Dr. Corey-Bloom in motion is a master demonstration of expertise and balance among the competing and complementary demands of research, teaching, and patient care – all conducted from a platform of considerable range and depth as a physician-scientist. That foundation, a cumulative composite of her career evolution, is not so much a story of stepwise progression of scientific interests as it is of mutually reverberating phases of professional transformation.
Initially earning a PhD in anatomy with research on the olfactory systems of birds and squirrel monkeys, she next pursued concentrated study of cellular organization in sea sponges at the Biozentrum in Basel, Switzerland, and the Marine Biological Laboratory in Woods Hole, Massachusetts. Captivated by the translational promise of that work on normal and abnormal cell structure and function for treatment of human diseases, particularly those of neuropathological consequence for cognition, she took a decidedly clinical turn toward medical training and research, graduating from the UCSD School of Medicine in 1986, followed by a neurology residency and a fellowship in dementing disorders.
Dr. Corey-Bloom works at the forefront of clinical research on the causes and treatment of dementia and other neurodegenerative conditions associated, foremost, with Alzheimer's disease (AD), Huntington's disease (HD), and multiple sclerosis (MS). Each of these diseases is tantalizingly complex in etiology and progression and in symptomatic presentation, variation, and clinico-pathological correlates. A particularly revealing case in point of the intrigues and ambiguities confronted by neuroscientists in disease analysis and description, and by physicians in disease diagnosis, is Alzheimer's dementia, the primary focus of Dr. Corey-Bloom's research.
While all types of dementia are progressive illnesses in which the structure and chemistry of the brain become increasingly and severely damaged over time, the prototypic or characteristic brain lesions of AD are of two kinds: neuritic plaques, which are abnormal deposits of amyloid protein that build up between nerve cells, and neurofibrillary tangles, which are abnormal twisted bundles of tissue, consisting primarily of the protein tau, that permeate brain cells. In this strange micro-world of brain cell degeneration, Dr. Corey-Bloom and colleagues have examined different variations in pathology of patients at autopsy who in life were diagnosed with AD dementia and have found significant correlations between range and severity of overt symptoms – cognitive and motor deficits and behavioral and psychological changes – and underlying pathology and patient age at onset of symptoms.
In general, elderly patients who begin to develop symptoms of dementia after the age of 85 show less underlying brain pathology. This research not only has important implications for treatment, in part by underscoring the need to diagnose and intervene early in the AD course, but also loosens further the already vague definitional boundaries of AD.
Some of the brains of Corey-Bloom's patients exhibited tangles only, others predominantly plaques, and still others exhibited in addition diffuse cortical Lewy bodies, another kind of cellular deformation of dementia that is most often found in the brain stems of patients diagnosed with Parkinson's disease.
Whether it is clinically meaningful in the absence of any known AD-specific biological marker to view these differences in underlying pathology as variants of AD dementia, or as concomitant diseases within a typological spectrum of dementias that can and do co-present, remains an open question.
Dr. Corey-Bloom's sense of urgency in finding a sufficiently sensitive diagnostic biomarker or test for AD, while shared by the AD and dementia research community at large, is in many ways emblematic of her all-encompassing patient-centered orientation in clinical practice. By her own account, she is first and foremost a physician, whose primary duty is to help her patients. This intense commitment to care is the wellspring of her healthy obsession about developing effective treatments for patients, and their caretaker family members, struggling under the daily burden of what are truly devastating neurodegenerative diseases.
As an investigator at the UCSD Shiley-Marcos Alzheimer's Disease Research Center and as director of multidisciplinary clinics at the UCSD and VA San Diego Medical Centers specializing in HD and MS (Huntington's Disease Clinic, designated a Center of Excellence by the Huntington's Disease Society of America; Multiple Sclerosis Center; and Genetically Handicapped Persons Program), Dr. Corey-Bloom regularly accesses or presides over clinical resources and database-enriching patient pools that are optimally positioned for development and testing of what may one day prove to be breakthough treatments that at least slow the progression of, if not outright derail or cure, these diseases.
Her reputation for early and aggressive treatment was earned, locally and nationally, when the first disease-modifying therapies became available for clinical trials with Alzheimer's patients, and she has since never let up. Much to the supportive amusement of colleagues, under approval of the Drug Enforcement Agency after a two-decade hiatus of U.S. research on the medical uses of marijuana, she is principal investigator on a placebo-controlled clinical study of this drug's efficacy in relieving the muscle pain and rigidity of MS patients.
She also conducted a pilot trial of the herbal supplement ginko biloba, to assess whether it can slow cognitive decline. Her preliminary findings suggest a beneficial effect on memory, attention, and overall cognitive functioning in patients with mild MS. Openness to so-called alternative therapeutics is just another element of the Corey-Bloom patient services package.
In both substantive and ethereal ways, Dr. Corey-Bloom views all of the care-related services provided at her clinics as treatment. She deals on a day-to-day basis with disease impact, up close and personal with patients and their families, down to what can be the most heartbreaking of details. Alzheimer, Huntington, MS, all have in common the insidious, and for now at least, unchallenged capacity of diminishing and isolating the ill. Whether loss of memory, confusion, problems with speaking and comprehension, reduced mobility, involuntary movements, or severe emotional disturbance, the lives of patients and their families are dramatically changed by these diseases, symptom by symptom, on multiple fronts of everyday living. The patients' needs are, in short, multidimensional, which defines the logic and necessity of multidisciplinary clinical teams in response.
