Neurologist’s Three Papers Provide Tools for Maintaining Brain Health and Addressing Alzheimer’s, Dementia Risk

A University of Miami Miller School of Medicine neurologist has written three papers on innovative screening tools to help clinicians assess brain health, identify risk of Alzheimer’s disease and related dementias (ADRD), and address the social determinants of brain health and root causes of disparities in health outcomes for older adults from diverse communities.

“While all physicians can diagnose mild cognitive impairment [MCI] and ADRD, it is much more difficult to assess the status of brain health and identify those at risk for future impairment,” said James E. Galvin, M.D., M.P.H, professor of neurology and director of the Miller School’s Comprehensive Center for Brain Health.

“We have developed and validated novel clinical tools to quantify brain health, identify risk factors for MCI and ADRD, and address health disparities,” he added. “This is a major step forward in developing personalized, precision medicine-like interventions for the primary prevention of MCI and ADRD and treating the symptoms and slow or halt progression of MCI and ADRD more effectively.”

With three recently published groundbreaking studies, Dr. Galvin is leading the way in quantifying the risk of ADRD at an early stage, and providing guidance to physicians, as well as individuals and family members concerned about a loved one.

“Our research indicates that risks appear to be lower in individuals who are physically and cognitively active, socially engaged, practice mindfulness, have higher educational attainments and eat a healthy diet,” Dr. Galvin said. “But there is no one-size-fits-all regimen, so interventions need to be tailored based on the results of a personalized risk profile and cognitive assessment.”

For instance, what amount and type of exercise would be most beneficial to an individual at risk for ADRD? Should an individual’s diet be modified to ensure good nutrition?

“We need to consider a patient’s lifestyle and behaviors, as well as appropriate medications, in developing an effective program for maintaining brain health,” Dr. Galvin said.

Studying Diversity

As the U.S. population becomes older and more diverse, Dr. Galvin, drawing on $34 million in grants from the National Institutes of Health (NIH), is examining the differences in ADRD risks and protective factors between men and women, whites and Blacks, Hispanics and non-Hispanics, and indigenous populations.

“A multicultural research approach that includes underlying medical and social determinants is essential for helping us gain a better understanding of the root causes of the disease,” said Dr. Galvin, who was the lead author of a study, “Medical and Social Determinants of Brain Health and Dementia in a Multicultural Community Cohort of Older Adults,” published recently in the Journal of Alzheimer’s Disease.

Early diagnosis and access to care is particularly important for Blacks and Hispanics, who have a substantially higher risk of ADRD compared with whites, according to Dr. Galvin.

“All older adults should have access to quality care and appropriate treatment, regardless of race, ethnicity or socio-economic status,” he said. “Improved engagement with primary care providers and health systems can improve delivery of care and medical decision-making leading to better health outcomes.”

Assessing Vulnerability

Dr. Galvin has also developed a new Vulnerability Index (VI) to help clinicians assess the risk of ADRD. He and Michael J. Kleiman, Ph.D., a post-doctoral data scientist in his laboratory, were co-authors of study, “The Vulnerability Index: A Weighted Measure of Dementia and Cognitive Impairment Risk,” published in the journal Alzheimer’s & Dementia.

Dr. Galvin identified 12 factors associated with an increased risk of developing cognitive impairment, including age, biological sex, race and ethnicity, years of education, obesity, frailty and depression.

Around 60% of the factors contributing to Alzheimer’s disease, including age and genetics, cannot be modified. “However other factors can be addressed by older adults and their physicians, lowering their overall score on the Vulnerability Index,” said Dr. Galvin. “We believe this new assessment tool will help older adults lower their risk and improve overall health and well-being.”

Evaluating Resiliency

Along with assessing vulnerability, Dr. Galvin developed a Resilience Index to quantify brain health. This six-factor index focuses on the 40% of ADRD factors with high potential to prevent or reduce cognitive impairment.

“A higher score on the resilience index means your brain is healthier — you have less risk of developing Alzheimer’s or other types of dementia,” said Dr. Galvin, who was first author of a study, “The Resilience Index: A Quantifiable Measure of Brain Health and Risk of Cognitive Impairment and Dementia,” published December 7 in the Journal of Alzheimer’s Disease. Dr Galvin added, “Further, individuals with high resilience have better cognitive, functional, physical and behavioral performance that those with low resilience.” This was true whether an individual was a healthy control or had MCI or ADRD.

Dr. Galvin said each of the six factors associated with resilience was carefully researched to provide the most accurate and compelling information, such as looking at occupation, rather than educational level.

“Someone might have a Ph.D. in astrophysics but spend most of their days playing video games,” he said. “They may have a tremendous education, but they’re really not doing anything for their brain, whereas someone with a high school diploma might start and direct a multinational corporation.”

At the Comprehensive Center for Brain Health, patients only need around 20 minutes to fill out the resilience assessment, Dr. Galvin said.

“We get so much actionable information before we even do any clinical diagnostics and start thinking about the personalized interventions for that patient,” he said. “Along with its clinical value, the Resilience Index has great potential to advance fundamental neurological research into what constitutes healthy brain aging.”

New medications are being developed to target the biological causes of ADRD, Dr. Galvin added.

“But those drugs don’t necessarily change the existing symptoms of cognitive impairment,” he said. “Looking ahead, we need to think about multimodal approaches that address the relationships between a person’s biology, lifestyle, environment, and resilience to think about how to prevent disease, rather than waiting to treat its symptoms.”

For more information on the Comprehensive Center for Brain Health, visit https://umiamibrainhealth.org/.

Tags: Alzheimer's disease, brain health, Cognitive impairment, Comprehensive Center for Brain Health, Dementia risk, Dr. James E. Galvin, Resilience Index, Vulnerability Index