Tell me about yourself and how you are involved with the Cleveland Alzheimer’s Disease Research Center (CADRC)?
I am a staff neuroradiologist at Cleveland Clinic and have been here since 2007. I serve as The Viguera Family Endowed Chair in Neuroradiology Research, Professor of Radiology at Cleveland Clinic Lerner College of Medicine, and Vice Chairman for Research in the Imaging Institute.

My academic background began in physics at Caltech, followed by a PhD in nuclear fusion from Cornell University. I later shifted my research focus to X-ray astrophysics at MIT before becoming interested in neuroscience and pursuing medical school at Tufts University. I completed my postgraduate training at Massachusetts General Hospital.

Today, my research focuses on brain function and brain connectivity. I also have research interests in epilepsy, degenerative disease, multiple sclerosis, and movement disorders. At Cleveland Clinic, I developed the clinical 7T MRI program in 2013 and helped bring the high-intensity focused ultrasound program here in 2016.

What are your main activities and goals as they relate to brain health?
I wear two hats: I’m a practicing neuroradiologist half the time, and researcher the other half (with a LOT of admin thrown in). My first hat is self-evident regarding its relation to brain health. I work to stay up to date about all current recommendations for all Alzheimer’s assessments, and other neurodegenerative disease. My second hat is studying new ways to see how the brain work…and how it doesn’t work! There are many ways I’m involved here, detailed more below. By wearing the two hats, I’m fortunate to be in a “middleman” position: I can see what the clinical problems are when wearing the first hat, and I’m aware of the scientific advances when wearing the second hat. Then comes the fun: playing matchmaker to advance patient care.

What is the focus of your research currently, and where do you see your work going in the next two-five years?
By biggest focus is with 3 projects: exploring use of 7T in neurodegenerative disease. The most interesting application is to scan an ex vivo brain over many many hours (like a weekend) and obtain exquisite imaging of the brain. This can improve from clinic voxel sizes of 1 mm to 0.15 mm! At this level you can see features unobtainable clinically. We use this technique for diseased brains in the CADRC program, looking for hallmarks of disease at that level to help use better understand what we may see at clinical resolution. We are trying to push the limits of this technology to the utter limits, and reminds me in astrophysics of the Hubble Deep Field images: point the telescope at a dark point in space and collect light for an astonishingly long period of time, to see what have never been seen before, and learn from that. Applied here to 7T brain MRI, this is using the decreased to help the living.

I’m also involved with HIFU, which uses focused ultrasound to affect the brain. There are other institutions exploring HIFU to “shake up” amyloid plaques and improve memory. As an institution, we should consider joining these efforts.

My last related efforts are with the Cleveland Clinic Brain Study, run by the Neurological Institute, in which many thousands of normal healthy older individuals are being studies in detail, including MRI. We are especially interested in MR Fingerprinting, to see the details of brain tissue quantitatively, and thereby see the changes earlier in the progression of neurodegenerative disease.

How do you see research in brain health/Alzheimer’s Disease/dementia evolving in the next 2-5 years?
1. Better monitoring after amyloid treatment. Not only for adverse side effects, but for efficacy.
2. Better prediction of those who will benefit from amyloid treatment. A common theme in many neurological diseases -and in fact with most human disease anywhere in the body - is earlier detection. But this is very difficult due to the large normal variability within the human population and trying to sort out between normal variation and early disease.
3. Study the efficacy or synergy between blood biomarkers and imaging biomarkers. It is likely blood biomarkers will become increasingly sensitive, likely better than imaging, so what would be the future role of imaging

Do you have any suggestion or recommendations for students or young researchers who wish to get more involved in brain health research?
Read about the field (especially books/article written with a bird’s eye view, don’t get bogged down early in the details), then sit back, put your feet up and think. Think big. Don’t settle for being a great clinical/research technician, be a visionary. It’s more important to ask the question than get the answers. This is an exciting time and a profound problem. Allow yourself to be excited by this important clinical problem, the future will thank you!