Introduction to the Minding Memory Podcast

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In this episode we introduce ourselves and provide an overview of the Minding Memory Podcast. This podcast is supported by the Center to Accelerate Population Research in Alzheimer’s (CAPRA) at the University of Michigan. Our guest this week is Dr. Julie Bynum. Julie is the director of CAPRA and we talk briefly about what the NIH-funded research center is and how to get involved.

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Transcript

Matthew Davis:               
Welcome to Minding Memory, a podcast devoted to exploring research on Alzheimer's disease and other related dementias. Here, we'll discuss compelling research and talk with leaders in the field about how their work is improving the detection and treatment of dementia. I'm Matthew Davis.

Donovan Maust:              
And I'm Donovan Maust.

Matthew Davis:               
We're both researchers and associate professors at the University of Michigan. I'm a PhD with a background in data science.

Donovan Maust:              
And I'm a geriatric psychiatrist, so I think a lot about the diagnosis and management of dementia.

Matthew Davis:               
I'll work to keep Donovan to the minimum use of medical jargon.

Donovan Maust:              
And I'll make sure we talk about research with real world applications to patients and caregivers of individuals with dementia.

Matthew Davis:               
Thanks for joining us and let's get started. Welcome to the podcast. Well, here we are, how are you doing Donovan?

Donovan Maust:              
I'm okay, Matt, I guess this is podcast official now, episode number one.

Matthew Davis:               
We've been talking about this for almost a year now. Sort of like working on the name and everything, but we're actually doing this. So we're new to podcasting. We're both professors here at University of Michigan. So in this first episode, we thought that we would get to know each other a little bit and introduce ourselves and also get to know Julie Bynum who will be talking to you a little bit later, who is basically the primary person behind the grant that's related to this podcast. So should we, should we start off with our elevator speeches?

Donovan Maust:              
That sounds good. I'll try to make sure it's not too long of an elevator ride. You better go first, Matt.

Matthew Davis:               
Okay. So when research, I don't know if this is at all institutions, but at the University of Michigan, people often will talk about their elevator speech, which is basically the opportunity to sort of talk about your research and kind of what you do. I'm an associate professor, I'm in the school of nursing and in the school of medicine, I'm a PhD. My background is in healthcare research. I do large observational research, which means I work with preexisting data. I teach as well, I teach introductory statistics, I've taught epidemiology and I teach graduate students how to do observational research with big datasets.

In terms of content areas. I'm relatively new to the dementia research space, and I'm getting to know some great people through this podcast and our center that we work with and kind of looking forward to sort of interviewing people out there in the field and learning more about their research. So that's, I guess, my little elevator speech. Why don't you tell us a little about your background, Donovan?

Donovan Maust:              
Yeah, so my spiel is I'm a geriatric psychiatrist. I came to the University of Michigan in 2013, I guess, kind of the umbrella that I think about for my work is sometimes I think a lot of times older adults and their partners have a variety of needs. And I think sometimes the way healthcare in the U.S. is set up that kind of gets medicalized. And when people say need like meals on wheels, they get our prescription for Zoloft instead. And so I'm interested in understanding sort of what types of medical care or prescriptions do older adults get that maybe is kind of potentially inappropriate or overuse. And then also interested in actually helping them get the care that they really need.

A little bit like Matt. I kind of like data that's already there or that somebody else has already collected. So things like data from the Medicare system or data from the veterans' health administration or other like big surveys that other folks run. So I like to analyze the data, I don't necessarily want to collect the data. So we're I think very similar in that respect. So, I'm really excited that we're getting this podcast launched and that we have the chance to work together on this new CAPRA center that's been funded at the University of Michigan.

Matthew Davis:               
So, the CAPRA center is the group that we're affiliate with for this particular podcast. It's the Center to Accelerate Population Research In Alzheimer's. And it's interesting that the podcast, when we applied for this big center grant, it was like a novel thing. So I feel like that's kind of funny actually that researchers, this is like novel for research and everyone else in the entire world has a podcast. So we get there eventually in research, but nevertheless, should we talk about our respective roles in the podcast and kind of what we want to accomplish?

