Welcome to the seventh season of the Dementia Researcher X ISTAART PIA Relay Podcast. Across six episodes, leading early career and senior researchers hand the mic from one ISTAART PIA to the next, giving you an honest, peer-to-peer tour of where dementia research is actually heading, from wearables and biomarkers to policy and trial design, in the run-up to AAIC.

Most people with hypertension after 50 never develop dementia, so what separates those who do? That is the question driving Dr Sindhuja Tirumalai Govindarajan, a neuroimaging researcher and outgoing Chair of the ISTAART PEERs PIA, recorded as she moves from a postdoc at the University of Pennsylvania to an assistant professorship at the Karolinska Institute. With host Dr Joe Kane she explains how machine learning on tens of thousands of MRI scans can pick up subtle brain changes years before symptoms, and why scans from different scanners have to be harmonised first. The conversation then turns to PEERs itself, a PIA built not around one research area but around early career researchers everywhere, and the work of levelling opportunity across borders through local routes like Neuroscience Next, WYLD and INTERDEM Academy. Sindhuja runs through the PIA's AAIC workshops, from narrative CVs to social bingo for ECRs, and closes with practical advice on getting people involved: make the ask specific.

Takeaways

• Machine learning on large MRI datasets can detect brain changes years before any cognitive symptoms show.
• Scans from different scanners must be harmonised first, stripping out machine noise so only the biology remains.
• PEERs exists to level opportunity for early career researchers wherever they are, across every research area.
• Local routes such as Neuroscience Next, WYLD and INTERDEM Academy widen access for those who cannot get to the big conference.
• Interest among ECRs is common but clarity often is not, so make the ask specific and people will step up.

--

The Alzheimer’s Association International Society to Advance Alzheimer’s Research and Treatment (ISTAART) convenes the global Alzheimer’s and dementia science community. Members share knowledge, fuel collaboration and advance research to find more effective ways to detect, treat and prevent Alzheimer’s and other dementias. Professional Interest Areas (PIA) are an assembly of ISTAART members with common subspecialties or interests.

There are currently 30 PIAs covering a wide range of interests and fields, from Neuroimaging to Diversity and Disparities and everything in between.

Find out more at https://istaart.alz.org/

--

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(upbeat music)

- [Voice Over] Hello, and

welcome to season seven

of the Dementia Researcher

"ISTAART Relay Podcast."

In this series,

members of the ISTAART

professional interest areas

interview each other about their PIAs

and the hot topics in their fields.

Each guest then becomes

the next episode's host,

passing the conversation

along from one researcher to the next.

We're releasing one

episode a day in the run

up to the Alzheimer's Association

International Conference

this year in London and online,

showcasing the work of the ISTAART PIAs.

Thank you for listening.

(upbeat music)

- Hello, everybody.

Thank you very much for tuning in.

I'm Joe Kane.

I'm geriatric psychiatrist

and a researcher,

and I work at Queen's University

in Belfast in Northern Ireland.

I am the chair of the

Lewy body dementias PIA,

which is the best PIA.

Today, I'm delighted to be speaking

with Sindhuja Govindarajan from the PIA

to elevate early career

researchers, or PEER.

Sindhuja, you're very welcome.

I'm really excited to be

speaking with you today.

Could I please start by asking you

just to tell us a bit

about yourself please?

- Happy to. Thank you,

Joe, for that introduction.

My name is Sindhuja.

I was until recently

a postdoctoral fellow at the

University of Pennsylvania.

As of the recording

time, I'm transitioning

to an assistant professor role

at Karolinska Institute in Stockholm.

I am the outgoing chair of PEERs PIA,

which is decidedly the

better PIA for sure.

- Well, agree to disagree

on that I think, Sindhuja.

- Fair.

- But it's really exciting,

it's really exciting that

you're making such a big move

over to Europe, and I'm

really excited to hear

about your journey there today.

Before we talk about

your work with the PIA,

could you tell us a little

bit about your own research?

- Sure, happy to.

I work primarily with neuroimaging.

I'm looking at the brain from outside

and so in-vivo scans,

and that's because I told

myself at a very young age

I'm scared of cutting open things.

