James Noble

5 Questions With Dr. James Noble

A multidisciplinary approach to neurological care driven by diverse interests

James Noble

Dr. James Noble isn’t one for being boxed in. The neurologist and neuroepidemiologist at NewYork-Presbyterian/Columbia is an expert in dementia, but a sampling of his work reflects his broad clinical and research interests: He’s investigating the link between periodontal disease and Alzheimer’s disease. He’s developed a prototype for a device that helps diagnose concussions in real time. He’s researching how hip-hop can be used in health education and cofounded a nonprofit, Arts & Minds, to support the power of visual arts in improving wellness for dementia patients and caretakers.

These seemingly disparate projects all tie together for Dr. Noble. “First, I’m passionate about each of them. They tend to reflect a problem that I’m trying to solve or a question that I’m trying to answer,” he says. “And second, if I can prove in a methodical and scientifically rigorous way that all these things can make a difference for people, I believe they are worth doing.”

Dr. Noble spoke with NYP Advances to discuss his diverse body of work and the motivation behind his passion projects.

When did you know you wanted to specialize in neurology, with a focus on dementia?

A seminal moment for me in med school was when a professor brought an individual with Parkinson’s disease into class while doing a lecture about the basal ganglia pathways affected by Parkinson’s. This gentleman walked very slowly and required two people to help him. But when the professor turned on the man’s deep brain stimulators, he began walking around the aisles normally. It made me excited about what was possible in neurological care.

My interest in dementia solidified when I was a third-year resident. I met with the neurology chair at Columbia at the time, Dr. Timothy Pedley, who asked me what I wanted to do for my fellowship. Through that discussion, I realized I was interested in the brain and behavioral neurology. During my residency, I also ended up working with almost every faculty member in our Division of Aging and Dementia, and I liked the very human approach they took with patients. It was “old school” in the sense that they recorded classic descriptions of what they saw and got to know each patient and how the disease affected them as individuals.

You received a grant to study periodontitis and Alzheimer’s disease. What led you to make this connection?

I come from a family of dentists, including my father, who is a retired periodontist. I remember hearing him talk about the ravages of periodontal disease on his aging patients. When I started my epidemiology fellowship, it was known that periodontal disease was related to stroke, and stroke was related to dementia. I thought it would be interesting to see if there was a more direct connection between periodontitis and dementia.

For my master’s thesis, I identified an association between Porphyromonas gingivalis antibodies and cognitive impairment within the Third National Health and Nutrition Examination Survey (NHANES-III) cohort. Then, along with Dr. Panos Papapanou, director of the Division of Periodontics at NewYork-Presbyterian/Columbia with whom I’ve been doing this type of research, we created a cohort within the Washington Heights-Inwood Columbia Aging Project (WHICAP), an existing epidemiologic study where they were already gathering data like brain imaging, plasma, and neuropsych testing. We added oral health examinations.

I see my research on periodontal disease and concussions as part of an effort to uncover life course risk factors for dementia.

We found periodontal disease is very common in this community, as high as 75% as people age. It’s been 10 years since we gathered that initial data. This grant will help us reassess these individuals to understand how their periodontitis has progressed and whether their periodontal disease markers can help predict cognitive impairment. Periodontal disease can begin in your 20s and 30s. If it's associated with cognitive aging, maybe we can identify a potential addressable target — say, tooth cleaning at an earlier age — that can help someone avoid the disease in the first place.

Other epidemiological work you’ve done led to the development of an in-helmet device to monitor for concussions. How did this come about?

During my residency, I met a Columbia football player who was having frequent headaches. I believed it was from getting hit too many times, but I was powerless to confirm that because I didn’t have the tools to make a diagnosis. Our conversations always stayed with me. In 2010, I found out there was a dataset of neuropsych testing on Columbia football players as well as other athletes, and I eventually published a retrospective analysis of the data. That led to working with the Department of Orthopedics at Columbia to develop and publish an algorithm to help determine when to retire an athlete who had suffered one too many concussions — which, in turn, made me wonder if there was a better way to diagnose concussions beyond volunteered information or observation.

When deciding on what to get involved with, I always try to think about what the impact is going to be today or in the future.

That’s how the idea came about to use an electroencephalogram inside a helmet to track brain injuries. The idea is that if you can identify a biomarker of concussion in real time, you can diagnose it closer to the time that it happens or maybe even after more subtle signs of injury. This could help avoid the long-lasting and cumulative injury that occurs from suffering multiple hits. As with my research on periodontal disease, I also see this as part of an effort to uncover life course risk factors for dementia, and ones that are potentially addressable. The hope is that this tool can help detect subtle but detectable changes sooner than we’re able to right now using conventional clinical assessments.

You’re extremely passionate about your work, but what are some of your passions outside of the office?

My greatest passion outside of work is music. Over the years I’ve played in bands and was the general manager of my college radio station. So when Dr. Olajide Williams, vice chair of the Department of Neurology at Columbia, came to me and said he was going to teach kids about stroke using hip-hop, I embraced the idea because I know the power of music. Through Hip Hop Public Health, we’ve delivered multigenerational health education programs and just completed a seven-year study where we teach elementary school kids about dementia using hip-hop. We haven’t published the results yet, but our hope is that we’re successful in helping kids recognize the symptoms of dementia and enabling them to have conversations about it with their families earlier.

I’ve also been a beekeeper for almost 15 years. After moving to a new home, I noticed I had no bees in my garden. So, I ordered the equipment to start keeping honeybees. I’ve gotten my kids into it, and we can gather anywhere from three to 17 gallons of honey from our hives in a given year. Bees are very mathematical, which I resonate with, and they are very neurological in how they remember where the best pollen is and communicate that to other bees.

The neurological nature of bees is part of the appeal of beekeeping for Dr. Noble, pictured here with his backyard hives.

Two decades into your career, what motivates you to continue expanding the boundaries of your work and research?

There’s always going to be somebody who needs your help, and not everybody can be your patient. This acknowledgment has often served as a motivation for me, including when I wrote a handbook specifically for dementia caregivers. When deciding on what to get involved with, I always try to think about what the impact is going to be today or in the future. I’m as passionate about new treatment for a patient in front of me as I am about making it so they don’t have to see me in the first place. As long as I can continue to keep an element of patient care at the center of it all and, in the process, make a meaningful difference for one person or many, I’ll continue to pursue these projects.

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James Noble: A multidisciplinary approach to neurological care driven by diverse interests

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