When blood vessels are damaged or blocked, it can deprive your brain of vital oxygen and nutrients, which could lead to a condition called vascular dementia.

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"Vascular changes in the brain most often damage the axons — or cables — that connect different parts of the brain," says Dr. Stephen English, a Mayo Clinic neurologist. "Therefore, signals take longer to travel, so our brains are not working at full speed."

Dr. English says the signs of vascular dementia include problems with reasoning, planning, judgment, memory and other thought processes. Factors that increase the risk of heart disease and stroke also raise vascular dementia risk.

"High blood pressure, high cholesterol, diabetes, smoking, obesity and sleep apnea — these are the modifiable risk factors that, if untreated, can cause wear and tear on the small blood vessels in the brain over time," says Dr. English.

If you are at risk or show signs of vascular dementia, consult a neurologist.

"We can potentially augment some of these risk factors," says Dr. English. "Medications and lifestyle changes can lower blood pressure and cholesterol; we can treat sleep apnea with certain devices or surgeries; and we can help you stop smoking. These are some things that can reduce the risk of developing vascular dementia."

Related posts:

• Mayo Clinic Minute: When to consider deep brain stimulation for essential tremor
• Mayo Clinic Minute: How to reduce your stroke risk
• AI-guided screening uses ECG data to detect a hidden risk factor for stroke

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Collaborating around patient need

Underpinning innovation at Mayo Clinic Laboratories is a unique ecosystem of integration. A network of laboratory scientists and bedside physicians collaborates to translate scientific discoveries into real-world tools that save patients’ lives.

“The clinician is limited when they don't have a good diagnostic test,” says Dr. John Mills, co-director of the Clinical Neuroimmunology Laboratory at Mayo Clinic. “There are many situations where clinically deciding if a patient has disease A or disease B is extremely challenging, and without lab tools to help them make those decisions, they can't provide the best care possible.”

At Mayo Clinic, the individuals developing tests in the Clinical Neuroimmunology Laboratory are a mix of laboratorians, clinicians, and doctors who perform both jobs.

“There is a sort of natural communication between the clinic because the individuals are the same ... and having that crossover really keeps that momentum going,” says Dr. Andrew McKeon, co-director of the Clinical Neuroimmunology Laboratory.

Treating patients with autoimmune neurological disorders in the clinic often reveals things not seen before, says Dr. McKeon, who is also a bedside physician. “And that will lead to research questions. Or you might see a test result that seems unusual, and that may lead to questions around whether there are things we can improve in the lab in terms of how we test for a particular antibody. Then, on the lab side, we may engage with an ordering clinician who has a question about an antibody and its significance that we just didn’t think of.”

The interaction between the lab and the practice is a key component of developing patient-centric laboratory testing, Dr. Mills adds. “It helps us identify areas for discovery, get access to samples, ask the right questions, develop the right tests, and really is the reason we're able to translate these discoveries before many other laboratories.”

Asking the right questions is central to Mayo Clinic Laboratories’ innovation strategy.

“The value of integration is that we’re always asking questions for patients: are we barking up the right tree, do we have the right test for that, do we have to create something new?” says William Morice II, M.D., Ph.D., CEO and president of Mayo Clinic Laboratories. “Sometimes the right questions can’t be answered. We realize that we don’t have the right tests to really evaluate for something. So that is what spurs the innovation.”

Harnessing the power of science

Since Mayo Clinic Laboratories was established in the early 1980s, neuroimmunology researchers have pushed the envelope on what is known about autoimmune neurological illness. Translation of discoveries into testing for autoimmune neurological disease was made possible with the creation of the Clinical Neuroimmunology Laboratory in 1989.

Since its founding, the lab has advanced the field by discovering antibodies associated with rare autoimmune neurological conditions, such as neuromyelitis optica, stiff person syndrome, myasthenia gravis, and paraneoplastic disorders. But there is more work to be done.

“The field of autoimmune neurology is really still in its early stages,” Dr. Mills says. “New novel biomarkers are discovered almost on a monthly basis. And so that really impacts how the lab operates — there's always new tests and new analytes to offer.”

In the Clinical Neuroimmunology Laboratory, physicians and scientists have discovered and are on constant lookout for new antibodies. When new, relevant antibodies are identified, the discoveries are quickly implemented into assays, Dr. Mills says. 

“We try to implement the new tests at the same time as the field evolves,” Dr. Mills adds. “The main driver for that is once we’ve discovered a test that has a clinical utility that we know can help patients, we want to get it to them as soon as possible.”

At present, of the 30-plus antibodies the neuroimmunology lab has tests for, more than five are only available at Mayo Clinic Laboratories because they are new or rare discoveries, Dr. Mills adds. Since newly discovered antibodies are continually added to the lab’s portfolio of autoimmune testing conditions, the lab’s testing is the most comprehensive available.

