The Cleveland Clinic has been thinking about investing in the brain and cognition for the last 20 years, according to Randy Schiffer, Chief Medical Director of what is now called the Cleveland Clinic Lou Ruvo Center for Brain Health. “As Dr. Cosgrove has said, ‘in the twentieth century the Cleveland Clinic led cardiovascular disease developments. In the twenty-first century, the brain, and especially cognition, will be our arena,’” Schiffer said.

Schiffer was chairman of neurology and psychiatry at Texas Tech, Lubbock, for 10 years. He had been recruited by the Cleveland Clinic to establish a medical program for cognitive disorders in January 2009, just before the clinic’s deal with the Lou Ruvo Brain Institute came together. He found his stint in Ohio to be short-lived, noting that he didn’t really move to Cleveland but more through it, and on out to Nevada. “Though the Center for Brain Health is throughout the Cleveland Clinic Enterprise system, and long-term the science and infrastructure will be in Cleveland, over the next couple of years the growth and opportunities will be here in Las Vegas,” Schiffer told ARF.

So what does the Cleveland Clinic deal mean for the Lou Ruvo Brain Institute? “Originally, the plan was to create a different model for how care is provided and also try to make the center a new model for collaborative research,” said Khachaturian, president emeritus of LRBI and CEO of Keep Memory Alive, the foundation set up to support the institute. “Right now, and I’m assuming until the building is paid for, the focus will be on setting up clinical operations and running the clinic.” What does this mean for cutting-edge AD research? Though sources were unwilling to go on the record, the sense leading AD researchers expressed privately was that at least in the near future, it means that there won’t be any.

“We are building a center of excellence, both in Cleveland and here, that will be dedicated to cognition,” Schiffer claimed. He envisages treating all the cognitive disorders, including Alzheimer’s and mild cognitive impairment, which will account for about half of the center’s operations. “We are first going to make a high-volume, high-quality, patient-care system that will be branded with the same kind of procedures here as in Cleveland, and long term at other sites.” (The clinical has plans for a center in Reno, Nevada, and potentially in Weston, Florida.)

A clinic for routine care of neurodegenerative disorders is a pressing need in Nevada, particularly the southern part of the state. Four hundred forty miles north of Las Vegas, the University of Nevada, Reno, does have a program. “Patients were waiting anywhere from a few months to six months to see a neurologist,” said Khachaturian. That has changed. The Cleveland Clinic’s Las Vegas center has brought in some neurologists, including Charlie Bernick, who had been running the UNR program, and the number of patients that are going through has increased substantially since the clinic opened its doors July 13. The clinic is now receiving 25-30 new patients per week, Schiffer said.

Attendees of the Clinical Trials on Alzheimer’s Disease meeting, held 29-30 October 2009 in Las Vegas, were treated to a tour of the new facility. The building is almost complete. To the admittedly architecturally unskilled eye of a reporter, its front side evokes the notion of an uncoordinated giant having played with a stack of house-sized Legos. At the back is the large atrium, draped with a convoluted steel lattice, which has become the iconic face of the center; it is still under construction. That atrium will serve as a hub of sorts, a space for people to congregate by day and a venue for educational outreach and philanthropic activities by night. On the clinic side of the building, the center is equipped with a state-of-the art 3 Tesla MRI machine, which takes faster brain images and is less claustrophobic than smaller machines—advantages when imaging patients who are susceptible to agitation and disorientation. The images are handed off to a team of neurologists in Cleveland who interpret the results. Patients don’t wait when entering the center. They are greeted by chaperones, many of them volunteers, and led straight to the examination room. This is partly to spare early-stage or MCI patients the discomfort of being in a waiting room with end-stage patients, said Schiffer, adding “That’s because we don’t want them to get to that stage.” (To date, there is no cure for AD; all patients progress to an advanced stage or die of other causes before.)

Model of the completed Lou Ruvo Center. Image credit: Keep Memory Alive

Wes Ashford of Stanford University, California, who took the tour, thought the program, with its heavy reliance of support staff, was similar in scope to those at other clinics, including the Stanford/VA Alzheimer’s Center. “The big problem with such programs is that they really are not cost-effective unless supported in some unconventional way,” he said.

As for research, Schiffer said he does have plans to get involved. “I believe we need new ideas in Alzheimer’s disease, I think we need novel approaches, such as non-amyloid interventions,” he said. “I’m only doing this because of the hope that we can, in effect, set up something here that will materially contribute to changing the course of Alzheimer’s disease.” The center has two NIH grants, one to develop a biomarker and the other to conduct a clinical trial. Schiffer was coy about future research plans but said he was interested in ideas that are even too creative for the NIH. He would not elaborate further. It seems that in Vegas, not only poker players hold their cards close to the chest.—Tom Fagan.