Jessica Zwerling, MD, MS, director, Montefiore Hudson Valley Center of Excellence for Alzheimer’s Disease, associate professor of neurology, Albert Einstein College of Medicine

Jessica Zwerling, MD, MS

“Talking about aducanumab, or any monoclonal antibody or disease-modifying therapy, it is again, another chance for education, [especially] in patients like ours that we feel rich in treating.”

Ongoing research in Alzheimer disease (AD) and dementia remains a topic of discussion, particularly with the controversial 

, Biogen’s disease-modifying, anti-amyloid agent, in June. Jessica Zwerling, MD, MS, spoke with NeurologyLive about upcoming research efforts and the continued need to collect reliable data, establish an age-friendly institute, and generate patient-centered outcomes. 

Approval of aducanumab, as well as discussions of other disease-modifying therapies, present opportunities for patient education, according to Zwerling. Patients can be informed about drug treatment trials, as well as the parameters and unique benefits participation can have. Considering the caregivers’ health is also important, Zwerling said, as caregivers of those with dementia account for a separate, at-risk population. 

Further emphasis was put on engaging community-based organizations to deliver comprehensive care that is both culturally fair and relevant when treating older adults. Zwerling also spoke on the positive aspect of being back in person and seeing patients and caregivers face-to-face, following primary use of telemedicine during the COVID-19 pandemic. 

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The director of Montefiore Hudson Valley Center of Excellence for Alzheimer’s Disease, associate professor of neurology, Albert Einstein College of Medicine, discussed recent developments in Alzheimer disease research, including FDA approval of aducanumab, as well as the importance of engaging community-based organizations to improve patient care.

Research in Alzheimer Disease and Dementia: Jessica Zwerling, MD, MS

“The point I want to drive home is that when you have [conversations about] social determinants of health, [the resources have] to be culturally relevant. We need to be able to bring those resources that are culturally relevant to our patients.”

Social determinants of health have been an ongoing topic of discussion for patients with Alzheimer disease (AD) and dementia, as a move to telemedicine has initiated a shift in how care is provided, primarily virtually. According to Jessica Zwerling, MD, MS, director, Montefiore Hudson Valley Center of Excellence for Alzheimer’s Disease, associate professor of neurology, Albert Einstein College of Medicine, bringing access to patients is crucial, and she stressed the need to assist senior centers in navigating important, virtual appointments to make the technological transition that much more convenient for older adults.

, Zwerling commented on the surrounding community’s willingness to commit to remaining culturally relevant and bring resources to incorporate technology, as well as to engage a culturally and educationally diverse population. For her and colleagues, Montefiore’s location in the Bronx, New York, and the surrounding area, offers a diverse patient population, making the need for personalized community engagement even more important.

Even during the height of the COVID-19 pandemic, Zwerling added, the Montefiore Health System was able to conduct a “stakeholder studio” entirely through Zoom, which engaged 99% of Black participants to talk about depression and its implications. The organization’s Center for Excellence for Alzheimer’s Disease (CEAD) was yet another area that thrived, as patients with dementia or AD were able to guide their own care alongside community members and experts. 

The director of the Montefiore Hudson Valley Center of Excellence for Alzheimer’s Disease commented on social determinants of health in relation to telemedicine and community willingness to engage.

Social Determinants of Health in Alzheimer Disease: Jessica Zwerling, MD, MS

 “The role of a primary care physician is really daunting, because you may have a patient not only that has a language barrier, but a gait disorder and cognitive impairment, so just getting to that office chair is extremely difficult. Telehealth decreases the amount of time it takes to walk from the waiting room to the examination room.”

, Jessica Zwerling, MD, MS, addressed the state of clinical trial recruitment for patients with Alzheimer disease (AD) and dementia, which has played a part in how providers remodeled care during the COVID-19 pandemic. Normalizing participation is key, Zwerling said, as well as preparing patients on an emotional level in the event they do not meet exclusion criteria. During the pandemic, experts at Montefiore Medical Center were able to deliver care via telehealth and teletherapy to patients with cognitive impairment and depression, in order to attack the 6-month mortality rate and clearly explain associated benefits of trial participation. 

