The National Institutes of Health has awarded James E. Galvin, M.D., M.P.H., director of the Comprehensive Center for Brain Health, and Neurology Cognitive Sciences chief for Palm Beach and Broward County at the University of Miami Miller School of Medicine, a $13 million grant to conduct a five-year series of studies on dementia in multicultural communities.

Need for the study arose because Alzheimer’s disease and related dementias (ADRD) is expected to increase three-fold by the year 2050. The primary affected age range includes people over 65 having a 62 % increase of developing ADRD and those over age 85 an 84 % chance.

In addition, as the U.S. population grows, so will its diverse makeup. African Americans are twice as likely and Hispanics 1.5 times as likely as Caucasians to develop ADRD. Having dealt with ADRD developed by his wife’s parents and his own grandfather, Dr. Galvin had first-hand experience with the disease that have caused him to continue looking for better outcomes through early detection.

Strategies for early detection

“Traditional approaches to medical care failed them, in part because of the seriousness of their illnesses, but also because each individual’s unique presentation, needs, and progression required more than the usual ‘one-size-fits-all’ approach embedded in conventional medicine,” Dr. Galvin said. “To me, the need to understand root causes of disease, provide strategies for early detection of disease that will work in all older adults regardless of background, improve health outcomes while containing health care costs, and do this in culturally-sensitive and personalized fashion is not just a professional activity. It has been a personal battle.”

With the grant, Dr. Galvin aims to develop screenings that detect the earliest signs of impairment, monitor response to interventions and correspondence to biomarkers, and increase the potential benefits versus harms from screening. He already laid the foundations in creating the AD8 model — a brief sensitive measure that reliably differentiates between nondemented and demented individuals. He also validated new screening evaluation and staging tools for MCI and ADRD, including the Quick Dementia Rating System. Since joining UM, Dr. Galvin has created 10 new dementia screening instruments that will be used in the project. 

The new screening model is set to follow a “healthy body, healthy mind” approach to make the concept of mild cognitive impairment and ADRD screening more acceptable to diverse populations by emphasizing deep phenotyping the acquisition of multiple types of data from the same individual repeated over time with multiple individuals.

“Deep phenotyping enhances the potential research value of data and biospecimens contributed by individual participants and creates opportunities for innovative approaches to data analyses and cross validation of screening efforts,” Dr. Galvin said. “This will link prevalent data to how brain biomarkers and relevant biological (i.e., sex) and sociodemographic variables (e.g., race, ethnicity) may interact to explain differential risk for transition across the amyloid-tau-neurodegeneration (ATN) Framework stages.”   

Increasing diagnostic accuracy

All of these processes are part of Dr. Galvin’s goal of increasing accuracy of early diagnosis, developing therapeutic targets, and improving health outcomes in ADRD. The research will also provide the groundwork for future studies to further characterize the mechanism underlying ADRD and its progression. Sharing of plasma, DNA, imaging, and phenotype data with national biorepositories, will enable numerous other investigators to pursue individual and collaborative research in ADRD.

Lastly, the diverse collaborative interactions (behavior and movement disorder neurology, neuropsychology, gerontology, electrophysiology, genetics, imaging, engineering, biostatistics, and epidemiology) will serve as a platform for future research into ADRD.

“With the results of this grant and our other projects, we hope to provide the evidence base to develop national dementia screening programs and precision-like medicine approaches to dementia diagnosis, treatment, and care,” Dr. Galvin said.