Louisville Magazine is Louisville's city magazine, covering Louisville people, lifestyles, politics, sports, restaurants, entertainment and homes. Includes a monthly calendar of events.
Issue link: https://loumag.epubxp.com/i/197412
By Jenni Laidman Photos by Mickie Winters A groundbreaking Louisville computer-analysis company and the University of Kentucky's Sanders-Brown Center on Aging are teaming up to track Alzheimer's disease in its true infancy. ete Nelson is 6-foot-5 with the most regular of facial features: a straight nose, small eyes, a rounded chin, and ears that lie trim to the sides of his head — a face completely in balance. He doesn't smile much today, even if this is the best he's felt in three weeks. Tat's how long it's been since he threw his back out — the curse, he says, of tall pathologists. He grabs a white lab coat from his small ofce on South Limestone Street in Lexington and lopes to the elevator, heading to his frst-foor laboratory, where the brains or brain sections of 820 people, most of them Kentuckians, sleep in a dozen tall freezers, waiting for someone to solve their secrets. Waiting for someone like Nelson. Tom and Nancy Conley's brains will be among these someday. It's hard to picture. Here's Nancy in a pink top, wisecracking in their living room, pantomiming silent commentary to Tom's serious monologue. Tese days, Tom and Nancy, who live just outside Jefersontown, are seldom apart. Tey've always been close, Tom says. Now they are together more often than they have been in 50 years of marriage. Ever since she was diagnosed with Alzheimer's disease, he's reluctant to leave her alone. It happened in 2008, when Nancy turned 66, the year following surgery, chemotherapy and radiation for breast cancer. After fve hours of testing at the Sanders-Brown Center on Aging at the University of Kentucky, where Nelson works, doctors said Nancy's occasional confusion and forgotten lunch dates were indeed signifcant. She was in the early stages of the disease. But what does that mean, early stages? It's one of those nebulous terms that hide as much as they reveal. Early compared to what? It turns out, early only in terms of medicine's ability to detect it. But biologically, maybe not so early at all. Nelson, 46, points to a graph illustrating Alzheimer's progression. Tis slope would frighten the most accomplished black-diamond skier. Its peak (a mesa, really) marks our many years of normal cognition, when the brain — this little 2½-pound miracle of 86 billion neurons and 400 miles of blood vessels — runs at its seldom-noticed best. But, in Alzheimer's disease, through every passing year, the slope heads downward, until fnally, falling at a 45-degree angle, it plummets to death. So far, this is no surprise. But here's the rub: About a third of the way down the slope on Nelson's graph there's a marker that says MILD IMPAIRMENT. Ten, almost halfway down the slope of brain failure are the words "early AD." Early Alzheimer's disease. Tis is the frst moment people can be diagnosed, and we're already halfway down the slope of cognitive impairment. Te graph has a second line, this one climbing. It tracks the progress of the biological hallmarks of Alzheimer's destruction — the so-called plaques and tangles — as they colonize the brain. At that moment of "early AD," this second line is climbing at a 45-degree angle and has been for years. By the time the disease is diagnosed, by the time anyone confrms a problem, the poison proteins in the brain are nearly halfway home. Early AD is actually, really, middle AD. Te frst half, it seems, grows in the dark. But one Louisville company intends to turn on a searchlight. A stoic plastic head in the East Chestnut Street ofces of Neuronetrix wears strange headgear. Its skull is crisscrossed by black ribbons that lace through 10 white plastic discs. Tose ribbons — more like wires — and discs together create a single printed circuit. A chinstrap holds the unit frmly in place, should the plastic head come to harm. It took 10 patents, both issued and pending, nine years, and some $8 million in investment to produce this simple-looking device, but if KC Fadem, CEO of Neuronetrix, is right, the Cognision system will transform how medicine looks at brain-disease injury. "I think we're going to identify Alzheimer's at the earliest stages of the disease," says Fadem, 55, whose shaved head gives him a vague resemblance to the plastic model — although the skull lacks the glasses and soul patch. Te device is actually a greatly streamlined, portable and more powerful version of something that's been used in laboratories for years — equipment that can record the brain's electric signals and use them to measure neurologic response. Te wearer hears a sequence of tones and is asked to push a button to indicate the highest pitched tone. Te electrodes in the white disks on the headset record the brain's electrical activity as it perceives the tone and decides whether to hit the button. Tat capture is relayed via Bluetooth to a computer, then via the Internet back to Louisville, where it's run through an algorithm that analyzes the complex results and produces a report. "It's a hyper-automatic computer classifcation system," Fadem says. "Tere's no need to analyze this crush of data. Te computer does it for you. Ten the data goes online and ends up in the patient's record." Even very slight brain changes are evident in the waveforms the Cognision system records. In fact, Fadem once demonstrated that Cognision could detect the boost from a bit of cafeine. Conversely, when the brain loses capacity, even very slight changes are evident to the system, both the longer response times and the recruitment of fewer cells for a given task. Fadem says the device has the potential to detect traumatic brain injury on the battlefeld as well as concussion on the football feld. Te company is talking to college football teams 11.13 LOUISVILLE MAGAZINE 39