photobiomodulation

The treatment of Alzheimer’s disease requires two distinct phases. The first is correcting the factors injuring or causing the degeneration of the brain. The second and equally important is the rehabilitation of brain structure and function. By the time symptoms are present in the disease measurable loss of brain volume has occurred and can be seen on volumetric MRI, a test that accurately measures volume in key brain areas. It is the loss of brain tissue that correlates with the loss of brain function.

Several tools are used to restore brain tissue and function. Collectively, there are analogous to exercise that is used to restore muscle volume and function after prolonged immobility that may have resulted secondary to a significant joint injury. These tools exploit the same processes in the brain associated with learning, neurotropism and neuroplasticity.
Neurotropism is the process of neuron stimulation to differentiate and grow. All cells and tissues in the body undergo tropism. The brain is continually regenerating and repairing. Neuroplasticity is the process of repeated stimulation of neurons to form connections that are how they accomplish functions such as memory. Both processes must occur to restore and maintain brain function.

Some of the tools used to rehabilitate the brain include neurofeedback (EEG guided brain biofeedback), cognitive training and photobiomodulation (PBM). PBM refers to using light to stimulate the brain. The forms of light able to due this are limited to specific types that are capable of penetrating to the areas involved in the disease. Pulsed laser and infrared light are suited to this task. Some new work with infrared light therapy has produced promising results in the disease.
The Vielight Neuro is a unique device for infrared light delivery to the involved areas of the brain in Alzheimer’s disease. The unit uses clusters of infrared diodes that spread the effect to multiple brain areas. As light diverges or spreads as it penetrates 5 surface diodes can treat extensive brain volume. One of the challenges in the use of this therapy in Alzheimer’s has been the difficulty of reaching a key area of the deep brain highly involved in memory processing, the hippocampus. The Vielight Neuro overcomes this problem with a unique intranasal diode. The skull separating the brain from the nasal passages called the cribriform plate is the thinnest part of the skull and is easily penetrated by infrared light.

A necessity to adequately stimulate neurons is the amount of light power reaching them or the joules of energy. This can be achieved by the length of application which is 20 minutes per treatment. The rehabilitation of brain volume and function takes time. This is analogous to learning a new language which requires studying it and practicing over several months.

The Vielight Neuro PBM works through two mechanisms. The first is by activating neuron energy production needed for neurotrophism and neurogenesis. The inability to neurons to produce energy is a key factor in their degeneration. Specific types of light activate a key enzyme in cell energy production (link to photobiomodulation under services) called cytochrome C. The upregulation of cytochrome C and the subsequent improvement in cell energy production helps restore neurotrophism and neurogenesis.

The second mechanism relates to the ability of PBM in the gamma frequency range of 40 hertz to activate brain immune cells called microglia. Activated microglia remove the toxic protein, beta amyloid which plays an important role in causing the progression of brain degeneration. 

The 40 hertz frequency means that the light is occurring in bursts 40 times per second. This observation was based on animal studies where exposing them to recurrent periods of 40 hertz white light caused lowering of beta amyloid. The problem was that because this type of light only stimulated the eye and visual pathway as it does not penetrate the skull. While it stimulated beta amyloid removal, it occurred only in the occipital cortex in the back of the brain where vision is processed. The areas involved in Alzheimer’s, the parietal and temporal cortex were unaffected by simply white light.
The innovation that was developed in the Vielight Neuro was that infrared light was used allowing direct transmission through the skull to the brain and the broad pattern of light emitting diodes cover the pattern of cortical areas involved in the disease. An initial case series in patients with well-established disease found that 12 weeks of treatment significantly improved subjective measures of behavior as reported by their caregivers and in the scores on the MMSE. The MMSE is the initial cognitive screening test patients receive in primary care to assess cognitive impairment.
These results, although based only on a case series study, triggered as lot of interest. Alzheimer’s and other forms of dementia are universally progressive without any know medical treatments that alter this course.  

A second case series study is underway which will look at a broader group of outcome markers with the Vielight system. The study at the University of California, San Francisco will look at markers of inflammation, cognitive testing, subjective caregivers’ surveys and cerebral spinal fluid betas amyloid levels. The patients are being separated into placebo and active treatment groups to look at true treatment effects. 

Also ongoing is a study with the most rigorous research protocol, a randomized, double blinded clinical trial. The trail is under the principle investigator Dr. Corrine Fischer, Associate Professor of Geriatric Psychiatry at the University of Toronto and involves 8 academic sites. Patients are being treated for 24 weeks and undergoing extensive comparison of a broad number of tests for cognitive and behavioral functioning.

Alzheimer’s is a complex degenerative disease. First and foremost, in the Bredesen treatment protocol is finding the driving factors injuring the brain. Once those are known a comprehensive program of resolving those factors is underway the task of rehabilitating the brain begins. Photobiomodulation is a powerful tool to help with this process.

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