Condition: Neurodegenerative disorders (e.g., Dementia)

Randall Espinoza

I am currently the Medical Director at the Garvey Institute Center for Neuromodulation and am providing leadership to help grow our portfolio in the area of Neuromodulation and Interventional Psychiatry. Before coming to the UW, I was the Muriel Harris Chair of Geriatric Psychiatry and Professor of Clinical Psychiatry at UCLA. While at UCLA, I held many administrative, clinical and teaching leadership positions including serving as Medical Director of Inpatient Geriatric Psychiatry, Chief of Staff of the UCLA Neuropsychiatric Hospital, Founding Faculty of the UCLA Neuromodulation Division, Medical Director of the ECT and Interventional Psychiatry Program, among others.

I recently became Editor-in-Chief of the Journal of ECT and Related Therapies, the official publication of the International Society of ECT and Neurostimulation. My research projects have included investigating various neuromodulation and interventional therapies and developing novel educational programs and curricula. I have an abiding interest in mentoring and helping faculty at the start of their careers and a commitment to fostering the advancement of women and underrepresented minority (URM) faculty in academic medicine.

Daniel W. Fisher

My clinical and research interests center around behavioral and psychological symptoms that present in neurodegenerative diseases, especially dementias. Though dementia is well-known to affect one’s memory and cognition, over 90% of people with dementia develop new neuropsychiatric symptoms – including apathy, dysphoria. anxiety, aggression, agitation, disinhibition, hallucinations, and delusions. Despite the ubiquity of these symptoms, very little is known about how they develop in dementia. My research interests are in understanding more about the molecular and cellular mechanisms of neuropsychiatric symptoms in dementia beyond the well-studied changes associated with cognitive deficits.

Along with my research mentor Martin Darvas PhD (Department of Laboratory Medicine and Pathology), we employ numerous approaches to better understand these neuropsychiatric symptoms, including techniques involving transcriptomic analyses of human and mouse post-mortem tissue, development and implementation of biomarkers derived from human and animal model fluids (plasma, serum, cerebrospinal fluid), virally-mediated gene manipulations, animal modeling of cognitive and neuropsychiatric phenotypes, and basic cellular and molecular biology techniques.

Michelle Wiese

I am an Acting Assistant Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington. I received my MD, MPH from the University of Nebraska Medical Center and completed my adult residency at the University of Washington where I was chief resident. I then went on to complete a fellowship in Consultation-Liaison Psychiatry at the University of Washington. I am currently on faculty at Harborview Medical Center on the inpatient psychiatry unit and inpatient psychiatry consult service. I have a longstanding interest in the intersection between medicine and psychiatry and in working with people who suffer from serious mental illness and treatment-resistant conditions. I have clinical interests in ECT, psychopharmacology, co-morbid medical conditions, and adjunctive psychotherapies. I value caring for the whole person through thorough and accurate diagnosis, treating co-morbid medical conditions, and minimizing medications when possible. I have teaching interests in reducing stigma surrounding serious mental illness and educating residents and medical students about psychiatric care.

Douglas Lane

I am a clinical psychologist with board certification in geriatric psychology.  I am based in the Geriatrics and Extended Care Service of the VA Puget Sound Healthcare System.

Michael J. Schrift

Dr. Michael Schrift is a Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington. He currently is an attending neuropsychiatrist at the Brain & Memory Center at Harborview Medical Center. He is he the director of the Behavioral Neurology/Neuropsychiatry Fellowship Training Program. He previously was the Division Director of Geriatric Psychiatry & Neuropsychiatry in the Department of Psychiatry and Behavioral Sciences at Northwestern University Feinberg School of Medicine in Chicago. He was also the director of the fellowship training program in Geriatric Psychiatry, co-director of the Clinical Neuroscience Fellowship program, and the director of the Neuromodulation Program and the Cancer Neuropsychiatry Program. He has many years of experience treating patients with Parkinson’s disease, Huntington’s disease, and Wilson’s, among other neuropsychiatric disorders. He also is an attending neuropsychiatrist in the Harborview Memory and Brain Wellness Clinic.

Dr. Schrift is the Book Review Editor for the Journal of Neuropsychiatry and Clinical Neurosciences.

He is board-certified in Psychiatry by the American Board of Psychiatry and Neurology as well as board certified in Behavioral Neurology and Neuropsychiatry by the United Council for Neurologic Subspecialties. He has training in Bioethics and serves on the ethics committee at Harborview Medical Center. Dr. Schrift is a fellow of the American Neuropsychiatric Association.

Eric Petrie

My work focuses on the diagnosis and treatment of post traumatic stress disorder (PTSD), mild traumatic brain injury (mTBI), and neurodegenerative dementias, as well as applications of positron emission tomography (PET) and other functional neuroimaging modalities to elucidating the pathophysiology of PTSD, mTBI, Alzheimer’s Disease, and other neurodegenerative dementias.

Gail Li

My research has focused on the clinical and epidemiological study of brain aging, Alzheimer’s dis-ease (AD), and, most recently, mild traumatic brain injury (mTBI).

The epidemiological study of aging and AD. Over the past 20 years, I have pursued studies investigating the putative risks and protective factors for AD in a large community-based longitudinal cohort known as Adult Change in Thought (ACT). I have used the ACT, which is led by Drs. Eric Larson and Paul Crane, to characterize the associations between an array of risk factors, ranging from cardiovascular traits to depression, and both the incidence of dementia and the neuropathological changes seen at autopsy. In collaboration with experts in environmental and occupational health, I am now co-leading an NIH-funded R01 study to investigate the adverse effects of air pollution on brain aging, cerebrovascular disease, and neurodegenerative diseases.

