InSight 2020/2021

Features on people and efforts that bring the knowledge we seek on Alzheimer’s disease and lifelong brain health ever closer in sight

Looking Forward 2020/2021

How dedicated research participants and a revamped set of safety protocols changed PMC research, clinical care, and care programs | Page 14

PENN MEMORY CENTER PERELMAN CENTER FOR ADVANCED MEDICINE

215-662-7810

www.pennmemorycenter.org

Dear Reader, Thank you for once again reading InSight magazine, our annual look back and vision forward at the research, programs, and people that make the Penn Memory Center unique. If you enjoy these stories, subscribe to InSight Weekly, an email newsletter sent every Sunday, at www.pennmemorycenter.org, or by emailing me at terrence.casey@ pennmedicine. upenn.edu.

On people and efforts that bring the knowledge we seek on Alzheimer’s disease and lifelong brain health ever closer in sight.

PUBLISHER Jason Karlawish jason.karlawish@uphs.upenn.edu EDITOR Terrence Casey terrence.casey@uphs.upenn.edu CONTRIBUTORS Abigail Ahearn Varshini Chellapilla Cait Kearney Alyssa Lamont Sharnita Midgett Danny Yarnall OFFICE 3615 Chestnut Street Philadelphia, PA 19104 www.pennmemorycenter.org www.makingsenseofalzheimers.org Follow us on Facebook www.facebook.com/ PennMemoryCenter Follow us on Twitter @Penn_Memory l The Penn Memory Center is a National Institute on Agingdesignated Alzheimer’s Disease Center (ADC), the only one in our tri-state region. l Our staff and programs are dedicated to research in Alzheimer’s disease, age-related cognitive problems, lifelong brain health and improving the well-being of our patients and their families. l Produced by the Penn Memory Center, part of Penn Medicine.

We welcome and encourage your questions, comments, suggestions and gifts.

PRINTING Fort Nassau Graphics fortnassaugraphics.net

INSIGHT

Like most other Penn Memory Center efforts, our editorial projects depend on your philanthropic support. Consider making a donation to support this magazine, our weekly newsletter, and other projects. Learn more on our giving page: www.pennmemorycenter.org/gifts. Thank you for your continued support.

— Terrence Casey

In this edition:

Cognitive Comedy improv program spreads laughter.......................3 Weekly Smile maintains intergenerational relationships...................3 TimeSlips: Changing the Story...............................................................4 Creative storytelling program continues virtually..............................5 Drawing attention to racial disparities.................................................6 brainSTIM Center grows through collaboration................................7 What is the future of aducanumab?......................................................8 Examining decision-making in older adults.......................................9 Using DNA to better understand Alzheimer’s.....................................9 The importance of brain imaging, donation........................................9 Meet our community partners.............................................................10 PMC presents: ‘Memory and the Aging Brain’..................................10 Researchers discover new, rare cause of dementia...........................11 Pandemic creates challenges for nursing home residents................12 Caregiver Forums offer solidarity, solace...........................................13 The New Face of Research..............................................................14-16 The Evolution of a PMC Clinical Visit...............................................17 Scholars program re-named, honoring founding director..............18 New clinical trial to launch in 2021....................................................19 MTL Study follows participants of all ages........................................19 REVEAL-SCAN concludes after four years.......................................19 The TRC-PAD Study.............................................................................20 The ActiviDaily App.............................................................................20 The CoGenT3 study...............................................................................21 Communication with Persons with Dementia..................................21 Caregiving during COVID-19.............................................................22 Caregivers experience stigma too.......................................................22 Supporting the Penn Memory Center...........................................23-27 The Problem of Alzheimer’s.................................................................28

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Cognitive Comedy improv program Weekly Smile spreads laughter during pandemic helps maintain

by Varshini Chellapilla

O

n the Tuesday before Halloween, Glinda the Good Witch, an Italian hotelier with a penchant for wine, a princess with rainbow hair, the Wicked Witch, and an absent-minded man joined together on a video call as part of the Penn Memory Center’s (PMC) Cognitive Comedy group.

Participants dressed in costume or assumed new personas to engage in the weekly improvisation comedy class hosted by Meg Kalafsky, a program and research coordinator at PMC. The goal of the program, created in 2015, was to encourage social engagement among older adults with cognitive impairment while having fun. A new iteration of the program was to begin in the spring of 2020. However, the pandemic changed circumstances, and the program moved to a virtual format.

“What I enjoy most about it at this point is the community that they have built. It’s a mix of caregivers and individuals with impairments,” Kalafsky said. “And it’s the little things that really build the community, like the way we end each class is by just complimenting each other, so we spend 10 minutes just talking about how nice everyone was.”

Jean Haskell, a veteran in the field of improv comedy, is responsible for designing the current curriculum and structure of Cognitive Comedy in collaboration with the Penn Memory Center.

Haskell interviewed caregivers, medical experts, research coordinators and people with dementia to understand what

her participants would want to achieve from each session and what activities would be valuable to them. She wanted to create exercises that would challenge her audience but provide them with emotional support and laughter in the midst of the pandemic.

“I try to figure out what’s going to be challenging for people, what’s going to make them laugh a little bit, what’s going to help them to feel connected to each other — because that’s an important goal — and how they can feel connected on the screen,” she said.

Some of the exercises Haskell has introduced include the favorite, ball toss, in which an imaginary object is tossed between random members of the group with the condition that the object changes with every toss. From mythical creatures to fruits to slinkies, the ball takes various shapes before it is retired for the day. This particular game also acts as a way for participants to introduce themselves to the group and learn each other’s names.

Following the initial game, participants move on to other exercises like creating commercials for bizarre goods, scavenger hunts with household items, and acting out different scenes in a group setting.

When one member mourned the loss of traditional Thanksgiving plans, the group made plans to spend Thanksgiving together, telling jokes virtually.

“I think that’s a testament, that they came to this class first,” Kalafsky said. “They felt that this was the group that they wanted to talk to on a hard day and have some time to laugh. What our class is best at is creating a safe space to socialize and to make some friends.”

intergenerational relationships

by Varshini Chellapilla

I

n the middle of the pandemic, many older adults found themselves more isolated than ever before, with their connection to the outside world restricted and the emotional toll of being at a higher risk for the virus weighing heavily.

During this time, Penn Memory Center (PMC) reimagined the Time Out Respite Care program, which encourages social engagement and companionship in the lives of older adults with cognitive impairments by connecting them with college students. Weekly Smile started in June and is run by Meg Kalafsky, a research and program coordinator at the PMC. Weekly Smile is conducted completely online. Students and older adults chat and engage with each other via video call or phone call for 45 minutes to an hour each week.

Time Out brought students to the homes of older adults with the objective of engagement and companionship for six to eight hours per week. Students often helped with simple housekeeping and any other activities that made the lives of their older companions easier.

Through Weekly Smile, students focus on engaging with their companion through games, virtual visits to museums or bird watching websites, and online classes. Students in the program help the older adults navigate technology, make origami and learn about each other’s lives.

Learn more about these programs: www.pennmemorycenter.org/programs-services INSIGHT

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TimeSlips: Changing the story David Ney was a Penn Memory Center editorial intern and is now a student at Sidney Kimmel Medical College at Thomas Jefferson University.

by David Ney

W

hen someone starts to lose their memory, there is usually a rush to recover the past. When this fails, as it does when a person develops dementia, the gap created by a lack of memory can be filled with a lot of things — including silence.

In the silence, the person with dementia can feel a crushing pressure to remember. It can lead to shame and embarrassment. People in these situations can be marginalized by isolation, stigma, and in more severe cases, by chemical restraints via anti-psychotics. Too often, the story ends with patients siloed into nursing homes with staff who are too busy, leading to downward spirals of isolation, dehumanization, and residents clinging to wisps of autonomy.

Older adults who perceive aging in this context can have negative thoughts about growing older, which could have dire consequences on long-term health. Researchers have shown that negative self-images about aging among the elderly were associated with an average loss of 7.5 years from life expectancy.

After college, I began medical school at Sidney Kimmel Medical College at Jefferson University so that I could learn how to take care of patients, like my grandfather, who are living with dementia. Midway through my first semester, I saw a poster for a meeting about creative approaches to dementia care. I INSIGHT

In a TimeSlips session, creative storytelling centered around a baseball.

couldn’t resist. In the presentation, I met a woman named Anne Basting, who spent the next hour disrupting my textbook understanding about how to deliver creative care to patients with dementia.

