AI-Driven Brain Imaging: A Game Changer in Preventing Cognitive Decline with Owen Phillips, PhD

How do we prevent cognitive decline before it even begins? The answer might not be what you think. I’m thrilled to share my conversation with Dr. Owen Phillips, a Stanford-trained neuroscientist and founder of BrainKey, who is helping to revolutionize brain care. His team is using AI technology to uncover subtle brain changes long before they result in disease—transforming the way we approach brain health.

And here’s the kicker — Dr. Phillips reveals why protecting your brain actually starts with protecting your vasculature. No surprise when you consider it’s essential for feeding this power-hungry organ. This shift in thinking could change how we all approach cognitive health moving forward. We touch on heavy metal toxicity, long Covid, sports injuries and more, so if you’re ready to rethink brain health and prevention, this conversation will leave you with a fresh perspective. Be sure to grab a copy of the Brain Anatomy PDF and follow along for even more insights. ~DrKF

AI-Driven Brain Imaging: A Game Changer in Preventing Cognitive Decline with Owen Phillips, PhD

In this episode of New Frontiers in Functional Medicine, Dr. Fitzgerald is joined by Dr. Owen Phillips, a Stanford-trained neuroscientist, to discuss how AI-driven brain imaging is revolutionizing brain health. Dr. Phillips reveals how advanced AI technology is enabling early detection of cognitive decline by identifying subtle brain changes long before symptoms appear. Together, they explore the critical link between vascular health and brain function, with a focus on how conditions like hypertension can impact the brain. Dr. Phillips also shares insights on emerging research in brain health, including the effects of heavy metal toxicity, brain injuries in athletes, and the impact of long Covid and CNS Lyme disease. With a vision for the future, Dr. Phillips emphasizes the role of AI in personalized brain health interventions and how it’s changing the way functional medicine practitioners approach brain care.

In this episode of New Frontiers, learn about:

Dr. Kara Fitzgerald: Hi everybody, welcome to New Frontiers in Functional Medicine where we are interviewing the best minds in functional medicine. And of course today is no exception. I am very excited to be sitting next to, at least in the virtual space with Owen Phillips. Let me give you his background and we’re gonna jump into what’s gonna be one of the coolest conversations this year, I am sure. Dr. Owen Phillips is a Stanford trained neuroscientist and a Y-Combinator backed entrepreneur. He leads BrainKey in revolutionizing brain health through AI-driven analysis of brain aging. His mission is inspired by a personal experience with his mother’s misdiagnosis, fueling his commitment to preventing cognitive decline worldwide. Owen, welcome to New Frontiers.

Owen Phillips, PhD: Dr. Fitzgerald, thank you so much for having me. Excited and looking forward to it.

Dr. Kara Fitzgerald: It’s great to have you. This is actually, think, maybe our third, if not fourth conversation. Every time I have a chance to pick your brain I’m just more excited by your work. By the way, folks, we will link to any articles. Dr. Phillips has an extensive bibliography. He’s been published many, many times in the peer reviewed literature, so we’ll link over there. Talk to me about how you got into neuroscience. I know you cite your mom as a really big motivator, but I’m kind of curious of the backstory of how you got started.

Owen Phillips, PhD: Yeah. If you want to dig into my publications, they don’t make the most exciting reading, but they’re out there. But we’ll try to make this conversation a little less tactical and more fun, but happy to dive into deeper things if people want to. I wanted to be a marine biologist, but nobody wants to pay for that and there wasn’t a lot of research going on, so the brain was always the most exciting thing that was happening. And there’s so much still we don’t know and that just always kind of lit me up and then got me excited to go into work and investigate what’s happening in the brain. And from that, I was just at a really good point in time when MRI scanners, these big machines that take pictures of the brain, started getting really good. And that allowed us to see into how the brain was in somebody’s head. You know, it’s really amazing to get through our thick skulls and see a brain.

Owen Phillips, PhD: We take this technology a bit for granted now, but it’s just incredible that you can take a picture of somebody’s brain and that always just excited me. These machines have just gotten better and better in the years since I got into this. And because of that, it’s just opening up the potential for what we can understand about what’s happening in a patient’s brain. And then that leads into all sorts of other things that we can do in terms of helping to prevent things like my mom, where she developed Alzheimer’s-like symptoms and that was really horrible. And so the goal here is that hopefully we can prevent that and not get into that kind of worst case scenario in the first place.

Dr. Kara Fitzgerald: Right, right. So your mom was misdiagnosed and therefore mistreated. Just give me a snapshot of that since it was so motivating. You know, it’s really kind of career defining for you that experience.

