By Joyce Lee

On average, some amount of decline in memory and thinking skills is expected with age. But every older adult experiences cognitive aging and decline differently. Some develop neurodegenerative disease that hastens cognitive decline, while others preserve cognitive skills into their later years.

Making changes to reduce the risk factors in your life, such as diet, physical exercise, social activity, and cognitive engagement, is key to staying on the path of steady cognitive skills with advancing age.

This is what Dawn Mechanic-Hamilton, PhD, ABPP/CN, addressed in her talk on healthy brain aging to a group of older, professional women in the Ralston Center in late October. Dr. Mechanic-Hamilton is the Penn Memory Center director of neuropsychological services and cognitive fitness programs.

Penn Memory Center Scholar Laura Wisse, PhD, was selected to present the 2018 Sanjeev Kumar Memorial Lecture at the annual Biomedical Postdoctoral Council Symposium on Monday, November 5.

In her lecture, which followed a series of presentations related to biomedical research, Dr. Wisse discussed her work on the effects of Alzheimer’s disease and aging on the hippocampus using a newly developed postmortem atlas. Dr. Wisse draws aspects of her data from the PMC Aging Brain Cohort (ABC) study.

At PMC, Dr. Wisse works with PMC Co-Director David Wolk, MD, associate professor of neurology, and Paul Yushkevich, PhD, associate professor of radiology in the Perelman School of Medicine. Dr. Wisse’s main interests are imaging of the medial temporal lobe in aging and diseases such as Alzheimer’s disease and Major Depressive Disorder. She is also a member of the Penn Image Computing and Science Lab.

By Janissa Delzo

A collaborative report issued by the National Institute on Aging (NIA) details a national strategy to both boost recruitment in Alzheimer’s disease research and increase diversity among those eligible research participants.

PMC Co-Director Jason Karlawish, MD, contributed to the October report titled, “Together We Make the Difference: National Strategy for Recruitment and Participation in Alzheimer’s and Related Dementias Clinical Research,” which reflects two years of work.

“This document focuses on one area of urgency—the pressing need for increased and diverse participation in research studies as these scientific opportunities emerge,” wrote NIA Director Richard J. Hodes, MD. “Additional studies on new approaches will require greater numbers of people from across the disease spectrum.”

From left: Janissa Delzo, Linnea Langkammer, and Sharnita Midgett

By Linnea Langkammer

Three new interns have joined the Penn Memory Center communications team, bringing together unique perspectives and skill sets for the 2018-2019 academic year.

Janissa Delzo, Linnea Langkammer, and Sharnita Midgett will work with Communications and Marketing Manager Terrence Casey and Communications Assistant Joyce Lee.

“This year’s interns bring backgrounds in public health, health communication and multimedia,” Casey said. “I look forward to seeing the impact they will make during their time at PMC.”  

Women in medicine from across Philadelphia, including several members of the Penn Geriatrics Division and Penn Memory Center, met at University of Pennsylvania’s 21st Annual FOCUS Fall Leadership Development Conference on Friday, October 12. Members of Penn Geriatrics in attendance included Chief of Geriatric Medicine Lisa Walke, MD, Instructors in the Division of Geriatrics Rebecca Brown, MD, and Shana Stites, PsyD, MA, MS, and Geriatrics Fellows Linnea Pepper, MD, Reshma Shah, MD, and Alyson Michener, MD. Dr. Shana Stites is also a PMC Scholar, while the Geriatrics Fellows see PMC patients as part of their training. PMC works in collaboration with Penn Geriatrics and Penn Neurology.

Founded in 1997, FOCUS looked to address the underrepresentation of women in senior levels of academic medicine by launching initiatives designed to help recruit, retain, and promote women faculty through seminars, workshops, and conferences related to career development and mentoring. FOCUS aims to support the advancement and leadership of women in academic medicine and to promote education and research in women’s health and women’s careers.

Penn Memory Center intern Mariya Bershad (right), reviews the app with research participant Isabel Gurbarg. (Photo by Joyce Lee)

By Joyce Lee

An array of cards appear on the screen, each with a vibrant, colorful image.

There’s a pair of red tomatoes. Yellow paper umbrellas. Brown cowboy boots.