David Ney

mentia. For the participants with cognitive impairment or dementia, it has been shown to boost joy and increase quality of life. In its most simple form, it’s an activity that a caregiver and a person with dementia can enjoy when they are together.

In 1995, Basting founded TimeSlips On a larger scale, it can be a reocto connect to older adults with de- curring group activity that brightmentia. She scrapped the concept of ens an assisted-living facility. pushing patients to remember their past. Instead, she focused on creat- The first time I witnessed a TimeSlips ing spaces and tools for people with session, I thought I had seen a miradementia to create new ideas. Using cle. I could not believe that the peohistorical or silly photos and objects, ple around me had dementia. They TimeSlips leaders ask open-ended were cracking jokes way faster than questions to the participants. The I imagined they would. My cheeks result: People with dementia gener- ached from smiling for the entire ated stories that sounded like per- session. Afterwards I thanked the sonalized Mad Libs comics. participants for letting me observe their humor, grief, and joy for nearly Today, TimeSlips operates in 20 two hours. When we hugged goodcountries and all 50 United States. bye, they urged me to come back. I Anyone can become a facilitator by felt I had been initiated into a club. completing an online course. The method has been praised for its pos- TimeSlips has redefined what deitive impact on facilitators and par- mentia means to me, and it has ticipants. Researchers have found changed how I support people with that participating in or leading these this disease. Now, when patients do sessions improves medical students’ not remember my name or cannot attitudes towards people with de- follow along in a conversation, we

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Creative storytelling program continues virtually

by Varshini Chellapilla

A

nna Kozlowska, a master of social service intern at the Penn Memory Center, held up a picture in front of her computer. The picture showed a young woman playing in the guitar on a park bench. She posed simple questions to her virtual audience of 10: Who is the young woman? Why was she there? What was she doing?

An hour later, the young guitarist’s story had been told by the participants: She was a musician who missed her husband while he was away at war; she was singing a song about the beauty of nature; she was someone who loved making music.

“It’s kind of like making a necklace from beads,” Kozlowska said. “We kind of string our thoughts and feelings together, and we read as it goes.”

This was the first session of TimeSlips, a program newly offered by the Penn Memory Center. Originally created by MacArthur fellow Anne Basting, TimeSlips aims to bring purpose through creative engagement for older individuals.

forge forward and forget about the pressures of who remembers what.

We laugh and make up stories and find new ways to connect.

In a time where many of us are confined to our homes and our typical routines are disrupted, new caregiving practices can be an important reprieve. For caregivers living with a person with a person with dementia, TimeSlips resources can be an effective way to shake up a routine. If you have a loved one with dementia who is far away from you and you cannot INSIGHT

Adobe Stock

TimeSlips participants use a photo like this to craft a story.

Kozlowska begins each session by introducing a prompt in the form of a picture. She asks questions to get participants to explore the picture and create a story out of it. From lonely artists singing about their lover to fantastical stories about defying gravity, participants have explored their own feelings through the stories they create.

things, you encourage them to just imagine things, respond to the picture, and respond to each other.”

connect with them physically, some of the stories and principles from TimeSlips may help you enjoy each other’s company over the phone or video chat.

create new ones together.

The sessions are virtual and contained to five participants and their caregivers to allow a free flow of responses and creativity.

“Once you create something, it’s out in the open,” Kozlowska said. “And “You don’t want to rely on memo- this story that was created, it was ry,” Kozlowska said. “That’s always connected together by all the para challenge for people who have ticipants. That’s how they express memory loss. When you relieve themselves — create a connection them of the pressure to remember between themselves and a meaning.”

For me, TimeSlips is an example of where I hope dementia care can go. It offers playfulness to brighten a disease that is so often cloaked in fear. If I were sitting on Pop’s couch today, I would put away the old photo albums and pull out zany pictures or objects. I would not force old memories out of him, but work to

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If this were me, I would want to find meaning in my life. I would want to have fun, be able to laugh, and find companionship, however fleeting those feelings will be. I would want to be known as more than a disease.

I would want to know that there are people doing everything they can to help me enjoy life. ____________________________ This version was edited for print.

Read the complete essay online at www.makingsenseofalzheimer.org.

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Drawing attention to racial disparities in Alzheim

by Abigail Ahearn

A

round the time Roy Hamilton, MD, MS, was completing his neurology training, his father began developing memory-related issues.

Dr. Hamilton noticed that his father was repeating himself in a conversation, forgetting important names, and having trouble with financial management and route finding.

At the 2020 Alzheimer’s Disease and Related Disorders (ADRD) Forum brainSTIM Center in November, Dr. Hamilton spoke At the inaugural brainSTIM retreat, Dr. Roy Hamilton advises faculty colleagues on about his personal experience with building and maintaining a diverse team of faculty and staff. the disease, as an African-American Attended virtually by top research- and the steps that can be taken to physician and as a son. ers, clinicians, and stakeholders, the address disparities and equity.

“Even though at the time I was train- forum discussed racial disparities ing to become a neurologist, there and inequities in early detection, di- Dr. Hamilton outlined his own famwere a lot of thoughts that went agnosis, and treatment, and empha- ily’s experience with his late father’s through our minds and different sized the need for increased partner- Alzheimer’s symptoms and subseways of framing what was happen- ships and support between medical quent diagnosis, pointing out how ing to my father, that sort of got in establishments and communities the family struggled with denial, the way of a clear-eyed view of what of color. It also urged an increase fear, and the stigma surrounding the was actually happening,” he said. “A in diversity amongst clinicians and disease, even as Dr. Hamilton was lot of thoughts went through our investigators, and the need for in- completing his neurology training. minds that may have “The clinician workforce, with respect to When looking at stagotten in the way of tistics, rates of Alzheihim getting the kind Alzheimer’s disease and related disorders, is mer’s disease are more of care that he needed heavily under-representative of communities of color. ” prevalent in minorities initially, even though he was the father of a neurologist creased awareness regarding the than amongst white populations. ...who sees patients with Alzhei- disproportionate impact of Alzhei- This is contributed to by a higher mer’s disease and related disorders set of risk factors in people of colmer’s disease (AD).” on Latinx, African American, and or, including social determinants of health, bias and discrimination in Dr. Hamilton is a physician re- Native American communities. medicine and disparities in research, searcher at the Penn Memory CenDr. Hamilton began by giving a recultural beliefs, and the impact of ter. He is Assistant Dean for Cultural Affairs and Diversity at the Perel- view of Alzheimer’s disease and other diseases, such as hypertension man School of Medicine, Associate its related disorders, including the or cardiovascular diseases, which Professor of Neurology, and Vice difference between them, before can increase the risk of AD. Chair of Inclusion and Diversity. He moving on to addressing the disproserved as the keynote speaker at the portionate burden of Alzheimer’s This is also bolstered by cultural difADRD forum hosted by the Penn- disease in minorities, disparities of ferences regarding the stigmas surdementia care for people of color, rounding aging and mental decline sylvania Department of Aging.

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mer’s research, care, training in communities of color, which leads to seeking out care at a later stage of AD than white communities.

He emphasized the importance of increased diversity in the clinician workforce in order to increase focus, consideration, and effort toward community Also, due to a lack of access to outreach and direct work with education on neurodegenera- patients. tive diseases, lack of access to care, and healthcare discrim- As an example of successful ination leading to higher care endeavors into bolstering dicosts, minorities in the United versity amongst clinicians and States receive inferior care for researchers, Dr. Hamilton highthese disorders when compared lighted Penn’s own pipeline proto white populations. grams dedicated to increasing the number of scholars comThe combination of healthcare mitted to the research and treatsystems not designed to equal- ment of Alzheimer’s disease that ly support people of color with come from diverse backgrounds that of white counterparts, and from communities of color. along with medical discrimination, biases, stereotyping, and He also emphasized the need uncertainty, allow for a large for the promotion of cultural disparity amongst the quality of competency and implicit bias care given to minority groups. training for clinicians and clinical researchers in order to en“It is critical that we partner sure that the approach taken with communities of color com- when treating people of color is prehensively to enhance aware- ethically sound and done with ness of Alzheimer’s disease and cultural competency and sensipromote diversity in research tivity. participants,” Dr. Hamilton said, emphasizing the need to In his conclusion, Dr. Hamilbuild up trust between the med- ton reemphasized the increased ical community and commu- prevalence and more severe nities of color after long histo- symptoms of Alzheimer’s disries of medical racism, human ease amongst communities of rights violations, and unethical color due to social determiand illegal practices. The lack of nants of health, racial bias and focus toward minority groups discrimination in medical care, when it comes to research can and differences in comorbid also be attributed to the lack of diseases. diversity amongst clinicians and investigators in dementia.