Owen Phillips, PhD: Yeah, it still is. I talk with people all the time that have some family member that they’ve gone through this with, maybe their own parents or grandparents or an uncle. One of my uncles also had a stroke that didn’t get an intervention soon enough and his outcome has been worse for that. So that’s super common as well as neurodegenerative disease.

Owen Phillips, PhD: But it’s still a bit of a blur where this kind of creeps up on you, this change in the person you love and you care about. They start acting a little different and you try to reason with them and you’re trying to help them as best you can, but you feel so helpless. Everything you do doesn’t seem to help the situation and you start thinking through these worst case scenarios and what to do and how do we plan ahead for this? And yeah, it’s really debilitating for them, but also for the people around them. Yeah, it’s tough.

Dr. Kara Fitzgerald: It’s incredibly tough. I can see how that would just light an extremely powerful fire. So with that, you know, it’s really cool that we can see the brain, but why do we care?

Owen Phillips, PhD: Yeah, that’s a great point. That always used to be the thing people would say is, well we can’t do anything, so what’s the point of knowing? My mom is a perfect example of why it is good to know. What was happening in her brain is the fluid filled spaces in her brain, the cerebral spinal fluid, it’s a really important part of your brain. It’s the fluid that’s in there that helps to remove waste product and cushion the brain and maintain the temperature of the brain. And that’s a very important complex system.

Owen Phillips, PhD: In some people, this system goes wrong and breaks down and when that happens, it can result in the fluid building up in the brain a bit like a balloon. You can think of a balloon inflating in the middle of your brain, and that’s an image you can take home and think, that’s not good. That’s not good if fluid is building up in your brain. And then what happens is that starts damaging the surrounding tissue and starts impacting how much waste is in the brain, maybe what the temperature of the brain is and all sorts of things, and the patients can start acting like Alzheimer’s patients. It’s very common. They have very similar symptoms.

Owen Phillips, PhD: They can have a lot of other symptoms as well. That’s the fascinating part about the brain is there are a lot of different systems, vascular systems, you know, different regions, but they can have similar downstream effects and similar symptoms, at least observable ones, unless very carefully teased out. And because of that, they often get grouped into the same patient cohorts. And that’s not great if you get kind of thrown in this Alzheimer’s dementia cohort, because there isn’t a lot of great drugs there. There are starting to be better things there, but if that’s not your problem, then these drugs really aren’t going to have an impact anyway. So you don’t want to be thrown there.

Owen Phillips, PhD: So it’s really important to know what’s driving your individual symptoms and what’s driving your changes in your brain. For my mom, we identified what was going on with her is that fluid system was going wrong and we were able to get intervention for her there and she’s doing a lot better because of it.

Dr. Kara Fitzgerald: Incredible. Yeah, that’s an incredible story. And standard MRI imaging is sufficient to capture really gross changes, I would imagine.

Owen Phillips, PhD: It is. It’s great for big, broad changes, sort of. OK, this is the fun part I’ve learned about it that’s coming out of research. When you’re at Stanford and you’re scanning, you’ve got a very fancy MRI scanner, the latest, coolest hardware. It’s basically a Ferrari and you get to drive it, you know, 200 miles an hour. If you go to Stanford clinical or any hospital, I don’t mean to throw Stanford under the bus, but this could be a normal environment, even a very, very high profile one, what they’re operating under is turnover. They’re trying to get as many patients in and out as quickly as possible. The scanner needs to be used as much as possible, so they’re not prioritizing high quality imaging. The prioritization is on turnover. So does that make sense? Even if they have the best hardware, they’re just trying to get the patients in and out on the bed, take the images they think they need, and then get them out.

Owen Phillips, PhD: What we would do with research is we put the patient in there and then we ramp that machine up to 200 miles an hour and take the best quality images we can. Very high resolution imaging that looks fantastic that can tell us all sorts of things about the patient’s brain and their microvasculature. So just at a baseline, if you are getting imaging done, it’s nice to try to get them to do the best quality imaging that they can possibly do. If you have the option for that, that’s a big one and that’s something we really push for. We really think it’s important.

Owen Phillips, PhD: The nice thing there is the machines are getting so fast now too. So you can do this reasonably and do it in a much quicker timeframe. You don’t have to sit there on the bed the whole time. You can get in and out in 15 minutes. So that’s what’s also happening simultaneously, which is making it easier to get these very high quality images that allow us to do all this new fancy stuff.

