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Heidi Roth admits that, when she was a child, she preferred English over equations, crafts over chemistry, and found herself more interested in people than in scientific principles.

 “Science just didn’t appeal to me,” she says. “I was much more drawn to creative expression and human stories.”

That perspective shifted dramatically in high school, when a biology class opened her eyes to the hidden mechanics of the natural world.

“It was this idea of learning the secret of how things work, this insight into nature, which seems so complex,” she reflects.

Roth has been chasing secrets ever since — the mysteries of meaning, life, and the brain. These are the threads that weave her passion for science, people, and the humanities into one tapestry.

“I’m a seeker,” she says. “I love learning and then distilling that knowledge into a clear picture.”

Today, Roth studies how memory, language, and sleep intersect with cognitive decline as we age. At the UNC School of Medicine, she serves as division chief for sleep medicine, directs the Aging Brain Clinic, and is an investigator within the Duke-UNC Alzheimer’s Disease Research Center. 

“Too often, when someone experiences changes in brain function, it’s dismissed as ‘just a little dementia’ without identifying the root cause,” Roth shares.

Her goal is to change that narrative.

“These changes can cause very specific deficits,” she says. “I want older adults to understand what’s happening with their cognition — and then help develop personalized interventions to support their brain health.”

Curiosity as a compass

As an undergraduate at Harvard University, Roth enrolled in an ethics class that explored how people think about justice. The theoretical debates captivated her. With medical school already on the horizon — a path she knew would consume years of her life — she made a bold choice: to spend a year in Germany studying philosophy.

“Philosophy, for me, is another way of seeking truth,” she shares.

When Roth returned to Harvard, she felt invigorated and ready to begin medical school. But during residency, while working in a lab studying proteins and retinal development in mice, doubt crept in.

“I realized this was not the kind of work I wanted to be doing,” she says. “I didn’t want to spend the next 30 to 40 years writing grants to study proteins. It just wasn’t motivating.”

Torn between medicine and philosophy, Roth even considered pausing her medical program — but didn’t. And while she did eventually earn a master’s in the history of science, she waited until after finishing her residency to pursue it.

During her time of uncertainty, a mentor offered a new path: behavioral neurology, a field that examines the mind through neuroscience, blending her passions for discovery and contemplation.  

“What interested me most was this question: How do we think?” she says.

That question led her to work with patients experiencing complete amnesia. They could recall past events but were unable to form new memories. To learn more, Roth took graduate courses on memory systems. These experiences reinforced her desire to translate abstract concepts into meaningful care.

For Roth, the work was never just about data or diagnoses; it was about understanding what it means to be human. Her journey from philosophy to neuroscience taught her that memory is more than biology — it’s the thread that shapes identity.

That pursuit ultimately brought her to UNC-Chapel Hill.

Cognitive clues decoded

In 2002, about five years after completing her neurology residency, Rothcame to Carolina to help start the UNC Memory and Cognitive Disorders Program. As a behavioral neurologist, she treats people with brain conditions that affect their memory and thinking.

 “There’s been a huge shift in the dementia field toward early diagnosis and getting ahead of the processes that cause neurodegeneration,” she explains. “We want to give people who are aging an individualized intervention program for brain health.”

Roth’s patients, typically 50 and older, come into the UNC Aging Brain Clinic because they’re experiencing lapses in their ability to think. They present with a variety of symptoms — changes in speech and personality, difficulty writing or multi-tasking, and shifts in depth perception and sight.

These cognitive impairments can have many causes. Some are a product of more familiar diseases like Alzheimer’s, Parkinson’s, and multiple sclerosis. But others might stem from Lewy body dementia, caused by protein build-up in the brain; multisystem atrophy, when multiple body systems stop functioning properly; or primary progressive aphasia, a language impediment often caused by damage to the left side of the brain.

“I like to see the whole picture,” Roth adds. “Most neurologists tend to define themselves by the specific diseases they study, like multiple sclerosis or epilepsy. But behavioral neurology isn’t focused on one disease. It cuts across conditions and looks at the syndromes that emerge when the brain is injured — especially those that affect thinking, behavior, and psychological function.”

To identify the cause of a patient’s symptoms, Roth and her team at the clinic will perform a neurological examination, scan their brain using MRI, assess biomarkers for different diseases, and run blood tests. They also consider the impact of medications, diet and exercise, and sleep.

“Some people present with cognitive impairments that are non-specific,” Roth says. “For example, someone could present with stuttering and upon looking through their history, we learn sleep has been a problem. So the solution may actually be treatment for insomnia or sleep apnea.”

Personalized care, national impact

Sleep is a vital yet often overlooked component of brain health. At Carolina, Roth has explored numerous topics in this field, from whether one hemisphere of the brain falls asleep before the other to how the sleep cycle influences memory formation. She has also studied insomnia, exploring behavioral interventions that don’t rely on medication and offering promising alternatives for individuals struggling with memory issues.

“One of the reasons I have found sleep so compelling is that sleep interventions can make such a tremendous difference,” she says.

That difference can be profound — studies suggest that up to 45% of dementia risk is tied to modifiable factors, including sleep quality. Roth’s research aims to better understand how these factors interact and how early interventions might delay or prevent cognitive decline.

At the Duke-UNC Alzheimer’s Disease Research Center (ADRC), she leads projects that collect sleep data using questionnaires and actigraphs — wearable devices that track sleep and wake patterns through movement. These studies help assess sleep quality and identify disorders like insomnia and circadian rhythm disruptions.

Beyond sleep, Roth also directs ADRC’s clinical core, overseeing a longitudinal study that aims to identify risk factors for Alzheimer’s disease and other types of dementia across a person’s lifespan.

Her research extends to the national level through a National Institutes of Health project that pulls data from Alzheimer’s Disease Research Centers across the country. The study analyzes PET scans and blood tests from more than 17,000 participants to understand how multiple brain diseases can interact to cause dementia.

By building a more diverse and comprehensive dataset, Roth and her collaborators hope to uncover patterns that lead to earlier, more effective interventions.

“I’ve learned to see the patient not just as a set of symptoms or an MRI scan, but as a person with a story, shaped by their environment and experiences,” she says. “The hope is we can make discoveries that allow us to intervene in the years before the symptoms of Alzheimer’s emerge.”