Reducing Dementia Worldwide: Meet the 2019–20 Atlantic Fellows for Equity in Brain Health

In September 2019, a new group of emerging leaders will join a global movement to protect the world’s aging population from threats to brain health: the 2019–20 Atlantic Fellows for Equity in Brain Health at the Global Brain Health Institute (GBHI).

Hailing from twenty countries spanning Africa, North America, South America, Europe, Asia and Australia—and from various disciplines including the arts and humanities, medicine, cognitive science, public health, education and advocacy—the fellows represent a wide range of expertise, ambition and promise.

“We are thrilled to welcome this new, distinguished cohort of fellows to the Atlantic community,” said Victor Valcour, MD, executive director of GBHI. “They represent a tremendous opportunity to grow the global movement of brain health.”

The incoming cohort expands the Atlantic Fellows for Brain Equity program’s geographic spread to include seven new countries, including Bermuda, Chile, Ethiopia and Kenya. The program now totals 119 fellows from 36 countries.

Meet the new cohort of Atlantic Fellows for Equity in Brain Health.

Since 2016, the Atlantic Fellows for Equity in Brain Health program has trained a global community of interprofessional emerging leaders in brain health, leadership, and dementia prevention through a 12-month residential program at one of its founding sites, University of California, San Francisco or Trinity College Dublin.

Through their work, fellows emphasize local and global inequities in brain health that need to be addressed by practitioners and policymakers, with the goal of reducing the scale and impact of dementia in local communities around the world. On completion of their training, fellows join a lifelong catalytic community of seven Atlantic Fellows programs working to advance fairer, healthier and more inclusive societies.

Atlantic Fellows at GBHI Celebrate Joint Graduation

By Niall Kavanagh

“Commencement is not the end, but the beginning of a deeper and enduring connection.”

Brian Lawlor, deputy director of the Global Brain Health Institute (GBHI), shared these words to close an inspiring joint ceremony celebrating the graduation of the third cohort of Atlantic Fellows for Equity in Brain Health at UC San Francisco (UCSF) and Trinity College Dublin (TCD) on August 8.

The graduating fellows—who have spent the last twelve months based at UCSF or TCD, GBHI’s founding sites, training in brain health, leadership, and dementia prevention—now join a lifelong community of seven Atlantic Fellows programs working to advance fairer, healthier and more inclusive societies.

“There’s an incredible movement for social justice happening around the world, said Victor Valcour, executive director of GBHI, in his opening address. “And we are a part of it.”

At the simulcast event, Veronica Campbell, Bursar & Director of Strategic Innovation at TCD, served as commencement speaker. She reflected on the practice of collaboration, which is foundational to GBHI’s multidisciplinary program, and the importance of changing the narrative of dementia.

“To effect change for elder care, you're much stronger if you can harness the support and the expertise of others,” said Campbell. “By working collaboratively, so much more can be achieved than any institution or any individual working on their own.”

Through their work, fellows emphasize local and global inequities in brain health with the goal of reducing the scale and impact of dementia in local communities around the world. Two graduating fellows shared reflections of their training year.

“What is most important of this experience is what we have had together,” said Maira Okada de Oliveira, a neuropsychologist from Brazil. “At the end of the day, it’s all about people.” She credited her closing line to the founder of Atlantic Philanthropies, Chuck Feeney.

Kirti Ranchod, a neurologist from South Africa, explored the challenging next steps to address the worldwide epidemic of dementia. “We thrive on challenges, we are problem solvers,” said Ranchod. “If you want to fly, you have to give up the things weighing you down.”

Atlantic Senior Fellows from GBHI, that is, graduates of the program, now total 78, spanning nearly 30 countries worldwide. They continue to have access to career-duration mentoring, funding opportunities, global gatherings, and more.

In his closing remarks, Lawlor shared appreciation for the opportunity to address the global challenge of dementia collaboratively, even in the face of differences.

“I think the beauty of GBHI and Atlantic is people are connecting where there is no common ground,” said Lawlor. “It's about connecting across differences. And when you bridge differences and connect, you can really change culture. That’s really what we're about: changing the culture around dementia.

