A Honolulu Neurologist and Architect Are Tackling Brain Health

A multidisciplinary team led by a Honolulu architect and neurologist is creating research-backed solutions to help individuals of all ages improve their brain health.

The Brain Health Applied Research Institute, also known as B+HARI, hopes to translate research and insights from neuroscience, longevity studies, oceanography, culinary pursuits, farming, Hawaiian cultural practices and other fields into accessible lifestyle adjustments.

The organization was founded by Dr. Kazuma Nakagawa, chief of The Queen’s Medical Center’s Neuroscience Institute, and Ma Ry Kim, a partner at Honolulu architecture firm G70 and CEO of design and development company I-ON Group. B+HARI is a project of the I-ON Group.

B+HARI’s work includes designing environments meant to encourage certain neurological responses and neuroplasticity, understanding the science behind the healing power of Hawaiian chanting, and promoting brain health through art.

“B+HARI can fit right there, overlapping with academic health care, so we actually incorporate the science, we understand the science, and then distill it to make something that’s actionable” and can be translated into something that can be done at home, Nakagawa says.

The institute also plans to build a 250,000-square-foot brain care campus on O‘ahu. Revenue from the campus will fund the nonprofit research side of the organization, and Nakagawa and Kim hope the campus can help to diversify the state’s economy.

“We’ve spent so much time watching the outside come in, and then all the money go off the island,” Kim says. “We’re trying to create a scenario where we create something so delicious that all of the money from around the world will come into Hawai‘i and very little of it will leave.”

Unlikely Partnership

Kim has been on a 13-year journey to better understand the brain’s capabilities after her youngest son, a fraternal twin, was born full-term with a broken umbilical cord. He weighed a mere pound but his brain, heart and lungs were fine.

She met Nakagawa in 2019 after one of her aging relatives in a memory care facility experienced cognitive improvement upon moving to a Buddhist monastery. Kim was captivated by the idea that one’s environment could positively influence brain health. She and Nakagawa began researching and brainstorming lifestyle modifications, and Kim’s father became their first student after he had a stroke.

In Hawai‘i, 1 in 4 residents are 60 and older, and roughly 25,000 individuals 65 and older are living with Alzheimer’s, the most common form of dementia, according to the 2023-2027 Hawai‘i State Plan on Aging. About 5,000 traumatic brain injuries and 3,000 strokes occur in the Islands each year, according to the state Health Department.

Scientists for decades have researched how the brain can adapt and grow from experiences and learning. Yet, Nakagawa and Kim saw that the health care sector was limited in getting people to be more proactive about their health. They decided to create an approach that delivers brain science in digestible and accessible ways.

“It may be changes in urban planning, it may be changing the architecture, changing the way we design our gyms and restaurants and concerts and all these things,” Nakagawa says. “They have a much bigger impact on people’s health and brain health than people like me, lecturing people, ‘Hey, you should do this.’ ”

Courtesy: Ma Ry Kim | Neurologist Dr. Kazuma Nakagawa and architect Ma Ry Kim co-founded the Brain Health Applied Research Institute.

Their organization’s abbreviated name, B+HARI, stems from “hari,” the Sanskrit word for “the sun.” Kim says the idea is to act like the sun and bring light to darkness.

In addition to Nakagawa and Kim, B+HARI’s core team includes a cultural director and a chef; an internist, an agronomist, an oceanographer; a Hōkūle‘a navigator; and a professional athlete. The team will apply research from the Global Brain Care Coalition, which is made up of the world’s leading academic medical centers dedicated to reducing the number of dementia, stroke and depression cases. It was founded earlier this year by Dr. Jonathan Rosand, a neurology professor at Harvard Medical School and co-founder of Massachusetts General Hospital’s McCance Center for Brain Health.

“Hawai‘i is not usually seen as the academic trailblazers in this brain space, but we are because we have all the heavy hitters in brain health research,” Kim says.

Feel First, Learn Later

It sounds simple, but watching the sun rise helps set your body’s circadian rhythm and encourages your brain to
be less self-critical, Kim says. Likewise, exposing yourself to cold air or jumping into the ocean in the morning increases your brain’s sensitivity to endorphins and helps with attention and focus for the day.

B+HARI’s motto is “feel first, learn later.” Nakagawa says: “Instead of saying ‘go and do exercise,’ we’ll focus on creating a venue and environment, social networks, so that people want to do this, not for their health, but just because it’s fun, it’s meaningful, whatever the reason, and later say, ‘Hey, that hula session did this to your body.’ ”

B+HARI is working on several projects to create and implement its brain health solutions. One is a partnership with the Honolulu Museum of Art, where Kim and Nakagawa are the first scholars-in-residence. They’ll spend the year working with the museum’s staff to conduct research and create a program that promotes brain health through art making.