And so it's been looking at

what's happening in the brain

inside the head with advanced

neuroimaging scanners.

In the field of dementia

research, I'm pretty new.

I started in '21.

In the field of dementia research,

I've been interested in looking

at what are the patterns

of brain changes that happen

years before people

have cognitive symptoms.

So we hear so much about

modifiable risk factors,

midlife cardiovascular risk factors,

and nearly half the human

population has hypertension

or something else beyond the age of 50.

But not everybody ends up

with neurological challenges

that come from that.

So my interest is in finding out

what exactly happens

when people have some

systemic risk factors

and how can we measure the severity of it

within an individual brain.

And so for that, we do machine learning,

which is just looking at

large quantities of data.

I'm talking tens of

thousands of brain MRI scans,

and looking at subtle patterns

that can be detected years

before even, you know,

when they present no cognitive challenges.

Yeah.

And the hope for that

is to potentially identify participants

or people who may be at increased risk

as opposed to tolerating

their risk factor well.

- Great, and what type

of imaging modalities

are we talking about?

You mentioned MRI.

Is it all structural imaging?

- That's great, so I do

have experience in MRI

with structural functional diffusion.

I've done other studies in

neurodegeneration before,

worked with PET in the past as well.

But for my work in dementia,

thus far it's been

primarily structural imaging

and looking at vascular integrity markers

using flare MRI and things like that.

So far in the area of dementia research,

I've been focusing

primarily on structural MRI,

that's T1 and flare imaging

for who's aware of those modalities.

And the primary reason for that

is that with machine learning and AI,

what you need are really

large quantities of data

that are easy to acquire.

So you are able to scan it

in pretty much any clinical scanner

without necessarily going

for specific, like, sensors,

specific processing paradigm.

So we've amassed a lot of

structural imaging data,

and it lends itself to

a lot of investigations

of highly specific hypotheses, I guess.

- That's great, so you're talking

about really big datasets.

Can you give us an idea

of how many scans we're talking about?

- Sure.

Currently, we're looking at a dataset

which has around 65,000 participants

in total with longitudinal scans.

So I think it's close to

90,000 total MRI scans.

And at UPenn,

we work on a way to harmonise damages,

which means different scanners

are collecting different sequences.

Even though they're the same label,

the way they're collected

may be different.

So we need to find a way to make them

comparable across different locations.

And so we have data

predominantly from the U.S.,

of course the UK Biobank,

some from Australia,

some from Germany, some from South Korea.

So we need to,

we have a way of harmonising them,

which is taking out the scanner noise

and retaining only what's relevant,

which is biological contributions

to the imaging measures.

- It's really interesting that, you know,

you're talking about

harmonisation and standardisation

after the scans have been taken,

which is really exciting and gives us,

it always makes us think

of the clinical scans

and all those scans that are right there

that aren't necessarily

yet being leveraged

in the way we could.

There is a lot of buzz about

AI and machine learning,

and I wonder,

do you engage with your

participants on that?

Are they able to understand the difference

between, you know, machine

learning that you do

and the machine learning that

they hear about in the news

and they talk about what their relatives?

- That's a fantastic question.

I've had an interesting background.

So I started my research

into brain imaging

sitting hands down at the scanner,

modifying the pulse sequences,

and trying to get the best picture

that's robust, reproducible,

and provides meaningful measures.

So I've interacted with participants

of, you know, different

clinical backgrounds,

and I'm also aware of

the different challenges

that come with scanners

of different types.

So I feel like I take a

very cautious approach

to machine learning and AI

in the sense that we're not

promising the world everything,

a tool that fixes all,

but instead I've so far been very focused

on a clear clinical question

and a very easy-to-interpret,

easy-to-understand

type of measurement that comes out of it,

more interpretable than,

let's say a black box,

which just says, "Hey,

you're gonna have this in 15

years," or something like that.

As far as engaging with participants now,

I don't do a lot of that.

I did not do a lot of that

during my postdoctoral fellowship,

but when my new job,

in the next role that I take on,

I foresee there will be some,

you know, more hands-on talking to people,

getting more scans, things like that.

