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Laura Ment, MD

Laura Ment, MD

Dr. Ment is the daughter (one of four children) of an exceptional physician who initially undertook general practice in Pennsylvania but subsequently trained in pediatrics at Columbia. Her mother is also an exceptional individual, a musician. Dr. Ment is a member of a family particularly marked for their sense of dedication both to meaningful achievement and to finding opportunities to learn and to  “do the right thing.” Dr. Ment’s teen-age educational perspective was enlarged by spending a summer in Switzerland with two of her father’s fellow Columbia trainees who had become professors, child neurologist/neuroscientist, Ray Chun and his wife, developmental pediatrician, Memee Chun. Ray Chun spent that summer engaged in basic science at the Brain Institute in Zurich. Asked what she wished to do, the classically educated Laura Ment told the Chuns she wished to travel to the Graubunden, where she was aware that the Latin dialect, Rhumantsch,  was still spoken. She was determined to converse with those who spoke this language. She did so (first ordering a loaf of bread), and in so doing manifested the remarkable preparation, resolve to learn and observe, quiet and unassuming poise, clarity of aspiration, and determination that have proven characteristic of her remarkable career.

Certain individuals played particularly important roles in Dr. Ment’s professional choices and development. Her father, as well as Rae and MeeMee Chun were her earliest role models. Dr. Ment was a member of the last class to enter Brown University’s adjunctive Pembroke Women’s College prior to Brown becoming a fully coeducational institution. The last Pembroke College Dean, Rosemary Pierrel told these women that they could “be anything they wanted to be, do anything they wanted to do.” This was a message that Dr. Ment believed with all of her very determined heart.

Dr. Ment’s MD degree was conferred by Tufts University in 1973. Her training in pediatrics and neurology was completed at the Massachusetts General Hospital, an achievement tragically shadowed by the death of her first husband during their internship year. Dr. Ment’s decision to become a pediatrician involved strong consideration of becoming a neonatologist. Her pediatric internship year was the same year that the first CT scanner arrived at the MGH. This modality and another role model –Dr. Krishnamoorthy, who was instrumental in employing that modality in studying and caring for children – were decisive in directing her towards devoting herself to the study of the brains of immature infants, the care and improvement of the outcome such brains might experience.

Nathan Talbot and Ray Adams arranged for Dr. Ment’s neurological training. Dr. Adams made the additional critical suggestions to Dr. Ment that she take Pasco Rakic’s course in developmental neurobiology at Harvard and that she pursue the neonatal neurological fellowship obtained in 1973 at Hammersmith Hospital under the guidance of Dr. Pamela Davies. Dr. Davies’ interest in intellectual aspects and other outcomes found in very low birthweight infants took seed and has remained at the center of Dr. Ment’s clinical and scientific endeavors throughout her career.”

In 1979, Dr. Ment joined the medical faculty of Yale University, rising to the rank of Professor of Pediatrics and Neurology in ten years. She concentrated from the start on the neurological care and scientific investigation of the neonate, demonstrating her earnest desire to better understand these infants and thereby improve their outcome. From the start she manifested extraordinary diligence in the evaluation of the neonate, with an unusual degree of attention to detail and deftness in examination. Small notes were passed to Pediatrics residents to assure that every important detail was attended to, in exchange for which they were invited to revisit the bedside to reinforce clinical observations she was sure they “had also noticed.” Her businesslike, meticulous professionalism and intelligent approach to the solving of clinical problems exemplified characteristics that were and remain irresistibly and easily acquired by those in training under this caring individual who is also a master clinician- scientist. A particular encouragement to do so was to receive in return one of the fleeting warm smiles that signified that things had been done right and well by that resident. It is not surprising that in her third year at Yale she received the Pediatric Faculty Teaching Award – the first of what has become a sizeable list of such awards.

Dr. Ment’s career as a neuroscientist began with her careful clinical observations of sick infants at presentation and in followup. Very quickly she carried the bedside to the bench and was awarded in 1981 her first grant, which underwrote the development of her well-known Beagle Puppy Model for the study of intraventricular hemorrhage. The three-year $75,000 award has been followed by 27 additional grants for both basic science and clinical studies as PI or site PI (20), Co-PI (1), Multicenter Site PI (2), or Investigator (4). Dr. Ment’s funding for these various grants has amounted, over an uninterrupted period of funding of 32 years, to an investment in excess of $18 million. The results are expressed (to date) as 144 original clinical and basic science papers. There are in addition eight case reports or thoughtful observations on clinical practice standards that variously address headache, muscular or metabolic genetic conditions, and child abuse. Dr. Ment is either first or senior author of 111 of the original scientific papers (76%). Of these, 128 concern the neonate (87.7%), 66 (45%) addressing questions concerning the antecedents, genetic and gestational age aspects of vulnerability, pathophysiology, clinical manifestations, prevention, treatment, and outcome of intraventricular hemorrhage in the premature infant. These studies include well known clinical and experimental assessment of the preventive and ameliorative aspects of a variety of variously times interventions, including indomethacin, corticosteroids, and mode of delivery. Factors ranging from cardiovascular stress or birth-related hemorrhage or from meningitis as well as neurosurgical entities including myelomeningocele and vascular malformations and their management are considered with regard to their impact on neonatal well-being.