But then, the cards flip over, obscuring their images.

Can you now match all the pairs?

This is the Memory Game app, a Penn Memory Center (PMC) initiative led by PMC Director of Neuropsychological Services Dawn Mechanic-Hamilton, PhD and PMC Co-Director David Wolk, MD. It’s part of an ambitious, innovative project looking at how apps can test and track cognitive skills in the progression of neurodegenerative disease.

By Janissa Delzo

When a patient chooses to learn they have amyloid in their brain difficult decisions and uncertainties lie ahead. What does that information mean? And how will they, their families, and co-workers, respond?

There’s no single answer. But often, the situations involve negative dialogue. For example, take “Angela.”  

Angela (an alias) is enrolled in the Penn Memory Center’s A4 study, a drug intervention for older adults who may be at risk of Alzheimer’s. In an attempt to help advance research, she experienced changing relationships with both her colleague and son, PMC Co-Director Jason Karlawish, MD, detailed in an Hastings Center Report editorial this month.

Clockwise from top-left: Sarah Bunjo, Nora Garland, Matt Volpe, and Laura Vargas

By Linnea Langkammer

This fall, Penn Memory Center welcomed a new group of social work interns to help develop and maintain psychosocial support programs for patients and caregivers at PMC.  

Sarah Bujno, Nora Garland, Laura Vargas, and Matt Volpe are students in the Master of Social Work program at the University of Pennsylvania’s School of Social Policy and Practice.

The interns will work with Executive Director Felicia Greenfield and Assistant Director of Care Programs Alison Lynn. Greenfield called the annual corps of social work students “integral to the PMC’s training mission.”

Penn Memory Center, “a model” for other Alzheimer’s research centers, will receive ARTZ Philadelphia’s Caring Community Award at a community exhibition and reception Friday.

An ARTZ Philadelphia Community Exhibition

Friday, October 5  | 5:30 to 7:30 p.m.
The Philadelphia Foundation Community Arts Gallery
1835 Market Street, Suite 2410, Philadelphia PA
Register on the ARTZ Philadelphia website.

“We have seen an intensification of Penn Memory Center’s emphasis on the importance of the arts and humanities in the last several years,” said ARTZ Philadelphia founder and executive director, Susan Shifrin.

“I think that Penn Memory Center is a model for what other Alzheimer’s research centers and care centers should be doing.”

Over the last three years, Penn Memory Center, has launched and expanded projects such as Art of the Mind, Making Sense of Alzheimer’s, and collaborations with our community partner, Curtis Institute of Music. For the last two years, the Art of Mind exhibition showcased artists’ work in the intersection of memory and art. Making Sense of Alzheimer’s is a creative space for stories and ideas that tackle the changing understanding of what Alzheimer’s disease is. Arlen Hlusko, cellist from the Curtis Institute, has performed at our Thank You Breakfast, and Rimbo Wong, violinist from the Curtis Institute, has brought classical music into the homes of Penn Memory Center patients.

The Caring Community Award is offered to organizations that have worked with ARTZ Philadelphia and are notable for their promotion of quality of life that is enhanced specifically by interaction with the arts. Shifrin looks for organizations focused on being welcoming and open to people living with dementia.

At the same event, Deborah Davis, LCSW, will be awarded the Community Catalyst Award. Awards will be given out at a public reception at The Philadelphia Foundation Community Arts Gallery.

ARTZ Philadelphia, an organization dedicated to providing opportunities for self-expression and for the rebuilding of self-esteem and dignity to people with dementia and their caregivers, has had a relationship with Penn Memory Center since its inception.

This is the second Caring Community Award being presented by ARTZ. The first award was offered to Woodmere Art Museum, one of ARTZ Philadelphia’s longtime partners that hosts programs, lectures, and panel discussions as well as a collection of art.

Dance for Health

Saturdays, Sept. 29 to Nov. 17, 2018
10 to 11:30 a.m.
Ralston Center, 1st Floor Wellness Center
3615 Chestnut Street, Philadelphia, PA 19104

Dance for Health, weekly dance sessions and social activities that promote brain health and healthy living among participants in West Philadelphia, will return to the Ralston Center this fall. With the support of the Penn Medicine CARES grant, the program is free and open to the public. Classes will be held at the 1st Floor Wellness Center in Ralston Center, 3615 Chestnut Street, Philadelphia, PA 19104.