To address these factors, he stressed a need for effective ef“The clinician workforce, with forts to address these disparirespect to Alzheimer’s disease ties in care, including authentic and related disorders, is heavily community partnerships, workunder-representative of com- force diversity, and ongoing culmunities of color,” he said. tural and bias trainings.

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Hamilton’s brainSTIM Center grows through collaboration

In early 2020, Penn Memory Center neurologist Roy Hamilton MD, MS took a six-month leave from his clinical duties to launch a new center at the University of Pennsylvania dedicated to noninvasive brain stimulation.

Since its launch, the Center for Brain Science, Translation, Innovation, and Modulation (brainSTIM) has brought together faculty from across the University of Pennsylvania and other institutions who use groundbreaking neuromodulation techniques to research, repair, and enhance human brain function. The Center serves as a hub for pioneering new treatments for patients living with an array of neurological disorders, including dementia and stroke.

Faculty Steering Committee members jointly presented work at a variety of lectures and conferences and appeared on WHYY’s The Pulse podcast, 1060 KYW, NPR, and the BBC’s Crowdscience podcast to discuss the world of noninvasive brain stimulation and how they hope to elevate patient experience and care through these novel approaches. In addition to continuing to grow and establish itself as a hub for interdisciplinary collaboration across departmental and institutional boundaries, in the coming year the brainSTIM Center will be at the forefront of the MINS Year of Neuromodulation, which will bring together speakers from across the world to discuss continued studies and research efforts regarding neuromodulation and enhanced patient care.

— www.med.upenn.edu/brainstimcenter

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What is the future of aducanumab?

by Varshini Chellapilla

B

iogen drug aducanumab was lauded as the beginning of the end of Alzheimer’s disease as we know it. It was, after all, the first disease-modifying drug facing approval from the Food and Drug Administration (FDA). But on Nov. 6, an independent advisory panel advised the FDA against approval of the drug, stating a lack of convincing evidence for efficacy.

Of the two Phase 3 trials studying the drug, only one trial, named EMERGE, showed successful results. The panel argued this was not enough evidence to support the drug’s potential success.

What is the EMBARK study?

EMBARK assesses the long-term safety and efficacy of aducanumab in participants with Alzheimer’s disease who were actively participating in the aducanumab clinical studies at the time of their termination in 2019.

The sudden stoppage of testing was upsetting for many participants and caregivers. Testing resumption amid the pandemic and the news of the recent FDA advisory committee meeting regarding aducanumab has compounded the emotional complexity surrounding the trials.

Clarissa Martin, EMBARK’s research coordinator, said overall participants of the study seem “cautiously optimistic” and willing to resume testing if there’s indication aducanumab may be effective.

“I think our participants are incredibly resilient,” she said.

For people with Alzheimer’s disease, abnormal levels of the protein amyloid clump together in the brain and disrupt cell function. Aducanumab targets the build-up of this protein, possibly slowing the progression of disease. EMBARK participants receive aducanumab treatment every four weeks for two years. This study is being conducted at 350 study centers worldwide with approximately 2,400 participants, making it one of the largest clinical trials in Alzheimer’s disease research. Eight of those participants are at the Penn Memory Center.

“This does not mean that the drug is ineffective,” said Penn Memory Center Co-Director David Wolk, MD. “Instead, it means that there was not enough evidence of efficacy, in the opinion of the committee, to approve at this time. In fact, the data Enrollment is invitation-only, and testing will continue throughout 2021. from aducanumab and some other recent trials of drugs with similar mechanisms suggest that targeting slow the progression of the dis- aducanumab could decelerate cognitive decline in patients living with amyloid may indeed influence dis- ease. early Alzheimer’s disease. Biogen reease progression and ultimately have The drug has had a long journey mains committed to the evaluation benefit.” of ups and downs. In March 2019, of aducanumab and will continue PMC has played an active role in the Biogen announced it would be shut- with the EMBARK study. aducanumab trials through previous ting down the two clinical trials participation in the EMERGE trial for aducanumab — EMERGE and “We remain hopeful that future and current participation in the EM- ENGAGE — due to a failed futility studies with aducanumab and reBARK Study, designed to evaluate analysis. The Boston-based phar- lated therapies will ultimately prove the long-term effects of the drug at a maceutical company concluded that to be effective,” Dr. Wolk said. “That high dose. Dr. Wolk is the principal the drug would not hit the targeted said, we will continue to aggresprimary endpoint. sively pursue a variety of different investigator at PMC. approaches to treating Alzheimer’s Aducanumab is an antibody that Six months later, Biogen reported disease in the months and years targets the amyloid-beta plaques that more data had been gathered ahead.” deposited in the brain that cause after the futility analysis that hadn’t neurodegenerative diseases. This been previously included. This data The FDA is expected to make a decican decrease amyloid deposits and revealed that the highest dose of sion on aducanumab in March.

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Examining decision-making in older adults

by Cait Kearney

Karolina Lempert, PhD, with Michael Cohen, PhD, Joe Kable, PhD, and Penn Memory Center Co-Director David Wolk, MD, is studying decision-making in older adults through behavioral testing and brain imaging.

Participants are shown photos of real people and told whether each person had previously decided to share money with an anonymous stranger or had kept the money for themselves. Participants are then tested on their memory of the person’s face and whether they kept the money. Often, older adults recognize nearly everyone, but their ability to recall their generosity was “no better than a coin toss.”

“We are finding, generally, that aging leads to people being worse at remembering whether people were being kind or not,” said Dr. Lempert. “We are interested in how this kind of memory affects subsequent decisions about interacting with others.”

This information could help explain why older adults are susceptible to scams and help create ways to protect older adults from exploitation.

Dr. Lempert is enthusiastic about continuing data collection in the new year. Due to COVID-19, participants can choose between completing the behavioral task virtually or during an fMRI scan.

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Using DNA to better understand Alzheimer’s

by Cait Kearney

Why does Alzheimer’s disease progress faster in some people than in others? Why do some individuals have a higher risk of developing it?

To answer questions like these, Corey McMillan, PhD, is studying the diversity of the way neurodegenerative diseases like Alzheimer’s disease manifest and present in people.

If researchers can better understand why a patient first has symptoms of Alzheimer’s disease at the age of 65 while another has symptoms at age 85, then it may lead to more personalized treatments for individuals and improved clinical outcomes.

“DNA provides a very rich source of data,” said Dr. McMillan. “By understanding the genetic factors that contribute to Alzheimer’s disease and related disorders, we can identify potential pathways for the development of new candidate therapeutics.”

In 2021, Dr. McMillan plans to investigate age as a heterogeneous factor in the new year. There are two measurements of age that Dr. McMillan will be examining: biological age (how old your body seems based on various biomarkers) and chronological age (the number of years you’ve been alive.)

The importance of brain imaging, donation “If we can reduce the duration of a clinical trial from four years to two, Paul Yushkevich, PhD, wants to that would be a huge benefit,” said make clinical trials for neurodegen- Dr. Yushkevich. erative diseases such as Alzheimer’s disease cost less and end earlier. When studying postmortem imOne strategy is conducting both in aging of the brain, Dr. Yushkevich vivo (during life) and postmortem seeks common patterns between (after death) brain imaging, such as brain anatomy and disease patholmagnetic resonance imaging (MRI) ogy. These patterns can help cliniand positron emission tomography cians and researchers make more ac(PET). curate diagnoses and analyses when examining the brain imaging of livBecause people with neurodegen- ing people. This increases the likelierative diseases tend to develop hood that participants are a good fit symptoms slowly, it can be difficult for the clinical trial treatment they to determine if a clinical trial treat- receive, saving institutions and parment is working. To develop testing ticipants time and money. that is more sensitive to disease progression, Dr. Yushkevich closely an- Brain donations from PMC realyzes in vivo brain imaging results search participants are so valuable for changes in brain structure or and special because years of particfunction that indicate treatment ef- ipants’ demographic information, ficacy. With more sensitive testing, cognitive testing data, and clinical researchers could test fewer partic- data, including in vivo brain imagipants over a shorter period of time. ing results, have been collected.

by Cait Kearney

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Meet our community partners:

“In 2012, I first heard about the Penn Memory Center at a health fair organized by Alpha Kappa Alpha Sorority Inc., Omega Omega Chapter. As a result, I enrolled my mother into a study. It has proven to be a tremendous asset and a blessing for our family. I want to help other families that are caring for loved ones with Alzheimer’s disease and dementia.”

