AI Spotlight: Predicting Risk of Death in Dementia Patients

Kuan-lin Huang, PhD, Assistant Professor of Genetics and Genomic Sciences at the Icahn School of Medicine at Mount Sinai

Dementia is a neurodegenerative disorder, commonly known to affect cognitive function—including memory and reasoning. It is also a factor contributing to death. According to the Centers for Disease Control and Prevention, dementia is currently the seventh leading cause of death in the United States. Alzheimer’s disease is the most common form of dementia, accounting for approximately 70 percent of cases.

Researchers have used artificial intelligence and machine learning to help diagnose and classify dementia. But less effort has been put into understanding mortality among patients with dementia.

A group of researchers at the Icahn School of Medicine at Mount Sinai seeks to tackle this problem by developing a machine learning model to predict risks of death for a patient within 1-, 3-, 5-, and 10-year thresholds of a dementia diagnosis.

“We really want to call attention to how Alzheimer’s disease is actually a major cause of death,” says Kuan-lin Huang, PhD, Assistant Professor of Genetics and Genomic Sciences and Principal Investigator of the Precision Omics Lab at Icahn Mount Sinai.

“When people think of dementia, they think of patients losing their memory, as opposed to when people think about cardiovascular disease or cancer, they think about mortality,” says Dr. Huang. “As someone who has a family member who unfortunately passed away from Alzheimer’s disease, I’ve seen how the late stage of the disease—because you lose certain bodily functions—can become quite lethal.” In late-stage dementia, the disease destroys neurons and other brain cells, which could inhibit swallowing, breathing, or heart rate regulation, or cause deadly associated complications such as urinary tract infections or falls.

In the study, the team focused on this question: Given a person’s age, specific type of dementia, and other factors, what will be the risk the person will end up passing within a certain number of years?

For its model, the team used XGBoost, a machine learning algorithm that utilizes “gradient boosting.” This algorithm is based on the use of many decision trees—“if-this, then-that”-type reasoning. It learns from errors made by previous simple trees and collectively can make strong predictions.

Here’s how the study’s lead authors, Jimmy Zhang and Luo Song in Dr. Huang’s research team, leveraged machine learning to shed light on mortality in dementia.

The study used data from more than 40,000 unique patients from the National Alzheimer’s Coordinating Center, a database spanning about 40 Alzheimer’s disease centers across the United States. The model achieved an area under the receiver operating characteristic curve (AUC-ROC) score of more than 0.82 across the 1-, 3-, 5-, and 10-year thresholds. Compared to an AUC-ROC of 0.5, which amounts to a random guess that correctly predicts 50 percent of the time, the model performed reasonably well in predicting a dementia patient’s mortality, but still has room for improvement. By conducting stratified analyses within each dementia type, the researchers also identified distinct predictors of mortality across eight dementia types.

Findings were published in Communications Medicine on February 28.

In this Q&A, Dr. Huang discusses the team’s research.

What was the motivation for your study?

We wanted to address the challenges in dementia care: namely, to identify patients with dementia at high risk of near-term mortality, and to understand the factors contributing to mortality risk across different types of dementia.

What are the implications?

Clinically, it supports the early identification of high-risk patients, enabling targeted care strategies and personalized care. On a research level, it underscores the value of machine learning in understanding complex diseases like dementia and paves the way for future studies to explore predictive modeling in other aspects of dementia care.

What are the limitations of the study?

While our study includes nationwide data, to make the model more generalizable, it still needs to be adapted to different research and clinical settings.

How might these findings be put to use?

These findings could enhance the care of dementia patients by identifying those at high risk of mortality for more personalized management strategies. On a broader scale, the study’s methodologies and insights could influence future research in predictive modeling for dementia, potentially leading to improved patient outcomes and more efficient health care systems.

What is your plan for following up on this study?

We plan to refine our dementia models by including treatment effects and genetic data, and exploring advanced deep learning techniques for more accurate predictions.


Learn more about how Mount Sinai researchers and clinicians are leveraging machine learning to improve patient lives

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How to Safely Observe a Solar Eclipse

Mount Sinai researchers used state-of-the-art imaging to closely examine a patient’s retina after the solar eclipse of August 2017 burned a crescent shape into her eye.