By Kaleah McIlwain

There’s a dance people do when they start listening to music and are getting a feel for it.

Some people sway back and forth, others bob their head.

On a Saturday morning, David Earley did both as he waited for the class participants to arrive.

Wearing a coordinated outfit of all-white Nike Air Force shoes, black jeans, a white and red jersey with the words “you’re in good hands,” and a red baseball cap, Earley set up his small gray boombox at the front of the room and began playing “Same Ole 2step” by Ent Distrikt. The music was a cue for everyone in the room to get up and start dancing.

September Memory Café
Friday, September 28
10:30 a.m. to Noon
Christ Church Neighborhood House
20 N. American Street, Philadelphia
RSVP: alison.lynn@uphs.upenn.edu

By Danielle Kennedy

As a Penn MPH student, I wondered how Penn researchers could strengthen their relationship with West Philadelphians. Working with Dance for Health in the spring enabled me to give back to the research community through social dance classes. Dance for Health (DFH), a partnership between the Penn Memory Center and Ralston House, creates a space for older adults in Philadelphia to get active through dance and preserve their cognitive health.

In the beginning, I was unsure if I would take part in learning the dance routines. I had never taken a line dancing class; but when the music started, it felt natural to join in. Dancing with DFH participants every Saturday helped me connect with them. Each time I started dancing on the wrong foot or turned left instead of right, I was encouraged to keep going by the DFH participants’ warm smiles.

As the weeks progressed, I noticed the dance instructors were not giving us as many instructions as they used to. I realized then that the instructors were testing participants’ memories of the choreography. I also looked forward to strengthening my relationship with DFH participants each Saturday and learned that they enjoyed the social aspect of the program as well. The older adults told me they appreciated that DFH provided them with a break from their usual routine and a chance to connect with others. Some participants brought friends or family members to class while others enjoyed making new friends and bonding over shared experiences between dances.

Interestingly enough, previous research suggests a positive correlation between social interaction and health. Working with DFH, I was able to witness firsthand how social dance can bring you joy and health.

Danielle Kennedy was a 2017-2018 Penn Memory Center intern.

Jerry Mikszewski, MD

PMC neurologist Jerry Mikszewski, MD, Clinical Associate of Neurology at the Perelman School of Medicine, announced his retirement on Friday. In his time at the Penn Memory Center, Dr. Mikszewski has been an integral member of the PMC clinical team. A neurologist, his expertise in dementia and cognitive impairments has been invaluable for the care of PMC patients and the education of the PMC community.

“It has been truly a pleasure working with Jerry during his time at Penn,” David Wolk, MD, PMC Co-Director, says. “I believe we have all learned much from him and his unique perspective on the care of patients with cognitive impairment and dementia. I also greatly appreciate his kind manner and gentle humor – I am sure his patients do as well!”

Felicia Greenfield, Executive Director, says, “I will miss working with Jerry. His unwavering support of the social work team demonstrated his commitment to improving patient outcomes. I will miss his welcoming smile and his warm, approachable demeanor. I wish Jerry and his family all the very best on this new chapter in life. He will be missed!”

PMC Co-Director Dr. David Wolk presents at the 2018 Research Partner Thank You Luncheon.

By Erin Alessandroni

The number of Alzheimer’s cases and related deaths has been sharply increasing, making it what some call a “global epidemic” and “public health crisis”. While the cost of care to our nation is rising, research shows that early diagnosis of cognitive decline could lead to individual and national long-term savings.

This year’s Alzheimer’s Disease 2018 Facts and Figures report includes the alarming fact that by 2025, the number of people age 65 and older with Alzheimer’s disease (AD) is estimated to reach 7.1 million, an increase from the 5.5 million age 65 and older affected in 2018.

John Witzman (left) was always by his wife Jacqueline’s side as she participated in a clinical trial at the Penn Memory Center. Jacqueline has Alzheimer’s disease. (Photo by Terrence Casey)

By Joyce Lee

In the world of clinical research, Alzheimer’s disease (AD) studies stand out due to their requirement of study partners: often a spouse, child, or close friend who provides support for the patient undergoing memory testing, MRI brain scans, and trial drug infusions.