Atlantic Institute Announces Winners of the Inaugural Atlantic Senior Fellows Awards

Two projects emblematic of the vision and values of the Atlantic Fellows win £50 000 each

This story originally appeared on

OXFORD, UK – The Atlantic Institute has awarded the inaugural Atlantic Senior Fellows Awards to two projects that advance its mission to create fairer, healthier and more inclusive societies.

This year’s Atlantic Senior Fellows awards, worth £50 000 each and open to Fellows who have graduated their programs, were presented to two teams for their impactful work:

• The East Mediterranean Brain Health Initiative (EMBHI)

EMBHI is a joint project of three Atlantic Fellows for Equity in Brain Health: Hany Ibrahim of Cairo, Egypt, Elaine Howard of Kilkenny, Ireland, and Stelios Zygouris of Thessaloniki, Greece.

Designed primarily to help people with dementia in underserved populations, the EMBHI promotes information and expertise sharing among participating countries. Starting with Greece and Egypt, the aim is to create a vibrant community of expertise in the East Mediterranean that will work collaboratively to implement better brain health services.

• The Development of a Health Impact Assessment Framework for the Philippines

This is a joint initiative of two Atlantic Fellows for Health Equity in Southeast Asia: Somporn Pengkam of Thailand and Beverly Lorraine Chua Ho of the Philippines.

This project successfully introduces a new way of engaging deeply with local communities in the Philippines to understand and address the health impacts of large-scale industrial projects. Both Pengkam and Ho see rich potential for sharing their experience more broadly in the Southeast Asia region.

Atlantic Institute Executive Director, Dr Penelope Brook said the inaugural Senior Fellow Awards recognise, support and celebrate impactful work that is emblematic of the vision and values of the Atlantic Fellows global community.

Four projects in all were shortlisted for the Senior Fellow Awards: other finalists were Atlantic Fellow for Social and Economic Equity, Jane Sloane for her project: Framing Equality and comedian and monologuist, Josh Kornbluth, Atlantic Fellow for Equity in Brain Health for his project: Citizen Brain. Both awards were presented at a ceremony at Rhodes House in Oxford where the Atlantic Institute is based and which was attended by more than 130 Fellows from the seven global Atlantic Fellows programs. Next year will see four Atlantic Senior Fellow Awards presented, each worth £50 000 to align with the year on year increase in the number of Fellows.

The Atlantic Fellows is supported by Atlantic Philanthropies.

About the winners:

The East Mediterranean Brain Health Initiative

• Elaine Howard, Kilkenny, Ireland: Elaine holds a master’s of science in dementia from Trinity College Dublin. Working in both the private and NGO health care sectors, her expertise lies in developing and implementing personalized care for people with dementia, facilitating changes in practice, and sharing that knowledge to enable practice and policy change across the wider sector. She also has extensive experience in operational management and service model development and implementation within the financial services sector.

• Hany Ibrahim, Cairo, Egypt: Hany is a geriatrician in the Geriatric and Gerontology Department, Ain Shams University Hospital, Cairo, Egypt. He completed his residency in both geriatric medicine and internal medicine at Ain Shams University Hospital with clinical experience in a variety of elderly care programs, such as acute, sub-acute, long term care, home care, and critical care management. He holds a master’s of science degree in late onset depression and a doctorate degree in geriatric medicine from Ain Shams University. He also holds a diploma in hospital management. Currently, Ibrahim is a lecturer in geriatric medicine and director of the Geriatric Intensive Care Unit at Ain Shams University Hospital.

• Stelios Zygouris, Thessaloniki, Greece: Stelios is a neuropsychologist focusing on computerized cognitive testing and specializing in the use of serious games for cognitive screening. He created the first serious game-based cognitive screen and participated in the design and translation into Greek of various computerized cognitive tests. He is a PhD candidate in a joint program at the Aristotle University of Thessaloniki and the Network Aging Research at the University of Heidelberg, with a scholarship from the Robert Bosch Foundation Stuttgart. His PhD project focuses on the use of longitudinal performance data on a self-administered serious game to detect mild cognitive impairment.

The Development of a Health Impact Assessment Framework for the Philippines

• Beverly Ho, Manila Philippines: Beverly is Health Research Division Chief at the Philippines Department of Health Policy Development and Planning Bureau. She works on providing the Department of Health with evidence needed to support health systems reforms to improve the health of Filipinos equitably and efficiently.

