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Dr. Rick Swartz

MD has passion, vision to improve lives after stroke

His interests range from small vessel disease to stroke in young adults to smartphone apps to the development of new screening tools.

To say that Dr. Rick Swartz, a PhD neuroscientist and busy stroke neurologist at Sunnybrook Health Sciences Centre, is “a researcher with many interests” would be an understatement.

Consider, for example, that 10 years before anyone else was talking about the links between small vessel disease and stroke, Dr. Swartz completed PhD studies on the topic. His research was so “out there” the biggest scientific journal in the field rejected it. Recently, as the subject became better understood, Dr. Swartz resubmitted the paper to the same journal and it was accepted without revisions.

Sunnybrook research leader Dr. Sandra Black, his PhD supervisor at the time, laughs when she tells that story because it proves to her that “when you are too far ahead of the curve, people don’t understand you.”

But describing Dr. Swartz as “ahead of the curve” only begins to tell the tale. He is a researcher and clinician who brims with ideas, who is passionate about understanding more about stroke disease, and who connects with people. During a recent visit to his office, a large container of homemade cookies and a thank-you note from a patient sat on his desk amid piles of papers and journal articles. “Help yourself,” he says to a visitor, who senses that gratitude abounds among his patients.

A researcher in the Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (CPSR), Dr. Swartz is co-investigator with Dr. Laura Middleton on a project to develop a smartphone app that measures physical activity in people with stroke and provides feedback.

Once the app is up-and-running, Dr. Swartz hopes to turn it into a behavioural intervention tool by linking physical activity goals to fundraising for stroke. “People drive their car to the store but will walk 60 kilometres for a cause,” Dr. Swartz says. “Maybe we could set up the app so that every day someone hits their goal, there is a small donation to charity. Donors could not only help people recover from stroke, but also support research. It’s sort of a win-win for everybody.”

With salary support from the CPSR, Swartz also continues to do research into small vessel disease, vascular dementia, and stroke in the young (people ages 18 to 45.)

When Pittsburgh Penguins defenceman Kris Letang recently revealed he was recovering from stroke, media across Canada called Dr. Swartz to gain greater understanding. “I see a lot of the unusual causes of stroke,” Dr. Swartz says, which is why he is driven to do research in the area. “The most common cause of stroke in young adults is ‘we don’t know.’ ”

He is particularly interested in the things that impair people’s ability to get back to their lives after stroke and that put them at risk for future strokes.

Why, for example, do some people with small strokes never return to their regular lives, while others with huge strokes make unbelievable recoveries?

“I have a patient, a young woman who is 30 years old, who had a huge stroke and her recent complaint was that her foot dragged a bit at the end of a 10K run,” he says. “How and why is it? She has massive damage to half her brain and she is functioning and getting back to work. And then you see other people with small strokes who are profoundly affected — another 30-year-old who can’t be left alone with her children.” These people will live with the consequences for so much longer than the typical person, and Dr. Swartz wants to ensure they have the best quality of life.

“I am interested in the effect of stroke on my patients’ function. Not just the clot.”
Understanding the big picture of stroke has led Dr. Swartz to develop a new tool, with support from the Heart and Stroke Foundation, to screen stroke patients in prevention clinics for “co-morbidities” – compounding conditions that affect recovery and recurrence of stroke.

“Stroke prevention clinics are a great strength and a great weakness. They are focused on things like the causes of stroke, vision testing, driving . . . but not enough of them are screening for depression and sleep apnea and cognition.”

So Dr. Swartz developed the DOC (Depression, Obstructive sleep apnea, Cognitive impairment) screen – a quick five-minute test that identifies other conditions along with stroke and looks at how they overlap and interact.

With HSF funding, the DOC screen has been tested for two years on 900 patients a year and compared to the gold-standard screening tools. The result? It has been found to be highly effective and able to identify more stroke risks. The tool is now being tested in six centres with up to 6,000 patients, thanks to funding from the Ontario Brain Institute, and will link screening to clinical outcomes in stroke patients.

Dr. Swartz sees a big future for the DOC to improve understanding of stroke. He eventually hopes to develop a user-friendly DOC app for physicians to screen patients, especially young adults, and interpret the results.

Dr. Swartz is also working on a project to develop a tool for computers to automatically scan imaging results in the more than 1,000 stroke patients who come through the Sunnybrook clinic every year to identify small vessel disease, white matter changes and shrinkage in the brains of people at high risk. “Can we screen imaging like we screen for DOC conditions, and can these simple automated imaging measures identify people who are at high risk of recurrent stroke, heart attack or death? There may be improved treatment targets we are missing.”

An observer might wonder how one young scientist-physician can be involved in so many projects and brimming with so many new ideas, but Dr. Swartz says “in my head and my passion and my vision, they all go together. It’s all about keeping stroke patients healthy and improving outcomes.”