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Neuronetrix CEO KC Fadem and his Cognision system headgear and remote. Alzheimer's disease, but they neither slow its progress nor reverse it. While they may temporarily delay the worsening of symptoms for six months to a year, even that record is only so-so, with fewer than half of all patients responding. Adding to the complication of the disease, not everything diagnosed as Alzheimer's disease is truly Alzheimer's disease. So patients treated for Alzheimer's may not respond because they actually have something else. Or they may have several diseases. In fact, they're likely to. "It's a funny thing about cognitive impairment in aging," Nelson says. "Te brain is by far the most complex organ of any in our body. It's geometrically and functionally complex; there is layer upon layer of complexity. But when people have impairment, they write it down to a single disease. Tat is a complete mistake. Tat is an error." In fact, Nelson says, no more than 20 percent of those diagnosed with Alzheimer's disease have Alzheimer's disease alone. Unfortunately, these are diagnostic details available through only one mechanism: an autopsy. Like everyone else who does brains for a living, Steven Schef, associate director of Sanders-Brown, has a plastic brain on his desk, which he uses to punctuate his explanations, alternately pointing out its features and wiggling it around like a rubber chicken. Schef is a pathologist, like Nelson. Both perform brain autopsies on UK volunteers. At the moment, some 700 people are on the list to donate their brains. When they die, a funeral home or a family member will call the "autopsy phone" that Schef and Nelson take turns carrying. 42 LOUISVILLE MAGAZINE 11.13 When a body arrives at the lab, an autopsy technician runs a saw around the circumference of the skull — actually, the cut is toward the back of the head, where sailors wear their white caps. Already, the brain is undergoing rapid deterioration. When the heart stops pumping, things fall apart quickly, but nowhere faster than in the brain. Enzymes begin dismantling the machinery, degrading tissues, disintegrating cells. Te sooner the brain is removed and preserved, the more it can tell researchers. With the skull open, the brain is still not visible, but lies cloaked beneath a leathery jacket called the dura. Membranes extend from the dura to the inside of the skull, suspending the brain in a pool of cerebral spinal fuid that, in life, cushions the organ against its own weight and a rap on the head. Te pathologist cuts through the attaching tissues and, tilting the head back, pulls the brain outward so he can reach in and sever its connection to the spinal column. Once that cord is broken, the brain is ready for inspection. Sometimes, Schef says, he knows even before the brain is out of the skull that disease has done its worst. Te Alzheimer's brain is small, shrunken — instead of 1,300 grams (2.8 pounds), it may weigh 900, just short of two pounds. Te once-snug arrangement of interlocking hills-and-valleys on the brain's surface is now a sloppy landslide, with much wider gullies and narrower ridges. In advanced Alzheimer's, a pair of little structures called hippocampi, where memories are knit together for storage, all but melt away. But the deepest secrets are entwined in the cells, wrapped among the neurons.