Alzheimer's in Arizona: One Group's Search for Biomarkers

Andrew N. Wilner, MD

Disclosures

September 19, 2016

Andrew Wilner, MD: This is Dr Andrew Wilner, speaking with Dr Bryan Woodruff, assistant professor of neurology at the Mayo Clinic in Phoenix, Arizona, and a specialist in cognitive behavioral neurology.

Dr Woodruff, I understand that you're involved with the Arizona Alzheimer's Consortium (AAC). What is its main purpose?

About the AAC

Dr Woodruff: As the name suggests, we are interested in better understanding Alzheimer's disease, which is a major problem. Anyone who works in medical specialties seeing aging patients realizes that Alzheimer's and other forms of dementia are very common and represent a big burden, not only for the patients and their families, but also for society, given the cost of care for individuals with progressive cognitive impairment.

The AAC is a multicenter initiative. We have a group of clinicians like myself who are actively seeing patients in the community with various types of cognitive dysfunction. Some of these patients have mild cognitive impairment, some have dementia due to Alzheimer's disease, and others have degenerative dementias, such dementia with Lewy bodies, frontotemporal dementia, and vascular dementia. Of course, the AAC's focus is Alzheimer's disease, because it is the most common of all of those disorders.

We collaborate across multiple institutions, including the Mayo Clinic, the Banner Alzheimer's Institute, the Barrow Neurological Institute, and the Translational Genomics Research Institute—all in Phoenix—and the Banner Sun Health Research Institute, in Sun City, Arizona, where our neuropathology core is located. We also have colleagues in Tucson, Arizona, affiliated with the Veterans Affairs hospital there and the University of Arizona. In addition, we collaborate with researchers at Arizona State University in Tempe. I am probably leaving some groups out. It's a very broad group of researchers, not just clinicians, but also basic scientists involved in bioinformatics, genetics, neuropathology, imaging, et cetera.

Clinicians such as myself are obviously seeing individuals with these disorders as part of our clinical practice. We consider recruiting local patients into a longitudinal study where they're followed over time. Many of those individuals have had serial neuropsychological testing to characterize the change over time in their cognitive status. Also, they provide blood and DNA specimens, which our basic scientist colleagues are actively involved in researching to look for biomarkers of dementia.

Individuals who are recruited into our longitudinal study are invited to participate in our brain bank program. Eventually, when they pass away, they are donating their brains to science. One of the key resources—and frankly, it's a scarce one in neuroscience research—is the availability of brain tissue. Dr Thomas Beach, who is the head of our neuropathology core, prides himself on having one of the most renowned brain bank centers in the country. This is partially because we have one of the shortest postmortem intervals—the time from when an individual passes away to when we obtain the brain tissue—and that's very important for good-quality neuropathology research.

Dr Wilner: That sounds like a delicate discussion to have with patients. At what point do you raise the possibility that their brains might contribute to science?

Dr Woodruff: It's often an ongoing discussion. If I think someone is a good candidate for that research project, we talk about the option of participating in a study. We make it clear to individuals that, for the most part, this is an opportunity to gather more information about the disease itself. There is not a guarantee, of course, that the research is going to directly help them, but it may help generations of future patients. When looking at it that way, most people are more than happy to participate. But it's usually a process. Once I've gotten to know an individual and have completed my initial round of diagnostic evaluations, that's when I broach a sensitive topic like that. But it usually doesn't raise eyebrows, shall we say.

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