“That's something we pride ourselves on, is to constantly be at the forefront providing these novel antibodies as soon as we can, once they've been clinically validated. And that really has driven the field forward,” Dr. Mills says.

Changing lives with advanced and esoteric tools

The autoimmune movement disorders panel is an example of an assay that has evolved to align with changing science. Launched in the early 2000s, the test looks for more than 20 antibodies associated with autoimmune illnesses that impact an individual’s ability to move. Autoimmune movement disorders and phenomena can occur suddenly or slowly, and involve dizziness, numbness, tingling, pain, muscle seizing, joint stiffness, and other problems. They have differing causes, including cancer, and varying prognosis and treatment options.

Detection of antibody biomarkers provides insights that direct individualized treatment protocols aligned with symptom severity, type of antibody discovered, and the presence or absence of cancer.

The movement disorders test uses a number of methodologies to evaluate for the antibodies, including cell-binding assay, indirect immunofluorescence assay, radioimmunoassay, Western blot, and immunoblot.

When patient samples arrive in the laboratory, they are transferred onto slides that contain different types of mouse control tissues, including brain, kidney, and gut. After the slides have incubated, they are viewed under an immunofluorescence microscope by clinical laboratory technicians.

“As part of our training, we memorize a variety of tissue staining patterns that signify which antibody a patient might have,” says clinical laboratory technician Steven Brady. “If a positive result is suspected, it is moved to the consultants and lab directors for further review.”

“When these patients develop their autoantibodies, they cannot move, they are bedridden and can’t function day to day and their lives have completely changed,” Brady says. “And we can help provide them an answer and a path forward to get them back into their normal life. It’s amazing to see the work that we’re doing can actually recover somebody’s life and put them back into society, back with their family, back doing what they love to do.”

The Mayo Clinic values, which include healing, teamwork, innovation, excellence, stewardship, integrity, and respect, are exemplified by Mayo Clinic Laboratories, says Dr. McKeon.

“For me, there's really no difference between what's done through Mayo Clinical Laboratories and what's done in the clinic itself,” Dr. McKeon says. “Patients who receive testing through Mayo Clinic Laboratories really get the very best care, including for neurology. Patients are getting the most up-to-date, the most cutting-edge, but also well-validated tests for autoimmune neurology available.”

Learn more about Autoimmune Neurology Testing at Mayo Clinic Laboratories.

Check out the next installment of “Life of a Specimen,” where we learn how antibody clues in one patient’s blood and spinal cord fluid pinpointed a diagnosis and opened a door to treatment.

This article firs appeared on the Mayo Clinic Laboratories blog.

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In May of 2024, Mayo Clinic launched a new prion test, RT-QuIC Prion, CSF, which can distinguish prion disease from other causes of rapidly progressive dementia — particularly autoimmune forms of dementia and rapidly progressive forms of Alzheimer's disease.

“Rapidly progressive dementias are forms of dementia where the patient goes from the first symptom onset to loss of functional independence, usually in less than two years,” says John Mills, Ph.D., co-director of Mayo Clinic’s Clinical Neuroimmunology Laboratory.

In the early stages of rapidly progressive dementias, patients often exhibit nonspecific symptoms that make reaching a definitive diagnosis challenging. However, it’s crucial to identify the correct cause as soon as possible, because some forms — such as those driven by autoimmune processes — may be treatable, while others are not.

“It's really important to be able to give the patient a quick diagnosis and an accurate diagnosis,” says Dr. Mills. “Because if it's treatable, you're going to want to treat right away.”

Human prion disease, also called Creutzfeldt-Jakob disease (CJD), results from the misfolding of a normal prion protein — an essential protein present in everyone. The misfolded form of the protein, the cause of CJD, can emerge due to an underlying genetic mutation that predisposes the protein to misfold or spontaneous errors in protein folding. The misfolded protein can trigger a self-perpetuating cycle by causing correctly folded prion proteins to adopt the pathogenic form. Over time, this process leads to the death of neurons. Unfortunately, there is no cure.

Until recently, lab testing for CJD has been limited to nonspecific neuronal degeneration markers. These tests can detect and confirm rapid destruction of the brain tissues is occurring, but they cannot confidently tell clinicians the underlying cause. With the development of an RT-QuIC (or “real-time quaking-induced conversion”) assay for prion disease, clinicians were able to, for the first time, get a diagnostic test result specific for prion disease with very high diagnostic accuracy. Before this test was available, it wouldn’t be until an autopsy was complete that the cause could be confidently identified.

Making a dangerous agent safe to work with

RT-QuIC Prion, CSF (cerebral spinal fluid) is the only definitive antemortem clinical test of its kind that doesn’t involve a brain biopsy.

“A lot of the labs that originally did this testing started with brain homogenates, and so when you talk about directly working with brain tissues, there’s a clear risk of transmission in instances of needlesticks, for instance,” says Dr. Mills.

