Advances in Neurological Therapeu cs Con nuing Medical Educa on

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1 2011 Advances in Neurological Therapeu cs Con nuing Medical Educa on September 17, 2011 Cleveland Clinic Lou Ruvo Center for Brain Health Las Vegas, Nevada Advances in Neurological Therapeutics Table of Contents Introduction Letter... 4 About the Course... 5 Accreditation Statement... 6 Faculty Information... 7 Faculty Disclosure... 8 Acknowledgements Agenda Biographies and Presentation Slides Brian Appleby, MD Rapidly Progressive Dementias: Current Treatments Charles Bernick, MD Alzheimer s Disease: Updates in Diagnosis and Therapies Jeffrey L. Cummings, MD, ScD Recent Advances in Neurological Pharmacological Therapeutics Stephen E. Jones, MD, PhD Neuroimaging: New Radiological Diagnosis with the 3T fmri Susan Linder, PT, DPT, NCS The Role of OT/PT in the Management of Neurological Disease Erik Pioro, MD, PhD ALS: New Approaches for Treatment Ryan Walsh, MD, PhD Movement Disorders: Advances in Neurological Therapeutics Timothy West, MD Multiple Sclerosis: Advances in Clinical Management Dylan Wint, MD Managing Depression & Psychosis in Neurological Disease