• Somporn Pengkam: Somporn is a Community Health Impact Assessment Practitioner based in Udon Thani, Thailand. She works with rights litigators and academics to facilitate community health impact assessment learning in Thailand and Myanmar.

About the Atlantic Fellows

There are currently almost 400 Atlantic Fellows from 61 countries and that number is expected to rise to almost 3000 over the next decade.

About the Atlantic Institute

The Atlantic Institute, based at Rhodes House, University of Oxford, supports the global network of Atlantic Fellows to learn and work across programs, borders and disciplines to advance fairer, healthier more inclusive societies. It supports a lifelong community of action among Atlantic Fellows by providing them with access to long-term resources, wider networks and opportunities to connect, learn and collaborate to tackle inequities.

About Atlantic Philanthropies

The Atlantic Philanthropies have committed over $660M, alongside other partner organizations and governments, to support the work of a global network of thousands of Atlantic Fellows over the next two decades, and beyond.

This investment – in both the Atlantic Fellows and the institutions that will support and nurture them – is the foundation’s biggest bet ever. It is the culmination of Atlantic’s long history of investing in people and in their vision, opportunity and ability to realize a better world.

For more information about the Atlantic Senior Fellows Awards and Programs:



Fionnuala Sweeney, Director of Communications, Atlantic Institute

For pictures of the winners:

Global Brain Health Institute Reaches Milestone, Sets Sights on Continued Impact for Brain Health

The Global Brain Health Institute (GBHI) reached a significant milestone June 24 when Atlantic Philanthropies finalized a gift to UC San Francisco and Trinity College Dublin (TCD) to continue to address the global dementia epidemic.

“Over the past four years, GBHI has built the foundation for a global network of leaders to address the social and physical determinants of brain health,” said Christopher G. Oechsli, president and CEO of The Atlantic Philanthropies. “This groundbreaking community is actively changing the practices, narratives and policies that will improve the quality of our lives.”

In 2015, the Atlantic Philanthropies granted $177 million to UCSF and Trinity College Dublin to create the Global Brain Health Institute. The latest commitment of $107 million, based on GBHI reaching institutional milestones, fulfills the final portion of this award, now totaling $179 million. The financial backing reflects the ambitions of Atlantic and its founder, Charles “Chuck” Feeney, to advance fairer, healthier, and more inclusive societies.

Read more from UCSF and TCD news:

Brian Lawlor Presents a Dementia Policy Paper to the Chilean National Congress

GBHI Deputy Executive Director Brian Lawlor was invited to Santiago, Chile, June 19-21, 2019, as part of the presentation of a Policy Paper about the Chilean National Plan of Dementia.

By Andrea Slachevsky

The Chilean National Plan of Dementia started in 2017 and in 2018 has been implemented as a Pilot in three regions across the country. The policy paper is a multi-professional effort created by clinicals, academics and patients’ organizations to emphasize and create awareness in the Chilean policy makers and politicians about dementia, inviting them to put dementia as a relevant issue in the political scene. It proposes the need to keep supporting the National Plan and expand it nationwide.

Prof. Lawlor visited one of the three Chilean memory units in the Hospital del Salvador. He was able to experience first-hand the multidisciplinary work that is done there and share his valuable knowledge. He exalted the unit’s members to not just keep up the good work, but also to start evaluating the progress and creating evidence that could help to change the Chilean political mentality. He also noted the importance of the teaching role of the memory unit, generating more trainees in dementia (both medical and non-medical professionals), and helping to mitigate the gap of knowledge between experts and primary care.

Prof. Lawlor also participated in the launch of the policy paper, giving the main lecture of the morning to a crowded and multidisciplinary audience that included patients, caregivers, clinicians, academics, senators, government personalities, and even the Chilean ministry of health.

The wonderful talk of Prof. Lawlor emphasized the importance of hope and humanity in all the process of dementia care, from prevention, diagnosis, treatment and caregiver’s care. He also showed the significant role of GBHI in developing the generation of leaders in Brain Health worldwide, and shared the interest of GBHI to work with Chileans to create new leaders that could drive the change. The first two Atlantic Fellows for Equity in Brain Health at GBHI from Chile will start later this year, and perhaps many more to come.