Fortunately, RT-QuIC for prion disease was proven sensitive using CSF specimens, which is a low-risk specimen and can be manipulated in a standard clinical laboratory that operates at biosafety level 2 (BSL-2). But to ensure an additional layer of safety, the goal at Mayo Clinic was to perform this testing in a BSL-2+ laboratory, which meant a special lab space had to be built from the ground up.

“Creating the right space for this test was a tricky bit of doing,” says Ellen Lexvold, technical specialist coordinator in the Neuroimmunology Lab, who helped build out the new test lab. “It was like building an airplane as you’re flying it. We had to tailor the workflow to special considerations, like engineered safety controls, seamless floor tiles, corrosion-resistant steel tables (bleach is one of the few substances that can inactivate pathogenic prion proteins), negative pressure airflow, and a lock-restricted area.” 

Grizzly bear country

Prion testing is so unique that, prior to Mayo’s development of the RT-QuIC clinical assay, there was only one other lab in the U.S. offering the test and only a handful of laboratories performing the test worldwide.

The birthplace of RT-QuIC is Rocky Mountain Laboratories (RML), a research facility situated in the tiny Montana town of Hamilton, wedged between the Bitterroot and Sapphire Mountain ranges on a picturesque landscape.

“In 2010, the RML reported the use of a test called RT-QuIC in a landmark paper,” says Dr. Mills. “They demonstrated how this assay was able to detect very small amounts of pathogenic prion protein, and they could amplify those prion proteins, in vitro, and detect them with very high sensitivity. This was the first time an assay that was specific to prion disease had enough sensitivity to be considered as a potential diagnostic test for prion disease.”

In 2018, Dr. Mills, Lexvold, and Matt Roforth, a senior developer for Mayo Clinic’s Department of Laboratory Medicine and Pathology, traveled to Hamilton to learn how to perform the test. The team spent a week at RML, which, because of its research specialization in vector-borne diseases and emerging infectious diseases, is one of the few labs in the U.S. that has a BSL-4 rating, a requirement to house things like Ebola. RML is a National Institutes of Health (NIH) biomedical research facility.

“The facility is encircled in barbed-wire fencing, security gates, and before you can enter you have to have a background check,” says Dr. Mills. “Every morning when we walked in, we had to go through a security checkpoint. They inspect your belongings, you walk through a metal detector. There was very tight security for good reason as it houses highly contagious, dangerous pathogens.”

RML is quite particular about the use of the RT-QuIC technology and will only teach it onsite. Dr. Mills continues, “They want to know that whoever is doing the testing is doing it right. They walk you through their protocols, they want to watch you perform some of the testing so they’re sure you know how to do it.”     

Right out of a movie

During the mornings and early afternoons at RML, the team learned cutting-edge technologies and established connections that would help them launch this test at Mayo. “Then there wasn’t much to do with our free time,” says Dr. Mills. “So we’d go hiking up the Bitterroot Mountains to check things out.”

They also often ended up at a local diner, where everyone knew everyone and the owner doubled as the cook. The whole experience was “right out of a movie,” according to Dr. Mills. In fact, parts of the TV series “Yellowstone” were filmed in Hamilton and the surrounding area. Dr. Mills also recounts, “We met some renowned and well-regarded researchers who moved to Hamilton to work at RML, often from around the world. Not exactly the type of people you’d expect to be handy with a shotgun, but they had bears and all sorts of wild animals coming into their homes.”

When the team returned to Rochester, they had to wait for a new lab space to be built before they could develop the test — a space they coined the “Bitterroot Lab” in honor of their Montana experience. It took more than two years (thanks to the pandemic interruption) to develop a clinically validated version of the prion test.

“We had to take something that was really meant for research and we had to update it, we had to scale it up to keep pace with the throughput workflow of a clinical space,” says Lexvold.

“At the Rocky Mountain Labs, everything is done manually. So somebody is directly pipetting the sample. They’re adding their agents into each well. It’s a very manual assay. We did something different. We looked at different robotic, automated instrumentation that we maybe could use to do all that pipetting so it didn’t have to be manual.”

Dr. Mills adds, “We wanted a system that was small so that it could actually fit into a biosafety cabinet because we didn’t want those samples being manipulated and mixed with all the reagents outside of the biosafety cabinet. So that was a challenge. But our lab staff really stepped up and embraced the challenge and believed in the vision of offering the test at Mayo Clinic.”

Staff worked with a vendor that had a piece of equipment with a small footprint that, after some modifications, would work inside of a biosafety cabinet.

Jack Wu, Ph.D., now a clinical chemistry fellow, developed and validated the test. “Basically, you take the patient’s CSF, mix it with a recombinant substrate prion protein that was made in-house at Mayo Clinic, and a fluorescent dye that labels the protein aggregates generated in the reaction,” he says. “You incubate this plate at a temperature of 55 degrees Celsius while shaking it with certain reagents. It measures for the fluorescence every 45 minutes and does this for 36 hours. 

