Psychiatric Times February 2005 Vol. XXII
Jeffrey L. Cummings, M.D., an interest in
identifying and treating neuropsychiatric
and neurodegenerative disorders, particularly
Alzheimer's disease (AD) and other dementias,
began early. After growing up in the rural
town of Basin, Wyo., Cummings went to the
University of Wyoming (graduating with high
honors) and then on to medical school at the
University of Washington (UW) in Seattle.
As an undergraduate student and even as a
high school student, I was greatly attracted
to philosophy, natural history and biology,"
he told Psychiatric Times. "So as I entered
my undergraduate studies, the zoology and
premedical courses attracted me to medicine,
but the philosophical theme drew me to behavior,
and to the choices of neurology or psychiatry.
Undecided between the two, my career has been
a union of those two disciplines."
At UW, Cummings worked with a neurologist,
John Green, M.D. An epileptologist "committed
to humanitarian care," Green encouraged
Cummings "to think about the relationship
between neuroscience and society and between
neurological disease and the human mind and
After his studies at UW, Cummings completed
a rotating internship at Hartford Hospital
in Hartford, Conn., followed by a residency
in neurology and a fellowship in behavioral
neurology at the Boston University School
of Medicine in Massachusetts and another fellowship
in neuropathology and neuropsychiatry at the
National Hospital for Neurological Diseases
It was at Boston University that Cummings
met neurologist D. Frank Benson, M.D. Benson's
1975 book Psychiatric Aspects of Neurological
Disease was a benchmark publication in which
neurologists and psychiatrists contributed
to discussions of brain diseases that produced
Cummings said, "Frank was very interested
in behavioral neurology and was a wonderful
mentor who was tremendously committed to education.
[He] influenced me to go into behavioral neurology
and to consider the dementing disorders and
other neurocognitive illnesses."
Like his mentors, Cummings has continued the
tradition of teaching and mentoring. In 1980,
he became assistant professor of neurology
at the School of Medicine at the University
of California, Los Angeles (UCLA), and in
1992 became professor of neurology and of
psychiatry and biobehavioral sciences. In
1996, he was made the Augustus S. Rose Professor
of Neurology. Since 2002, he has served as
executive vice chairperson in the department
of neurology and, since 2003, as director
of the Deane F. Johnson Center for Neurotherapeutics
Equally important, he has directed UCLA's
Dementia and Neurobehavior Research Fellowship
for over 15 years. Many of the approximately
50 fellows he has trained during that time
currently hold leadership positions in dementia
programs throughout the country. He has also
supervised the training of some 19 international
scholars and been a presenter or plenary speaker
at numerous international conferences, including
those in China, India, Indonesia and Egypt.
A prolific writer, Cummings has authored and/or
edited 20 books, more than 450 peer-reviewed
papers, some 170 chapters in books and several
hundred abstracts. He is associate editor
for several publications and is on the editorial
board of several journals, including Dementia
and Geriatric Cognitive Disorders and Alzheimer's
Disease and Associated Disorders.
His relationship with Psychiatric Times began
in the 1980s when he was lecturing in the
Southern California area and John Schwartz,
M.D., Psychiatric Times' founder and editor
in chief, asked him to speak at Psychiatric
Times'-sponsored meetings. In 1988, Cummings
began writing his widely read "Brain
and Behavior" column, which appeared
four to six times a year until 1996. Since
then, he occasionally contributes articles,
such as "Advances in Alzheimer's Disease
Research: Implications for New Treatments"
in January of 2000 and "New Practice
Parameters for Dementia" in October of
2001. He has served on the publication's editorial
board since 1992 and helps as an occasional
Because he is executive vice chairperson of
UCLA's department of neurology, Cummings was
asked about the major changes he has seen
in the field during the last 20 years.
advent of imaging has been one of the major
diagnostic advances and is increasingly playing
a role in understanding the pathophysiology
of neurological diseases. Imaging in all of
its varying modalities has been one of the
major developments in terms of neurology,"
Another major advance, he added, is the advent
of neurotherapeutics. There has been the discovery
and proliferation of new treatments for AD,
Parkinson's disease, amyotrophic lateral sclerosis,
epilepsy, multiple sclerosis and migraine.
"There has been a remarkable paradigm
shift in neurology from being a largely diagnostic
specialty to being one that is largely a therapeutic
specialty," he added.
Looking ahead, Cummings said, "The increasingly
precise definition of the molecular mechanisms
of neurological disease provides a variety
of targets for pharmaceutical intervention.
I think we are on the verge of seeing much
more meaningful therapies for a number of
neurological diseases, including neurodegenerative
The Deane F. Johnson Center for Neurotherapeutics
that Cummings helped initiate will be at the
forefront of identifying those meaningful
therapies. "This is a multidisciplinary
clinical trials program structured to treat
multiple types of neurological illnesses and
also to provide educational services to physicians,
pharmaceutical company personnel and the public,"
Because of his interest in developing and
testing new treatments for AD, Cummings has
long worked for expanding research in this
field and was able to obtain federal funding
from the National Institute on Aging (NIA)
as well as funding from the state of California.
In 1991, UCLA successfully competed for an
Alzheimer's Disease Core Center under his
leadership. In 1998, the Alzheimer Disease
Research Center was established by a grant
from NIA as a mechanism for integrating, coordinating
and supporting new and ongoing research by
established investigators in AD and aging.
