$11 Million NIH Grant Will Support Evaluation of an Einstein-Developed Alzheimer’s Screening Tool in Primary Care Settings in the Bronx and Indiana

Investigators at Montefiore Einstein, Regenstrief Institute and Indiana University School of Medicine 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 grant will be used to conduct a clinical trial that will recruit 6,600 participants from 22 primary care sites in the Bronx and Indiana. The goal is to improve the diagnosis of mild cognitive impairment (MCI) and dementia as well as to raise the level of care for cognitively impaired patients.

The five-minute screening tool was designed to reduce disparities in pre-dementia and dementia diagnosis and treatment. It was developed to be used on people from a range of racial and ethnic backgrounds, education levels and socioeconomic circumstances.

“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, MBBS, MS, Chief, Unified Divisions of Geriatrics, Department of Medicine, and Cognitive & Motor Aging, Saul R. Korey Department of Neurology, and Professor, Neurology and Medicine, Montefiore Einstein, and the principal investigator on the grant.

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, 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.

“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,” said Malaz A. Boustani, MD, MPH, Founding Director, Center for Health Innovation and Implementation Science, Indiana University School of Medicine, and co-principal investigator on the grant. 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.

During the clinical trial, primary care teams will be prompted to give the assessment by the electronic medical record system. Responses will be classified automatically 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.

“It also gives people the opportunity to modify their lifestyle to improve the trajectory of their disease,” said Dr. Verghese.

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, MPH, Albert Einstein College of Medicine; Nicole Fowler, PhD, MHSA, and Paul Dexter, MD, both of Regenstrief and Indiana University School of Medicine; Richard Holden, PhD, MS, Regenstrief and Indiana University Bloomington School of Public Health; and Sujuan Gao, PhD, Indiana University School of Medicine.