Dr. Ment’s basic science studies have resulted in 19 papers reporting results based on the Beagle Puppy Model, as well as a number of more recent studies employing rat and mouse models. These animal models have been employed not only in studies of IVH, but also of stroke, asphyxia, and other forms of hypoxic-ischemic brain injury. The studies detail results obtained from a variety of methods of studying and assessing the effects of cerebral blood flow alterations, metabolic derangements, gestational age related aspects of microvascular/angiogenetic and brain cellular (neuronal and glial) development, They have examined developmental and other variations in the effectiveness of mechanisms for plasticity and repair of brain injury, particularly including the role that astroglial cell lineages play in brain development, regeneration, and repair. Recent studies have provided important evidence concerning the influence of the growth factor FGFR-1 on cellular plasticity in injured developing brain and the influence that GFAP promoter activity has on GABA interneuron development in the postnatal cerebellum.

Among the many other important observations that have been made in these studies is the early and unexpected recognition of the role that sex of the infant plays in vulnerability and type of injury as well as outcome. Dr. Ment and her colleagues observed the possible association of heterozygous Factor V Leiden expression and neonatal stroke. Careful studies have demonstrated the role that such elements as adenosine receptors, suppression of oligodendrocyte influence on axonal sprouting, and other processes may play in outcome after premature birth or other vulnerabilities to neonatal stress. They have on the other hand expanded understanding of the role that chronic perinatal hypoxemia may play in enhancement of cortical neogenesis.

Clinical studies that advanced from local studies at Yale to multicenter trials have served as a foil for the basic science observations, each informing and modifying the approach to the other. Imaging techniques have been studied from the very beginning of Dr. Ment’s carefully crafted program of investigations, allowing the information garnered in carefully controlled animal experiments to be placed within the context of observations made in human infants on the basis of various forms of imaging including bloodflow studies. Dr. Ment’s important and pioneering role in imaging the newborn brain has provided leadership that has been equaled by few others, Dr. Ment was first author of the 2002 practice parameter on brain imaging of the neonate. She has extended her approach to functional images employed in the study of language processing and cognitive outcome of the premature neonate. Dr, Ment and her colleagues have turned part of their mutifactorial attention to the functional connectivity of the non-dominant hemisphere in language development and function in adolescents that experienced premature birth. Various forms of intracranial pressure and electroencephalographic monitoring are also considered.

The many multicenter followup studies that Dr. Ment originated and organized, or those that she has subsequently participated in as a Site PI, have proven an enormous boon to the understanding of the cerebral palsies; she has been a pre-eminent leader in such studies throughout her career. The many important contributions include not only the long- overlooked distinctions in vulnerability of boy and girl infants, but the delayed onset forms of deterioration that may occur and have also been overlooked. Regional variation in brain volume have been correlated with particular aspects of long-term cognitive outcome – her paper on this subject from 2000 is her most highly cited paper (357 times). Ninety-nine of her papers (59%) have been cited more than ten times. It has been mentioned that from the start of her career no detail was too small or seemingly insignificant enough to fail to be noted by Dr. Ment. Her most recent paper, concerning early predictors of hypertension in prematurely born adolescents demonstrates that that discerning scrutiny and her unceasing desire to achieve whatever may be achieved in improving the lives of children does not end as those children grow older. Dr. Ment’s papers have been cited more than 4300 times. She has written fifty thoughtful and stimulating chapters, has presented 67 original papers at scientific meetings, and her invited presentations are too numerous to list in this space.

Dr. Ment’s own family life has been something that is of great importance to her and she has throughout her career served as a model as well as counselor for the manner in which career and family life may best be balanced – not only to women in medicine, but also to men (who may need the advice even more). It is indicative of this balance that her second husband, the distinguished neurosurgeon Charles Duncan, is among the co-authors of 58 (38%) of her papers. There is in this professional relationship some well-balanced variation as to whom is identified as senior author. Their collaboration has extended to the raising of five children. As an additional aspect of Dr. Ment’s life, she is a devoted runner. In that avocation as in all aspects of her professional and domestic life, she is true to the character of her parents: she always achieves what she sets out to do and does it well. In 1999 Dr. Ment became Chief of the Pediatric Specialty Center at Yale, and in 2006 Associate Dean of Admissions. Yale has recognized her distinction with the Leah Lowenstein Award (1988), the AMWA Award (1997), the Francis Blake Gilman Award (2001) election to the Society of Distinguished Teachers (2002) and the Yale School of Medicine Class of 2006 Teaching Award. She was the first recipient of the Raymond W. Chun, MD Visiting Professorship at the University of Wisconsin (1996). In 2002 she was awarded the 18th Annual Philip Dodge Lectureship at Washington University, St. Louis. In 1999 she was a Visiting Professor at the Taiwan University School of Medicine and in 2004 she was Visiting Professor at the University of Kentucky.