A blog from MND researcher, Dr Ratko Radakovic

In 2024 Dr Ratko Radakovic was awarded the Young Investigator award, at the ENCALS MND symposium in Stockholm, in recognition of his important research into apathy in MND. ENCALS  is an annual meeting of MND researchers, where they share their work and findings with their peers. Ratko was funded by MND Scotland between 2017 and 2020 to undertake research in this area and so we asked him to look back at his research career and reflect upon being recognised by peers at the symposium.  

Tell us about you.

I am an Honorary lecturer and researcher based at the University of East Anglia, also working as a Clinical Psychologist at the Cambridgeshire and Peterborough NHS Foundation Trust. In addition to this, I hold an Associate Principal Investigator position at the Euan MacDonald Centre for MND research and am an Associate Member to the Alzheimer Scotland Dementia Research Centre.  

I have studied some variation of Psychology throughout my career, starting at the University of Hull and then specialising further in neuropsychology through my MSc and PhD at the University of Edinburgh. There I focused on behaviour and cognitive functioning, or thinking ability, in MND but also other neurodegenerative conditions, such as dementia and Parkinson’s disease. I completed my Doctorate in Clinical Psychology at the University of East Anglia, with a focus specifically on cognitive functioning, behaviour and quality of life in MND for my thesis. Throughout my career so far, I have been incredibly fortunate to work with fantastic researchers, clinicians and also meet the most wonderful people and their families or caregivers, who have heavily influenced who I am today as a researcher and clinician. 

What drew you to MND research? 

Initially, I wanted to try to understand and characterise behaviour and cognitive functioning in general. Also, I wanted to explore how these difficulties impact people practically in everyday life. However, through a series of unexpected encounters and decisions, I ended up working in MND research. This was in part due to the unwavering motivation and support from my mentor Professor Sharon Abrahams. We seemed to share a drive to help people with MND and understand the details of their experiences of cognitive and behavioural impairment, which notably can occur for around 50% of people with MND. But while these seemed such integral experiences for so many people, I was surprised how relatively unexplored they were in MND.  

Apathy particularly, or lack of motivation, was something that was not well understood or recognised, particularly in MND. As such, we wanted to “drill down” and understand the different types of motivational problems (or apathy subtypes) people may experience. We created a measure to explore this called the Dimensional Apathy Scale. This has now been validated and used in multiple languages across different neurodegenerative, neurological and neuropsychiatric conditions, as apathy is something we all experience at some point in our lives. 

We used this measure to characterise types of apathy in MND and start to understand the mechanism of apathy through how it associated with different elements of cognitive functioning. This apathy profile, or signature, in MND differed from those people with dementia, i.e. Alzheimer’s disease and frontotemporal dementia, and other movement disorders, i.e. Parkinson’s disease. Importantly, we also found that types of apathy associate with different elements of everyday life for people with MND and their caregivers and family members. What keeps pushing me to continue doing this type of MND research is that there are still so many areas left under-researched and as such unexplored in the practical applications of our findings. We hope this can help improve the lives of those living with the condition, at least from the psychological side.  

What was your MND Scotland funded research about?  

The research MND Scotland funded was probably the first project that explicitly looked at apathy in MND. It explored the practical and clinical impact of apathy in MND, by trying to understand how types of apathy change over time, as well as how they might influence quality of life and wellbeing of both people living with MND and their families or caregivers. It was an opportunity to start exploring how different types of apathy can be assessed in an MND clinic, which was an international collaboration with colleagues in the USA, including Professor Zachary Simmons at Penn State University, with an aim to make it more accessible and accepted clinically. This research also helped raise awareness of apathy and its subtypes to normalise these experiences and provide much needed psychoeducation around this area. We further started to think about how we can intervene and support the people experiencing apathy and also the people around them. 

What are you doing in your current research? 

Currently, I am trying to broaden this work internationally with collaborators to improve assessment and recognition of different types of apathy across different conditions, as well as MND, as a real-life problem for people and their families. We are also focusing more on self-perceived quality of life and wellbeing associations with other behavioural and cognitive impairments in MND and translating this into practice. More generally, we continue to try to put practical neuropsychological and psychological research on the map, along with a collection of wonderful researchers and clinicians. 

What do you hope the future of your research and impact will be? 

This is such a tough question. I hope that people continue asking psychological or neuropsychological questions and answering them with the real-world impact for people with MND and their families in mind. Ultimately, it would be great if we get to a point where everyone knows what apathy, as well as other behavioural impairments, are and can confidently start developing ways to intervene and manage these, in a therapeutic way but equally in any way that helps. 

How did it feel to win the young investigator award at ENCALS? 

It honestly felt surprising as it feels quite rare for a psychologist or neuropsychologist to receive such an award. In a word, I would say I felt humbled and consider this a recognition of the monumental effort of everyone involved in this research and the endless contributions of the people with MND and their families in their participation. It makes me want to keep going with this type of research and keep looking to make it more applicable in MND. 

MND Scotland would like to congratulate Ratko on his award and are proud to have been able to support his career and research. Alongside the funding we commit to research into investigating new treatments, improving diagnosis, and better understanding the biology of MND, it is crucial we continue to support research such as Ratko’s. Understanding the impacts, mentally and socially, of MND on people with MND and carers, is critical in helping us to support people affected by MND in meaningful ways.