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Introduction
Additional affiliations
January 2006 - December 2013
January 2003 - December 2004
January 2003 - present
Education
September 1994 - December 1999
Publications
Publications (137)
Background:
The International Psychogeriatric Association (IPA) published a provisional consensus definition of agitation in cognitive disorders in 2015. As proposed by the original work group, we summarize the use and validation of criteria in order to remove "provisional" from the definition.
Methods:
This report summarizes information from th...
Objectives:
To develop an agitation reduction and prevention algorithm is intended to guide implementation of the definition of agitation developed by the International Psychogeriatric Association (IPA).
Design:
Review of literature on treatment guidelines and recommended algorithms; algorithm development through reiterative integration of resea...
Introduction:
Little work has compared the effectiveness of using multiple types of memory tests alone or in combination to distinguish dementia severity in diverse research cohorts including Black individuals and Spanish speakers. Here we evaluate word list and paragraph recall tests to distinguish cognitively normal, mild cognitively impaired, a...
Background:
Little is known regarding healthcare expenditures for patients with dementia with Lewy bodies (DLB) during the end of life.
Objective:
This study estimated Medicare expenditures during the last 5 years of life in a decedent sample of patients who were clinically diagnosed with Alzheimer's disease (AD) or DLB and had autopsy confirmed...
The consensus‐based definition of agitation by the International Psychogeriatric Association (IPA) has not been evaluated in community‐based samples who are not preselected for behavioral disturbances. Here we use a well‐characterized cohort of community‐dwelling older individuals with cognitive impairment to assess the IPA criteria associated with...
Alzheimer's disease (AD) is more prevalent in populations of non‐European ancestry, with Black and Hispanic adults 1.5 and 2.5 times more likely to develop AD respectively. Health disparities in AD could be explained by race and ancestry, where race captures risk factors due to socio‐economic aspects of health and ancestry captures the biological m...
This cohort study analyzes patterns of apathy and functional impairment in patients with progressive severity of behavioral variant frontotemporal dementia.
1. Aims. This randomized control trial compared an adaptive computerized cognitive training intervention with a non-adaptive version. The primary hypothesis predicted better diabetes self-management in type 2 diabetes patients at 6 months post-intervention than baseline, with seven secondary outcomes.
2. Methods. Intent-to-treat analysis of veteran...
Introduction:
This pilot study aims to explore the psychometric properties of the Cognitive Function Instrument (CFI) as a measure of subjective cognitive complaints (SCC) and its performance in distinguishing mild cognitive impairment (MCI) from normal control (NC) compared to an objective cognitive screen (Montreal Cognitive Assessment [MoCA])....
Background
The major aims of the three Predictors Studies have been to further our understanding of Alzheimer’s disease (AD) progression sufficient to predict the length of time from disease onset to major disease outcomes in individual patients with AD.
Objectives
To validate a longitudinal Grade of Membership (L-GoM) prediction algorithm develop...
Preoperative frailty is strongly associated with risks of postoperative delirium. However, gaps exist in targeted recommendations for clinical decision making related to surgical interventions in frail older patients. A case study is presented involving a frail 74-year-old referred to the palliative care team for assistance with clinical decision m...
Background and objectives:
Evaluating and understanding the heterogeneity in dementia course has important implications for clinical practice, healthcare decision-making, and research. However, inconsistent findings have been reported with regard to the disease courses of the two most common dementias, Alzheimer's disease (AD) and Dementia with Le...
OBJECTIVES
Consensus-based definition of agitation by the International Psychogeriatric Association (IPA) has not been evaluated in community-based samples who are not preselected for behavioral disturbances. Here we use a well-characterized cohort of community-dwelling older adults with cognitive impairment to assess the IPA criteria associated wi...
Introduction:
Understanding the relationship between different depression presentations and cognitive outcome may elucidate high-risk sub-groups for cognitive decline.
Methods:
In this study we utilized longitudinal data from the National Alzheimer's Coordinating Center (NACC) on 16,743 initially not demented older adults followed every 12 month...
