December 18, 2023—(BRONX NY)—Neurologists often diagnose Alzheimer’s disease after evaluating patients during lengthy, in-person office visits. This poses a significant challenge for many groups, particularly people with limited access to specialized care, including people from historically marginalized groups and people living in rural areas.
Albert Einstein College of Medicine has received a five-year, $10.9 million grant from the National Institutes of Health (NIH) to study whether remote neuropsychological testing can substitute for in-person office visits when assessing whether people have Alzheimer’s disease or other dementias.
“In-person assessments are the gold standard when it comes to measuring cognitive impairment in clinical practice and in research studies of Alzheimer’s disease,” said Richard B. Lipton, M.D., a multi-principal investigator on the grant, vice chair of neurology at Einstein and Montefiore Health System, and director of the Einstein Aging Study (EAS), the long-running study of normal brain aging and dementia in Bronx residents. “However, valid alternatives are urgently needed in situations where in-person assessment is not feasible.”
According to the Alzheimer’s Association, 6.7 million Americans over 65 are living with Alzheimer’s disease, and the number may grow to a projected 12.7 million by 2050, barring medical breakthroughs. Twenty U.S. states are considered “dementia neurology deserts,” with fewer than 10 neurologists per 10,000 people with dementia.
And thanks to the ethnic and racial diversity of our study participants, our results should lead to a better understanding of disparities in Alzheimer’s disease and related dementias, which in turn will have implications for intervening in and for monitoring disease progression in future studies.
Richard B. Lipton, M.D.
In their NIH-funded study, Dr. Lipton and colleagues will compare in-person to remote evaluation of older adults with the goal of refining and validating a set of remote-testing methods referred to as the Remote Cognitive Aging and Alzheimer’s Disease REsearch (R-CARE) Toolbox. The study’s participants will be 600 dementia-free, racially and ethnically diverse Bronx residents (200 non-Hispanic Blacks, 200 Hispanics, and 200 non-Hispanic whites) aged 65 and older. At the start of the study, all participants will undergo comprehensive assessments for cognitive and functioning abilities both in-person and remotely, with a 2-to-6-week interval between the two testing modes.
Following baseline testing, participants will be followed with in-person and remote assessments, at 18 and 36 months. Digital biomarkers for dementia (computerized tests and speech-based biomarkers) will be collected during remote assessments, and blood-based dementia biomarkers (amyloid beta and phosphorylated tau, for example) will be collected from all participants.
“Although the study participants are drawn from an urban population, we’re confident that our findings regarding remote cognitive testing will apply to the millions of people in rural areas who lack access to in-person testing,” said Dr. Lipton, who is also professor in the Saul R. Korey Department of Neurology, of psychiatry and behavioral sciences, of epidemiology & population health and is the Edwin S., Lowe Chair in Neurology at Einstein and a clinical neurologist at Montefiore. “And thanks to the ethnic and racial diversity of our study participants, our results should lead to a better understanding of disparities in Alzheimer’s disease and related dementias, which in turn will have implications for intervening in and for monitoring disease progression in future studies.”
The other principal investigators on the grant are Ali Ezzati, M.D., adjunct clinical assistant professor in The Saul R. Korey Department of Neurology at Einstein and associate professor of neurology at the University of California, Irvine School of Medicine; and Laura Rabin, Ph.D., visiting research professor in The Saul R. Korey Department of Neurology at Einstein. Mindy Katz, M.P.H., senior staff scientist in The Saul R. Korey Department of Neurology, will play a key role as a co-investigator. The grant, “Validation of the Remote Cognitive Aging and Alzheimer’s Disease REsearch (R-CARE) Toolbox for Diverse Populations,” is funded by the National Institute on Aging, part of the NIH. (1R01AG080635-01A1)