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Melanie Cole (Host): Did you know that with seriously high computer and math skills, medical insights and extreme motivation; experts are dedicating their talents to both understanding the mysteries of the human brain and at the same time, solving some of the most crucial needs in clinical practice, such as Alzheimer’s Disease. Today, we are speaking with renowned neuroscientist Dr. Shahar Arzy on this episode of Hadassah On Call.

Welcome. My guest today, is Dr. Shahar Arzy. He is the Director of the Computational Neuropsychiatry Lab and Neuropsychiatry Clinic and the Epilepsy Center of the Hadassah Medical Organization in Jerusalem Israel. Welcome to the show Dr. Arzy. So, what conditions are your main interests? What are you studying?

Dr. Shahar Arzy (Guest): Hi. It is a great pleasure to speak to you Melanie. There are so many wise questions that you evoke. So, we are in the computational psychiatry lab and what we are interested in mostly are high cognitive function and specifically the new field in essence new field of the human self, what it is like to be a self and the status that we have in the world. And it is a relatively new, like several years of researching the domain of spatial cognition and temporal cognition and this divides through fundamental domains like memory or body and from memory and body we can go to the disorders of memory and especially Alzheimer’s Disease and also dissociative disorder that are suffering or neuropsychotic suffering that are related to the human body. So, this is the framework of the lab in general.

Melanie: So, how did you begin exploring what’s going on the patient’s brain using data from patient’s own world taken from digital media, Facebook, smartphones? How did you begin to explore this? It’s fascinating.

Dr. Arzy: Yeah so, that’s exactly the thing and that’s why I was a little bit concerned with respect to the self-question because it is much easier to speak about memory. Like if somebody has memory problems and then there is a function named memory and then that is a concept that is easy to perceive and to understand. However, we actually now know that things are much more than that. It is not that we say that we know everything, but we know that memory is just some sub function of something that is much broader than this and this is like what it is we call the self or the behaving self or the experience. Because memory is a way to serve the experience, the experience of being alive, the experience of meeting people, the experience of going to different places, the experience of experiencing important events; which is especially important for old people, I think for all of us, but for old people it is more prominent like what is the most important like really from event to event, from birthday to birthday, of grandchildren, from a bat or bar mitzvah, Chatunah wedding and graduation of their great child from the university so these are the most important things in life. So, what we claim is that these are much more than just memories. You cannot compare it to a memory test like when I ask you to remember 3 words. It is something that is very substantial. And this defines our life in a much better way than just call it memory.

And then when we go to the world let’s say of Alzheimer’s disease, so we hypothesize that this is quite the same. It is not that people who suffer from Alzheimer’s or they just suffer from memory decline. Because if you have some memory problems, okay you can write a note and then compensate for it. It is something that is much more substantial. Like people that lose their way in their surroundings or that they don’t remember the most dearest person for them and this a huge suffering in Alzheimer’s disease. And this is much more than just memory.

Now with respect to your question, so now old neuropsychology just used the term, paper test in order to examine all of these just ask you to remember and so well and then I wait one-minute and see if you remember them or not. But now here we speak about something that is much broader. And the question is how we as clinicians can get access to all of this. It is much easier to ask about three items, but I have to ask you about your own life, I don’t know anything about your own life. But now, in the recent years, with the huge amount of data that is available over social media and over the digital world, these things actually do it better. We are not wealthy because we just use our smart phone and we just use our computers but actually people in the world know everything about us. They can Google everything about all of us, so use Gmail and Facebook now all of us if we use Facebook. And this thing availability things are also accessible with the permission of the patient. And then we can with one click, can use our algorithms to go – our robots to go into the patient’s digital world and then create the world either for our scientific research or for clinics and then using this world, we can really test the patient on this world and not only this, we can also create a virtual world for the patient in order to enhance and to augment his or her ability to use or to restore the relation to this most important things in life like close family members, or important events in one’s life.

Melanie: Absolutely brilliant. So how can neuro imaging examinations of the brain, how does that enable this early detection, if you are using the social media, which is so fascinating that you are able to take this information that people put out there themselves and use it to recreate somebody’s memories and their life; so how can this neuro imaging, the MRIs and such that you are using, how can this help to improve the prognosis for people with Alzheimer’s or even detect it early?

Dr. Arzy: So, in neuro imaging, we speak about structural neuro imaging and functional neuro imaging. Structural neuro imaging is the MRIs, it is all of us that know that shows the brain. The functional neuro imaging shows the function of the brain, how does the brain function, how does the brain create thoughts and memories and all of this cognitive and emotional stuff. And in the last thirty years, it becomes available to detect the function of the brain using functional MRI which is a way to look for blood changes in the brain which are correlated to the functions of neurons. So, we can see this almost in real time nowadays and the old neuro imaging functional imaging what people did is to show generic simulations. How function neuro imaging works is you show the patient or subject with stimulus and then you see the reaction in the brain to this stimulus. Most stimuli are generic like if I want to detect the area in the brain that is responsible for face, I show faces, faces of whoever just any face will evoke it, even a drawing of face. But here, we are looking not from some generic thing like to retain words or to identify faces, but we want to identify what it we call mental orientation. Orientation of one to the world. And as I stated earlier, this orientation is different if I refer to my own beloved daughter, who is for sure know the most brilliant, smart and beautiful creature on earth and you would say the same for yours and I would say how come that the two take the same place. With all due respect, to your daughter or granddaughter, for sure mine is more beautiful. We don’t talk about it. So, it will be what we presume to just – if we just show an image of a baby to everybody, all of us love – most of us like babies and this will evoke a response. But it will be different if we show the dearest ones, but this is difficult because if we can – how can we in clinical practice create such a thing?

