In Context

782 www.thelancet.com/neurology Vol 10 September 2011

Kristine Yaff e loves to delve into a subject area, and to learn everything she can. She has been doing this since childhood and nothing has changed now that she is the Roy and Marie Scola Endowed Chair in Psychiatry, associate chair of clinical and translational research, and professor of psychiatry, neurology, and epidemiology at the Uni versity of California, San Francisco (UCSF; CA, USA). She is also the director of the Memory Disorders Clinic at the San Francisco VA Medical Center (CA, USA).

“The thing that turned me on was taking a topic and really researching it. I have a distinct memory of doing that at a pretty young age: 10, 11?”, says Yaff e. “I loved biology. I remember pulling out my father’s old medical books and doing these crazy reports…I was very passionate about them.”

Yaff e’s father was an academic physician, which no doubt sparked Yaff e’s interest in the sciences and medicine. But for a long time, Yaff e was unconvinced about becoming a doctor. She double-majored in biology and psychology at Yale Univeristy (New Haven, CT, USA) and seriously contemplated a career as a science journalist. This view was in part due to her love for writing reports and her passion for literature—“I read voraciously. That’s how I got through high school. I was always reading under the desk”—and in part because she saw medicine as too structured. “I was a little wary of going to medical school because I thought it might be less creative…I was afraid medicine would box me in.”

After fi nishing undergraduate studies, Yaff e set off to Europe and spent a year working in France as a medical writer for a group of doctors. Rather than sparking a writing career, however, the experience persuaded her to enrol in medical school. Working closely with the doctors and learning more about their day-to-day lives helped with the decision, she says.

Yaff e studied medicine at the University of Pennsylvania, Philadelphia (PA, USA)—the city where she had grown up—and then moved to UCSF for a neurology residency. UCSF off ered one of the best neurology residencies in the country, she says, but adds, “It was still very old-school neurology”. After 3 years, says Yaff e, “I felt that I still hadn’t learned as much about behaviour or psychopharmacology as I would have liked, so I did a second residency in psychiatry”. This decision perplexed Yaff e’s professors, who were a little annoyed that she was ditching neurology. According to Yaff e, one professor even asked “are you done with your foolishness yet?”

Yaff e had no intention of ditching neurology, however. By now she had decided she wanted to focus on Alzheimer’s disease and preclinical cognitive decline, but she also

wanted a more rounded training in behavioural sciences. “It was really hard for me because I was somebody who was very studious and really wanted to perform and do well and yet my interests were so at odds with the mainstream.” On the positive side, she adds, “it was also a good thing, because I just forged my own path”.

With a double-major from college, and two residencies under her belt, Yaff e continued the dual-study theme by taking on two fellowships. One was in geriatric psychiatry and the other was in epidemiology and clinical research methods. “I realised that in order to be able to do rigorous clinical research I needed to get the tools, so that’s why I did the additional fellowship”, she explains.

After this extensive training, Yaff e fi nally joined the faculty at UCSF in 1997. Bruce Miller, director of the Memory and Aging Center at UCSF, joined shortly after. From day one, he was impressed by her depth of knowledge in neurology, psychiatry, and epidemiology: “There were very few people either as well trained or as broad and deep in their understanding of de-generative diseases.”

Yaff e’s work focuses on modifi able risk factors for Alzheimer’s disease, other dementias, and mild forms of cognitive impairment. She studies the ways in which physical activity, intellectual activity, chronic diseases of the body, and other factors interact with cognitive ageing. “Many of the major epidemiological discoveries in Alzheimer’s disease, Kristine has played a role in”, says Miller. “She’s always been one of the key people who is the fi rst to come up with new ideas on risk factors for dementia”, echoes Deborah Barnes, assistant professor in the department of psychiatry, UCSF.

Two areas that Yaff e is now investigating are the ways in which sleep disorders aff ect cognitive decline, and how some elderly people escape decline completely. “It is a common belief that everyone has some degree of cognitive decline as they age”, says Yaff e, “but, that is not necessarily the case. There are people who actually don’t…I do think there may be something unique about them that we can learn.”

On a personal level, Yaff e is “charming and very fun”, says Barnes “but she’s also very private”, tending to keep her personal and professional lives separate. Indeed, in an interview with Yaff e, she does not mention her artistic talents, or that she has had a few exhibitions. “She is a very good artist”, says Miller, who himself says he only learned about Yaff e’s artwork from another artist. “She doesn’t brag about these things.”

Ruth Williams

Profi leKristine Yaff e: delving into the varied depths of dementia

See Review page 819