The tricky thing about a partial solar eclipse is that if you look at it directly, you won’t feel any immediate pain. But the sun’s energy can still permanently damage your retina—and your vision.

In this Q&A, Avnish Deobhakta, MD, Associate Professor of Ophthalmology at the New York Eye and Ear Infirmary of Mount Sinai, explains how to safely look at a solar eclipse and the potential harm that can occur if you do not follow basic precautions for viewing this spectacle, which will take place Monday, April 8.

Avnish Deobhakta, MD

Why should I avoid looking at a solar eclipse? What damage can it do to the eye?

The solar eclipse is a very, very dangerous event for your eyes. Light beams from the sky carry a lot of energy that can be transmitted into the retina and damage it. Usually, the sun is very bright and it’s almost impossible to look directly at it without discomfort. But during a solar eclipse, you can look at the sun for a long period of time and be fooled into thinking that it’s safe because it doesn’t hurt. This is because most of the sun’s rays are blocked off by the eclipse. But the sun’s rays that you see during a partial eclipse are the most damaging to the eye. It’s almost like you’re getting a disproportionate helping of the most energetic and damaging rays because all of the other rays are blocked and the ones that make it through are not so bright that they force you to look away.

What can happen if I take a quick peek?

Even a very quick look at a solar eclipse can burn your retina. During the last solar eclipse, in 2017, one of my patients looked at the eclipse and sustained damage to her retina. She thought she was using protective glasses—but they weren’t the right type. She still has a blank section, a visual blind spot, in the center of her visual field. I used groundbreaking technology to take a close look at the damage to her eye. The damage was in the exact shape as the moon—a crescent shape. We were one of the few sites that had that prototype machine and could take that photo. It may not help the patient, but it gave us new information about the damage caused by exposure to the sun’s rays. Other people have been known to have visual distortions in part of their visual field. Even with a total solar eclipse, there will always be a moment when the sun re-emerges, and some of those rays can damage the retina.

Is the damage permanent?

Yes. We cannot fix it. At the New York Eye and Ear Infirmary of Mount Sinai, we have the technology to take an image and see the part of the retina that is damaged, but there is nothing a doctor can do to treat it. The damage doesn’t go away. Even decades later, your vision will still be impaired.

Can I look using a mirror?

No. Mirrors reflect the damaging sun rays. Looking in a mirror is the equivalent of looking directly at the solar eclipse–it’s not safe.

What about special sunglasses? Are those safe?  

It’s fine to use approved sunglasses that have the right filters. However, you have to make absolutely sure that you have those filters, and you need to obtain them from a reputable vendor. If you are not sure of either of those things, then you should not look at the eclipse, and instead look at a projection of the rays. Most of the people I’ve seen whose eyes were damaged by looking at a solar eclipse thought they were wearing the right glasses. And if you think you’re protected, you’re going to look longer, which increases the chances—and the extent—of damage. (Click here to learn more about safe viewing on the JAMA Patient Page created by the Journal of the American Medical Association.)

How about using a camera, like the one on my phone?

Generally speaking, if you look through your phone camera, you’re looking at an image rendered through the camera. You’re not actually looking directly at the sun, which means, theoretically, that it is safe. What worries me is not the phone camera—it’s that when people hold the camera up toward the sun, they might look around it for even just a brief period of time and can end up with a damaged retina. Think about a concert, when people have their phones out and are recording the concert, but they’re also looking around and watching the band on the stage. That’s not safe during a solar eclipse.

Is there a safe way to look at a solar eclipse?

Pinhole cameras are safe. They reflect light off an object and onto a surface such as a cardboard box or a wall. That way you’re not looking at the rays themselves, you’re looking at a projection of what the rays look like. You can watch a pinhole camera image as long as you’d like; you can even watch the entire solar eclipse reproduced on a pinhole camera and it’s perfectly safe. (Click here to get instructions on how to make your own pinhole camera.)

What if I’m outside during a solar eclipse but I don’t look up?

I don’t want anyone to think if they’re just in the presence of a solar eclipse they’re going to go blind. It’s okay to be outside during a solar eclipse, just be very careful. Be very mindful not to look directly at the sun in any way–and certainly not on purpose. The problem is that if you don’t know what’s going on and the sky looks different all of a sudden, your first instinct is to look up at the sun. The first instinct of all humankind is to look up. But that instinct can be dangerous during a solar eclipse.

