A patient with Alzheimer’s disease ambles up the walkway to the Cleveland Clinic Lou Ruvo Center for Brain Health, a two-faced building with one side resembling something like molten steel poured over a rolling hillside. Its strangeness calls to mind that she’s been here before for an appointment, and she’s pleased to have remembered. At the same moment, via videoconference, a doctor at the center reads a short story to test the memory of a patient in Winnemucca who has Huntington’s disease. And another patient, who has Parkinson’s, meets with the sole nurse practitioner at the Ruvo outpost in Reno, where she’ll assess his tremors.
“This is the new model,” director Randy Schiffer says of this snapshot of a typical day. “If you’re really going to be taking care of these disorders, you can’t just be in one place. That’s the old mass model.” That “one place” is, of course, Las Vegas, home to the 65,000-square-foot facility that diagnoses and treats conditions that cause brain cell deterioration. The center fully opens in May with the christening of that peculiar half, known as the Life Activity Center, but it has been operating out of the more traditional-looking medical institute with its benefactor, the Cleveland Clinic—one of the largest and top-rated medical organizations in the world—since last summer. Both parties realize that with 13 percent of people over 65 and half of those over 85 suffering from Alzheimer’s disease and a population that’s aging, the center’s outreach must extend beyond the Ruvo Center’s 13 examination rooms.
The center’s focus is on Southern Nevada, where an estimated 25,000 residents have Alzheimer’s. But beyond that, Schiffer says, “our second constituency is the entire world of Alzheimer’s disease, where we hope to have an impact.” To that end, he anticipates about 6,000 clinical visits this year and double that in two to three.
This new approach will also attract a number of diverse minds to the Las Vegas Valley. Charles Bernick, associate medical director of the center, envisions his city blossoming with innovation. He talks of think tanks and symposiums that will gather in a place that’s never been thought of as a mecca for brainiacs. Until the Ruvo Center opened, that is. “I will say this, at least in the medical field, Las Vegas is now thought of for some of the exciting ideas,” says Bernick, who has lived here for 15 years. “There will be this sense of intellectual curiosity that will be stimulated here.”
The wheels are constantly turning. “I just had a recent conversation with a neurologist in town about starting a Clark County Neurological Society,” Bernick says. Meantime the center has become home to the annual Leon Thal Symposium, an international think tank of hundreds of Alzheimer’s scientists and researchers. And a regular rotation of residents comes to learn about neurocognitive disorders at the facility, as do a host of other learners, from psychology interns to nurse practitioners.
Joint research projects between the center and UNLV are still in the works, but it’s expected to produce a partnership that will accomplish another thing that Las Vegas isn’t known for: keeping its talent. “The hope here is that if we train students correctly, they will see that staying in Nevada is a good thing,” Bernick says. “If they’re interested in research, they can follow research paths here and be innovative.”
Ultimately, the center’s mission is to find a cure for Alzheimer’s disease by 2020, which is a national plan proposed last year by Zaven Khachaturian, consulting science adviser to the Ruvo Center and president of Prevent Alzheimer’s Disease 2020 Inc. He charged a task force with finding new models to finance clinical trials and establishing an international patient registry as a means of reaching the goal. But Schiffer has a more unassuming plan of attack. “I myself am quite skeptical of treating scientific breakthroughs in that manner—setting a goal and number of years and thinking that will work. In the history of medicine that hasn’t ever worked. What I’m trying to do—and what works in medicine—is when you have a therapeutic dilemma where everything that’s been tried, more or less, hasn’t worked, you need a variety of creative approaches in the hope that one will hit.” While the search for a cure continues, Schiffer’s mission at hand is for the center to truly become embedded into the community’s identity. “We’re not that big,” he says of the 10-person staff, which includes three doctors, two nurses, two social service providers and three researchers. “We’re just one thing, and we’re here to do one thing: Bring the brain dimension of health care into the system of Vegas. We’re crafting this as a center of excellence that’s additive or synergistic with health-care systems in place, not competitive.”
Since opening its doors last July, the clinic has had about 2,300 total patient visits. Nearly 1,000 patients followed Bernick to the Ruvo Center from both his former post at UNLV and his role as director of a network of Alzheimer’s clinics in Las Vegas, Reno and Elko. The center will likely hire more doctors in Las Vegas—possibly a rehabilitation physician and a Huntington’s and Parkinson’s specialist—in the next six to 18 months. “It was somewhat of a deliberate decision to not flood the center with doctors,” Bernick says. “We wanted to just ramp up and get the bugs out first.” As part of the center’s Nevada mission, doctors will video-conference in patients who wouldn’t have otherwise been treated, call on radiologists at the Cleveland Clinic to look at scans on the spot, and maintain Ruvo’s outpost in Reno as part of its Rural Medicine Outreach program. The Reno clinic is modest in comparison to the winding hallways, grass-green bench cushions and serene caregiver library at the $100 million Las Vegas headquarters; it comprises two exam rooms, two offices and a conference room. The doctors visit the center a couple of times each month.
Right now, the diagnosis of a patient’s neurocognitive disease usually involves cognitive testing and an MRI scan. A doctor might then prescribe a drug treatment, such as an inhibitor that prevents the breakdown of a chemical messenger essential to learning and memory. But for the patient whose memory is still somewhat sharp—perhaps he or she drew an immediate flashback upon recognizing the center, for example—the doctor might prescribe lifestyle interventions, including exercise or a change in environment.
