Alzheimer's disease is the most common form of degenerative dementia, affecting more than five 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.

Ohio State Wexner Medical Center's Douglas Scharre, MD, a neurologist who focuses on treating patients with Alzheimer's and other dementias, recently published results from a clinical trial that explored ways to slow the decline of problem-solving and decision-making skills in patients with Alzheimer's disease.

As part of this study, Dr. Scharre partnered with Ali Rezai, MD, a neurosurgeon who specializes in deep brain stimulation, to surgically implant thin electrical wires into the frontal lobes of the brains of patients to determine if using a brain pacemaker could improve cognitive, behavioral and functional abilities. The deep brain stimulation (DBS) pacemaker wires were implanted in specific regions of the brain. This is the first use of DBS in Alzheimer's disease in a behavioral regulation brain region target.

The medical center's strategic plan includes a goal to pioneer life-altering biomedical discoveries and their translation into breakthrough health care decisions.

Discovering novel therapies

"While we have developed many memory aids, tools and pharmaceutical treatments to help Alzheimer's patients with improving their memory, we didn't have anything to help with improving decision-making abilities or with increasing patients' abilities to selectively focus attention on the task at hand and avoid distractions. These skills are necessary to perform many daily activities, such as making the bed, maintaining a healthy diet and socializing with friends and family," says Dr. Scharre.

The frontal lobes are responsible for our ability to solve problems, organize and plan, and make decisions. By stimulating this region of the brain, patients' cognitive and daily functional abilities as a whole declined more slowly than those in a matched comparison group not being treated with DBS. The pilot study found that DBS targeting frontal brain regions can reduce the overall decline typically seen in people with mild or early stage Alzheimer's.

Improving and extending quality of life

All three study participants showed improvement, including LaVonne Moore, 85, of Delaware, Ohio. When she entered the study, she was not doing any meal preparation. After two years of deep brain stimulation, she could independently initiate preparations of a simple meal, including assembling ingredients and cooking the meal. LaVonne was able to organize an outing, including arranging the transportation and destination, planning for the weather and bringing the needed money. She also regained independence to select her clothing attire, researchers noted.

Findings of the study were published online in the Journal of Alzheimer's Disease on Jan. 30. Next, Ohio State researchers want to explore nonsurgical methods to stimulate the frontal lobe, which would be a less invasive treatment option to slow down the symptoms of Alzheimer's disease. Funding for the initial study was provided by The Ohio State University Center for Neuromodulation, the Wright Center of Innovation in Biomedical Imaging and philanthropic donations. Additional Ohio State researchers involved in this study include Emily Weichart; Dylan Nielson; Jun Zhang, PhD; Punit Agrawal, DO; Per Sederberg, PhD; and Michael Knopp, MD, PhD.

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