You’ve been working in neurology for more than three decades. What attracted you to this particular field of medicine?
I’ve always been interested in the mind and the life of the mind. And the brain is the physical basis of the life of the mind. At the University of Wyoming, I double-majored in philosophy and zoology, so [I encountered] all the philosophical questions, the mind/brain problems: When is someone dead? What comprises a mental life? These are all actually brain issues, so I was pulled into this idea of cognitive neurology.
How far away are we from a cure for Alzheimer’s?
It’s impossible to tell. We might be one step away or 100 steps away, but we can only get there if we take the next step. It is a very complicated disease, [but] we understand its complexity more as we go along, and we’re definitely making advances. For instance, in 1990, we didn’t have a single approved medication for Alzheimer’s disease. Now have we five. We didn’t have anything like the kind of scans that we have now. Our trial methodology has matured so that we’re able to test drugs more effectively than before. So there have been many, many advances in our understanding of the disease and even our therapies. But when that’s going to represent the breakthrough of a new treatment, it’s very difficult for anybody to foretell.
If you came to work tomorrow and found that a $5 million check had been anonymously slipped under your office door, what would you use it for?
I would create a brain-health education registry, try to get as many people in Las Vegas registered as I could and make this a demonstration city—a model city—for how one can reach out and provide brain-health information, from the youngest people to middle age to old age.
Brain health is something that has to be built over the lifespan; our concept is that we need to build a brain span that matches our lifespan. I would [create the registry], and then I would use that to bring people in for clinical trials, and I would do more clinical trials with that money. And we are going to find a way to do that, even if nobody slips that $5 million check under my door. But I hope they do! [Laughs.]
What’s the status of the Professional Fighters Brain Health Study that the Lou Ruvo Center is conducting?
We are going great guns. I think we have now seen 340 fighters and mixed martial artists—it’s by far the largest combat-sports study in the world. And we’re already seeing results. We can see that there are relationships, for example, between educational level and [cognitive] effects from boxing, in particular. The lower the educational level, the more vulnerable the boxer seems.
Our real goal is to sort out which boxers have cognitive risk. Because we know that some boxers have no cognitive risks; they do just fine. But what we would like to understand is which boxers are likely to undergo cognitive decline, so that we can empower that fighter to make a decision about his or her future.
Your wife, Dr. Kate Zhong, does clinical research at the Ruvo Center and has spoken about the relationship between nutrition and brain health. How often does she harass you about your diet?
[Laughs.] Well, we collaborate in trying to have a good diet. We eat a lot of fish, and we do try to adhere to a Mediterranean diet. And she’s convinced me that it’s good food and that I enjoy it!
So what’s the best thing a person can do to improve their brain health?
Exercise—physical exercise. It’s clear, and it’s the strongest literature that we have, that 30 minutes of vigorous exercise three times a week to get your pulse up will make a difference in your brain health. The studies are most compelling for midlife and late life, but I would confidently extend that to early life.
When is the last time you couldn’t remember where you left your keys?
I can’t remember. But that’s because I’m very systematic. So it would be very rare for me to misplace something like my keys or my wallet. Whereas my wife, I’m sorry to say, isn’t as systematic, and we’re always looking for her keys!
In layman’s terms, what are the most significant advancements in Alzheimer’s research that have been made in the last couple of years?
One of the most important things is our ability to use a special type of brain imaging to actually see the protein of Alzheimer’s disease in the brain. For a long time, we were never able to determine for sure who had Alzheimer’s and who didn’t until autopsy. Now, if someone comes in with a memory impairment, and then they have a positive scan, that means they have Alzheimer’s disease as the cause of their memory impairment. So this new scan has helped us refine both our diagnostic capability and our research capability, because some of our drugs are aimed at removing the protein that we can see on the scan.
The other major advancement has been in our work on drugs that actually intervene in the disease process and not just improve the symptoms. None of them have been approved yet, but … eventually we’re going to have new therapies that actually intervene in the disease.
My grandfather—who was an Italian immigrant—died from Alzheimer’s complications back in 1987, and toward the end, he reverted back to speaking Italian, which he hadn’t done in decades. And while he couldn’t remember he had a wife or the names of his kids, he remembered details about his childhood. Why is that?
In Alzheimer’s disease, memory is erased from the most recent to the most remote. So it’s very typical that people revert to their mother tongue, because that was their first language, their first memory. That’s also why they’re able to remember things about their early life—their first-grade teacher, the neighbor who lived next door—but don’t remember their children or their wife. That’s the systematic way in which memory is affected in Alzheimer’s [patients], and we actually use that clinically: If someone comes in and they have a pattern where remote memory is affected, we know that’s not likely to be Alzheimer’s disease. So we test this recent/remote dichotomy, because it’s so characteristic of the disease.
Concussions and football have made major headlines in recent years. Given your knowledge, if you had a 14-year-old son who desperately wanted to play high school football, would you let him?
[Pause.] Yes I would, but I would be very reluctant to do early return to play after a concussion. I think we can continue to support contact sports, but we need more protection, we need more monitoring, we need to make sure it doesn’t happen repeatedly—we need a much higher degree of vigilance in contact sports than we currently have.
The Ruvo Center is a stand-alone, nonprofit medical facility without the presence of an academic medical institution to bolster it—which is the exact same challenge that the Nevada Cancer Institute faced. How can this facility avoid the pitfalls that doomed the NCI?
A huge difference is that we’re part of the Cleveland Clinic, which also has clinics in Cleveland; Toronto; Weston, Florida; Abu Dhabi. We are also part of a medical school—the Cleveland Clinic Lerner College of Medicine. So we are embraced by a giant, well-functioning medical enterprise. We’re not really as stand-alone as we look.
What are the best techniques available to improve one’s memory?
There aren’t great ways of improving your memory, but there are tricks. For example, people’s names—my name is Cummings, so you think, “The doctor is coming.” Or let’s say you’re trying to remember three things that you want to pick up at the store. If you envision a house, and you envision the carrots on one chair, the potatoes on another chair and the potato chips on another chair, then when you go to the store, you can think, “Oh yeah, those are those three guys sitting on the chairs.”
I’ve always had a difficult time remembering the names of people after I’m initially introduced to them. Do you have any memory-related challenges?
I think we all have difficulty remembering names. Because there’s that social interaction, and you’re kind of paying attention to that and you miss the name. One way [to overcome that] is to say, “What was your name again? Let me make sure I caught your name”—go ahead and acknowledge it right away. Because it’s not embarrassing right then, but it’s embarrassing a week later when you can’t remember their name. So, yes, I suffer from that just like everybody else does, but there are techniques to help manage that.
Why does it seem that my 12-year-old daughter can remember things that happened six years ago better than I can?
The speed of memory does decline in the course of normal aging. And some children have what’s called eidetic memory, or they have the ability to just re-visualize, and that’s almost always lost by adulthood. So there are special memory capacities in children that simply don’t persist into adulthood.
True or false: Elephants never forget?
False. [Laughs.] I don’t know how they got that reputation for having a great memory. I’m not a great elephant psychologist, but as far as I know, they have the same vulnerabilities as other mammals.
The Cleveland Clinic Lou Ruvo Center for Brain Health is conducting clinical trials for Alzheimer’s disease, Parkinson’s disease and multiple sclerosis. If interested in participating, call 483-6025.