Broadening the Reach of Alzheimer’s Research

It all started when Adam Brickman noticed an ad in his Twitter feed a few years ago.

The ad was for a portable MRI machine, a logical match given Brickman, a professor of neuropsychology in the Department of Neurology at Columbia University Vagelos College of Physicians and Surgeons, is an Alzheimer’s researcher who uses MRI to image the brains of people with and at risk for the disease.

“The idea of a portable MRI scanner seemed ridiculous,” he remembers thinking. “MRI is a highly specialized and extremely costly piece of medical equipment. It requires extensive shielding and infrastructure, often taking up an entire room, with construction costs alone reaching into the millions of dollars."

Brickman called up the company despite his doubts. The scanner was real but couldn’t produce the quality of images he needed for his research.

In Brickman’s studies, MRI sees the brain regions that have shrunk and bright white spots that mark places of damaged brain tissue. These are changes in the brain that drive cognitive decline in people with Alzheimer’s and other forms of dementia.

“With this technology, we're starting to understand the types of biological changes that are happening in the brain as we age and how they can be modified by different health and social conditions,” says Brickman.

By integrating the brain MRI scan data with other signals measured in blood samples, cognitive assessments, and medical histories, the researchers seek to understand the different biological pathways that shape risk for cognitive decline in aging, Alzheimer’s disease, and other forms of dementia. Understanding how social variables like education or factors that reflect unique socioeconomic conditions in different environments can slow or speed cognitive decline may be as important in fighting the impact of the disease as finding drugs, adds Brickman.

But given the high cost of MRI, studies that use the technology have generally been restricted to high-income countries.

“When you think about who's affected by Alzheimer's disease and then who's included in studies, there's a huge mismatch,” Brickman says. Alzheimer’s is a growing problem in South Africa and other low- or middle-income countries as people live longer. “Yet we're making inferences about Alzheimer’s from a small minority of people who don't represent the vast majority of people actually affected by the disease.”

Brickman kept in touch with the MRI company, and in a few years, they had improved the resolution of the machine’s scans. At the same time, the NIH put out a call for investigators interested in bringing research infrastructure to Africa and helping African scientists launch their own research programs into Alzheimer’s and related dementias. Brickman saw an opportunity. His proposal, in collaboration with Wits University and Harvard University, to send a portable MRI to rural South Africa was funded.

MRI-powered local research

Like most academic researchers, Brickman was not familiar with the ins and outs of sending heavy machines to other continents. When securely packaged, the portable MRI and its crate weighed 3,000 pounds and had to be shipped via freighter.

“You have to work with specialized companies that are licensed to deal with importing medical equipment and experienced in transporting such packages after they arrive at the port,” Brickman says.

Even the slope of the driveway to the clinic had to be altered for the final delivery. “It was a huge effort. Each time we resolved a challenge, we had a mini celebration. And then we went on to the next one.”

The scanner, the only MRI machine available within a few hours drive, now sits in a small building in an eastern town called Agincourt. Since 2014, town residents have participated in the “Health, Aging and Dementia in South Africa (HAALSI)” study, which is looking for factors that either protect older South Africans from dementia or exacerbate the risk.

Run by Harvard and Wits universities, HAALSI has over 5,000 participants and has generated a wealth of data on cognitive function, dementia, chronic disease, and social conditions as participants age.

With the portable MRI machine, the researchers will begin scanning more than 3,000 HAALSI participants to examine associations of brain atrophy and cerebrovascular disease (the cause of the white spots on the scan) with Alzheimer’s blood tests, cognition, vascular conditions, and social determinants like education and access to health care.

“This type of technology will give us the ability to identify the unique set of factors that shape cognitive aging and dementia risk in this environment,” Brickman says.

Beyond aging

An explicit goal of integrating this technology is to foster a research community in this part of South Africa that becomes empowered to address health issues that impact their local populations.

“In five years, I would love to see our efforts help to establish an MRI research program in Agincourt that has even branched out to study other conditions. If successful, our efforts could also help pave the way to build similar research programs in other under-resourced environments, including some rural parts of the United States,” Brickman says.

“At Columbia, we have been really committed to making research benefit broader populations and we’ve really been at the forefront of that effort in many ways. This project is just one example.”