Forensic Psychiatry; Geriatric Psychiatry; Neurology; Psychiatry; Multiple Sclerosis; Alzheimer Disease / Memory Disorders; Neurodegenerative disorders; Neuropsychology
I direct two UBMD clinics: an outpatient neuropsychology practice at the Buffalo General Medical Center and an inpatient consultation service at the Erie County Medical Center. In addition, I provide services for patients at the Jacobs Multiple Sclerosis Center and the UB Alzheimer’s Disease and Memory Disorders Center. Our clinical mission is to provide compassionate, state-of-the-art care for patients and families affected by a wide range of neurological and psychiatric disorders. Our top-rate neuropsychological services are based on the integration of neurological, psychiatric and imaging findings and structured to meet the needs of our patients and their caregivers. Our neuropsychology service is dedicated to the teaching mission of UB. We support the departments of neurology and psychiatry as well as the rehabilitation services in the orthopaedic, occupational therapy and physical therapy divisions at our UB-affiliated hospitals. Students, residents and fellows have a rich learning experience with us and see a wide range of diseases such as personality disorder, malingering, depression, head trauma, concussion, multiple sclerosis (MS), stroke, dementia, epilepsy and pervasive developmental disorders. Medical students have the opportunity to work with both children and adults during didactics, and they may choose to focus on the evaluation of either patient population based on their clinical focus. My research mission is to employ behavioral psychometrics to understand how cerebral disease affects personality, cognition, and psychiatric stability. Two memory tests I developed, the Brief Visuospatial Memory Test Revised (BVMTR) and the Hopkins Verbal Learning Test Revised (HVLTR), are widely used in neuropsychology, especially in the areas of multiple sclerosis, head injury, and schizophrenia, and they are included in consensus panel test batteries for athlete concussions in the NHL and NFL. I work to develop new tests in order to understand more about the effect of cerebral injuries and disease. I also focus my research in multiple sclerosis (MS) and have conducted several studies on pharmacological treatments for cognitive function in MS patients. I have contributed in noteworthy studies as the lead author on a consensus battery for MS patients (the Minimal Assessment of Cognitive Function in MS), which is a gold standard in the literature, and as a major contributor to the idea that brain atrophy is the primary driver of cognitive impairment in MS, and in particular, deep gray matter atrophy. My major findings also include that personality changes can be assessed in MS patients, are more common in MS dementia, and relate to clinical outcomes, that self-report is not a valid indicator of neuropsychological status in MS, and that Symbol Digit Modalities Test is a reliable and valid marker for cognitive outcomes in clinical trials.
Alzheimer Disease / Memory Disorders; Neurology
I am a board-certified neurologist with specialty training in genetics and cognitive disorders, and I direct the Alzheimer’s Disease and Memory Disorders Center and Translational Genomics Research Laboratory, state-of-the-art facilities specializing in cognitive disorders. Our clinical mission is to provide compassionate, state-of-the-art care for patients and families affected by Alzheimer disease (AD) and other cognitive disorders. Our multidisciplinary approach includes a team of neurologists, neuropsychologists, neuroimagers, social workers and nurses dedicated to the needs of our patients and their caregivers. Our research mission is to employ genetic tools to identify novel risk factors and potential pathways that can be targeted with medications to prevent or modify the course of AD. Our focus is translating discoveries made in the laboratory into improved methods of disease prevention, diagnosis, and treatment. AD is a progressive neurodegenerative disease with high prevalence imposing a substantial public health problem. The heritability of AD is estimated at 60-80 %, forecasting a potential for using genetic biomarkers for risk stratification in the future. The main risk factor of late-onset AD is the APOE4 allele with a population attributable fraction of 0.2-0.3. Several large scale genome-wide association studies (GWAS) using high frequency variants identified nine additional loci with a combined population attributable fraction of 0.31. My laboratory focuses on finding the missing heritability using copy number variation as a genetic marker map. We perform CNV GWAS analysis on case-control datasets and quantitative endophenotypes, such as age at onset and biomarker data. We identified an olfactory receptor CNV association with age at onset of AD. Loss of smell sensation has been associated with AD and other neurodegenerative disorders; we are now applying a novel method, aCGH to study the olfactory subgenome in relation to smell sensation and cognition in normal aging individuals, patients affected by amnestic mild cognitive impairment and mild AD. This multicenter study is ongoing and is funded by the National Institute of Aging. In order to increase the power of association studies, we developed a method to use CNV as a genetic marker map and whole genome gene expression as quantitative trait loci within the same individual using post-mortem human temporal lobe tissue. In a pilot study, we identified a replicable 8 kb deletion association with AD upstream of CREB1. This small deletion harbors a PAX6 transcription factor binding site. We are pursuing iPSC technology to study the effect of this deletion on human neurons. We are also applying the same methodology on a larger set to identify additional signals. Our laboratory also collaborates with the Mendelian Project of Baylor College of Medicine in Houston, Texas. We are studying neurodegenerative dementias with Mendelian inheritance pattern by whole exome sequencing of informative pedigrees. My laboratory performs the data analysis and the follow-up studies for these mutations.
Neurology; Neuroradiology - Radiology; Vascular and Interventional Radiology; Parkinson's; Multiple Sclerosis; Alzheimer Disease / Memory Disorders; Developmental Neurology; General Neurology; Neurodegenerative disorders; Neuroimaging
I direct the Buffalo Neuroimaging Analysis Center (BNAC) and have established the center as a world leader in performing quantitative MRI analysis in neurodegenerative disorders. I also direct the Translational Imaging Center at UB’s Clinical Translational Research Center (CTRC). I strive to extend the boundaries of current knowledge about neurological diseases and disorders through innovative imaging research techniques and the application of bioinformatics resources. My efforts are directed toward advancing technical, basic and translational research at UB which will, in turn, advance patient care. I have secured more than $30 million in research grants for collaborative research projects involving UB investigators as well as national and international collaborators. My research interests include structural and functional quantitative MRI analysis for humans and animals, including lesion/tumor identification and segmentation; perfusion and dynamic contrast-enhanced (DCE) mapping and quantification; fluid flow quantification; functional MRI analysis; diffusion tensor reconstruction and tractography; voxel-wise mapping and image-based group statistical analysis; longitudinal change analysis and tissue/pathology/structure volumetry. I study the application of these techniques in healthy individuals and in patients with various disease states such as multiple sclerosis (MS), stroke, Alzheimer’s disease, Parkinson’s disease, epilepsy, systemic lupus erythematosus and traumatic brain injury. I also concentrate on therapeutic interventions, including therapy directed toward assessing neuroprotective efforts in neurodegenerative disorders as well as the venous function, genetic and neuroepidemiology fields of these diseases. I direct the neurology resident research program. Over a period of two years, I guide third- and fourth-year medical residents through a rigorous assigned scientific research project that is a critical, required part of their training. In addition, I mentor and supervise undergraduate, master’s and doctoral students and MRI fellows. In this role, I help to educate these trainees on clinical MRI use as well as neuroimaging analysis. I also oversee students and fellows conducting research in neurological disorders. One of the most rewarding experiences in my career is helping young physicians and researchers start successful clinical or research careers.