Pharmacological treatments are the backbone of most therapeutic protocols and can be divided into symptomatic therapies, which help address symptoms that patients experience, and etiological therapies, which address the underlying pathological process of the nervous system that causes the symptoms. In addition to choosing the best possible medication for a patient, expert clinicians consider its dose and timing (chronotherapy) for maximizing its benefit to patients. This highlights the need for patients and caregivers to also know the name, dose, and timing of medications taken.
Clinical research trials are structured studies in which novel therapies are evaluated for efficacy and safety in neurological disorders. In most clinical trials, novel treatments are compared to established standard-of-care therapies to examine if they provide comparable or better outcomes. Clinical trials at the NIA follow medical ethical principles of patient autonomy, justice, beneficence and non-maleficence, while respecting personal information through data privacy and security. To verify that a proposed study is constructed and overseen according to ethical principles, it is first reviewed by the NIA Review Board comprised by internal and external experts prior to its initiation. It is because of patients who volunteered to participate in clinical trials that effective treatments have been identified to benefit patients around the world. In the end, participation in research starts and ends according to a patient’s desires and priorities.
Stem Cell Therapies leverage the dynamic physiological potential of stem cells towards protecting and, potentially, improving the structural and functional integrity of the nervous system. Traditional views hold that stem cells work by differentiating into specific cells that integrate into the nervous system, however, more recent studies suggest a large part of their effectiveness is achieved through their ability to produce neurotrophic factors and cytokines. Stem Cell Therapies at the NIA are pursued under investigational protocols in degenerative conditions, such as Motor Neuron Disease.
Lifestyle interventions refer to habits that people can pursue to protect their brain and improve its function. Key categories are: regular exercise, healthy diet, and consolidated sleep-wake rhythms.
- There are several studies proving that moderate intensity exercising, such as running, swimming, or dancing, for more than 150 minutes per week can protect the brain, and its benefits are present even in people who start exercising in their 80s.
- Studies on the Mediterranean diet, based on the Greek diet of the 1960s of olive oil, fish, fruits, vegetables and legumes indicate that it is helpful in protecting the brain and associated with delayed cognitive decline
- A consolidated sleep-wake rhythm is achieved with regular daily schedules that aim for adequate and good quality sleep as well as daytime activities. Ways to achieve this include daytime exposure to sunlight, timing of food intake to heavier meals in the daytime and lighter in the evening, and relaxing non-stimulating rituals at night, all following the principle of being active during the daytime and resting at night.
Social education and support are critical aspects in the care of patients with neurological disorders. Social workers and psychologists work with patients and their caregivers to address social daily aspects of care that prevent optimal medical benefit. These include education on patient legal rights and actions, access to healthcare and insurance coverage, rights to financial benefits, help-at-home services, and ways for optimizing communication with family and caregivers.
Psychotherapy is helpful for certain patients with neurological disorders and their caregivers, and addresses complex psychological and psychosomatic symptoms and helps the person improve their quality of life. An agreed upon contract is first created between the person and their therapist as the goals of the therapeutic relationship are set. There are different techniques of psychotherapy implemented in clinical practice, and chosen depending on people’s symptoms and social environment, and can range from talk therapy to targeted Cognitive Behavioral Therapy to address a person’s dysfunctional beliefs and maladaptive behaviors.
PAP/NIV are non-invasive mechanical device therapies aimed at improving people’s air movement in and out of the lungs during sleep, and work as air compressors that push using a nasal or nasal-oral mask. They primarily treat, which is often caused and present in most neurological disorders, including neurocognitive, neuromuscular and movement disorders. PAP devices help address upper airway obstruction during sleep, whereas NIV machines (e.g., bilevel PAP, auto/adapt servo-ventilation, volume-assured pressure support) address poor ventilation in addition to upper airway obstruction.
People with Obstructive Sleep Apnea whose facial anatomy leads to a narrow upper airway may be candidates for orthodontic or surgical interventions that open the upper airway, rather than pursuing lifelong PAP therapy. After a polysomnography that verifies OSA diagnosis, sleep physicians together with maxillofacial surgeons and/or orthodontists discuss with candidate patients on interventions that may help improve or, even, resolve OSA symptoms.