Using biomarkers to identify the preclinical stage of AD, understand brain aging, and assess out-comes in clinical trials. The neuropathological changes of AD begin decades prior to a clinical diagnosis of AD. In collaboration with Dr. Elaine Peskind at VA Puget Sound, I have investigated several established (e.g., Ab42) and novel (e.g., E-selectin) AD biomarkers in cerebrospinal fluid (CSF) as we seek a way to improve both the early diagnosis of AD and the differential diagnosis of dementing diseases. Leveraging a large biorepository bank at VA Puget Sound, we have studied several of these CSF biomarkers in a cohort of cognitively normal subjects, and through this work, we have shown that (a) high CSF concentrations of F2-isoprostane, a biomarker for oxidative stress, are associated with poor executive function, cigarette smoking, and elevated body mass index; and (b) reduced levels of CSF brain-derived neurotrophic factor, a protein critical to the organization of neuronal networks and synaptic plasticity, are associated with poorer memory and predict cognitive decline over the next 3 years. Finally, we have established the feasibility of using CSF biomarkers, such as phosphorylated tau, as surrogate markers for AD in clinical trials during the pre-clinical stage of AD.

Primary prevention for AD: From observational study to clinical trial. The 3-hydroxy-3-methylglutaryl-coenzyme A (HMGCoA) reductase inhibitors, known as statins, decrease mortality from coronary heart disease and stroke. Our epidemiological studies found that the use of statins at relatively younger ages (e.g., prior to age 80) is associated with a decreased incidence of AD, especially in APOE ε4 allele carriers; statin exposure was also associated with fewer AD neuropathologies, especially in terms of neurofibrillary tangle burden. To provide further evidence of a potential protective effect of statins for AD, I recently completed a proof-of-concept, double-blind clinical trial in collaboration with Drs. Elaine Peskind, Eric Petrie, and Cynthia Mayer on the effects of simvastatin on CSF AD biomarkers in cognitively normal individuals. In that study, we found that simvastatin-related reductions in CSF p-tau181 concentrations may be dependent on low-density lipoprotein (LDL) cholesterol. To learn more, we will next investigate the potential disease-modifying effects of simvastatin on tau phosphorylation in persons with hypercholesterolemia.

mTBI research. Because neurodegenerative diseases like chronic traumatic encephalopathy (CTE) are the long-term consequences of repeated head injuries, I recently expanded my research interests to understand the risk of mTBI in combat Veterans with blast-related injuries for neurodegenerative diseases. To that end, I am an active member of a multidisciplinary research team at VA Puget Sound that seeks effective treatments for Veterans with mTBI. As a collaborator in this work, which is led by Dr. Elaine Peskind, I am striving to develop strategies to reduce the long-term sequelae of mTBI.

Shaune DeMers

Personal Statement

I am a geriatric and consultation liaison psychiatrist with expertise in diagnosing and managing cognitive disorders. I attend in the Memory and Brain Wellness Center, where I see primarily middle aged and elder patients with concerns about their memory or thinking. Although most of my patients have Alzheimer or vascular dementia, I have experience in diagnosing and managing less common types of neurodegenerative disease as well, for example frontotemporal dementia, dementia with Lewy Bodies, and Parkinson disease dementia. I have a particular interest in palliative medicine and end of life issues. I am board certified in both psychiatry and psychosomatic medicine. I am also the medical director of the psychiatry consultation service at Harborview Medical Center, which is where I spend most of my clinical time. That service is a large team busy with consultations throughout the hospital, and sees patients with serious medical and surgical illnesses who require psychiatric assessment and care. In all of my clinic work, I am proud to be part of teams of very talented professionals, which include other attending psychiatrists, neurologists, geriatric internists, nurse practitioners, neuropsychologists, social workers, nurses, and addiction specialists. I enjoy training fellows, psychiatry, psychology, and neurology residents, and medical students. There is a sense of mission and a level of commitment to clinical excellence at Harborview that I value greatly.

Amanda Focht

Personal Statement

I am experienced in the evaluation and treatment of a range of psychiatric conditions including anxiety and panic, mood disorders, psychosis, obsessive-compulsive disorder, posttraumatic stress disorder and personality disorders. I work with adult and geriatric patients in the outpatient setting.

Julia Ruark

Personal Statement

I am a board certified psychiatrist and work at Fred Hutchinson Cancer Center. I am a Clinical Assistant Professor of Psychiatry and Behavioral Sciences at the University of Washington.  I obtained a fellowship in consultation-liaison psychiatry, a specialty that focuses on providing psychiatric care for people with complex medical conditions.  My primary clinical focus is people with cancer. I love my work.  Being ill is a vulnerable time and my goal is to ease suffering and provide a sense of connection and understanding for all I work with.  I believe in working collaboratively with patients and families. We work together to identify what the goals of treatment are. I have expertise in diagnosis, psychopharmacology and psychotherapy and adapt my recommendations to best serve the goals of the person before me. I am also passionate about education. I am the site director at Fred Hutch Cancer Center for our Psycho-oncology Fellowship Program. I supervise Cl fellows, addiction fellows, psychiatry residents and provide education to social workers and psychology trainees.