Exploring Neurodegenerative Diseases and Advancements

In an interview with Life Sciences Review APAC, Dr. Narayanaswamy Venketasubramanian Ramani, Specialist in Neurology and Consultant, Raffles Neuroscience Centre, highlights the latest trends in the neurology space and how innovation is transforming the way healthcare professionals explore innovative options to boost diagnosis and treatment methodologies. 

Could you briefly outline the roles and responsibilities you currently carry out at Raffles Hospital as a Neurologist? How was the journey for you before you took up the role?

I completed my neurology training in 1992 and specialized in stroke. Throughout my career, I had a strong research interest and focused much of my work on stroke and the epidemiology of various neurological conditions. However, over time, I observed a growing prevalence of degenerative diseases like Parkinson's disease and dementia, which demanded increased attention due to the limited reversibility of these conditions with current therapies. Consequently, I began collaborating with colleagues at the National University of Singapore (NUS), delving deeper into dementia research, and decided to join Raffles Neuroscience Center over a decade ago to engage in extensive clinical work. Despite this transition, I have continued undergraduate and postgraduate teaching in NUS and maintained active involvement in dementia research at NUS. Additionally, I conduct independent research in the field of stroke. As a result, I am still well engaged with NUS on dementia research, furthering my contributions to this area of study.

At Raffles Hospital, my primary responsibility revolves around providing clinical services to patients. I primarily see patients who are acutely ill, often receiving them from the emergency department and admitting them for further care. I also engage in regular outpatient clinic visits for patient follow-ups and reviews. Apart from my clinical duties, I am involved in teaching activities both within Raffles and outside. While my research activities at Raffles are relatively smaller in scale compared to my clinical work, I am fortunate to have permission and support from Raffles to continue conducting research and collaborate with NUS and its collaborators. I am grateful for the opportunity to balance my clinical responsibilities with teaching and research endeavors.

What are some of the challenges you face in the neurology or neurodegenerative space?

One of the significant challenges in the neurology and neurodegenerative space is the vast amount of ignorance that still exists. There is a multitude of aspects that we are not aware of and this knowledge gap poses a challenge as we strive to understand the complexities of these conditions and seek ways to address them through research and clinical practice. As researchers, we aim to shed light on the unknowns and continuously expand our understanding.

Another challenge lies in attracting and retaining researchers in this field. Neurology and neurodegenerative research require individuals who are genuinely interested in this area, despite it being less glamorous or exciting compared to other medical disciplines. It involves persistent hard work, incremental breakthroughs, and long-term commitment. Therefore, it is crucial to have supportive mentors, intrinsic motivation, and an environment that fosters and values research contributions. 

Adequate compensation for researchers is also essential to sustain their dedication to the field. Finding and recruiting senior researchers to join these efforts can also be challenging.

Securing funding is another obstacle in neurology and neurodegenerative research. Obtaining financial support for research projects can be difficult due to the limited availability of funds and increasing competition for grants. While the government is generally supportive of such research, the funding landscape has become more stringent over the years. Researchers are grateful for the funding they receive, however the pressure to demonstrate a return on investment has become more prevalent, which can shift the focus away from pure scientific inquiry.

Additionally, time constraints affect everyone in the field. Researchers face the challenge of managing their time effectively to balance clinical work, teaching responsibilities, and research commitments. This juggling act requires careful planning and prioritization.

What tools and technologies are you looking forward to seeing in the neurology landscape?

In terms of tools and technologies, there are several areas I am looking forward to for advancements. Firstly, in the field of imaging, while our current techniques for structural imaging, such as MRI, are already good, we hope for even better imaging capabilities in the future. It would be beneficial to have imaging techniques that provide a more detailed look at tissue structure. Additionally, imaging techniques that can visualize pathways, connections, and cellular functioning in living human beings are of great interest. PET imaging has made progress in revealing cellular metabolism, but further advancements with new ligands and a better understanding of cell biology could enhance our understanding of cellular function.

Working with living human subjects remains crucial for studying the impact of changes on various bodily systems. Exploring new technologies to uncover additional proteins or chemicals that contribute to diseases like Alzheimer's Disease is an area of focus. While we already know about the deposition of amyloid and tau, there may be other factors involved in disease progression or severity. Discovering these new proteins or chemicals could potentially provide us with a fresh understanding and lead to improved treatments.

In the laboratory setting, finer technologies are desired for detecting even the smallest amounts of proteins and chemicals in the body. Additionally, better animal models that closely mimic human physiology would greatly aid in studying the mechanisms underlying neurodegenerative diseases. These advancements in technology hold the promise of providing us with a deeper understanding of these conditions and ultimately lead to more effective interventions and treatments.

Before we conclude the discussion is there any specific piece of advice that you would like to share with your fellow peers?

I would like to emphasize the importance of collaboration and teamwork. No one can accomplish everything alone, and we should work together, both within Singapore and across institutions regionally and globally. Collaboration allows us to leverage diverse perspectives, share knowledge, and address the unique challenges and patterns of illness in our respective regions. I am grateful for the support I have received and encourage my fellow peers to continue guiding and mentoring us, as they possess invaluable insights gained through years of experience. To the junior researchers, I want to emphasize that the journey may be long and filled with ups and downs, but with persistence and support, you will make progress. Remember that the work we do is part of a larger purpose, and while the financial rewards may not be significant, the satisfaction of contributing meaningfully to the world is immeasurable.