But the importance of study partners also extends to the preclinical setting. As researchers start to study and identify individuals at high risk of developing Alzheimer’s disease with genes and biomarkers, study partners can help reduce participants’ anxiety and distress, report to researchers how participants are doing, and ensure findings of these studies have practical applications.

This is why Penn Memory Center Co-Director Jason Karlawish, MD, and University of California, Irvine Professor Joshua Grill, PhD, argue that study partners should be required in all preclinical Alzheimer’s disease studies. Their review article was published in Alzheimer’s Research and Therapy.

By Erin Alessandroni

Research suggests that cognitive complaints are associated with greater self-reported negative psychological feelings. This relationship could have implications on Alzheimer’s prevention trials and management of clinical populations in research.

PMC Co-director Jason Karlawish, MD; PMC Scholar Shana Stites, PsyD, MS, MA; PMC Senior Research Coordinator Kristin Harkins, MPH; and Manager of Psychometrics for the National Board of Medical Examiners Jonathan Rubright examined the relationship between self-reports of cognitive complaints and quality of life in people with varying degrees of cognitive impairment. Their findings were published in the Alzheimer’s Disease & Associated Disorders International Journal.

Dawn Mechanic-Hamilton, PhD, ABPP/CN

By Erin Alessandroni

Penn Memory Center Director of Cognitive Fitness Programs and Neuropsychological Services Dawn Mechanic-Hamilton, PhD, ABPP/CN, recently received an Institute on Aging (IOA) pilot grant for a project focused on apathy in patients with neurodegenerative disease. The grant for her project, titled “Development of a Goal-Directed Behavior App: Changing Apathy into Action in Neurodegenerative Disease,” began on July 1.

In dementia patients, apathy, or impairment of goal-directed behavior, is a symptom that has a significant negative impact on a patient’s ability to engage in everyday activities and can increase care partner burden. The project aims to develop a mobile app that will increase goal-directed behavior and decrease apathy by targeting behaviors like motivation, planning, and initiation, with an emphasis on individualized patient goals. The app will measure progress and outcomes for both the patient and care partner.

Adapted from an Alzheimer’s Association statement.

There are no universal, multidisciplinary guidelines for clinicians in Alzheimer’s (AD) care, often leading to symptoms going unrecognized or misattributed.

In response, the Alzheimer’s Association convened a group dedicated to creating best practices for clinicians. This group, which includes PMC Co-Director Jason Karlawish, MD, intends for these guidelines to improve timely and accurate diagnosis and disclosure of AD and other dementias, according to an Alzheimer’s Association press release.

Shana Stites, PsyD, MA, MS

Adapted from Alzheimer’s Association press release.

Many individuals worry that an Alzheimer’s disease diagnosis will lead to discrimination in the workplace and exclusion in the medical setting, according to Penn Memory Center research. These perceptions may prevent someone from going to the doctor to get the care they need, or from participating in clinical trials needed to advance Alzheimer’s disease research and care.

At PMC, clinical psychologist and researcher Dr. Shana Stites led a team to look at responses from a general public survey featuring descriptions about a man named “Mr. Andrews.” In one version of the survey that went to 317 randomly selected respondents, Mr. Andrews went to the doctor’s office complaining of memory problems and was diagnosed with Alzheimer’s disease. (Other versions had Mr. Andrews diagnosed traumatic brain injury, or not diagnosed with anything at all.)

Respondents were then asked questions about Mr. Andrews. More than half of respondents expected him to face workplace discrimination (55.3%) and to be excluded from medical decision-making (55.3%). Nearly half also thought his health insurance would be limited due to information about his diagnosis being placed in his medical record (46.6%) or based on the result of a test, such as a brain imaging scan (45.6%) or genetic test (44.7%).

Penn Memory Center patient Carl Duzen and his wife Susan Jewett were featured on 6abc news channel last week for copper art, which Mr. Duzen creates from taking apart old electronics. This was a hobby he adopted as a coping mechanism after his Alzheimer’s disease diagnosis at PMC a few years ago. What started out as just a hobby of taking apart discarded TVs turned into an art exhibit after Ms. Jewett, who is also an artist, began to frame the work Mr. Duzen created. 