“The most critical component of this test is the production of high-quality substrate proteins, which sets the basis for the assay’s superior performance in detecting some rare subtypes of human prion diseases. The RT-QuIC methodology is the first of its kind at Mayo.”

Turnaround time for a test result is less than a week, which is no small feat considering how specialized the RT-QuIC is. “The laughing joke was that RT-QuIC wasn’t so quick,” says Dr. Mills. “But I think we are changing attitudes about this.”

A definitive answer in place of a cure

Part of the reason Mayo went through all this trouble to get this test is, heretofore, there was only one other lab in the U.S. that performed a clinical version of the test: The National Prion Disease Pathology Surveillance Center (NPDPSC), a lab in Cleveland, Ohio, also trained by RML. The NPDPSC was founded by the CDC as a result of the mad cow disease scare, that happened many years ago, to monitor this disease threat in the future.

“The problem is they’re not a traditional reference lab,” says Dr. Mills. “They offer a prion test, but one of our concerns was that their turnaround time (for a test result) is long. They’re not operating in the normal reference lab industry standards where you have 24/7 lab coverage including holidays.  We knew we could provide a faster turnaround time, innovate around the technology, and increase accessibility of this testing through Mayo Clinic Laboratories.”

Dr. Mills continues, “In addition, Mayo Clinic strives to offer a one-stop shop for diagnostic testing. This test fits in nicely with that philosophy. Our patients were waiting a long time for diagnostic answers. And having to wait has a huge impact on them and their family.”         

Now, patients showing symptoms of a rapidly progressive form of dementia can get a definitive answer, quickly, with a highly sensitive test. This small comfort is what drove Mayo Clinic to send a team to Montana, build an entirely new lab space, and automate a complex research test for clinical use. “There was a lot of heavy lifting that had to happen in the clinical lab, because this test is very unique from everything else we do,” says Dr. Mills. “But Mayo Clinic and our people have a history of supporting complex projects, even when they seem daunting to do, especially if there is an opportunity to improve patient care.”

This article first published on the Mayo Clinic Laboratories blog.

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Dr. Victoria Clark, a Mayo Clinic neurosurgeon and researcher, focuses on finding better treatments for patients with meningiomas, now and in the future. 

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Meningiomas are usually noncancerous tumors that form in the membranes surrounding the brain. It may sound strange, but some of these tumors may not need treatment.

"But for the ones that grow or for the ones that cause symptoms, they do require treatment, which is either surgery and/or radiation," says Dr. Clark.

The goal of the surgery is to take out as much of the tumor as possible.

"Meningiomas have this tendency to enwrap very critical structures, like the types of nerves that control sight or control hearing, facial expression, and also encircle around critical blood vessels," she says.

Better tools allow for better outcomes.

"We have what's called navigation. So that allows us to use a pre-op MRI, sort of a GPS for the brain, to know exactly where the tumor is in relationship to the structures that we're trying to preserve and avoid," says Dr. Clark.

Advanced imaging tools used in the operating room help ensure surgeons remove all the tumor.

"Brain surgery is much safer with all of these wonderful new technologies," she says.

Research

While these advancements help patients now, Dr. Clark is looking to the future.

"My hope is that the research that we will do will create new medical treatments that can be used in combination with the surgeries and radiation that are currently available in order to improve the treatment for patients with meningiomas," says Dr. Clark.

The post VIDEO: Making surgery for meningiomas safer with advanced technology appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: A friend from my book club recently had a stroke. I learned that women have a higher risk of strokes. What are the risk factors, and are there signs to watch for that indicate someone is having a stroke? 

ANSWER: A stroke can happen at any time and to anyone. You might be talking to your loved one and notice they're suddenly slurring their words. Or, while grocery shopping, you realize you can't move your hand to pick up a jar from the shelf. You can go from feeling as usual to feeling sick within a matter of seconds to minutes. Here are five key things to know about stroke.

1. Strokes affect the oxygen and nutrients supplied to your brain.

Strokes occur when nutrients and oxygen are not delivered to the brain through blood vessels, leading to the death of brain cells. This lack of delivery can be caused by a clot in a blood vessel obstructing the blood flow to the brain, known as an ischemic stroke, or when a blood vessel ruptures and prevents blood flow to the brain, known as a hemorrhagic stroke.

Sometimes, the obstruction to the blood flow and the resulting symptoms are caused by a temporary clot and are transient, resulting in a transient ischemic attack, or TIA, often called a ministroke.

2. Strokes can happen to anyone.

Strokes can happen to anyone regardless of age, gender or race. Certain risk factors can put you at a higher risk of stroke.

