Our ability to technologically assess the brain has room for improvement, according to panelists at the recent Association of Health Care Journalism 2015 conference. Amit Etkin, PhD, MD, a neuropsychiatrist at Stanford, summed it up when he said, “We need to develop tools to answer questions we want to ask, rather than ask questions we can answer with the tools we have.”
Etkin asserted that there have been no fundamental advances in psychiatry since 1987; all the medications put out now are basically the same, and the treatments work partially, sometimes, and for only some people. Interdisciplinary work combining psychiatry, neuroscience, and radiology is the frontier: Researchers are just getting a sense of how “interventional neuroscience,” such as that pioneered at the interdisciplinary NeuroCircuit initiative at the Stanford Neurosciences Institute, can identify which brain regions control various processes. This involves looking at brain signatures that are common across disorders, instead of dividing and parsing symptoms, which is the approach of the Diagnostic and Statistical Manual of Mental Disorders.
Researchers are searching for an ideal marker for Alzheimer’s: something predictive (will you get the disease?), diagnostic (do you have the disease?), and dynamic (how severe is your disease right now?)
Michael Greicius, MD, MPH, professor of neurology and neurological sciences at Stanford, researches Alzheimer’s and has a bone to pick with media hype about Alzheimer’s research conducted in mice. What the mice have shouldn’t be considered the same condition, he says, so he’s termed it “mouseheimer’s.” Only 2 percent of the Alzheimer’s population has the dominant, inherited, exceedingly potent genetic form, which is the form used in research on rodents. Further, the mice are double or even triple transgenic. We still use these improbable biological hosts because we need an artificial model: Alzheimer’s is really just a human thing, and even great apes don’t get it. The next best modeling possibility, he suggested, are flies.
But silly names aside, Greicius’ assessment of Alzheimer’s research is that a breakthrough is needed. Researchers are searching for an ideal marker by which the progression of the disease could be noted: something predictive (will you get the disease?), diagnostic (do you have the disease?), and dynamic (how severe is your disease right now?). We need a marker to predict who will progress to Alzheimer’s from mild cognitive impairment, a common condition of aging. Current ideas include looking at spinal fluid and plaque between neurons, and the not-yet-FDA-approved Tau imaging.
Pratik Mukherjee, MD, PhD, professor and neuro-radiologist at UCSF, started his talk noting how far we’ve come from 1973, when cerebral angiography and pneumoencephalography were the only options for brain imaging, technologies that were “completely barbaric!” That was the year CT scans arrived on the scene, followed by the watershed of the MRI in 1984. But since then, innovations have been scarce. “Clinical brain imaging is not currently useful for the majority of neuropsychological diseases,” Mukherjee noted, and considering that neurological disorders and neurodegenerative diseases are an enormous (and growing) source of morbidity, the time is ripe for innovation. New concern with things like sports concussions and sensory processing disorder increases the need. Something on the horizon is MRI corticography, a cheap process that produces exquisite images and is being pioneered at UCSF and UC Berkeley.
Previously: Stanford bioengineers and clinicians team up to shed light on how concussions affect the brain and A one-minute mind reading machine? Brain-scan results distinguish mental states
Photo by Eric Wienke