A trailblazer in the study of brain health, Dr. Charles Bernick is our guest this week on Nevada Week In Person.

♪♪♪♪♪ Support for Nevada Week In Person is provided by Senator William H. Hernstadt.

-Welcome to Nevada Week In Person.

I'm Amber Renee Dixon, joining you from the Cleveland Clinic Lou Ruvo Center for Brain Health, where our guest has been a neurologist for the past 15 years, and his involvement in the research and treatment of Alzheimer's disease spans more than 30 years.

Dr. Charles Bernick, thank you for joining Nevada Week In Person.

(Dr. Charles Bernick) It's a pleasure to be here.

-You are like so many Las Vegans, in that you are originally from Los Angeles.

-Yes, yeah.

-1994, though, is what brings you to Nevada.

What brings you here and with what hopes and dreams?

-Yeah, I think I'm like a lot of Las Vegans; that is, I came here for opportunity.

I was in Sacramento before coming here but was ready to make a move.

And my interest is in Alzheimer's disease.

And at that time, there really wasn't much in this city, in fact in this whole state.

And so I felt it was really an opportunity to build something from the ground up, and it's been a project ever since.

-Kind of a daunting task.

-Yes.

You know what's really interesting, Amber, is the city, the support of everybody who really kind of come together if there's a cause or if there's an initiative.

And it's like a lot of things.

I mean, it's really who you work with and the support you get that makes things happen, and that was here in Nevada.

-You found that?

-Absolutely.

-Your goal at the time when moving here, as you said in a UNLV article, was to develop a statewide system of Alzheimer's research and care.

How did you go about doing that?

-Well, it began actually here in Las Vegas.

So we got together the people we need--social workers, help with clinical research, research assistants, things like that--and then we felt that we had the opportunity to really branch out throughout the state.

So we developed a clinic actually in Reno.

And through telehealth-- and this is, this is what, 20 years ago, before covid.

Nevada really had a very strong infrastructure for telehealth, and so we had clinics set up in Elko, in Ely, in Winnemucca.

And so we were really able to cover the whole state through telemedicine, which was at that time pretty novel.

-Well, I mentioned "trailblazer" in the intro, and I think that is an example of how you helped implement something that was, I mean, now so common, but back then, not really.

What was it that sparked your interest in Alzheimer's research in particular?

-Well, this dates back even further.

So when I was finishing some of my training, had a job, like a moonlighting job at a, well, what we now call a memory care unit, so in a nursing home.

And so I had to quickly learn about Alzheimer's disease.

But there wasn't much on Alzheimer's disease then.

This is 1984.

And so it really became kind of an interest of mine in this field because we really, again, had the opportunity to take a disease that nobody really knew much about but yet affected so many people and try to really learn about it, develop therapies, treatments, and not really only for the patient, but, of course, for the families as well.

-What was treatment like back then, the state of medical care for someone with Alzheimer's?

-I can answer that very simply: zero.

There were no treatments.

So at that time, 1985, there were no specific treatments for Alzheimer's disease.

And really the care was just supportive, treating symptoms.

And we've come a long way.

-Treating symptoms, the support.

I mean, I imagine even back then, there was not a lot known about what caregivers need to be doing.

-No, there wasn't.

And I think that's evolved over time.

It's something we're proud of here at the Cleveland Clinic, because that's really part of the equation.

You can't just treat the patient.

That's half of-- that's half of the equation.

The other part is the family, the caregivers, they in sometimes really bear more of the burden than the patient themselves.

-Can you point to areas of education for caregivers that are so crucial?

-Yeah.

Well, I think it's, it's just getting information, talking with peers.

That's why support groups are so important.

Learning-- I go, sometimes when I go to support groups, I learn new things about kind of what people figured out on how to deal with behaviors or situations or travel.

So I think it's, I think it's really just getting engaged, trying to find the resources, and hopefully, again, a center like ours can help to help people in dealing with that task.

-Is there an example you could give me of a time when you've been working with a patient whose behavior is perhaps preventing you from doing what you need to do or what you need to find out?

-Yeah, it happens a lot, because, you know, sometimes patients, as part of the disease, don't have insight into the illness.

They may resist some of the things you're trying to do, some of the things the caregivers are doing.

It's extremely frustrating.

But I think through, you know, learning techniques, medications if necessary, most of these things can be really handled now.

I had kind of a personal experience.

My mother had Alzheimer's disease.

And even in somebody who, like, should know everything about this, it was a challenge.

It's a challenge anytime you're a caregiver.

-I wondered when I was going to ask you about what inspired you to get into this field, if it was going to be a person.

But it initially was that job that you had.

At what point did you find out that your mother had Alzheimer's?

-Well, she developed it, at least symptomatically, in her mid-80s.

So this was probably around 2010, something like that.

And I think, you know, she had a good life.

She made it to 96.

So having the disease itself doesn't mean your life ends, but again, it's a hard road and it's difficult for caregivers.

-I imagine that gives you a lot of insight.

I mean, how powerful to have had that experience in your own life.

-Yeah.

You never know until you walk in those shoes.

I mean, so you may think you know what's best for a person or for a patient, but until you're in that situation, you really probably don't know.

I think it did give me perspective and insight into kind of what people are going through.

-What did your mom think of the line of work you chose?

-I think-- well, of course, at the time I started, she wasn't really affected.