Dr. Lawlor’s speech was greeted with a standing ovation and generated an immediate impact in the public and in dementia care in Chile. Just a few hours after the presentation of Prof. Lawlor, the Chilean Ministry of Health announced via the government website his intention to prioritize Alzheimer’s Disease and other dementias in the agenda, trying to ensure access to prevention, diagnosis and treatment to every Chilean, no matter their socioeconomic status.

The visit of Brian Lawlor was cover by the University of Chile:

The impact of the policy paper was reported by several media report and the web page of

- Ministry of Health

- Government of Chile:

Read the full report from Andrea Slachevsky here.

Dementia Awareness and Education

In a letter to the editor to the Colombian Neurological Association, Alejandra Guerrero highlights the urgent need to take action for dementia awareness and education. Here she shares an abbreviated, English-language version.

By Alejandra Guerrero , MD, Atlantic Fellow

As life expectancy increases, dementia prevalence grows every year. Its costs and burden are increasing worldwide, especially in low and middle-income countries, including Colombia, a country with a national dementia prevalence of 9.4%, according to the Survey on Health, Wellbeing, and Ageing in Colombia, SABE study. Research has shown there are lifestyle modifications that can reduce dementia prevalence by addressing risk factors such as low educational level, hypertension, obesity, hearing loss, smoking, depression, physical inactivity, loneliness, and diabetes.

Dementia diagnosis is usually surrounded by negativity, fear, and stigma—even in the health care community. These challenges result from a lack of knowledge about dementia treatment and prognosis. This lack of knowledge leaves dementia as a hopeless disease that is inevitable and inherent to aging and humanity, without treatment and with a bleak prognosis.

Since 2017, when the Global action plan on the public health response to dementia 2017– 2025 was adopted by the World Health Organization (WHO), there has been international concern about dementia awareness and education. One of the action areas of the plan is to create public awareness campaigns on dementia to increase knowledge and reduce stigma. These campaigns are essential to developing a dementia plan. They are the starting point to make dementia visible and to create the social movement that will lead the change in the narrative and the change in the public policies around dementia in each country.

Health care professionals have to take an active role and get involved locally or nationally in dementia awareness campaigns to increase knowledge, not just in the general public but also among health care professionals. We have to help to make dementia visible, showing that there is a way for its prevention and treatment. It is crucial to promote research in this field and to obtain information and data adjusted to each population. Education is the first step to empower people living with dementia and their families and thereby influence policymakers to create more inclusive and dementia friendly societies.

Building Community for PCA, a Rare Brain Disease

Jamie Talan shares her journey to help people affected by posterior cortical atrophy.

By Jamie Talan, MPH, Atlantic Fellow

Lani dropped 25 pounds in three weeks. It was a puzzle that had her fitting in the pieces with specialists, mostly oncologists. On one particular day, she ended up in front of an endocrinologist who asked about her vision. The middle-aged woman who had gone back to school for her third masters said that she had new glasses but had difficulty reading the blackboard. Other referrals – first to a neuro-ophthalmologist and then a neurologist – would be the start of a journey that ultimately led to a diagnosis of posterior cortical atrophy (PCA), a rare variant of Alzheimer’s disease.

This visual and spatial dementia made good sense to Lani. She was having problems figuring out where to put her feet. Her gait had changed. She was tentative when walking. When she was asked how she gets around the streets of Manhattan, she said that she follows the feet in front of her. Looking straight at the sea of people throws her off balance. She was also having problems with numbers. She couldn’t see things that were right in front of her. She developed a sensitivity to lights and began seeing what she thought were faces in squares of tile.

She had a long journey to a diagnosis. She is not alone. Rebecca is 55, around the same age as Lani when her symptoms began. Rebecca started losing track of the days and she’d look at an address that she knew well and nothing about it made sense. “My brain is not connecting with the things I am looking at,” she said. Her father was only diagnosed with PCA at autopsy. His sister, now virtually blind, had been having similar symptoms. She’d been diagnosed with PCA, and it was her doctor who asked for her brother’s medical records and autopsy results.