Background:
Racial/ethnic disparities in anti-dementia medications use in longitudinally followed research participants are unclear.
Methods:
The study included initially untreated participants followed in National Alzheimer's Coordinating Center Uniform Data Set who were ≥65 at baseline with Alzheimer's disease dementia.
Outcomes:
Outcomes fo...
Objective:
Evidence on simultaneous changes in body mass index (BMI) and cognitive decline, which better reflect the natural course of both health phenomena, is limited.
Methods:
We capitalized on longitudinal data from 15,977 initially non-demented elderly from the Alzheimer's Disease Centers followed for 5 years on average. Changes in BMI were...
Racial/ethnic minorities are less likely to use anti‐dementia medications and less likely to participate in dementia studies. It is unclear if treatment disparities remain in those who participate in longitudinal research at Alzheimer’s Disease Centers (ADCs). Data were drawn from the National Alzheimer's Coordinating Center Uniform Data Set (9/200...
Despite the relevance of body mass index (BMI) to the risk of incident cognitive impairments and the subtle but consistent decrease in BMI which accompanies old age, there is limited evidence on the simultaneous changes in BMI and cognitive decline, which better reflect the natural course of both health phenomena. Whether BMI stability contributes...
Background:
Data collection by smartphone is becoming more widespread in healthcare research. Previous studies reported racial/ethnical differences in the use of digital health technology. However, cross-language group comparison (Chinese- and English-speaking older adults) were not performed in these studies. This project will expand to smartphon...
Research increasingly suggests that subjective cognitive complaints (SCC) in cognitively healthy older adults may be a harbinger of cognitive decline and dementia. However, there is virtually no investigation on SCC across language groups (English and Chinese). This study examines SCC in Chinese American older adults who are monolingual Chinese spe...
The relationship between different affective presentations and cognitive outcome is poorly understood and may elucidate subgroups of patients who are more at risk for decline. Here we utilized longitudinal data from subjects ≥ 60 years, enrolled in the National Alzheimer’s Coordinating Center (NACC) study for an average of 5 years and who were not...
Background:
In response to the COVID-19 pandemic, the Alzheimer's Disease Research Center (ADRC) at the Icahn School of Medicine at Mount Sinai began conducting evaluations for the National Alzheimer's Coordinating Center Uniform Data Set (NACC UDS) by telephone in March 2020. The ADRC designed a survey to evaluate participant and research coordin...
Background:
During the spring of 2020, New York was overwhelmed by COVID-19 and older adults as well as ethnic minorities were disproportionately affected. The Alzheimer's Disease Research Center (ADRC) located in East Harlem in New York City, serves a predominantly low income, Latinx community. It was imperative to gauge the impact of COVID-19 on...
An increasing number of identified Parkinson’s disease (PD) risk loci contain genes highly expressed in innate immune cells, yet their role in pathology is not understood. We hypothesized that PD susceptibility genes modulate disease risk by influencing gene expression within immune cells. To address this, we generated transcriptomic profiles of mo...
Objective: This study aims to evaluate the performance of a Chinese version of the Montreal Cognitive Assessment (MoCA) as a screener to detect mild cognitive impairment (MCI) and dementia from normal cognition in the monolingual Chinese-speaking immigrant population. Method: A cohort of 176 Chinese-speaking older adults from the National Alzheimer...
To assess the predictive value of neuropsychological tests for severe dependency in Alzheimer’s disease as defined by the Equivalent Institutional Care Rating Scale, in a multiethnic, community cohort. The sample included 146 elders from the Predictors 3 cohort. Cox proportional hazard models tested the predictive value of each neuropsychological t...
Objectives
This study describes the performance of the Multilingual Naming Test (MINT) by Chinese American older adults who are monolingual Chinese speakers. An attempt was also made to identify items that could introduce bias and warrant attention in future investigation.
Methods
The MINT was administered to 67 monolingual Chinese older adults as...
Background:
Latinx elders are underrepresented in dementia research. In a previous study we assessed research attitudes in urban minority elders and found a significant minority expressed neutral to negative attitudes relating to trust, safety, and personal responsibility to help research.