2 Advances in Neurological Therapeutics Saturday, September 17, :00 AM 6:00 PM Keep Memory Alive Event Center 888 W. Bonneville Avenue Las Vegas, NV Program Description This course aims to advance the understanding of neurological therapeutics and to update practitioners regarding diagnosis and treatment of neurodegenerative disorders including Alzheimer s disease, Parkinson s disease, Multiple Sclerosis, Amyotrophic Lateral Sclerosis, and Rapidly Progressive Dementias. By providing the latest advances in diagnosis and treatment, we will help practitioners effectively manage patients in the earliest stages of these diseases and thereby raise the standards of patient prognosis and care. Target Audience This activity is intended for clinicians who treat patients with neurological disorders. We especially want to encourage neurologists, psychiatrists, family practice and primary care physicians, physician assistants, nurse practitioners, physical therapists and other allied health care professionals to attend. Goals and Objectives Upon completion of this program, the clinician/practitioner will be able to: 1. Identify early signs and symptoms of neurological diseases. 2. Utilize advances in neurological imaging to better diagnose neurological diseases. 3. Recognize and better manage the variety of behavioral complications of neurological illnesses. 4. Distinguish major advances in the pharmacological therapies of neurological disorders. 5. Anticipate the major drug-drug interactions. 6. Manage combination therapies in order to optimize patient function. Disclaimer The information in this educational activity is provided for general medical education purposes only and is not meant to substitute for the independent medical judgement of a physician relative to diagnostic and treatment options of a specific patient s medical condition. The viewpoints expressed in this CME activity are those of the authors/faculty. They do not represent an endorsement by the Cleveland Clinic Foundation. In no event will the Cleveland Clinic Foundation be liable for any decision made or action taken in reliance upon the information provide through this CME activity. 5 Accreditation Statement Advances in Neurological Therapeutics The Cleveland Clinic Foundation Center for Continuing Medical Education is accredited by the Accreditation Council for Continuing Medical Education for physicians. The Cleveland Clinic Foundation Center for Continuing Medical Education designates this live activity for a maximum of 6.0 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Participants claiming CME credit from this activity may submit the credit hours to the American Osteopathic Association Council on Continuing Medical Education for Category 2 credit. This course has also been submitted to the State of Nevada s Physical Therapy Examiner s Board for approval of 0.6 CEUs. Evaluation Form and Certificate MYCME An online evaluation process has been instituted in order for you to receive CME credit for this conference. To receive AMA PRA Category 1 Credit(s), please go to to complete the evaluation, and to print your CME certificate. Once you enter this site, please enter The code is active 30 days following the course. User Instructions: If you are a first-time user of MYCME, you will need to create a six-digit password comprised of any combination letters and/or numbers. This will become your permanent log-in for future Cleveland Clinic MYCME programs. 1. Log in to 2. Click on New User? located under the log-in box. 3. Complete all the fields in the form and click on Create Account. 4. Click on Click Here to Login. 5. Log in using the information you just provided in the registration form. 6. In the Regularly Scheduled Series box enter the code Complete all the fields and hit Submit. 8. Your official CME certificate will appear. Please print and keep with your permanent files. Please note: Be sure to print your CME certificate and keep for your files. This is your permanent record; no other certificate will be generated. If you have problems claiming credit online, please contact the CME office at Physical Therapy Evaluation and Credit Certificate In order to obtain credit for this conference, you must: 1. Complete the evaluation form and return it to the registration desk before you depart. 2. Complete the 2-ply certificate. Return the colored copy to the registration desk before you depart. Please keep the WHITE copy for your records as it serves as your official certificate. Certificates are not mailed. 6 Advances in Neurological Therapeutics Advances in Neurological Therapeutics Conference Chair Jeffrey L. Cummings, MD, ScD Neurologist and Director Cleveland Clinic Lou Ruvo Center for Brain Health Cleveland Clinic Faculty Brian Appleby, MD Geriatric Psychiatrist Lou Ruvo Center for Brain Health Charles Bernick, MD Neurologist and Associate Director Lou Ruvo Center for Brain Health Stephen E. Jones, MD, PhD Neuroradiologist, Diagnostic Radiologist Center for Neuroimaging Susan Linder, PT, DPT, NCS Research Physical Therapist Biomedical Engineering Erik Pioro, MD, PhD Neurologist Lerner Research Institute Department of Neurosciences Ryan Walsh, MD, PhD Neurologist and Movement Disorders Specialist Lou Ruvo Center for Brain Health Timothy West, MD Neurologist Lou Ruvo Center for Brain Health Dylan Wint, MD Neurologist/Psychiatrist Lou Ruvo Center for Brain Health Faculty Disclosures In accordance with the Standards for Commercial Support issued by the Accreditation Council for Continuing Medical Education (ACCME), the Cleveland Clinic Foundation Center for Continuing Education requires resolution of all faculty conflicts of interest to ensure CME activities are free of commercial bias. The following faculty have indicated that they may have a relationship which, in the context of their presentation(s), could be perceived as a potential conflict of interest: Charles Bernick, MD Teaching & Speaking Novartis Pharmaceuticals Jeffrey L. Cummings, MD Abbott Acadia Accera / Ownership Interest ADAMAS Astellas Pharma US Avanir Avid Bayer Healthcare Bristol-Meyers-Squibb Co. CoMentis / Teaching & Speaking Eisai Elan Pharmaceuticals, Inc. EnVivo ExonHit / Teaching & Speaking Forest Pharmaceuticals GE Healthcare Genentech GlaxoSmithKline / Teaching & Speaking Lundbeck / Ownership Interest MedAvante Medivation Medtronic Merck & Company, Inc. / Teaching & Speaking Merz / Ownership Interest Neurokos Owns copyright Neuropsychiatric Inventory / Ownership Interest Neurotrax / Teaching & Speaking Novartis Pharmaceuticals / Teaching & Speaking Ortho McNeil Janssen Scientific Affairs LLC / Teaching & Speaking Pfizer / Ownership Interest Prana remynd Sanofi Aventis Schering Plough Corporation SIGNUM BIOSCIENCE / Ownership Interest Sonexa Takeda Toyama UBC Wyeth 7 8

