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Mount Sinai Researcher Launches Three Studies of Alzheimer’s Disease in Asian Americans

Updated on Oct 5, 2023 | Diversity and Inclusion, Featured, Psychiatry, Research

Clara Li, PhD, a clinical neuropsychologist and Associate Professor, Psychiatry, at the Icahn School of Medicine at Mount Sinai, has received new grants that will total more than $12 million from the National Institute on Aging (NIA), part of the National Institutes of Health (NIH). The funding will support three new projects that seek to improve the diagnosis and treatment of Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD) in Asian Americans.

Asian Americans are historically under-represented in clinical research on AD/ADRD. As a result, many older adults with Asian ancestry do not receive adequate diagnosis and treatment for mild cognitive impairment (MCI) or AD/ADRD.

Clara Li, PhD

“Chinese is the third-most-spoken language in the United States after English and Spanish, yet we don’t have many of these tools available,” Dr. Li explains. She’s hoping to change that, with three new studies launched in 2023.

Adapting Assessments for Alzheimer’s: Chinese Translation and Cultural Adaptation

In one of the studies, a five-year effort, Dr. Li will develop assessment tools that are linguistically and culturally adapted for older adults who speak Cantonese or Mandarin, with the hope to extend it to other Asian languages in the future.

Researchers rely on assessment tools from the National Alzheimer’s Coordinating Center Uniform Data Set (NACC UDS) to identify research participants with cognitive impairment or AD/ADRD. But those tests were developed for English speakers and Western cultures.

“I’ve seen many Asian American patients who try to take the English tests because a Chinese version isn’t available, and the language is a barrier,” Dr. Li says. “Sometimes a test would suggest cognitive impairment, but when I would translate the test myself into Chinese, the patient would score in the normal range.”

Language isn’t the only barrier. Cultural differences also make the test confusing for many Asian American patients. When asked to identify an image of a witch on the standard test, for instance, some of Dr. Li’s patients said “janitor” or “cleaner”—a common error because witches aren’t typically depicted with brooms in Chinese culture.

The lack of adequate tests hampers diagnosis and treatment, and also affects research seeking to better understand AD/ADRD in Asian Americans.

“Because we can’t enroll patients unless they can take the tests in English, many are excluded from studies. As a result, Asian Americans make up less than 2 percent of the participants in U.S. clinical trials,” Dr. Li explains. “If we want to increase diversity in research, we need to adapt these materials for Chinese speakers and eventually other Asian languages.”

A Research Infrastructure for Alzheimer’s Disease in Asian Americans

In the second study, Dr. Li will develop a research infrastructure and tools for studying AD/ADRD in older Asian Americans. She and her colleagues will develop questionnaires to fully characterize Asian American participants, including social determinants of health and any environmental or lifestyle factors that could increase or decrease their risk of developing AD/ADRD.

This five-year study will also investigate blood samples from Asian American participants to determine whether there may be novel biomarkers in this population, and whether known biomarkers are relevant to people from Asian backgrounds.

“Amyloid and tau are well known as biomarkers associated with Alzheimer’s disease, but those biomarkers were developed primarily from Caucasian samples. Therefore, the generalization of these findings in Asian Americans is not always clear, including criteria for amyloid and tau burden to establish AD/ADRD risk,” she says. “There may be different thresholds for those biomarkers in different populations.”

Support for Mild Cognitive Impairment

Dr. Li’s third newly funded project is a two-year pilot clinical trial. She and her colleagues will adapt the Memory Support System (MSS) for use in Chinese Americans who speak Cantonese or Mandarin. The MSS is a memory calendar training program to help older adults with MCI organize and remember their daily activities. The system is a component of the Healthy Action to Benefit Independence & Thinking^Ò (HABIT) Program, an evidence-based intervention that provides lifestyle and behavioral treatments for older adults with MCI.