Karen Askew-Teel (left) Alpha Kappa Alpha Sorority, Inc. Omega Omega Chapter

With community partner AKA Sorority, PMC presents ‘Memory and the Aging Brain’

On Oct. 28, in collaboration with Alpha Kappa Alpha Sorority’s Omega Omega Chapter, the Penn Memory Center hosted a panel titled “Memory and the Aging Brain.”

Sharnita Midgett, a clinical research and outreach coordinator at PMC, and Felicia Greenfield, executive director of PMC, served as panelists, covering a wide range of topics — from the maintenance of healthy brain aging to participation in research programs.

“I became a community partner with Penn Memory Center to take an active role in addressing brain health disparities among the African American community in Philadelphia. Representation in research means a great deal to me, and working with Penn Memory Center has shown me the importance of strong community engagement.

“Specifically, when it comes to cognition and brain aging, we focus on five lifestyle changes: physical exercise, nutrition, cognitive stimulation, social engagement, and mood management,” Greenfield said. She recommended volunteering, cognitive stimulation through reading or puzzles, and taking part in online classes as well.

I look forward to cultivating relationships with Philadelphia community leaders and organizations to tackle brain health issues together.”

What are Social Determinants of Health?

Frederick Okoye (center), Medical Student Philadelphia College of Osteopathic Medicine Alpha Phi Alpha Fraternity, Inc. “Alzheimer’s disease dementia disproportionately impacts our community, which causes us major concern. My mother, prior to her passing, exhibited cognitive decline. It was very challenging as her son to experience my mother in this state, and equally, I did not know how to support her. We appreciate the Penn Memory Center’s practical approach to caring for our loved ones.”

Rev. Leroy Miles (right), Associate Pastor Enon Tabernacle Baptist Church INSIGHT

In 2020, the Penn Memory Center (PMC) started the process of creating a new series of questions for ABC participants: the Social Determinants of Health Survey.

People have different experiences, opportunities, and challenges depending on their background and living situation. These factors can be important determinants of a person’s health and wellbeing. With this new survey, PMC hopes to learn more about how social factors impact health. These factors range from one’s childhood experiences, educational experiences, caretaker wellbeing, employment history, financial situation, early and current life stressors, and support systems.

PMC plans to collaborate with other Alzheimer’s Disease Research Centers to compare data and better understand how these factors impact people in different locations.

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Researchers discover new, rare cause of dementia

by Varshini Chellapilla

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esearchers at the Penn Memory Center (PMC) have discovered a new and rare form of dementia, which they have called vacuolar tauopathy. Where Alzheimer’s disease is focused on memory issues early in the disease, this type of dementia affects behavioral, language and executive problems instead.

Led by Edward Lee, MD, an assistant professor of pathology and laboratory medicine at the University of Pennsylvania Perelman School of Medicine, the research focused on Edward Lee a family in the United States and a Image of stained brain section showing empty holes (vacuoles) in the tissue. These abnorfamily in Greece that exhibited signs mal vacuoles are not seen in normal brain tissues and helped scientists recognize a new disease called vacuolar tauopathy. of a new genetic mutation. tations in the gene that encodes for ginning such as agitation, aggresIn order to learn how the mutation tau itself. While the tau mutations sion, loss of impulse control, and was causing the disease, Dr. Lee and are about the formation of tau ag- poor judgement. Dr. Lee said that, his team studied the Valosin-con- gregates, the newly discovered mu- with time, language difficulties and taining protein (VCP) gene. It is tation is about the process of break- cognitive issues also begin to show, responsible for breaking down ing them up. which leads to placement in a longproteins that are no longer needed term care facility. within cells. They found that while Although Dr. Lee became involved VCP normally helps break apart with the research just four years ago, “It has kind of been a mystery, what tau proteins, the build-up of which the family in the United States has they had,” Dr. Lee said. “It’s almost causes Alzheimer’s disease, the ge- been followed since 2010. heartbreaking to see three of three netic mutation impaired that funcsiblings having the same neurodetion in the patients and caused tau “There was this genetic mutation, generative disease, dementia. They aggregates to form. and researchers were thinking that really were grasping answers.” maybe it’s causing another disease,” “We have evidence across multiple Dr. Lee said. “But it’s not really until The discovery of rare genetic forms people with this mutation that their we did the autopsy [for the deceased of disease can shed light on more brains build up a protein called tau, family member] four years ago that prevalent forms of the disease. In inside their neurons, and that this we realized, ‘No, there’s something this case, Dr. Lee said that this rare is leading to neurodegeneration,” completely different going on here.’” form of dementia could help reDr. Lee said. “The tau protein that searchers further understand Alzwe saw is very similar to the tau ag- This extremely rare genetic muta- heimer’s disease. Since the loss of gregates that we see in Alzheimer’s tion was also found and studied in function of VCP is responsible for disease.” a family in Greece, with whom Dr. building up tau protein, he hypothLee got in touch with a year ago. esizes an increase in VCP activity Until this study, the only other could treat neurodegenerative disknown genetic mutation that causes Symptoms of vacuolar tauopathy eases like Alzheimer’s disease or the build-up of tau proteins are mu- include subtle changes in the be- other causes of dementia.

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Pandemic creates unique challenges for nursing home residents

by Varshini Chellapilla

P

eggy Williams has seen her husband only three times since March. Jack Williams, who was diagnosed with Alzheimer’s disease in 2013, is a resident at a long-term care facility that locked down at the very beginning of the coronavirus pandemic. The last time they met, a plexiglass wall stood between them as they maintained a distance of six feet from one another. With Jack’s hearing problems, the masks, and the traffic from the road, Peggy had to yell to be heard.

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A woman maintains social distance while visiting her mother.

home setting was, is, and probably will be a series of tragic events that revealed the faults in our system of long-term care in America,” said Jason Karlawish, MD, co-director of the Penn Memory Center.

tions that required compassionate care for residents. Peggy’s struggle to see her husband echoed the sentiments of caregivers who have gone months without being with their loved ones.

Facilities had restricted contact between residents and the outside world, halted volunteer-based programs, and quarantined residents in small spaces for their safety. But a survey showed nursing home residents were emotionally and mentally affected by the restrictions. The survey, administered in the summer At the end of the visit, Jack was up- by Altarum, a nonprofit aiming to set. He couldn’t understand why his improve the health of vulnerable wife had to leave. populations, revealed that 76% of respondents reported feeling lone“They’ve kept Jack safe from COVID lier under the restrictions and 64% but, as far as emotionally and the of them did not leave their rooms to mental toll, it’s been hell,” Peggy socialize with other residents. said.

Nursing homes and long-term care In March, nursing homes and long- facilities needed to find a balance term care facilities across the coun- between care and safety for their try locked down to protect residents residents. In September, the Centers from the coronavirus pandemic. for Medicare & Medicaid Services Soon, however, they became ground (CMS) issued revised guidance that zero for the virus, making up for provided facilities some leeway in 39% of all COVID-19 deaths na- organizing visitations. Outdoor vistionwide, according to The Covid its were encouraged as they have a Tracking Project. In Pennsylvania, reduced risk of transmission. If no 60% of COVID deaths were report- COVID-19 cases had occurred in ed from long-term care facilities. the past 14 days, indoor visits were to be allowed as well. The CMS also “What happened in the nursing encouraged visitation during situa-

“With Jack, we would get FaceTime visits,” Peggy said. “Then, there were window visits and then, porch visits with plexiglass between us.”

“I didn’t even know that Jack started to gain a lot of weight and his clothes weren’t fitting him until the first time on the porch visit,” Peggy said. “Because I’d only seen him from the shoulders up on FaceTime.

And Jack, of course, can’t communicate with me. His verbal skills are almost gone.”

