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Rick Swartz

Also known as: Richard H. Swartz, R.H. Swartz, Richard Swartz

University of Toronto, ICES, York University, North East GTA Regional Stroke Program

ORCID iD 0000-0001-6571-5531
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About

My early publications explored the combined impact of cerebrovascular disease and dementia, using structural brain imaging. These publications demonstrated some specificity to subcortical vascular disease that was previously considered non-specific, most centrally affecting the thalamus and cholinergic white matter pathways. We demonstrated that thalamic lesions are frequent, have a threshold volume for symptomatic expression, and have differential contributions to cognition with location. We showed that atrophy, small vessel disease and strategic infarcts contribute independently to cognitive and functional abilities, and white matter disease in cholinergic fibres are of key importance. These publications reinforced the need to simultaneously examine cerebrovascular pathology and neurodegenerative markers, a theme which current large-scale studies such as ADNI2 and the ONDRI study have are further developing. Using neuroimaging to more directly impact clinical care and decision making, I have explored MRI vessel wall imaging to better diagnose and prognosticate both rare and common stroke causes and to provide new targets for therapy. Through a Heart and Stroke Foundation (HSF)/CIHR/Canadian Stroke Network “Focus on Stroke Research Scholarship”, with collaborators at the Toronto Western Hospital, I published leading case series including the seminal series showing that wall imaging differentiates intracranial atherosclerosis from vasculitis and intracranial dissection.

As a clinical trialist with interest and expertise in large-scale, impactful clinical trials, I have been involved in field-changing studies, including the ESCAPE trial (demonstrating effectiveness of endovascular therapy for stroke), ESCAPE NA-1 trial (showing that neuroprotection may be possible in hyperacute stroke). I am the co-PI of the AcT trial (Alteplase compared to Tenecteplase) a CIHR-funded, pragmatic registry embedded RCT, and lead a cognitive outcome sub-study (AcT-Cog). I am the lead neurologist on the steering committee for the ROMA trial (an international cardiac surgery trial comparing outcomes with different surgical grafting techniques).

The long-term effects of stroke are not mediated through motor impairment alone. Thus, I explored the rationale for and barriers to identifying common comorbidities after stroke. I built a team of collaborators to address some of these barriers and, funded by HSF Canada (”post-stroke triage DOC: screening for Depression, Obstructive sleep apnea, and Cognitive impairment”) we designed a novel evidence based screening battery. We showed that screening can be performed in less than 6 minutes in almost all stroke prevention clinic patients and that the resulting data can help to rapidly categorize people into low- intermediate- and high-risk groups to facilitate both clinical care and research protocols. The DOC studies are not only important on their own; they also provide a mechanism to collect rich data on specific sub-populations, for example stroke in younger adults. We have screened over 10,000 patients across 8 stroke centers to determine the utility of the screen for predicting clinically important outcomes (e.g. mortality, recurrent stroke, institutionalization), demonstrating success in large-scale data acquisition. We are now examining the heart-brain connection and the indirect impact of vascular disease on cognition by applying DOC screening in cardiac and heart failure clinics.

Through several team grants, I am exploring the foundations of vascular cognitive impairment seeking methods to limit its impact and improve functional abilities with aging and after stroke. The Ontario Brain Institute Integrated Discovery Neurodegeneration Program ONDRI (Funded, PI: Strong; OBI; 2014-20189, $28.5 million) seeks to identify biomarkers (neuropsychological, imaging, genetic, ocular and gait) of neurodegeneration across multiple diseases and centres. I helped to co-wrote write the first phase grant and design the protocol, serve on the executive of this team grant and led the Vascular Cognitive Impairment team, and now PI the second phase (Funded, PI: Swartz, Masellis, Munoz; OBI; 2018-2023) in which we have explored detailed endophenotyping of aging and neurodegenerative diseases, developed tools and linkages to study aging and neurodegeneration in the community with remote wearable monitoring and understand the impact of aging and neurodegeneration on individuals and health systems. We will recruit 150 patients across 6 Ontario stroke centres. This project will adds to, builds on and complements my independent research projects by collecting detailed, multi-modal data on a sample of patients and comparing these data across diseases. Similarly, I also lead the VCI component of the BEAM study (Validation of ocular measure as potential biomarkers for early detection of brain amyloid and neurodegeneration (Funded, PI: SE Black, Brain Canada) and am collaborating on the CCNA VCI platform.

Employment

  • University of Toronto Associate Professor
    2019 - Present
  • ICES Adjunct Scientist
    2019 - Present
  • North East GTA Regional Stroke Program Medical Director
    2013 - Present
  • Sunnybrook Health Sciences Centre Scientist, Staff Neurologist
    2009 - Present

Education

  • University of Toronto Neurology Resident
    2004 - 2009
  • University of Toronto PhD
    1998 - 2002
  • University of Toronto MD
    1996 - 2004
  • York University BSc Combined Honours, Biology and Psychology
    1992 - 1996

Projects & Funding

Projects & funding information is unavailable.

Publications (233)