“I see patients with MCI who want to do something to prevent the development of dementia, but if they can’t speak fluent English, they aren’t able to participate in clinical trials,” Dr. Li says. “We hope that by adapting this program, we can offer Chinese American older adults with MCI an opportunity to participate in a trial that seeks to improve memory and function, as well as their mood and quality of life.”

Alzheimer’s Disease Research at Mount Sinai

In addition to the three new studies Dr. Li has launched this year, she is leading two clinical trials at the Alzheimer’s Disease Research Center at Icahn Mount Sinai and is the site Principal Investigator for the Asian Cohort for Alzheimer’s Disease (ACAD) study, a multisite project to analyze genetic data to identify risk variants for Alzheimer’s disease in Asian Americans and Asian Canadians.

Through these projects, she hopes to improve research participation, diagnosis, and treatment related to patients of Asian ancestry—an effort that is long overdue, she says.

“There’s a lot of work that needs to be done. In addition to research inequities, there aren’t enough bilingual physicians outside the community, which often makes it difficult for Asian American older adults to receive integrated specialty care, leading to delayed diagnosis and treatment for AD/ADRD,” she adds.

Mount Sinai serves a diverse patient population and is committed to improving care by addressing bias and racism. Icahn Mount Sinai and Mount Sinai Health System created the Center for Asian Equity and Professional Development to address the equity and professional development challenges faced by Asian Americans and Pacific Islanders.

Learn more about the Alzheimer’s Disease Research Center

Mount Sinai Receives Five-Year Grant to Support First-of-Its-Kind Translational Science Program for Nurses

Oct 4, 2023 | Featured, Nursing, Research

Mount Sinai’s Center for Nursing Research and Innovation (CNRI) is developing a first-of-its-kind program that supports Doctor of Nursing Practice (DNP) students from underrepresented minority communities and disadvantaged backgrounds to become experts in translating research into clinical practice. The program’s development is being funded by a five-year grant from the National Heart, Lung and Blood Institute (NHLBI) of the National Institutes of Health.

“We are so excited to have achieved this significant milestone,” says Kimberly Souffront, PhD, RN, FNP-BC, Associate Director of CNRI. “This initiative is a significant step toward fostering diversity, equity, and inclusion in our research and health care communities. It not only creates opportunities for underrepresented DNP students but also underscores the vital role of diverse perspectives in advancing translational research and eliminating health disparities.”

The 12-week summer program, Translational Research and Implementation Science for Nurses (TRAIN) at Mount Sinai, will provide DNP students with impactful translational research mentorship within the clinical setting. TRAIN will deliver collaborative, multidisciplinary, multispecialty classroom education and hands-on research experiences mentored by experts in fields of health disparities, hypertension, and other clinical topics central to the NHLBI mission. Students who meet the criteria and are enrolled in any accredited DNP program are eligible to apply.

“DNP-prepared nurses from diverse backgrounds are uniquely and exceptionally qualified to lead translational research for advancing health equity,” says Bevin Cohen, PhD, MS, MPH, RN, CNRI Director.

The inaugural TRAIN program will run from Tuesday, May 28, through Friday, August 16, 2024, with participants devoting 30 hours per week to program activities. A generous stipend is provided to offset the financial impact of professional development in this critical field.

“Having nurses who are prepared to participate as full partners in the research enterprise is critically important,” says Lynne Richardson, MD, FACEP, Founding Co-Director of the Institute for Health Equity Research at Mount Sinai and Endowed Professor of Emergency Medicine and Health Equity Science, Icahn School of Medicine at Mount Sinai. “TRAIN will build the pool of doctoral nurses who are engaged in translational research and implementation science.”

Those interested in learning more about the TRAIN program can email questions to TRAIN@mountsinai.org.

Public Health and Racial Justice Program Encourages Girls of Color to See Themselves As Agents of Change

Updated on Oct 4, 2023 | Community, Diversity and Inclusion, Featured

The Mount Sinai Department of Health Education, with support from The Blavatnik Family Women’s Health Research Institute, hosted its first in-person cohort of the Public Health and Racial Justice Program. Over the course of six weeks in July and August, 15 youth participants, all identifying as girls of color, met daily at The Mount Sinai Hospital to explore a variety of public health issues through a racial justice lens.