3 Advances in Neurological Therapeutics Faculty Disclosures continued The following faculty have indicated that they may have a relationship which, in the context of their presentation(s), could be perceived as a potential conflict of interest: Erik Pioro, MD, PhD Teaching & Speaking; Avanir Membership on advisory committee or review panel The following faculty have indicated they have no relationship which, in the context of their presentation(s), could be perceived as a potential conflict of interest: Brian Appleby, MD Stephen E. Jones, MD, PhD Susan Linder, PT, DPT, NCS Ryan Walsh, MD, PhD Timothy West, MD Dylan Wint, MD The Cleveland Clinic Educational Foundation acknowledges educational grants for partial support of this activity from: Baxter Biogen IDEC Elan Martek Biosciences TEVA Neuroscience Please visit our vendors in the Exhibit Hall next to the Event Center. Accera GAITRite - CIR Systems, Inc. life sdha Medtronic TechnoGym TEVA Neuroscience Creekside Home Health Creekside Hospice Nevada Premier Care ALS Nevada Alzheimer s Associa on American Parkinson s Disease Associa on Lou Ruvo Center for Brain Health Na onal Mul ple Sclerosis Society 9 10 Advances in Neurological Therapeutics Conference Agenda 8:00-8:45 AM Registration Breakfast Exhibits 8:45-9:00 AM Introduction Jeffrey L. Cummings, MD, ScD 9:00-9:30 AM Movement Disorders: Advances in Neurological Therapeutics Ryan Walsh, MD, PhD 9:30-10:00 AM Rapidly Progressive Dementias: Current Treatments Brian Appleby, MD 10:00-10:30 AM Managing Depression & Psychosis in Neurological Disease Dylan Wint, MD 10:30-10:45 AM Break Exhibits 10:45-11:15 AM ALS: New Approaches for Treatment Erik Pioro, MD, PhD 11:15-11:45 AM Neuroimaging: New Radiological Diagnosis with the 3T fmri Stephen E. Jones, MD, PhD 11:45-12:15 PM The Role of Occupational/Physical Therapy in the Management of Neurological Disease Susan Linder, PT, DPT, NCS 12:15-1:15 PM Lunch Exhibits 1:15-1:45 PM Alzheimer s Disease: Updates in Diagnosis & Therapies Charles Bernick, MD 1:45-2:15 PM Multiple Sclerosis: Advances in Clinical Management Timothy West, MD 2:15-2:45 PM Recent Advances in Neurological Pharmacological Therapeutics Jeffrey L. Cummings, MD, PhD 2:45-3:30 PM Panel 3:30-4:00 PM Qualitative & Program Evaluations Exhibits 4:00 PM Adjourn CME 4:00-6:00 PM Guests are cordially invited to stay for a Q & A/Meet & Greet/Reception/Exhibit Visits at the conclusion of the CME conference. BRIAN APPLEBY, M.D. Geriatric Psychiatrist Lou Ruvo Center for Brain Health, Main Campus, Ohio Dr. Appleby is a neuropsychiatrist who treats and researches dementia and cognitive disorders. His clinical and research interests include prion diseases (e.g., Creutzfeldt-Jakob disease) and young-onset dementias. Dr. Appleby received a B.A. in biology and philosophy from Goucher College and a M.D. from Georgetown University School of Medicine. He completed an internship at Georgetown University Hospital and a psychiatric residency at The Johns Hopkins Hospital, where he also completed a geriatric psychiatry fellowship. Following his training, Dr. Appleby became Assistant Professor within the Division of Geriatric Psychiatry and Neuropsychiatry at Johns Hopkins University School of Medicine. He founded and directed the Johns Hopkins Creutzfeldt-Jakob Disease (CJD) Program and was co-director of the Frontotemporal Dementia and Young-Onset Dementia Clinic. He joined the Cleveland Clinic Center for Brain Health in July 2011 to focus on dementia care, education, and research. Dr. Appleby is a member of the FDA Transmissible Spongiform Encephalopathy Advisory Committee and is a member of the CJD Foundation Board of Directors. He is also a member of the Friends/Advisors Group of the CJD International Support Alliance. He was nominated to the Rare Disease Day Research Hall of Fame in Rapidly Progressive Dementia: Current Treatments 11 12