Now, she is on the hunt for those same records. She’d gone to a local neurologist with a long list of symptoms and her family history. He shook his head and said that there was no evidence of dementia. He said that she was depressed. She is now undergoing a proper diagnostic workup at University of California, Los Angeles, where her aunt had been seen, and where her father’s autopsy was done.

I came on to PCA when I was a reporter for a daily newspaper in New York. I always covered the brain and a colleague asked whether I could help a friend with some odd symptoms. She would show up to work with her shoes on the wrong feet. Most mornings, she had trouble putting on her shirts. She was a lawyer in her 50s and I took her in to see a neurologist friend of mine. He listened to her symptoms and began doing a very unconventional exam. He put five objects on the table and asked her to point to something you write with. She picked up the keys. She picked up a letter opener. She picked up a pen. The pen held no more weight in her brain as the letter opener. She could not answer him.

We walked out of there with a diagnosis of PCA. I had never heard of it. I would be the one to diagnose another middle-aged woman when moving to Boise a decade ago. She’d been told that she had Alzheimer’s disease. She didn’t. Her symptoms were visual and spatial. Like Lani, she could no longer keep numbers in her head. I told her neurologist about PCA and he said he’d never heard about it.

Five years later, as an Atlantic Fellow for Equity in Brain Health at Global Brain Health Institute (GBHI), I spent my days in the memory clinic at University of California, San Francisco. It is a mecca for the rare dementias, and every week I am sitting in an exam room with another family facing this unusual diagnosis. They have been led down different paths and ended up there, and finally are given an explanation – or at least a name -- for why they can’t see things that others can.

They are going cortically blind – and I realized that I had a job to do in helping them understand more about their disease. The fellowship ended and I set out to create a lecture series and a support group for patients and caregivers. The hope was to connect them to experts and to one another. I wanted to end their feeling of confusion and isolation in a new world whose focus is primarily Alzheimer’s and few have ever heard of posterior cortical atrophy.

Using videoconferencing, patients and their loved ones from around the world join us for an hour-long lecture once a month. We are now in our second year. Twice a month, we offer two different support groups: one for patients and the other for patients and caregivers. I hired Harvard neuropsychologist, Bonnie Wong, PhD, to co-facilitate the support groups. She is an expert on PCA and other rare dementias. It has been an invaluable resource for patients. I also connect people through a Facebook PCA Support Group and a website: There is a map on the site that helps connect people throughout the United States. We believe our programs are helping patients and their loved ones navigate their new journey with love, acceptance and compassion. Most important, we are creating community.

Today, Lani has a set of friends who know exactly what she is going through. And recently Rebecca found me online and I reached out to help her find the scientists at UCLA to help her complete the puzzle of PCA in her family. We talk. We share. We laugh. We cry. And we are thankful and stronger for these connections.

GBHI Neurologists Call for Action as Health and Socioeconomic Disparities Compromise Brain Health

By Camellia Rodriguez-SackByrne

Socioeconomic and health disparities compromise a person’s well-being, with specific risks for their brain health, writes Elisa de Paula França Resende, MD, Jorge Jesus Llibre Guerra, MD, MS and Bruce Miller, MD, of the Global Brain Health Institute (GBHI). In a recent article in Jama Neurology, the authors emphasize how these disparities influence dementia prevalence in communities across the globe.

“A reasonable proportion of risks are attributable to conditions that can be changed across an individual’s life span,” the authors say.

Can is the operative word. With risk factors for dementia such as access to quality education, healthy diet, treatments for ongoing health conditions, and protection against head injuries not equally available across countries, widespread and timely access to these basic resources is crucial. Access also requires will – both political and economic – to create change.

The statistics they cite are sobering. Dementia is more prevalent and occurs 10 years earlier in low- and middle-income countries than in high-income countries. Further, low educational attainment is associated with higher risk of developing symptoms and earlier symptom onset. Equally concerning is the limited access to affordable and healthy food as well as the increased cognitive risk of highly stressful situations on vulnerable individuals.

The authors make recommendations on how to advance equity:

  1. Increase funding for research on dementia prevention.

  2. Advance policies that address socioeconomic and health inequities related to dementia and having dementia plans prioritize actions to reduce inequities in prevention and care.

