James E. Galvin, MD, MPH

"There’s rampant COPD [chronic obstructive pulmonary disease] in adults and asthma in children because of the particulate air pollution. We know that COPD may be a risk factor for Alzheimer disease. COPD accelerating COVID, both together, may contribute to worsening outcomes in terms of Alzheimer disease.”

Much has been learned about COVID-19 since the beginning of the pandemic; however, questions remain about the long-term impact of the virus. Specific neurological symptoms previously documented in people with COVID-19 include loss of smell, inability to taste, muscle weakness, tingling or numbness in the hands and feet, dizziness, confusion, delirium, seizures, and stroke. Although there is a consensus that these can occur, experts do not know how the virus causes such neurological symptoms.

The knowledge of COVID-19 and its associations with cognition, Alzheimer disease (AD) and other related dementias, is relatively limited at this point. Pooled data from 3 presentations at the 

2021 Alzheimer’s Association International Conference

, July 26-30, found the virus to be associated with persistent cognitive deficits, including the acceleration of AD pathology and symptoms. One such study conducted by Thomas Wisniewski, MD, and colleagues, found higher levels of certain biological markers, including total tau, neurofilament light, and phosphorylated tau, in COVID-19 patients with toxic-metabolic encephalopathy compared to those without.

, noted that as systems within the body fail, they affect brain function, which could potentially be the case for patients with COVID-19. Galvin, director of the Comprehensive Center for Brain Health at the 

University of Miami Miller School of Medicine

, also stressed that there could be subacute effects on cognition that stem from the increased social isolation and lack of intrapersonal connections. He sat down with 

to provide thoughts on what we currently know about COVID-19 and its long-term effects, the realism behind whether the virus causes AD, and how it has affected different age groups.

COVID-19 associated with long-term cognitive dysfunction, acceleration of Alzheimer’s symtpoms. News release. Alzheimer’s Association. July 29, 2021. Accessed September 1, 2021. https://www.alz.org/aaic/releases_2021/covid-19-cognitive-impact.asp

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The director of the Comprehensive Center for Brain Health at the University of Miami Miller School of Medicine discussed the current understanding of COVID-19 and its associations with cognitive decline and Alzheimer disease.

COVID-19’s Potential Effect on Dementia Risk: James E. Galvin, MD, MPH

"We need to figure out how we take our tools out into the communities, rather than expecting the communities to show up at our doorstep.”

Numerous studies have documented differences in dementia prevalence among racial and ethnic groups in the US. African Americans and Hispanics have been found to have a higher risk of dementia compared to whites across studies despite differences in designs, sampling methods, and definitions of dementia. These differences may be a product of biological, behavioral, sociocultural, and environmental factors including socioeconomic determinants such as education, income, occupation, wealth, and access to health care.

Understanding and researching these differences may aid in the development of interventions, therapeutics, and public policy. A recently awarded 5-year, $13 million grant to 

, director, Comprehensive Center for Brain Health, 

, will be used to conduct a series of studies that aim to increase accuracy of early diagnosis, develop therapeutic targets, and improve health outcomes in patients with Alzheimer disease and related dementias With the grant, Galvin hopes to create a screening model that will follow a “healthy body, healthy mind,” approach to make the concept of mild cognitive impairment and ADRD screening more acceptable to diverse populations.

Galvin detailed the projects entailed with the grant. He stressed that there are a number of factors, including higher blood pressure, that impact prevalence of dementia among individuals within rural and multicultural communities that need to be more-often identified.

The director of the Comprehensive Center for Brain Health at the University of Miami Miller School of Medicine discussed projects dedicated towards improving dementia recognition and care within multicultural communities. 

Dementia Research in Multicultural Communities: James E. Galvin, MD, MPH

"People who are old that have memory problems don’t have memory problems because they’re old. They have memory problems because there’s something causing their memory problems. It could be Alzheimer disease, it could be a stroke, it could be a lot of things—but it’s not age."

The associations between age and dementia have been well documented through countless studies, but the stigma that dementia is an inevitable part of getting older is incorrect. A 2018 survey conducted by Alzheimer’s Research UK found that the awareness of dementia is increasing but understanding the underlying causes of the disease remains low. In fact, 1 in 5 UK adults (22%) incorrectly perceived dementia as an inevitable part of getting older, whereas 60% correctly disagreed and a further 17% were unsure either way. 

Despite the mounting evidence which has suggested dementia cases could be linked to risk factors within a patient’s control, only just over one-third (34%) of individuals who answered that survey thought it was possible to reduce their risk, compared to 81% who thought it possible to reduce their risk of developing diabetes. 

, has been at the forefront in promoting dementia awareness and education. He recently helped conduct a study that used a telephone app to improve dementia knowledge in rural communities, as well as identify those who may be at risk for memory impairment.

to provide his thoughts on the areas of dementia knowledge that cause the most concern, and how the clinician community can help change the publics misperceptions.

Dementia Attitudes Monitor. Alzheimer’s Research UK. 

https://www.dementiastatistics.org/wp-content/uploads/2019/02/Dementia-Attitudes-Monitor-Wave-1-Report.pdf#zoom=100

. Published 2018. Accessed August 23, 2021.

The director of the Comprehensive Center for Brain Health at the University of Miami Miller School of Medicine discussed the real-world level of dementia education and where it needs improvement. 

Public Misconceptions About Dementia: James E. Galvin, MD, MPH

"The first step is raising awareness, raising health literacy, and making people understand something about the disease—and have it resonate with them as a personal issue. That requires understanding their knowledge of the disease, giving them the information, and doing some type of assessment so that we can decide who has a problem and who doesn’t. And then, what kinds of services that person may benefit from."