Mr. Duzen and Ms. Jewett with PMC Co-Directors Dr. David Wolk and Dr. Jason Karlawish at his exhibition opening. (Terrence Casey / Penn Memory Center)

Mr. Duzen’s copper art is currently featured in PMC’s ‘Art of the Mind’ exhibition. The grand opening was in early May when a group of the couple’s close friends and members of the PMC community gathered to celebrate his work.

“Carl Duzen: Shaping Copper, Making Meaning” will be on display outside the Penn Memory Center clinic until late October. Guests can view the exhibition during regular business hours by entering the Perelman Center for Advanced Medicine through the main doors, taking the elevator to the second floor, and following the hallway to the South Pavilion.

Kristin Harkins, MPH

By: Erin Alessandroni

As advances in imaging and other technologies continue to take place, clinicians will have the ability to diagnose Alzheimer’s disease (AD) years before the onset of clinical symptoms. This progress may present difficulties, such as informing cognitively healthy individuals of potentially distressing information.

Kristin Harkins, MPH and Jason Karlawish, MD, both of the Penn Memory Center, provide considerations clinicians must make when disclosing amyloid status to a person without cognitive impairments in an article published to Practical Neurology.

Riddhi Patira, MD

By Erin Alessandroni

Every 70 seconds, someone in America is diagnosed with Alzheimer’s disease (AD). Two Penn Memory Center clinicians have a published set of recommendations regarding the care that follows.

Riddhi Patira, MD and Sanjeev Vaishnavi, MD, PhD discuss the “epidemic proportions” AD is reaching, with no effective therapies to prevent onset or stop disease progression, in a recent article published to the journal Practical Neurology.

By Erin Alessandroni

Shana Stites, PsyD, MS, MA

The stigma associated with Alzheimer’s disease (AD) often presents patients and their families with psychological and social challenges. Penn Memory Center provides steps clinicians can take to minimize this stigma in a paper published to Practical Neurology.

PMC Scholar Shana D. Stites, PsyD, MS, MA and PMC Co-Director Jason Karlawish, MD describe stigma’s consequences on both how a patient and caregiver react to a diagnosis (“internalized stigma”) and how the community treats the diagnosed in discriminatory or patronizing ways (“public stigma”). Additionally, a third type of stigma called “spillover stigma” can affect caregivers and family members who become associated with presumed negative societal traits.

By Kaleah McIlwain

Penn Memory Center neurologist Sanjeev Vaishnavi, MD, PhD recently visited senior living and memory care center Atria Center City, where he presented the talk “Dementia: Getting a Proper Diagnosis.”

Atria Center City is sponsoring PMC’s November Caregiver Retreat, and part of this sponsorship includes a presentation from a PMC dementia specialist.

By Kaleah McIlwain

Papa John yells “zap” and shoots his hand towards Abby, charged with shouting “zop.” What comes out, however is a loud “zip.”

The error is met not with jeers but raucous applause.

Cheering when someone makes a mistake is Leah Lawler’s way of emphasizing that mistakes are acceptable. She encourages this way of thinking in her weekly Cognitive Comedy workshop, where more than a dozen participants come together and exercise memory muscles with various improv exercises. Lawler, a Philadelphia actor, started the weekly workshop with the Penn Memory Center (PMC) as a way to combine social engagement with learning a new skill and having fun.

“It provides a sense of community and belonging. It is fun and gets older adults out of the house with something stimulating and meaningful to do,” said Felicia Greenfield, PMC executive director. “They are engaged, they’re learning new skills, [and] they’re exercising their memory muscle.”  

By Kaleah McIlwain

A typical research visit at the Penn Memory Center (PMC) asks quite a bit of research study participants and their study partners.

There’s the travel needed to get to the center, the time spent in the waiting room, and then the series of cognitive tests, blood draws, MRI scans, possible PET scans, and more that participants are asked to undergo.

In response, PMC holds an annual Research Partner Thank You Luncheon (or, in previous years, a breakfast) to show appreciation for research participants and their study partners and to update them on the status of current research studies and programs.