- Great, that sounds really exciting.

And we look forward to

following up on your work.

Thinking more broadly

about the field in general,

what's really exciting you

about dementia research

or neuroimaging at the minute?

What's really making you develop ideas

and get excited about your work?

- I like that it's a

very personal question,

so I can tell you what excites me

rather than what I've heard

people are excited about.

Personally, I believe

we're starting to leverage the power

of, you know, larger models.

There are very phenomenal studies

coming out of many labs across

the world with large data.

What interests the most is,

or what excites me the most

is we've moved kind of beyond looking at,

"Hey, this is dementia,

this is hippocampus that's shrinking,"

and going to addressing polypathology,

like, different forms of dementia.

And we're trying to see,

can we measure this in vivo?

Can we find ways to relate

what we see in structural MRI

or different types of,

you know, PET imaging

with the different tracers?

Can we look at what are the different ways

in which the disease or the pathology

develops over time?

So what I'm talking, in essence,

it would be considered subtyping

and staging kind of algorithms,

which have come from the UK as well.

I think that's very interesting

because at the end of the day,

the brain is the same.

Everybody has hippocampus

for the most part.

But the way people are at increased risk

or increased resilience,

how education provides

some kind of reserve in

developing dementia symptoms

in how the modifiable risk factors

we have every few years

we're adding a couple more

based on research,

how the effect seems

to have specific patterns.

They have a specific imprint in the brain

and we're able to now start

mapping the trajectory of it

and have these, like,

diverging paths saying,

"You start here, you go over there,"

and then start developing

a core pathology and things like that.

I think that's the part that

excites me, which is learning

as a community about how

the brain is affected

with different vulnerable factors

as well as different

progression pathologies.

Yeah.

- There's something so cool

about neuroimaging that,

you know, the prospect

of being able to show

our patients and the public,

"This is what it looks

like when you've got,

you know, cognitive resilience.

This is what it looks like

if you go down one of those

paths compared to the other,"

and all the statistics in the world

and all the encouragement

and public health initiatives in the world

aren't really as good

as being able to show something

to somebody on a brain.

So that sounds really cool.

- I agree with the public

health aspect of it.

That's another thing that I'm

very interested in following,

which is all the lifestyle

intervention trials

that have been coming out recently,

looking at modifications

over decades if possible

and seeing how ageing is so heterogeneous

and how with certain checks

and balances along the way,

we can potentially have people

have long, fulfilling lives.

- It's amazing.

And you're here, I suppose,

not because of your

neuroimaging expertise,

but because of your role in PEERs.

What are your colleagues

and what are your PEERs

talking about in your PEER?

What's the big issue

and what are the big challenges

that face them at the moment?

- That's great.

I think before getting to that question,

I will give you an overview

of what PEERs PIA does.

As the name suggests,

it's for elevating

early career researchers

and that's our entire paradigm,

which is offering programming support,

professional development opportunities

for early career researchers.

Not only from a specific area of research,

but across the board of dementia research.

That's our primary goal.

So that includes advocacy programmes.

We can talk more about the

specific programming that we do,

but the biggest challenges

we would like to address

are how unequal opportunities are,

depending on where you are from,

depending on what area

of research you are from

and whether you have the mobility

to be able to reach across borders.

So we try to bridge some of these

through virtual programming.

But Alzheimer's Association

also has some ways

of having local programming,

like the Neuroscience Next Conference

that happens that's free

for online registration

that happens in different locations.

So people who are not generally attending

the annual international conference

either through funding

reasons, visa concerns,

any number of possible reasons

that could be preventing

them from travelling,

they're able to go to a local conference

and present, participate, and learn more.

I mean, and we try our best to interface

with the local communities

and promote them as well

as offer programming

from behind the Zoom camera.

- And do you get the sense

that's something that's,

you mentioned borders as

being really significant

and very significant obstacle.

Do you think that's something

that's becoming better

or worse or staying the same

in terms of how we look

at research globally?

- Antarctica, and that's our whole goal.

So the working groups,

we have them across the

different continents,

and we have representatives

from these continents

that could be senior or

mid-career researchers

who are offering the mentorship.