Not only do rural, ethnically diverse older adults faced an increased risk of Alzheimer disease (AD) and related dementias, they also experience disparities in dementia education, detection, and treatment. A study presented at the 

2021 Alzheimer’s Association International Conference (AAIC)

, July 26-30, implemented the Montreal Cognitive Assessment telephone app, or MoCA-T, in a rural community of 89% African American, Hispanic, and Haitian Creole residents to see if the method is effective in increasing AD knowledge and detecting cognitive risk in a rural setting.

Faith-based health educators, trained using online Alzheimer’s Association resources, contacted church congregants who responded to announcements during virtual workshop services. Among a cohort of 90 individuals who participated, t-tests showed a significant increase in dementia knowledge (

<.004). Of the 60 who completed cognitive screening using the MoCA-T, 15 (25%) were found to be at risk for memory impairment. Of those, 80% (n = 12) followed up with their provider.

James E. Galvin, MD, MPH, was an investigator on the study and feels as though to begin to create change, the overall awareness of the disease needs to be elevated. Galvin, the director of the Comprehensive Center for Brain Health at 

to discuss the efforts being done to improve dementia knowledge from within rural communities. He stressed the advantages the MoCA-T app and other telemedicine may bring, especially as the pandemic continues.

Wiese LA, Williams IC, Schoenberg NE, Galvin JE, Lingler JH. Employing the Moca-T (telephone) as a means of cognitive screening in rural, ethnically diverse population during COVID-19 restrictions. Presented at AAIC 2021; July 26-30.

The director of the Comprehensive Center for Brain Health at the University of Miami Miller School of Medicine discussed employing the MoCA-T app as a means of cognitive screening in rural and ethnically diverse populations. 

Improving Rural Community Dementia Knowledge, Screening Rates Using Telemedicine: James E. Galvin, MD, MPH

"Low resilience, high vulnerability—you’re going to do the worst. Again, 40% of the attributable risk are things that we have some control over. It’s never too early, it’s never too late, but it’s probably better to be too early than too late."

The terms “prevention” and “risk reduction” are often used interchangeable in medicine when referring to clinical interventions that aim to delay or prevent the onset of a disease. For Alzheimer disease (AD), there has been growing evidence over the past decade that specific lifestyle factors and choices can play a significant role in the risk of this disease. Among them include dieting and exercising properly, lowering smoking and alcohol intake, and engagement in late-life cognitive activities that keep the mind active.

Another lesser-known controllable factor may be location and access to open greenspace. Recently published findings indicated that living in neighborhoods with more tree canopy is associated with lower episodic memory but higher executive function at baseline, slower annual declines in executive function, and fewer white matter hypointensities. Senior author of the study James E. Galvin, MD, MPH, feels as though there needs to be a balance of evaluating both vulnerability and resilience benefits.

Galvin, director of the Comprehensive Center for Brain Health at the 

, outlined several lifestyle choices and social determinants of health. He broke down how each factor in achieving low vulnerability and high resilience.

The director of the Center for Brain Health at Miami University Miller School of Medicine discussed how much influence people have on lowering their Alzheimer disease risk. 

Weighing Impact of Social, Lifestyle Factors on Alzheimer Disease Risk: James E. Galvin, MD

"Because we’re doing this using independent datasets collected in longitudinal studies, it reaffirms the fact that these are things to think about when developing smart cities. But also, in our early and later life, we want to stress getting outside of our house/office and experience the beauties of the world as it is."

To date, there has been little research regarding the associations of greenspace types and Alzheimer disease (AD) risk. A study presented at the 

, July 26-30, investigated these associations using a cohort of 553 cognitively-normal participants who completed Uniform Data Set assessments from Knight Alzheimer’s Disease Research Center. Addresses geocoded to US Census tracts were linked to the National Land Cover Dataset to identify open spaces and areas with tree canopy (forest).

Using multi-level linear regression models controlled for demographics, comorbidities, and neighborhood disadvantage and population density, investigators found that although a greater percentage of forest was associated with lower baseline episodic memory (estimate = –0.79 [95% CI, –1.13 to –0.46), slower annual episodic memory declines (estimate = 0.069 [95% CI, 0.002-0.137), higher baseline executive function (0.15 [95% CI, 0.03-0.26]) and fewer white matter hypointensities (estimate = –3521 mm3 [95% CI, –6443 to –600]).

reached out to senior investigator James Galvin, MD, MPH, to better understand the clinical significance of the results. Galvin, director of the Comprehensive Center for Brain Health at the 

, stressed that choosing areas with better open space is among the many controllable factors to reduce AD risk.

Besser LM, Chang L, Mitsova D, et al. Associations between neighborhood greenspaces and cognitive and brain volume measures in cognitively normal older adults. Presented at AAIC 2021; July 26-30, 2021.

The director of the Comprehensive Center for Brain Health at the University of Miami Miller School of Medicine discussed the clinical significance of his findings on neighborhood tree canopy and brain health. 

James E. Galvin, MD, MPH

Articles

COVID-19’s Potential Effect on Dementia Risk: James E. Galvin, MD, MPH

Dementia Research in Multicultural Communities: James E. Galvin, MD, MPH

Public Misconceptions About Dementia: James E. Galvin, MD, MPH

Improving Rural Community Dementia Knowledge, Screening Rates Using Telemedicine: James E. Galvin, MD, MPH

Weighing Impact of Social, Lifestyle Factors on Alzheimer Disease Risk: James E. Galvin, MD

Associations Between Greenspace and Cognitive Performance: James E. Galvin, MD, MPH

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