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5 17 18 CHARLES BERNICK, M.D. Neurologist and Associate Director Lou Ruvo Center for Brain Health, Las Vegas, NV Dr. Bernick graduated summa cum laude from Rice University with a BA degree in history. He received his MD from University of Texas Southwestern, being elected to the medical honor society, alpha omega alpha. Dr. Bernick completed a neurology residency at the University of Miami, followed by a fellowship in neurology at the University of Arizona. Dr. Bernick has been involved in the field of Alzheimer s disease research and treatment for close to 20 years, beginning as the attending neurologist for the University of California, Davis Alzheimer s Disease Diagnostic and Treatment Center. Dr. Bernick moved to Las Vegas in 1994 to join the University of Nevada School of Medicine. Since that time, he has directed the development of a statewide network of Alzheimer s disease care, with clinics in Las Vegas, Reno and Elko. In addition to co-authoring numerous scientific articles, Dr. Bernick has participated in studies of virtually every medication now available for Alzheimer s disease. He has served as a grant reviewer and committee member for the national Alzheimer s Association and is currently part of their regional Medical and Scientific Committee. Alzheimer s Disease: Updates in Diagnosis and Therapies 19 20

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7 JEFFREY L. CUMMINGS, M.D., ScD Neurologist and Director Lou Ruvo Center for Brain Health, Nevada, Florida, Ohio Ranked by the Journal of Alzheimer s Disease as the 6 th most prolific researcher of the disease over a 23-year period, Dr. Cummings research and leadership contributions in the field of Alzheimer s disease have been recognized through the Henderson Award of the American Geriatrics Society (2006), the Research Award of the John Douglas French Alzheimer s Research Foundation (2008), and the Ronald and Nancy Reagan Research Award of the national Alzheimer s Association (2008). In 2010, he received the Legacy Award from the Ticki Wilkerson-Kassel Movement Therapy Foundation and was honored by the American Association of Geriatric Psychiatry with their Distinguished Scientist Award. Dr. Cummings is the author of the Neuropsychiatric Inventory (NPI) which has become the most commonly used tool for characterizing behavioral disturbances in dementia syndromes and for measuring the effect of antidementia therapies on neuropsychiatric symptoms in Alzheimer s disease and other dementias. Dr. Cummings is an experienced clinical trialist with expertise in clinical trial design and analysis, global trial implementation, and trial outcome measures. He is a member of the Alzheimer s Disease Cooperative Study and of the oversight committee of the NINDS Neuroprotection in Parkinson s Disease program. Dr. Cummings completed Neurology residency and a Fellowship in Behavioral Neurology at Boston University, Boston, Massachusetts. U.S. training was followed by a Research Fellowship in Neuropathology and Neuropsychiatry at the National Hospital for Nervous Diseases, Queen Square, London, England. Dr. Cummings was formerly Professor of Neurology and Psychiatry at UCLA, director of the Mary S. Easton Center for Alzheimer s Disease Research at UCLA, and director of the Deane F. Johnson Center for Neurotherapeutics at UCLA. He is past president of the Behavioral Neurology Society and of the American Neuropsychiatric Association. Dr. Cummings has authored or edited 30 books and published nearly 600 peer-reviewed papers. Recent Advances in Neurological Pharmacological Therapeutics

8 29 30 STEPHEN E. JONES, M.D., Ph.D. Neuroradiologist, Diagnostic Radiologist Cleveland Clinic Center for Neuroimaging, Cleveland, Ohio Dr. Jones is a member of the neuroradiology division at the Cleveland Clinic. Prior to medical school, he was a research physicist at MIT, after receiving his PhD in physics at Cornell University (Ithaca, NY), and an undergraduate education at Caltech. After his research interests shifted from astrophysics to neuroscience, his wife (a psychiatrist at the time at Massachusetts General Hospital) convinced him to enter medical school at Tufts (Boston) and apply his physics and mathematical skills towards medicine. He completed internship, radiology residency, and a neuroradiology fellowship at the Massachusetts General Hospital. His current interests are in applying MRI, fmri, DTI, and functional connectivity towards neurological illness. He lives in Cleveland Heights with his wife, three children, two dogs, one cat, and a decreasing number of goldfish. Neuroimaging: New Radiological Diagnosis with the 3T fmri 31 32