Dr. Kara Fitzgerald: So, they have this beautiful Ferrari, and they’re like, what, driving it at five miles an hour or something? I don’t know if that quite works.

Owen Phillips, PhD: Yeah, essentially they’re driving it like a little old Volkswagen. It drives me drives me nuts from the nerdy technical side. You just have this beautiful camera and you’re not using it. There’s very human reasons for that. If you’re human and you need to inspect these images, having thousands of images that are beautiful isn’t necessarily good for your day job. It means you have to go through all of those images and inspect them and evaluate if there’s anything going on in those images and then sign off on that.

Owen Phillips, PhD: Taking very high quality imaging is not necessarily human friendly, so there are things that are working against utilizing the hardware. What’s fascinating too, is if you talk to the nerdy engineers at GE, at Siemens, Philips, they know this and they love their machines. They love making the best possible hardware and so they are really working hard to try to get this very high quality imaging more into the clinical workflow. So it’s starting to change, but I would just keep that in mind if you’re getting imaging that sometimes you might not be getting the best possible imaging, even if you’re going to a top tier institution.

Dr. Kara Fitzgerald: Yeah. Yeah, that’s right. So, as a lot of clinicians are listening to this, I mean obviously we’re going to talk about BrainKey in a minute, but how would we order a brain MRI where we might get a little bit more valuable insight?

Owen Phillips, PhD: Yeah, we’re really trying to push and change the standards here. So you can ask for 3D imaging, isotropic imaging, these are some keywords. You could look up the type of imaging you actually want. You can reach out to us, of course, we’re happy to chat there. Then there’s other groups you can reach out to. But it’s not easy to know what images to acquire and how to do that, so we’re trying to be super transparent about that and put that out there. We’d like to see every single MRI be the highest possible quality so that patients like my mom aren’t missed and they end up getting the right treatment in the end. That’s really important to us.

Dr. Kara Fitzgerald: Folks, I’m going to put a basic Brain Anatomy PDF or something on our show notes page, by the way. I meant to mention that before. This is just extraordinary. It’s extraordinary, Owen, and it’s like your calling manifested. So you have the opportunity at Stanford to really test drive these extraordinary vehicles and look at all sorts of stuff that I completely respect in the clinical setting. I mean, I see patients.

Dr. Kara Fitzgerald: You can only ingest and process and use so much data. And in functional medicine, believe me, we try to use it all. It’s incredibly important to us to do the best overall investigation on our patients as we possibly can— clinically, labs, imaging, the whole thing. But it’s incredibly daunting, and we’re human, so to your point, of course, I can imagine a physician needing to read thousands of images. It’s not even close to being sustainable. So you’ve got this piece, you have that awareness, you have this background at Stanford, and so then talk to me about BrainKey where you layered in AI. So I want to understand the big picture, but I also want to understand how you built the AI. What did you put into the system to really help with this exquisite interpretation? And then we’ll get into some of what BrainKey can do.

Owen Phillips, PhD: Let’s see, this is a representation of what we do. We can take these flat images that come off from the scanner. They usually look black and white, and we can reconstruct them in 3D. This is actually my brain we’re looking at right here, and that’s my hippocampus. That’s the structure involved in learning and memory. You really need that. It’s important. That structure degenerates early in patients with memory impairment and Alzheimer’s disease. It’s not great so it’s used as a very common biomarker in flagging for potential risk for Alzheimer’s disease, but also used in pharmaceutical studies as an endpoint. So that’s just an example of the type of thing you can do with AI is you can take these images and pull out the different structures, the anatomy, and calculate exactly how big they are. Just use that as an example.

Owen Phillips, PhD: So that means that you’ve now got raw data you can work with and you can do this for all different parts of the brain as well. That becomes very useful for understanding if a patient’s brain is in a normal range or if it’s abnormal. That gives you a reference point for really understanding these scans. Again, if you’re a neuroradiologist, an expert, you can do this just by visually inspecting and you can kind of tell. They get really good at this. The difference here is we’re doing this at a pixel, a voxel level is the technical term, but just down to a pinpoint. And we’re comparing that against a reference population and that allows us to really do that. A radiologist could do everything, or mostly everything, that we do but it might take them 12 hours, 24 hours sitting there to go through all of these scans and do this.

Owen Phillips, PhD: And we also get a lot of help from them. So they help us build this type of things up and that’s super important to take that knowledge and bring that into the models we build in the AI we built. But yeah, you’re basically compressing 24 hours of work that they do, but we build computers around that and can do it, knock it out almost instantaneously, and then report that back, which is really exciting to be able to get that out.