Risk factors are divided into two categories:

• Controllable — the ones you can control or improve
• Uncontrollable — those that are not within your control

Common controllable risk factors include:

• Atrial fibrillation, which increases stroke risk by five times
• Diabetes
• Excessive alcohol intake — an average of more than one drink per day for women or more than two drinks a day for men
• High blood pressure
• High cholesterol
• Obesity
• Obstructive sleep apnea
• Physical inactivity
• Smoking or vaping

Uncontrollable risk factors include:

• Gender
• Heredity
• Increasing age
• Race

3. Be prepared to spot the signs of a stroke.

Learn to recognize the signs of stroke quickly.

The American Stroke Association lists these symptoms to help you know when to seek medical care:

F = Face drooping: Ask the person to smile and see if the smile is uneven.

A = Arm weakness: Ask the person to raise both arms and see if one arm drifts down.

S = Speech difficulty: Ask the person to speak and see if the speech is slurred.

T = Time to call 911: Stroke is an emergency. Call 911 at once. Note the time when any of the symptoms first appear.

Other stroke symptoms to watch for include:

• Numbness of the face, arm or leg, especially on one side of the bod.
• Sudden confusion, trouble speaking or difficulty understanding speech.
• Sudden-onset, severe headache with no known cause.
• Sudden vision issues, such as trouble seeing in one or both eyes.
• Trouble walking, loss of balance, dizziness or coordination.

If you or someone you are with have any strokelike symptoms, seek immediate medical care.

4. A stroke is a medical emergency.

Every second counts when someone is experiencing a stroke. Once a stroke starts, the brain loses around 1.9 million neurons each minute. For every hour without treatment, the brain loses as many neurons as it typically does in nearly 3.6 years of regular aging.

While waiting for paramedics, do these things if possible:

• If the person is conscious, lay them down on their side with their head slightly raised and supported to prevent falls.
• Loosen any restrictive clothing that could cause breathing difficulties.
• If weakness is obvious in any limb, support it and avoid pulling on it when moving the person.
• If the person is unconscious, check their breathing and pulse, and put them on their side.
• If they do not have a pulse or are not breathing, start CPR straight away.

5. Women have an increased risk of stroke.

According to the American Stroke Association, stroke is the third most common cause of death in women. Over 90,000 women die from a stroke in the U.S. each year. Every 1 in 5 women will have a stroke, and about 55,000 more women than men have a stroke each year, with Black women having the highest prevalence of stroke.

The risk of stroke increases in women who smoke, have atrial fibrillation or migraines with aura, take birth control pills, use hormonal replacement therapy, are pregnant, or have preeclampsia.

Talk to your healthcare team about your stroke risk and ways to lower your risk by addressing controllable factors. — Prashant Natteru, M.B.B.S., M.D., Neurology, Mayo Clinic Health System, La Crosse, Wisconsin

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DEAR MAYO CLINIC: My neighbor had a stroke and received a "clot buster" medication. Then, I found out my uncle had a surgery after a stroke. Can you help me understand different kinds of stroke treatments? My neighbor seems almost back to normal, but my uncle is still in rehabilitation because of some paralysis on his left side.

ANSWER: We have excellent treatments to reverse stroke symptoms, but these treatments are incredibly time dependent. This is a good opportunity to remind people to seek emergency medical care — call 911 — as soon as possible at the first sign of a stroke.

Treatments also depend on the type of stroke. During an ischemic stroke, blood vessels in the brain are blocked or narrowed. During a hemorrhagic stroke, there's bleeding into the brain.

The first treatment for stroke is to potentially offer a medication called tissue plasminogen activator (TPA) that helps dissolve blood clots. This often is called a clot buster. It has to be given within 4.5 hours from when symptoms began.

These drugs are administered by IV, and they can help dissolve blood clots in the brain and restore blood flow. The faster you're able to restore blood flow, the less likely that the stroke symptoms are permanent. 

Another treatment for stroke is a flexible tube called a catheter that is placed in the blood vessels at the groin. The catheter is navigated up to that clot in the brain using X-ray. A device can be administered to help remove that blood clot. This procedure can help with large clots that can't be dissolved with TPA. This procedure often is performed in combination with TPA that's injected into the bloodstream.

Hemorrhagic stroke is treated by lowering blood pressure to help prevent continued bleeding. So if people are on blood thinners, we use other medications to try to reverse the blood thinner medications. If patients have a coagulopathy, or a tendency to bleed, medication is used to try to reverse that. 

Then there are surgical interventions that potentially help remove that blood in the brain to prevent the downstream swelling that can occur after a brain bleed.

Unfortunately, stroke outcomes are incredibly variable. We'd love to have excellent outcomes for every patient who experiences an acute stroke. But with timeliness of treatment, we are much more likely to have a favorable outcome. 

The goal is to keep people independent after their stroke. So the faster someone arrives to the hospital, the more likely to achieve that outcome. 

Stroke symptoms include trouble speaking and understanding others; numbness or weakness, often on one side of the face, arms or legs; vision problems; a severe headache; and trouble walking. 

