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Beau Ances, MD, PhD

Dr. Ances is member of the American Academy of Neurology, Society of Neuroscience, International Society for NeuroVirology, Society of Cerebral Blood Flow and Metabolism, International Society for Magnetic Resonance Imaging, and Human Brain Mapping Society. He serves as peer reviewer for journals including Lancet Neurology, Brain, Journal of Neuroscience, Neurology, Annals of Neurology, Archives of Neurology, NeuroImage, Human Brian Mapping, and Journal of Cerebral Blood Flow and Metabolism.

In the US, HIV infection affects nearly 1 million people. HIV quickly crosses the blood brain barrier soon after infection and reservoir of HIV develops in the brain leading to HIV associated neurocognitive impairment (HAND) - impairments in neurocognition, slowed motor movements, and behavioral disturbances. Research in the Ances laboratory and collaborative group is focused on the development of novel diagnostic and therapeutic strategies for HAND.

More HIV infected (HIV+) individuals are living longer due to the introduction of medications for treating the virus, combination antiretroviral therapy (cART). While the overall incidence (the number of new cases) of HAND has not changed since cART, the prevalence (the total number of cases) of HAND has risen with ~20% of all HIV+ subjects eventually developing HAND. Even mild forms of HAND impair daily functioning, reduce quality of life, and cause greater unemployment. Since HAND is a significant burden to HIV infected persons, caregivers, and the healthcare system, the development of effective treatment strategies for diagnosing and treating HAND are of great public health importance.

HAND is quite difficult to detect using current diagnostic criteria such as neurological examination or pencil and paper tests administered as part of neuropsychological testing. These methods are labor intensive and can be influenced by the state of the patient (i.e. a subject had a bad night's sleep or has been worrying about a family matter). Other biological markers of HAND need to be developed and validated. The aim of the Ances laboratory is to translate discoveries of the pathophysiological mechanisms of HAND into novel neuroimaging therapeutics.

Functional magnetic resonance imaging (fMRI), a neuroimaging technique that provides pictures of brain activity during different behaviors, could be a powerful in vivo non-invasive biomarker of HAND. Blood oxygen level dependent imaging (BOLD) and arterial spin labeling (ASL) are utilized by the Ances laboratory to measure functional changes in cerebral blood flow (CBF), cerebral metabolic rate of oxygen consumption (CMRO2), and cerebral blood volume (CBV) during normal behaviors. Alterations in the coupling relationship between functional changes in CBF and CMRO2 may be a "stress test" of neuropathology.

Consensus cART guidelines do not provide specific recommendations concerning management of HAND. Current recommendations are based on peripheral blood markers (plasma viral load and CD4 count) and not neurocognitive status. Initiation of treatment often does not occur until significant thinking problems are observed by the subject, family member, or physician taking care of the patient. By this time the benefit of cART is reduced compared to earlier initiation of medications. Differences also exist in ability of antiretrovirals to get into the brain. The Ances laboratory is using fMRI to assess the efficacy of various cART regimens. This laboratory also investigates the optimal time to start therapy in regards to brain function.

In addition the Ances Laboratory is interested in dementias including Alzheimer's Disease and Rapidly Progressive Dementias such as Cruetzfeld Jacob Disease. This group is interested in discovering early neuroimaging biomarkers of these diseases.

Ances Laboratory

Medical Training

Dr. Ances graduated magna cum laude from University of Pennsylvania in 1989 with a B.A. in International Relations and Biology. He received a Thouron Fellowship and obtained a MSc. in Health Planning and Finance from the London School of Economics/ London School of Hygiene and Tropical Medicine in 1994. He returned back to the United States and entered the University of Pennsylvania School of Medicine as a part of the NIH Medical Scientist Training Program. He received a National Research Science Award in 1996 for his graduate thesis work. He was awarded a Ph.D. degree in Neurosciences in 2000 and a M.D. degree in 2001. His PhD thesis work investigated the mechanisms and mediators of activation flow coupling, the basis of functional neuroimaging, and was performed in the laboratory of Dr. John Detre. During medical school he was awarded Eric C. Raps Memorial Prize for excellence in Clinical Neurology at the University of Pennsylvania in 2001.

He completed an internship in Internal Medicine in 2002 at Pennsylvania Hospital and Neurology residency in 2005 at the Hospital of the University of Pennsylvania. During his residency he was awarded the Penn Pearl Award for excellence in medical student education in 2004. He was chosen by the Neurology department faculty at the Hospital of the University of Pennsylvania for the prestigious Arthur Asbury Neurology Resident Award for Clinical Excellence in 2005.

