Q&A with Luciana Mascarenhas Fonseca
Published January 25, 2023, by Judith Van Dongen
An estimated 6.5 million older Americans are living with Alzheimer’s disease, an incurable brain disorder that causes dementia and ultimately robs people of their ability to carry out everyday tasks. When the disease is diagnosed early, medications and cognitive therapies can be used to delay its progression. However, diagnosing Alzheimer’s in its early stages is challenging as reliable biomarkers are not yet widely available. Neuropsychologist Luciana Mascarenhas Fonseca—an associate in research in the College of Medicine’s Department of Community and Behavioral Health—is conducting research that she hopes will help change that.
Can you explain what your research entails?
My research examines the connection between intraindividual cognitive variability and Alzheimer’s disease in different populations. Intraindividual cognitive variability refers to how a person’s cognitive functioning might vary across tests and cognitive domains at one time point or within a short period of time, such as a few days. Recent research has suggested that intraindividual cognitive variability may be a promising non-invasive biomarker that could predict the onset of dementia. Some studies have shown that even 10 years before you are diagnosed with dementia you already have increased fluctuations in cognition that can be identified through neuropsychological testing. If we can show that measuring intraindividual cognitive variability is a useful way of identifying individuals who will develop dementia in the future, that would be very helpful to scientists, clinicians, and patients.
How exactly would it help them?
Intraindividual cognitive variability could prove to be a low-cost way to screen for dementia in a variety of settings, including rural and remote areas. It could help get people into treatment sooner, helping to delay or ease symptoms and giving patients and their families time to plan ahead. In addition, it could be used to identify individuals who could enroll in clinical trials of potential Alzheimer’s treatments, many of which target early stages of the disease. Finally, we could measure cognitive variability as an outcome to evaluate whether a treatment is effective.
How did you first become interested in studying dementia?
Growing up in Brazil, I had a close relationship with the older members of my family and especially my grandmother, with whom I shared a room until I moved to São Paulo at age 17 to study psychology. She was very healthy with a strong memory and good cognition and ultimately lived to age 98. Having her as an example of healthy aging, I was really puzzled when I met older people who had dementia or functional difficulties. It got me interested in focusing my psychology studies on dementia and aging. I completed my bachelor’s thesis on dementia in low-income, institutionalized older adults in Brazil.
How did your educational journey unfold after that?
After getting my bachelor’s degree, I started working with older adults with dementia before earning a master’s degree on death and palliative care at the University of Padova in Italy. When I returned to Brazil I started working with individuals with Down syndrome at the country’s largest institution for intellectual disability. People with Down syndrome now live much longer than they used to, but they experience accelerated aging and have a higher incidence of Alzheimer’s disease. By age 40, most have a buildup of amyloid plaques in their brains that is the hallmark of Alzheimer’s disease, even though they may not show dementia symptoms yet. Their pre-existing cognitive impairment made it even harder to identify early-stage Alzheimer’s in this population. To offer effective support to my patients, I felt that there was a need to better understand the unique process of dementia in individuals with Down syndrome. This led me to my research career. I started a PhD at the University of São Paulo in partnership with the University of Cambridge in the United Kingdom. As part of my PhD project, we validated the first instrument for diagnosing dementia in Down syndrome in Brazil.
What brought you here to Washington State University Spokane?
My husband, André Miguel, is a clinical behavioral psychologist who conducts research on the treatment of substance use disorders. He was hired in 2019 to work with WSU addictions researcher Sterling McPherson, and we moved our family here. I also looked for someone to do research with at WSU and found Naomi Chaytor, a neuropsychologist who was very welcoming and open to helping me achieve my career goals to conduct research on dementia.
What research projects have you been working on since joining WSU?
Naomi and I are collaborating on her NIH-funded project on type 1 diabetes and the relationship between blood glucose excursions—low and high blood glucose—and cognitive performance. I received funding from the Alzheimer’s Association to look for associations between cognition with Alzheimer’s disease biomarkers within this study. The study has adults with diabetes completing cognitive assessments through a smartphone app three times a day for 15 days while wearing continuous blood glucose monitors. They also provide blood samples for biomarker testing. Together, these measures enable us to examine the relationships between type 1 diabetes, cognitive variability, and Alzheimer’s disease risk.
Another recently completed pilot study looked at how intraindividual cognitive variability relates to brain structure shown in MRIs of Native American participants in a long-time NIH-sponsored cohort study. The pilot was supported by the Native Alzheimer’s Disease Resource Center for Minority Aging Research, a multicenter program led by Dedra Buchwald in WSU’s Institute for Research and Education to Advance Community Health (IREACH). My collaborators and I are hoping to receive NIH funding to continue this work by looking at these associations over a longer time period.
I am also pursuing grant funding to conduct research on cognitive variability in Down syndrome. This would allow me to get back to studying Alzheimer’s disease in this population and collaborating with my research teams at the University of São Paulo and the University of Cambridge.
What is the secret to your success so far?
My research builds naturally on my clinical experience, allowing me to identify dementia research questions with real clinical implications. I also owe a big debt of gratitude to the many mentors who have so generously shared their time and knowledge with me, but most of all to Naomi Chaytor here at WSU, Tony Holland at the University of Cambridge, and my late PhD mentor Cassio Bottino at the University of São Paulo.
This interview has been edited and condensed for clarity.