Dr. Kara Fitzgerald: How did you create the technology? What is the AI comprised of? You must have dumped a ton of data sets in there and then you had a bunch of radiologists, I mean… Just give me a little bit of the background, as somebody ignorant to this world by and large, even as I’m leaning on it and really using it and appreciating it. I’m just curious. You obviously have a range of normals and you’re picking up radically subtle perturbations in some cases. Anyway, speak to that.

Owen Phillips, PhD: So this is what I did. A lot of the neuroimaging labs, and this still goes on, grad students and undergrads sit at scans and will even draw on them at a very fine point and identify structures very accurately. Hopefully accurately, but with if they’re undergrads maybe not so accurately. So I’m basically a neuroanatomist at this point, very good at identifying different structures and images. The people we work with are also very good so that allows us to identify things in the scans and build out data sets from that. I really saw the need for this when I was at UCLA earlier, but then later at Stanford where Stanford students would be sitting for hours in front of a computer, hand annotating scans. You’re talking about some of the brightest people paying to go to this university and then spending all their time with their headphones on drawing on MRI scans.

Owen Phillips, PhD: And that can be very useful for research studies, but it’s a bit of a crazy use of human talent to do that. But I did that a ton. And because I did that, I’ve gotten very good at it and we can tap into that knowledge and that’s helped us build out the models we built. You kind of start with the small and then get better and better and better and we’ve gotten to a point where we’re very good at it now. And we’ve been around for a while. I’ve been kicking at this since 2018 and that’s given us time to get really good at it.

Dr. Kara Fitzgerald: I want to just highlight for people listening, Owen and his team at BrainKey will assist you in figuring out how to order this correctly for your patients. And then also, if your patient comes to you with a brain MRI in hand, you can interpret it through the BrainKey technology. It’s not going to be as juicy. As you mentioned earlier, the images are lacking, but it’s still a little bit more than what they showed up in your office with. I’ve seen both of those. I’ve got a lot of questions, but we might as well jump to these.

Dr. Kara Fitzgerald: I’ve had the privilege of experiencing this as a clinician, reviewing data with you and using BrainKey, and one of my patients sustained a traumatic brain injury many years ago in a motor vehicle accident. And she had a standard MRI and it wasn’t satisfying to me in the way that the information from BrainKey is reporting. So with her, we filtered it through and we got a little bit more detail, but not enough to inform my clinical decision-making in her case, beyond, you know, as people in functional medicine are thinking about people with traumatic brain injury, you know, adequate support with circulation and detoxication, et cetera, and sort of cleaning up globally. And we did that in her case but I didn’t have the same kind of details.

Dr. Kara Fitzgerald: Now, somebody else in my patient base who had a BrainKey scan, and you and I talked that through, now he happens to travel internationally quite a bit. And you were able to take a look at his brain and validate that he was in extraordinarily good health and he is somebody who takes exquisitely good care of himself. But he also does a lot of international flying, and what was mind-blowing to me was that you were able to see some perivascular changes, some things that might be indicative of maybe a lack of deep sleep from these international flights. Can you just kind of speak to those two cases? Any thoughts on that?

Owen Phillips, PhD: Yeah, the first point is, if you have clients or patients with traditional imaging that was done at a provider, we’ll do our best to do what we can with it. That’s really important to us to try to maximize—

Dr. Kara Fitzgerald: At no cost, by the way.

Owen Phillips, PhD: Yeah, we try our best there. Specifically talking about perivascular spaces, let’s just do a little back up there. So you’ve got your vasculature in your brain. Your brain is 2 % of your body weight but it’s using 25-30 % of your energy. It’s just a hungry beast so you need a ton of blood going through there. And if anything is using that much energy, it’s going to generate a lot of waste product as well and so you’ve got to get that out. And so the brain has this very complicated system to kind of flush that out.

Owen Phillips, PhD: And what has become very hot in the neuroscience field lately is you’ve got your microvasculature and your vasculature, and then hitching a ride around that vasculature are these things called perivascular spaces, these fluid filled spaces. And so as your vasculature kind of pumps, they get to hitch a ride. It’s mostly a passive system that is powered by the vasculature. And what’s common is for patients with sleep abnormalities, often this system looks a little funky, for lack of a better term. Their brains look a bit dirty. It shows up as kind of dark spots in the white matter of their brain. And the reason for that is that system really goes to work as you sleep. Your brain pumps out, cleans out itself while you’re sleeping. That’s one of the primary functions of sleep.