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12 SUSAN LINDER, PT, DPT, NCS Research Physical Therapist Cleveland Clinic, Main Campus, Ohio Susan Linder conducts clinical research to investigate interventions that facilitates neuromotor recovery and decreases disability in patients with neurologic diseases. As a physical therapist, Susan developed expertise in neurologic rehabilitation specializing in the treatment of stoke, brain injury, and neurodegenerative diseases. She obtained board certification as a neurologic clinical specialist and has taught numerous courses in neurologic physical therapy as part of the Physical Therapy curriculum at Cleveland State University. Susan developed the Stroke Exercise Program at Lakewood Hospital with the mission to provide an environment where patients with chronic stroke can participate in aerobic and task-based exercise to improve their cardiovascular fitness. She is currently the research physical therapist and study coordinator in a NIH R01 multi-site trial investigating the utilization of robotics to improve upper extremity function with acute stroke. She is also a co-investigator (PDF grant, CCF) in a project to develop a portable, computerized concussion assessment system. The Role of Occupational/Physical Therapy in the Management of Neurological Disease

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14 ERIK PIORO, M.D., Ph.D., FRCPC Director of the Section of Amyotrophic Lateral Sclerosis and Related Disorders Cleveland Clinic, Cleveland, Ohio Dr. Pioro specializes in the care of patients with ALS and other complex neurodegenerative motor neuron disorders and runs clinical trials to find effective treatments for these diseases. His primary research focus is using magnetic resonance imaging to identify and monitor the progression of motor neuron degeneration in the brains of patients with ALS and related conditions, and the correlation of imaging changes with human and mouse ALS brain tissue. Dr. Pioro received his medical degree from the University of Calgary in Alberta, Canada, which was followed by a doctorate in philosophy (PhD) at the University of Oxford in England as a Rhodes Scholar. He completed his neurology residency at the Montreal Neurologic Institute at McGill University in Montreal, Canada, where he also completed a fellowship in magnetic resonance spectroscopy. He also trained as a clinical and research fellow in electromyography/ neuromuscular diseases at Cleveland Clinic, where he remained on staff. Dr. Pioro is the recipient of several awards as well as grants from the National Institutes of Health, the ALS Association and the Packard Center for ALS Research at Johns Hopkins University. He is a member of several professional associations, including the American Academy of Neurology, Society for Neurosciences, American Association of Neuromuscular and Electrodiagnostic Medicine and World Federation of Neurology. He serves on the scientific committee for the international ALS CARE Database. He holds the Barry Winovich Chair for ALS Research at the Lerner Research Institute of Cleveland Clinic. Dr. Pioro has published numerous journal articles, book chapters and abstracts on clinical and basic-science topics related to neuromuscular function and disease, particularly in relation to ALS and related disorders. He also serves on the Editorial Board of the journal Neuroscience Imaging, and he serves as an ad hoc reviewer for several journals, including ALS and Motor Neuron Disorders, Annals of Neurology, Brain, Muscle and Nerve, Journal of Neurochemistry, Journal of Neuroimmunology, Journal of Neuroscience, Molecular Neurobiology, and Neurology. ALS: New Approaches for Treatment