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Dr. Karlawish stressed that the pandemic revealed the importance of providing good care to older adults in long-term care facilities.

“What happens when you give bad care is people do poorly,” Dr. Karlawish said. “In the case of persons living with dementia and residents in long-term care facilities, they lost weight, developed agitation, became ill independent of COVID-19, and got sicker. Many died. And it was because the care they were getting wasn’t the kind of care they needed.”

At PMC, Caregiver Forums offer an opportunity for caregivers with loved ones in long-term facilities and nursing homes to share grievances and advice. “The only thing you can hope is that someone, somewhere, who can do things about this, is learning from this situation and can make some changes that will be better for everybody,” Peggy said.

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Caregiver Forums offer solidarity, solace in virtual meetings

by Varshini Chellapilla

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ix days a week, Deborah Maser had her morning jazzercise class. On Wednesdays, her husband taught at the University of Pennsylvania School of Dental Medicine. Her daughters would visit in his absence. That was the routine until March.

“When the pandemic struck, jazzercise had stopped­— as did dental school, of course — for several months,” Dr. Maser said. “And it became a little bit more stressful because my wife had nothing to do in the mornings.”

The pandemic has seeped into nearly every aspect of caregivers’ lives.

With increased health risks, mental stress and adjustments to a virtual world, caregivers across the country found themselves faced with new challenges. The Penn Memory Center (PMC) launched the Caregiver Forums to provide caregivers a space to talk freely and share resources and tips as they learn to navigate caregiving during a pandemic.

Hosted online on a biweekly basis, the forums are run by Felicia Greenfield, executive director of PMC; Alison Lynn, associate director of social work at PMC; and Cynthia Clyburn, a licensed social worker at Penn Neurology.

“I begin each forum by telling people it is a safe place for you to come to listen and talk with other caregivers,” Greenfield said. “The forums are a community, a place to come together, get and receive support, and also share tips or ideas that may be working for you.”

INSIGHT

Early on, Greenfield and her team “She just doesn’t have the get-upnoticed a distinct divide in the ex- and-go that she used to have,” Dr. periences of the caregivers.

Maser said. “And I’m blaming that partly on the pandemic, partly be“We began to see two types of care- cause she’s not exercising like she givers: those who were caring for did in jazzercise, and partly because loved ones at home and those who it’s a disease.” were separated from their loved ones who were in nursing homes or Lynn, Clyburn, and Greenfield have memory care facilities,” she said. seen a notable decline in patients’ health across the board.

For caregivers at home, questions arose about the safety of bringing “For most of our patients that are help (in the form of a home care diagnosed with Alzheimer’s disease aide) into the home, and conflicts or a related dementia, we expect the regarding risk management with- progression to be very incremental in families. Meanwhile, most care- and very slow over the course of givers with loved ones in facilities seven to 10 years,” Lynn said. “But had not seen them since March and we have seen that — when stripped struggled with lack of information, of a lot of the things that are so imworries about restricted social inter- portant to keeping our patients staaction and the emotional toll of be- ble, like regular social interaction, ing separated during unprecedented and routine and stability, and regtimes. ular help from the primary caregivers, family and friends — they’ve The forums are open for all to at- just declined a lot faster.” tend, and moderators do not adhere to an agenda.

The forums provide space to vent and gain emotional support from “Sometimes the conversation veers other caregivers in similar positions. towards logistical questions about professional caregivers, how to ex- “You get the power of crowdsourcplain the pandemic to their loved ing,” Lynn said. “You also get a feelone, or activities that help your per- ing of being included in something, son to be engaged and stimulated,” being understood, and being seen Lynn said. “And then we also have a and validated for all of the hard lot of emotional themes. Many talks work you’re doing as a caregiver in about fatigue, burnout, and ‘Oh this one-on-one interaction.”

God, when will this end.’”

Lynn said the forums provide an opThe Masers have had to come up portunity to learn what caregivers with alternative ways to stay occu- need and what PMC can do to help. pied and engaged. They began to take walks and read the newspaper. In March, most of PMC’s suite of But it’s different. Deborah forgets services were adapted to be online. headlines a few minutes after read- This move included support groups ing them, and she no longer remem- as well as programs like Memory bers to call her friends back.

Café and Weekly Smile (page 3).

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The

New Face of Research

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PMC adapts research, care programs throughout coronavirus pandemic

by Varshini Chellapilla

J

“I actually haven’t seen the inside of my ofay Austin was the first study participant fice since March,” said Emily Largent, RN, to return to the Penn Memory Center JD, PhD, a Penn Program on Precision after in-person testing was resumed.

Medicine for the Brain (P3MB) researcher.

“Although my research hasn’t been severeBefore his July visit, Austin, a participant of ly impacted, it has opened my eyes to new the Aging Brain Cohort (ABC) study, had or different research questions. I’ve spent a to undergo COVID-19 pre-screening as fair amount of time this year thinking about part of new safety protocols. how COVID-19 has affected different populations that I care about, like older adults, On the day of his appointment, he walked people with dementia, and their care partinto the Perelman Center for Advanced ners.”

Medicine, where he was greeted by volunteers wearing masks and personal pro- The pandemic has seeped into nearly every tection equipment (PPE) who checked his aspect of life. As clinicians and researchers temperature. noticed changes in patients and caregivers, new opportunities for research opened up.

“I think, with all of the safety precautions, I felt really good and very safe and very Dr. Largent began the COVID Caregiving secure about everything PMC was doing,” project (see page 22) — a deep dive into the Austin said. “Every individual that assists in impact of COVID-19 on caregivers and peocoordinating the scheduling and conducts ple with dementia. Andrew Peterson, PhD, the research has just been amazing. So help- a P3MB researcher and assistant professor ful and thoughtful in staying in touch, ad- of philosophy at George Mason University, vising of the process and necessary steps, surveyed more than 1,800 Americans about as well as being available to accompany me their opinions on potential reallocation of throughout my entire time in the Penn fa- scarce medical resources during the pancilities.” demic.

In March, most of the world shut down. As streets emptied and entire countries went into lockdown in an effort to restrict the spread of the novel coronavirus, the doors of the Penn Memory Center closed too.

In-patient participation in research studies resumed in July. Since then, every participant has been required to go through COVID pre-screening as well as temperature checks on the day of their appointment.

Masks are mandatory at all times. At MRI Researchers, clinicians, and social workers and PET scans, practices like sanitation moved to work from home and were faced time, use of PPE by clinicians and particiwith the challenge of adapting their work to pants, and social distancing are employed. a virtual environment so they could provide necessary resources and services to patients “Overall, we are making sure to do what we and caregivers. can to make the visit as safe and comfortLeft: Jay Austin, the first Aging Brain Cohort study participant to return to in-person testing at the Penn Memory Center, poses outside of the Perelman Center for Advanced Medicine. (Credit: Terrence Casey) INSIGHT

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able for our participants as possible,” said Melissa Kelley, a clinical research coordinator who helps coordinate the ABC MRI study. “It is our goal to make sure people know that we take their safety seriously.”

Programs and services like the caregiver classes, Shake It Up exercise classes, and Memory Café were adapted for online platforms. Executive Director Felicia Greenfield; Alison Lynn, associate director of social work; and Cynthia Clyburn, a licensed social worker at Penn Neurology, also created forums for caregivers to share experiences and advice during the pandemic (see page 13). Additionally, social workers continue to meet with patients, conduct psychotherapy and teach the caregiver class.

Lea Brovedani Lea Brovedani, another ABC Study participant, returned to the Penn campus in July for a PET scan. “I don’t think research should stop because of this,” she said.

by Sharnita Midgett

Inspired by a family history of Alzheimer’s disease, Lea Brovedani joined the ABC study in 2019. A mother of two, Brovedani dedicated her time to the study with the future of her family and others in mind.

And not even the COVID-19 pandemic would keep her from living up to that dedication.

“I don’t think that research should stop because of this,” said Brovedani, who had a PET scan in July. “So many things have completely halted because of the pandemic, and I am certainly supportive of taking as many precautions as possible. But I still believe that in order for us to find answers for anything — including the pandemic, including Alzheimer’s, including different forms of cancer — that research needs to continue. I trust that Penn has my best interest at heart as well and will do everything to keep me safe.”

Brovedani knows a thing about trust, leading talks on the topic at conferences and before crowds.