Donovan Maust:              
So I think the primary role is that I let Matt do a lot of work here and he helps identify cool papers and cool people that we want to talk to. And then he drives the bus and then I kind of chime in here and there when I have some additional questions that I want to ask. Is that an accurate description, Matt?

Matthew Davis:               
I don't know about that, but I am always happy to drive the bus if you let me. So I sort of see our roles, I mean, I think that you bring an amazing clinical perspective to the things we're going to be talking about. Obviously I do research for a living, so I really appreciate this stuff, but I'm relatively new to the space. So I think that in some ways I can sort of provide that perspective of someone that's kind of getting into the space of dementia, which is what the center is about. The center is about getting people involved in this research and helping promote it across the country.

I should also mention too, that this isn't just University of Michigan, is Housing University Michigan, but we have people affiliate with the center across the United States. In this podcast, I think that our idea for this that Donovan had been discussing for some time is we're going to mostly interview specific researchers on specific papers, but we're going to have other discussions as well. And we'll hopefully have some fun along the way. I have to say, Donovan, that two different people on two separate occasions said that you're really funny. So no pressure, but I expect you to bring it.

Donovan Maust:              
Occasionally I try.

Matthew Davis:               
So one thing that we're doing this first podcast, we thought it will be sort of fun to do some icebreaker questions. I am not an icebreaker person. I never really include these in my courses or anything like that, maybe I should. And I think it's kind of funny, but this is like, I provided a list of the icebreaker questions to Donovan, and being a psychiatrist, he ranked ordered them, which I feel like that is some kind of implied meeting of like, somehow he's going to like diagnose me or figure me out based on the raking of the questions, but should we do one or two?

Donovan Maust:              
That sounds good. Let me just clarify, it's more about being a perfectionist, I think, than it is about being a psychiatrist.

Matthew Davis:               
All right, I'm going to start with the top. What is your least favorite food as a child? And do you still hate it or do you love it now?

Donovan Maust:              
Okay, so fortunately I think the only time that I had this food in my life was when I was a child at a friend's house. And that was liver, which I thought was just totally disgusting. And I've never, I don't believe, had to have it again. So that's my answer, liver.

Matthew Davis:               
Liver. That's-

Donovan Maust:              
How about you Matt?

Matthew Davis:               
That's probably many peoples... So mine is, this is going to uncover some deep stuff in my history. So my least favorite food was something called polenta. You ever heard of polenta? It's like a corn based-

Donovan Maust:              
Oh yeah, yeah.

Matthew Davis:               
But the problem, the reason it was so bad for me is because I was sent away to boarding school at 11 and that was the first meal I had on my own at boarding school. So you see, you are getting into sort of my deep psyche here already. Since then I actually like it.

Donovan Maust:              
I was going to say polenta is like pretty innocuous. So there had to be something else going on to really make you hate polenta as a kid.

Matthew Davis:               
It was the emotional component, I'm sure. All right. Why don't we get to work? What do you say?

Donovan Maust:              
That sounds great.

Matthew Davis:               
We are super excited to be joined by our guest today, Dr. Julie Bynum, who's a good friend of both of ours. And then one of my very early mentors in my career. Officially, she is the Margaret Terpenning collegiate professor of internal medicine, the University of Michigan. And she is the director of the center that we work for or work with, I suppose, The Center to Accelerate Population Research In Alzheimer's. So Julie, welcome to the podcast.

Julie Bynum:                     
Thank you. I'm glad to be here. And I'm glad that you corrected yourself instead of saying that you work for the center you work with.

Matthew Davis:               
Yes, that's better.

Julie Bynum:                     
Because I do all things in collaboration.