He completed a post-doctoral fellow in NeuroAIDS at the University of California San Diego (UCSD) where he worked with Dr. Ronald Ellis and Dr. Richard Buxton. For his cutting edge research in NeuroAIDS he was awarded the Universitywide AIDS Research Program of California Clinical Fellowship Award and American Federation for AIDS Research (amFAR) Fellowship. In 2007 he was the recipient of a K23 career development award from the NIH for his work using fMRI to assess HAND. He was also recognized the faculty and residents within the department of Neurosciences at UCSD with Junior Faculty Teaching Award for teaching excellence (2008). He was recruited to Washington University in St. Louis in 2008 and was awarded a Dana Foundation Brain Immuno-Imaging Scholar.

Currently, Dr. Ances is an Associate Professor in the Department of Neurology and Neurosciences. He is certified by the American Board of Psychiatry and Neurology in Adult Neurology. Dr. Ances is an active member of multicenter NeuroAIDS organizations such as the Neurologic AIDS Research Consortium (NARC), the AIDS Clinical Trials Group (ACTG), and the CNS HIV Antiretroviral Therapy Effects Research (CHARTER), and Alzheimer's Disease Research Center (ADRC), as well as the Hope Center.

Dr. Ances treats patients with HIV associated neurocognitive disorders (HAND), HIV peripheral neuropathy, progressive multifocal leukoencephalopathy, cryptococcal meningitis, toxoplasma encephalitis, primary CNS lymphoma, cytomegalovirus encephalitis/radiculomyelitis, and HIV myelopathy. He also sees patients with general neurocognitive complaints due to paraneoplastic limbic encephalitis, post concussive syndrome, Creutzfeldt-Jakob disease (CJD), and other rapidly progressive dementias. He currently sees outpatients on the 6th Floor of the Center for Advanced Medicine (CAM) at Washington University in St. Louis. The CAM is located at Forest Park and Euclid Avenues. Please contact (314) 747-8423 to schedule an appointment.

Selected Publications

Selected Research Publications, peer reviewed:

  1. Detre, J. A., Ances, B. M., Takahashi, K., and Greenberg, J.H. (1998) Characterization of Flow Changes in the Rat Somatosensory Cortex in Response to Forepaw Stimulation Using Laser Doppler with Signal Averaging. Brain Research; 726(1-2): 91- 98.

  2. Ances, B. M., Detre, J. A., Takahashi, K., and Greenberg, J.H. (1999) Laser Doppler Mapping of Activation Flow Coupling in the Rat Somatosensory Cortex. Neuroscience Letters; 257(1): 25-28.

  3. Ances, B. M., Greenberg, J.H, and Detre, J. A. (1999) Activation-Flow Coupling with Forepaw Stimulation in Female and Male Rats. Neuroscience Research; 35(1): 37-41.

  4. Ances, B. M., Greenberg, J.H. and Detre, J. A. (1999) Laser Doppler Imaging of Activation Flow Coupling in the Rat Somatosensory Cortex. NeuroImage; 10(6): 716- 723.

  5. Ances, B. M., Greenberg, J.H and Detre, J. A. (1999) Activation Flow Coupling in the Rat Somatosensory Cortex Using Laser Doppler Imaging Biomedical Products; 3: 44.

  6. Ances, B. M., Greenberg, J.H. and Detre, J.A. (2000) Stimulus Duration Effects on Activation Flow Coupling and Somatosensory Evoked Potentials. Journal of Cerebral Blood Flow and Metabolism; 20(2): 290-297.

  7. Ances, B. M., Greenberg, J.H. and Detre, J. A. (2000) Acute Carotid Occlusion Alters the Activation-Flow Coupling Response to Forepaw Stimulation in a Rat Model. Stroke; 31(4): 955-960.

  8. Ances, B.M., Zarahan, E., Greenberg, J.H. and Detre, J.A. (2000) Non-linearity of the Activation Flow Coupling with Forepaw Stimulation in the Rat Using Laser Doppler. Journal of Cerebral Blood Flow and Metabolism; 20(6): 921-930.

  9. Ances, B. M., Wilson, D.F., Greenberg, J.H., and Detre, J. A. (2001) Temporal Dynamics of the Changes in Cerebral Blood Flow and Calculated Oxygen Metabolism Due to Forepaw Stimulation: Implications for Neuroimaging. Journal of Cerebral Blood Flow and Metabolism; 21(5): 511-516.

  10. Ances, B. M., Greenberg, J.H., and Detre, J. A. (2001) Sex Differences in the Cerebral Blood Flow Response After Brief Hypercapnia. Neuroscience Letters; 304(1-2): 57-60.