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16 RYAN WALSH, M.D., Ph.D. Director, Parkinson s Disease & Movement Disorders Program Lou Ruvo Center for Brain Health, Las Vegas, NV Dr. Walsh has long-standing clinical and research interests in the neurosciences that began as an undergraduate at Georgetown University. During Dr. Walsh s subsequent training in the NIH-funded MD/PhD program at The University of Cincinnati, he built upon his interest in brain networks which led to an interest in the clinical field of Neurology. Dr. Walsh pursued residency training in Neurology at The University of Chicago, and his growing research and clinical research interests resulted in a first-author scientific publication in the journal NeuroImage, the publication of a book chapter reviewing the etiology of Parkinson s Disease, and the publication of a clinical report in the journal Neurology during his residency. These experiences as a physician-scientist led Dr. Walsh to pursue fellowship training in Movement Disorders, Memory Disorders, and neuroimaging to investigate the fundamental mechanisms underlying brain network physiology as well as treat the clinical phenotype of their dysfunction. Dr. Walsh pursued fellowship training with two acknowledged world leaders in Movement Disorders, Dr. David Standaert and Dr. Ray Watts, at The University of Alabama at Birmingham (UAB), where he developed an MRI-based analysis of brain networks underlying cognitive dysfunction in Parkinson s Disease. Though Dr. Walsh s imaging approaches were novel to UAB at the time, he actively sought and obtained external guidance from a world-leader in this field, Dr. David Eidelberg. Utilizing this collaborative mentorship approach, Dr. Walsh was able to obtain highly competitive funding from the Parkinson s Disease Foundation (PDF; their only Clinical Postdoctoral Fellowship awarded for ) and from the Civitan International Research Center Emerging Scholars Program during the second year of his fellowship. He also received a consecutive year of funding from the PDF. Movement Disorders: Advances in Neurological Therapeutics

17 TIMOTHY WEST, M.D. Director, Multiple Sclerosis Program Lou Ruvo Center for Brain Health, Las Vegas, NV Director of the Multiple Sclerosis Program at Cleveland Clinic Lou Ruvo Center for Brain Health, Dr. West received his undergraduate degree in Neuroscience at Brigham Young University in Provo, Utah. He completed his medical degree and Neurology residency at the University of California, San Francisco. After serving as Chief Neurology Resident he stayed on to complete a fellowship in clinical neuroimmunology that was funded by the National MS Society. Dr. West is very involved in clinical research and has experience running clinical trials within an MS Center. He has published original articles on Multiple Sclerosis relating to the safety of therapeutics and the clinical predictors within the early stages of the disease. His research interests are focused on improving patient outcomes and the development of novel therapeutics in the treatment of Multiple Sclerosis. Aside from research, Dr. West has a great passion for teaching and has taught within the medical school at UC San Francisco for the past three years. He frequently participates in patient education programs and is very committed to providing comprehensive care for patients with Multiple Sclerosis. As such, part of his clinical fellowship included special training in neuro-urology, spasticity management and neurodiagnostics. Multiple Sclerosis: Advances in Clinical Management

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19 DYLAN WINT, M.D. Neurologist Psychiatrist Lou Ruvo Center for Brain Health, Las Vegas, NV Dr. Wint joined the staff at the Lou Ruvo Center for Brain Health in May He has extensive experience in researching, diagnosing, and treating disorders of the brain. He has designed and/or participated in research studies of behavioral sequelae of traumatic brain injury, the effects of dopaminergic medications on the human reward system, cognition in schizophrenia, and irritability and aggression in Huntington disease. At the Center for Brain Health, Dr. Wint supervises the Education in Neurodegeneration program for high school, college, and professional students. He also directs the Center s Fellowship in Cognitive Disorders. Dr. Wint received his undergraduate and medical degrees at Stanford University and the University of Miami, respectively. After finishing simultaneous residencies in Neurology and Psychiatry at the University of Florida, he completed a fellowship in deep brain stimulation and served on the faculty. During a two-year fellowship at the Section on Integrated Neuroimaging at the National Institutes of Health, Dr. Wint performed studies of the brain s attentional and reward systems in healthy individuals and those with a variety of brain disorders. He subsequently joined the Emory University Department of Psychiatry and Behavioral Sciences. At Emory, he developed the Program in Neurologic Psychiatry, a clinical, research, and educational unit dedicated to optimizing the understanding, diagnosis, and treatment of behavioral problems in patients with neurologic illnesses. Managing Depression & Psychosis in Neurological Disease

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