Pacing the Brain

The news outlets were abuzz this week with a new line of research going on in Toronto and several US centers. This research uses deep brain stimulation (DBS) to help improve the cognitive function of people living with Alzheimer’s.

Here’s how it works: electrodes are implanted in certain affected areas of the brain, which are accessed through holes made in the skull. The electrical impulses are hoped to reawaken nerve endings that are malfunctioning, thus staving off the decline that can be seen with the condition.

The research is just beginning, with a few dozen people scheduled to be studied. The article (http://www.cbc.ca/news/health/story/2013/01/21/alzheimer-brain-implants.html) lists some anecdotal reports of improved memory and other skills, including one man who appears to have had little or no decline over four years (though the article allows that no one knows what his rate of decline would have been without the DBS).

Several people are hailing this new step in our approach to Alzheimer’s as a possible breakthrough in the making. So why do I not get filled with hope when I read about studies like this? At the risk of being seen as a “wet blanket” or having an overly simplistic understanding of the process, I will share some concerns I have.

First of all, I want to better understand what we are trying to accomplish. Most available approaches to Alzheimer’s are focused on increasing the presence of certain chemicals in the brain synapses, to fight the loss of these chemicals. So we use drugs to squeeze out a bit more acetylcholine, or to keep it in the synapse a bit longer before it gets broken down. This does nothing to slow the nerve changes in the condition, but it may give people several more months at a certain level of function before they begin to lose the beneficial effect.

It’s not a cure, not even effective in slowing the illness, but if it buys several more months of improved function, it can have an important effect on people’s lives—six more months before needing a nursing home, for example. But I have to ask how DBS works and what added benefit it might offer?

It seems to me that “overdriving damaged nerve cells” is likely to be the major effect of the procedure. DBS may also awaken cells that are not being adequately used, but we all have those; might that not also happen in people without Alzheimer’s? We’ll never know, because there will never be a control group who gets these implants.

If we are simply overdriving the damaged nerves, won’t the effect wear off, or exhaust those nerve reserves? And how long will that take? These are important questions, because this is an invasive surgical procedure, with associated risks and costs. Are we looking toward a future that will see this approach being used for the millions of people who will develop memory loss over the next few decades? Who will pay for these surgical procedures that may offer little more than the benefit that our current pills have given?

These questions are important to me because there are non-invasive and non-medication techniques that also awaken brain connections and revive previously lost abilities. One perfect example is Dan Cohen’s iPod Project, which has shown the power of personalized music to cause impressive “awakenings” in people who had become withdrawn, non-communicative or distressed.

There are many other examples I have seen with pets, art, therapeutic touch, storytelling, even good-old-fashioned attention to good communication and connection with people who have been disempowered and disengaged by our stigmatized approach to care. And while the anecdotal reports of DBS sound exciting, I can tell stories of these approaches that are far more numerous and just as striking.

So…I don’t want to discount the exciting frontiers that people are exploring, but I have to ask: Why do we rush to fund studies that drill holes in people’s heads, but fail to fund studies that put iPod headphones over their ears?