The Public Health and Racial Justice Program emphasizes the power and importance of civic engagement, community organizing, and youth activism in addressing the inequities that drive health disparities. The program aims to build skills, foster pride, and nurture community connection so that participants understand themselves as lifelong stakeholders invested in shaping the policies, institutions, and structures that affect the health and well-being of their families and their communities.

“Hearing from both younger people and people who were actively involved in their communities and making a difference was inspiring and presented tangible ways for me to get involved in the community.”

The Public Health and Racial Justice Program was designed and launched in the spring of 2020 as a direct response to the COVID-19 pandemic and the Black Lives Matter movement. Due to pandemic restrictions, the previous four cohorts participated in a part-time version of this program over video conferencing.

With generous support from the Helen Gurley Brown Foundation, and in partnership with The Blavatnik Family Women’s Health Institute, the Department of Health Education was able to significantly expand this summer programming, offering a full-time opportunity with a stipend for participating youth.

More than 80 guest speakers—primarily women of color—from across the Mount Sinai Health System, and from local and national organizations, spoke on a variety of issues, broadening participants’ understanding of the many different pathways one can follow into health equity and social justice work. The program featured union labor organizers, doulas, scientists, clinicians, sexuality educators, grassroots activists, researchers, and leaders from city agencies, including the Bureau of Health Equity Capacity Building at the New York City Department of Health and Mental Hygiene, and the New York City Public Advocate Office.

“My favorite part was hearing from the different activists and non-profit workers,” said one participant. “Hearing from both younger people and people who were actively involved in their communities and making a difference was inspiring and presented tangible ways for me to get involved in the community.”

Another participant added, “I loved meeting all the guest speakers and organizations. The most meaningful part was the new relationships I made and learning more about how to help my community.”

Participants completed a culminating project reflective of their summer experience. Each participant selected a public health issue affecting their community, which they documented using a unique photography application. They were then led through a series of semi-structured, dialogue-based activities with staff and peers to support their development of a complementary narrative. This narrative included suggested action steps for those inspired to get involved.

Participants presented their projects at a celebratory symposium on the final day of programming, attended by Mount Sinai staff, community partners, and their family and friends. Their work was featured in a gallery at The Mount Sinai Hospital, and guests were invited to explore.

For many of the participants, spending the summer in a safe space with other girls of color was a profound experience.

When asked about the most meaningful part of the program, responses included:

“Having that space to be myself and being able to express what I am thinking at the moment. Being vulnerable and having that respect that most of the time adults don’t give to teenagers. I loved the relationships that were built in such a short amount of time.”

“Feeling comfortable and welcomed into this space and meeting all these wonderful and intelligent people who inspire me to embrace who I am.”

“Getting to know other people of color that are around my age and listening to everyone’s different opinions and perspectives.”

For some participants, learning about the relationship between racism and health was new and eye-opening.

“All the things we talked about and learned about in the program were all new information to me so everything surprised me,” said one. “It surprised me that we aren’t taught these things in school but if we want to gain more knowledge on these topics, we have to learn it on our own or from a program like this. I learned a lot about Black maternal health, homelessness, workers’ rights.”

Many of the participants also appreciated learning more about the various career paths that can contribute to health equity.

“At first I thought I knew what career I wanted to be, to become a nurse practitioner. But I met really nice people in the program who talked about their careers and that gave me more options to be open to my opportunities,” said one. “I also thought that many professionals had one path and that they knew they were going to be where they are now but I learned that there is nothing wrong with switching to a different field and it’s all about being happy that you’re doing that job.”

When asked to share their final thoughts on the program, one participant said, “I truly appreciated having the opportunity to be a part of such a wonderful program. I learned so much from the positive and caring program leaders/educators, the speakers, and the other girls in the program.”

