Gathering Information on Inflammation

June 17, 2020

Adam Gerstenecker’s older brother was born with damage to his brain’s right hemisphere, causing cerebral palsy and intellectual disability.

The boys talked and played together, but from early on Gerstenecker knew his brother could not do some things other children could. He grew up wanting to understand the world his brother lived in and, later, how differences in the brain can lead to differences in cognition.

Dr. Gerstenecker is now a clinical neuropsychologist at the University of Alabama at Birmingham and studies neurodegenerative disorders and cognitive decline. His groundbreaking work in inflammation and its potential impacts on brain development and cognitive decline has earned him a 2020 Federation of Associations in Behavioral & Brain Sciences Early Career Impact Award. He was nominated by the National Academy of Neuropsychology.

He is the principal investigator on an observational study on multiple sclerosis (MS) and systemic inflammation funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. He is recruiting 40 patients with relapsing MS and 40 with progressive MS and “theorizing that people with multiple sclerosis with more inflammation will have more hippocampal subfield atrophy and worse cognition,” he says.

The study uses an MRI sequence called HR-MICRA “to visualize the hippocampus with a high degree of clarity,” Gerstenecker says. The 54-minute scan is structural and non-longitudinal.

In addition, participants undergo neuropsychological testing for memory and other cognitive abilities, which might include remembering a series of words, drawing lines connecting alternating stimuli, and drawing figures from memory.

They also are tested on functional measures, which may include being given scenarios for problem solving and performing financial transactions. Blood is drawn to test for the presence of systemic inflammation.

Ultimately, he hopes to use data from the study to mitigate cognitive decline in people with multiple sclerosis. “If a relationship is found between level of inflammatory load, hippocampal internal architecture, and cognitive decline, then interventions such as diet and exercise can be designed to target inflammation,” Gerstenecker explains.

Gerstenecker is also working on three other studies, including the Alabama Udall Project which, through the use of funding from the National Institutes of Health, uses PET imaging to determine if there is a relationship between neural inflammation and cognitive decline in persons with Parkinson’s disease.

In this $12 million longitudinal study, researchers hypothesize that the neuroinflammatory load will affect the rate of cognitive decline.

Sixty participants have been recruited and will be tested each year for the duration of the five-year study.  “We’re trying to determine how the inflammation starts, how it gets into the brain, and whether there is a relationship between the neuro-inflammatory load and cognitive decline,” Gerstenecker says.

Also a clinician, Gerstenecker works with two patients a week as well as their caregivers to help them understand how changes in the brain affect behavior.

In patients with another neurodegenerative disorder, progressive supranuclear palsy, apathy emerges as a typical behavior

“It seems as if they no longer care about their family,” he says.  “One thing we do clinically is to help caregivers understand the [seeming lack of interest] is because of the neurodegenerative disorder.”