When she’s not behind a podium, she pursues adrenaline-fueled activities like skydiving, scuba diving, bungee jumping, and whitewater rafting. The PET scan experience was “a bit of a treat,” she said, even if it didn’t get the heart pumping as much as other activities.

“Once they inject the tracer, you wait for that to take effect and there’s a chance to reflect on what you’re doing,” she said. “For me, it’s a moment to reaffirm why I’m doing it.”

“Our heart is breaking every day,” Lynn said. “We see how traumatic this is for patients and caregivers. We see how tired they are, we think they are doing a great job, and we just want to support them. None of us have all the answers and we’re figuring things out as we go.

So, thank you for your patience as we figure out how to transition everything online.”

Meanwhile, Austin continues to be an active study participant at PMC. He has visited the campus two other times since July and believes that his role in the research is important.

“You know, whether this pandemic is with us for months to come or it goes away forever, the cruelty of dementia and memory loss is horrific,” Austin said. “The only way to develop protocols and medication is for people to stay in these research studies. I would hope that people will continue to participate.”

To learn more about the ABC Study, visit pennmemorycenter.org/abc. To learn more about PMC’s COVID safety protocols, visit pennmemorycenter.org/ covid-19

by Varshini Chellapilla

Scholars program re-named, honoring PMC founding director

by Danny Yarnall

T

he Penn Memory Center Scholars Program — the cornerstone of PMC’s efforts to train the next generation of Alzheimer’s disease researchers — is now named after the man responsible for first launching the Center.

The new title, The Christopher M. Clark Scholars Program at the Penn Memory Center (PMC), honors the late Dr. Clark, PMC founding director, for his contributions to Alzheimer’s research. This commitment also underscores the belief that perspectives from psychology and economics belong at the table just as much as neurology and geriatrics when it comes to our work.

Current Clark Scholars are Lasya Sreepada (left) and Xueying Lyu.

Current scholars are Lasya Sreepada and Xueying Lyu. They, with previous scholars, have brought diverse perspectives from fields including economics, law, and psychology, and Over the next 17 years, Dr. Clark are responsible for innovative and forged the field of Alzheimer’s re- exciting research at PMC. search as the director of the clinical core of the National Institute of Sreepada is a bioengineering PhD Aging. He led an investigation that student at Penn under Dr. Christos “Chris Clark was committed to a vi- successfully showed that a florbeta- Davatzikos in the Artificial Intellision: excellence in Alzheimer’s dis- pir PET scan could detect deposits of gence in Biomedical Imaging Lab. ease diagnosis, care, and research beta-amyloid on the brain. He pre- For her doctoral work, Sreepada required a diversity of disciplines sented these findings to the FDA but applies machine learning and statistical modeling to large and sciences working “Chris Clark was committed to a vision: multivariate datasets and learning togethto build informative excellence in Alzheimer’s disease diagnosis, er. The Christopher signatures of M. Clark Scholars care, and research required a diversity of disciplines imaging Alzheimer’s disease.

Program was foundand sciences working and learning together. ” This could aid early died to fulfill that viagnosis, prognosis and sion,” said PMC died in 2012 before hearing that they targeted treatment efforts in a preciCo-Director Jason Karlawish, MD. were accepted. sion medicine framework.

“We seek to nurture and support the best minds and to instill in them the virtues Chris lived. He understood Since 2014, the Human Amyloid Lyu is a bioengineering PhD stuthe value of listening, tolerance, and Imaging Conference has presented dent at Penn co-advised by Drs. Daa consistent and unwavering com- the Chris Clark Award to a research- vid Wolk and Paul Yushkevich. Afer to be used for an educational or ter college, she joined the Yale PET mitment to professional ethics.” training opportunity in the field of Center working with Dr. Jason Cai to study SV2A PET imaging of stroke Before founding what would be- human amyloid imaging. rat models for a year and determined come the Penn Memory Center in 1990, Dr. Clark was a professor of “Chris would be thrilled and hum- to further study biomarkers of brain neurology at Penn Medicine from bled” about the name change, said imaging. During her PhD career, 1977 to 1984. He left Penn in 1985 Anne Clark, Dr. Clark’s widow. Lyu is looking forward to exploring for Duke University, where he and “Eight years later, he is remembered the relationships of biomarkers for a colleague started the multicenter for the work that meant so much to Alzheimer’s disease using data-driven and engineering methods.

Consortium to Establish a Registry him. This is very touching.”

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for Alzheimer’s Disease (CERAD), a groundbreaking effort in the United States to establish a consistent assessment for Alzheimer’s disease.

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New clinical trial to launch in 2021

by Cait Kearney

A new clinical trial will open for enrollment in early 2021.

AHEAD is a double-blind placebo-controlled phase III clinical trial that investigates the experimental drug lecanemab in cognitively normal older individuals who may be at risk for memory problems. Lecanemab is a humanized antibody that binds to amyloid — a protein in the brain that can build up and lead to impairment of memory and thinking. Amyloid build-up is often found in people with Alzheimer’s disease. Principal investigator Sanjeev Vaishnavi, MD, PhD, and his team are investigating if lecanemab can help reduce the risk of developing Alzheimer’s disease dementia.

“Ideally, we’ll have an intervention that can reduce the chances of someone developing Alzheimer’s disease when they are found to be at risk. We can ‘get ahead’ of Alzheimer’s disease,” said AHEAD Coordinator Melissa Johnston Esparza.

It’s possible that lecanemab could slow or eliminate progression of the disease, delaying or preventing an Alzheimer’s disease diagnosis.

“If the drug is found to be successful, we’ll have a better understanding of the effects of eliminating amyloid plaques early on in the Alzheimer’s pathophysiological continuum and have a potential intervention for people with preclinical Alzheimer’s disease,” said Johnston Esparza.

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MTL Study follows participants of all ages goal is to determine which cognitive measures are most sensitive to The medial temporal lobe (MTL) is AD-related changes in the medial the part of the brain thought to be temporal lobe and how this differs related to memory processes and from the measures and regions asvulnerable to aging and Alzheimer’s sociated with the effects of “normal” disease (AD). This brain structure is aging. being studied at the Penn Memory Center through a research project “The most interesting part of this led by Co-Director David Wolk, study is learning how specific areas MD, called the MTL study. of the medial temporal lobe impact different types of memory processThe MTL study seeks to better un- es,” said Michael Dicalogero, coorderstand age-related changes in dinator of the MTL study. brain structure and function, and to compare this with the earliest Currently, there are more than changes of Alzheimer’s disease. This 150 participants in the MTL study. three-year study involves linking Additionally, a group of younger MRI scans with experimental com- adults, 21-59 years old, are also beputerized cognitive testing. One ing followed.

by Cait Kearney

REVEAL-SCAN concludes after four years

by Cait Kearney

After four years, Penn Memory Center Co-Director Jason Karlawish, MD, and colleagues are wrapping up the REVEAL-SCAN (Risk Evaluation and Education for Alzheimer’s Disease — The Study of Communicating Amyloid Neuroimaging) study. The study enrolled cognitively unimpaired individuals between the ages of 65 and 80. Participants were randomly assigned to learn both their amyloid PET scan result and their risk estimate of developing Alzheimer’s disease by age 85 right after their PET scan, or just their risk estimate. They were followed for a few months to see how they interpreted and adapted to the information they received. At the end of the study, those who did not already learn their amyloid PET scan result received their result.

sult affected the participants’ performance on tests of memory. The study also asked who people shared their biomarker information with, what changes they made to their daily habits (such as diet and exercise), and the impact the information had on their life planning, such as employment, living situation, and legal and financial planning.

Results will help inform the psychological and behavioral impact of diagnosing people at risk of developing Alzheimer’s disease dementia based on biomarkers, such as amyloid, and help determine whether disclosure of elevated brain amyloid will bias cognitive test scores.

“My colleagues and I are quite keen to analyze the data,” said Dr. Karlawish. “We’re so excited about getting these results out into the world so that they can shape a clinical Researchers hoped to discover how practice that enhances our dignity learning an amyloid biomarker re- and self-determination.”

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TRC-PAD study provides an innovative approach to study enrollment

The ActiviDaily App: Turning apathy into action in persons with dementia

by Cait Kearney

Alzheimer’s disease remains one of the most important medical conditions for which there is no treatment. And if researchers hope to conduct a successful clinical trial, they need to study large numbers of individuals and follow participants over long periods of time. The Trial Ready Cohort for the Prevention of Alzheimer’s Dementia — shortened to TRC-PAD and pronounced “track pad” — identifies individuals for these trials.

