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Brain 'Pacemaker' Could Lessen Alzheimer's Effects

tom and lavonne moore alzheimers

Feb. 2, 2018 -- For decades, LaVonne Moore hosted talk shows on WBCO, the Bucyrus, OH, radio station that she and her husband, Tom Moore, founded in 1962. About 5 years ago, she asked her husband to take her off the air.

“I can’t remember the questions,” she told him.

Soon after, a doctor informed Moore, now 85, that she had Alzheimer’s disease and that nothing could be done for her.

“That,” said Tom Moore, 89, “was not a satisfactory answer.”

Now, a first-of-its-kind study, which LaVonne Moore took part in, offers some new hope of changing that answer. Researchers have found that implanting an electrical device that sends signals to the brain’s frontal lobe appears to slow the advance of certain symptoms caused by Alzheimer’s.

“It’s never been done before, and we didn’t know if it would make things worse, make things better, or cause issues,” says study co-author Douglas Scharre, MD, director of the Division of Cognitive Neurology at Ohio State’s Wexner Medical Center.

Called deep brain stimulation, or DBS, the technique has been used for many years to reduce tremor, walking difficulties, stiffness, and other physical movement problems caused by neurological disorders like Parkinson’s disease and essential tremor. It’s also been studied as a potential treatment for depression and obsessive-compulsive disorder.

Over the last several years, studies have looked at the effect of DBS on memory problems. The results were mixed.

Scharre’s study, published Tuesday in the Journal of Alzheimer’s Disease, is different. Rather than targeting memory, he and his colleagues used DBS to stimulate a different part of the brain: the area that, when working properly, allows a person to manage activities of daily life.

“We chose the frontal lobe primarily because we’re trying to help the patient’s executive abilities, where they often have impairment, like problem solving, decision making, focused attention, planning, and organization,” he explains.

Those kinds of abilities allow people to plan their day, pay their bills, pick out clothes to wear, and prepare meals. The loss of such functions leads to disability, and, says Keith Fargo, PhD, that makes them important research and treatment targets that need more attention.

“Alzheimer’s disease is not just a memory problem, but a lot of people have that misconception,” says Fargo, director of Scientific Programs and Outreach, Medical and Scientific Relations, at the Alzheimer’s Association. “Memory is one of the first functions that people with Alzheimer’s lose, but it is certainly not limited to that. At the end of the day, Alzheimer’s is a universally fatal disease of the brain.”

A year or so after LaVonne Moore’s diagnosis, her neurologist introduced her and her husband to Scharre, who was recruiting for his DBS study. The Moores talked it over for a couple of days and then followed their first instinct and volunteered.

“Lavonne said several times, I will do anything to help other people not go through what I’m going through,” says Tom Moore.

Two others took part in the study. They each had surgery to implant the device. Wires to the brain connected to a battery-powered box implanted under the skin, much like a pacemaker.

Moore’s husband says that in the hours after the surgery, his wife did not know what was going on and required almost constant attention in the hospital.

“The nurse earned her money that night,” he says, chuckling. “But everything was fine after the trauma of the surgery.”

All three participants had brain examinations of all sorts -- MRI, EEG, CT, and PET scans -- at the start of the study, along with tests to measure their mental skills. A month or so after the participants got the implants, the researchers spent several weeks fine-tuning each device. More adjustments were made as needed after a year. In all, the researchers followed the study participants for 24 months, testing them to measure how their symptoms progressed.

Another group of Alzheimer’s patients, who did not receive DBS, served as a control group, which allowed the researchers to compare the effects of DBS to normal care.

The results: Two of the three patients, including LaVonne Moore, showed significantly less decline based on the results of a commonly used test to evaluate dementia. A third patient also showed improvement, just not as much as the other two. In other words, they held on to more of their executive abilities than similar Alzheimer’s patients.

“We’re seeing a signal here that could be a true signal that’s helping those frontal brain circuits,” says Scharre.

In fact, Moore seemed to regain some of the abilities she had lost, according to the study. Working with her therapists, she organized an outing: how to get there, what to wear based on the weather, and how much money to bring. Also, she was able to plan and prepare a simple meal. That surprised Scharre.

“Usually, once you lose a function, you don’t get it back,” he says.

Moore’s husband believes that the device helped her respond positively to the therapy she received, which included making brownies with her therapist.

“They brought me a brownie. How about that?” he says. “She did well with those skills, before they deteriorated.”

But he suggests that it was not only the implanted device that helped his wife.

“Going through the study, through the surgery and everything else, gave LaVonne a confidence, and that would have an impact on what she did as well,” he explains. “When you know you’re going downhill, there’s a negativity that injects itself into your mind, but once she had the surgery and things were going better, she responded positively. It had a great effect upon her.”

Scharre cautions that the results need to be confirmed in much larger studies. DBS specialist Nader Pouratian, MD, who was not involved in the research, agrees but says this study does offer hope.

“I think it’s exciting,” says Pouratian, an associate professor of neurosurgery at the David Geffen School of Medicine at UCLA. “It represents our current state of the art and our current interest in exploring new treatment options for diseases like Alzheimer’s disease.”

He cautions that DBS likely does not reverse or slow down the disease itself; instead, it targets specific Alzheimer’s symptoms that harm executive abilities.

“Trying to improve those early on may actually contribute to significant improvement in quality of life if we’re targeting the right circuits, which it seems like they might have been doing in this case,” says Pouratian.

Scharre speculates that saving executive abilities may be a more realistic goal than slowing or reversing memory loss. That happens in the disease’s early stages, and by the time a person gets a diagnosis, too many memory cells already may have been destroyed. The disease also threatens the frontal part of the brain, but because that happens later, there may be more time to protect its functions.

“When they’re still working and still robust, maybe the frontal circuits are better able to be saved than memory cells,” Scharre suggests.

Time -- and more research -- will tell.

“This is not going to change medical practice in the near term,” says Fargo. “In the future, it may radically alter medical treatments for Alzheimer’s disease, but that has to wait for clinical trials to be done.”

In addition to its effectiveness, the treatment must also be safe and tolerable. Scharre, Pouratian, and Fargo all say it’s much too early to ask your neurologist for this treatment; but they do encourage people to take part in Alzheimer’s research.

“Without this type of innovative approach and without the patients who are willing to participate, we won’t be able to move forward,” says Pouratian.

Fargo points those interested to the Alzheimer’s Association’s Trial Match: https://www.alz.org/research/clinical_trials/find_clinical_trials_trialmatch.asp

Tom Moore agrees, and he has seen the benefits of such research firsthand. As he spoke on the phone, his wife of 65 years worked on a jigsaw puzzle nearby. He has watched her decline, but he says that it has happened more slowly than it likely would have without the implant, which she continues to use.

“The study’s over, but we’re continuing with treatment,” he says. “Due to the reaction of her brain to the electric impulses, she has held in there quite well, and I’m pleased with that, although she continues to go down. But we survive. We get along.”