The theme of this year’s luncheon was “Precision Medicine and the Aging Brain,” focusing on the shift in Alzheimer’s disease research towards using biomarkers to determine who has or is at risk of developing the disease.

“Someday you won’t have to be sick, you won’t have to be ill, to be diagnosed with Alzheimer’s disease,” said Dr. Jason Karlawish, PMC co-director. “Signs and symptoms won’t matter.”

Penn Memory Center 2017-2018 Cognitive and Behavioral Fellow Dr. Riddhi Patira (Photo by Joyce Lee)

By Joyce Lee

Five afternoons a week, Riddhi Patira, MD, sees patients and families in the Penn Memory Center clinic. She talks about their concerns with memory, evaluates their cognitive tests, neurological exams, and brain scans, and helps them make a plan of action that could include medications, clinical study enrollment, and referrals.

Dr. Patira was trained to do all this as a Cognitive and Behavioral Neurology Fellow at the Penn Memory Center this past year. This unique fellowship program trains neurologists in all aspects of clinical care for dementia, and is one of only a handful of such programs nationwide that produces UCNS-certified specialists in Behavioral Neurology and Neuropsychiatry.

Seetha Chandrasekhara, MD (Photo by Joyce Lee)

By Joyce Lee

If you walked into the Penn Memory Center clinic on a Monday afternoon this past year, you probably saw Seetha Chandrasekhara, MD, helping both patients with memory problems and their loved ones.

A Geriatric Psychiatry Fellow with the University of Pennsylvania Department of Psychiatry, Dr. Chandrasekhara joined PMC in the summer of 2017 after completing her psychiatry residency at Temple University. Her time at PMC was a core yearlong rotation as part of the program, “because geriatric psychiatry involves a lot of dementia and management of the behaviorial symptoms of dementia,” she said.

By Joyce Lee

Join Penn Memory Center in saying farewell and good luck to research coordinator Benjamin Bear, MSW.

Mr. Bear joined the Penn Memory Center (PMC) in 2017, after graduating with his Master’s degree in social work from the University of Maryland, Baltimore. At PMC, he primarily conducted qualitative data collection and analysis for the SOKRATES II study, working with Kristin Harkins, MPH, to understand why individuals decide to share or not share with others knowledge of their APOE genotype, a gene used to predict risk of developing Alzheimer’s disease.

“Benjamin’s social work training made him a skilled interviewer. He connected with research participants and treated them with empathy and compassion,” said Ms. Harkins. “His kindness and unique clinical perspective were great assets to our work together. He will be missed.”

Join us in saying farewell and best of luck to Kayci Vickers, MS, who has been a neuropsychology practicum student at the Penn Memory Center (PMC) for the past two years. She came to PMC as a doctoral student at Drexel University in Clinical Psychology, specializing in neuropsychology.

Ms. Vickers has had a role in all aspects of neuropsychological services at PMC, including conducting comprehensive neuropsychological evaluations, testing PMC patients and Aging Brain Cohort (ABC) study participants, and acting as co-facilitator of the Cognitive Fitness Psychotherapy and Skills groups. She also recently published a normative paper on olfactory testing (Sniffin’ Sticks) in older adults in the Archives of Clinical Neuropsychology.

Ms. Vickers will be moving on to an internship training program at Emory University next month.

“She has been a pleasure to work with, is a team player and has a bright future. She will be missed!” said her supervisor and PMC director of neuropsychological services Dawn Mechanic-Hamilton, PhD.

Penn Memory Center Scholar Emily Largent, PhD, JD, RN has been selected to participate in the National Institute on Aging (NIA) Butler-Williams Scholars Program, to be held from July 30 to August 3 on the NIH Campus in Bethesda, MD.

The program provides qualified individuals an opportunity to further their knowledge through lectures, seminars, and small-group discussions in research design relative to aging, including issues relevant to aging of racial and ethnic minorities.

Dr. Largent is an assistant professor of Medical Ethics and Health Policy at the Perelman School of Medicine and a senior fellow at the Leonard Davis Institute of Health Economics.

The Butler-Williams Scholars Program is sponsored by the NIA with support from the National Hartford Centers of Gerontological Nursing Excellence.