How Ohio State's pioneering deep brain stimulation technology is targeting executive functions to preserve independence in Alzheimer's patients
In an operating room at The Ohio State University Wexner Medical Center in October 2012, a medical team made history. During a meticulous five-hour surgery, they implanted thin electrical wires into the brain of Kathy Sanford, who was gradually losing her cognitive abilities to Alzheimer's disease. What made this procedure extraordinary wasn't just the sophisticated technology—it was the bold new approach to treating a condition that has stubbornly resisted effective treatments for decades 1 .
"We have many memory aides, tools and pharmaceutical treatments to help Alzheimer's patients with memory, but we don't have anything to help with improving their judgments, making good decisions, or increasing their ability to selectively focus attention on the task at hand and avoid distractions."
Alzheimer's disease is the most common form of degenerative dementia, affecting approximately 5.5 million Americans and ranking as the third costliest disease in terms of healthcare expenditures in the United States. The condition progressively disables patients through loss of memory, cognition, and behavioral function, gradually robbing them of independent functioning 1 6 .
Problem-solving, organization, planning, and utilizing good judgment - cognitive skills managed by the brain's frontal lobes.
These skills are necessary for tasks like making the bed, choosing what to eat, and meaningful socializing with friends and family 6 .
The "brain pacemaker" is the popular term for deep brain stimulation (DBS), an established neurosurgical procedure that involves implanting electrodes into specific brain regions to deliver controlled electrical impulses 3 .
One or more electrodes implanted into targeted brain areas to deliver electrical impulses.
An implantable pulse generator (IPG) containing the battery and circuitry that powers the system.
An extension wire connecting the electrodes to the IPG, typically implanted under the skin.
"Basically, the pacemakers send tiny signals into the brain that regulate the abnormal activity of the brain and normalize it more."
The FDA-approved study at Ohio State Wexner Medical Center enrolled up to 10 patients with mild or early-stage Alzheimer's disease. These carefully selected participants were in the early phases of the disease, when interventions have the greatest potential to slow progression 1 .
The research team, led by neurologist Dr. Douglas Scharre and neurosurgeon Dr. Ali Rezai, employed DBS technology to stimulate regions of the brain governing executive function. Unlike some other DBS trials for Alzheimer's that targeted memory-related structures like the fornix, the Ohio State team specifically focused on the frontal lobes—the brain region responsible for problem-solving, judgment, and attention 3 6 .
All participants received the surgical implant, but in a designed approach:
This allowed researchers to compare outcomes between those receiving immediate treatment and those who initially received no electrical stimulation 7 .
Using precise stereotactic techniques, the surgical team mapped the exact coordinates for electrode placement in the frontal lobes 3 .
Through small openings in the skull, thin electrical wires were carefully guided to the targeted frontal lobe regions. This required extreme precision to reach the specific neural networks involved in cognition and behavior 6 .
The wires were connected to a pacemaker-like device implanted under the skin near the collarbone, similar to cardiac pacemakers 1 .
The device was programmed to deliver 130 tiny electrical pulses per second to the brain. Patients typically do not feel these electrical currents 7 .
Patients were closely observed to determine the effectiveness of the technology in improving cognitive and behavioral functioning 1 .
The findings from Ohio State's pilot study, published in the Journal of Alzheimer's Disease, offered encouraging evidence that DBS could indeed modify the course of Alzheimer's progression—particularly for executive functions 6 .
85-year-old participant from Delaware, Ohio
When she entered the study in 2013, she was no longer able to prepare meals. After two years of deep brain stimulation:
All three initial study participants showed measurable improvements in their daily functioning. The research team observed that DBS targeting frontal brain regions appeared to reduce the overall performance decline typically seen in people with mild or early stage Alzheimer's 6 .
| Condition | Targeted Brain Area | Purpose of Stimulation |
|---|---|---|
| Alzheimer's Disease | Fornix | Enhance memory processing |
| Alzheimer's Disease | Frontal Lobes | Improve executive function, problem-solving |
| Alzheimer's Disease | Hippocampus | Support memory formation |
| Parkinson's Disease | Subthalamic Nucleus | Reduce tremors, motor symptoms |
| Essential Tremor | Ventral Intermediate Thalamus | Control tremor |
| Dystonia | Globus Pallidus internus | Reduce muscle contractions |
Source: 3
| Functional Area | Specific Improvements Noted | Timeframe for Improvement |
|---|---|---|
| Meal Preparation | Able to initiate meal prep, assemble ingredients, cook simple meals | 2 years of DBS treatment |
| Activity Planning | Could organize outings, arrange transportation, plan for weather | 2 years of DBS treatment |
| Personal Care | Regained independence in selecting clothing attire | 2 years of DBS treatment |
| Social Engagement | Improved ability to engage in meaningful socialization | Not specified |
Source: 6
"LaVonne has had Alzheimer's disease longer than anybody I know, and that sounds negative, but it's really a positive thing because it shows that we're doing something right."
The development and implementation of DBS for Alzheimer's requires specialized tools and biological materials. The following table details key components of the research toolkit used in this pioneering field:
| Research Tool | Function/Purpose | Application in DBS Research |
|---|---|---|
| Deep Brain Stimulation System | Delivers electrical pulses to specific brain targets | Neuromodulation of frontal lobes, fornix, or hippocampus |
| Stereotactic Surgical Equipment | Enables precise electrode placement in the brain | Accurate implantation of DBS electrodes |
| Cognitive Assessment Scales | Measures changes in cognitive function | Evaluating treatment efficacy (e.g., ADAS-Cog) |
| Biomarker Assays | Tracks pathological changes in the brain | Monitoring disease progression and treatment effects |
| MRI/PET Neuroimaging | Visualizes brain structure and activity | Surgical planning and outcome assessment |
While the Ohio State findings are promising, researchers emphasize that DBS for Alzheimer's remains experimental. Dr. Rezai cautions, "If the early findings that we're seeing continue to be robust and progressive, then I think that will be very promising and encouraging for us. But so far we are cautiously optimistic" 1 .
The future of Alzheimer's treatment will likely involve combination therapies that address the disease through multiple mechanisms. The recent FDA approval of anti-amyloid immunotherapies like lecanemab and donanemab represents another significant advancement, particularly for early-stage Alzheimer's 2 8 .
Growing evidence suggests that brain health is closely linked to heart and blood vessel health, with conditions like high blood pressure, heart disease, stroke, diabetes, and high cholesterol increasing dementia risk 2 .
The pioneering work at Ohio State to develop a brain pacemaker for Alzheimer's represents more than just a novel treatment—it signifies a fundamental shift in how we approach this complex disease. By targeting executive functions rather than memory alone, and by using neuromodulation rather than solely pharmaceutical interventions, researchers are expanding our arsenal against Alzheimer's.
"I'm just trying to make the world a better place. That's all I'm doing."
"This study seemed to just give us hope. I guess we were at the place where you just don't do anything and watch the condition deteriorate over the years, or try to do something that would give us hope and might stop the progression of this disease."
While deep brain stimulation for Alzheimer's is not yet a cure, it represents a promising pathway toward slowing the progression of this devastating condition. As research continues, the brain pacemaker may one day offer a powerful option for preserving quality of life and functional independence for millions affected by Alzheimer's disease worldwide.