Mind, Matter, and Movement: Studying the Intersectionality of Risk Factors in Age-Related Cognitive Decline: A Profile of Dr. Joe Verghese

When asked about what inspired him to pursue a career in medicine, Dr. Joe Verghese jokingly recalls that growing up in Kozhikode, India, you had two options: if you were good at math, you became an engineer and ultimately a CEO of a big tech company. If you were not at the top of your class in math, then you went into medicine. Full disclosure: Dr. Verghese is good at math.

Joe Verghese

Joe Verghese, M.D.

Clearly when speaking with him, his demeanor, intellect, and compassion make him the ultimate physician-researcher: One that has the utmost respect for patients and a drive to discover new ways to make their lives better through scientific investigation. In his case, the study of the brain and aging.

Dr. Verghese is the former chief of the department of medicine's division of geriatrics (recently succeeded by Dr. Amy Ehrlich after more than a decade at the helm), director of cognitive and motor aging in the department of neurology, and director of the Resnick Gerontology Center at Einstein, among other things.

He has received numerous awards and grants, including the prestigious Beeson Award from the National Institute on Aging, and recently an $11 million grant from the National Institutes of Health (NIH) to evaluate a 5-minute test he developed for assessing cognitive impairment and dementia. The test is designed for historically marginalized and medically underserved populations with the goal of reducing disparities in pre-dementia and dementia diagnoses and improving care.

Stepping down as division chief, Dr. Verghese will concentrate on expanding his Alzheimer and related dementia research – both locally and globally – which includes an NIH-funded portfolio of more than $20 million to support epidemiological and clinical translational studies as well as non-pharmacological interventions. He will also continue his research mentoring and career development activities within the division of geriatrics and other department of medicine and neurology divisions and will be clinically involved with the Montefiore Einstein Center for the Aging Brain.

We were fortunate to speak with him about his career and the changes he has seen in his area of medicine.

Why did you choose to focus on the brain and, later, aging?

Of all the fields I was exposed to in medical school, the one that captivated me most was neurology. I found it fascinating that even minor damage or impairments to the brain could have such profound effects – from changes in cognition to personality to mobility and how one might inform the other. For example, traditionally gait was considered something outside of the brain. The connection with the brain at the time wasn't clear. Now through our research we know that gait is an indicator of cognitive health. Gait and cognitive dysfunction often go hand-in-hand and is common in neurological diseases.

Later, when I was training in the UK, I was posted to geriatrics, which was my first real exposure to treating only older patients. And that spurred my interest in aging issues. Combined with my interest in the brain, it was a natural fit for me to specialize in neurology and geriatrics.

What are the goals of your research?

I am interested in how the brain influences how the body functions. My interest in general has been to identify people with cognitive deficits as early as possible so that we can intervene and reduce the risk of them transitioning to a more severe stage of dementia. These are people experiencing mild and subtle changes like difficulty with language, planning things, forgetting appointments, or managing finances. They are so subtle that they may not be caught by primary care physicians.

Relatedly, we recently completed a clinical trial – a 5-minute test that not only serves as a detection tool for cognitive impairment but also comes with a set of recommendations to guide primary care physicians on next steps in care. The results of the study – conducted in the Bronx – and funded by the NIH, have been promising. So promising that the NIH has funded a follow up clinical trial that will include the Bronx as well as other sites in Indiana. Our paper is under review so stay tuned for more details.

What changes have you seen in your field?

I have seen tremendous changes during my life as a doctor in the treatment of older adults. When I started, there really wasn't a focus on the different needs of older adults versus middle-aged adults. They were mostly treated the same. There wasn't an appreciation that there's a whole different physiology and pathology that affects patients later in life.

The biology in the way the body's systems act is different later in life so different medical interventions are warranted. At the time, there was also a reluctance to do interventions because of the assumption that diseases and disorders older adults presented with were just a “normal” part of aging. We have a totally different clinical world view now.

While the field of geriatrics has been around for 100 years, it has only gained its own identity – especially in the U.S. – in the last 30 to 40 years. Textbooks are devoted to it, medical students are exposed to it, and specific medication management guidelines have been created. Clinicians now realize that older people can't be treated exactly the same way as younger people. There are different approaches and some of it does involve not over-treating but also the understanding that treatment has to vary.

It seems like there are a lot more people with dementia. Is it because people are living long enough to develop cognitive disorders or that some of us are at the age where we are caring for aging parents so that we are more sensitive to it? How does this compare with other countries?

There is clearly an increase in age-related or associated diseases like dementia. However, some medical studies are reporting that the incidence of dementia is actually decreasing. But because the population is increasing, especially the older population, the absolute numbers of dementia cases are going up so it is clearly a big issue. I think in the U.S. we are more aware of it.

In my hometown in India, it has only been recently, with the release of movies depicting cognitive decline, that many citizens have become aware of and more concerned about Alzheimer's disease, which also aligns with the overall aging of the Indian population (equal to the entire population of the U.S.)

The NIH supports a dementia study I have been conducting in the south of India for the last 12 years and when we began the study, there was clearly a lack of awareness about Alzheimer's and dementia. When we held a press conference informing people about our research, we ended up spending most of our time explaining what Alzheimer's disease was. Journalists had a limited understanding of a disease that affects millions of people in India and worldwide. Now when I go back to India, people are a lot more informed and want to know what we, as clinicians and researchers, are doing about it.

So there has definitely been a shift.

The other place I have done work is in Japan, which is considered a “super aging society” because of the large number of centenarians. There is a hyper awareness of Alzheimer's and other diseases of aging and more of an imperative to come up with interventions and ways to deal with aging issues. This affects not just the health of the Japanese people, but society as whole. There is an economic impact to an aging society.

Final thoughts?

There are many positives about growing older. People are living longer, working longer, and leading productive lives. Older adults are contributing in many ways.

For those of us caring for older adults, we want to ensure more people live longer as healthy as possible.