  3. Seek additional measures to define neurogenerative disease internationally since biomarkers are not accessible in many parts of the world.

  4. Increase widespread awareness of health and socioeconomic inequities that put people at risk for dementia.

Two of the authors, Resende and Llibre Guerra, are Senior Fellows from the Atlantic Fellows for Equity in Brain Health program at GBHI, a training program based at University of California, San Francisco and Trinity College Dublin that aims to address inequities in brain health.

“The rigorous training of new leaders in brain health around the world gives societies everywhere a chance to transform how they view and care for their elders,” says Miller, co-director of GBHI.

The authors also highlight the important role of nonprofit organizations such as Alzheimer’s Disease International and the Alzheimer’s Association. With partnerships on the ground, these groups generate information such as comprehensive global dementia reports and provide funding for training programs and research.

Since the article’s publication, the authors have received positive feedback.

“My colleagues from Brazil thank me for addressing such an important issue for our country and for the world,” says Resende. “This Viewpoint article allowed us to spread worldwide the GBHI core message: we need to address inequities if we want a world without dementia and brain diseases in the future.”  

Their call to action is timely, with the prevalence of dementia expected to increase in the years ahead and the sharpest increases expected in the low- and middle-income countries.

The neurologist trio strikes a chord of hope as representatives of a larger global network of seven Atlantic Fellows programs. The Atlantic Fellows program at GBHI and its sister programs work to advance fairer, healthier, more inclusive societies. With a cadre of leaders completing intensive training and gaining connections with peers around the globe, fellows return to their communities upon completion of their training to use newly-honed skills to be change makers and champions for equity.

“I am excited about the Atlantic Fellows program,” says Llibre Guerra. “It’s unique in our focus on equity, vulnerable populations, a global approach, and a powerful mix of disciplines. As a result, the Atlantic Fellows will help to translate research evidence and innovation into more informed and effective policies targeting vulnerable populations and shaping a recipe for global equity.”

GBHI Gathers Brain Health Specialists to Focus on Dementia in Latin America and Beyond

Scientists, clinicians and health professionals convene to consider the latest research and ideas in dementia.

By Niall Kavanagh

“Brain health is embedded in equity,” said Victor Valcour, MD, professor of neurology and executive director of Global Brain Health Institute (GBHI), to open the Alzheimer’s Association International Conference (AAIC) Satellite Symposium in Sao Paulo, Brazil, on April 10. “Risk factors for dementia are rooted in health disparities.”

It’s no surprise, then, that Brazil and, more broadly, Latin America—where a third of the population lives in poverty with limited access to health care, combined with one of the world’s fastest growing elderly populations—are experiencing growing rates of dementia faster than most of the world.

Such was the setting for this global gathering of about 600 scientists, clinicians and health professionals, co-hosted by UC San Francisco and Trinity College Dublin’s collaborative GBHI.


In Brazil, about 1.7 million people live with dementia, and three quarters of them are undiagnosed. Across Latin America, roughly 4.6 million people have dementia, and two-thirds of them have Alzheimer’s disease. Like much of the world, dementia cases in Latin America are expected to triple by 2050.

“With this will come great challenges in dementia care, diagnosis, and prevention,” said Valcour.

The prevalence of dementia is higher in Latin America than much of the world, including North America and Europe, in part due to the aging population, but also because of health disparities. Dementia symptoms tend to emerge earlier in Latin American populations than others, likely due to low literacy rates, few years of formal education, high rates of poverty, and limited access to health care.

Together, these attributes reduce “cognitive reserve”—or the brain’s ability to adapt—which may protect against dementia symptoms. Further, many Latin Americans have high blood pressure and diabetes—known risk factors for dementia—compared to people in high-income countries.

There is no cure for dementia, but drug and behavioral interventions—such as healthy diet, regular exercise, and controlling blood pressure—are thought to delay onset of symptoms, and thus prevent disease.


The aim of the symposium was to consider the latest research in dementia science and the need to create a National Dementia Plan for Brazil, part of the WHO’s 2017 goal to make dementia a public health priority.

