Neurology Study Receives $8.5 Million to Increase Focus on Dementia and Cognitive Impairment

The Northern Manhattan Study (NOMAS), started in 1990 and believed to be the longest-running cohort study with a Hispanic majority, has received an $8.5 million, five-year NIH grant to begin a directional shift that puts new emphasis on dementia and cognitive impairment.

NOMAS is a collaboration between the Miller School of Medicine’s Department of Neurology and the Neurological Institute at Columbia University to study stroke and stroke risk factors among residents of the multi-ethnic Washington Heights section of northern Manhattan. The interdisciplinary team of doctors and researchers has studied 3,497 stroke-free adults, who have been followed annually for a median of 13.9 years. NOMAS was the first study of its kind to focus on stroke risk factors in whites, blacks and Hispanics living in the same community.

“As the population we have been following has aged, we have begun shifting much of the research focus to dementia and cognitive decline,” said Ralph L. Sacco, M.D., M.S., professor and Olemberg Chair of Neurology, and the Miller School’s lead investigator in NOMAS. “In this new phase of the study, we will be focusing on inflammation. Specifically, we will be measuring a panel of biomarkers involved in a variety of inflammatory pathways. We want to see if we can discover the associations between certain pathways and cognitive decline, dementia and stroke.”

The sub-cohort being studied consists of 1,290 subjects who have had a standardized brain MRI and two neurophysiological assessments over a five-year period. The researchers will be taking a variety of new measurements to determine if they can design intervention programs to prevent stroke and cognitive decline in diverse populations.

Sacco noted that the proclamation for World Stroke Day on October 30 was all about vascular risk factors, and that the focus of the whole field is moving from vascular disease and stroke to vascular disease and cognitive impairment.

The enormous volume of data generated by NOMAS has opened up opportunities for cross-disciplinary research at the Miller School, generating collaborations with Clinton B. Wright, M.D., M.S., associate professor of neurology, neuroscience and public health sciences, and Scientific Director of the Evelyn F. McKnight Brain Institute, Tatjana Rundek, M.D., Ph.D., professor of neurology and Director of the Clinical Translational Research Division, and Bonnie Levin, Ph.D., professor of neurology and Chief of the Neuropsychology Division, among others. Chuanhui Dong, Ph.D., associate professor of neurology, has provided statistical support for the study.

“We have also been able to assist faculty with their career development,” Sacco said. “This is fertile ground for younger people interested in clinical translational work.”

Two examples he cited were Alberto R. Ramos, M.D., assistant professor of clinical neurology, who is researching the relationship between sleep and stroke, and Teshamae Monteith, M.D., assistant professor of clinical neurology, who is studying migraine and stroke.

When the new grant runs out, NOMAS will be nearly 30 years old.

“This may be our last funding cycle,” Sacco said. “As the cohort gets older, people are dying off. Nonetheless, it will be the source of a tremendous amount of valuable data for years to come.”

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