TRC-PAD will recruit cognitively normal people who may be at risk for developing Alzheimer’s dementia in the future. The cohort will help researchers enroll participants into their clinical studies and allow new treatments to be discovered as soon as possible.

TRC-PAD is for individuals age 50 and older who are, as determined by TRC-PAD, at increased risk for memory loss caused by Alzheimer’s disease changes in the brain and who are interested in participating in clinical trials of investigational drugs.

“TRC-PAD will allow us to recruit individuals who are at increased risk for Alzheimer’s dementia and follow them over time,” said principal investigator Sanjeev Vaishnavi, MD, PhD. “As clinical treatment trials open, we will use this cohort to help us rapidly recruit for the treatment studies. This study is also unique in that it allows patients as young as 50 to join.”

Thus far, two people have enrolled in TRC-PAD through the Penn Memory Center. Coordinator Melissa Johnston Esparza and Dr. Vaishnavi are optimistic TRC-PAD enrollment will increase in 2021.

INSIGHT

by Cait Kearney

The ActiviDaily study took “there’s an app for that” to a new level. Principal Investigators Dawn Mechanic-Hamilton, PhD, and Lauren Massimo, PhD, CRNP, research coordinator Sean Lydon, and app developers Alex Miller, MS, and Dan Schiffrin created a smartphone app called ActiviDaily to help individuals with cognitive impairment who have difficulty planning, starting and completing daily activities.

The app includes features for selecting individualized goals such as physical activity, cognitive stimulation, and engaging in hobbies. Alerting mechanisms are programed to help initiate behaviors to attain goals. Calendars and checklists simplify the activities in a step-by-step fashion, and rewards such as music or games are used to motivate the individual to attain their activity goals.

The image above shows the home screen of the app, which displays participants’ schedule for the day.

In this example, the participant has three tasks on their schedule: stretching, taking medication, and reading; and, thus far, the participant has marked stretching as complete. As the participant completes their daily tasks, bar towards the bottom of the screen fills up, providing more incentive to perform the tasks that remain.

Researchers hope that by providing more structure to the day and alerting participants to complete tasks, ActiviDaily will reduce the burden of their care partners. One care partner said, “I’m excited by how much [the participant] was able to complete without me.” Another care partner said, “less nagging for me... he did it for the app.”

The study team presented at International Neuropsychological “The main thing we’re hoping Society and the Gerontological to get out of the app is improv- Society of America meetings in ing quality of life for patients by 2020, and the team is excited to getting them more involved in continue to make improvements activities,” Lydon said. to ActiviDaily in 2021.

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The CoGenT3 study: Gender in aging research

by Cait Kearney

As men and women age, they differ in how they protect their cognitive health, manage cognitive changes, and perform on cognitive tests. These associations have been documented over many decades, and the consistency of findings highlights the salience of gender’s impact on cognition in older adults. It also raises an important question: What drives these differences? The CoGenT3 study aims to answer this question and advance the study of gender in aging research.

large sample of older adults that spans three generations.

“Gender and its effects can shift with cultural changes, such as those that occur from one generation to the next,” Dr. Stites said. “Studies that compare and contrast older adults in differing generations can help us to understand the reasons for differences in health outcomes such as cognition.”

What researchers learn from cross-generational studies, such as the CoGenT3 study, can help inform understanding of disease mechanisms and lead to The CoGenT3 study is com- development of interventions prised of a series of research that improve cognitive outprojects that examine how comes. gender is conceptualized, measured, and studied in medi- More generally, Dr. Stites said cal research. Currently, Shana it is important in all studies to Stites, PsyD, MA, MS, along consider sex and gender effects with co-principal investigator and to foster an environment Jason Flatt, PhD, MPH, at Uni- that respectful and inclusive — versity of Nevada, Las Vegas and not only in research specifically colleagues of the Penn Program focused on sex and gender. on Precision Medicine for the Brain (P3MB) are identifying “This work with older adults incommon methods of measuring cludes special attention to how gender in aging research. They issues of sex/gender intersect are also comparing demograph- with other aspects of identity, ic, occupational, and economic such as age, race, and educadata of men and women from a tion,” said Dr. Stites.

Learn more about these and other studies: pennmemorycenter.org/research

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Experiences with and Perspectives on Communication with Persons with Dementia

by Cait Kearney

The Caregivers’ Experiences with and Perspectives on Communication with Persons with Dementia study examines how people with dementia and their caregivers communicate with one another in the late stages of the disease. Principal investigators Jason Karlawish, MD, and Andrew Peterson, PhD, researchers of the Penn Program for Precision Medicine of the Brain, seek to systematically describe this communication and to study how it affects caregivers’ well-being, emotions, and care decisions.

“Caregivers often make decisions for people with dementia based on their daily interactions and communication. We want to understand how communication changes in the later stages of dementia,” Dr. Peterson said.

Studying how communication between people with late-stage dementia and their caregivers unfolds may better prepare clinicians to respond to certain caregiving concerns and issues. It may also give researchers a window into discerning how caregivers understand the personhood of people living with dementia.

Participants in this study will complete a 60-minute interview over the phone. The interview will focus on participants’ relationship with the person with dementia, including how, if at all, they communicate with one another. Dr. Peterson expects data collection to start in early 2021.

“I’m very excited about this project. Communication between caregivers and people with dementia is understudied,” Dr. Peterson said, “We hope members of the PMC community are eager to share their stories.”

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Caregiving during COVID-19

Caregivers experience stigma too

by Cait Kearney

The stigma of Alzheimer’s disease is experienced by not only those living with the disease but caregivers as well. Due to the adverse social connotations surrounding Alzheimer’s disease, caregivers may feel their social status or sense of self is devalued or tainted. Stigma can exacerbate the difficulties of being a caregiver and ultimately result in a decreased quality of care of the person they care for.

A woman maintains social distance while visiting her mother.

by Cait Kearney

The COVID Caregiving project conducted by the Penn Program on Precision Medicine for the Brain (P3MB) aims to characterize the practical, emotional, social, and behavioral effects of COVID-19 on care partners and persons with dementia. It also seeks to compare the experiences of care partners when the person living with dementia resides in the home versus in a long-term care setting.

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us, we thought it would be helpful to go straight to caregivers and to talk with them about what they are experiencing. Interviews have a way of providing insights and understandings of new phenomena, like COVID, that surveys simply cannot capture,” Dr. Largent said.

Research on caregiving during the COVID era is particularly important because it may expose vulnerabilities and flaws in existing systems for persons living with dementia and their care partners. This can offer insight into interventions that can improve or protect the quality of life of persons living with dementia and their care partners during times of non-emergency, and it may inform pandemic and emergency preparedness going forward.

Principal investigator Emily Largent, RN, JD, PhD, and her team are interviewing caregivers to better understand these effects and experiences. Interviews typically last one to two hours, depending on how much participants wish to share with the interviewer.

Dr. Largent hopes to interview 60 caregivers in total. Interviews will “Because COVID is new to all of continue in 2021.

INSIGHT

the penn memory center annual magazine

Jason Karlawish, MD, Shana Stites, PsyD, MA, MS, and collaborators are conducting research to better understand the complexities of caregiving stigma. In a recent study, they tested stigmatizing behavior endorsed by people who identified as a current or past caregiver in comparison to people who did not identify as a current or past caregiver. Contrary to their prediction, people who identified as a current or past caregiver more strongly endorsed stigmatizing behavior than people who did not.

“This might suggest a person who is subject to stigma may be more likely to stigmatize another, leading to a cycle of compounding effects of stigma,” Dr. Stites said.

Dr. Stites said that further research is needed to replicate the results; however, the outcome of their study underscores the importance of examining and addressing caregiving stigma and how caregivers may internalize and externalize its negative effects.

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lzheimer’s disease threatens to become the largest and most costly public health crisis ever faced by our nation. This hard reality makes your tax-deductible gifts and bequests even more vital now to aid our research and nurture our advances.

Planned giving, matching gift programs, and a range of tax-advantageous structured giving approaches are also available. To learn more about how your support can strengthen and advance the work of the Penn Memory Center, please contact Elizabeth Yannes at (215) 573-4961 or elyannes@upenn.edu.

