as likely to develop Alzheimer’s as nonsmokers.

      Solution: Join a support group and quit smoking.

    • Alzheimer's disease

      A progressive and fatal brain disease that affects memory and emotions.

      Scope: More than 5 million Americans suffer from the disease. By 2050, scientists expect more than 100 million people will have the disease worldwide.

      Symptoms:

      • Memory loss

      • Personality and behavior changes

      • Poor judgment

      • Language problems

      • Difficulty perceiving spatial relationships

      • Losing one’s way

      Treatment: Oral medications and vaccines are being developed to try to control the spread of toxic proteins, but no prescription drug so far has been effective.

      Source: Cleveland Clinic Lou Ruvo Center for Brain Health

    • Dementia

      Alzheimer’s is the most common cause of dementia, but there are other causes as well.

      Causes:

      • Kidney or liver disease

      • B12 deficiency

      • Thyroid problems

      • Allergic reactions to medication

      • Drug or alcohol abuse

      • Psychiatric disorder

      Stages of Alzheimer’s disease:

      • Mild: Daily function begins to be impaired.

      • Moderate: Severe impairment of memory, thinking, behavior and speech.

      • Severe: Difficulty walking, incontinence.

      How to protect yourself from the disease:

      • Mental activity

      • Physical activity

      • Healthy diet with antioxidants

      Source: Cleveland Clinic Lou Ruvo Center for Brain Health

    • Multiple sclerosis

      A disease of the central nervous system, MS causes the body’s immune system to attack myelin, the fatty substance that protects the brain’s nerve fibers, spinal cord and eyes, while scar tissue impairs nerve signals. MS isn’t fatal but can cause severe disability.

      Symptoms:

      • Extreme fatigue

      • Numbness and tingling

      • Weakness

      • Difficulty walking

      • Poor coordination

      • Impaired vision

      • Slurred speech

      • Tremors

      • Stiffness

      • Bladder problems

      • Blindness

      • Paralysis

      • Confusion

      How to detect MS: Doctors typically diagnose patients with MS between ages 20 and 50. The majority of people who suffer from MS are women.

      Types:

      • Relapsing-remitting: The disease flares (relapses), then disappears (remission).

      • Primary-progressive: The disease worsens over time. There are no effective medications.

      • Secondary-progressive: Remissions stop, and the disease worsens.

      • Progressive-relapsing: The diseases worsens between relapses.

      Treatment: Medications are available for some types of MS but not all.

      Source: Cleveland Clinic Lou Ruvo Center for Brain Health

    • Parkinson's disease

      A neurological disorder that impacts nerve cells, or neurons, affecting movement and mood.

      Causes: Unknown, but scientists believe genetics may play a role. Exposure to herbicides and pesticides also could increase susceptibility. Risk increases with age, and the disease is likely to start in mid-life.

      Treatment: Patients can take medication to reduce tremors.

      Symptoms:

      • Tremors or shaking in hand, leg or other body part

      • Slowness of movement

      • Muscle stiffness

      • Difficulties with balance and coordination

      • Depression and anxiety

      • Difficulty chewing or swallowing

      • Cramped handwriting

      • Urinary problems and constipation

      • Trouble sleeping

      Source: Cleveland Clinic Lou Ruvo Center for Brain Health

    • Huntington's disease

      Causes unsteady and uncontrollable movements in hands, feet and face, making walking, talking and swallowing difficult. Mental illness also can stem from this disease.

      Symptoms:

      • Muscular twitching

      • Clumsiness

      • Irritability and mood swings

      • Depression

      • Anger

      • Memory loss

      Causes: Huntington’s is an inherited disease. A child inherits a mutated gene from a parent.

      Source: Cleveland Clinic Lou Ruvo Center for Brain Health

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