In January 2016, Massachusetts General Hospital’s new Institute for Brain Health opened its doors. The Institute brings the hospital’s specialists in clinical neuroscience together to focus on the prevention of brain disorders and the preservation of brain function across the lifespan.
The need for new ways to treat and prevent brain disease, brain injury and mental illness has never been greater. Cases of Alzheimer's Disease and dementia are expected to triple by 2050, with annual costs in the U.S. Rising to $1.1 trillion from $226 billion today, according to the Alzheimer’s Association. Further, stroke and depression are both leading causes of severe disability in the U.S., according to the Centers for Disease Control and Prevention. In most hospitals, separate specialists treat these conditions, usually after the disease has set in and often with few tools at their disposal.
The Mass General Institute for Brain Health is taking a new approach that integrates specialist care and works towards prevention. “This Institute will create a community of caregivers around the concepts of prevention of brain disease and preservation of brain health,” says Mass General neurologist Dr. Jonathan Rosand, co-founder and co-director of the Institute. “Psychiatric and neurologic diseases are probably the most debilitating and difficult to treat. But we know more about them and how they are related to one another than ever before. It’s time for a more unified approach to thinking about brain disease and brain health.”
Brain-related disorders span a wide range, from traumatic brain injuries to neurodegeneration to psychiatric disorders. But common symptoms cut across these disorders. For instance, problems with attention can occur in patients with attention deficit disorder, stroke, Alzheimer's Disease or schizophrenia. “We want to integrate the neurosciences and look at the brain as a single organ with multiple dimensions that can be relevant in many disorders,” says psychiatrist Dr. Joan Camprodon, a provider for the Institute.
To achieve this goal, the Institute for Brain Health will bring together the Mass General departments of neurology, psychiatry, psychology, neurosurgery, rehabilitation medicine, occupational therapy, and nutrition, as well as mind/body specialists at the Mass General Benson-Henry Institute for Mind Body Medicine.
A Place for Prevention
Rosand first envisioned the Institute’s new approach while caring for Neuroscience Intensive Care Unit (ICU) patients who were suffering from critical illnesses, such as brain trauma, major stroke, or encephalitis. He noticed that as patients recovered, their close family members often developed depression, anxiety or post-traumatic stress disorder. “I started thinking, if we know this is going to happen, how can we prevent it?” he says.
For other specialties, such as cardiovascular disease, preventive medicine has become commonplace and precise. Doctors know which patients need cholesterol-lowering drugs, blood pressure regulation, or lifestyle changes. In contrast, says Rosand, “prevention is an area that has not been explored for brain disease. There’s no clinical program for it.”
There is also nowhere for patients worried about their brain health to go. For instance, with the rise of genetic testing, people might choose to learn about their genetic risks for Alzheimer's Disease, depression or schizophrenia. “These are the people who might walk into the Institute,” says Mass General neuroscientist Dr. Rudi Tanzi, co-founder and co-director of the Institute. Tanzi has spent his career discovering and characterizing the genetic risks of Alzheimer's Disease.
The Institute will offer these patients — both those with a known risk and those who are healthy but concerned about maintaining brain health — with state of the art risk assessment including genetic testing and a review of family and personal histories. The Institute will offer personalized brain wellness and prevention plans and follow-up visits. All patients will also be offered the opportunity to participate in the Institute’s innovative research programs, all of which will be deeply tied to the extraordinary neuroscience, genetics, and clinical trials research programs of Mass General and its affiliated institutions across Boston.
New Approaches to Prevention and Preservation
The clinical trials offered through the Institute will test a range of interventions, including new medications, brain stimulation techniques, mind/body interventions such as meditation or yoga, and lifestyle interventions such as exercise or diet changes, according to Tanzi. Trials will include efforts to prevent brain illness among those at risk and to preserve brain health in those who are well or who have already been diagnosed with a brain-related condition.
The successes of these interventions will be measured not just by how they alter cognitive outcomes, but also how they affect other biological measures. “We’ll be looking at what’s happening to gene activity, markers of inflammation, metabolism changes,” says Tanzi. “Our goal is to quantify the outcomes of these interventions way beyond psychological assessments.”
Clinical research efforts will also support the integration of care across specialties by investigating how treatments that are successful in one realm might be used elsewhere. For instance, brain stimulation techniques such as transcranial magnetic stimulation and direct current stimulation are approved for the treatment of depression. Since they have fewer side effects than brain-related medications, they are also attractive as potential tools for prevention or brain health preservation. “These techniques can move brain function in a healthy direction,” says Camprodon. “We want to understand how to use brain stimulation, mind/body and lifestyle interventions to minimize the risk of developing a condition or maximize brain health in someone who is at risk.”
Rosand’s original concern about the development of PTSD, anxiety and depression among Neuro ICU patients’ and their families provides another example of the research the Institute will undertake to advance preventive medicine for brain health. He has launched a pilot trial that is currently enrolling family members of patients in the Neuro ICU at the time the patient is admitted. The trial will test the effectiveness of mind/body interventions in the prevention of these disorders. “It’s an urgent intervention - an effort to prevent problems before they start,” says Rosand.
The Institute sees patients and visitors on the eighth floor of the Wang building on the Mass General main campus in Boston. For appointments, please visit the center's website.
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