This project will investigate the potential of Deep Brain Stimulation to improve cognitive abilities and counteract the effects of Alzheimer's disease. Deep Brain Stimulation electrodes targeting the Nucleus Basalis of Meynert (NB) will be implanted bilaterally in a cohort of patients. NB is the sole source of acetylcholine to the neocortex. Such stimulation may not only treat the cognitive symptoms but may have disease-modifying effects. Drawing from animal experiments in non-human primates that showed success of this approach, intermittent stimulation will be delivered at 60 pulses per second for 20 seconds of each minute for one hour per day. The study team will recruit patients, shortly after first being diagnosed with Alzheimer's disease. The study design will test the safety and efficacy of stimulation, potential benefits in cognitive function assessed with a battery of neurocognitive tests, cholinergic neurotransmission evaluated with Positron Emission Tomography, and ability to reverse Alzheimer's biomarkers, including beta amyloid and tau in the cerebrospinal fluid. Successful completion of this project will lead to a potential new intervention for the cognitive impairments of Alzheimer's disease.

Inclusion Criteria:

• Probable, early-stage AD, as defined by NIA-AA 2018 criteria, including amnestic Mild Cognitive Impairment (MCI)

  • Clinical Dementia Rating (CDR) global score of 0.5-1.0 with a memory box score of at least 0.5
  • MMSE ³ 23
  • Stable cognitive enhancer medication equivalent to 10 mg/day donepezil or less for at least 60 days
  • Stable other medications (e.g., psychotropics)
  • Valid informed consent if female, subjects who are post-menopausal or surgically sterile or willing to use birth control methods for the duration of the study
  • an available caregiver willing to participate
  • subject is living at home and likely to remain at home for the study duration.

Exclusion Criteria:

• Active or unstable psychiatric illness
• Inability to tolerate general anesthesia.
• Another concurrent CNS condition or clinical co-morbidity interfering with the study (ie, stroke, Parkinson's disease, Lewy-Body dementia or other form of dementia, other evidence of significant structural brain pathology).
• Current major psychiatric disorder such as schizophrenia, bipolar disorder or major depressive disorder based on psychiatric consult at screening visit
• Verbal IQ<85
• Contraindication regarding anesthesia, stereotactic operation, MRI (e.g. claustrophobia, or implants), or PET (e.g. insulin dependent diabetes) procedures
• Inability to undergo PET or MRI imaging
• Active alcohol or substance abuse as defined by DSM5
• Is unable or unwilling to comply with protocol follow-up requirements
• Is actively enrolled in another concurrent clinical trial.
• Terminal illness associated with expected survival of <12 months

This experiment will generate behavioral/cognitive assessment, imaging data, and biochemical assays under intermittent stimulation of the nucleus basalis from 2 patients. De-identified, quality-controlled raw data sets and documentation for the processed data will be made available for research purposes, in accordance with Vanderbilt IRB policy for sharing de-identified data to maximize dissemination. All data will be de-identified prior to receipt by the repository, but the information needed to generate a unique identifier (Digital Object Identifier [DOI]) will be collected for each subject. Data will be archived and shared using the Open Science Framework (OSF) repository, which is a widely accessible, open, and secure online platform for sharing scientific data and documentation. Data analysis will be performed using MATLAB and Python; these scripts will be made available on our GitHub lab website.

Data will be made available at the time of an associated publication or at the end of the project period, whichever comes first. Unpublished data will also be made available at the end of the project period. Data will continue to be shared for a minimum of five years after the end of the project period.

Data will be freely available at OSF, and any research can access the data by creating a free OSF account.