Q+A with Keith L. Black, MD
Neurosurgeon Keith L. Black, MD, has led pioneering advances in the understanding and surgical treatment of brain cancers and complex neurological conditions. Under his direction, scientists at the Maxine Dunitz Neurosurgical Institute are currently pursuing a breakthrough study of Alzheimer’s disease focused on early detection using a simple eye exam. This work took on greater significance for Dr. Black when his mother, Lillian, was diagnosed with Alzheimer’s several years ago.
Q: Your focus on Alzheimer’s disease research has a very personal foundation.
A: The disease took my mother’s life in 2012, and going through this physically exhausting and emotionally draining experience gave me personal insight into the toll Alzheimer’s takes on families. It strengthened my resolve to help find a cure. Alzheimer’s patients face a long, steady decline that places unbearable stress on relationships, and even livelihoods. The disease also pressures our healthcare system. If we fail to solve this problem as the population continues to age, Alzheimer’s alone has the potential to bankrupt Medicare.
Q: Any hope for treatments on the horizon?
A: Yes. I think we’ll start to see therapies entering clinical trials in just a few years. Pharmaceutical companies are researching drugs to stop the accumulation of neuron-killing proteins, or plaques, in the brain, and we believe these medications will lessen the disease’s effects. But getting to the source of the proteins—which we think is an intense and complex inflammatory cascade—could be even more effective. So far, in animal models, we have seen that if we modulate inflammation in the brain, we can significantly slow the disease’s progression. Whether we focus on plaque or the immune system, early detection will be the most effective treatment.
Q: Why early detection?
A. In Alzheimer’s, brain cells start to die 10, 15, or 20 years before symptoms appear. By the time we observe memory lapses, 40 percent to 50 percent of brain cells are gone, and it’s too late to make a difference. To turn this around, we have to detect the disease earlier, and we need a practical, noninvasive way to distinguish Alzheimer’s from other disorders. Today’s imaging systems simply do not provide that level of detail. But what if we could offer early diagnosis by simply looking into a person’s eyes? A clinical trial is going on right now to help determine the answer.
Q: What’s involved?
A: We discovered that beta-amyloid protein plaques accumulate in the brains of Alzheimer’s patients and also form in the retina in the back of the eye, where they can be seen even before they accumulate in the brain. We created an investigational device that allows us to look into the eye—just as an ophthalmologist does to diagnose retinal disease—and see these plaques. The system was effective in animal models, and if the clinical trial, which is under way at several sites across the country, produces similar results, we could soon have a quick, inexpensive, and painless way to provide early screening.
Q: What good is early detection if there is no cure?
A: Think about how we manage diabetes today. If you detect it early, you can take steps to regulate your blood sugar, which will help you avoid kidney disease, eye disorders, nerve damage, and other serious consequences. But if you go to your doctor after having uncontrolled diabetes for 10 or 20 years, and you already have organ failure, gaining control of your blood sugar will not reverse the damage. Similarly, even before we have a cure for Alzheimer’s, I believe we may be able to control some of its destructive effects, but the key is to move the focus to the early stage when intervention may help.
Q: So the goal could be long-term management rather than total cure?
A: A cure is the ultimate goal, but long-term management might often be effective. If we can make it so that memory loss begins at age 100 rather than at 75, most Alzheimer’s patients could enjoy a good quality of life instead of spending their last five, 10, or 20 years in a nursing home unable to recognize their loved ones. This scenario is much easier to imagine with Alzheimer’s than with cancer. With brain tumors, we have to remove or kill 100 percent of diseased cells. If we leave even 1 percent behind, the cancer can recur. With Alzheimer’s, we could greatly improve people’s lives by simply slowing the process or stopping the destructive pattern of the disease—a much more attainable objective.
Dr. Keith L. Black is chair and professor of the Department of Neurosurgery at Cedars-Sinai, director of the Maxine Dunitz Neurosurgical Institute and the Johnnie L. Cochran, Jr. Brain Tumor Center, and the Ruth and Lawrence Harvey Chair in Neuroscience.