And we have junior

researchers taking on the role

of the committee lead

or the special interest group chair,

and they bring us this kind of concerns

that are most prevalent in their location.

How can we bridge, how

can we tap into resources

that are available in the Western world

and how can we pass this on

as mentorship meetings or as

grants-related programming?

That's what we do.

With that, what we've observed

is in some of the continents,

there already exist a good network.

There is already a critical mass

of researchers pursuing this

and awareness of dementia

research as a career possibility.

But in a couple of places

it's not very common.

So finding members

interested in a working group

and sustaining them

through leadership transitions

has been a challenge that we face.

But on the bright side,

the kind of things we do

is we leverage our working group members

and connect people to local organisations.

I'll give you an example.

So in South America there

is an organisation coming up

as the World Young Leaders

in Dementia or WYLD.

It's led by people from there.

And so PEERs PIA interfaces

with them quite a bit

to offer programming that

promotes funding opportunities

or mentorship opportunities

to people who may need it.

In Europe, we interface

with what's called the INTERDEM Academy.

And our working group

members from PEERs PIA

also have a working role there.

And so we're able to offer

more programming to that.

But in some other continents,

for example, as you can

imagine, I'm from India

and Asia is a huge continent

and we try to have one representative,

but that doesn't cover the breadth

of opportunities that may be available.

So what we end up having

is a rotation of people

from different countries

within the continent,

and being able to offer programming

for the duration of their tenure,

offer programming relevant

to the country they are in.

That's how we operate.

- That's really cool, 'cause it sounds

like a really democratic,

inclusive process

that really makes sure

you reach all four corners of the globe.

And what's really interesting as well

is that I find that working with PIA

to be a good kind of primer

in the leadership anyway,

so not only are you directing people

towards leadership things,

but being involved in the PA itself

is nurturing leadership skills.

That's really clear.

(mellow music)

That's been really

helpful to set the scene

for what I want to talk about next,

which is get into a little bit more detail

about the work of the PIA itself.

Could you gimme some specific examples

of how the PIA has supported

the field that you work in?

- Sure.

As with other PIAs,

we have specific types of programming

that I briefly glossed on.

We have webinars

where we try to partner with

individual scientific PIAs.

As I mentioned before,

our PIA doesn't have

strict borders on what area

of research people are from.

This is for all early career researchers,

all parts of the world.

So we have interfaces

with specific research areas

where we provide webinars

that are geared towards ECRs.

We promote, like, we promote the PIA

that we are collaborating with

along with promoting

the ECR within the PIA.

So we provide opportunities

for early career researchers

to present their work in a global stage.

So that's one way we've

connected with the science.

Another way we do that is also

what we call neuroscience mentoring clubs.

These are off-the-record

non-recorded meetings

where a more senior person,

either could be from a

continental group representative

or it could be someone very general,

will share their career

trajectory, including what kind

of tools and resources

they couldn't find earlier,

but what they would be able to

support new researchers with.

And that's where ECRs

from other parts of the

world could join in,

ask questions that could be related to,

"How do I find grants?"

or it could be related to,

"How do I train on this specific skill,

this specific technical component?"

And they have been very fruitful.

We've had closed room

discussions like that.

In addition, we also collaborate

with the ISTAART ambassadors

to provide programming in person at AIC,

and this could be workshops

on specific skills,

like, how do you use AI in

research kind of a thing.

Or we also do regular workshops

on how to build your writing portfolio,

how to manage,

how to do project management,

or in this upcoming year,

I'm sure we'll have some time

to go over specific programmes,

but we have how to give an elevator pitch,

so we kind of get people

ready for the conference

and ready for their career.

And somehow that translates back

into how they're able to

advocate for themselves

and move up in dementia science.

- That sounds really great,

sounds really practically focused.

And also, it's great to see you

shout out some of the ambassadors,

the ISTAART ambassadors

who just bring a real enthusiasm,

and it's great that you're providing them

with a platform to look

at their next steps

and to bring them into the community.

So that sounds really exciting.

Our next question I want to

ask you about your own journey.

So how did you end up

getting involved in this PIA?

