Research Procedures

Neuropsychologists use standardized tests to evaluate cognitive abilities such as attention, memory, language, processing speed, visuospatial, and executive functions. These assessments enable neuropsychologists to determine a pattern of relative cognitive strengths and weaknesses, which provides information about the structural and functional integrity of an individual's brain.

A Lumbar Puncture, also known as LP or Spinal Tap, is a routine outpatient procedure to withdraw a small sample of CSF, (cerebral spinal fluid) from the lower spine. A needle is inserted between the vertebrae (backbones) in the lower back and into the space containing the spinal fluid which surrounds and cushions the brain and spinal cord.

• A neurologist injects a local anesthetic (like Novocaine) under the skin in the lower back and then inserts a thin needle into the space that contains the CSF. This is below the level where the spinal cord ends, so there is no danger to the cord.
• About 1-2 tablespoons of CSF are removed.  The body replaces this in about 2-3 hours
• The procedure takes about 20-30 minutes.

Lumbar puncture fact sheet - English (PDF)

Frequently Asked Questions about LP: how to prepare for your LP appointment

Post-LP Aftercare instructions

 

Dr. James Brewer and colleagues are conducting research to measure the size of different regions in the brain, and the strength of connections between these areas.  This research uses advanced ways of analyzing MRI signals.

What is an MRI?

Magnetic Resonance Imaging (MRI) is a noninvasive procedure that allows us to look inside the brain, without exposing patients to radioactivity, unlike many other imaging methods.  MRI is an advanced medical technique that uses a powerful magnet, radio waves, antenna, and a computer to produce detailed images of brain structure from different angles. This safe, painless procedure can reveal tumors, strokes, and atrophy (or shrinkage) in particular parts of the brain. In addition to providing pictures of brain structure, some specialized MRI scans provide pictures of the brain chemistry (MR spectroscopy) and brain function (functional MRI). Volumetric MRI (vMRI) scans enable researchers to give special attention to certain regions and structures within the brain that are known to be important in memory formation and retention.  Persons can be compared with themselves over time, or with others in various diagnostic groups which can be helpful in reaching an accurate diagnosis (important for Alzheimer's disease and other neurodegenerative dementias) and better understand what changes are occurring in these specific brain regions.  However, because of the large magnet, persons with metallic implants, such as pacemakers or cochlear implants are not able to undergo a MRI scan.

Why am I being asked to undergo an MRI?

MRI is mostly used to distinguish normal tissue from pathologic tissue, for example, in ruling out the presence of a stroke, tumor, or bleed.  However, such uses of MRI vastly underestimate its power.  In fact, the resolution of modern MR technology is so high that the entire brain can be reconstructed digitally within sub-millimeter accuracy.  We can analyze this image of the brain with exquisite detail and take advantage of automated computer software to make calculations about the brain's structure and function.  Research suggests that the ability to monitor how the brain actively changes as it ages is one of the most powerful tools in predicting whether a person will develop Alzheimer's disease.  We hope to significantly impact the clinical approach to Alzheimer's by allowing physicians to identify individuals at risk, detect the disease in its earliest stages, and monitor the success of treatments.

What will I experience?

You will be asked to remove all metal objects from your body before entering the scan room.  You will lie down on a cushioned table that will be moved into the magnet after you have been comfortably positioned for scanning.  The MR technologist will leave the magnet room but you will be in constant contact with him or her throughout the exam.  When the MR scan begins, you will hear a muffled thumping sound, which will last for the duration of the MRI.  Other than sound, you should experience no other sensation during scanning.  Try to relax during your MRI; it will last approximately 35 minutes.

When will the scan be performed and how do I set up the appointment?

A member of our ADRC staff will contact you to set up your MRI scan appointment.  At that time, they will provide you with specific instructions and address logistical questions or concerns that you may have regarding the scan.

More information

Magnetic Resonance Imaging Information (PDF)

About MRI's - Radiologyinfo.org 

What is a PET scan?

Positron emission tomography (PET) uses a small amount of a radioactive substance, called a tracer, to measure specific brain activity or to detect abnormal accumulations of certain proteins. Different types of PET scans use different tracers. PET is frequently used in dementia research but less frequently in clinical settings.

Where will the scan take place?

The UCSD Alzheimer's Disease Research Center currently sends participants to the Radiation Oncology PET/CT center on the UCSD medical campus and to the California Protons Cancer Therapy Center in Miramar for PET scans. The exact procedure site will depend on the study protocol.

What happens during the procedure?

