To help address the rising tide of Alzheimer's disease nationwide, researchers at Albert Einstein College of Medicine in collaboration with faculty at Pennsylvania State University and other institutions, have received a five-year, $32 million grant from the National Institutes of Health (NIH) to support the ongoing Einstein Aging Study (EAS), which focuses on both normal aging and the special challenges of Alzheimer's disease, and other dementias. EAS was established at Einstein in 1980 and has been continuously funded by the NIH.
"In our fifth decade of the Einstein Aging Study, we are well-positioned to build on our earlier findings to identify ways to delay the onset and progression of Alzheimer's disease," said Richard Lipton, M.D., who has led or co-led the study since 1992 and is the Edwin S. Lowe Professor of Neurology, professor of psychiatry and behavioral sciences, and of epidemiology & population health. He is also the vice chair of neurology at Einstein and Montefiore Health System.
Along with Dr. Lipton, the renewal is led by Carol Derby, Ph.D., research professor in the Saul R. Korey Department of Neurology and in the department of epidemiology & population health, and the Louis and Gertrude Feil Faculty Scholar in Neurology at Einstein. Dr. Derby has been a project leader on the EAS for over a decade. The leadership team also includes Orfeu Buxton, Ph.D., the Elizabeth Fenton Susman Professor of Biobehavioral Health at Pennsylvania State University.
The burdens and inequities of dementia
In the United States, more than one-third of people over the age of 85 have Alzheimer's, the fifth-leading cause of death among people age 65 and older. Some 6.5 million people over 65 have the disease today-;a number predicted to edge closer to 13 million by 2050.
As with many diseases and health conditions, racial and ethnic inequities are associated with Alzheimer's. "Black Americans are about twice as likely to develop Alzheimer's than their white counterparts, and Hispanics are also at increased risk for the disease," said Dr. Lipton. "In addition, diagnosis is often delayed in these historically marginalized communities. We need to do better and find ways to address these disparities."
The EAS has studied more than 2,500 Bronx residents age 70 and older. It is uniquely positioned to examine factors related to inequalities, thanks to the diversity of its participants. Currently, 40% are non-Hispanic Black, 46% are non-Hispanic white, and 13% are Hispanic.
"One of our study's aims is to examine how social forces contribute to the inequities in cognitive health," said Dr. Derby. "It is critical that we examine how race, ethnicity, neighborhood conditions, and discrimination are risk factors for cognitive decline and Alzheimer's disease."
Tapping into technology
For the past five years, the EAS has taken advantage of mobile technology to gain unprecedented insights into the aging brain.
"In the past, we assessed cognition exclusively through in-person tests in our clinical laboratory. By giving our study participants smartphones, we're able to measure cognitive performance directly as they engage in everyday activities in the community."
Mindy Joy Katz, M.P.H., senior associate, Saul R. Korey Department of Neurology at Einstein and the EAS project coordinator
The new grant will allow EAS investigators to follow more than 700 Bronx adults over the age of 60 who live at home. Each study participant will be given a customized smartphone for two weeks each year. The device will alert them multiple times a day to answer questions about their daily experiences and state of mind and to play games that measure their cognition.
During this two-week period, participants will also wear devices that monitor their physical activity, sleep, blood sugar levels, and measure air pollution and other environmental conditions. Researchers will use this data to determine how risk factors influence short-term and long-term cognitive function. They will also assess genetic risk factors and blood-based biomarkers to clarify the pathways that link risk factors to cognitive outcomes and the development of Alzheimer's disease.
Taking frequent measurements over many days rather than isolated lab readings "gives us a truer sense of a person's cognitive [thinking] abilities and how those abilities change from day to day, in the course of their daily lives," Ms. Katz said. "These methods have also allowed us to follow people throughout the pandemic, when in-person visits were not safe."
Ultimately, the goal of the study is to identify the factors that lead to poor cognitive outcomes for each individual and then, if possible, to modify those risk factors to prevent dementia from developing. "We know that there are a range of factors-;medical, social, behavioral, environmental-;that contribute to developing Alzheimer's," said Dr. Derby. "By teasing out each person's individual experiences, we hope to one day provide custom therapies that will help people maintain brain health and stay cognitively healthy well into their later years."
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