Interview with Prof. Dr. Heiko Braak

A pioneer of brain research reports

Prof. Dr. Heiko Braak from the ICNF is one of the major protagonists in neurosciences. Using detailed anatomical analyses, Braak developed a system to classify changes in the brain associated with Alzheimer's disease into six stages. The so-called Braak stages help clarify the systematic spread of the pathological processes accompanying the disease. Since his appointment in 1980, Braak has been Professor of Anatomy at the University of Frankfurt am Main (Center for Morphology, Dr. Senckenbergische Anatomy). In 1998, Braak received the prize from the 6th International Alzheimer congress in Amsterdam for his ground-breaking contributions to research on Alzheimer's disease.

In an interview with our ICNF Newsletter editor Nicola A. Mögel, Prof. Braak describes his current research. The interview took place on March 10, 2008.

Editor: Prof. Braak, what fascinates you about brain research?

Braak: I am especially interested in the human nervous system. Research in this area was severely neglected in previous decades and I always wanted to focus my own efforts on this field. After I completed my medical degree at Kiel, I started working in psychiatry. Naively, I assumed that psychiatrists were interested in the human nervous system. To my surprise, I came across no reciprocation and found the psychiatrists were mostly interested in the sex life of their patients.

I was very disappointed and decided to change from psychiatry to anatomy. Here, basic research is valued. But again I found no enthusiastic interest in the human nervous system, because at that time electron microscope analyses were all the rage, but highly unsuitable for tissues from an autopsy. For many reasons, in those days as nowadays, the anatomists specialized in the nervous system of mice and rats.

Research on the human nervous system blossomed for a time in Germany around the turn of the last century. Then came the two world wars, destroying the research base and what was already known was not followed up. New research directions were developed such as molecular biology, but the anatomy of the human nervous system remained neglected. This meant an open research field for me.

Ed.: You developed the Braak stages. What are these?

Braak: These are defined pathological changes that occur over the course of a neurodegenerative disease of the human nervous system. I defined such stages for both Alzheimer's disease and Parkinson's disease. This concept allows one to use histological analysis to determine the level to which the disease had progressed (which stage). The idea that the disease progresses slowly but relentlessly in the nervous system was based on clinical observations. With Alzheimer's and Parkinson's disease there were clear clinical indications that the disorder crept up slowly and then progressed continuously over years or decades, with the corresponding symptoms becoming more and more obvious.

Ed.: Are any of these stages lethal?

Braak: Parkinson or Alzheimer patients can die at all stages of the disease partly due to reasons independent from the disease.

Ed.: You are already an emeritus professor but continue to do research. What theme interests you today?

Braak: Currently, we are almost entirely concentrating on Parkinson's disease. We, means a scientific assistant funded by a DFG grant and myself. We are particularly focusing of the pathological changes in Parkinson's disease that arise in the early, non-symptomatic stages. In other words, when the disease is not yet clinically apparent. Although the pathological changes are clearly recognizable, they are not yet severe enough to induce clinical symptoms. Many people already have Parkinson's or Alzheimer's disease in their nervous system, but know nothing about it, nor do their relatives or their doctor. The disease then spreads further over years until crossing the threshold to be clinically recognizable.

Ed.: As long as the disease is not recognizable, the patient doesn't notice.

Braak: Correct, but the disease has already started and progresses relentlessly until one day it is recognized. This is why we are interested in describing these preclinical stages as well as possible, and to make them visible, possibly with newly developed diagnostic "telescopes".

Ed.: Do you intend to slow down or even cure the disease?

Braak: It is possible that something like this may turn up. But first it is a step forward to identify the disease earlier than is possible today. Naturally, we are also looking for ways to improve treatment of the disease.

Ed.: Can your go-getting research work in pensioner age count as evidence that the brain is still capable of learning and developing at an advanced age?

Braak: I am not protected against age-related changes in my nervous system and am sure I show signs of age-related loss of memory performance.

On the other hand, I have a treasure trove of experience and this is my advantage over younger scientists. That I have been looking down a microscope for decades is a fact that should not be underestimated. I still feel highly capable and enjoy working. However, without support from the DFG I could not continue my work. I need a laboratory as well as funds for personnel and materials. My colleagues at the Anatomical Institute are very friendly and accept my work. The grant money depends on the success of our research. Currently, we are still churning out results on a conveyor belt.

Ed.: Professor Braak, thank you very much for the interesting discussion and enjoy your continued research.

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