We use an acronym you may have heard previously to help people recognize warning signs of a stroke:

FAST

• F = Face drooping: Ask the person to smile. Does one side of the face droop?
• A = Arm weakness: Ask the person to raise both arms and see if one arm drifts down or if one arm is unable to be lifted.
• S = Speech difficulty: Ask the person to speak and see if the speech is slurred.
• T = Time to call 911: Stroke is an emergency.

With any of these signs, call 911 or emergency medical care at once to allow for the treatment of stroke. Note the time when any of the symptoms first appear. — Stephen English Jr., M.D., Neurology, Mayo Clinic, Jacksonville, Florida

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A 3D animation of the region of the brain called the motor thalamus (shown in red and yellow) where Mayo Clinic researchers detected more precise information about brain cell activity in patients during deep brain stimulation (DBS). DBS electrodes are placed into the motor thalamus to treat movement disorders.

Mayo Clinic researchers have found a new way to more precisely detect and monitor brain cell activity during deep brain stimulation, a common treatment for movement disorders such as Parkinson's disease and tremor. This precision may help doctors adjust electrode placement and stimulation in real time, providing better, more personalized care for patients receiving the surgical procedure.

Deep brain stimulation (DBS) involves implanting electrodes in the brain that emit electrical pulses to alleviate symptoms. The electrodes remain inside the brain connected to a battery implanted near the collarbone and controlled by a remote control. While a neurologist and neurosurgeon monitor the brain waves throughout the surgery, the monitoring typically is limited to a narrow frequency range that provides a rough snapshot of brain activity.

However, Mayo Clinic researchers used more sensitive, research-grade equipment and custom algorithms to record a broader frequency range of brain cell activity that yielded higher resolution and more precise information on when and where brain cells were firing in patients during DBS surgery.

"We looked at brain activity in a different way and recorded a type of brain signal called 'broadband' that reflects the combined activity across all frequencies and is related to the firing of all brain cells in that region. We found that the broadband activity signal increased with movement and was more precise in location than the standard, more narrow frequency signal," says neurologist Bryan Klassen, M.D., lead author of the study published in the Journal of Neurophysiology.

Dr. Klassen and colleagues detected the broadband signal in the motor thalamus, a region deep within the brain that controls movement. Previous studies have detected it only on the surface of the brain.

The researchers recorded broadband signals associated with hand movement in 15 patients undergoing awake DBS. Each of the patients were instructed to open and close their hands while the researchers recorded brain cell activity in their thalamus. 

"This study enhances our understanding of how the thalamus, a brain region that is frequently targeted for deep brain stimulation, processes movement. It may lead to more precise mapping of the brain as well," says Mayo Clinic coauthor Matthew Baker, Ph.D., a postdoctoral fellow in the neurosurgery department.

Using broadband to monitor during DBS surgery may improve the treatment and outcomes for patients.

"These findings underscore the remarkable advances we can achieve through the close collaboration between the neurology and neurosurgery departments and will help us develop the next generation of brain stimulation therapies," says neurosurgeon Kai Miller, M.D., Ph.D., senior author of the study.

The next steps for this research involve further exploring how these brain activity patterns in the thalamus can be used to improve neurostimulation therapy, says Dr. Baker, a recent graduate of Mayo Clinic Graduate School of Biomedical Sciences.

"We will be investigating how this signal responds to different types of movements and whether we can use it to control new devices that only stimulate when patients need it, as opposed to constant stimulation, which is more prone to cause side effects," he says.

Review the study for a complete list of authors, disclosures and funding.

The post Thinking outside the box: Uncovering a novel approach to brainwave monitoring appeared first on Mayo Clinic News Network.

Dizziness, headaches, confusion, fatigue, blurry vision and sensitivity to light are among the most common symptoms of a concussion. Once these symptoms have subsided and patients begin to resume their regular activities, they also may experience often-overlooked, underlying effects of concussion — persistent ringing in their ears, sensitivity to noise and hearing difficulties.

A concussion is a mild form of traumatic brain injury caused by an impact to the head. It can change brain cells, including those associated with hearing. Some of these changes will heal, while others are permanent.

Hearing can be affected in adults and children who have been diagnosed with concussions following common incidents such as a head injury from a fall, vehicle accident or riding a bike without a helmet. Other people, like athletes or military service members, can be affected due to their sports activities or professions.

How a concussion can affect your ears

Tiny hair cells line your inner ears. These hair cells are crucial for changing the energy from the vibrations of your eardrum and middle ear bones into electrical energy that can move through the nerves to the brain for processing.

Think of these tiny hair cells as blades of grass. When you step on the grass, some blades spring back up, while others stay flattened or broken. The hairs in your ears are the same. Those that are damaged by a concussion can't be regrown or repaired, and they can no longer send signals to the brain.

