Discoveries Magazine

Cedars-Sinai

Q+A with Keith L. Black, MD

Keith L. Black, MDSetting His Sights on Alzheimer’s Disease

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.

Press Delay: Keith Black discusses the benefits of early detection of Alzheimer’s at the Solve for X global forum »

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.

Tags: , , , , ,

Comments do not necessarily reflect the opinions of Cedars-Sinai. Cedars-Sinai does not endorse any product, service, or views posted here.

16 Responses

  1. Regina Jones says:

    Good article filled with information and the truth that clinical trials should start in a few years. I wish I was young enough to be a part of those trials. I hunger for the truth and it does not make me feel hopeless but clear that I have to keep trying my best to be healthy no matter how hard it is.

  2. Bob Greenberg says:

    Excellent article — in plain English too!

  3. Paula L. Smith says:

    Dear Dr. Black, so sorry to hear about your loss. My father has been suffering from Alzheimers for many, many years. His twin, died from Alzheimers. My father is now in hospice care and my mother who is in her late 70′s is his primary caregiver, although we as a family are pitching in as to not to exhaust her.

    I was diagnosed with MS 15 years ago and I am doing well. However, MS has some similar brain disorders as Alzheimers. I remember feeling a fog over my brain and could not think straight and got lost. I am 52 years old and taking precautionary measures such as staying healthy. I do not know if having a diagnosis with MS will put me at risk for Alzheimers. I try not to think about it and live my life day to day. I am so very grateful to see that you have taken a special personal interest in finding a cure. Kind Regards, Paula Smith

  4. Tobie says:

    Excellent article. Could you please write about the corelation to Dementia.Is that what the beginning stage of Alzheimers would be.

    • Discoveries Admin says:

      Thank you for your question.

      Dr. Black has responded to your question below.

      Alzheimer’s disease is one form of dementia. There are several others. In fact, Alzheimer’s sometimes is called Alzheimer’s dementia. It is the most common, but not the only cause of dementia, which is a general term for memory loss and other problems associated with the thinking process that are serious enough to interfere with daily life.

      Dementia – memory and thinking difficulties – can be caused by blood vessel changes and strokes in the brain or certain medications or drug interactions. Some dementias tend to occur along with certain diseases, such as Huntington’s and Parkinson’s. Others may result from medical conditions, such as certain extreme vitamin deficiencies.

      The first stages or symptoms are not the same for each disease or cause. In Alzheimer’s, problems with short-term memory often are seen first and other symptoms begin later as the disease progresses. It often isn’t easy to quickly diagnose which type of dementia, if any, may be causing memory problems. A neurologist can perform lab tests and clinical evaluations that will begin to identify the source of a cognitive disorder.

  5. Francoise Bush says:

    MY CONDOLEANCES TO DR. BLACK.
    I WOULD BE VERY INTERESTED TO KNOW THE NAME OF THE EYE TEST AND WHERE TO HAVE IT DONE
    THANK YOU IN ADVANCE

    • Discoveries Admin says:

      We are asking our expert medical staff and will get back to you as soon as we can.

    • Discoveries Admin says:

      Dear Francoise,
      Thank you for your interest in this story and for your question. The eye test for early detection of Alzheimer’s is in clinical trial stage. The company managing the trial is Neurovision Imaging, under Study Protocol NVI002. For more information, please email info@neurovisionimaging.com. Good luck!

  6. Vincent D. Perez says:

    Hi Dr. Black, Sorry to hear about your mother.Is there a way of determining the difference
    between regular forgetfulness and Alzheimer sysmtoms at age 83? Thank you.

    • Discoveries Admin says:

      Thank you for your question.

      Dr. Black has responded to your question below.

      “All of us, young and old, forget things from time to time, and there are many factors that can affect memory. Inadequate nutrition, alcohol and drugs, stress and sleep deprivation are a few common things that may affect mental function and recall. Incidental lapses in memory – such as forgetting where you put your keys – usually are not signs of Alzheimer’s or dementia. But if there is a noticeable consistency in memory lapses, or if there’s something routine that you no longer remember how to do – such as if you forget what the keys are for or how to use them – something more significant may be going on. If memory, cognitive or behavioral issues appear to be increasing, consulting a neurologist may be in order. He or she could help allay your fears or determine if problems may be a sign of Alzheimer’s or another type of dementia. Not all, but some forms may be treatable.”

  7. Gerardo Castineira says:

    Keep at it! You are right in that this will be a disaster for Medicare and for many families. I am now in my mid-seventies and I am scared witless because I have some memory lapses that may be the prelude and I certainly do NOT want to become a burden for anybody.

  8. Ever since I first heard of Dr. Black some 20+ years ago, I have been enthralled with his intellect, enthusiasm and committment to helping people live better lives.
    The concept of determining onset of Alzheimer’s Disease as early as possible in order to provide at least some measure of intervention is another one of his trailblazing ideas. For the sake of sufferers, I hope that the trials will come as soon as is feasible.

  9. Gale Calvin says:

    Dear Dr. Black sorry your mother had this dreaded disease. My mother passed as well April 2013.
    It is not easy to get over seeing the deterioration take places, it still hurts my heart. I know if anyone can help with this disease it’s you. Thank you for connecting the retina and when this test is perfected it will be non-invasive.
    I would like to find out if I have have the trait but also afraid to know, especially after watching my mother go from an outgoing, fun loving personality to not knowing me. However I don’t want my daughter to go through what I had to endure.
    So again thank you.
    God’s blessing.

  10. Paula Willoughby says:

    Dear Dr. Black Is Alzheimer’s inheritable? My Grand Mother and Mother both died from this disease. So I along with my sister are very concerned with the dreadful illness.

    • Discoveries Admin says:

      Thank you for your very important question, Paula. We asked Dr. Black to answer this, and here is his response:

      “The short answer is yes, there is a genetic risk, based on several genes, such as ApoE4, that can be inherited. You may want to consider undergoing genetic testing to look for these genes. On the positive side, there is significant scientific evidence that good nutrition – a heart- and brain-healthy diet – and exercise – such as brisk walking 30 minutes a day – may alter the course of this disease. And I believe we are only a few years away from beginning to see treatments that may slow or even reverse some of its effects.”

  11. Deb V says:

    Dr Black. I’m so thrilled to have run into you again on the Cedars Sinai site. My husband and I met you about 15 years ago when you removed a brain tumor from our son’s brain. Your interest in Alzheimer’s is fabulous for mankind. I am sorry to hear about your loss and my condolences. What an insidious disease. My father is showing signs of it at age 89. Two of his sisters have passed with Alzheimer’s and dementia. I understand there is a genetic component and this worries me greatly. My lifestyle is pretty impeccable. A thorough regimen of vitamins, green juices, mostly plant based eating, no alcohol or tobacco. Your comments to responders of the article have been helpful and I will do just that; have my father see a neurologist and also do genetic testing for myself and siblings. Keep fighting the fight. Me and my family appreciate you.

Leave a Comment


+ 3 = nine