Albert Einstein College of Medicine

5-Cog Battery to improve detection of cognitive impairment and dementia

To overcome the technical, cultural and logistic barriers of current cognitive screens in primary care settings we have developed a 5-minute cognitive screen (5-Cog) coupled with a decision tree to identify persons at high risk of developing dementia. The 5-Cog will sort out patients with or at high risk of developing ‘cognitive impairment’ from those with ‘no cognitive impairment’, and the decision tree will guide clinicians through the follow up on 5-Cog results.

The 5-Cog includes the Picture-based Memory Impairment Screen (PMIS), that relies on culture fair pictures and does not need to be administered by a medical professional, Motoric Cognitive Risk (MCR) syndrome, a highly accessible tool that relies on the presence of slow gait and cognitive complaints to identify individuals at high risk of converting to dementia, and a 2-item depression screen (PHQ-2).

The PMIS is a brief, 4-item delayed free- and cued-recall test that takes 4 minutes to administer, which includes a minimum 2-minute delay period between picture presentation and recall. During this delay, patients will complete a timed walk assessment to diagnose MCR and PHQ-2 screen. We will also pilot short, non-memory tests for possible inclusion in the 5-Cog to increase the delay period. Both the PMIS and the MCR are highly sensitive and specific first-line assays that can be followed up with more thorough and complex cognitive testing.

The 5-Cog battery will overcome many of the implementation barriers of previous cognitive screens; it will be fast, low cost, easy to implement (requires only pen, paper and stopwatch), can be administered by non-clinicians after minimal training, not educationally or culturally biased, not confounded by depression and does not require informants.

Investigators

Joe Verghese, Principal Investigator, Steering COmmittee

Amy Ehrlich, Clinical Practice Committee

Erica Weiss, Clinical Practice Committee

Asif Ansari, Co-Investigator

Cuiling Wang, Analysis Committee

Rubina Malik, Data Harmonization Committee

Emmeline Ayers, Steering Committee, Data Harmonization Committee

Rachel Chalmer, Clinical Practice Committee

Jessica Zwerling, Co-Investigator

JOE VERGHESE, MBBS, MS

professor of neurology and medicine

Chief, Integrated Divisions of Cognitive & Motor Aging and Geriatrics

Murray D Gross Memorial Faculty Scholar in Gerontology

Departments of Neurology and Medicine, Albert Einstein College of Medicine

Dr. Joe Verghese graduated from St. Johns Medical College, Bangalore, India. He did his postgraduate training in Internal Medicine and Neurology in United Kingdom. He completed his Neurology residency at the Albert Einstein College of Medicine, Bronx, NY. He did fellowship training in Neurophysiology as well as Aging & Dementia in 1999 at the same institution. He received a Master of Science degree in Clinical Research Methods with Distinction from the Albert Einstein College of Medicine in 2001. Dr Verghese is board-Certified in Neurology.

Dr. Verghese is Professor of Neurology and Medicine at the Albert Einstein College of Medicine. He is the Chief of the integrated divisions of Cognitive & Motor Aging in the Department of Neurology and Geriatrics in the Department of Medicine. He is Director of the Resnick Gerontology Center, Albert Einstein College of Medicine. He is also Director of the Montefiore –Einstein Center for the Aging Brain, Yonkers, NY.

Dr. Verghese’s research interest is the effects of disease and aging on mobility and cognition in older adults, and has several research grants funded by the U.S. National Institutes of Health in these areas. He has over 150 publications in high profile peer-reviewed journals such as the New England Journal of Medicine, JAMA, Neurology, Journal of the American Geriatrics Society and Journal of Gerontology Medical Sciences. His current projects include studying the influence of cognitively stimulating activities on reducing risk of dementia and mobility loss, cognitive control of gait and mobility, and global health studies in dementia.

Amy R Ehrlich, MD

Associate ChieF, Division of geriatrics at montefiore medical centeR

Medical diretor, montefiore certified home health agency

professor of clinical medicine, albert einstein college of medicine

board certified in internal medicine, geriatrics and hospice and palliative care

Dr. Ehrlich has been involved in program design and development in geriatrics education for medical students, residents and fellows at Albert Einstein College of Medicine.  She was the Program Director for the Geriatrics Fellowship at Montefiore-Einstein for many years and remains active in the educational activities of the fellowship.