The three-day meeting featured contributions from Atlantic Fellows for Equity in Brain Health at GBHI, including Maira Okada de Oliveira, who is working to improve diagnosis of dementia among illiterate groups in Brazil; Elisa Resende, MD, who is studying how teaching literacy to adults in Brazil has a high potential to lower their risk of dementia; and Barbara Costa Beber, PhD, who is increasing awareness of dementia among Brazil’s 40,000 speech and language therapists.

“From projects rooted in local communities, to national training initiatives and pan national networks, we want to equip leaders with tools to address dementia across Latin America and beyond,” said Lea Grinberg, MD, PhD, associate professor of neurology and GBHI executive committee member.

In addition to discussing the unique challenges dementia poses for Latin American countries, the AAIC Satellite Symposium considered a wide range of dementia-related topics, including sleep medicine, gender differences in dementia, and how to reduce stigma about dementia.

Atlantic Fellows Boon Lead Tee, MD, MSc and Yue Leng, PhD, MPhil—as well as Drs. Flavia Garcez and Ismael Calandri—won best posters for their respective projects, “Neurolinguistcs Presentation of Chinese Speaking Primary Progressive Aphasia Individuals” and “Sleep Medication Use and Risk of Dementia in a Biracial Cohort of Older Adults."

Brian Lawlor, MD, deputy director of GBHI director, said he is hopeful the gathering will emphasize the importance of a public health approach to dementia, and thus strengthen collaborations and innovations. “Together as an activated community, change can be delivered,” said Lawlor.

Dr Serggio Lanata Named an Inaugural UCSF School of Medicine Population Health and Health Equity Scholar

Dr Lanata will use mapping software to study how geographic vulnerability affects brain health.

Interview by Camellia Rodriguez-SackByrne, GBHI

Serggio Lanata, MD, MS, Assistant Professor of Clinical Neurology at the University of California, San Francisco (UCSF) and Global Brain Health Institute (GBHI) faculty is an inaugural recipient of the 2019 UCSF Schol of Medicine  Population Health and Health Equity Scholar Award. The prize provides Dr Lanata with pilot funding for his research in underserved and underrepresented communities in San Francisco. The study will map people’s social determinants with their brain health and shed light on pressing healthcare needs and priorities in the city.  

Congratulations on being named an inaugural UCSF School of Medicine Population Health & Health Equity Scholar. What is the focus of your project?

My proposal is around mapping and visualizing vulnerabilities that exists across different neighborhoods in San Francisco. San Francisco is a relatively small city; only seven miles by seven miles and the second densest city in the country after New York City I think. People are surprisingly segregated across neighborhoods, and with that segregation comes marked neighborhood differences across different social determinants of health. These life-influencing factors impact people differently across the city, making some groups more vulnerable than others.

This project will use mapping software to identify areas in San Francisco that are most vulnerable according to a number of social determinants that we know are relevant to brain health. Then, I’ll overlap those findings with a map that shows where our current research participants are coming from in the city. This overlap will highlight the regions that are underrepresented in our research projects at the UCSF Memory and Aging Center (MAC). If there is a highly vulnerable region that we're not recruiting from, we can refocus our outreach efforts to that region.

What types of research projects do recruits of the MAC join? Any links to your study?

There are three main research projects at the MAC. A large one that I’m most involved in is our Alzheimer's Disease Research Center. We also have a project that studies the frontotemporal lobar degeneration spectrum of diseases, including frontotemporal dementia, and a large healthy aging project. I’ll be leveraging these projects and bringing in more vulnerable and underrepresented individuals to participate in them. Once enrolled, I’ll run a questionnaire with them that assesses vulnerability at an individual level. It will have very specific questions such as asking about food security, financial strain, safety at home and in their neighborhood, exposure to violence, etc. These type of questions will allow me to objectively assess a person’s vulnerability at different times in their lives. Once we have enough participants to make sense of the data, I’ll assign a vulnerability level to them and then ask, “how does this vulnerability level influence their brain health today?” We can understand this through different mechanisms at the MAC. We have MRIs of participants, blood markers of inflammation, neuropsychological assessments, PET imaging, and other biomarkers to look at. I'm hoping to try to link all the data we are already collecting with a person’s vulnerability.

