Joel Salinas, MD, MBA

Dr. Joel Salinas is a cognitive-behavioral neurologist with expertise in epidemiology and health outcomes research. As director of the UNICORN Lab, his mission is to understand how our social environments and our brain biology are linked together and harness what we learn to design and implement strategies for improving brain health at the population level using interventions that are universal, precise, and human-centered.

Healthy brain functioning is vital for our society to flourish. Yet dementia and cerebrovascular disease remain extremely common and devastating neurologic diseases; drug trials to treat Alzheimer’s disease and other causes of dementia remain largely unsuccessful. Thus, these age-related neurologic diseases not only represent a persistent slow-growing threat to our society, but also a looming threat to each of us and our loved ones.

Many established risk factors for these diseases are based in biology and physiology, such as genetics and high blood pressure, though an emerging body of evidence suggests that the risk and course of these diseases may be heavily influenced much further upstream by a category of potentially modifiable risk factors known as social determinants. One social determinant that is of specific interest is social relationships. Improved physical and mental health are closely associated with stronger social relationships, which encompass distinct functional (social support) and structural elements (social networks). The evidence implicating social isolation and loneliness with higher risk of stroke, cognitive dysfunction, and accumulation of Alzheimer’s disease pathology suggests that a complementary socially-based approach to potential therapeutic targets is necessary.

Studying social determinants for their impact on brain health could help us learn how to leverage them for prevention and therapy. Underlying molecular responses to genetic and environmental exposures begin early in disease development, so the parallel study of related preclinical molecular, physiological, neuropsychological, and imaging markers of vulnerability for cognitive decline allows for a unique opportunity to identify neurobiological pathways for the social determinants of brain health. Therefore, he uses the intersection of biology and sociology to understand the mechanisms through which social environments alter brain biology and use these insights to improve brain health for the population. His research specifically applies socio-behavioral science, health outcomes research methods, and mathematical network theory in longitudinal epidemiologic cohorts to identify the influence of a person’s social environment as an independent predictor of brain health outcomes, particularly cognitive resilience and markers of vulnerability for cognitive decline. These findings then inform social interventions that are designed to balance between being universal (able to be scaled at the population level; equally representative and accessible to underrepresented minority groups), precise (despite being universal, the same intervention is designed to be complex and nuanced enough on the “back end” that it can dynamically address specific barriers, motivations, needs, and other characteristics at the level of the individual), and human-centered (commitment to authentic empathy, compassion, and kindness to involve the human perspective in all steps of the process with a focus on improving brain health outcomes that truly matter to the person). His research approach is uniquely positioned to contribute to the next generation of insights, tools, and strategies that ultimately will:  (1) provide practical and empowering guidance to patients, clinicians, and caregivers; (2) clarify the temporal relationship between dynamic social determinants in relation to risk and biological progression of cognitive decline; (3) enhance intervention studies in Alzheimer’s disease and related conditions; and, (4) extend beyond neurology to increase our wider mechanistic understanding of the social determinants of health and aging.

Improving our understanding of social determinants of brain health will provide the backbone for a novel, paradigm-shifting clinical approach to treat age-related neurologic disease and radically improve population health. This work, at a minimum, will generate useful findings to contextualize existing work, inform future health interventions, and support emerging areas of clinical research in neurology. In the long term, Dr. Salinas and the UNICORN Lab are committed to advancing these methods and concepts to one day create a virtuous cycle between the physical, mental, and social aspects of health that are necessary for all of us to thrive.