Alongside internists and other primary care physicians and nurses, Corey-Bloom practices with physical therapists, speech therapists, psychiatrists, and mobility experts, whoever and whatever is required to fill a patient need. The goal is to provide "one-stop shopping" or a complete treatment experience, beyond pharmacologic regimens, for patients who cannot easily and frequently come into the clinics.
Even after two decades of clinical practice, Corey-Bloom never ceases to be amazed by the ingenuity and humor of her patients in overcoming mental, physical, or emotional barriers erected by their illnesses, no matter how fleeting or how small the victories. She is clearly awed by what she considers their genuine bravery in a constant fight against an enemy within. Hers is a disciplined sentimentalism, however.
Fully exposed as a physician and a clinical researcher to the extremes of neurodegenerative disease in impacting and destroying people's lives, she is acutely aware of how a genetic disorder like HD can be readily "cured." In symptomatic adults, each child of an affected parent has a 50% chance of having the Huntington's disease gene. These are poor odds for a happy ending. If every would-be parent worldwide in the currently presenting or diagnosed Huntington generation declined to have children, HD would disappear from the human disease ranks, never to harm or afflict again.
From two distinct angles, we glimpse the depth of Dr. Corey-Bloom's own humanity.
Dr. Corey-Bloom’s clinical activities amount to nearly 900 hours per annum and include clinics at UCSD Medical Center (General Neurology, twice weekly), the multidisciplinary clinic for the Genetically Handicapped Persons Program (GHPP, once monthly), and the VA Hospital (multi-disciplinary clinic, twice monthly). Dr. Corey-Bloom also serves as director of the Multiple Sclerosis Center at the UCSD Medical Center, which meets on the first Tuesday of each month. In addition she is the director and Medical Advisor for the UCSD Huntington’s Disease Center of Excellence (HDSA), also located at the UCSD Medical Center. The UCSD Medical Center’s Huntington’s disease (HD) program was designated a Center of Excellence in 2001 and was among the first treatment and research centers west of the Mississippi to receive the Center of Excellence Honor. In addition, Dr. Corey-Bloom attends in the VA Neurodegenerative and Urgent Neurology Clinics each month. As previously mentioned, Dr. Corey-Bloom was named a San Diego “Top Doctor” three times in the review period. It’s particularly significant to note that in the last three years, only 6 San Diego County Neurologists per year have been named a top doctor, and for two of those three years, Dr. Corey-Bloom was the only Neurologist on the UCSD faculty named, thus demonstrating that this is a truly unique honor. As a further testament to Dr. Corey-Bloom’s outstanding clinical competence, she also received the Health Care Champion Award from the San Diego Business Journal in 2007.
Dr. Corey-Bloom is a physician-scientist well known for studying the causes and treatment of dementia and other neurodegenerative conditions associated, foremost, with Alzheimer’s disease (AD), Huntington’s disease (HD), and multiple sclerosis (MS). Within this realm, she is also looking at treatments for dementia-related sleep disorders and conducts clinical trials for drug therapies in movement disorders. Dr. Corey-Bloom’s work on the causes and treatment of dementia focuses on cortical and subcortical dementias and has been in five main areas: 1) Differences in Lewy body dementia vs. Alzheimer’s disease in early-stage dementia. This work has led to better indicators of diagnosis – namely that visual hallucinations at presentation were the best positive predictor of Lewy Body dementia, while lack of visuospatial impairment was the best negative predictor; 2) The impact of APOE genotype on hippocapal volume and paired associate learning. This work, which has been conducted longitudinally on non-demented adults, revealed a relationship between reduction in hippocampal volume and possessing the APOE e4 allele. 3) Cognitive deficits in patients with HD. This work indicated that source memory for both visual and olfactory stimuli was impaired in HD patients compared to normal controls and that source memory for olfactory stimuli may be particularly sensitive to neuropathological changes in preclinical stages of HD. 4) Best predictors of phenoconversion to HD in presymptomatic gene carriers. Though results from this work are pending, the aim is to determine the factors that determine onset of symptoms in patients carrying the gene for HD. And 5) The use of brief screening instruments to detect early cognitive dysfunction in various dementing conditions. Dr. Corey-Bloom’s work on obstructive sleep apnea (OSA) in patients with dementia found that optimal therapeutic CPAP was associated with reduced subjective daytime sleepiness and significant improvement in cognition. Finally, Dr. Corey-Bloom actively participates as Principal Investigator for 8 Clinical Trials investigating drug treatment for patients with AD and HD. Dr. Corey-Bloom’s research in the review period has yielded 15 scientific publications, with 1 more in press, in high quality refereed journals, 1 new review article, and 1 new book chapter, with 4 more in press, and 3 new book editor credits. This publication record is consistent with her productivity over the course of career, having published a total of 57 research articles, 11 review articles, 32 books or book chapters, and 2 conference proceedings for a total of over 100 refereed publications in her career. Further, she has published nearly 100 additional abstracts. Her research productivity is especially noteworthy considering that Dr. Corey-Bloom also maintains a strong clinical commitment and is not required to conduct independent research in the Health Sciences Clinical Professor series.