Dr. Ehrlich’s research interests include screening for mild cognitive impairment and dementia in ethnically and racially diverse primary care settings. Funded by a HRSA Geriatrics Workforce Enhancement Program (GWEP) grant, she has implemented the Annual Wellness Visit in primary care settings across Montefiore.

In her role as Medical Director of Montefiore Home Care, she works with the interdisciplinary home care team to develop innovative disease specific programs which help address challenges in transitions of care in the Montefiore network.

Erica f Weiss, phd

Erica F. Weiss is a clinical neuropsychologist who completed her doctorate in Clinical Psychology with a Health emphasis at the Ferkauf Graduate School of Psychology at Yeshiva University. She completed her clinical internship and post-doctoral fellowship training in Clinical Neuropsychology within the division of Neuropsychology at Montefiore where she is now director of the fellowship program and faculty in the department of Neurology.  Dr. Weiss is Associate Director of Neuropsychology at the Montefiore Center for the Aging Brain, Director of Neuropsychology for the Hudson Valley Center of Excellence in Alzheimer’s Disease and Director of Neuropsychology at the Montefiore Memory Disorders Clinic. 

Dr. Weiss’ clinical work includes the cognitive evaluation of children and adults with a variety of neurological disorders including epilepsy and dementia. She is interested in the expansion of cognitive services to a greater percentage of the population and spearheaded the expansion of clinical neuropsychology services to underserved/under represented populations through the creation of bilingual/bicultural internship and fellowship programs in Clinical Neuropsychology.  Dr. Weiss’ research interests correspond to her clinical work and include the cognitive correlates of childhood seizure disorders, neuropsychological functioning in healthy aging, and the use of briefer neurocognitive evaluations in clinical and research settings. She is involved in several NIH funded projects looking at these aspects.

Asif Ansari, MD

Dr. Asif Ansari is a Regional Medical Director for Montefiore Medical Group.  He manages physicians from 10 Montefiore Medical Group primary care practices in the Bronx and lower Westchester County.  Dr. Ansari received his medical degree from Manipal College of Medical Sciences.  He is a graduate of the Montefiore-Einstein Internal Medicine Residency Program (Primary Care and Social Medicine Tract) and served as Ambulatory Care Chief Resident.  He completed a New York State Department of Health Empire Clinical Research Investigator Program Fellowship focusing on improving the quality of care in HIV patients in the ambulatory setting.  In addition, Dr. Ansari is a graduate of the Greater New York Hospital Association/United Hospital Fund Clinical Quality Fellowship Program.  He was the lead physician for his practice in the BELT Asthma Study (AHRQ grant), a large-scale multi-center study designed to compare the effectiveness/safety of long-acting beta agonists (LABA)/inhaled corticosteroids (ICS) versus tiotropium/ICS in African-American patients with moderate to severe asthma.  Currently, he is bringing awareness to the rising issue of inappropriate antibiotic use.  He is a clinical champion for outpatient antibiotic stewardship in collaboration with the United Hospital Fund.

Cuiling Wang, PHD

Associate professor, department of epidemiology and population health, the SAul B Korey department of neurology, albert einstein college of medicine

Dr. Cuiling Wang graduated with Ph.D degree in biostatistics from Columbia University. She is currently an associate professor of biostatistics at the Albert Einstein College of Medicine. Her research interests include statistical methods for designing and analyzing longitudinal studies with missing data, mediation analysis, ROC analysis and survival analysis.  She has extensive collaborative experience in aging research. One focus of her methodological research is on dealing with missing data, a major source of potential bias in aging studies. She is currently the principal investigator of a NIH funded grant on statistical approaches to eliminate or reduce bias in the evaluation of cognitive decline, mobility decline and incidence of dementia in aging studies. In addition to aging, she also collaborates on research on Parkinson’s disease, cardiovascular disease, obstetrics & gynecology, autism, and multiple sclerosis.

Rubina Malik, MD MS

Rubina Malik, MD, MS completed her medical education at SUNY Stony Brook School of Medicine, her Internal Medicine residency at University Hospital at Stony Brook, fellowships in Ambulatory Medicine at Stony Brook and Geriatrics Medicine at Montefiore Medical Center. She also completed a Masters Degree in Clinical Research Methods at AECOM under the mentorship of Dr Eran Bellin. She joined the faculty of Geriatrics at Montefiore in 1997 and is currently Assistant Professor of Medicine and the Program Director of the Geriatrics Fellowship at Montefiore Medical Center (Moses and Weiler campus).

