Alzheimer’s disease (AD) presents a profound challenge as the most prevalent neurodegenerative disorder globally. It is marked by a relentless progression of cognitive decline and memory loss, often accompanied by a complex pathological framework that remains largely unresolved. As the world witnesses an aging population, the ramifications of AD resonate across families and societies, with an alarming statistic indicating that a new case emerges every three seconds. The implications are staggering, with advanced-stage patients often losing their autonomy, resulting in medical and caregiving expenses that reach upward of 1.3% of the global GDP. This escalating issue necessitates innovative solutions and interventions to alleviate the burden of Alzheimer’s disease.
Current treatment modalities predominantly focus on symptomatic relief rather than addressing the underlying disease process. The existing landscape of therapies, such as cholinesterase inhibitors and the NMDA receptor antagonist memantine, afford only transient respite without halting the disease’s inexorable progression. Furthermore, the latest advancements with anti-β-amyloid (Aβ) monoclonal antibodies, including lecanemab and donanemab, target the fundamental pathological mechanisms of AD. However, these treatments are encumbered by prohibitive costs, limited applicability, and a spectrum of potential long-term side effects. Herein lies the crux of the challenge: a lack of early diagnostic techniques paired with the invasive nature of many targeted interventions. The development of precise, minimally invasive technologies that seamlessly integrate diagnosis, treatment, and monitoring has therefore become critical to overcoming these challenges in the realm of Alzheimer’s disease management.
Among the most promising advancements is the Endovascular Brain-Computer Interface (EBCI), an innovative approach representing a subtype of invasive brain-computer interfaces (BCIs). EBCI fosters the delivery of electrodes to intricate brain regions through an endovascular route, effectively bypassing the need for craniotomy. This technique melds the precision of high-quality signal acquisition with the safety associated with minimally invasive interventions. The EBCI framework enables profound insights into memory circuit involvement in Alzheimer’s, invoking hope for enhanced therapeutic strategies in this domain.
EBCI offers several critical technical advantages. First, it leverages the anatomical pathways of cerebral blood vessels to access essential deep brain structures implicated in Alzheimer’s, such as the fornix and the basal nuclei of Meynert—regions that are not readily accessible through traditional non-invasive BCIs. Clinical anatomical studies bolster these assertions, revealing that the intracerebral venous systems present in Alzheimer’s patients provide an accessible pathway for implantation, dramatically enhancing targeting efficacy.
In addition to anatomical advantages, EBCI’s minimally invasive approach significantly reduces surgical trauma, a crucial aspect when one considers traditional invasive therapies that are fraught with risks. Evidence from human clinical trials indicates that EBCI patients are mobile within 24 hours post-implantation, with a postoperative infection rate of less than 1%. This marks a critical advancement in the realm of neural interface technologies, providing enhanced safety for patient populations typically considered at risk due to preexisting conditions.
Another pivotal advantage of EBCI is its superior signal acquisition capabilities. The local field potential (LFP) signals gathered through this interface rival the quality of those acquired from subdural electrode arrays, showcasing signal strength that ranges between two to five times greater than standard scalp electroencephalography (EEG). Long-term viability studies in animal models demonstrate that EBCI can stably record neural signals for periods extending up to 190 days, with human clinical studies corroborating substantial stability over twelve months without significant signal attenuation.
The evolution of EBCI hardware provides further evidence of its transformative potential within neurological applications. Since its inception, EBCI technology has transitioned through five distinct generations. From the first-generation guidewire electrodes developed in 1973, which allowed initial intravascular recordings, to the latest innovations incorporating artificial intelligence. Each iteration has systematically improved upon the last, achieving milestones in miniaturization, stabilization, and longevity. The advancements in hardware corroborate a consistent trajectory towards enhancing usability in a clinical context, ultimately rendering EBCI a pivotal instrument in both diagnostics and therapeutic approaches.
EBCI further sophisticates the therapeutic landscape through its multifaceted mechanisms that govern the regulation of memory and cognitive functions implicated in Alzheimer’s disease. Its dual capabilities for signal acquisition and neural modulation drive a comprehensive intervention process, inclusive of diagnosis, stimulation, and ongoing feedback. Clinical evidence supports the formation of a “diagnosis-stimulation-feedback” framework, underscoring the utility of EBCI in addressing the complexities inherent within the cognitive decline characteristic of AD.