That same year, the center began receiving
recurring funding from the state to be applied
to new research efforts.
availability of this funding greatly augments
our Alzheimer's research, giving us the ability
to recruit patients; to study them in drug
trials; to seriously study the brain when
patients succumb to the illness; to collect
imaging and genetic information on them; and
to provide education to the community,"
In terms of his own research on cognitive
problems, Cummings said, "We have recently
been looking at the neuropsychiatric symptoms
that occur in patients with mild cognitive
impairment to help us understand whether the
behavioral changes might help us predict which
patients with mild cognitive impairment are
going on to Alzheimer's disease. There is
substantial evidence that patients who have
mild cognitive impairment plus depression
or plus apathy are those who are going to
progress relatively soon to a full-blown diagnosis
of Alzheimer's disease."
In the search for a cure for AD, research
efforts at multiple centers have focused on
preventing or reversing amyloid deposition
in the brain. Efficacy evaluation of these
anti-amyloid therapies would greatly benefit
from tools that enable in-vivo detection and
quantitation of amyloid deposits in the brain.
Cummings' colleague John M. Ringman, M.D.,
in conjunction with Jorge Barnos, Ph.D., and
Gary Small, M.D., is engaged in amyloid imaging.
Ringman is studying patients who have an inherited
form of AD. At this point, Cummings explained,
one of the mysteries is how long before the
disease becomes manifest does the protein
accumulate in the brain.
are imaging those patients with amyloid imaging
to determine when the protein that accumulates
in the brain of the Alzheimer's patient is
laid down," he explained. "Is it
only a few years or 20 years? Dr. Ringman's
population along with this novel form of imaging
will help us answer that [question]."
Cummings is also enthusiastic about a study
by colleague Il-Seon Shin, which was first
presented as a poster at the International
Psychogeriatric Association meeting in Seoul,
South Korea, last September, and now is in
press at the American Journal of Geriatric
Psychiatry. The study involved some 40 patients
with AD, who were evaluated at UCLA using
both the Quality of Life - Alzheimer's Disease
(QoL-AD) instrument and the Neuropsychiatric
Inventory (NPI). The article discusses the
relationship between neuropsychiatric symptoms
in AD and their impact on quality of life
for patients and their caregivers.
we can show is that agitation is a major negative
influence on quality of life for the caregiver,
and depression has a major negative influence
on both the quality of life for the caregiver
and the patient," Cummings said. "Our
message ... is that neuropsychiatric symptoms
are a very important part of the dementing
illnesses, and they have major impact on quality
of life for both the patients and the family
members who care for them."
As immediate past president of the board of
directors for the Alzheimer's Association
of Los Angeles, Cummings is attuned to the
needs of caregivers and patients with dementia.
According to the Alzheimer's Association,
in Los Angeles County alone there are more
than 150,000 people afflicted with AD or related
Cummings pointed out that assistance to the
caregiver can improve the life of both the
patient and the caregiver. He explained that
referral to the Alzheimer's Association and
other caregiver groups; use of educational
materials, so caregivers can understand the
disease better; and the provision of some
interventions (e.g., support groups) that
can reduce the burdens on caregivers all have
an effect on both patients and caregivers.
Another aid is individual therapy for caregivers
who are having more substantial psychological
struggles, he said. Additionally, specific
educational programs can inform caregivers
on how to better manage behavioral disturbances
or how to better manage the lack of cooperation
that patients may manifest.
With regard to how care for patients with
dementia can be improved, Cummings talked
about multiple approaches.
are both underdiagnosed and undertreated once
they are identified," he said. "Certainly
a patient cannot receive treatment and a caregiver
cannot receive services unless it is recognized
and discussed that a patient is suffering
from a dementing illness. It is very critical
that caregivers draw attention to memory deficits
in the person that they are concerned about.
Similarly, it is very important that practitioners
hear these complaints and not just ascribe
the deficits to normal aging. They need to
do the careful assessments to determine whether
the deficits go beyond normal aging and then
either evaluate the patients themselves or
initiate a referral to a dementia specialist
if that is appropriate."
Because primary care physicians are often
the first line of medical services that caregivers
and patients seek, Cummings explained, "It
is very important that they take those complaints
seriously and refer [patients] to a dementia
specialist, for example, if the complaints
Improved pharmacotherapy is a major way to
benefit patients, according to Cummings. "We
need better drug therapies that are more powerful
and that are truly disease modifying and will
reduce the progression of the illness or the
risk of developing the illness," he said.
more systematic use of the available agents
may be of benefit to patients," he added.
"The cholinesterase inhibitors such as
Aricept [donepezil], Reminyl [galantamine]
and Exelon [rivastigmine] all have been shown
to improve patients' cognition, function and
behavior. Similarly, Namenda [memantine] has
been shown to improve patients' behavior,
cognition and activities of daily living in
the advanced phase of the disease. The thoughtful,
systematic and persistent use of these drugs
would be of benefit to patients."
Reviewing his career, Cummings said the combining
of neurology and psychiatry has proven beneficial
and is a harbinger of the future:
day these two disciplines become more integrated
on both a conceptual and therapeutic basis.
One example, the drugs that we use to treat
dementia now, such as the cholinesterase inhibitors
and Namenda, although developed for their
cognitive impact, have been shown to reduce
the behavioral disturbances that accompany
Alzheimer's disease, so they also have a psychiatric
impact. On the other hand, drugs such as Prozac
[fluoxetine] have been shown to be not only
antidepressants but also to increase the rate
of nerve cell generation in the medial temporal
lobes of individuals to whom the drug is given.
Therefore, there is a neurological impact
of psychiatric drugs and a psychiatric impact
of neurological drugs that is forcing us to
the increasingly obvious conclusion that behavioral
disturbances are a product of brain disorders
and that neuropsychiatry is a unified field
that includes both the neurological basis
of psychiatry and the psychiatric manifestations
of brain disorders."
2005 Psychiatric Times.
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