Matthew Davis:               
Very collaborative, yes. So we were hoping for this first episode, just to kind of talk about the center a little bit, what the center is. The audience that we're trying to reach through this podcast is not only researchers of field that might be interested in dementia research in general, people that are work in the healthcare sector and people that might be caregivers for people with dementia and Alzheimer's. So with that, should we just talk a little about, I mean, I was actually thinking before we got together for this, like how long we've known each other? What's it been like?

Julie Bynum:                     
Oh, good Lord. I'm afraid to think, but my hair wasn't going gray. Let me think, long time. And when did you start your K award?

Matthew Davis:               
Oh, geez. It must be, I mean, maybe not 10 years, but headed in that direction.

Julie Bynum:                     
I would say it's at least 10 years. So Matt gave this wonderful talk at a seminar at Dartmouth all around use of social media and data. And he was just so creative so we sort of started connecting him up with people to get him launched and doing interesting data work.

Donovan Maust:              
You were already at Dartmouth at that point, right?

Matthew Davis:               
I was. So I was kind of training at Dartmouth, kind of getting my feet on the ground for those people that don't know a ton about research, a lot of people they get started on something called a career development award and it's the opportunity to kind of do some research and get a lot of training. And I was doing that at Dartmouth at the time before I came here to the University of Michigan and I got to know Julie. So Julie was, it's a small place, I've come to found. I thought that Dartmouth was really big until I got to the University of Michigan.

Donovan Maust:              
Oh, yeah.

Matthew Davis:               
So I got to know some people and Julie was doing a ton with people that were early in their careers and mentoring people and just had a wonderful way about her and someone that I really looked up to. And every time I talked to you, I remember talking the first time getting coffee at the co-op. I always felt uplifted and I always wanted to work harder. So it's kind of an attribute that seemed like something I was really kind of drawn to you and wanted to work with you more and more over the year. So we've kind of evolved from a mentorship sort of standpoint. And over the years now, I guess we're collaborating more and more.

Julie Bynum:                     
Yeah. Well, and now we're peers or proteges and maybe someday you'll be the dean somewhere that I'll work. We can always look forward to a brighter future for me. Yeah, I think we met at a time when I was struggling with how to navigate my own research career and create a community like, how do you create a community? We are a small institution. And so I decided to just call together all the junior faculty who had good ideas to share. And you were one of those people and I think for me, it's so much more fun when you can pull the ideas and the innovation and the excitement of junior people together and have them problem solve together. And that's partly the goal of the center that we have.

So the name of the center is The Center to Accelerate Population Research in Alzheimer's. In the way I was really thinking about it was, "There is so much to be done in the space of Alzheimer's. There are so many challenges that we face. We need an army of creative people solving the problems that this disease creates for the population. And so we need to create an on-ramp. We have to take the experience and knowledge of people who've been in the field and get everyone else excited to bring them in and make it easy for them to come in, to join the sort of energy around reducing the burden of this disease."

So a lot of what I learned about trying to develop my own community at Dartmouth, or trying to translate here, like this isn't about me owning something or having some method that I don't want to share, or I want to show off. This is about how do you learn from people who are ahead of you and make what they do better and also not recreate the mistakes everybody else made. Let's just share it, let's do it together. So I think that focus on junior people and the energy they bring is a lot behind what I want to see out of the center.

Matthew Davis:               
So we've been using the term center now, should we sort of define what an NIH research center even is?

Julie Bynum:                     
Do you want to go first?

Matthew Davis:               
I have my take on it, but I don't know if it's accurate. I mean, I can try.

Julie Bynum:                     
Go for it.

Matthew Davis:               
So, okay, the NIH is a collection of institutes for people that might not be research savvy out there, that fund cutting edge research, and they have a variety of different types of grants with different purposes. They have some grants that are designed for training new people and developing new talent. They have some kind of core research grants that are fund a specific research project, but center grants are specific and a little bit different. They're more around funding areas of research that the NIH wants to promote and get going. Would you describe it that way?