- I think I have to give

credit to the PIA itself

and Adam Smith, our host.

My first in-person AIC was in 2022

and I was checking out these

lunchtime skills workshops.

I think that's what they're called now,

but they had different names in the past.

I was mind blown.

I was mind blown at how it was organised

and how it removed the frills of having

a fantastic research idea, hypothesis,

the funds to do the science

and then present it and

have compelling results.

No, this was all about

learning how to be a scientist

or how to be a researcher more generally.

I remember one of the first

workshops I went to was,

what does neuroimaging actually tell you?

Like, what does the different

fields actually tell you?

And we had these live demonstrations

and people had a chance to do

a trivia quiz kind of a thing.

It was a learning journey packed

into a very tight workshop

that had practical, take-home messages.

That's when I decided,

"I'm joining this via."

That's how I got involved.

And I was very fortunate

that the position was open

for an election during the off season,

not during the cyclical season.

And I put my hat in the

ring and I got elected.

I think that's how I got into it.

It's been very rewarding.

I get to move across research areas.

It feels like I have a ticket

to go to any field I want

and I get to hear about the different

research topics that our members work on,

as well as how science is done

in different institutions,

in different countries

and things like that.

It feels like I have an all-access pass,

and I'm very grateful

for this opportunity.

- Your enthusiasm really,

really comes through,

and for anyone who's listening to this,

you're just beaming

talking about being involved in the PIA,

so that's fantastic.

So given everything you've said

and the great ideas

and the great mechanisms that

brought you into the PIA,

could you tell us a bit

about what you've got planned for AIC?

- Absolutely.

The first thing I've got planned

is I am not going, unfortunately.

I will be moving between countries,

and hopping onto a third country

was not in my agenda for this summer,

but we have some great programming.

Our executive committee

is made of phenomenal,

phenomenally talented

and motivated members,

and we have several

programming opportunities.

Let me open up that so I can

give you the exact details.

So we have,

before the conference starts on Friday,

there are two workshops.

One is on leadership skills

and development workshop

for emerging scientists,

which we partnered with AWARE,

which is Alliance for Women

Researchers in dementia.

So we partnered with them

for a leadership workshop.

And in the afternoon on Friday, July 10th,

we have a workshop on engaging people

with lived experience

in dementia research.

Again, this is a collaboration

with the partnering PIA

who primarily work on how to

engage with the caregivers

and partners who make

dementia research possible.

On Saturday, which is considered PIA day,

at very early in the morning at 8:30

we have a skills kind of conversation

about how to identify your

60-second research story,

how you can own your expertise.

And this is great because

you go there and prepare,

practise your research speech,

your elevator pitch,

and you're prepared for

the rest of the conference.

And on Sunday, which is the

first day of the conference,

we have social support and bingo,

social bingo, for early

and mid-career researchers.

These are easy ways to get to know people

in your own career stage

and, you know, perhaps mid-career as well,

build your network that's

outside of your usual pathways

of finding network,

and sometimes we get great topics

that are challenges

among different groups of people

and we bring that back to PIA

and discuss how we can offer

programming in the future.

So that's a great place to meet

with our executive committee

as well as meet new people

and form your own circle of

friends for this conference.

And then during the conference,

Monday through Wednesday,

every afternoon at lunchtime,

there are skills workshops,

and PEERs PIA is partnering

and collaborating

with other PIAs

for at least one workshop every day.

So on Monday at lunchtime

we have collaborating

with people with lived

experience in dementia research,

again, with partnering PIA.

On Tuesday we have a workshop

on crafting your narrative CV.

And this I thought was very important

because a lot of the

institutions funding partners

are moving away from a written CV

which just lists your

accomplishments and your papers

into a more narrative

one where you highlight

how this contributes

to science in general.

So we have that workshop on Tuesday

in partnership with the neuroimaging PIA.

And on Wednesday we have a

PEERs PIA only skills workshop

on how to establish an

effective writing routine.

And to me,

one of the highlights

for all these workshops

is how collaborative they are,

not only with ECs and other groups,

but some of these are

being led by our members.

