Alzheimer's disease (AD) is the neurodegenerative disease responsible for the majority of dementia cases across the United States. Its pathology involves the accumulation of protein plaques in areas of the brain directly involved with learning and memory formation, causing cognitive impairments and loss of independence in everyday life. Deep brain stimulation (DBS) is a relatively young field in medicine that has gained a great deal of traction with its efficacious clinical outcomes in neurological diseases including Parkinson's disease, epilepsy, depression and obsessive-compulsive disorder. More recently, researchers have sought to discover the proper application of DBS to improve the formation of episodic memory to provide a comparable or superior therapy for AD. Many experiments have been performed using different electrical parameters, hardware, or locations stimulated in the brain, which produced mixed results for benefits in memory reinforcement. Of the various brain structures available to target, the Entorhinal Cortex (EC) has been shown to lead to numerous positive outcomes. Additionally, one study used a novel approach, applying DBS in response to the neural activity of the individual brain during memory encoding tasks, which produced improvements in memory performance. This proposal aims to use these modalities in concert - a closed-loop stimulation approach that monitors neural activity and targeting the EC - in AD dementia patients to act as an adjuvant therapy to current acetylcholinesterase inhibitor medications that provide weak efficacy when used alone. This will be conducted in a 2 year, multicenter, double-blind, randomized controlled clinical trial comparing treatment with dual therapy consisting of DBS and an acetylcholinesterase inhibitor, to those with acetylcholinesterase inhibitor monotherapy. Participants will have mild or moderate AD at baseline, evaluated using the Mini-Mental State Examination and their progress in both experimental arms will be recorded using the 13 item Alzheimer's Disease Assessment Subscale-Cognitive over a 2-year period. Investigators will study the primary outcome of delaying cognitive decline, with secondary effects involving the differences between age groups, stages of AD and how frequently stimulation was received in those within the DBS and standard therapy group. The results from this study have the potential to further improve future approaches involving DBS in the treatment of AD dementia, as the projected number of those affected by the disease continues to grow with advances in modern medicine.
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/32973 |
| Date | 24 October 2018 |
| Creators | Andrade, Jonathan |
| Contributors | Vu, Thai, Weinstein, John |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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