Dr. Kara Fitzgerald: And deep sleep, would you say? Deep sleep specifically of all the stages?

Owen Phillips, PhD: Yeah, that seems to be very important. And this is very cutting edge and there’s a lot of research at Stanford that’s going on here. So there’s a lot happening here, but everything is emphasizing that this system really works while you’re sleeping and then if something’s going wrong here, this is what happens often. And so that can show up and it’s very common. There are degrees of that, of course. Most people are moderate to normal, but there can be some people who vary. Their brains just look so scattered and so dirty in terms of the system going haywire.

Owen Phillips, PhD: That can be two things: Sleep can be a primary thing that seems to have an impact there and the other thing is they often have some underlying vascular issues. And so that can be very common as well. And again, this just makes sense.

Dr. Kara Fitzgerald: Such as underlying vascular issues? I just want to push you to be a little more specific in what it might be.

Owen Phillips, PhD: No, no, please. Yeah. Like hypertension.

Dr. Kara Fitzgerald: Okay. Okay.

Owen Phillips, PhD: Things like they might have a very elevated resting heart rate and all the common things that go along with this.

Dr. Kara Fitzgerald: And that’s how it will show up in the brain. So uncontrolled hypertension, elevated resting heart rate, long-term, you can begin to see this.

Owen Phillips, PhD: Yeah, that’s the biggest thing we’ve been learning and is just coming out is how dependent the brain is on the vasculature. Again, it’s such a small structure in terms of its size, but it’s just so hungry for energy and so there’s so much blood that’s being pumped into it and pumped out. And if something’s going wrong with that system, it starts to show up very early. And I can give you a cascade of things, like your hippocampus, for example. This little structure is involved in learning and memory. If there’s abnormalities in the vasculature, your hippocampus stops the neurogenesis, the new neurons that are produced in the hippocampus. It’s one of the few structures in your brain that actually actively does that when you’re adult. That system seems to slow down in patients with abnormal vasculature. So that’s one system that’s impacted.

Owen Phillips, PhD: Your brain’s white matter starts to be impacted so that shows up in the scans as well. And then your blood brain barrier, you know, that’s obviously very important and helps prevent all sorts of things from getting into your brain. And so that system gets impacted when the vasculature isn’t normal. So if you’re going to concentrate on one system to try to keep your brain healthy, I don’t think you could pick anything better than to really try to maintain your vasculature.

Dr. Kara Fitzgerald: It’s incredible. God. It’s so powerful. So I want to just go back to my patient where we just saw a smidge of change. His report came back great, he had a young brain and you validated that. But we saw this smidge of change and we were kind of analyzing why that might be. And perhaps it was a spat of poor sleep quality with travel and we’ll do a follow-up because he’s interested in that. So, I’ll let you know and we’ll see what we see. And hopefully it’s not there, or hopefully if it is it’s just a non-event.

Dr. Kara Fitzgerald: But hypertension, of course, is ubiquitous everywhere, and probably the majority have pretty poorly controlled hypertension, so we’re going to be seeing a continuum of these and it’s just… God, what an extraordinary way to hit home the importance of paying attention to blood pressure. You know, it’s something a lot of people don’t really want to care about.

Owen Phillips, PhD: Yeah. So this 3D visualization, we originally built it so I could show my mom and explain to her what was happening in her brain. We thought this visualization is really important to communicate. And that was such a pain point, a struggle for me with my mom, with my family and we found that images are very powerful, especially images that the patient can wrap their brain around are very important. And so we put a lot of effort into that. And yeah, I don’t know how to…

Dr. Owen Phillips, PhD: We have this conception about ourselves and the idea that something physical in our brain could really impact who we are. It is sometimes just kind of scary to think about. But once you see the images and you get to understand that it could have a negative effect on you, can have a powerful effect, you try to pay attention to things so it doesn’t get worse and hopefully you can maintain your optimal brain health as long as possible.

Dr. Kara Fitzgerald: You have to be thinking about when a baseline scan is optimal. Or maybe there’s multiple at different time points. I don’t know if you’re thinking about childhood or maybe a kid who’s active in sports and sustaining some head knocks. I’m curious about… It just seems like your technology is going to revolutionize standard of care. Rather than waiting until somebody is frankly symptomatic when it’s going to be much more challenging to reverse whatever’s going on and it may be impossible, when do we get this done?

