In conversation with neurologist Lesley Fellows

Posted on Thursday, March 22, 2018

Lesley Fellows works with patients who have problems with complex behaviours such as memory, thinking and decision-making.

By Anita Kar

Lesley Fellows is a neurologist and researcher at the Montreal Neurological Institute and Hospital. Fellows works with patients who have problems with complex behaviours such as memory, thinking and decision-making. She is passionate about her work because she gets to help people reintegrate into society and it enables her to develop creative new ways to understand the brain.

Fellows, one of the featured researchers in the Neuro’s new Neuro XXceptional video series, spoke to the Reporter about her work and how we can “design optimal environments” for our brain.

You say we need to think about designing our environments for our brains, what do you mean by that?

We have the ability to create environments that are optimal considering the vulnerabilities of our brains. For example, the brain does not do well with decision making when a lot of information comes at once. This may lead to over-emphasis on the decision information that was easiest to notice, rather than on the considerations that are actually most important in reaching our goals.

Advertisers may take advantage of this, and our brains may be especially susceptible when we are tired, distracted or stressed. The idea that we are making a ‘perfect’ free choice based on complete information ignores the fact that the brain making this choice is a biological system with weaknesses and capacity limits.

We have seen an evolution of this thinking, for example, in relation to smoking. There is awareness that we have to construct a safer decision environment to reduce smoking rates. We cannot expect individuals to show perfect self-control through willpower alone, because the addictive properties of tobacco take advantage of a weak spot in how the brain works.

Instead, we have decided as a society to change the decision ‘playing field’ to help people make healthier choices, offsetting this brain vulnerability to some degree by banning advertising, restricting smoking in public places, increasing the prominence of health warnings on tobacco products, as well as traditional health education campaigns, etc. We can think of ways to use our ability to design our decision spaces better for other kinds of choices.

Computers can help us prioritize what is important. This has been applied during elections for example – computers could help boil down party platforms to help us structure our own decisions. Not to lead you in a certain direction but to help you analyze complexity in a way the brain can actually manage.

You try to give your patients ‘the equivalent of a walker for their thinking,’ can you explain that?

I see patients who have problems with complex behaviour such as memory, thinking and decision-making. These patients have an invisible disability. They have damage in the frontal lobe, which is commonly injured and dysfunctional in several common conditions. The frontal lobe is involved in executive functions such as planning, important in organizing your behaviour so that you can to reach a distant goal.

My research and clinical work is motivated in part by the idea that you can give people with such problems the equivalent of a walker for their thinking. The question and challenge is to understand what is happening in the brain in order to bring new ideas for rehabilitation.

We develop computer games or tasks to measure very specific behaviour. We try to understand the function of parts of the frontal lobes, by working with people who have had damage to specific parts of the brain. In other words, we ask the brain to show us how it is working (or how it is malfunctioning after an injury). The tasks we develop in the lab can become tools to better diagnose and treat patients in the clinic, or to understand what is going wrong in other conditions that affect the frontal lobes in more subtle ways, such a mental health disorders.

Understanding brain mechanisms of complex behaviour helps us to design tools and approaches to help patients to reintegrate into society – whether through work, school, or family. The more we understand the brain mechanisms, the more precise we can be in helping them. That is what drives me from a clinical point of view.

Your work has implications with HIV patients. We normally think of HIV as affecting other parts of the body other than the brain.

We have done a lot of work with people who have had HIV for many years and are now in their 50s and 60s. They are well treated with drugs that suppress the virus in their body so they are relatively healthy from a physical point of view.

Now we are seeing that long-standing HIV infection can take a toll on their brains: many have at least mild trouble with their thinking, or memory, or mood or a lack of motivation or a combination of these problems. It is not clear why – it is probably due to several factors rather than only an effect of HIV itself.

My research is giving us a framework to think about the problem. Working with a large team of researchers, students and people living with HIV, we are creating novel approaches to rapidly assess this kind of subtle cognitive trouble. In order to detect thinking problems and try to fix them before they get worse.

The idea is that just the way you use ultrasound tests to measure blood flow with each heart beat – cardiac output – a very general number that captures how well the heart is working, we are looking for something similar for the brain. We do not normally think of the brain that way. Usually we think about problems with specific aspects of brain function like memory or language, but in certain conditions where the brain is slightly failing like in HIV for example, we are investigating ways to capture a “brain output” measure by testing cognition as a single quantity. We hope this will provide a simple way to follow complex impairments, usable in any clinic, not just by specialist neurologists or neuropsychologists. We can ask the brain to show us how it’s working with computer tests and provide a single score to help patients and the clinical team optimize treatment.

Why did you decide (pun intended) to focus your work on decision-making?

Like most people, I found my area of work by chance. I am interested in complex problems and I’m impatient. I do not want to spend time looking at a lot of detail in an area that is already very well studied. When I had to choose a topic for my post-doctoral training, I did not know anything about the field. I went to the library and looked through the last 12 months of Science and Nature journals to see what was on the cutting edge of cognitive neuroscience. I came across decision-making.

I found it remarkable that we know almost nothing about how human brains make decisions – this field of study has only really existed for about 20 years. We do not know that much more about how memory works and it has been studied intensively for 100 years, so I do not feel too bad that we do not have decision-making figured out quite yet. Give us a little longer!

Watch the Neuro XXceptional feature on Lesley Fellows (below).

 

 

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