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Paul Borghesani MD, PhD

Assistant Professor
Adjunct Assistant Professor, Radiology
Phone: (206) 685-0491
Fax: (206) 543-9520

Site: UW Medical Center
Health Sciences Building
1959 NE Pacific Street, PES
Box 356560
Seattle, WA 98195
Link to CV

Child and Adolescent Psychiatry

Board Certification
American Board of Psychiatry and Neurology


Aging is associated with cognitive decline in multiple domains including memory, language and executive function. However, the progression of cognitive loss and the development of dementia, characterized by the overt inability to think or behave as we once did, is variable across the population with some individuals maintaining a their cognitive abilities until late in life. The goal of my research is to understand what constitutes healthy or optimal cognitive aging and how we can use neuroimaging to differentiate benign age-related cognitive changes from early dementia. In collaboration with Dr. Sherry Willis, who leads the Seattle Longitudinal Study (SLS), I use magnetic resonance imaging (MRI); including diffusion tensor imaging (DTI), arterial spin labeling (ASL) and blood-oxygen level dependent (BOLD) and structural imaging, to explore how gray and white matter pathology contributes to cognitive changes across the life span. We have recently found that cognitive improvement or decline during midlife (age 40-60) occurs in 10-15% of the population and predicts gray and white matter structure in old age (after age 65) but not during midlife when the cognitive changes are occurring. This suggests that midlife cognitive changes may reflect very early neural changes that are undetectable using standard structural imaging. Thus we are now using functional MRI to assess neural connectivity and activation of attentional networks to determine if functional changes precede or follow structural changes. These finding are only possible because of the longitudinal nature of the ongoing SLS tracks cognitive abilities in individuals across their entire lifespan. Ongoing/future research will explore; a) how neural connectivity assessed via functional and structural methods may change in midlife, b) whether changes in functional connectivity proceed or are the result of damage to white matter integrity, c) if changes in specific cognitive domains are specific for certain neural networks or more general brain aging, and d) how genetic or health/behavioral factors contribute to neural function and optimal brain health.

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