  11. Ances, B. M., Buerk, D.G., Greenberg, J.H., and Detre, J. A. (2001) Temporal Dynamics of the Partial Pressure of Brain Tissue Oxygen During Functional Forepaw Stimulation in Rats. Neuroscience Letters. 306(1-2):106-110.

  12. Ances, B. M., Greenberg, J.H., and Detre, J. A. (2001) Effects of Graded Hypercapnia on Activation Flow Coupling. Brain Research. 911(1): 82-88.

  13. Buerk, D.G., Ances, B. M., Greenberg, J.H., and Detre, J. A. (2003) Temporal Dynamics of Nitric Oxide as Measured by Brain Tissue Electrode Oxygen During Functional Forepaw Stimulation NeuroImage. 18(1):1-9.

  14. Ances, B. M. and Detre, J. A. (2003) Perfusion Changes with Photic Stimulation During Two Phases of the Menstrual Cycle: A Pilot Study Comparing Controls and True Menstrual Migraine Patients. Cephalgia 23: 907-913.

  15. Ances, B.M., McGarvey, M.L., Abrahams J.L., Maldjian J.A., Alsop D.C., Zager, E.L., Detre, J.A. (2004) Arterial Spin Labeled Perfusion Imaging in Patients Pre and Post Carotid Endarterectomy Journal of Neuroimaging 14:133-8

  16. Ances, B.M., Ellenbogen, J.M., Herman, S.T., Jacobs, D., Liebeskind, D.S., Chatterjee, A., Galetta S.L. (2004) Heidenhain Variant of Creutzfeldt-Jakob Disease Presenting as Balint's syndrome. Neurology. 63(2):395.

  17. Ances, B. M., Newberg, A., Alavi, A., Liebeskind, D.S. (2004) Concomitant SPECT and PET Reveal Early Uncoupling of Cerebral Blood Flow and Metabolism After Bilateral Thalamic Infacts. American Journal of Neuroradiology. 25(10):1685-7.

  18. Ances, B. M., Vitaliani,R., Taylor, R.A., Liebeskind, D.S.,Voloschin, A., Houghton, D.J., Galetta,S.L., Dichter, M., Alavi, A., Rosenfeld, M.R., Dalmau, J.O. (2005) Treatment- responsive limbic encephalitis identified by neuropil antibodies: MRI and PET correlates. Brain.128(Pt 8):1764-77.

  19. Vitaliani, R., Mason, W., Ances, B.M., Swerdling, T., Jiang. Z., Dalmau, J. (2005) Paraneoplastic encephalitis, psychiatric symptoms, and hypoventilation in ovarian teratoma. Ann Neurol. 58(4):594-604.

  20. Roc, A.C., Wang, J.J., Ances, B. M., Liebeskind, D.S., Kasner, S.E., Detre, J.A. (2006) Altered Hemodynamics and Regional Cerebral Blood Flow in Patients with Hemodynamically Significant Stenoses. Stroke. 37(2):382-7.

  21. Ances, B. M., Roc, A.C., Wang, J.J., Korczykowski, M., Okawa, J., Stern, J., Kim, J., Wolf, R., Lawler. K., Kolson, D.L., Detre, J.A. (2006) Caudate Blood Flow and Volume are Reduced in HIV+ Neurocognitively Impaired Patients. Neurology. 66 (6): 862-866.

  22. Li, M., Ratcliffe, S.J., Knoll, F., Wu., J., Ances, B.M., Mardini, W., Floyd, T.F. (2006) Aging: Impact Upon Local Cerebral Oxygenation and Blood Flow with Acute Isovolemic Hemodilution. Neurosurg Anesthesiol. 2:125-31.

  23. Ances, B.M., Sullivan, J., Weigele, J.B., Hwang, V., Messe, S.R., Kasner, S.E., Liebeskind, D.S. (2006) Stroke Associated with Barth Syndrome. Child Neurology 21(9):805-7.

  24. Ances, B.M., Letendre, S., Buzzell, M., Marquie-Beck, J., Lazaretto,D., Marcotte,T.D., Grant, I., Ellis, R.J. HNRC Group (2006). Valproic Acid Does Not Affect Markers of HIV Disease Progression. J Neurovirol. 12(5):403-6.

  25. Ances, B.M., Ellis, RJ. (2007) Dementia and Neurocognitive Disorders due to HIV-1 Infection in the Era of Combination Antiretroviral Therapies Semin Neurol. 27(1):86-92.