These treatments are simply not adequate, Bernick says. The center is researching and practicing ways to identify diseases earlier and when treatments will be most effective. Raising awareness is the best way to delay the onset of Alzheimer’s, he says. The average age at diagnosis is 80, with signs typically showing up 10 to 20 years before. Delaying the disease by five years cuts the diagnosis by 50 percent for a given generation. And delaying the onset by 10 years essentially eradicates the disease. That reflects the reality that, in those five or 10 years, many potential Alzheimer’s sufferers will have died from other causes.
As part of the Alzheimer’s Disease Neuroimaging Initiative, the Ruvo Center has started researching an imaging process to tag amyloid, a protein that’s abundant in brains with the disease and may be part of the cause. Amyloid imaging can be done before the appearance of any symptoms. Funding includes $1 million from the National Institute of Health to study a multimodal treatment for Alzheimer’s disease—a combination of drugs, physical fitness and a program called “Memorcize,” which focuses on cognitive rehabilitation targeting a patient’s specific deficiency.
These advanced efforts are something Larry Ruvo, the Las Vegas philanthropist (see page 110), could have only wished for his father, who was diagnosed with Alzheimer’s a year and a half after being misdiagnosed in Las Vegas. His father, the namesake for the center, died in 1994. In hopes of bringing treatment to Nevada and finding a cure for the disease, Ruvo raised funds to commission famed California architect Frank Gehry to build the institute and secured the partnership with the Cleveland Clinic.
Gehry’s design for the clinic is clean and contemporary, but the events center is something else. It comprises 199 windows—no two alike— forming an angular, dramatic dome. The 10,000-square-foot space with room for 900 people officially opens May 1. Keep Memory Alive, the center’s fundraising foundation, recently held its 14th annual Power of Love Gala fundraiser at Bellagio, replete with high-profile guests including Danny DeVito and Wolfgang Puck walking a pink carpet. Next year, the event will be held at the center.
Part of the $27 million raised this year goes to another ambitious side of the Ruvo Center. The foundation has been active on Capitol Hill, providing Congress with evidence necessary to secure Alzheimer’s patients a spot in the Independence at Home Act, part of the new health-care bill. It includes a three-year pilot study aimed at proving that providing in-home care for Alzheimer’s patients—as opposed to placement in an assisted care center—saves Medicare costs. The act will also reimburse caregivers for expenses or services such as counseling. The Ruvo Center, says Maureen Peckman, CEO of Keep Memory Alive, is “a depot for all things happening in this disorder. We’re the benchmark for legislation to science to treatments to diagnosis to prevention.”
Entrenched in research on one end of the facility and aflutter with celebrity guests and power hitters in the other, the Ruvo Center is potentially a microcosm of a new Las Vegas: still holding onto its ever-present image, but becoming something grander, says Robert Lang, director of research at Brookings Mountain West think tank at UNLV. “It’s been thought that Las Vegas isn’t a serious place,” he says. “It doesn’t do grownup-y things like medical research. Well, there’s a new message.”
And he points west to the precedent-setters. “It’s similar to the way L.A. was once thought of only for Hollywood but has now moved beyond just its entertainment industry identity,” he says, calling it the alternative to New York, as Chicago once was. “L.A. is massive, sprawling, trendsetting, diverse, rich and poor, funky, fun, innovative, and yet totally dysfunctional. … At some point, Vegas will also see this expanded image.”
Imagine, for example, a permanent trade show here that introduces the world to the latest innovations, from technology to design. But he’s quick to point out that it’s not out with the old and in with the new. “That image of the Strip is so well-known,” he says. “You could show it to people from Kathmandu to Carache, and people will say, ‘That’s Las Vegas.’ That image is something we should never run from.” It may seem that for doctors so committed to finding a cure, they’d be taken aback by the fact that, at this point, the building has become known just as much for its peculiar design and its celebrity sightings as it has for its medical care. But Bernick is pleased the building has drawn so much attention to neurocognitive diseases. And Lang agrees: “It’s a serious venture and signals a kind of permanence of the institution.”
And the Ruvo Center might gain even more staying power. The city of Las Vegas has offered the Cleveland Clinic an additional 12 acres of land adjacent to the brain center in Symphony Park. The center has until fall to decide what to do with the offering. Clinic executives aren’t giving any indication of what might be in the works, just that it “won’t provide inpatient care,” according to Nicole Wolf, spokeswoman for Keep Memory Alive. There have been rumblings, however, of what might happen with the parcel of land. There’s a possibility the clinic will build a medical school and a college of medicine, maintains Robin Leach, a writer for the Vegas Deluxe website and former host of the television show Lifestyles of the Rich and the Famous.
A patient who comes to the Ruvo Center may have traveled from California, never thinking he’d end up in Las Vegas for treatment. He may be there because of money raised as the result of a celebrity’s star power. And he may end up part of the very research efforts that will cure the disease. But when the patient walks out the door, he’s likely not thinking about any of that. He may be admiring the flower he received as a parting gift from the center. Or he may glance up and notice the abstractly wrinkled shades covering the hanging lights, symbolic of Gehry’s unorthodox practice of crumpling up paper when he began brainstorming the design of the building—a building built from power, intelligence and opportunity. Conceivably, it’s a building that could mean all this and more for Las Vegas’ future.