New Opera on a Gender-Affirmation Pioneer Is Authored by Mount Sinai Neuroradiologist

A new opera, Lili Elbe, tells the story of one of the earliest recipients of gender-affirming surgery in 1930. The opera is a collaboration of Grammy Award-winning composer Tobias Picker and Aryeh Lev Stollman, MD, a neuroradiologist at Mount Sinai, who wrote the story and lyrics. Photos: Edyta Dufaj

“It’s a love story,” says Aryeh Lev Stollman, MD, a neuroradiologist at Mount Sinai, and the librettist for a new opera, Lili Elbe, which tells the story of one of the earliest recipients of gender-affirming surgery, in 1930. The opera, commissioned by the Theater St. Gallen of Switzerland, was named “Best World Premiere of 2023” at the OPER! AWARDS ceremony on January 29 at the Dutch National Opera in Amsterdam.

Lili Elbe focuses on a successful Danish painter who was married to another painter, Gerda Wegener. Though their marriage was eventually annulled by the King of Denmark and Lili’s name and sex were legally changed, they remained in love with each other. Lili’s case drew international attention, and a semi-autographical account of her story was captured in a book, Man Into Woman: An Authentic Record of a Change of Sex. Another book, The Danish Girl, was loosely based on her story and has become an important text in LGBQT+ literature and the basis for a film.

“We based our story on historical sources,” emphasizes Dr. Stollman. “The Danish Girl was highly fictionalized. But Lili Elbe was quite famous in her day, so we relied on her own writings and news accounts from the time.”

The opera Lili Elbe, in addition to being acclaimed for its artistry, is a significant milestone. It stars Lucia Lucas, a baritone, in the first grand opera for and about a person with trans experience. The Grammy Award-winning composer Tobias Picker, who is married to Dr. Stollman, befriended Lucia when he cast her in Don Giovanni in a Tulsa Opera production—the first time a transgender singer had played the leading role in an American opera. Mr. Picker, Dr. Stollman, and Lucia wanted to collaborate on an original project, and the story of Lili Elbe was chosen.

Tobias Picker, left, and Aryeh Lev Stollman, MD, taking a bow after a performance of the new opera at the Theater Saint Gallen in Switzerland. “This resonates with our work as physicians, health care workers, and support staff, because behind our work is love for humanity,” says Dr. Stollman. “We serve people, no matter their physical appearance, their background, or gender identity. And we do it through all types of difficult times and situations.”

“Tobias asked me to write the libretto—or the story and lyrics,” Dr. Stollman says. “But I worked very closely with Lucia as the dramaturg, to gain the insight of her experience and authenticity.” This is the second time Mr. Picker and Dr. Stollman have collaborated. The first was the inspiring opera Awakenings, based on the story of Oliver Sacks, MD, and his efforts to treat patients with sleeping sickness. That opera opened in June 2022 at the Opera Theatre of Saint Louis.

“Like Awakenings, we wanted Lili Elbe to have a mythic undercurrent,” Dr. Stollman says. “In Awakenings, we used the story of Sleeping Beauty. In Lili Elbe, the myth of Orpheus leading his lover, Eurydice, out of the underworld is a motif that reoccurs. I believe that myths have a strong emotional truth. In the myth, Orpheus is saying, ‘Don’t look back, you cannot return to your old life, but you are coming into a new life.’ And our characters are always moving to the future, to a new life, a new realization. And that’s the mythological underpinning.”

Lili Elbe discovers her true nature as a woman when her wife, Gerda, asks her to stand in for a female model who was delayed for a painting session. Gerda is entranced with the beauty of her husband, then called Einar Wegener, and it is she who bestows the name Lili. And as Lili embraces her identity, she says, “When you paint me now, I feel I have always been her.” Lili becomes a muse to Gerda, whose paintings of Lili win acclaim. But Gerda wrestles with how much space to allow Lili in their marriage. At first, she insists that Lili transition back to Einar in the evening. But as Lili makes her true identity known among their circle of friends, Lili wants to experience all the feelings of womanhood, including marriage and motherhood. And even though their marriage is annulled and they become involved with other lovers, their love for each other endures.

