Tracking schizophrenia through syllables and sounds

For a psychiatrist, a patient’s words, sentences and tone of voice—plus their silences and even the breaths they take—provide crucial insight. Speech and language disturbances can be strong indications of disorders like schizophrenia, for instance. Now a team led by psychiatrist Sunny Tang, MD, is using artificial intelligence (AI) and machine learning to analyze patient speech, quantifying information about factors like pitch and vocal qualities on a millisecond-by-millisecond basis, while also examining word choice, grammar and the ideas being expressed. 

Their findings: This AI-driven approach of analyzing and quantifying speech, known as natural language processing (NLP), can accurately identify speech from patients with schizophrenia and may help with diagnosis. Even better, NLP may lead to a deeper understanding of the changes in brain circuitry at the core of the disorder, which could help doctors more quickly pinpoint solutions for patients.

“Right now, we have some very effective treatments for mental health disorders, but it’s a guessing game as to which treatment will work for which patient. Sometimes it takes months of trial and error before patients can find the right regimen for them,” Dr. Tang said. “My goal is to analyze the biomarkers that we find in speech, to guide doctors to the treatment that will work best for the patient in front of them.”  

Using belly fat to treat brain cancer

Brain cancer is a terribly daunting diagnosis — not only because the disease attacks the seat of thoughts and emotions, but because something called the blood-brain barrier makes it particularly hard to treat. The blood-brain barrier is like a specialized filter in the blood vessels that supply the brain: It lets essential molecules get through but blocks most other substances, including many of the medications used to treat cancer. 

A team at Lenox Hill Hospital may have a solution: They’ve been investigating whether a layer of fatty tissue from the lower abdomen, called the omentum, can provide an entry point for crucial treatments. Led by brain cancer expert John Boockvar, MD, vice chair of neurosurgery and director of the hospital’s Brain Tumor Center, the team removes a patient’s tumor, then harvests a piece of omentum and uses it to line the cavity left behind. They join the blood vessels of the belly fat to those in the neck in order to bypass the blood-brain barrier and allow the delivery of cancer drugs to the tumor site. 

Dr. Boockvar and his colleagues have performed the complex surgery on two patients so far and plan to provide the treatment to eight more.

“Finding a way to bypass the blood-brain barrier is critical if we’re going to improve the prognosis for patients suffering from many of the most lethal brain cancers,” Dr. Boockvar said. “We believe belly fat may provide an entry that allows us to deliver high doses of anticancer medication directly to the tumor site, where it can do the most good.” 

Clinical trials are the tool that science uses to come up with new ways to prevent and treat disease. So it’s essential for researchers to include all types of people — of every age, sex, income bracket and racial background — to ensure that the results are accurate and that the benefits reach everyone.

Unfortunately, studies have shown that science is still falling short of that goal. That’s why Northwell physicians and scientists turned to virtual trials this year, said Christina Brennan, MD, MBA, vice president of clinical research at Northwell Health’s Feinstein Institutes for Medical Research. “If we look at clinical trials as a whole, recruitment is always a challenge,” Dr. Brennan said. “Using a virtual trial or a hybrid approach makes it easier for people to participate, no matter what difficulties they face in terms of distance, transportation, work schedules or other commitments. It gives us a broader reach and increases our geographic footprint for recruitment.” 

Northwell’s first fully virtual trial, launched in January 2021, is looking at whether the common indigestion remedy famotidine (in Pepcid and other medications) can treat Covid-19. The medication (or, for some, a placebo) was overnighted to participants, who used an iPad to answer daily questions about their symptoms and monitored their vital signs with Bluetooth-enabled technology; study results are expected soon. 

In another remote trial, researchers are delivering “smart” pill bottles to individuals identifying as Black/African American, who are at elevated risk of a heart attack or other cardiovascular disease. The tech-enabled bottles will keep track of when the study participants take their statin medication — info that will trigger text messages to remind or encourage the volunteers to adhere to their medication regimen.

“Cardiovascular disease is a major driver of death, particularly among people in the Black community,” said Mark Butler, PhD, an assistant investigator in the Feinstein’s Institute of Health System Science and principal investigator on the trial. “Understanding how to promote adherence to life-saving medications is one of the best ways we have to reduce health disparities.” 

Beating paralysis with a brain-computer interface

Nearly 5.5 million people in the United States live with paralysis. Depending on their injury, they may be unable to walk, feed themselves or even hold the hand of a loved one. Biomedical engineer Chad Bouton, vice president of advanced engineering at Northwell Health and professor in the Institute of Bioelectronic Medicine at Northwell’s Feinstein Institutes, is developing ways to give them back the ability to move and feel. 

In previous work, his team used brain implants and computers — AKA a brain-computer interface —to allow tetraplegics (people with paralysis of all four limbs) to move their hands. Now, Bouton and his colleagues are going further. The researchers implant tiny electrodes on the surface of the brain, record the signals that are produced when the person thinks about moving, and then send those signals onward to nerves and muscles in order to produce the imagined movement; the scientists are working to complete the loop by picking up sensations from the fingertips and sending those nerve impulses back to the brain. The intent is to allow persons enrolled in the study to regain muscle control and the sense of touch while using the technology. 

“We call it a bidirectional neural bypass,” Bouton said. “It’s like a two-way highway, routing signals from the brain around an injury to the muscles, and then from the fingertips back into the brain, so someone can move and feel again. In surveys, tetraplegics have said that their highest priority is regaining function in their arms and hands, and our aim is to help them do that — to restore motion, sensation and, ultimately, independence. With this technology, we think they’ll be able not just to hold the hands of their loved ones but feel their touch in return.”