Alzheimer's doesn't just steal memories. It eventually robs sufferers of the ability to do the simplest of tasks. How could stimulating a brain so damaged do any good?
A healthy brain is a connected brain. One circuit signals another to switch on and retrieve the memories needed to, say, drive a car or cook a meal.
At least early in the disease, Alzheimer's kills only certain spots. But the disease's hallmark gunky plaques act as a roadblock, stopping the "on" switch so that healthy circuits farther away are deactivated, explained Dr. Andres Lozano, a neurosurgeon at Toronto Western Hospital whose research sparked the interest.
So the plan was to put the electrodes into hubs where brain pathways for memory, behavior, concentration and other cognitive functions converge, to see if the jolts reactivate those silenced circuits, added Ohio State's Rezai.
"It's like going through Grand Central Station and trying to affect all the trains going in and coming out," he said.
Lozano's team found the first clue that it's possible by implanting six Alzheimer's patients in Canada. After at least 12 months of continuous stimulation, brain scans showed a sign of more activity in areas targeted by Alzheimer's. Suddenly, the neurons there began using more glucose, the fuel for brain cells.
"It looked like a blackout before. We were able to turn the lights back on in those areas," Lozano said.
While most Alzheimer's patients show clear declines in function every year, one Canadian man who has had the implants for four years hasn't deteriorated, Lozano said, although he cautioned that there's no way to know whether that's due to the DBS.
The evidence is preliminary and will take years of study to prove, but "this is an exciting novel approach," said Dr. Laurie Ryan of the National Institutes of Health's aging division, which is funding a follow-up study.
In research under way now:
—The Toronto researchers have teamed with four U.S. medical centers — Johns Hopkins University, the University of Pennsylvania, University of Florida and Arizona's Banner Health System — to try DBS in a part of the brain called the fornix, one of those memory hubs, in 40 patients. Half will have their electrodes turned on two weeks after the operation and the rest in a year, an attempt to spot any placebo effect from surgery.
—At Ohio State, Rezai is implanting the electrodes into a different spot, the frontal lobes, that his own DBS work suggests could tap into cognition and behavior pathways. That study will enroll 10 participants including Sanford.
Surgery back in October was Sanford's first step. Then it was time to fine-tune how the electrodes fire. She took problem-solving tests while neurologist Scharre adjusted the voltage and frequency and watched her reactions.
Sanford was cheered to see her test scores climb a bit during those adjustments. She said she knows there are no guarantees, but "if we can beat some of this stuff, or at least get a leading edge on it, I'm in for the whole deal."