  26. Letendre S, Ances B.M., Gibson S, Ellis RJ. (2007) Neurologic Complications of HIV Disease and Their Treatment. Top HIV Med. 15(2):32-39.

  27. Mowry, E.M. Woo, J.H, Ances, B. M. (2007) Can Neuroimaging Provide Insights Into the Role of Ischemia in Balϑ's Concentric Sclerosis? Nature: Clinical Practice Neurology. 3(6): 341- 348.

  28. Mowry, E.M. Woo, J.H, Ances, B. M. (2007) Balϑ's Concentric Sclerosis Presenting as a Stroke-Like Syndrome. Nature: Clinical Practice Neurology. 3(6): 349-354.

  29. Sanossian, N., Ances, B.M., Shah, S.H., Kim, D., Saver, J.L., Liebeskind, D.S. (2007). FLAIR vascular hyperintensity may predict stroke after TIA. Clin Neurol Neurosurg. 109(7):617-619.

  30. Ances, B. M., Roc, A.C., Chawla, S. Korczykowski, M., Wolf, R., Lawler, K., Kolson, D.L., Detre, J.A., Poptani, H. (2007) MRS Detects HIV-Induced Inflammation and Oxidative Stress in Lenticular Nuclei Despite Antiretroviral Therapy. Arch Neurol. 64(9): 1210-1214.

  31. Ances, B.M., Letendre, S.L., Alexander, T., Ellis R.J. (2008) Role of Psychiatric Medications as Adjunct Therapy in the Treatment of HIV Associated Neurocognitive Disorders. Inter J Psychiatry 20(1):89-93.

  32. Ances, B.M., Leontiev, O.L., Perthen, J.E., Liang, C.L., Lansing, A., Buxton, R.B. (2008) Regional Coupling Differences in Cerebral Blood Flow and Oxygen Metabolism: Implications for BOLD-fMRI. Neuroimage. 39(4):1510-21.

  33. Ances, B.M., Liang, C.L., Leontiev, O.L., Perthen, J.E., Fleisher, A.S., Lansing, A.E., Buxton, R.B. (2008) Effects of Aging on Cerebral Blood Flow, Oxygen Metabolism, and Blood Oxygenation Level Dependent (BOLD) Responses to Visual Stimulation. Human Brain Mapping. 15(5): 317-322.

  34. Ances, B.M., Clifford, D.B. (2008) HIV Associated Neurocognitive Disorders (HAND) and the Impact of Combination Antiretroviral Therapies (cART). Current Neurology and Neuroscience Reports. 8(6):455-61.

  35. Ances, B. M., Roc, A.C., Korczykowski, M., Wolf, R., Kolson, D.L. (2008) Combination Anti-Retroviral Therapy Modulates the Blood Oxygen Level Dependent Amplitude in HIV+ patients. Journal of Neurovirology, 14(5):418-24.

  36. Ances, B. M., Bhatt A., Vaida, F., Alexander, T., Rosario, D., Marquie-Beck, J., Ellis, R.J., Letendre, S., Grant, I., McCutchan, J.A., HNRC. (2009) Role of Metabolic Syndrome Risk Factors in HIV-Associated Stroke. Journal of Neurovirology. 15(3):249-256.

  37. Letendre, S., Ellis, R.J., Everall,, I., Ances, B. M., Bhatri, A., McCutchan, J.A. Neurologic Complications of HIV Disease and Their Treatment. Topics in HIV Medicine. 17(2):46-56.

  38. Ances, B. M., Sisti, D., Vaida, F., Liang, C.L., Leontiev, L., Perthen, J.L., Buxton, R.B., Benson, D.A., Smith D.A., Little, S.J., Richman, D.D., Moore, D.J., Ellis, R.J. (2009) Resting Cerebral Blood Flow: A Potential Biomarker of the Effects of HIV in the Brain. Neurology. 73(9):702-8.

  39. Ances, B. M., Vaida, F., Rosario, D., Marquie-Beck, J., Ellis, R.J., Simpson, D.M., Clifford, D.B., McArthur, J.C., Grant, I., McCutchan, J.A. (2009) Role of Metabolic Syndrome Components in HIV Associated Sensory Neuropathy. AIDS. 23(17):2317-22

  40. Ances, B. M., Vaida, F., Yeh, M, J., Liang, C.L., Buxton, R.B., Letendre, S., McCutchan, J.A., Ellis, R.J. (2010) HIV and Aging Independently Affect Brain Function as Measured by Functional Magnetic Resonance Imaging. J Infect Dis. 201(3):336-40

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