December 8, 2022

$11M NIH grant will support evaluation of Alzheimer’s screening tool in primary care settings

Joe Verghese, MD, and Malaz Boustani, MD

Researchers Led by Albert Einstein College of Medicine, Montefiore Health System, Regenstrief Institute, and IU School of Medicine Will Evaluate Test in Urban and Rural Communities

Investigators at Albert Einstein College of Medicine, Montefiore Health System, Regenstrief Institute, and Indiana University School of Medicine have received an $11 million grant from the National Institutes of Health (NIH) to evaluate an Einstein-developed test for assessing cognitive impairment and dementia. The 5-minute screening tool was designed for people from a range of racial and ethnic backgrounds, education levels and socioeconomic circumstances with the goal of reducing disparities in pre-dementia and dementia diagnosis and treatment and improving dementia care overall.

“With Alzheimer’s becoming increasingly common, we must find a way to involve more physicians in diagnosing the disease and its precursor conditions and directing people to the appropriate care and supportive services,” said Joe Verghese, M.B.B.S., M.S., principal investigator on the grant and chief of the unified divisions of geriatrics in the department of medicine and cognitive & motor aging in the Saul R. Korey Department of Neurology at Einstein and Montefiore.

The Rising Tide of Alzheimer’s
According to the Alzheimer’s Association, 6.5 million Americans older than 65 are living with Alzheimer’s disease, and the number is expected to rise to 12.7 million by 2040. But not all people are equally affected: 19% of African Americans and 14% of Hispanics age 65 and older are diagnosed with Alzheimer’s, compared to 10% of whites. Despite this, Black participants in Alzheimer’s disease research studies were 35% less likely to be diagnosed than white participants and were diagnosed with more severe symptoms.

Traditionally, neurologists diagnose Alzheimer’s or its precursor, mild cognitive impairment (MCI), after a lengthy evaluation. This poses a significant challenge for many groups: people with limited access to specialized care (including people from historically marginalized groups) as well as people living in poverty, in rural areas, or who require a referral from a primary care physician who may not recognize their symptoms.

“Primary care physicians are on the front lines of caring for those with dementia, but it is challenging for them to make diagnoses—in fact, more than 50% of dementia cases are missed during primary care appointments,” said Malaz Boustani, M.D., M.P.H., co-principal investigator on the grant and the founding director of the Center for Health Innovation and Implementation Science at the IU School of Medicine. “The 5-Cog screening paradigm seeks to address this challenge by providing a tool that does not require special equipment or training, is inexpensive, available in English and Spanish, and takes only five minutes.” He also is a research scientist at Regenstrief Institute.

A Novel Test
The 5-Cog assessment involves a picture-based memory-impairment screening test, a short picture-based symbol match, and confirmation that a patient has cognitive complaints and problems with mobility. Previous research has found that the image-based assessment effectively negates influences resulting from a person’s preferred language, education level, and gender. Having previously validated the 5-Cog assessment at one clinical site, the researchers will now evaluate the test in real-world primary care settings.

The study will enroll 6,600 participants presenting with cognitive concerns in 22 primary care clinics in the Bronx and Indiana. Primary care teams will be prompted to give the assessment by the electronic medical record system. Responses will be automatically classified as “normal” or “abnormal” based on results, and care teams will be provided with a decision tree to ensure patients receive appropriate follow-up care and support.

“Earlier diagnosis and treatment of dementia and MCI may enable people to remain in their homes longer and will help families make appropriate plans,” said Dr. Verghese. “It also gives people the opportunity to modify their lifestyle to improve the trajectory of their disease.”

5-Cog Battery to improve detection of cognitive impairment and dementia,” is funded by the National Institute of Neurological Disorders and Stroke, part of the NIH. The team also includes Emmeline Ayers, M.P.H., at Einstein; Nicole Fowler, Ph.D., M.H.S.A., Paul Dexter, M.D., both of Regenstrief and IU School of Medicine; Rich Holden, Ph.D., M.S., Regenstrief and Indiana University School of Public Health-Bloomington; and Sujuan Gao, Ph.D., IU School of Medicine.

About Albert Einstein College of Medicine
Albert Einstein College of Medicine is a research-intensive medical school. For more than 60 years, the diverse faculty and staff have set the standard for excellence in medical and graduate education and patient-centered clinical care and have made major contributions to scientific research enhancing human health in their communities and beyond. Their mission is to prepare a diverse body of students to become knowledgeable, compassionate physicians and innovative scientific investigators, and to create new knowledge. Einstein is affiliated with both Montefiore Health System and Yeshiva University.

About Montefiore Health System
Montefiore Health System is one of New York’s premier academic health systems and is a recognized leader in providing exceptional quality and personalized, accountable care to approximately three million people in communities across the Bronx, Westchester, and the Hudson Valley. It is comprised of 10 hospitals, including the Children’s Hospital at MontefioreBurke Rehabilitation Hospitaland more than 200 outpatient ambulatory care sites. The advanced clinical and translational research at its medical school, Albert Einstein College of Medicine, directly informs patient care and improves outcomes. From the Montefiore-Einstein Centers of Excellence in cancer, cardiology and vascular care, pediatrics, and transplantation, to its preeminent school-based health program, Montefiore is a fully integrated healthcare delivery system providing coordinated, comprehensive care to patients and their families. For more information, please visit Follow us on Twitter and Instagram and LinkedIn, or view us on Facebook and YouTube.

About Regenstrief Institute
Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. A key research partner to Indiana University, Regenstrief and its research scientists are responsible for a growing number of major healthcare innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the globe.

Sam Regenstrief, a nationally successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making healthcare more efficient and accessible for everyone. His vision continues to guide the institute’s research mission.

About IU School of Medicine
IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability.

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