So, we take all of this from the social media and digital media, the stupid smartphones that we carry with us all over and they are stuck to them and they know everything about us, so we can just take all of this information out of it, then show it to the individual patient and then see how this patient is oriented to his own world and then when we see how you are oriented to your own world, we can offer you a precise medicine, not something generic that is good for everybody, but something that will take your own situation with your own difficulties and with respect to your own needs and this circles of family members and people that are important to you, specifically. So, this is new era of precise decision medicine that is enabled by this data revolution and the computational revolution that we face nowadays.

Melanie: Well and in this precision medicine, you are able to use human patients that you are working with to be able to compare their own self before and after whatever interventions you offer, so is that better than working with animals, because they can actually tell you the difference, yes?

Dr. Arzy: Yeah, that’s very wise what you just said. First of all, in my domain, I don’t know about other domains, but in my domain of neuropsychiatry, animal models are very problematic because you know I really love dogs, but I never saw a dog who came to me and said that I’m the Messiah. However, I did see several people who said so. So, for example this is an example of a delusion, so it is something that is very difficult to study in animal models. And so, where it is that we overcame it is what you just suggested is to do things on longitudinally and now all this is available because we have all of this information now. My phone knows not only that I am now at Hadassah Medical Center in Jerusalem, but he knows that this morning, I was at my home and didn’t forget it and moreover it can even predict that in two hours I will be teaching in the neuropsychiatry computational psychiatry course at Hebrew University. Now how smart this guy is. So, we can use and compare things longitudinally and then we can track not only the static state of the patient off of this but the most important dynamics of the disease and if we know the dynamics, we can predict what will be in the future of the disease and then we can make our intervention much more precise and much more helpful.

Melanie: And that’s the whole point of this. So, what’s one key point you have learned in regard to Alzheimer’s disease for medicational intervention?

Dr. Arzy: in general, you know the world is so wide, so I don’t like questions that say one thing, but if you ask me for one thing, and you really understand so, I think that the main – the most important thing is that we treat Alzheimer’s far too late. It is like patients with the heart attack and then if you come and do an intervention two days after and not in the first five minutes, so there is nothing to - nothing to save. And people are coming to us to the doctors when things are already very, very deep into the disease and then the drugs that are developed are not helpful. And if you want to cure Alzheimer’s we have to present drugs much, much earlier and like ten or even twenty years before the time that people come now to us. And therefore, this we have learned together with the Hadassah Medical Organization in New York and with the Alzheimer’s Foundation of America and we are working on it to do a huge effort that we may call it Screening America and like the people will go and undergo our mental orientation tasks with that we were describing and then we can run our machine learning algorithm on this huge amount of data and then we can identify people at risk and when people are at risk, can come early enough so hopefully, drugs may be much more effective than at the very time point when they finally present to the clinic.

Melanie: We only have a few minutes left Dr. Arzy, but how are your team’s efforts able to translate some of this interesting research into usable clinical applications, because as you mentioned smartphones, and everybody is carrying them, these clinical apps are what people are looking to especially those in your field. So, how are you able to translate that? What are you doing with that?

Dr. Arzy: So, at President Obama stated once in one of his very many remarkable notes and he spoke with children and he said don’t use smartphones, talk on them. We, are facing in the recent years, are facing a tremendous change in the way that we are related to the world and the same very ways that the world relates to us. And this is composed from two things. One is the data revolution, that there is so much data on us and it’s stored in so many places, everything is known. And the second is the computational revolution and this is especially related to the new relatively new domain of machine learning and artificial intelligence that by the combination of these two, of this huge data set what we call big data and algorithms together, we can extract knowledge about ourselves t even us and even the most genius expert could not extract or come with. And this combination enables it. Now, this can be related to everything. But if you relate it especially to one’s life because we carry all of the things and what we do with our smartphones, we communicate with other people, so this is social, this is relation and then we trek our way, we use navigation aids but we also – we have this GPS that will remember where we are all the time and we plan our future and we come back to old memories by using cameras and stuff like that. So, these are the three main components. So, one today has to be a little bit, if we are gonna understand, in order to capture all of this because you have to – you have to do cognition like all of these things together. You have to do the computation. You have to do the algorithms. You have to relate to the data. And if you want to apply into medicine you also have to be a clinician, that’s exactly what we do at Hadassah.

This is a model of Hadassah. It is a combination of all these things together. And then we can just take the algorithms and direct them to take all of this information and to extract what is relevant to the clinic and we are indeed we just finished a study and if we compare our performance, the performance of our algorithms in identifying as the very, very early stage of Alzheimer’s Disease, so our accuracy is 95% when the best experts, the best human experts can go into a precision of only 71%, which is really a huge, huge difference. So, and then that’s the way of the world is going and we at Hadassah, should lead it.

Melanie: Thank you so much Dr. Arzy for being on with us today in this absolutely fascinating segment. This is Hadassah On Call, New Frontiers in Medicine brought to you by Hadassah the women’s Zionist organization of America. The largest Jewish woman’s organization in America, Hadassah enhances the health of people worldwide through medical education, care and research innovations at the Hadassah Medical Organization. For more information on the latest advances in medicine please visit Hadassah.org, and to hear more episodes in this podcast series, please visit Hadassah.org/podcasts, that's Haddasah.org/podcasts. I’m Melanie Cole. Thanks so much for listening.