Julie Bynum:                     
Yeah. Often the centers don't fund a specific research project. Normally, you know, Donovan has this great idea to try to understand how benzodiazepines are used in older adults and whether they're getting real quality out of their use, improvement in their lives. And they'll write a study to answer questions specifically about that. Centers have a broad area and they are funded to more like an infrastructure kind of idea, to develop areas of research without necessarily answering very specific questions.

So our center is really focused on those aspects of research, that address how public entities, governments, healthcare systems, healthcare providers, social policy can address reducing the burden of Alzheimer's disease. It's a general area, and we're going to do a number of things to try to bring people together in advancing that area. We're going to do podcasts to disseminate the research and bring it closer to home and generate some energy. We're going to do seminars. We're going to share SAS code as not exciting as that is. That's really, really helpful for people. We're going to have research networks where people get together and talk about their research and generate new ideas. And we're going to fund early studies, pilot studies to get people going so that they can write that first big independent study and have some something on which to grow.

So we get funded to support a number of different activities around of area, rather than answer a single specific question. Does that help, Donovan?

Donovan Maust:              
Yeah, that helps a lot. One thing that I think would be really interesting to hear that I've heard you talk about before is in 2021, say there are many resources out there for people who are interested in doing dementia related research. That however is really a contrast to when you started your research career. So I think that evolution is a really interesting piece of background that that folks might find interesting.

Julie Bynum:                     
Yeah. So I'm actually trained, we didn't really talk about this very much. I'm a geriatric medicine physician and I trained at Johns Hopkins. So we do know some of the same people, Donovan was telling the truth. And in the field of geriatrics, it tends to be a very clinical field, but I came to medicine interested in systems. Why as a society do we institutionalize the elderly in nursing homes, but deinstitutionalize the mentally ill?

What's going on? That's not about medical science. That's something about culture, history, payment, and those kinds of issues. So when I went into medicine, I was interested in public health and health policy, but that wasn't really done in my field. Geriatrics was about clinical syndromes, falls, incontinence. So I had to go outside my field to find mentorship. And that's how I ended up at the school of public health and working with Peter Reed and he was working in Alzheimer's disease. And I developed the skill set using Medicare claims data, because this is a data source where you can study the entire population and how they get their healthcare and really understand what's going on for them.

So then I got to Dartmouth where I was a junior faculty member, and this may be the specific story Donovan's thinking about. I said, "I want to write my K award, my career development award on Alzheimer's disease." And everybody looked at me and said, "You can't do that." And I was like, "Why?" And they said, "Because people just aren't going to buy this as important enough that the data can say anything about it." They really just said, "You need to do something else." So what I did was choose to study people over the age of 80, knowing that almost 50% of the population would have Alzheimer's disease.

So that's where I started out. And in fact, my career development award, I was quietly in the background doing Alzheimer's work with Katie Maslow and others for the Alzheimer's association. And as I got more senior and more of my own footing, I've been able to develop my own research area and just happened to have the great fortune of having the NAPA, the national advisory plan-

Donovan Maust:              
National Alzheimer's Plan.

Julie Bynum:                     
Thank you, National Alzheimer's Plan Act. This really accelerated research. So the 180 now is that people like me or Ken Langa and others who were involved in our center, who started early in the Alzheimer's, we're now more senior and there's lot of people who want to learn and enter the field, but there's not so many people with the senior experience. And so how do you take our experience and translate it to lots of people when it's really hard to mentor one-on-one. So we really have got 180, where there's more demand for the knowledge and the experience. Now, then there was a long time ago. So we're having to fill those gaps.

Matthew Davis:               
You need a center to do it.

Julie Bynum:                     
You need a center to do it.

Matthew Davis:               
I'm curious, I don't know, what are your thoughts about how this center differs from the other centers at the University of Michigan?

