Transcript Mary Woo - Council for the Advancement of Nursing Science

The NIH BRAIN
Initiative:
How It Will Help My
Patients To Stop Losing
Their Minds
Mary A. Woo, DNSc, RN
Professor – UCLA School of Nursing
Disclosures: grant funding from NINR (R01 NR013625
[PI]; R01 NR014669 [PI]; R01 NR013972 [co-Inv]) and
NHLBI (R01 HL113251 [co-Inv])
Target Patient Populations
1. Heart Failure
a. Over 6 million Americans
b. More than 600,000 newly diagnosed/year
2. Obstructive Sleep Apnea
a. Over 12 million Americans
b. Estimated UNDIAGNOSED prevalence rate is
10 million Americans
3. BOTH patient groups have increased morbidity
and mortality, poor quality of life, high frequency
of major depression, and impaired cognition
(especially memory and executive function)
Primary Activities Linked To
BRAIN Initiative
#6. Advancing human neuroscience:
1. (Develop)/Use innovative technologies to understand the
human brain and treat its disorders
2. Create and support integrated human brain research
networks
#7. From BRAIN Initiative to the brain:
Integrate new technological and conceptual approaches
produced in Goals #1-6 to discover how dynamic patterns of
neural activity are transformed into cognition, emotion,
perception, and action in health and disease
HF Gray
Matter Loss
RI – right insula
LI – left insula
P – putamen
GP – globus
pallidus
Postcentral Gyrus
Posterior Lateral Parietal Cortex
OSA Gray
Matter Loss
right
left
Posterior Lateral
Parietal Cortex
Anterior Superior
Frontal Gyrus
Ventral Lateral
Frontal Cortex
superior
Left Temporal Lobe
anterior
Lateral Prefrontal Cortex
Parahippocampal Gyrus
Common Areas of Loss
1. Cerebellum – breathing, motor
coordination
2. Cingulate – autonomic and breathing
control
3. Frontal cortex - cognition
Mean
Diffusivity
(MD)
Figure: Increased MD values (indicating tissue injury) in insular (a), frontal cortices (b),
hippocampus (c), and cerebellar areas (white circles) in HF (n = 16) compared to control
subject (n = 26). (L = Left; R = Right).
Fiber
Tractography
Figure. Global cerebellar fiber tracts in Controls (Left) and HF (right). The cerebellum (and
brainstem) is located within the white ovals. Note the extensive axonal fiber loss in the
males and to a lesser extent in the female HF subjects. There appears to be greater fiber
loss on the right in comparison to the left in HF patients.
Figure. Tractography of white matter fiber tracks between the cerebellum and
dorsal lateral pons. Control subject is on the left and HF on the right. Note that the
control subject has more (and longer) fibers on both sides in comparison to the HF
subject. Additionally, communicating fibers between the right and left tracts are
significantly diminished in the HF patient.
Blood-Brain Barrier (BBB)
Figure. Kw maps (indicator of BBB function) from a control subject and a HF patient.
Multiple brain regions in HF subject show reduced Kw values compared with control subject
(sites with hot vs. cool color).
Sleep Problems and Brain Injury
Figure. Highlighted areas indicate sites with decreased gray matter in comparison to controls.
Left: HF with SDB (AHI = 42) with significant differences in cingulate cortex, deep cerebellar
nuclei, and insulae; Right: HF without SDB (AHI = 2) with little gray matter volume loss.
Latest Version of Limb Stimulator
BRAIN Initiative Goals and My
Research
1. Use innovative technologies/methods
a. Mean Diffusivity
b. Fiber Tractography
c. Blood-Brain Barrier
d. Arterial Spin Labeling (blood flow)
2. Integrated human brain research networks
(nursing, cardiology, neurophysiology,
neuroradiology, sleep specialists,
bioengineering, otology, pulmonology)
3. Develop new technologies for treatment