Objective:
To assess the impact of a composite intervent...
Introduction:
Identifying the course of Alzheimer's disease (AD) for individual patients is important for numerous clinical applications. Ideally, prognostic models should provide information about a range of clinical features across the entire disease process. Previously, we published a new comprehensive longitudinal model of AD progression with...
In March 2020, the novel coronavirus (COVID-19) became a global pandemic that would cause most in-person visits for clinical studies to be put on pause. Coupled with protective stay at home guidelines, clinical research at the Icahn School of Medicine at Mount Sinai Alzheimer's Disease Research Center (ISMMS ADRC) needed to quickly adapt to remain...
Introduction:
Extrapyramidal signs (EPS) are a common feature of Alzheimer's disease associated with worse outcomes in observational studies of dementia. Less research has been conducted on ethnic minority and non-clinic-based populations.
Methods:
One hundred and forty-two multiethnic community-dwelling participants with dementia were selected....
Importance:
There has been a significant increase in the implementation and dissemination of geriatric emergency department (GED) programs. Understanding the costs associated with patient care would yield insight into the direct financial value for patients, hospitals, health systems, and payers.
Objective:
To evaluate the association of GED pro...
Objectives:
This report describes the efficacy and utility of recruiting older individuals by mail to participate in research on cognitive health and aging using Electronic Health Records (EHR).
Methods:
Individuals age 65 or older identified by EHR in the Mount Sinai Health System as likely to have Mild Cognitive Impairment (MCI) were sent a ge...
The US military veteran population receiving care through the Veterans Health Administration (VHA) is particularly susceptible to cognitive impairment and dementias such as Alzheimer's disease and related dementias due to demographic, clinical, and economic factors. In this report we summarize the prevalence of dementia among US veterans and risks...
Introduction:
Understanding of the natural history of apathy and its impact on patient function is limited. This study examines, in a large, national sample of Alzheimer's disease (AD) patients with long follow-ups: (1) prevalence, incidence, and persistence of apathy, and (2) impact of apathy on function across dementia severity.
Methods:
A lon...
Background and Objectives
Many investigators of Alzheimer’s disease and related dementias (AD/ADRD) are unfamiliar with the embedded pragmatic clinical trials (ePCTs) and the indispensable pilot phase preceding ePCTs. This paper provides a much-needed example for such a pilot phase and discusses implementation barriers and additional infrastructure...
Extrapyramidal signs (EPS) are a common feature of Alzheimer's Disease (AD) associated with worse outcomes in observational studies of dementia. Prior studies have been primarily conducted in predominately white, clinic‐based samples. Less is known regarding the role of EPS in the disease course of dementia in ethnic minority and non‐clinic‐based p...
Apathy is a common behavioral symptom of dementia, yet information on its impact dementia is limited. This study examines prevalence, incidence, and persistence of apathy longitudinally. Sample was drawn from the National Alzheimer's Coordinating Center Uniform Data Set (NACC‐UDS) including participants enrolled 9/2005‐5/2019 with at least one foll...
To compare rates of amyloid positivity in non‐Hispanic whites with diverse cohorts including Hispanic, Black, Asian, and other research participants. Participants were enrolled in the ADRC, completed the Unified Data Set (UDS) and underwent amyloid imaging (2011‐2019). Racial and ethnic origin was self‐reported. Referral source and study enrollment...
Dependence has been proposed as a holistic, transparent, and meaningful representation of dementia disease severity to quantify and stage disease progression. Modeling clusters in dependence trajectories can help understand changes over time in the course of dementia and related cost of care. 199 initially community‐living patients with probable AD...
Neuropsychiatric symptoms (NPS) are common early signs of cognitive impairment and dementia. The Mild Behavioral Impairment (MBI) Checklist was created to capture these symptoms. Our objective was to use the MBI to measure NPS in non‐demented normal and MCI research participants and to identify associations among MBI and other established clinical...
