If deep brain stimulation (DBS) can help people with Parkinson’s disease walk and speak again, could it help people with Alzheimer’s disease, too? It’s a natural question, and one that researchers are taking seriously.
DBS, a treatment that uses implanted electrodes to send electrical pulses to targeted areas of the brain, has long been used for symptom control of movement disorders. Researchers continue to test whether this is a viable option for those afflicted with Alzheimer’s to slow cognitive and behavioral decline. It’s not a cure, but it may buy time and quality of life. And for the 7 million Americans who have Alzheimer’s disease, and their family, that’s everything.
Read on to learn more about the potential for deep brain stimulation to help Alzheimer’s disease and what researchers are still studying.
[See: Preventing Dementia and Alzheimer’s: 8 Habits to Reduce Your Risk]
What Is Alzheimer’s Disease?
Dementia is the general term for cognitive decline, particularly in memory and thinking abilities. Alzheimer’s is both a type of dementia and the most common cause of dementia.
Alzheimer’s disease is an inflammatory disease, where immune cells play an important part in both compensating for the evolving brain damage and causing the brain damage itself, says Dr. Jeremy Koppel, a psychiatrist in Glen Oaks, New York. Koppel is also a member of the Alzheimer’s Foundation of America’s Medical, Scientific and Memory Screening Advisory Board.
What does Alzheimer’s look like in the brain? Clumps of a protein called amyloid build up outside the brain cells. Inside the cells, another protein called tau forms twisted tangles. Over time, these changes cause more brain cells to die, and the brain shrinks.
Now more than ever, it’s easier to diagnose Alzheimer’s early on.
“This is a disease that begins years before the first symptoms become apparent,” Koppel says.
He adds that because of new technologies, we can now see hallmarks of Alzheimer’s on imaging scans and in blood tests.
Medical professionals take a comprehensive approach when diagnosing Alzheimer’s. They consider:
— Problems with memory, behavior changes or personality. These may either be self-reported or reported by a caregiver or loved one.
— Current medical history, including diet, medications and current medical conditions. This is to rule out other similar conditions, such as other types of dementia or delirium.
— Results of memory and cognition tests
— Lab tests, such as urine, blood and cerebrospinal fluid testing
— Imaging, such as CT, PET or MRIs of the brain, which can help with diagnosing Alzheimer’s and ruling out other conditions
What are the symptoms of Alzheimer’s disease?
Alzheimer’s disease affects many domains of cognition, not just memory, Koppel says.
Some symptoms of Alzheimer’s disease include:
— Early symptoms: losing items around the house, asking people to repeat questions, wandering or personality changes
— Moderate symptoms: increased confusion, changes in sleep, repetitive movements or forgetting family members or friends
— Later symptoms: trouble communicating at all, difficulty swallowing or an inability to control bowels or bladder
[READ: Understanding Sundowning: Symptoms, Causes and Coping Strategies]
What Is Deep Brain Stimulation?
DBS is a surgical procedure that connects electrodes to the brain.
Here’s how it works:
— Surgical clearance. Medical providers evaluate you to make sure that undergoing the procedure is safe for you.
— Brain imaging. You’ll get brain scans done to map your brain in preparation for surgery. This will help the neurosurgeon decide the optimal location for electrode placement.
— Brain surgery. A neurosurgeon will drill two tiny holes, called burr holes, on either side of your skull. Neurosurgeons use technology to ensure that the DBS electrode is precisely placed within the planned location in the brain.
— Pacemaker insertion. The surgeon will make a small incision below the collarbone. The DBS apparatus, a pacemaker-like machine, is then implanted in the chest wall.
— Connection. The surgeon connects the DBS apparatus with the DBS electrodes.
— Recovery and programming. After you’ve recovered from the procedure, your medical team determines the correct parameters for DBS, and you begin treatment.
What is deep brain stimulation for Alzheimer’s?
DBS has many parameters that neurologists can set.
DBS treatment varies depending on how the DBS settings are programmed, such as:
— Amplitude
— Frequency
— Pulse width
— Rate
— Location of DBS electrodes within the brain
As DBS research for Alzheimer’s is ongoing, there isn’t a scientific consensus for many of these parameters. For example, researchers haven’t agreed on the best brain location for Alzheimer’s DBS. However, all locations that are typically used relate to memory circuits.
Scientists still don’t quite understand exactly why DBS provides therapeutic effects, but there are plenty of theories. With DBS in Alzheimer’s, researchers think it could be because of a number of reasons, from increased blood flow to the area, to promoting brain cell regeneration, to improving release of brain messengers and more.