Julie Bynum:                     
Oh yeah. So we should back up a little bit there to say, why in the world did I make the move from Dartmouth to Michigan? What was going on in my head? And it really is all about why the center at Michigan. So at Dartmouth was a great place, a great place for health policy, people doing Medicare research. And as we already alluded to, it was small and there wasn't very much by way of an aging program.

When I was looking to make a change and I looked at places that had real breadth of aging research. There's not a lot of them that have everything from economic research, basic science, the biology of aging.

Donovan Maust:              
Mice.

Julie Bynum:                    
We have mice. We actually have, more rare than that, we have geriatric psychiatrists.

Donovan Maust:              
That's true, that's very true.

Julie Bynum:                     
So we have the health retirements study. We have all these great, great groups here. And so I saw a place that had a tremendous amount of opportunity in the field that I liked, where I could be intellectually stimulated by having all the aspects of aging around me, without me having to do it. And I also saw a gap. I saw this gap that what I do is really about population health care, health delivery, health policy, social policy, public policy. And that was one of the areas, there were lots of people who had little tiny pieces of, but I saw a place where we could really grow and had enough of the junior people around to populate that research infrastructure. So that was a major determinant of why I chose to come to University of Michigan.

So the center, you asked me about why the center, there's actually a number of research centers at the University of Michigan in aging. It's probably way down in the weeds, but The National Institute of Aging has a bunch of different groups, one that does clinical work, one that studies the biology and mechanisms of Alzheimer's disease. And another that really focuses on social behavioral research. And they have center grants in each of those areas. There's the pepper centers and the Alzheimer's disease centers. And also the centers that we are a part of, which are the aging and demography centers.

They in addition, have centers to support minority research and researchers. So here at University of Michigan, we have an Alzheimer's center, an aging center and two minority centers through us, as well as the social science centers and economic research groups. So we're really fortunate to have a rich community of researchers that allow for us to really be generous and give away what we have, because it'd be really great if we could get those universities that don't have the size or the scale to be able to have a center, but could really use the resources of our center, hence seminars and podcasts.

Matthew Davis:               
So that's an interesting point. I mean, The University Michigan is really large, like many other big research academic institutions, but the center isn't necessarily just for people at Michigan, right?

Julie Bynum:                     
No, absolutely not.

Matthew Davis:               
So how can other people get involved and learn more about the center?

Julie Bynum:             
Yeah, so like everything today, we all have a website, finding a website is always challenging, but for investigators, we do have pilot funding. For research, for people who are doing secondary data research, the social and public policy. We have a call once a year. So that's one way to get involved. The other is as we build our podcasts and our seminars to use them, we hope to have training tools that people will be able to not need to have Ken Langa as their mentor to get the wisdom of Ken Langa on how to use the HRS memory, you know, cognitive measures.

So use those resources and give us feedback. What do you want to learn? What do you want to hear about? Then we will have research networks growing in various areas. So there'll be lots of opportunities to participate. And let us know if you have something that you think you'd be a great podcast. You think your research, reach out to us. We would love to be the clearing house for people doing interesting and exciting work and to be interviewed by Matt and Donovan.

Matthew Davis:               
All right. Well, I just want to thank Dr. Julie Bynum for joining us today. This has been great. And next time we'll be talking with Ken Langa on the value of early detection for dementia.

If you enjoyed our discussion today, please consider subscribing to our podcast. Other episodes can be found on Apple Podcasts, Spotify, and SoundCloud, as well as directly from us at capra.med.umesh.edu where a full transcript of this episode is also available. On our website you'll also find links to our seminar series and the data products we've created for dementia research. Music and engineering for this podcast was provided by Dan Langa more information available at www.danlanga.com.

Support for this podcast comes from The National Institute on Aging at The National Institutes of Health, as well as the Institute for Healthcare Policy and Innovation at the University of Michigan. The views expressed in this podcast not necessarily represent the views of the NIH or the University of Michigan. Thanks for joining us. And we'll be back soon.


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