By Heather M. Butts
Sharon Brangman, MD is the chair of Geriatric Medicine and director of the Upstate Center of Excellence for Alzheimer’s Disease at State University of New York Upstate Medical University. She spoke with the Amsterdam News about geriatrics, Alzheimer’s, and preventative care. This conversation has been edited and condensed for clarity.
AmNews: Can you give us an overview of your work and how you became interested in geriatrics?
Brangman: I became interested in geriatrics during my training. I did my training in internal medicine at Montefiore in the Bronx. I was working in a clinic in the South Bronx, and I noticed that my older patients had such a fierce determination to maintain their independence. I had all of these younger patients with minor medical problems asking me for notes so they could stay home from work, and my older patients who had all these problems were telling me how they wanted to maintain their independence. That was in the late 1980s when geriatrics was just becoming a specialty here in the United States.
I did a formal training in geriatrics, and I actually took the first boards that were offered in the specialty. I started out working as a medical director of a nursing home in Harlem, but I missed the academic environment so I moved up to Syracuse and it was a very small program that was getting started and I kind of dug in my heels and helped establish geriatrics at Upstate which included getting accredited to have a geriatric fellowship program and developing curriculum for medical students and residents as well as practicing physicians to get geriatric content into the nurse practitioner training programs and physician assistant training programs.
I had a lot of patients with dementia, and we started a program that was sponsored by the New York State Department of Health. At that time it was called the Alzheimer’s Disease Assistance Center, and that evolved over the years [into] what it is now a Center of Excellence for Alzheimer’s Disease because as a state, we help to set the standards of evaluation and diagnosis, and treatment. There are three in New York City, and the rest are scattered throughout the state. What we do is we help teach the next generation of health care providers.
From that, my interest in Alzheimer’s disease kind of expanded and I got involved with some national programs, and eventually that led me to start a clinical trials program here at Upstate. We have a clinical trials program that is part of our Center of Excellence for Alzheimer’s disease, focused on bringing some of the potentially new treatments to people in Central New York because prior to that, they had to come down to New York City or go to Boston, and that was a big struggle.
AmNews: Could you talk a bit more about the clinical trials work that you do?
Brangman: One of my interests has been in ethnogeriatrics, and I helped start the Ethnogeriatrics Committee for the American Geriatric Society. That’s really the intersection of aging with race and culture, and one of the things I’ve noticed through my training is an increased incidence of certain diseases, especially Alzheimer’s disease in African-Americans. [I have been] trying to figure out why that is and why there may be delays in getting a treatment plan or a diagnosis, and certainly delays in participating in clinical trials so that we know about how the next generation of treatments might impact Black patients. Some of the major drugs that are currently available for treating Alzheimer’s disease were tested using clinical trials that had very low diversity [and a] small numbers of African-Americans [and] Latinos.
A disease like Alzheimer’s disease impacts African-Americans twice as high as it does white counterparts. The risk is very high, but the participation in trials and information about how it might be different in different cultures or races… we have very little information. So it doesn’t seem as though there’s a genetic difference, but it could be based on some of the social determinants of health that impact African-Americans. Increased risk for developing Alzheimer’s disease could be related in part to some of the increased risk for chronic illnesses that we see, such as hypertension and diabetes. We know that it has a negative impact on brain function over time, being overweight, having a high cholesterol, having poor sleep habits, having stress, and we know stress is a huge issue.
Everybody interprets stress differently, but if you are subject to say economic stress or discrimination or racism for your lifetime, you may have higher levels of background stress that over time takes its toll on your body, so there’s a lot of reasons why they may be higher risks in African-Americans, but it has not been studied as closely as I think is appropriate. There’s certainly not been enough participation in clinical trials so that we could know how medications might help. Part of this is due to so many different factors…What they’re thinking about is their everyday interaction with the health care system, and when they interact with the health care system, are they being treated fairly or are their needs being met? Are their problems really being addressed? After I saw how few African-Americans were in these big international trials for Alzheimer’s drugs, I worked with a colleague and we got a grant to address this, and this was in the middle of the pandemic.
AmNews: Is there anything else you want to tell Amsterdam news readers?
Brangman: I think just about everybody has been touched with somebody who’s had Alzheimer’s disease or some kind of serious memory problem and right now there’s no cure but there’s a lot of intense work going on to figure out what’s causing this disease and how we can either prevent it or treat it. Since African-Americans have the highest risk of getting this disease, it’s so important for us to be participating in figuring out a solution.
To learn more about the Center of Excellence for Alzheimer’s Disease, please visit www.upstate.edu/geriatrics/healthcare/cead/
This post appeared first on New York Amsterdam News.