Lili becomes engaged to Claude LeJeune, a young man whose passion is creating perfumes from flowers through a delicate process called enfleurage. The symbolism of the flowers living on becomes a motif as Lili dies as a result of complications of one of her surgeries. And the life and story of Lili Elbe still resonate today.

“The opera is more than about love with a transgender person,” Dr. Stollman says. “It’s about love and transcending difficulties. It’s about a tragic heroine’s journey that starts with self-knowledge. And it’s about loss, because Gerda loses Lili. But also because Lili dies in the end, as many tragic heroines do.”

The staging and choreography of the opera are innovative, witty, and symbolic. As Gerda exhibits her paintings of Lili, they are symbolized by actors suspended above the stage, swirling in evocative poses. The prominent German newspaper Die Welt gave it an enthusiastic review, calling it “emotionally gripping, a delicate work of musical theater that unfolds as an Art Nouveau arc, amidst a bright, symbolist stage.” A leading Austrian paper, the Voralberger Zeitung, called it “an emotionally charged masterpiece.”

Dr. Stollman related the theme of love transcending all to the mission of Mount Sinai, which was founded to care for underserved people and is home to the Center for Transgender Medicine and Surgery, a world leader in gender-affirming care. “This resonates with our work as physicians, health care workers, and support staff, because behind our work is love for humanity. We serve people, no matter their physical appearance, their background, or gender identity. And we do it through all types of difficult times and situations.”

At the Mount Sinai Morningside Spine Program, the Personal Touch Is Key to Healing

Team members at the Spine Program at Mount Sinai Morningside include, from left, Kiran Ballani, Rachel Newman, PA-C, Patrick Reid, MD, Lauren Mcnoble, PA-C, Divaldo Camara, MD, and Priscilla Garcia

If you are having problems with your back and believe you may need to consult with a surgeon, then Mount Sinai has a program for you.

Mount Sinai Morningside has launched a Spine Program with a uniquely personalized and integrated approach. In addition to its advanced and compassionate clinical providers, the Spine Program is one of the few in New York City to have a care coordinator who focuses on helping patients find the right specialist for their needs.

Priscilla Garcia, a clinical navigator for the Spine Program, is one of the many people who make it work. She helps patients get what they need as soon as possible, prioritizing non-surgical treatments when possible.

“My role is to triage patients,” she says. “Some patients think they need a neurosurgeon right off the bat, but if they’re in pain, I schedule them with one of our pain management specialists first.”

If patients need multiple appointments, she often will try to schedule appointments in the same day for the patient’s convenience. A pain management specialist may order an MRI and notice something that a neurosurgeon should evaluate, so she will try to make that happen on the same day—a more efficient and convenient option for patients.

“It’s great for the patient because they don’t have to go home and come back again in a short timeframe. And the patients feel that we are addressing all their needs in a holistic way” she says.

Patrick Reid, MD, left, and Divaldo Camara, MD. “What sets us apart is how we try to make it easier for patients,” says Dr. Reid. “Some try to do it with computer systems or software, but we are devoting human resources to it.” To make an appointment, call 212-523-8500.

Patrick C. Reid, MD, Director of the Spine Program and Chief of Neurosurgery at Mount Sinai Morningside, makes every effort to help patients get care quickly and easily.

“When people go to the doctor, it can be confusing, especially with something as complex as the spine and surgery. Many times, people are forced to navigate the system themselves and hope for the best,” he says. “But an easy way to improve care is to get the patient in the right room with the right specialist, and that’s what we do in our program.”

Patients with spine issues are often older, and reducing the number of trips to the doctor’s office is beneficial.

“Any patient who sees us needs to have things simplified as much as possible,” says Dr. Reid. “People who have jobs, childcare needs—they all need help coordinating their health care. You don’t want to miss two days of work. That’s the benefit of having a navigator who’s had a lot of experience coordinating these things—it’s invaluable.”

The program at Mount Sinai Morningside has all the advantages of a major academic medical system, including access to the latest equipment and to the most advanced treatment techniques.

“But what sets us apart is how we try to make it easier for patients,” says Dr. Reid. “Some try to do it with computer systems or software, but we are devoting human resources to it.”

Only a small percentage of patients at the Spine Center actually receive surgery.

“There are a full range of treatments we can try before suggesting surgery,” says Dr. Reid. “But if our colleagues are running out of options trying to make a patient feel better, then we start having the discussion about surgery—the risks and benefits and likely outcomes.”