Telehealth has also been of benefit to primary care physicians, in that it not only effectively minimizes the amount of travel required of patients in this population, who may have comorbidities that make it that much more difficult to attend an in-person office visit, but in its effects on time efficiency. For providers outside of specialty centers, Zwerling encouraged engaging community organizations, such as the Alzheimer’s Association or CaringKind, which are equipped with specialists trained to speak about additional trials that may be advantageous for certain patients to participate in. 

In Alzheimer disease and dementia, Jessica Zwerling, MD, MS, director, Montefiore Hudson Valley Center of Excellence for Alzheimer’s Disease, believes normalizing trial recruitment aids and telehealth to increase participation is another way to ease delivery of care.  

Telehealth and Trial Recruitment in Alzheimer Disease: Jessica Zwerling, MD, MS

“There are definitely tweaks and challenges, and that can be built into the visit and workflows can be adjusted so that support staff can help. But I really think it's such an added value that the burden of adapting the technology is just a minor point of it.”

The use of telehealth over the course of the COVID-19 pandemic is something that Jessica Zwerling, MD, MS, believes will persist, particularly for patients with Alzheimer disease; however, some barriers do continue to generate difficulties for both patients and providers. A primary hinderance is the actual use of technology, which can be difficult for those in the AD population, who are often elderly and may not be as adept at navigating the virtual sphere. 

, Zwerling, the director of the Montefiore Hudson Valley Center of Excellence for Alzheimer’s Disease and associate professor of neurology, Albert Einstein College of Medicine, commented on the navigation of these issues during the pandemic, as well as how experts continue to navigate them presently. Setting up proper camera angles within the home is of particular importance, ensuring that providers and social workers can evaluate the individual as a whole; often, additional insight can be drawn by observing patients in their living spaces. While transitional challenges remain, Zwerling further alluded to the fact that improved workflow during visits can be of assistance and adjusted so as to allow support staff to help.  

Challenges surrounding the use of telehealth for patients with Alzheimer disease are affected by technological barriers, according to the associate director of the Montefiore Hudson Valley Center of Excellence for Alzheimer’s Disease

Implementing and Maintaining Telehealth for Alzheimer Disease: Jessica Zwerling, MD, MS

“We really did flip the switch to telemedicine, and we engaged both the patient and the caregiver, and it was a wonderful opportunity.”

With the onset of the COVID-19 pandemic, telehealth became standard practice for many healthcare providers, but it provided specific benefit for those with Alzheimer disease (AD), according to Jessica Zwerling, MD, MS, director, Montefiore Hudson Valley Center of Excellence for Alzheimer’s Disease, and associate professor of neurology, Albert Einstein College of Medicine. In discussion with 

, Zwerling spoke to the impact of telehealth on the AD community, particularly on the relationship between caregivers and providers, as well on care visits, which were able to incorporate social workers and additional family members easily due to the virtual aspect. 

Zwerling spoke on development of the C-Care model, which outlines continuity of care for at-risk home elderly. Following a call with the provider and a social worker to address mobility, weight loss, sleep, behavioral disturbances, and other issues faced by that specific population, patients and caregivers were then connected with appropriate community-based organization. Acceptance rate also showed benefits from technology; according to Zwerling, a clinical trial program that was fully conducted during the pandemic showed a 100% acceptance rate in conversion to a virtual format, further highlighting the advantages telehealth presents for the AD patient community.

The director of the Montefiore Hudson Valley Center of Excellence for Alzheimer’s Disease discusses the use of telehealth for patients with Alzheimer disease during the COVID-19 pandemic, as well as her thoughts on why it is here to stay.

Jessica Zwerling, MD, MS

Articles

Research in Alzheimer Disease and Dementia: Jessica Zwerling, MD, MS

Social Determinants of Health in Alzheimer Disease: Jessica Zwerling, MD, MS

Telehealth and Trial Recruitment in Alzheimer Disease: Jessica Zwerling, MD, MS

Implementing and Maintaining Telehealth for Alzheimer Disease: Jessica Zwerling, MD, MS

Telehealth for Patients with Alzheimer Disease: Jessica Zwerling, MD, MS

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