2011
Advances in Neurological Therapeu!csCon nuing Medical Educa on
September 17, 2011
Cleveland Clinic
Lou Ruvo Center for Brain Health
Las Vegas, Nevada
www.ccfcme.org/ANT11
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Advances in Neurological Therapeutics
Table of Contents
Introduction Letter .................................................................................................................... 4
About the Course ...................................................................................................................... 5
Accreditation Statement ........................................................................................................... 6
Faculty Information ................................................................................................................... 7
Faculty Disclosure ..................................................................................................................... 8
Acknowledgements .................................................................................................................... 10
Agenda ........................................................................................................................................ 11
Biographies and Presentation Slides
Brian Appleby, MD
Rapidly Progressive Dementias: Current Treatments ................................................ 12
Charles Bernick, MD
Alzheimer’s Disease: Updates in Diagnosis and Therapies ...................................... 19
Jeffrey L. Cummings, MD, ScD
Recent Advances in Neurological Pharmacological Therapeutics ........................... 26
Stephen E. Jones, MD, PhD
Neuroimaging: New Radiological Diagnosis with the 3T fMRI ................................. 32
Susan Linder, PT, DPT, NCS
The Role of OT/PT in the Management of Neurological Disease .............................. 46
Erik Pioro, MD, PhD
ALS: New Approaches for Treatment .......................................................................... 53
Ryan Walsh, MD, PhD
Movement Disorders: Advances in Neurological Therapeutics .............................. 62
Timothy West, MD
Multiple Sclerosis: Advances in Clinical Management ............................................. 66
Dylan Wint, MD
Managing Depression & Psychosis in Neurological Disease .................................... 74
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Advances in Neurological Therapeutics
Saturday, September 17, 2011 | 8:00 AM — 6:00 PM
Keep Memory Alive Event Center
888 W. Bonneville Avenue | Las Vegas, NV 89106
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.
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Advances in Neurological Therapeutics
Accreditation Statement
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 www.ccfcme.org/MYCME to complete the evaluation, and to print your CME certificate. Once you enter this site, please enter 020756. 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.
Log in to 1. www.ccfcme.org/MyCME.
Click on 2. New User? located under the log-in box.
Complete all the fields in the form and click on 3. Create Account.
Click on 4. Click Here to Login.
Log in using the information you just provided in the registration form.5.
In the “Regularly Scheduled Series” box enter the code 6. 020756.
Complete all the fields and hit 7. Submit.
Your official CME certificate will appear. Please print and keep with your permanent files.8.
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 216.444.9990
Physical Therapy Evaluation and Credit Certificate
In order to obtain credit for this conference, you must:
Complete the evaluation form and return it to the registration desk before you depart.1.
Complete the 2-ply certificate. Return the colored copy to the registration desk before you depart. 2. Please keep the WHITE copy for your records as it serves as your official certificate. Certificates are not mailed.
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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
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Advances in Neurological Therapeutics
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 Consulting Abbott
Consulting Acadia
Consulting Accera
Consulting / Ownership Interest ADAMAS
Consulting Astellas Pharma US
Consulting Avanir
Consulting Avid
Consulting Bayer Healthcare
Consulting Bristol-Meyers-Squibb Co.
Consulting CoMentis
Consulting / Teaching & Speaking Eisai
Consulting Elan Pharmaceuticals, Inc.
Consulting EnVivo
Consulting ExonHit
Consulting / Teaching & Speaking Forest Pharmaceuticals
Consulting GE Healthcare
Consulting Genentech
Consulting GlaxoSmithKline
Consulting / Teaching & Speaking Lundbeck
Consulting / Ownership Interest MedAvante
Consulting Medivation
Consulting Medtronic
Consulting Merck & Company, Inc.
Consulting / Teaching & Speaking Merz
Consulting / Ownership Interest Neurokos
Owns copyright Neuropsychiatric Inventory
Consulting / Ownership Interest Neurotrax
Consulting / Teaching & Speaking Novartis Pharmaceuticals
Consulting / Teaching & Speaking Ortho McNeil Janssen Scientific Affairs LLC
Consulting / Teaching & Speaking Pfizer
Consulting / Ownership Interest Prana
Consulting reMYND
Consulting Sanofi Aventis
Consulting Schering Plough Corporation
Consulting SIGNUM BIOSCIENCE
Consulting / Ownership Interest Sonexa
Consulting Takeda
Consulting Toyama
Consulting UBC
Consulting Wyeth
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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
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Advances in Neurological Therapeutics
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
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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.
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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 2010.
Rapidly Progressive Dementia: Current Treatments
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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
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JEFFREY L. CUMMINGS, M.D., ScD
Ranked by the Journal of Alzheimer’s Disease as the 6th 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.
Neurologist and Director
Lou Ruvo Center for Brain Health, Nevada, Florida, Ohio
Recent Advances in Neurological Pharmacological Therapeutics
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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 intern-
ship, radiology residency, and a neuroradiology fellowship at the Massachu-
setts 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.
Neuroradiologist, Diagnostic Radiologist
Cleveland Clinic Center for Neuroimaging, Cleveland, Ohio
STEPHEN E. JONES, M.D., Ph.D.
Neuroimaging: New Radiological Diagnosis with the 3T fMRI
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SUSAN LINDER, PT, DPT, NCS
Research Physical Therapist
Cleveland Clinic, Main Campus, Ohio
The Role of Occupational/Physical Therapy in the Management of Neurological Disease
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 dis-
eases. 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 environ-
ment 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 coor-
dinator 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.
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ERIK PIORO, M.D., Ph.D., FRCPC
Director of the Section of Amyotrophic Lateral Sclerosis and Related DisordersCleveland 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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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 2009-2010) 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
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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.
Director, Multiple Sclerosis Program
Lou Ruvo Center for Brain Health, Las Vegas, NV
TIMOTHY WEST, M.D.
Multiple Sclerosis: Advances in Clinical Management
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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 2010.
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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