Owen Phillips, PhD: That’s so big. Just take my mom’s case for example, that tissue damage, the structural change. You know, she’s older, you don’t have the resources at that point to really rebuild those systems. That’s very hard, so once you have these changes, these bad things happen, and it’s very, very hard to do anything about. That’s where so much work is going into drugs and trying to develop things that clear out amyloid and try to kickstart some of these systems. And that’s great and there’s a ton of work going into that. But it’s really hard.

Dr. Kara Fitzgerald: Way down the line.

Owen Phillips, PhD: Yeah. So these are downstream events and it’s much easier to keep things in better shape. So that’s the best possible thing you could do. Again, we don’t think of the brain like this. This is still very new. We’re starting to think this way in cardiology much more— you would like to prevent a heart attack, so we should probably take a look and do interventions before you actually have a heart attack. So that’s becoming much more mainstream. You don’t like to have breast cancer so we should screen for that and identify things as early as possible so you don’t end up with breast cancer. Same with prostate cancer, that’s becoming much more mainstream for an early screening. And again, we’re in the early days here, but it feels like brain is going to go that same direction. It’s going there pretty fast because the technology is getting there. So I think that’s a good thing.

Dr. Kara Fitzgerald: It’s so exciting. It’s really exciting. I mean, it wouldn’t have been useful using it in the old way, which is actually still the dominant way. We wouldn’t be really seeing what we need to be seeing.

Owen Phillips, PhD: There’s a recent paper from the Lancet, which is a major journal indicating that almost 50% of dementia cases are preventable. That came out in August this year. This is just, again, the field’s been saying, dementia… you can’t do anything. And now we’re really changing the conversation that this is preventable in a large body of these cases and we can really do things about this. And so that is really exciting to start changing, reframing the conversation around brain health.

Dr. Kara Fitzgerald: Yeah. And folks, we’ll link to the Lancet article. Yeah. And they’re looking at different lifestyle variables that can make a difference. And of course we have Dale Bredesen, who’s been on this podcast before. Extraordinary. I think that you guys are working together now. There’s the Bredesen protocol and Dean Ornish published recently on his dietary pattern improving mild cognitive impairment, I think. Or Heather Sandison actually published a really cool study using a modified Bredesen protocol. So we’re actually seeing changes using a functional medicine model in cognitive impairment, which is extremely exciting. But to your point, you know, the whole prevention piece. So then just quick, when should we start? Like, when should somebody actually have a BrainKey?

Owen Phillips, PhD: I don’t mean you can’t have a significant impact. You definitely can. My mom’s an example. There’s a functional medicine intervention. Exercise is so big, Bredesen’s protocol seems to have a major impact on the brain, and there’s ongoing imaging analysis going on right now that’s really exciting. So you can have an impact on the brain. I think that’s just so great and exciting. Yeah, again, it’s easier if you’ve got extensive damage and your brain is… What happens in Alzheimer’s patients, to use an example, is basically everything starts kind of going wrong in their brain. It starts shriveling a bit like a raisin and if you look at a lot of brains, it’s rough. They look like they’ve shrunk and you see that. That’s really tough.

Owen Phillips, PhD: You’re talking about an 80 year old patient and you’re expecting their brain to come all the way back? That’s a really tough ask in terms of the body at that point in time. But having some positive impact at that point, you definitely seem to be able to do that and that’s really exciting. That can mean the difference for somebody at that age between having a very high quality of life and being able to go out and walk and talk with their kids and meet their grandkids versus not. And that’s really important.

Dr. Kara Fitzgerald: It’s incredibly important.

Dr. Kara Fitzgerald: Okay. So I want to just get your idea on a few other things here as we wrap up on CNS Lyme, long COVID, you and I were talking off air a little bit about maybe CNS toxin accumulation. What can we see in a BrainKey scan in some of these conditions? Or can we see? Can we pick it up actually? So let me restate that. Can we see it? What can we see? And can we see correction after intervention?

Owen Phillips, PhD: There’s quite a bit of imaging research that’s coming out on long COVID patients. They’re very varied patients, but often what happens, the technical thing is white matter hyperintensity, so changes in the white matter pop up on the imaging. That’s probably due to some vascular changes or maybe potential breakdown of the blood brain barrier. So that seems to be a common finding in these patients. There also seems to be some areas where they seem to be shrinking a little bit, some volume changes. But again, it’s a very, varied population. The presentation can be quite different from person to person. But those are the kind of common things that are popping up. But very active research going on there. That’s obviously a hot topic. Covid does seem to have some impact on particular people in their brain. Yeah, what was the other one we were going to dive into?