Much of the work we've done in the past three years is to establish relationships in the community. This is where we will carry out some of the initial conversations with people who take part and we will also do the evaluations in community centers. I feel that we've laid strong groundwork to start developing this project.

What are your long-term hopes and goals for this research?

My hope is that that the vulnerability assessment we create for San Francisco can be used in other big cities. It's a very urban assessment. A long-term goal would be creating collaborations across cities in the US and internationally. The GBHI Vulnerable Populations and Social Determinants Interest Group, composed of Atlantic Fellows for Equity in Brain Health, would be a good group to start thinking about this international effort. The Atlantic Fellows are from countries across the globe, so there’s great potential for collaboration.

Down the road, a long-term goal would be that this work could influence policy in San Francisco. If we're showing important brain health outcomes in highly vulnerable groups, it adds to the conversation that already exists around social determinants of health in the city.

I hope results from this work will change people’s thinking a little bit. To me, that's the most inspiring type of research: doing work that you feel may have a palpable impact on society.

How do any aspects of this study link to your Peruvian origins, if at all?

I think growing up in a country like Peru, where social inequities across different domains are so blatant, had an impact on me. Then after living in the U.S. for years and going back home, the social reality of my country felt even more desperate. Inevitably, you start telling yourself, “this is wrong.” And at first your response is something like, “somebody has to do something about this”. But if the discomfort sticks in your mind long enough, you start thinking that that somebody could be you, and that no effort is too small. I think I'm leaning towards trying to be part of the solution now, and I’m so grateful for my colleagues at the MAC and GBHI for inspiring me and enabling me to do this work. I also recently received an awesome endowment that supports my work in this area, and that’s also incredibly inspiring too.  

If you could wave a magic wand to influence how national science institutions define diversity, what would be your wish?

I think the definition of diversity in clinical research should go far beyond race and ethnicity. If as a researcher your only marker of diversity is race and ethnicity, then your research findings will be linked to those races and ethnicities, and this carries the risk of perpetuating the social inequities we’re trying to address. In other words, if you find differences in health outcomes between racial groups, for example, and you haven’t collected data on their living conditions and social determinants, then you end up associating these outcomes with race, not their living conditions. This carries the risk of perpetuating false ideas of biologically driven racial differences in health outcomes.

How does this work connect to GBHI's larger vision and aims around equity?

I think this work is intimately tied to promoting social equity. Not just health equity, but social equity. If you're living in vulnerable conditions that shape a certain life trajectory that puts you at risk of brain disease, and this can be shown with data, then I think this could be a call for action on a policy level. If you're in charge of city government and receive data showing how certain social determinants affect people's brain health, this would be a strong motivator, I hope, to do something structurally to create equity across our neighborhoods. Nothing impacts a person’s quality of life and productivity more than his or her neurological health. The city of San Francisco is already mindful of the impact of social determinants on other health conditions, but I don’t think brain health is a big enough priority yet.

Are there threads of this work you want to pass on to your children?

I've been thinking a lot about that lately. My children know I'm a brain doctor and they ask me questions about the brain, so I’m hoping I pass on that sense of awe and curiosity to them. This work certainly aligns with what I try to teach in the house too. My oldest is very aware that she is in a school district where many Latino immigrant families live. Many of these kids don't speak English. She sees that English and Spanish speakers start to separate from each other, they don’t hang out. I think that's the beginning of these tribal mentalities that are so strong in this region, the segregation. It happens around language, socially defined racial or ethnic groups, income, etc. This is how people start thinking along the lines of “we're different people because we speak different languages, look different, eat different food…” I talk to my daughters about this, we talk about how these differences happen, how each person is unique, and how despite these differences, there is so much more we have in common.

The UCSF School of Medicine Population Health and Health Equity Scholar Award is the result of a partnership between the UCSF School of Medicine and the Global Brain Health Institute. Applications are judged on the degree to which the proposed work would enhance equity training and engagement of Atlantic Fellows for Equity in Brain Health. As one of five awardees across the UCSF campus, Dr Lanata will work with the Dean’s office around UCSF’s growing emphasis on equity within the community. A similar award will be announced at GBHI’s other founding site, Trinity College Dublin in early 2019.