Dr. Malik is a clinician educator who has interests in functional and cognitive assessments, and osteoporosis. She has extensive clinical experience in the long term care setting and was an Assistant Medical Director at Beth Abraham NH. Currently, she is the co-director at the Center for the Aging Brain and core faculty for our newly funded NY State Center of Excellence for Alzheimer’s’ disease in Hudson Valley. She continues to see patients both in the ambulatory and LTC setting, and teaches and supervises trainees in Geriatrics Medicine.

Emmeline i Ayers, MpH

Emmeline Ayers is principal associate in the Integrated Divisions of Cognitive & Motor Aging and Geriatrics at Albert Einstein College of Medicine in New York. She received her MPH degree from Rollins School of Public Health at Emory University, GA and holds a BA in Psychology from the College of Wooster, OH.

She coordinates and manages many of the ongoing NIH funded studies within the Integrated Divisions of Cognitive & Motor Aging and Geriatrics, which include several clinical trials and longitudinal studies of older adults. Her research interests include study design, data management and harmonization of large datasets for epidemiological studies. Currently she is involved in a clinical trial to examine the effectiveness of using computerized brain games to improve mobility and a multi-country consortium to harmonize data from existing studies to examine the biological underpinnings of a pre-dementia syndrome.

Rachel Chalmer, MD

Dr. Rachel Chalmer is an Assistant Professor of Medicine in the Division of Geriatrics at Albert Einstein College of Medicine/Montefiore Medical Center in the Bronx, NY. Dr. Chalmer completed her medical education at the Medical University of South Carolina and Residency in Internal Medicine at Montefiore (Primary Care and Social Internal Medicine track). As a resident, she received the Leo M. Davidoff Society Award for Excellence in Medical Education. Dr. Chalmer subsequently completed her Fellowship in Geriatrics at Montefiore Medical Center in 2017 and joined the Geriatrics faculty. Dr. Chalmer’s primary clinical role is as Geriatrics Consultant at the Montefiore-Einstein Center for the Aging Brain in Yonkers, NY.

She is currently also supported by a Geriatric Academic Career Award (GACA) from Health Resources and Services Administration (HRSA) for career development as a clinician-educator. Her GACA project focus is on training interprofessional teams to recognize and care for older adults with cognitive impairment and geriatric syndromes. Dr. Chalmer’s research interests are in quality improvement in ambulatory dementia care, enhancing medical education around dementia, and assessment and management of caregiver stress in families affected by cognitive impairment and dementia.

Jessica Zwerling, MD MS

Dr. Jessica Zwerling MD MS is a neurologist with board certification in neuromuscular disease, and NIH T32 research/clinical fellowship training in cognitive neurology (T32 AG023475-04). Her career has focused on identifying risk factors for cognitive decline and dementia, as well as factors that promote successful aging, with a focus on underserved populations. She is the Associate Director for the Center for the Aging Brain and the Director of the Memory Disorders Center at Montefiore Medical Center and has been mentoring the next generation of geriatric neurologists over the last two decades. She is the Project Director for the Hudson Valley Region Center of Excellence for Alzheimer’s Disease Dr. Zwerling has developed the clinical and didactic programs used to enhance health professionals’ capacity to screen, diagnose and develop personalized plans of care for patients with Alzheimer’s and related dementias for the Montefiore Health System.

Dr. Zwerling serves as the Fellowship Director for the UCNS accredited Geriatric Neurology Fellowship at Montefiore. She has received multiple grants from the Leslie R. Samuels and Fan Fox Foundation for work in memory and gait in the field of health disparities research. In addition, Dr. Zwerling is the site leader for the HRSA (Health Resources and Administration) Grant focusing on an inter-professional, multi-modal educational intervention entitled “Clinical/Community Partnership to Expand Primary Care of Older Adults (CC-PCOA).” She provides a comprehensive Alzheimer’s Disease and Related Dementias (ADRD) program to address the needs of providers, patients’ families and caregivers through community support networks and educational materials and resources. She is the Clinical Director of the Einstein Aging Study and has been with the study since 2004. Additionally, Dr. Zwerling serves as the Director of Neurodegenerative Trials and has been a leader in PET scanning biomarkers as well as the use of technology assisted programs for patients/caregivers with memory disorders at Montefiore.