Owen Phillips, PhD: Oh, metal, iron, things like that. That’s also a very hot topic in movement disorders, in Parkinson’s and Huntington disease. There seems to be iron accumulation and so that becomes interesting to monitor and to see how that’s impacting. the thought there is that—

Dr. Kara Fitzgerald: Can you see that accumulation?

Owen Phillips, PhD: On some imaging, yeah, you can pick that out. This toxic accumulation of iron. There’s a lot of work going on in France out of the University of Toulouse that we’ve also been a part of that’s really interesting in terms of assessing iron. But yeah, as I just touched on earlier, the blood brain barrier is so important for monitoring what gets in and out of your brain. And so if that’s not functioning well, whether it’s because abnormal vasculature or other things like inflammation that are really impacting it, that system can break down and then things that aren’t supposed to get in your brain get in your brain. And that’s not good. Your brain has this very, very complex blood brain barrier for protecting what gets in and out for a really good reason. So that’s an important system to try to maintain and try to keep that operating as good as possible.

Dr. Kara Fitzgerald: You can see improvement on follow-up with certain interventions. I mean, just taking long COVID or going to people with cognitive impairment using the Bredesen protocol, on follow-up, you can see some turnaround, correct?

Owen Phillips, PhD: Yeah, that’s really exciting to see interventions have an impact. So again, structures like the hippocampus, those are used as endpoints in clinical trials. And so if you can show your intervention has an actual impact on these structures, that can be a really positive signal. That’s a pretty big structure in your brain and we’re getting better and better at getting smaller and smaller changes identified and so that makes it easier to identify what’s working for a particular person and what’s actually having an impact for them.

Dr. Kara Fitzgerald: Well, and going back to the whole perivascular space conversation, I would imagine you can pick up some pretty subtle shifts at this point.

Owen Phillips, PhD: Yeah, that’s something. So think of early imaging were we could take a picture of your brain so you could see is there a brain there, you know? The image quality has just gotten so much better so we can measure smaller and smaller things and that becomes really exciting for actually seeing if something’s changing. It’s very hard to change, you know, a big structure in your brain, but smaller things can have a quicker impact and so that becomes easier to assess if it’s really having an impact.

Dr. Kara Fitzgerald: That’s very exciting. I want to try to pin you down on this because you haven’t quite answered it. What about sports injuries? Actually, you said something earlier. Two questions and then we’ll kind of start heading home. UFC fighters. (Ultimate Fighting Championship) If you’re kind of ignorant about UFC fighters like me, I would be thinking about the repeated head injury and that being a problem. And I’m sure it is, but they also, you say have these incredibly high performing brains. And so I’m curious about that, like the amazing brains and who has them and talk about that. But also just again, should we all, at age X, be getting our baseline scan or should we consider getting our kids scanned if they’re playing football and they’ve sustained repeated head injuries. So there’s a plethora of questions I’m throwing at you.

Owen Phillips, PhD: So this is my brain.

Dr. Kara Fitzgerald: Oh, that’s cool.

Owen Phillips, PhD: We like to do things like that. We’ve done this for a number of UFC fighters and other professional athletes. Their brains look fantastic. I look at brains so often, and some people have good looking brains. They’re operating at such a high level, the professional athletes, you’re operating in three dimensional space with another thing that’s very, very complex, very demanding on your brain. And then physically they’re in such great shape to be able to power their brain and I think that can’t be under emphasized. The hits to the brain, that can’t be good. You know, if you have the option, and your lifestyle allows it, yeah, try to avoid the hits to the brain. I think that’s really just basic.

Owen Phillips, PhD: I mentioned these structures, like your blood brain barrier. It’s very complex. It’s robust, but it’s delicate. Your perivascular spaces that clear out waste products, that’s very delicate as well. You’ve got these long connections in your brain that are very important and you’re taking big hits that might disrupt those connections. It’s not great. That said, your brain has got a big thick skull. It’s got a bunch of fluid around it. It’s got a bunch of padding. So it’s really trying its best to protect you and to make sure that doesn’t get worse. But yeah, it’s not great if you’re taking repeated hits.

Owen Phillips, PhD: The professional football player Brett Favre was very public about it. He was recently talking about Parkinsonia movement disorder issues that he’s having. That’s really rough. I grew up watching him play and even at that time you just saw him taking these hits again and again and you were like, he’s so tough. But at the same time you’re like, that can’t be great. He’s gonna pay for that at some point. And that’s really rough. So it’s an active conversation with lot of athletes now. Yeah, it is good to have (a baseline). I’m fortunate I have a baseline of my brain, which is great, so I can monitor how that’s changing and I think that’s really nice. So if you do have that luxury, I think that’s really great to be able to monitor how your brain is changing.