This damage to the hair cells can cause ringing in the ears — known as tinnitus — hearing loss, noise sensitivity and the inability to correctly process sounds, such as speech.

How a concussion can affect sound processing

Tiny nerve cells in the ears detect sounds and pass the signals to the brain, where the sounds are processed. Any injury to the nerve cells can disrupt this process. Those who have experienced a concussion may have difficulty distinguishing words in noisy environments, although their overall hearing may be fine.

Researchers have tested athletes who have had concussions, using a tool called Speech-in-Noise exams. The athlete listened to a simple sentence such as "Sugar is sweet." The phrase was repeated with increasingly loud background noise. Researchers found that the louder the background noise, the less able the athlete was to distinguish the words.

Other tests have revealed that athletes who have had concussions also may be hypersensitive to sounds or have difficulty processing rapidly spoken words.

Don't ignore hearing issues

People of all ages can experience concussions from various activities or as the result of an accident, including:

• Accidental falls
• Basketball
• Bicycling
• Car accidents
• Football
• Hockey
• Inline skating
• Skateboarding
• Soccer
• Volleyball
• Winter sports like skiing and sledding

If your child has experienced a concussion, once their major concussion symptoms have eased it's essential to take note if they comment about dizziness, ringing in their ears or having trouble hearing. Some of these symptoms may improve, while others may be permanent.

Hearing or sound processing issues may also show up as difficulty concentrating or new challenges with schoolwork.

Where to seek help

When seeking help for suspected hearing issues from a concussion, consider consulting an ear, nose and throat (ENT) specialist who can assess ear health and determine if any previous underlying conditions could be contributing to the symptoms.

An audiologist can assist with dizziness and balance issues, test hearing and provide tools and strategies for managing symptoms. In more severe cases, an audiologist may determine if hearing aids are needed and discuss options to address hearing issues.

Katie Dease, Au.D., is an audiologist in Audiology in Owatonna, Minnesota.

This article first published on the Mayo Clinic Health System blog.

The post Don’t miss a quiet symptom of concussion appeared first on Mayo Clinic News Network.

Alzheimer's disease affects nearly seven million Americans over the age of 65, or 1 in 9 people in this age group, according to the Alzheimer's Association. Symptoms such as memory loss, trouble concentrating and performing familiar tasks, and personality changes start slowly and progress. Researchers have come a long way in understanding Alzheimer's disease and Alzheimer's Disease Related Dementias (AD/ADRD). A new consensus study report, "Preventing and Treating Dementia: Research Priorities to Accelerate Progress," identifies prevention and treatment strategies for the next decade.  

"We need cutting-edge treatments to help improve the lives of patients who are suffering from debilitating symptoms of dementia and prevention for those at risk," says Nilüfer Ertekin-Taner, M.D., Ph.D., chair of the Department of Neuroscience at Mayo Clinic and leader of the Genetics of Alzheimer's Disease and Endophenotypes Laboratory at Mayo Clinic's campus in Florida. "Neurodegenerative diseases not only affect patients but also the friends and family who care for them."

Dr. Ertekin-Taner served on the select ad hoc committee of the National Academies of Sciences, Engineering, and Medicine (NASEM) which conducted a study assessing the state of research on AD/ADRD and outlined critical research priorities for treatment and prevention, as well as potential barriers to progress. The National Institutes of Health, National Institute on Aging, and National Institute of Neurological Disorders and Stroke asked NASEM to form the committee in response to a request from the U.S. Congress to accelerate research into these diseases.

Researchers looked broadly at the field, including basic to translational to clinical research; lifestyle interventions aimed at preventing and treating AD/ADRD; barriers to advancing progress in the field; and the most promising areas of research. The study looked at Alzheimer's disease, frontotemporal dementia, Lewy body dementia and other vascular causes of cognitive impairment and dementia.

The report identified 11 research priorities for further NIH-funded biomedical research, including:

• Developing better tools, including novel biomarker tests and digital assessment technologies, to monitor brain health across the life course and to screen, predict and diagnose AD/ADRD at scale.

• Implementing advances in clinical research methods and tools to generate data from real-world clinical practice settings that can inform future research.

• Identifying factors driving AD/ADRD risk in diverse populations, particularly understudied and disproportionately affected groups, to better understand disease heterogeneity — including molecular subtypes and disparities in environmental exposures — and to identify prevention opportunities and advance health research equity.

• Characterizing the exposome and gene-environment interactions across the life course to gain insights into biological mechanisms and identify opportunities to reduce AD/ADRD risk and increase resilience.

• Integrating innovative approaches and novel tools into the planning, design and execution of studies to accelerate the identification of effective interventions.

• Advancing the development and evaluation of combination therapies (including pharmacological and nonpharmacological approaches) to better address the multifactorial nature of AD/ADRD.

• Evaluating precision medicine approaches for the prevention and treatment of AD/ADRD to better identify interventions likely to benefit specific groups of individuals.

