A lot of doctors know from the beginning of their training what they want to focus on. For Dr. Curtis Schreiber, though, it was different. He trained in neurology at the Mayo Clinic, and he does practice as a general neurologist. When he started his practice, he found that taking care of people and families with cognitive disorders, like Alzheimer’s Disease, was really important.
Today, he works at the Missouri Memory Center, which is part of Citizens Memorial Hospital in Bolivar. He’s begun a clinical research program at CMH over the past few years. We want to disclose that that hospital is an underwriter with KSMU.
“We've had the great opportunity to participate in clinical research studies for possible drugs for Alzheimer's disease, and we've been able to work on studies that are done not just here at our center in Bolivar,” Schreiber said. “But we are one center of dozens around the country and around the world participating in clinical research studies for drugs that may become medicines for treating Alzheimer's disease currently at our center.”
Currently, Schreiber and his team are involved in a study that's looking at Alzheimer's disease at the earlier phases.
“Earlier phases mean for people that are mild with the symptoms, and who have been diagnosed with Alzheimer's disease, but also for individuals that have the early symptoms and may not even have been diagnosed yet with Alzheimer's disease,” Schreiber said.
The current study he’s participating in from Bolivar is around an abnormal protein deposited in the brain called Amyloid. In the brain of someone with Alzheimer’s Disease, these Amyloid proteins clump together to form plaques that make it impossible for brain cells to function correctly.
“[Amyloid is] a needed component for the one hundred percent diagnosis of Alzheimer's disease, so we know that amyloid is part of the process of Alzheimer's disease,” Schreiber said. “What part of the process is not entirely clear, but the current study and many of the studies that have been conducted recently are focused on elimination of amyloid deposits from the brain of people with Alzheimer's disease, and that's currently being done with monoclonal antibodies.”
Basically, monoclonal antibodies are a very high-tech way to harness the immune system to clear out these abnormal proteins. They are created in a lab, and they’re designed to go after specific targets, like something harming the body.
“So, the clinical trial that we're currently involved in is an amyloid monoclonal antibody. It's specifically targeting, targeting the amyloid protein in the brain,” Schreiber said.
People in the Ozarks are participating as research subjects for that clinical trial, including some of Schreiber’s patients.
“Research subjects for the clinical trials come from a variety of sources,” Schreiber said. “Some of those are people that are patients right here at Missouri Memory Center, patients that are referred from other neurology practices in the region and some of those are patients that know there's research going on.”
The drugs you find at a pharmacy, like blood pressure medicine, pain meds, antibiotics those were all tested in clinical trials.
“So, the people that participate in Alzheimer's disease research, there are individuals that have some altruism,” Schreiber said. “They, of course, are hopeful there might be something for them, for themselves, but they also know that part of this is to help other people down the road.”
How does amyloid actually change brain function? Schreiber said that isn’t known with 100 percent certainty.
“Is it part of what's changing the brain or is it just the ashes that are left over after the brain changes have occurred,” Schreiber said. “The treatments that are the drugs that are being studied for possible treatments that focus on amyloid have been shown to clear amyloid out of the brain.”
The biggest question, though, is does that lead to better outcomes for the patient?
“Do they do better with their memory and their thinking when they're treated in that way,” Schreiber said. “It's logical to think that by directly attacking the amyloid or the Tao that there would be a change in the cognition associated with the progressive dementia from Alzheimer's disease, but that's still a theory, and that theory is what is being tested in clinical trials to see if the patients that are on the treatments actually hold steady or improve with their memory or thinking deficits.
Kacie Atchison is a research nurse working on those clinical trials with Schreiber. She meets with the research subjects regularly.
“I want to make sure that they fully understand what they're getting involved in, because a lot of times they have to not just want to do it for themselves, but they have to have another greater purpose, whether it be for science or for their kids,” Atchison said. “You hear a lot of ‘I want help my kids’, ‘I want to have my grandkids’ and ‘I don't want to see them go through what I went through’.”
Once the patients understand what they’re signing up for, the clinical trials begin. They will be tested by staff here to monitor them on a regular basis.
“Every study is very different on what that regular basis may be, and maybe once a month, maybe every two weeks,” Hutchison said. “They do have to come here to Bolivar for those clinic visits, and so that can be time consuming and there can be travel expenses and travel, especially during the wintertime.”
This isn’t the first clinical study the Bolivar clinic has participated in; it’s also participated in research on migraine headaches and how Amyloid PET testing of Alzheimer’s patients can impact diagnosis.
It’s been over 100 years since the German psychiatrist Dr. Alzheimer discovered plaques and tangles. That’s a long time to be searching for a cure. But research is always building on previous research, and the clinical trials underway here in Bolivar, Missouri, involve cellular technology Dr. Alzheimer could have only dreamed about.
No one knows exactly how close researchers are to finding a cure, but we do know that each clinical trial, each research study gets them one step closer.