Improving clinical diagnostic accuracy and refining criteria is challenging in dementia research. To explore our ADRC’s diagnostic accuracy, a QI project was initiated to identify potential systemic areas affecting our center’s performance. Clinical consensus diagnoses were compared to the neuropathological findings of 68 ADRC brain bank participan...
Mobile technologies are becoming ubiquitous in the world, changing the way we communicate and provide patient care and services. Some of the most compelling benefits of mobile technologies are in the areas of disease prevention, health management, and care delivery. For all the advances that are occurring in mobile health, its full potential for ol...
Objectives:
To evaluate whether allostatic load (AL), a measure of cumulative biological risk, fully or partially mediates observed socioeconomic status (SES) differences in cognitive function in the elderly.
Design:
Cross-sectional mediation analysis.
Setting:
Community-dwelling US elderly who participated in the National Health and Nutrition...
Introduction:
Dependence in Alzheimer disease has been proposed as a holistic, transparent, and meaningful representation of disease severity. Modeling clusters in dependence trajectories can help understand changes in disease course and care cost over time.
Methods:
Sample consisted of 199 initially community-living patients with probable Alzhe...
An increasing number of identified Parkinson's disease (PD) risk loci contain genes highly expressed in innate immune cells, yet their potential role in pathological mechanisms is not obvious. We have generated transcriptomic profiles of CD14+ monocytes from 230 individuals with sporadic PD and age-matched healthy subjects. We identified dysregulat...
Background: Most investigators studying Alzheimer’s disease and related dementias (AD/ADRD) are unfamiliar with embedded pragmatic clinical trials (ePCTs) and pilot studies designed to inform ePCTs. This paper provides a much-needed example for the pilot phase proceeding a nationwide AD/ADRD ePCT, reporting feasibility, applicability, and fidelity...
Objectives:
To estimate effects of dementia on Medicaid expenditures in an ethnically diverse community.
Methods:
The sample included 1,211 Medicare beneficiaries who did not have any Medicaid coverage and 568 who additionally had full Medicaid coverage enrolled in the Washington Heights-Inwood Columbia Aging Project (WHICAP), a multiethnic, pop...
Introduction:
There is an unmet need for effective methods for conducting dementia prevention trials.
Methods:
Home-based assessment study compared feasibility and efficiency, ability to capture change over time using in-home instruments, and ability to predict cognitive conversion using predefined triggers in a randomized clinical trial in (1)...
Objective:
The objective of this study was to examine whether reduced awareness of memory deficits in individuals with dementia is associated with more frequent need for Medicare home health care services.
Methods:
Cross-sectional analyses were conducted in a multicenter, clinic-based cohort. In total, 192 participants diagnosed with dementia an...
Objective:
Apathy is common in Alzheimer disease (AD) and has a far-reaching impact on patients' clinical course and management needs. However, it is unclear if apathy is an integral component of AD or a manifestation of depression in cognitive decline. This study aims to examine interrelationships between apathy, depression, and function.
Method...
Introduction
Human studies on low-dose resveratrol are scarce. This study aims to evaluate the safety, tolerability, and efficacy of an oral preparation of resveratrol, glucose, and malate (RGM) in slowing the progression of Alzheimer's disease (AD).
Methods
Thirty-nine subjects with mild to moderate AD who were free of life-threatening disease an...
OBJECTIVES
To examine how misidentification of dementia affects estimation of Medicare costs in a largely minority cohort of participants for whom accurate in‐person diagnoses are available.
DESIGN
Prospective cohort study.
SETTING
Washington Heights‐Inwood Columbia Aging Project, a multiethnic, population‐based, prospective study of cognitive ag...
Objectives
This study aimed to determine the diagnostic utility of a Chinese test battery for evaluating cognitive loss in elderly Chinese Americans.
Methods
Data from a pilot study at the Mount Sinai Alzheimer’s Disease Research Center was examined. All participants were > 65 years old, primarily Chinese speaking, with adequate sensorimotor capac...
Introduction:
Little is known about factors affecting motivation and satisfaction of participants in dementia prevention trials.