To learn more about the summer 2023 session, read the full report

Mount Sinai Researchers Publish First Genome-Wide Analysis of Binge Eating Disorder

Sep 22, 2023 | Featured, Psychiatry, Research

Binge eating disorder is the most common eating disorder in the United States, thought to affect as many as 3 percent of people during their lifetimes. Yet it remains poorly understood.

Now, researchers from the Icahn School of Medicine at Mount Sinai have made important progress with the first genome-wide analysis of binge eating disorder (BED). The study, published in Nature Genetics in August, identified genes that appear to be associated with BED risk. The study also found evidence that iron metabolism may play a role in the disease.

“By applying machine learning to the study of binge eating disorder, we’ve gained important insights into this poorly understood condition, and a new tool for exploring other underdiagnosed diseases,” says Panos Roussos, MD, PhD, Professor of Psychiatry, and Genetics and Genomic Sciences at Icahn Mount Sinai and Director of the Center for Disease Neurogenomics, who is a co-author of the study. “By combining Neuroscience with genomics and big data analysis, we can discover more about how the brain works and ultimately prevent psychiatric disease.”

A Fresh Look at Binge Eating Disorder

Binge eating disorder has significant impacts on a person’s health and well-being. “It can cause substantial distress and impairment in quality of life,” says Trevor Griffen, MD, PhD, a psychiatrist and neuroscientist who collaborated on the recent study while he was a fellow in child and adolescent psychiatry at Mount Sinai. “BED often co-occurs with other psychiatric disorders, such as depression, ADHD, and substance use, and seems to be a nexus of metabolic dysfunction, with associations to conditions like diabetes and high blood pressure.”

Trevor Griffen, MD, PhD

Yet it took a long time for the scientific community to recognize BED as a distinct disorder. It was first included as a new diagnosis when the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in 2014. As a result, the diagnosis is all but absent in the electronic health records and large biobanks that researchers tap into for large-scale genetic analyses. Luckily, the Mount Sinai team developed a workaround.

“A big part of this study was using machine learning to figure out the people most likely to have BED,” says lead author David Burstein, PhD, a data scientist at Mount Sinai who works in the labs of Dr. Roussos and study co-author Georgios Voloudakis, MD, PhD, Assistant Professor of Psychiatry, and Genetics and Genomic Sciences.

Using electronic health record data from more than 767,000 people through the Million Veterans Project, Dr. Burstein and his colleagues applied machine learning approaches to sift through medical diagnoses, prescription medicines, body mass index (BMI) data, and other factors, looking for patterns that would predict if a person had BED. Applying their model to smaller cohorts of people with diagnosed BED, they showed the approach could meaningfully predict the disorder, even in the absence of a formal diagnosis.

Genes Point to New Binge Eating Disorder Treatments

Applying the machine learning model to some 362,000 people for whom genetic information was available, the researchers zeroed in on several genetic loci that appear to be associated with BED risk. One of the genes implicated in the new study is MCHR2, which is associated with the regulation of appetite in the brain. Two others, LRP11 and APOE, have previously been shown to play a role in cholesterol metabolism.

David Burstein, PhD

Another gene identified in the study, HFE, is involved in iron metabolism. The identification of HFE aligns with recent research suggesting iron metabolism may have an important role in regulating overall metabolism, Dr. Griffen says. In particular, iron overload seems to be associated with binge eating, the team found. Interestingly, iron deficiency has been implicated in pica, a disorder that drives people to eat non-food items such as soil or hair.

“There have been hints that iron is a player in the eating disorder world,” Dr. Burstein says. “This new study is more evidence that the mineral deserves a closer look.”

The findings also point toward new directions for treating BED. So far, treatment has mostly focused on repurposing therapies used for other disorders, such as depression or ADHD.

“This study identifies genes and systems that could serve as potential targets for treatments that finally address the underlying biology of BED,” Dr. Griffen says. “It also continues to build evidence that there are biological and genetic drivers of binge eating behaviors. The more we get that message out there, the more we can decrease stigma associated with binge eating.”