[READ: Dementia Care Activities]
Potential Benefits of Deep Brain Stimulation Treatment for Alzheimer’s Disease
DBS is not a cure for Alzheimer’s disease, but it can help with symptom control.
“Symptom control is about changing an experience,” Koppel says.
In contrast with disease control, it is more like targeting what’s wrong with the body at the microscopic or molecular level, he explains. Symptom control does not always equal disease treatment, and such is the case with DBS for Alzheimer’s.
Koppel says DBS may help relieve Alzheimer’s disease symptoms, such as:
— Improving memory and language
— Reducing anxiety and distress
— Increasing attention
Research in Deep Brain Stimulation for Alzheimer’s Disease
Research on DBS for Alzheimer’s now is based on decades of animal and human research by thousands of dedicated scientists, says Dr. Nandakumar Narayanan, a professor of neurology at University of Iowa in Iowa City.
Early research
The earliest research on humans studying DBS for Alzheimer’s was in the early 2000s in Toronto. The first study, with just a handful of participants, revealed that half the participants appeared to have better memory scores and recall after DBS treatment.
“Brain scans of these patients revealed increased glucose use in memory regions, suggesting that these circuits may have been more active under stimulation,” says Shebna N. Osanmoh I, a psychiatric nurse practitioner at SavantCare in Los Altos, California.
Ongoing research
At this point, there have been a handful of clinical trials and research studies on humans. Most of these are small trials to show potential, Narayanan says.
Narayanan adds that there are two main strategies in current clinical trials:
1. Using DBS to target specific memory circuits in the brain
2. Using DBS to target chemical messengers in the brain that are typically decreased by Alzheimer’s
There is currently an ongoing, larger Phase 2 clinical trial called ADvance II, designed to target memory circuits. This study is a 12-month double-blind, randomized, controlled study, meaning the study is designed to be as reliable and unbiased as possible. The study was completed in October 2024, but researchers have not released the full study or its data yet.
Future research
In the future, scientists will continue larger and more robust clinical trials. Researchers are still exploring optimal DBS placement and parameters for those with Alzheimer’s.
“While DBS for Alzheimer’s remains experimental, these studies teach us important lessons about brain networks,” Osanmoh I says.
Risks of Deep Brain Stimulation Treatment for Symptoms of Dementia
Since this research is still experimental, researchers don’t know if DBS will be of benefit to everyone. Some may benefit, some may have no benefit, and in others it could even worsen the condition. Scientists are still determining the best location and parameters for safe and effective DBS treatment for Alzheimer’s.
In general, Osanmoh I says there are three main risks to DBS:
— Surgical risks. Infection at the implant site, or rare but serious brain bleeding can occur during the procedure. Some may experience mild headaches or nausea afterward as well.
— Wear and tear on the device. Over time, the battery may need replacement, so you’ll need to keep up with your machine maintenance and follow-up appointments to keep DBS safe and effective.
— DBS symptoms. Sometimes, DBS can cause tingling, muscle tightness or sleep disturbances, especially if the settings aren’t fine-tuned.
All of these risks are discussed thoroughly in presurgical counseling, Osanmoh I says.
“DBS is generally safe, in experienced hands,” Osanmoh I adds.
On the other hand, some medical professionals may not agree with recommending neurosurgery for a treatment that still has so much ongoing research. Multiple providers declined to comment on this article, stating that this treatment is not widely given at their practice and that they do not currently recommend it.
Does insurance cover DBS for Alzheimer’s disease?
Most likely, your insurance will not cover DBS for Alzheimer’s disease. Because DBS is still considered experimental and investigational, most insurance companies would not consider the treatment medically necessary or eligible for coverage. You may still be able to get the treatment, you would just need to pay out of pocket.
In the future, DBS for Alzheimer’s disease could be covered by insurance, if the treatment receives Food and Drug Administration approval for Alzheimer’s disease and enough studies deem the treatment medically necessary for Alzheimer’s disease treatment.
The Bottom Line
While DBS has shown potential in treating symptoms of Alzheimer’s disease, it is not a cure and researchers are still discovering the optimal parameters for Alzheimer’s treatment.
The complexity of this research lies in the need for researchers to carefully titrate multiple factors, including the precise location of stimulation and various DBS parameters, such as pulse width, frequency and amplitude, with countless combinations of these factors potentially influencing the effectiveness of the treatment. Although DBS may help alleviate symptoms of Alzheimer’s, it’s not guaranteed to help everyone. As more studies unfold, it could help refine and clarify its potential benefits for Alzheimer’s patients.
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Alzheimer’s Disease: Could Deep Brain Stimulation Help? originally appeared on usnews.com