The exact steps can vary depending on the protocol and type of scan. Typically, the person having a PET scan receives an injection of a radioactive tracer into a vein in the arm. The tracer looks and feels like cool water upon injection. The person then waits for 50 minutes to allow the tracer to circulate into the brain. When time is up, they are moved by a technician into the scanner, which consists of a cushioned table and a donut shaped machine. The PET scanner takes pictures of the brain for about 20 minutes, revealing regions of normal and abnormal chemical activity. The person having the PET must keep his or her head still for the duration of the scan. A PET scan is much quieter than MRI, and looks like a CT scanner. The entire process, including the injection, waiting time, and scan takes a little over an hour.

What if I need to cancel or reschedule my PET scan?

If you cannot make it to your scheduled PET scan, please inform the study coordinator at least 24 hours before your assigned check-in time. Each dose of radioactive tracer must be prepared for every participant visit ahead of time. Due to the short, radioactive half-life of the tracers, we cannot recycle or reuse doses at a future time. Please be sure to arrive at your PET scan appointment on time to ensure that the dose of tracer is not wasted.

Is the radiation exposure safe?

The amount of radiation exposure during a PET scan is relatively low. However, you may be discouraged from participating in a PET scan study if you have received many x-rays, imaging scans, or radiation therapy (e.g. for cancer treatment) in the past.

What does it show?

Fluorodeoxyglucose (FDG) PET scans measure glucose (energy) use in the brain. Studies show that people with dementia often have abnormal patterns of decreased glucose use in specific areas of the brain. An FDG PET scan can show a pattern that may support a diagnosis of a specific cause of dementia.

Amyloid PET scans measure abnormal deposits of a protein called beta-amyloid. Higher levels of beta-amyloid are consistent with the presence of amyloid plaques, a hallmark of Alzheimer's disease.
Tau PET scans detect abnormal accumulations of a protein, tau, which forms tangles in nerve cells in Alzheimer's disease and many other dementias.

Why are PET scans important for research?

Amyloid and tau PET scans are used to determine which individuals may be at greatest risk for developing Alzheimer's disease, to identify clinical trial participants, and to assess the impact of experimental drugs designed to affect amyloid or tau pathways.

Will I receive the results of my PET scan?

We currently do not disclose the results of PET scans performed for research, although this may change in the near future. Ask your study coordinator for more information regarding the disclosure guidelines for your specific protocol.

The SMADRC has a Brain Autopsy Program for enrolled research participants. This enables our researchers to corroborate neuropathological findings with clinical data gathered during research participation.  We are unable to accept brain donations from persons not enrolled in our studies unless they are pre-consented clinical patients referred by one of our SMADRC neurologists.

To report the passing of an enrolled participant, call to activate the autopsy process.

• During regular business hours M-F, 8-4pm call the ADRC Main Number at 858-822-4800
• On weekends and after hours, call the UCSD operator to reach the doctor on call. The number is 619-543-6737. Tell the operator that you are calling about a brain autopsy for the Shiley-Marcos Alzheimer's Disease Research Center Longitudinal Study and Jeff Matcalf is the technician on call.

IF you are an enrolled participant and want to speak with the ADRC autopsy coordinator in anticipation of a participant's passing or for more information about our procedures and processes. You can call the ADRC during regular business hours to speak to a study coordinator.

About the Program

One donated brain can make a huge impact, potentially providing information for hundreds of research studies to better understand Alzheimer's and dementia. Our team of neuropathologists maintains a state-of-the-art Alzheimer's brain bank with well-characterized cases from our longitudinal study cohort. Many neurodegenerative diseases can only be conclusively made by examining post-mortem brain tissue to identify the characteristic pathological proteins.

Autopsy provides valuable information that can educate and enlighten families, physicians, and researchers, who are working to discover more reliable tests for ADRD. The autopsy results of participants who have been followed over time at our SMADRC are especially valuable because, in conjunction with the substantial treatment and care histories that are collected, researchers can obtain information essential to the search for effective treatments for AD. This research will contribute to our eventual understanding of the chain of events that leads to AD and related dementias.

SMADRC Resources

Brain autopsy information packet (PDF)

 

 

Additional Resources

Why should you donate your brain to science?

NIH National Institute on Aging - English

Legal and finanacial planning for people with Alzheimer's disease fact sheet (PDF)

UC San Diego School of Medicine Body Donation Program

 

 

Obtaining a small sample of a study participant's skin through a skin biopsy has the potential to be transformative in our efforts to develop therapies for Alzheimer's Disease. Through this sample that contains a person's specific genetic code, we are able to test therapies in the lab that have the potential to move us closer towards personalized medicine. We are able to see if a particular treatment or drug is able to effect change in the lab which may reduce the time and expense of testing therapies in large numbers of people in a randomized clinical trial. Skin biopsies are obtained in several research protocols using a standardized outpatient procedure.  Skin cells can be used to generate induced pluripotent stem cells (iPSCs). 

Click here for care instructions following skin biopsy procedure.