So people who are interested

in gaining leadership experience

or expanding their skill on

a specific topic of interest

could absolutely get involved

and build on their leadership skills.

- That all sounds really interesting.

You've come up with some

really exciting, engaging ideas

as a means of engaging with your PIA.

From the perspective of someone who,

both in PIA and and locally,

trying to engage early career researchers,

what do you think is

the most common pitfall

that organisations fall into

when they're trying to go

about engaging that group?

- That's a great question.

I can speak of an example

that we've frequently faced

in the last few years of my time here.

I would say a lot of the times,

organising groups like

the executive committee,

including our own,

we've shouldered all

of the organisational duties on ourselves,

thinking, "We wanted to

be part of this group,

so it's up to us to make it happen."

But in the more recent

years what I've noticed

is that our members are very interested,

they're interested in participating,

they're interested in contributing

and organising things as well.

But often, more often

than not, what we hear

is that you're not sure

how to get started,

where to get involved.

Some of the options we've tried

are having specific examples

of the kind of support we need.

We could say, "Hello,

we're planning this event,

we're looking for people who can host

and looking for people

who can monitor chats

on the Zoom question and answers, Q&A,"

and if we have some specific requests

and we are able to provide

the time, that's easy.

That's an easy way to ask people to join

because the asks are clear and

they're able to contribute.

And another way we've done,

especially some of the skills

workshops we've done recently

with collaborative

mindset, is reaching out,

reaching out to our network.

Like I said, I'm very fortunate

that my area of research

has perhaps one of the largest

PIAs, neuroimaging PIA,

and I have this all-access

pass to other PIAs as well.

So I'm able to, say,

call out a friend of mine

or a colleague of mine

or someone whose paper I really admire,

call them and say, "Hey,

we're interested in putting this together.

Would you like to contribute?

These are the expectations,"

or, "These are some of the ideas we have,"

and then they bring own ideas.

So I think in my experience,

the quickest answer would be reach out.

A lot of the times there is interest,

but not clarity,

and sometimes there are pitfalls as well.

In some cases with our

continental groups we found

that we operate on a timescale,

not just a time zone, but a timescale

that cannot be met by people

in a different environment.

And so we've had to take

on the lead if necessary,

but more than anything,

we've specifically

tried to involve members

and provide support behind the scenes

in how they can organise

the different events.

Yeah.

- Thank you. That sounds

like great advice.

So being really specific

about what you're asking people to do

is definitely something

I'm going to reflect on.

- If I may add one more thing to that,

recently, because AIC is in London

and over the last few months,

I believe perhaps February or March,

we requested that ISTAART reach out

to all PEERs members in UK

and ask if they're definitely

attending the conference,

can they participate, can

they help us organise?

I believe it was UK and Europe,

and we did have a lot of

members contributing ideas

and how they would,

how they feel prepared

to be part of a programme

that we plan to have.

And it was so good

that we received perhaps

more than a dozen responses

and we've had to turn some of them, like,

turn some of them away

or ask if they would do a webinar instead.

So that's definitely been

successful in our current,

like, or immediate AIC programming.

- Great, so there's loads

of interesting things

you guys have lined up at AIC and beyond,

so it's really exciting

to hear about both your work

and the work of the PIA.

We would love to keep chatting,

but we're constrained by time.

So it's time to end today's podcast.

I want to thank you, Sindhuja,

and I want to welcome you to Europe.

I want to wish you the very best

for what I know is a

big move ahead for you.

So thank you very much for joining us.

- Thank you, Joe. I'm

very glad to be here.

And for anyone interested,

please look up PEERs PIA

on the ISTAART website

and you'll be able to find us

and reach out to all of EC.

You're also able to email [email protected].

You can find information of all of this

on the Alzheimer's Association website.

Thank you.

- Thank you.

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- [Voice Over] You have been listening

to the "Relay Podcast,"

delivered as a collaboration

between Dementia Researcher and ISTAART.

This podcast is made at

University College London

with generous funding from the NIHR,

Race against Dementia,

Alzheimer's Association,

Alzheimer's Research UK,

and the Alzheimer's Society.

Please like and subscribe

and share your thoughts in the comments.

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