Halona Norton-Westbrook, director and CEO of HoMA, says many museums are looking at how they can enhance the wellness of their audiences. She adds that she loves that B+HARI’s partnership empowers people of all ages to take control of their brain health, rather than waiting until there’s a problem.

Another B+HARI project aims to investigate how one’s voice can help rewire the brain through singing, vibrations and frequencies. Manaola Yap, B+HARI’s cultural director, will record himself chanting in Hawaiian and using traditional implements at Abbey Road Studios in London. Kim says the hope is that the partnership will enable the studio to respectfully learn about Hawaiian music and sound and help expand Hawaiian music’s reach across the world.

Yap says that people often get chicken skin when they hear chanting, even if they don’t know the Hawaiian language or culture. That means the body is reacting to some kind of vibration and intention, he says.

“One of our main focuses for Manaola Group is … the perpetuation of culture through purpose-driven practice, so when we look at purpose-driven practice and the need for brain health and well-being, this is just such an honor, and we’re just really, really blessed to be amongst all these brilliant minds and being able to bring our heritage to the forefront of these projects and really looking at how Hawai‘i on a broader scope can help bring healing to the world,” he says.

Design can also activate certain brain responses. B+HARI is exploring what a neuroscience-based play space could look like at Assets School, an independent school in Honolulu that focuses on gifted and dyslexic children. Ryan Masa, head of Assets School, says the new play space will replace the K-8 campus’s beloved community-designed playground, a wooden setup built 25 years ago.

The design, which is still being finalized, will incorporate elements that promote neuroplasticity and prime students for learning and other mental states. For example, the swaying motion of a hammock can activate the brain’s default mode network, which slows things down, Kim says.

Brain Care Campus

B+HARI plans to build a net-zero-energy campus on O‘ahu, with a culinary institute, a fitness center, an agroforestry farm, cultural activities, at least 200 guest rooms and, potentially, long-term rentals for seniors. Kim says the campus will be open to both community members and Hawai‘i visitors.

The grounds and buildings will be designed so that simply being there could improve one’s brain health, Kim says. For example, guest-room designs will encourage overnight guests to decompress and disconnect after a day of learning. Quality sleep helps the brain rid itself of a metabolic waste product that has been linked to Alzheimer’s, she adds.

Courtesy: Ma Ry Kim | The Brain Health Applied Research Institute plans to build a 250,000-square-foot brain care campus on O‘ahu. It will include a culinary institute, fitness center, agroforestry farm, cultural activities and at least 200 guest rooms.

The campus will surround an agroforestry farm filled with some of the lā‘au lapa‘au (Hawaiian medicine) crops that once grew there. Part of guests’ stays will include working on the farm and walking along a 1-kilometer circular walking path: Research shows that walking in circles increases relaxation, and Kim says such walkways are often built in hospitals and senior homes.

Garrett Kam, who handles procurement and sourcing for I-ON Group, says the campus puts culture at the forefront. Action spots will be scattered throughout the grounds where guests can focus on the healing powers of the sun, water and other natural elements, and learn about Hawaiian culture.

“You have wellness retreats, you have care centers for people who have brain injuries, but ours will be the first to be based in culture … and scientific research and data,” Kam says.

The culinary institute will have menus that support brain health, chef Jeffrey Vigilla says. And he’ll teach guests to replicate the meals at home using local ingredients.

“If we really want to make a public health impact and move the marker, we have to create programs that anyone can do in their home, no matter how much money or where they are in the world,” Kim says. “It’s an incredibly humanistic approach to public health that’s equitable.”

New Model

Kim says the goal is to open the first phase of the institute in 2027. Highgate is B+HARI’s capital partner and will run the hospitality portion of the campus.

Says Kelly Sanders, president of Highgate’s Hawai‘i group: “We think this is just such a brilliant opportunity to help people that want to learn the potentials of avoiding not just Alzheimer’s and dementia … (but) head trauma overall. … To be able to partner with great, smart individuals that really just want to take care of the world at large is something that I think Highgate believes in and is very interested in working with the group to bring this to life.”

Sanders says there’s been a lot of discussion around Hawai‘i’s dependence on tourism, specifically leisure hospitality, but the state has not looked at medical tourism.

In the future, Kim says B+HARI hopes to build two additional agricultural-based learning centers, one near the mountains and one near the sea.