Summary: Deep brain stimulation to the frontal lobe may help to improve cognitive, behavioral and functional difficulties in those with Alzheimer’s disease, a new study reports.
Source: Ohio State University.
While most treatments for Alzheimer’s disease focus on improving memory, researchers at The Ohio State University Wexner Medical Center conducted a study aimed at slowing the decline of problem-solving and decision-making skills in these patients.
For the first time ever, thin electrical wires were surgically implanted into the frontal lobes of the brains of patients with Alzheimer’s disease to determine if using a brain pacemaker could improve cognitive, behavioral, and functional abilities in patients with this form of dementia.
The deep brain stimulation (DBS) implant is similar to a cardiac pacemaker device, except that the pacemaker wires are implanted in the brain rather than the heart.
Findings of the study are published online in the Journal of Alzheimer’s Disease.
“We have many memory aides, tools and pharmaceutical treatments to help Alzheimer’s patients with memory, but we don’t have anything to help with improving their judgments, making good decisions, or increasing their ability to selectively focus attention on the task at hand and avoid distractions. These skills are necessary in performing daily tasks such as making the bed, choosing what to eat and having meaningful socializing with friends and family,” said Dr. Douglas Scharre, co-author of the study and director of the Division of Cognitive Neurology at Ohio State’s Wexner Medical Center’s Neurological Institute.
“The frontal lobes are responsible for our abilities to solve problems, organize and plan, and utilize good judgments. By stimulating this region of the brain, the Alzheimer’s subjects cognitive and daily functional abilities as a whole declined more slowly than Alzheimer’s patients in a matched comparison group not being treated with DBS,” he said.
The pilot study found that DBS targeting frontal brain regions can reduce the overall performance decline typically seen in people with mild or early stage Alzheimer’s, Scharre said.
Scharre is a neurologist who focuses on treating patients with Alzheimer’s and other dementias. He collaborated with Dr. Ali Rezai, a neurosurgeon who specializes in neuromodulation, to conduct this clinical trial.
“This same technology has been successfully used to treat more than 135,000 patients worldwide with Parkinson’s disease. Our findings suggest that frontal network modulation to improve executive and behavioral deficits should be further studied in patients with Alzheimer’s disease,” said Rezai, the former director of Ohio State’s Neurological Institute who is now leading the Rockefeller Neuroscience Institute at West Virginia University.
All three study participants showed improvement, including LaVonne Moore, 85, of Delaware, Ohio. When she entered the study in 2013, she was not doing any meal preparation. After two years of deep-brain stimulation, she could independently initiate preparations of a simple meal, assemble ingredients and cook the meal.
She was able to organize an outing, including arranging transportation and destination, planning for the weather and bringing the needed money. She also regained independence to select her clothing attire, researchers noted.
Her 89-year-old husband, Tom Moore, said her Alzheimer’s disease has progressed, but more slowly than he expected. “LaVonne has had Alzheimer’s disease longer than anybody I know, and that sounds negative, but it’s really a positive thing because it shows that we’re doing something right,” Moore said. She didn’t hesitate to volunteer for the study, he added.
He said she told him: “I will do anything to help others not go through what I’m going through.”
Next, Ohio State researchers want to explore non-surgical methods to stimulate the frontal lobe, which would be a less invasive treatment option to slow down the symptoms of Alzheimer’s disease.
Alzheimer’s disease is the most common form of degenerative dementia, affecting more than 5 million Americans. By 2050, this number could rise as high as 16 million, according to the Alzheimer’s Association.
The disease – which has no cure and is not easily managed – becomes progressively disabling with loss of memory, cognition and worsening behavioral function, in addition to a gradual loss of independent functioning, Scharre said.
Funding: Funding for this study was provided by The Ohio State University Center for Neuromodulation, the Wright Center of Innovation in Biomedical Imaging, OTF-TECH-11-044 and philanthropic donations.
Other Ohio State researchers involved in this study include Emily Weichart, Dylan Nielson, Jun Zhang, Punit Agrawal, Per B. Sederberg and Michael V. Knopp. The authors have no conflicts of interest to report except Rezai, who declares that a patent (US 8,538,536) was issued.
Source: Drew Schaar – Ohio State University
Publisher: Organized by NeuroscienceNews.com.
Image Source: NeuroscienceNews.com image is credited to The Ohio State University Wexner Medical Center.
Video Source: Video credited to OSU.
Original Research: Abstract in Journal of Alzheimer’s Disease.
Deep Brain Stimulation of Frontal Lobe Networks to Treat Alzheimer’s Disease
The study objective was to evaluate the safety and efficacy of deep brain stimulation (DBS) at the ventral capsule/ventral striatum (VC/VS) region to specifically modulate frontal lobe behavioral and cognitive networks as a novel treatment approach for Alzheimer’s disease (AD) patients. This is a non-randomized phase I prospective open label interventional trial of three subjects with matched comparison groups. AD participants given DBS for at least 18 months at the VC/VS target were compared on the Clinical Dementia Rating–Sum of Boxes (CDR-SB), our primary outcome clinical measure, to matched groups without DBS from the AD Neuroimaging Initiative (ADNI) cohort. Serial 2-Deoxy-2-[18F]fluoro-D-glucose (FDG) positron emission tomography (PET) images of AD participants were also compared longitudinally over time. Three AD DBS participants were matched to subjects from the ADNI cohort. All participants tolerated DBS well without significant adverse events. All three AD DBS participants had less performance decline and two of them meaningfully less decline over time on our primary outcome measure, CDR-SB, relative to matched comparison groups from the ADNI using score trajectory slopes. Minimal changes or increased metabolism on FDG-PET were seen in frontal cortical regions after chronic DBS at the VC/VS target. The first use of DBS in AD at a frontal lobe behavior regulation target (VC/VS) was well-tolerated and revealed less performance decline in CDR-SB. Frontal network modulation to improve executive and behavioral deficits should be furthered studied in AD.