A New Tool for Eating Disorder Research

Dr. Griffen is continuing to collaborate with Dr. Roussos and Dr. Voloudakis to expand on their findings, with plans to develop mouse models and dig deeper into the mechanisms. Ultimately, their goal is to develop new treatments that target the underlying biology of BED.

Meanwhile, the researchers are eager to apply their new computational approach to other diseases such as bulimia nervosa—another common eating disorder for which no genome-wide analysis has ever been done.

“Being able to infer a diagnosis from medical records is really significant, not only for BED but for other eating disorders, which are often extremely underdiagnosed” and therefore challenging to study using electronic health records, Dr. Burstein says.

The approach can also extend the science into populations that have been overlooked in past research. Most research on eating disorders has focused on white females. Using machine learning, researchers can more thoroughly study eating disorders in males and populations with other racial or ethnic backgrounds.

“This is exciting work, with so many potential future directions,” Dr. Burstein says.

Why it Is Important for Men to Get Tested for Prostate Cancer

Updated on Sep 9, 2024 | Featured, Your Health

Prostate cancer is the second most common cancer among men in the United States, after skin cancer, and the number of cases has been rising yearly. About one man in eight will be diagnosed with prostate cancer during his lifetime, according to the American Cancer Society.

Prostate cancer comes in many different forms, which is why Mount Sinai offers a wide variety of treatment options while conducting research to find new and innovative treatments and expanding care to those communities most at risk.

“The most important thing people can do is find this cancer early, when it is easier to cure. That starts with understanding your own risk, and talking with your doctor before there are any symptoms,” says Ash Tewari, MBBS, MCh, FRCS (Hon.), Professor and Chair, Milton and Carroll Petrie Department of Urology and Director of the Center of Excellence for Prostate Cancer at The Tisch Cancer Institute at Mount Sinai.

One key message remains unchanged: Prostate cancer screening is critical to detecting this cancer early, before you have any symptoms, when you have more treatment options.

Click here to watch a series of short videos on prostate cancer from the Department of Urology and learn more about the importance of your family history and how to minimize your risk for prostate cancer.

In this Q&A, Dr. Tewari, who is also Surgeon-in-Chief of the Tisch Cancer Hospital at The Mount Sinai Hospital, explains when men should be tested for prostate cancer and what options are available to those who may be diagnosed with prostate cancer.

What should patients and consumers know about the rise of prostate cancer?

Ash Tewari, MBBS, MCh, FRCS (Hon.)

It is likely that this perceived rise of prostate cancer is not a true rise in prostate cancer incidence but rather there has been increased awareness about testing and screening. This is a good thing because we can prioritize delivering care to those who need it and make sure they are managed appropriately.

Who should be tested for prostate cancer, and when?

The decision of when to initiate screening should be an individual one that is based on shared decision making between physician and patient. There are several factors to consider including race, family history of cancer (not only prostate but also breast, ovarian, and pancreatic cancer), and age. According to the U.S. Preventative Services Task Force, all men over the age of 55 should have this conversation with their physician about the decision to begin screening with Prostate-Specific Antigen (PSA) testing. Patients who are at higher risk, such as those with family history, should start this conversation earlier, and some as early as age 40.

Who is most at risk for prostate cancer?

Those who are most at risk of prostate cancer include:

Black men
Men with a family history of prostate cancer and other cancers
Men over 55 years old
Men who have done genetic testing and were found to have mutations, such as BRCA2, that are known to be correlated with a higher risk of prostate cancer

How is prostate cancer diagnosed?

Prostate cancer is diagnosed when a PSA test rises above a certain threshold, and a biopsy becomes indicated. A biopsy can be done even if PSA is not above threshold—for example if a patient has other factors that might put him at risk or has a concerning magnetic resonance imaging (MRI) test. This biopsy can be performed transperineally or transrectally. Sometimes, this biopsy is guided by imaging tests such as an MRI and micro-ultrasound imaging to increase the sensitivity of the biopsy.