Early diagnosis emerges as a fundamental component of EBCI’s applicative prowess. Capturing electrophysiological markers during the preclinical stage of Alzheimer’s disease represents a transformative capability, as early cognitive symptoms are notoriously nuanced. Conventional imaging and cerebrospinal fluid analyses often fall short, with studies indicating that a notable percentage of early-onset AD patients display non-memory-related symptoms that lead to misdiagnosis. By employing EBCI’s long-term dynamic monitoring of neurological signals, healthcare professionals gain the ability to identify AD-specific electrophysiological features, effectively achieving diagnosis prior to overt symptom presentation.
The EBCI technology facilitates nuanced monitoring of abnormal brain frequency rhythms associated with AD. Studies illustrate a distinct elevation in θ-wave power alongside a corresponding reduction in both α and β-wave powers during the preclinical phase of the disease. This altered rhythm, particularly the increased θ/α ratio, signifies a core indicator for predicting conversion from mild cognitive impairment (MCI) to AD with commendable accuracy. Moreover, alterations in event-related potentials, such as prolonged P300 latency, further substantiate EBCI’s diagnostic capabilities within this context.
Additionally, EBCI plays a crucial role in the stimulation of neural circuits directly associated with memory retention and cognitive functioning. The intricate pathological mechanisms underlying AD, particularly the disruption of synaptic connectivity due to Aβ deposition, necessitate targeted neural interventions. EBCI’s capacity for deep brain stimulation (DBS) equips it to selectively influence memory-related circuits, ushering an avenue for cognitive restoration. Interventions targeting the fornix and basal nuclei of Meynert culminate in enhanced glucose metabolism and neurotransmitter release—a promising nexus of neuroplastic recovery.
Moreover, the EBCI framework ushers advancements in neurofeedback training tailored explicitly for Alzheimer’s disease patients. Recognizing the cognitive challenges inherent in this demographic, EBCI provides a platform for simplified training paradigms alongside direct feedback. By targeting specific brain wave patterns, patients engage in a self-regulatory approach to brain activity, promoting cognitive restoration and potentially staving off further degeneration.
The application of EBCI synergizes brilliantly with multimodal techniques to bridge the gap between diagnostic precision and therapeutic efficacy. Functional Near-Infrared Spectroscopy (fNIRS) complements the electrophysiological data collected via EBCI, providing comprehensive insights into cerebral hemodynamics. This integrative approach demonstrates a profound capacity for long-term monitoring without the discomfort often associated with magnetic resonance imaging (MRI), indicating EBCI’s profound adaptability within clinical contexts tailored for elderly patients.
The integration of EBCI into clinical practice spans various stages of Alzheimer’s disease, underscoring the technology’s versatility. For those at the mild AD or MCI stage, EBCI emerges as an invaluable tool for both diagnosis and early intervention. The technology’s ability to provide dynamic measures of cognitive functionality, alongside targeted low-intensity stimulation protocols, highlights its potential to preserve cognitive resilience and mitigate decline in this vulnerable population.
As the disease progresses to moderate stages, EBCI serves to enhance therapeutic regimens further. Traditional therapies may exhibit limited efficacy when employed in isolation, but EBCI’s implementation could augment the benefits of anti-Aβ antibody strategies, facilitating comprehensive monitoring of both neurological and pathological changes. This approach not only enhances treatment efficacy but also provides critical insights into patient-centric care.
The role of EBCI culminates in severe stages of Alzheimer’s disease, where the need for functional preservation and communication becomes paramount. Through neurofeedback and affective BCI modalities, EBCI provides mechanisms for patients to maintain engagement and communication, thereby improving their overall quality of life. EBCI’s intervention strategies adapt to the complex needs of individuals grappling with the challenges posed by severe cognitive impairment.
In sum, the integration of EBCI into the framework of Alzheimer’s disease management heralds a new era marked by innovation and hope. However, the path forward is ripe with challenges, including a need for robust clinical evidence through longitudinal studies, refinement of technologies for enhanced miniaturization, and cost mitigation strategies for broader accessibility. As researchers delve deeper into the neurobiological mechanisms underpinning EBCI’s efficacy, the potential for personalized treatment paradigms becomes increasingly tangible. BHarnessing the unparalleled advancements in artificial intelligence, coupled with the integration of multimodal approaches, positions EBCI as a transformative entity in the ongoing battle against Alzheimer’s disease, fostering aspirations of improved patient outcomes.
Subject of Research: Not applicable
Article Title: Applications of Endovascular Brain–Computer Interface in Patients with Alzheimer’s Disease
News Publication Date: 23-Dec-2025
Web References: Not available
References: Not available
Image Credits: Copyright © 2025 Yuhao Sun et al.
Keywords
Alzheimer’s disease, Endovascular Brain-Computer Interface, EBCI, cognitive decline, miniaturization, deep brain stimulation, neurofeedback, multimodal integration, early diagnosis, biomarker detection, technological advancement.
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