Methods:
A Research Satisfaction Survey was administered to 422 nondemented older adults who participated in the Home-Based Assessment trial.
Results:
Overall satisfaction was high, with means of all individual items...
Background:
The concept of dependence has been proposed as a unified representation of disease severity to quantify and stage disease progression in a manner more informative to patients, caregivers, and healthcare providers.
Methods:
This paper provides a review of the Dependence Scale (DS) as a quantitative measure of Alzheimer's disease sever...
Introduction:
While individuals live with dementia for many years, utilization and expenditures from disease onset through the end-of-life period have not been examined in ethnically diverse samples.
Methods:
We used a multiethnic, population-based, prospective study of cognitive aging (Washington Heights-Inwood Columbia Aging Project) linked to...
Objectives:
To examine the effect of an emergency department (ED)-based transitional care nurse (TCN) on hospital use.
Design:
Prospective observational cohort.
Setting:
Three U.S. (NY, IL, NJ) EDs from January 1, 2013, to June 30, 2015.
Participants:
Individuals aged 65 and older in the ED (N = 57,287).
Intervention:
The intervention was...
Background:
Subjective cognitive complaint is a sensitive marker of decline.
Objective:
This study aimed to (1) examine reliability of subjective cognitive complaint using the Cognitive Function Instrument (CFI), and (2) assess the utility of the CFI to detect cognitive decline in non-demented elders.
Methods:
Data from a four-year longitudina...
Background:
Diabetes is a risk factor for the development of cognitive impairment and possibly for accelerated progression to Alzheimer disease (AD) and other dementias, though the trajectory of cognitive decline in general and in specfic cognitive domains by diabetes is unclear.
Methods:
Using the National Alzheimer's Coordinating Center's Unif...
Introduction:
Informant report of symptoms is essential for diagnosing and characterizing Alzheimer disease (AD). Differences in the perception and experience of dementia across ethnicities may influence informant report. Understanding such differences is critical given that among those with AD, Hispanics are disproportionately affected.
Methods:...
Background/Study Context: Magnetic resonance imaging (MRI) markers of cerebrovascular disease and atrophy are common in older adults and are associated with cognitive and medical burden. However, the extent to which they are related to health care expenditures has not been examined. We studied whether increased Medicare expenditures were associated...
Objective:
Examine caregiver and care recipient healthcare costs associated with caregivers' participation in Resources for Enhancing Alzheimer's Caregivers Health (REACH II or REACH VA) behavioral interventions to improve coping skills and care recipient management.
Design:
RCT (REACH II); propensity-score matched, retrospective cohort study (R...
Background:
Few studies have examined how dementia and comorbidities may interact to affect healthcare expenditures.
Objective:
To examine whether effects of dementia severity on Medicare expenditures differed for individuals with different levels of comorbidities.
Methods:
Data are drawn from the Washington Heights-Inwood Columbia Aging Proje...
Disordered awareness of memory loss (i.e., anosognosia) is a frequent and clinically relevant symptom of Alzheimer's disease (AD). The metacognitive errors which characterize anosognosia in AD, however, have not been fully articulated. The current study examined metamemory performance as a function of clinically defined awareness groups using diffe...
Objective:
To compare the effectiveness of two "treatments"-early, intensive home health nursing and physician follow-up within a week-versus less intense and later postacute care in reducing readmissions among heart failure (HF) patients discharged to home health care.
Data sources:
National Medicare administrative, claims, and patient assessme...
Disclosure of dementia diagnosis to patients is not universal, in part due to family concerns about patient quality of life. The extent to which such disclosures are associated with patient healthcare outcomes is unknown. The current study examines the association of dementia diagnosis disclosure in relation to the Medicare based health care utiliz...
Few studies have examined patterns of health care utilization and costs during the period around incident dementia.
Participants were drawn from the Washington Heights-Inwood Columbia Aging Project, a multiethnic, population-based, prospective study of cognitive aging of Medicare beneficiaries in a geographically defined area of northern Manhattan....