Ruddell Laconsello plopped himself in a folding chair under a tent a few steps from the long white semi-trailer parked outside a Zuni Pueblo health clinic. He was clutching a color picture of his brain.
“It was an experience,” he said, seeming slightly dazed. “The sounds are awfully loud.” The 64-year-old silversmith had just emerged from having his brain scanned inside a magnetic resonance imaging (MRI) machine housed inside the trailer.
Laconsello was participating in a first-of-its-kind study conducted by the Alzheimer’s Disease Research Center (ADRC) at The University of New Mexico. By administering cognitive screening and using the 1.5 Tesla mobile MRI scanner, UNM scientists hope to fill a gap in national Alzheimer’s disease databases relating to American Indians.
Laconsello was one of more than a dozen Zunis who volunteered to be scanned during a three-day visit in September by a team of researchers led by ADRC principal investigator Gary Rosenberg, MD, director of the UNM Center for Memory & Aging, and co-investigator Vallabh O. “Raj” Shah, PhD, Distinguished and Regents’ Professor in the Department of Biochemistry & Molecular Genetics.
MRI scanners emit loud clanging sounds while they are operating. Laconsello said he distracted himself by watching a video screen depicting fish swimming around in a tank. He decided to participate in the Alzheimer’s study in part because his late wife suffered from dementia. “She wasn’t herself anymore,” he said.
Zuni, 36 miles southwest of Gallup, is the most populous of New Mexico’s pueblos, with about 6,200 residents. Like many other American Indian communities, its residents experience unusually high levels of diabetes and kidney disease.
In the late 1990s Shah, who grew up in the northwest Indian state of Gujarat, joined other UNM faculty members in responding to a request from Zuni’s then-governor to investigate the pueblo’s kidney disease epidemic. A quarter century later, Shah is on his third Honda CRV after years of making the 320-mile round trip from Albuquerque on an almost weekly basis.
His original research into the genetic underpinnings of diabetes has evolved into related projects, like a $3.2 million federally funded initiative to help protect seniors from falling in their homes. The program is hiring community health representatives to deliver in-home physical therapy and inspect living spaces for safety features.
“We are looking to see whether they have mats in the bathroom and grab bars near the toilet,” Shah said. The grant will pay for sensor lights that come on automatically as residents move from one room to the next.
Shah has also investigated the barriers to receiving optimal care for kidney disease at Zuni and discovered that many residents had concerns about their treatment at the local Indian Health Service clinic.
He created a randomized trial in which 100 people received home visits from community health representatives for kidney care, while another 100 were seen at the clinic as usual. After a year, the home group saw marked improvement in their blood sugar and body mass index – and their quality of life improved. “Go figure,” Shah said. “Without medicine we did that.”
In 2020, during the COVID pandemic, he obtained a $379,000 supplement to a National Institutes of Health-funded study of chronic kidney disease and brought 25 Zunis to Albuquerque for cognitive and MRI testing at the Mind Research Network.
More than 30 percent of diabetics see early cognitive decline, which is going to lead into dementia. Those with diabetes also have typical early-stage brain lesions
“More than 30 percent of diabetics see early cognitive decline, which is going to lead into dementia,” Shah explained. “Those with diabetes also have typical early-stage brain lesions.”
The same year, UNM received a three-year exploratory grant from the National Institutes of Health to create an ARDC, part of a national network of 34 institutions, and the only one in the Intermountain West.
According to Rosenberg, New Mexico’s diverse population was a selling point with NIH, as was access to the mobile MRI scanner operated by the Mind Research Network.
UNM’s research contribution in the grant will include conducting memory assessments and MRI studies on 120 American Indians, who are badly under-represented in national ADRC research, he said.
“There are no American Indians in that group,” he said. “The mandate at NIH is diversity, and this is perfect.”
Shah’s work at Zuni has been supported by a succession of tribal governors and council members. “The Tribal Council and I support Dr. Shah and his colleagues in their commitment and compassion for the well-being of our people,” said Zuni Gov. Val Panteah.
Head councilwoman Virginia Chavez serves as liaison for health and has recorded public service announcements for the local radio station urging listeners to volunteers for his studies.
She knows first-hand the challenges of caring for a loved one living with a dementia diagnosis. “My mother had Alzheimer’s,” Chavez said. “She passed away 10 years ago.”
As another study participant emerged from the trailer, she added, “I’m glad our people are doing this. It helps to learn more.”
The UNM-run health clinic at Zuni came about when Shah won a $100,000 federal grant to renovate a tribally owned storage building. Today it is leased from the tribe and includes office space, lab space for biometric testing and an exercise facility. Several Zunis are employed by the project as community health representatives.
For the initial round of MRI screening on the UNM campus research assistant Michelle Quam distributed flyers and recruited the 25 participants, driving each of them to Albuquerque for overnight stays during the COVID pandemic. She often translates for older people who might not be fluent English speakers.
“Most of the participants I already knew,” she said. “They do it to learn more about their brain and their health.”
The COVID pandemic interrupted plans to bring the mobile MRI to Zuni, Rosenberg said. To reach the total of 120 research subjects, he plans to recruit additional study participants at Acoma Pueblo and First Nations Community HealthSource in Albuquerque.
He is also making plans to apply for long-term funding for the ADRC, but the pandemic upset the usual funding cycle. “The NIH has not told us yet when we need to renew it,” he said.
Meanwhile, after 33 years at UNM, Shah is planning to dial back his work commitment to quarter-time starting in January 2023, but he is satisfied with all that he has accomplished. “I came 10,000 miles from India to do this,” he said. “That’s my destiny. I’m happy that I delivered what I did.”