[-empyre-] Introducing Tina Gonsalves, Trish Adams and Lucette Cysique

[Lucette Cysique]

First I would like to thank Michelle Barker for inviting me on this forum.
As a clinical scientist, I believe that inter-disciplinary endeavours are crucial
for the advancements of knowledge.

Most scientists sees collaborations with other scientists to be the most
relevant, but maybe because I have always hesitated between my current career and
one in philosophy, I am very open to innovative collaborations.

In fact, I may underestimate the prevalence and art/science collaborations...

Still, since I started to first study psychology in early 90's and because I did
my cursus in 4 different countries, I have encountered somewhat resistance to
inter-disciplinary collaborations especially in the field of neuropsychology.

It is true that neuroimaging based fields are in fact showing the way by
promoting exchanges within and beyond their field. They have also been creative in
developing a web imaging community where many free tools are available. Then many
questions that were thought not to pertain to science not so long ago have made a
significant come back (e.g., emotional processing) and inter-disciplinary imaging
neuroscientists are leading the way. I have been at QBI recently and this is a
concrete example of this evolution.

However, maybe as a clinical scientist who is also considerate of what are the
impact of scientific advancements for the well-being of patients suffering from
different neurological disorders, and also as a politically minded person, I feel
that science and especially neurosciences in the last decade has been driven by
technological fashion instead of building strong experimental study design (not
always, but as a main trend). As much as neuroimaging can open to questions that
cannot be tackle otherwise, all the methods have important limitations.

I graduated in 1995 in Psychology at la Sorbonne in Paris. I did a research
project then that was focused on cognitive psychology and auditory perception.

I completed a postgraduate degree in France in neuropsychology with a study on
emotional processing in Alzheimer's Disease (AD). At the time this questions were
relatively new. We showed that when persons with AD are already moderately
demented, their emotional processing (which was assessed by facial emotions
recognition and recognition of emotional prosody in some short stories) is
partially preserved. At the same time we used Event-Related Potentials (ERPs which
have a better time resolution than MRI-based imaging) to determine if attentional
deficits were associated with emotional processing abilities. We found that in
some cases better attentional processing measures by ERPs was associated with
better emotional processing.

I then worked for 2 years as a clinical neuropsychologist in a Parisian Hospital
working on the detection of different type of dementia and psychiatric illnesses
in the elderly. At this time, I worked with a neurologist, a gerontologist, and we
had the input of the neuroradiologist when relevant. I think as a young
neuropsychologist, two thinks struck me. One is that the level of brain atrophy as
seen on the MRI was sometimes not related with the level of cognitive functioning
as assessed by neuropsychological testing. This is in fact the case in many
neurological diseases. The other thing is a clinical appreciation of individuals
with dementia. The personality/memory loss with advancing dementia that
accompanies mostly cortical neurodegeneration (such as AD) was contrasting with
the  patient ability to be socially or emotionally appropriate.

I then came to Australia and did my Ph.D in neuropsychology and HIV infection. I
had planned a neuroimaging part that did not get funded using Magnetic Resonnance
Spectroscopy. This work has an important clinical spin and less cognitive than
what I did in the past. But we were among the first internationally to make
recommendations based on our findings to improve treatment of dementia in HIV. We
were also among the first to demonstrate that neurocognitive complications of HIV
are as prevalent now that combination antiretroviral treatment is available. This
lead me to longitudinal analysis of cognitive functions which I can develop later.
But this is an area for example where I believe neuroimaging techniques
(MRI-based) are lagging behind and also have serious limitations (especially
fMRI..).

I then moved for 2.5 years in the U.S. at University of California San Diego at
the HIV Neurobehavioral Research Center for a post-doc. This center is one of the
most funded centers in the world and they have enormous resources compared to
Australian research. But interestingly, they may be less creative than smaller
places.. This goes into the socio-economic context of scientific research which I
am also interested in, but this is beyond our talk. In the U.S. I had my first
serious experience with MRI-based imaging. I started with a big amount of reading
and going to class, attending courses on MRI and fMRI by Richard Buxton for
example at UC San Diego. He is one of the fMRI expert who is highly philosophical
about his work. Some are more into the techniques, but are also important of
course. I then started my own research project using fMRI to study the neural
correlates of Hepatitis C infection neurocognitive impairment. I am still working
on this at the moment. In this study we included assessment of motor functioning
and attentional functioning. While doing fMRI I became very critical of it and
this resonates with what Trish mentioned. The interpretation of the BOLD signal
which is the signal of interest in fMRI is ambivalent in that it can accommodate a
variety of interpretations. Because the technique is still fairly new, there are
no definitive standard for some important steps of the images processing.
Artefacts and errors can be missed easily. The management of movement in fMRI for
example is a bit of a dark affair. Then I also work on morphometric or volumetric
MRI. In this area, there are also a lot of different methods, but it is somewhat
less subject to errors because the signal of interest is not as "small" as in
fMRI. The new method I plan to use in the future is DTI (diffusion tensor imaging)
which is fairly new and is receiving lot of attention. There are new methods
emerging as well, and I can talk about it in future emails if you are interested.

In my new project here, I will use a combination of MRI imaging, PET imaging and
neuropsychology in a longitudinal study. The combination of methods are a way to
overcome the limitations of one method. But they may pose new problems.. I decided
to re-introduce a component on emotional processing in my new study. But this will
be pilot at this stage and will not include direct studies of emotional processing
with neuroimaging, but with neuropsychological computerised tests.

One thing that I did not discuss is that while in the U.S. I was the manager of a
study conducted in China about neurocognitive complications of HIV infection. This
work was important in developing my interest in cross-cultural neuropsychology. I
think one aspect of cognitive neurosciences and imaging studies that can be easily
amenable to criticism is the fact that most studies are conducted on young white
males (working in HIV or with people with substance use disorder for example
highlights the demographic representation issue in fMRI studies). Although this is
changing, fundamental questions regarding the universalism of emotion perception
and cognitive functions are starting to be very challenging. I can develop on this
later.

I think the recent umbrella field of "social neurosciences" is bringing
scientists together about all the things I mentioned. I hope to be part of this
keeping the clinical aspect of my research.

I like the idea that artists and intellectuals question, play and even distort
the finalities of scientific research. I think it is with this critical spirit
that scientists should work more often. I also think that the collaborations can
lead to discoveries. 

Regards,
Lucette

Lucette A. Cysique, Ph.D.
Post-Doctoral fellow at Brain Science University of New South Wales, Sydney

Department of Neurology
Xavier Building, Level 4
St. Vincent's Hospital
390 Victoria Street
Darlinghurst 2010 NSW
Australia
Ph: (+61)  2 83824104
fax: (+61) 2 83824101
lcysique at unsw.edu.au
lcysique at ucsd.edu (HNRC email)


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