And I think, I think she was just proud that, you know, I had a job.

I was doing something.

But yes, I think-- when she had the disease, she was one that really didn't have a lot of insight, so she thought it was just aging.

And it was fine, you know.

And she was just very happy and pleasant, and that's probably the best you can hope for.

-Would it have helped for her to have been aware?

-I don't think so.

I think in some sense it's almost more frustrating.

But you see it in different situations, so it's not-- with Alzheimer's disease, it's just not one size fit all.

There's different-- some people get, you know, very happily demented during their course.

Some people become more agitated and change their personality, and there's just no really rhyme or reason of it.

So as far as treating it, you just try to improve, really, the quality of that person's life.

-Talking about some of the advancements, I read a New York Times article ahead of this, the first line of which was, quote, Over the last three years, a new class of Alzheimer's drug, the first to treat a root cause of the disease, has set off a roller coaster of hope and disappointment.

Where have you been on that roller coaster, or have you even been on it?

-Well, I'm on the hope side.

I mean, I don't-- the disappointment, I think it's only disappointing if you have unrealistic expectations.

I think in having been in this field for over 30 years, it's probably the biggest advance that we've had.

And so, yeah, it's not a cure, these new drugs, lecanemab and this other that's coming out probably later this year.

These aren't cures, but we do believe they can slow the trajectory of the disease.

Here at the Cleveland Clinic, we're involved in a study, a prevention study, actually trying to prevent Alzheimer's disease, which I think people are hopeful about.

So I think-- I think there's a lot of hope in the field as long as, again, you have realistic expectations of what some of these drugs can do.

-How do you handle the valleys?

There are the peaks, and then there are the valleys.

How do you handle those?

-I think it's, it's like everything in life.

I mean, you know, you do the best you can.

I think even in difficult times, there are things you can do.

So there's always things you can do.

And I'm not one to believe that, well, this is your diagnosis and then things end.

I think, again, a person can have an enjoyable and productive life even with a disease like Alzheimer's disease.

-That study, you are in year what of five?

It's a five-year study?

-Yes.

Well, it's just wrapping up enrollment now, so it's still going to be another five years before we get the results.

But we'll get those results, and I think they're going to hopefully change our approach to treating Alzheimer's disease.

-What is its hypothesis?

And if it's true, what will the impact be?

-The idea is that we can, we actually can recognize the disease process 7 to 10 years before you have symptoms.

So we have tools to do that.

So the idea of the study is that we take people who are not having any symptoms, who are normal but who have evidence of the disease starting, and treating them at that time with some of these drugs that remove the protein that builds up in Alzheimer's disease called amyloid.

So the thought is, if you can take it away, pull it out of the brain early before it causes damage, you can prevent the disease or at least prevent the more advanced stages of the disease.

So I think we're-- again, it's a hopeful hypothesis.

I think there's a lot of evidence to suggest it will be successful, but we'll have to see.

-All right.

That could be a career-defining moment for you, I imagine.

-That would be absolutely exciting, that's for sure.

I might be the first patient.

I don't know, we'll see.

-What about the Professional Fighters Brain Health Study?

That has to be something significant in your career as well.

You've been working on that how many years?

-We started that-- well, the study started in 2011.

We probably started planning it a little earlier than that.

It's somewhat similar to the situation when I got involved in Alzheimer's; that is, this other condition, chronic traumatic encephalopathy, this is what you hear about in some of the professional athletes, football players who have had some tragic deaths because of it.

There's more tension coming out about it in the early 2000s, and we felt that we were in a position to try to learn more about this condition.

So we started a study here in Las Vegas, really the first of its kind, that was to follow individuals who were exposed to repetitive head impacts.

Now, we happened at that time to choose fighters--so boxers, MMA fighters--because we're the fight capital of the world.

We again have this tremendous support from the community--from the UFC, from Top Rank Boxing, from our Nevada Athletic Commission--who really made this a feasible project.

So we've been following fighters and now other athletes 13 years now.

-And so CTE, you can't diagnose it until after someone has passed.

But how are you monitoring their brains then?

What are you looking for when you are watching these fighters?

-So we have a lot of measures we look at.

We look at blood measures, of inflammation in the brain, we do brain imaging every other year, they get speech samples, we test their cognitive function.

We get a lot of information about how they're really doing.

And the goal is to develop a test that we are confident in that can diagnose CTE before death, while somebody still has it, and particularly diagnose it early.

But the same hope is with Alzheimer's disease, that you can treat it early and potentially prevent long-term consequences.

-What was that like getting into this when I imagine there are other neurologists who were like, Boxing and MMA, they shouldn't even exist as a sport.

And what about the people who don't believe that CTE is caused by contact sports?

-Well, I would challenge those people.

But I think as far as, you know, studying sports like boxing and MMA, they've been around forever.

Well, maybe not MMA, but boxing's been around forever.

It's not going to go away.

I think you could say the same thing about football for that matter.

In fact, there may be more or harder impacts if you make it up to the professional football level.

So we don't make really any judgments about the sport itself.

Our interest is really, how do we make these things safer?

How do we detect changes early?

What are the risk factors?

What can we advise athletes and really empower them to make decisions on their own health?

-Dr. Charles Bernick, thank you so much for joining Nevada Week In Person.

-It's been a pleasure.

Thanks so much.

And went so fast.