The report calls for breaking down silos for more collaborative, multidisciplinary research; fostering inclusive research to eliminate health disparities; developing innovative funding strategies; and increasing innovation in research through the expansion of public-private partnerships, among others.

"The past decade of research investments in AD/ADRD has led to significant progress in our understanding of these diseases, bringing us closer to treatments," Dr. Taner said. "In the next decade, we must maintain the momentum of research and innovation to translate these advances to cures for millions of patients and caregivers affected by the dementia epidemic."

Note: Dr. Ertekin-Taner will participate in a webinar on Jan. 15 with other committee members to discuss the report.

The post Mayo Clinic contributes to national Alzheimer’s disease research priorities in new report appeared first on Mayo Clinic News Network.

Most patients with Alzheimer's disease and Alzheimer's Disease Related Dementias (ADRD) experience the gradual onset and progression of cognitive symptoms, leading to decline over years or decades. However, in a small subset of patients, symptoms begin rapidly, leading to dementia within one year and complete incapacitation within two years of symptom onset. A new study at Mayo Clinic aims to determine why patients with Alzheimer’s disease and ADRD develop this rapidly progressive dementia (RPD).

"The factors that give rise to extreme, rapidly progressive clinical traits are unknown," says Gregg Day, M.D., a neurologist and clinical researcher at Mayo Clinic in Florida. "These cases are challenging to treat in practice because there are many possible causes and diseases to consider, many tests that can be done and a clear need to coordinate evaluations rapidly."

Dr. Day will lead a team of researchers from Mayo Clinic in Florida and Rochester, Minnesota, to study the biology of RPD through a project funded by the National Institute on Aging of the National Institutes of Health (NIA/NIH).

Specifically, the research team and collaborators aim to:

• Determine the factors that make patients with Alzheimer's disease and ADRD susceptible to RPD.
• Study the contributions of amyloid and tau toxic proteins and vascular changes in the brain to rates of progression in patients with Alzheimer's disease and ADRD.
• Identify cellular pathways that contribute to rapid declines in patients with Alzheimer's disease and ADRD.

The researchers plan to collect clinical and genomic information from 120 diverse patients with rapid progressive Alzheimer's disease and ADRD over the next three years. Findings in patients with RPD, identified through Alzheimer's Disease Research Centers studies nationally, will be compared with data from participants with typical progressive Alzheimer's disease and ADRD enrolled in studies at the Alzheimer's Disease Research Center at Mayo Clinic.  

The team hopes to learn how factors such as age, sex, medical history, structural and social determinants of health, genetic variants and other brain changes may make some patients more susceptible to rapid decline. Findings will be validated through expansive protein analyses in cerebrospinal fluid from an independent group of patients with autopsy-confirmed rapid progressive Alzheimer's disease and ADRD. Results will be extended to identify biomarkers and disease-modifying targets that may improve diagnosis and treatment of patients with Alzheimer's disease and ADRD.

"This project represents a substantial investment from NIH to study patients with RPD," says Dr. Day. "We hope the results of our research will inform new approaches, diagnostic tests and treatment targets that will improve outcomes in patients with AD/ADRD. The ultimate goal is to slow down the pathologic progression of disease in these patients, independent of their rate of decline."

The research will combine Mayo Clinic's expertise in digital innovation and telemedicine to engage patients across the United States. This study will also leverage Mayo's Clinical Trials Beyond Walls program, which allows patients to complete some, if not all assessments from the comfort of their own homes or local community facilities. The decentralized clinical trials initiative is designed to remove barriers to clinical trial participation by providing digital solutions and remote services to reimagine the trial experience for all involved, including participants, investigators, study teams and clinical care providers. Decentralized research ― studies conducted outside the walls of traditional research facilities ― may use a wide range of technologies and services such as telehealth, remote monitoring, mobile phlebotomy, retail pharmacy and home healthcare.

Other Mayo Clinic researchers working on this project include:

• Christian Lachner, M.D.
• Neill Graff-Radford, M.D.
• Leonard Petrucelli, M.D., Ph.D.
• Tania Gendron, Ph.D.
• Manoj Jain, M.D.
• Owen Ross, Ph.D.
• Nilufer Ertekin-Taner, M.D., Ph.D.
• Dennis Dickson, Ph.D.
• Melissa Murray, Ph.D.
• Vijay Ramanan, M.D., Ph.D.
• David T. Jones, M.D.
• Prashanthi Vemuri, Ph.D.
• Alicia Algeciras-Schimnich, Ph.D.
• John R. Mills, Ph.D.
• Rickey Carter, Ph.D.
• Lauren Haydu, Ph.D.

The research will be made possible through NIH grant award number R01 AG089380.

Related:

Researchers identify new criteria to detect rapidly progressive dementia

Researchers find other diseases may mimic rare brain disorder linked to dementia

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