In addition, patients with back or neck pain often have health issues that contribute to their condition, and one of the advantages at Mount Sinai Morningside is ready access to specialists in many other areas throughout the Mount Sinai Health System.

“We see many patients with conditions such as diabetes, hypertension, or heart disease, and we will help them get the any additional treatments as quickly as we can,” Dr. Reid says.

Rehabilitation Therapist Rises to the Occasion and Delivers a Baby Outside The Mount Sinai Hospital

Aura Weltman, a senior clinical specialist in the Department of Rehabilitation and Human Performance at The Mount Sinai Hospital

On Thursday, December 28, shortly before 8:30 am, Aura Weltman, OTR/L, SCLV, was walking on Fifth Avenue toward The Mount Sinai Hospital and heard a woman scream. Aura, a senior clinical specialist in the Department of Rehabilitation and Human Performance at the hospital, looked around and noticed that the street seemed unusually deserted. The only people she could see were a couple walking about half a block ahead of her.

She was unsure who was in distress, but a second scream was clearly coming from the woman, who seemed to be losing her balance as she walked up the ramp to the hospital. Aura ran to her as she started to fall, caught her, and helped her to the ground.

The woman said “baby,” and Aura instinctively dropped to the ground to assist.

“I noticed someone standing close to the hospital entrance, and I called for him get help. I could tell that there was no time to wait,” she says, adding that the delivery took only a few minutes. “It was miraculous to have a perfect, beautiful baby boy crying in my arms. The mom was so brave and strong—her only concern was that the baby be wrapped and warm.”

Although Aura had never delivered a baby before, she had trained as an emergency medical technician through a summer program at UCLA after graduating from high school. She explains, “When I was 16, I was a passenger in a near-death car accident. As a result of this, I wanted to know what to do to help others in case of an emergency.”

Aura remained with the baby and his mom, reassuring her and caring for the baby until a team from the hospital arrived. “One of the security guards came out and took off his coat to wrap the baby. He also removed and unlocked my phone so I could advise my manager that I had a ‘minor emergency’ and would be a little late!”

She continues: “Once the teams arrived, they cut the umbilical cord. One team took the baby, and I began to help the mom to a stretcher. After entering the hospital and checking that both were okay (and checking on dad, who clearly did not expect this), I wished them well. By the time I turned around, the baby and mother were being wheeled away, and the team of medical professionals dissipated.”

Debra Zeitlin, who is Aura’s manager in the Department of Rehabilitation and Human Performance, was not surprised to learn about her efforts to help someone in need. “Aura’s actions and calm demeanor are no surprise to me or her colleagues,” she says. “Aura is an excellent, dedicated clinician who goes above and beyond for her patients on a daily basis.”

Aura was also recognized for her courage and compassion in the Mount Sinai Health System’s daily leadership huddle.

When asked about her courageous actions, Aura speaks about the influence of others. “I am so grateful to my parents and my community—they have always placed an emphasis on seeking knowledge and helping others. I am grateful for learning so much about compassionate care and excellence from many of my Mount Sinai colleagues,” she says. “The members of the Department of Rehabilitation and Human Performance, including doctors, nurses, therapists, and staff are hard-working, devoted, and creative; they honestly would have done the same. Our department is constantly involved in rebirth—working to aid those recovering from brain injuries, spinal cord injuries, and a host of other challenges—it may be a bit less dramatic but it is every bit as miraculous.”

Aura believes she was not alone during this experience. “I genuinely felt that I was being guided from above—all the training that I had received years ago flooded back. I feel lucky to have been placed there at the right time and fortunate to have been a part of such a miracle.”

What You Need to Know About COVID-19 and Other Respiratory Viruses Right Now

 

It’s that time of the year when everyone seems to know someone who is under the weather. Respiratory illnesses, not just COVID-19, have been on the rise.

Experts say your best defense remains the same: Keep up to date with your vaccinations, consider taking steps to limit your exposure to large indoor crowds and wearing a well-fitting mask at public gatherings, and talk with your health care provider if you are feeling sick.