Owen Phillips, PhD: So if you do have some events, you do have that kind of reference point to look at. That said, that single reference point when you need it is super important. So you don’t necessarily need to run out and go get your baseline scan. I’m not advocating for that yet, but it’s nice. I’m happy I have one. So I’ll leave it at that.

Dr. Kara Fitzgerald: Right, right. And kids, I mean, what are we thinking about there?

Owen Phillips, PhD: I don’t want to over scare people getting out, but it’s just if you can… I will say I did some research on pediatric acute neuropsychiatric syndrome and things like that. They’re much more acute. If there’s a behavioral change, I would advocate for that. That can be just so intense and brutal. And so if you can rule out anything from imaging, I think in cases like that, that’s really important to just check out. If you’ve got the healthy, super high performing kid, then you don’t necessarily need to run out and do that. I would just put it at that. That makes sense.

Dr. Kara Fitzgerald: Okay. I got it. So do the best you can. If you can get a baseline image as an adult and it’s not big deal, do it, but yeah. All right. So the brain takes up a ton of energy for being such a small organ and you’re talking about sort of living to power your brain. And I’m curious, what lifestyle habits, what nutrients really of resonate with you. What is optimal? How do we optimally power our brain? What are your thoughts around that? That would be such a cool book actually.

Owen Phillips, PhD: There’s so many people telling you how to live fantastically now.

Dr. Kara Fitzgerald: Yeah, that’s true. But just from your vantage point of looking at an insane amount of brain imaging for many, many years and under different conditions and looking at optimal brains to brains that are really very degenerative. So yeah, I’m curious, what have you seen that really powers the brain?

Owen Phillips, PhD: Take care of your heart health, number one. I don’t think you can do anything better than that. So if you’re doing a good job there, that’s at least taking care of so many things about maintaining your brain. I know that’s not how we often think about ourselves, but the brain is physical. It’s very complex, but it’s this very energy hungry tissue that’s sitting there and it really needs to be powered. And so if you can take care of just getting it power, you’re doing a very good job. And all of these other things, the Bredesen type things that he talks about, interaction, exercise, those become so important. That’s a continual issue with my mom. It’s really important that she gets out and interacts with other people. That really stimulates her and that’s important.

Owen Phillips, PhD: So things like that are just really great if you can use your brain. You’ve got it, so it’s really great if you actually take advantage of it. We seem to be such social animals and our brain really needs that and that’s very important for it. Otherwise, like I said, it can shrivel up and that’s not great.

Dr. Kara Fitzgerald: Well, listen, it was awesome to spend this hour with you, Dr. Phillips. I just appreciate your brilliance. I appreciate your big brain sitting there in the back of you and also in your hands and in your head as well. Anything that you wanted to leave with, anything we missed in this?

Owen Phillips, PhD: This was fantastic. Thank you so much. I had a wonderful time and thank you for the questions. If anybody reaches out, I’m happy to chat further. Love diving into this research stuff. And then, yeah, if you have ideas about research, feel free to connect with me.

Dr. Kara Fitzgerald: I will. Will.

Owen Phillips, PhD: Yeah, you’ve got great ideas so I’m very excited about it. Thank you.

Dr. Kara Fitzgerald: Yeah. All right, stay tuned, folks, and we’ll put all the contact information on the show notes.

Dr. Owen Phillips is a Stanford-trained neuroscientist and the founder and CEO of BrainKey AI, a company at the forefront of brain health innovation. As a Y Combinator-backed entrepreneur, Owen has dedicated his career to advancing brain longevity through AI-driven insights that quantify brain aging and help guide personalized treatment plans.

Owen’s commitment to brain health is deeply personal. After his mother was misdiagnosed with Alzheimer’s disease, her condition worsened without the proper care. When Owen applied BrainKey’s cutting-edge technology to her case, he identified the true cause of her abnormal brain aging. This insight led to the right treatment, improving her health—a profound experience that drives Owen’s mission to prevent others from suffering due to misdiagnosis or delayed care.

Beyond his work at BrainKey, Owen is an active researcher and collaborator with leading institutions worldwide, including Stanford, UCSF, and Charité. His work focuses on integrating biological, cognitive, and imaging data to better understand brain aging. His vision is global: with 1 in 3 people facing the risk of abnormal brain aging or dementia, Owen is on a mission to make a lasting impact on brain health.

Owen Phillips

BrainKey

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Report: Dementia prevention, intervention, and care: 2020 report of the Lancet Commission

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