For over 20 years, Dr. Pauline M. Maki has led a program of NIH-funded research focused on the role of sex steroid hormones on cognition, mood, brain function (neuroimaging) and stress responsivity in women. Women’s cognitive abilities, mood, and response to stress can be affected by changes in sex hormones, like estrogen, including changes that occur during the menopausal transition, during pregnancy, and across the menstrual cycle. In particular, the goal of her work is to improve the lives of women by identifying factors that alter their risk of cognitive decline and affective disorders. Dr. Maki received her Ph.D. in experimental psychology from the University of Minnesota in 1994. She received post-graduate training at the Johns Hopkins University School of Medicine in the dementias of aging and at the National Institute on Aging in neuroimaging. In 1999, she joined the Intramural Research Program of the National Institute on Aging. In 2002, she joined the faculty at the University of Illinois at Chicago.
Dr. Maki is best known for her contributions to the field of menopause and cognition. A central focus of her research has been the effects of hormone therapy (HT) and alternative treatments for menopausal symptoms on cognition, mood, and brain function in women. Professor Maki’s primary contribution to clinical practice is her research on the risks and benefits of HT on cognition and brain function. Epidemiological studies demonstrate that women who used HT had a 39% reduced risk of Alzheimer’s disease compared to women who had not used HT. In contrast, the Women’s Health Initiative (WHI) demonstrated a doubling of dementia risk in women aged 65 years and older who were randomized to combined estrogen plus progestin treatment. It was unclear if the WHI findings generalized to younger women and to other HT regimens. Clinically this is important because: a) two-thirds of Alzheimer’s patients are women, b) 80% of women experience vasomotor symptoms (VMS; hot flashes and night sweats), c) most women who initiate HT do so at around age 50 (20+ years younger than women in the WHI), and d) non-hormonal therapies have limited efficacy in treating VMS.
Dr. Maki’s clinical studies demonstrated that the effects of HT on cognition and brain function depend on both the timing of initiation and the use of progestins. With respect to timing, later use but not early use is harmful. With respect to progestins, the addition of medroxyprogesterone acetate, which used to be the most widely used progestin in the US, is harmful. As a member of the expert panels contributing to national and international practice guidelines, she has incorporated these findings into the position statements of the North American Menopause Society (NAMS) and the International Menopause Society (IMS), as well as the Global Consensus Statement issued by multiple women’s health organizations. Dr. Maki’s leadership in this area is recognized by her serving as President of NAMS in 2014 and 2015. She is a frequent national and international speaker on this topic. In 2016 alone she was keynote speaker at the Royal College of Obstetrics and Gynecology in London, the Nordic Federation on Obstetrics and Gynecology in Helsinki, the South African Menopause Society in Cape Town, and the International Menopause Society in Prague, Czech Republic.
Currently, Dr. Maki is funded by NIH to examine the role of vasomotor symptoms on cognition and brain function, as her pilot work showed that physiological hot flashes (measured with ambulatory skin conductance monitors) are associated with memory deficits, ischemic brain lesions, and functional alterations in the brain at rest (RF1 AG053504-01). She is also funded by the NIH to examine the role of an anesthesia procedure, Stellate Ganglion Blockade (SGB), as an effective non-hormonal treatment for vasomotor symptoms and related memory problems (R01 AG049924).
Dr. Maki’s research on women’s cognitive health and mood extends to the study of women with HIV and she is credited with the seminal study of cognitive function in women with HIV. She is the immediate past-Head of the Neurocognitive Working Group (NCWG) of the Women’s Interagency HIV Study (WIHS), the largest study of the natural and treated history of HIV in women in the U.S. In that role, she directed the implementation of the largest longitudinal study of cognitive function in HIV-infected women and HIV-uninfected controls (n=~1521). Her NIH-funded work in the Women’s Interagency HIV Study (WIHS) revealed a significant and prominent deficit in verbal memory in HIV-infected women compared to at-risk HIV-uninfected women, a pattern that appears to differ from that of HIV-infected men. Other NIH-funded work demonstrated that substance use and mental health factors contribute to verbal memory declines in HIV-infected women, effects that are mediated by the prefrontal cortex. This work points to a unique pattern of cognitive dysfunction in HIV-infected women, one that is largely influenced by mental health factors. In addition to her work within WIHS, Dr. Maki also serves as the Leader of the Special Emphasis Area on HIV and Aging Group for the Chicago Developmental Center for AIDS Research.
PREGNANCY & POSTPARUM
Dr. Maki has successfully built a collaboration with the Department of Obstetrics and Gynecology to address disparities in the screening and treatment of mental health disorders of pregnant and postpartum women. She has pursued innovative approaches to fill in gaps in depression screening by creating a research infrastructure that involves undergraduate research assistants who screen for perinatal depression during routine clinic visits. With input from monthly meetings with clinical staff from Psychiatry and OB-GYN, she is addressing barriers to treatment through efforts such as delivery of cognitive behavior therapy (CBT) via the web.
Throughout her career, Dr. Maki has made mentorship a priority at the undergraduate, graduate, and assistant professor levels. Currently in her lab, she has 11 undergraduate research volunteers. As a UIC Honors College Fellow, she also mentors honors college undergraduates. In 2015 she was honored with the first Capstone Mentor of the Year award from the Honors College. At UIC she has held many leadership positions in mentorship, including serving as the Program Director for the NIH-funded K12 grant Building Interdisciplinary Research Careers in Women’s Health (BIRCWH), serving as the College of Medicine (COM) Representative to Provost’s Mentorship Training Workshop, and serving on the COM Mentorship Planning Task Force. Additionally, in the last two years she served as primary mentor for four assistant professors on funded HIV studies and four individual K awardees in women’s health. Annually, she teaches Introduction to Behavioral Neuroscience to undergraduate students. She serves on the Executive Committee for the Graduate Program in Neuroscience and mentors graduate students in that program, as well as in the Behavioral Neuroscience Division of the Department of Psychology (2 current; 5 past).