New Guidelines Shorten the Time You Should Isolate if You Are Infected

If you have COVID-19, or another respiratory infection, health experts say you can return to work or school sooner. New recommendations from the U.S. Centers for Disease Control and Prevention (CDC) suggest returning to normal activities when, for at least 24 hours, symptoms are improving, and if a fever was present, it has been gone without the use of fever-reducing medication. (Previous guidance from the CDC recommended people who were infected with COVID-19 remain in isolation for five days.)

Now the CDC says that once people resume normal activities, they are encouraged to take additional prevention strategies for the next five days to curb disease spread, such as taking more steps for cleaner air, enhancing hygiene practices, wearing a well-fitting mask, keeping a distance from others, and/or getting tested for respiratory viruses. Enhanced precautions are especially important to protect those most at risk for severe illness, including those over 65 and people with weakened immune systems, according to the CDC. Click here to read more from the CDC.

Note: The updated CDC guidelines do not apply to health care facilities. Click here for the latest Mount Sinai visitor policy.

“It’s the season for respiratory viruses,” says Bernard Camins, MD, MSC, Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai and the Medical Director for Infection Prevention for the Mount Sinai Health System. “It’s no longer all about COVID-19. That is now just one of a number of respiratory viruses we need to contend with.”

In addition to COVID-19, health authorities are watching a number of respiratory viruses that are circulating: influenza or seasonal flu (there are actually two forms of it this year); respiratory syncytial virus (RSV); and the common cold (rhinovirus). Taken together, they can make for a difficult season for patients and health care providers alike.

A Spike in Influenza, COVID-19, and Other Respiratory Illnesses Can Lead to a Rise in Cardiovascular Complications

Mount Sinai cardiologists are warning about the risk of heart problems this winter. Click here to read more

For COVID-19, the New York City Department of Health and Mental Hygiene reports hospitalizations in New York had surged at the end of December to their highest levels in about a year, following a smaller upturn in September. But the numbers were about half of what they were during a surge a year ago, and they are about one-tenth of the number in January of 2022 during the last big surge.

Bernard Camins, MD, MSC

Vaccinations for COVID-19 and the flu may not completely prevent you from becoming infected, but they are likely to keep you from getting seriously ill and requiring hospitalization. For both of these illnesses, it’s not too late to get vaccinated if you have not already done so. The flu season typically extends until spring.

RSV commonly causes mild, cold-like symptoms in most healthy adults and goes away after a few days. However, for infants and older adults with pre-existing conditions like heart disease or lung disease, RSV can cause severe disease and even death. The CDC recommends the RSV vaccine for adults 60 and older.  The vaccine is also recommended for expectant mothers towards the end of their pregnancies so their newborns will have antibodies against RSV. The last preventive measure is a monoclonal antibody against RSV administered to newborns less than 8 months old.

Dr. Camins’ general recommendations for keeping healthy remain unchanged:

  • Those at risk for complications from respiratory infections may want to wear a more protective mask in crowded areas, such as riding the bus or subway or shopping. A surgical mask provides some protection but not as much as a high-quality N95 or KN95 mask.
  • Wash your hands frequently especially when you get home or arrive at work.
  • Individuals at high-risk should talk with their health care provider and have a plan for how to get antiviral medications if they become infected with COVID-19 or the flu, as these prescription medications must be taken within the first days of symptom onset. Those at high-risk include older adults, those with chronic medical conditions, such as diabetes, and those with reduced ability to fight infections, such as those being treated for some cancers.

Dr. Camins offers these additional key takeaways:

Staying home: If you are feeling very sick, you should stay home, especially if you have a fever. You may go to work when you’re feeling better, and you may want to wear a mask until your symptoms fully resolve to prevent infecting your co-workers. There’s no need for extended isolation at home as people were doing in the midst of the COVID-19 pandemic, he says.

Taking medications: Talk with your provider about medications if you become infected. Anti-viral mediations make good sense. Paxlovid™ (nirmatrelvir/ritonavir) for COVID-19 can help adults who may be at high risk for more severe illness. Anti-viral medications such as Tamiflu® (oseltamivir) for  seasonal flu can lessen symptoms and shorten the time you are sick, and they can be helpful for those at risk of complications.

The new variant: The latest variant of the virus that causes COVID-19, JN.1, does not seem to be any more worrisome than others that came before it, and existing treatments work well against it. “We will probably continue to see more variants as the virus that causes COVID-19 mutates,” says Dr. Camins. “You just have to accept there is always going to be a new variant.”

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