How do doctors use the PSA test?

The PSA test is a blood test that can be used for screening. It also is used as a marker to track treatment response and for surveillance to detect recurrences after treatment. A single PSA test is often insufficient to draw meaningful conclusions. A single elevated PSA during screening is followed up with another PSA test to corroborate that the rise was not due to other factors, such as the result of inflammation or infection in the prostate.

What treatments are available for prostate cancer?

If you are diagnosed with prostate cancer, what follows next would be a discussion with your doctor about next steps. The conversation depends largely on the type of prostate cancer diagnosed. There are a number of different types and grades of prostate cancer, and treatment must be appropriate for the individual patient. Some patients are diagnosed with a disease that is confined to the prostate. Options for these patients range from active surveillance for low-risk disease to radical treatments such as radiation or surgery for intermediate-risk and high-risk disease. There are also emerging experimental therapies, called focal therapies, that are being investigated for their appropriateness and safety for certain patients. For advanced and metastatic disease, sometimes hormones and other treatments that target the entire body, such as chemotherapy may be used. This is also a very active field of research. There is a tremendous effort to improve the outcomes and quality of life for patients.

What is active surveillance, and why is that important?

Active surveillance is an approach that is used for patients who have low-risk and very low-risk cancer confined to the prostate. Because these cancers are usually slow growing and do not involve complications or pain, we prefer not to implement radical treatments if they are not necessary, and so active surveillance can be a good option for them. This protocol often involves periodic imaging and biopsies to monitor the disease and intervene only if necessary.

Can I reduce my risk for prostate cancer?

There is no evidence that one lifestyle choice will either cause or prevent prostate cancer. Studies show that patients who eat more vegetables and less red meat, and patients who exercise regularly, are at lower risk for prostate cancer. Overall, leading a healthy lifestyle has many wide-reaching benefits.

What steps is Mount Sinai taking to bring prostate cancer screening to the community?

In 2022, we launched the Mount Sinai Robert F. Smith Mobile Prostate Cancer Screening Unit, a state-of-the-art mobile facility equipped with advanced PSA tests and trained staff that visits predominantly Black neighborhoods across New York City. We are very excited about this initiative. We want to reach patients who cannot easily access a urologist, and we want to make it easier to screen for prostate cancer and treat them if necessary to save their lives. So far, we have screened more than 3,000 patients and of those, we have found several hundred with elevated PSAs that required further follow up. We detected cancer in 30 patients and conducted surgery to remove the cancer in half of these patients. In addition, we are following up with these patients to make sure they have the most appropriate testing and treatment.

Learn more about our services and make an appointment

Mount Sinai West Installs Dedicated Cardiovascular CT System

Sep 21, 2023 | Community, Featured

As part of a continued expansion of cardiology imaging, Mount Sinai West has opened its first dedicated cardiovascular computerized tomography (CT) system, called Cardiographe.

This new CT system addresses the challenges of scanning patients with high or unstable heart rates, a common issue in urgent cardiac imaging, providing robust clinical detail needed for diagnosis and assessment.

“The launch of CardioGraphe at Mount Sinai West underscores our commitment to providing the best possible care for our patients, enhancing both accessibility and quality in the early diagnosis and treatment of heart disease,” said Jeffrey Bander, MD, FACC, Chief of Cardiology, Mount Sinai West. “Our aim is to improve access to high-quality imaging solutions, and the CardioGraphe is an affordable and accessible tool that allows physicians to diagnose and treat patients with cardiovascular diseases more efficiently.”

This system can create a 3D image of the coronaries, valves, chambers, and myocardium in a single heartbeat and can perform CT angiography studies beyond the heart, including the aorta and carotid arteries. It provides physicians with crucial information about heart function and the necessary anatomic detail to plan procedures like Percutaneous Coronary Intervention (PCI) and Transcatheter Aortic Valve Replacement (TAVR).

To schedule a patient, call 212-636-4107 or email MSWCT@mountsinai.org.

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