Thank you, Dr. Jason Karlawish and Dr. David Wolk Penn Memory Center Co-Directors

Caplan Family Caring Difference Mrs. Janet D. Caplan Mr. and Barry R. Elson Mr. Philip D. Levinson Mr. Elliot Maser Mr. and Mrs. Albanus R. Ryland, Jr. Mr. Benjamin B. Shankroff Mr. and Mrs. Michael E. Shott Dr. Robin Lowey Charitable Fund

In Memory of Martha Bomgardner Beard Mr. And Mrs. Ronald Hetrick In Honor of Eli Caplan Mr. And Mrs. Francis J. Dixon In Memory of Mrs. Janet Caplan Mr. Jeffrey Thomases In Memory of Joseph J. Gatta Jr. Mr. Richard B. Rubin Mrs. Christine M. Gatta

Christopher M. Clark Scholars Program Fund Mr. Edwin B. Parker

In Memory of Christopher Clark Ms. Anne Clark

Diane Eisen Memorial Vascular Cognitive Impairment Research Fund Mr. Joel B. Eisen

Janet Caplan Endowed Fellowship Mr. Perry C. Caplan Mr. Eli J. Caplan Mr. Sloan Caplan

Making Sense of Alzheimer’s Fund Mrs. Melissa Jolly

In Memory of Mrs. Marcia Hoff Ms. Karen R. Ott

Michael and Marilyn Glosserman Research Fund

In Memory of Bill Lyon Mr. David Michael Naughton

Penn Memory Center Research Fund

In Honor of David A. Wolk, MD Mr. and Mrs. Daniel Leder

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Mr. and Mrs. Michael J. Glosserman

In Memory of Eugene Block and In Honor of David A. Wolk, MD Mr. Charles X Block Cecilie Block

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Penn Memory Center Gift Fund

With your support, the Penn Memory Center is able to accelerate our research, clinical care, and education programs.

Dr. Barbara Androski Stewart J. Avart, PhD Mr. Joseph F. Blazewicz Prof. Stephen Burbank & Ms. Ellen Burbank Mr. & Mrs. William Burns Mr. Max Buten Mr. & Mrs. David A. Canan Mrs. Marie H. Castellan Elizabeth M. Cecil, Esquire Michael E. Childs, PhD & Nancy M. Childs, PhD Mr. Paul D. Chrystie Ms. Kathlynn Ciompi Mr. Andrew T. Coen Mr. Patrick E. Coggins Ms. Carmen Comella Mr. Thomas P. Corcoran & Dr. Robin Lowey Ms. Courtney R. Coulter Ms. Prudence Dalrymple Mr. Robert Delphais & Ms. Alice Delphais Mr. & Mrs. Robert DeGeorge Dr. & Mrs. Julius J. Deren Ms. Bonnie Noel Devlin Mr. & Mrs. John A. Doyle Mr. Joseph H. Donahue & Mrs. Carolina M. Donahue Mrs. Catherine P. Durkin Ms. Ellen Erhart Mr. James H. Edwards Ms. Deborah F. Faulkner

Dr. Kathleen M. Finn & Mr. Michael C. Panis Mrs. Kristy McCann Flynn Mr. Segundo Formoso & Ms. Hortensia Formoso Dr. Richard G. Fried & Dr. Fern G. Fried Mr. Joe Gatta Mrs. Mary Ellen Gibbons Mr. & Mrs. B. Granor Mr. And Mrs. John Hayden Mr. Jack Heller Mr. Clemens Herbst Mr. & Mrs. Michael A. Iacocca Ms. Izorie V. Irvin Mr. Thomas Kapp Dr. and Mrs. Soo S. Ko Dr. & Mrs. Corey Langer Mr. & Ms. Bernard Ledieu Mr. & Mrs. Walter J. Legenstein, Jr. Mr. Harry M. Leister Mrs. Nancy S. Lonsdale Mr. and Mrs. William Lawrence Dr. Marilyn Luber Mr. & Mrs. Jack G. Mancuso Mr. Lawrence E. McAlee Mr. And Mrs. James McKenna Ms. Amy J. Deren-Milgrim Mr. and Mrs. Steve T. Min Dr. & Mrs. Allen J. Monfried Mr. Victor Kodzo Ofori Mr. James Panacek & Mrs. Helga M. Consten

Mr. & Mrs. John Peakes Dr. Hermann W. Pfefferkorn Mrs. Romaine Rood Mr. & Mrs. John J. Rooney Ms. Julie Rouvina Mr. & Mrs. Lawrence D. Ryan Ms. Michele Sands Mrs. Sandra F. Schwartz Mrs. Cornelia H. Seidel Richard L. Siller, DMD & Mrs. Mary Siller Mr. James Sim Mr. & Mrs. William H. Shore Ms. Rheta R. Smith Ms. Hazel Souder Ms. Betsy Steelman Ms. Joan W. Tyson Mr. Gary Updegraff Mr. Stanley L. Walicki Mrs. Rudolf M. Wertime Ms. Carolyn L. Whitaker Ms. Elaine Young The Don and Maggie Buchwald Foundation Nicoletti Hockey Complex Seniors Helping Seniors of NDELCO Woodbridge Foundation In Memory of Burnell Balfour Ms. Gloria B. Hopkins

Introducing the Steve Rosengarten Alzheimer’s Fund Eight years ago, Nadine Flexer’s husband was diagnosed with mild cognitive impairment. This year, she founded the Steve Rosengarten Alzheimer’s Fund to provide financial support for fellowship positions and caregiver services at the Penn Memory Center.

“I wanted a way to show my gratitude and my appreciation for the services and the support that we have received,” Flexer said. “I also believe in the need for more research, more professional service providers, and more caregiving INSIGHT

services for this particular disease.”

Flexer credits PMC support groups as a big source of support during a time when she was working full-time and taking care of her husband.

“If I can give in some way to help others have more services, have more doctors available to them, and more caregiving services get provided to them, I’m fortunate enough to be able to do that to make it easier for others in the future,” Flexer said.

the penn memory center annual magazine

In Memory of Dr. John Bidwell Mr. Bernard Enright Mr. & Mrs. Mark Heppenstall Mr. Russell A. Loverdi Dr. Christopher Pine Mr. & Mrs. William H. Scott In Memory of Eugene Block Ms. Gail M. Berger-Barrus Ms. Elizabeth F. Capella Mr. & Mrs. Don Davidow Mr. & Mrs. Marc Felgoise Ms. Toni A. Goldberg Mrs. Anne D. Jankoski Ms. Sondra N. Jones Ms. Mimsye W. Katz Mr. & Mrs. Bernard J. Kelley Mr. & Mrs. Julian Krinsky Mr. and Mrs. Theodore A. Matlow Mr. Margo B. Michel

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Ms. Cathy Moss Mr. Gerard T. Murphy Ms. Diane Petrosky Emery H. Rosenbluth, Jr., Esquire Bernard N. Rothman, D.D.S. Mr. Robert Rovner Mr. & Mrs. Fred A. Shabel Steven W. Spector, Esquire Mr. & Mrs. Charles Toll Peggy Brenner Wachs, Esquire Mr. & Mrs. Bryan Weingarten In Memory of Mr. Harry H. Brown Mr. & Mrs. Al Angello Mrs. Rosanne S. Bockhorn Ms. Peggy L. Klepfer Mrs. Amity Meyer Miss Jane Marie Mingey Ms. Tricia Triolo In Honor of Dr. John Bruza Mr. Graeme Clapp & Ms. Anne Wright In Memory of Lawrence Burnetski Feldman and Feldman, LLP Mr. Allan Lowenstein Mr. & Mrs. William Pittler Mrs. Debra Skolnick

In Memory of Mary Cooper Ms. Maureen Baldwin Ms. Ann Bodalski Ms. Denise M. Bruckno Mr. John Cooper Mr. Tom Cooper Mr. Kenneth H. Costello Ms. Colleen Marchinek Ms. Colleen V. McCarthy Ms. Susan O’Donnell Mr. & Mrs. Chuck O’Hara Ms. Jennifer Ukstins In Memory of Eileen Curnane Mr. & Mrs. John P. Neary In Memory of Virginia Daye Ms. Nanette S. Cunningham In Memory of Lorraine Diahy Mr. & Mrs. George Maalouf In Memory of Martin Dimmerman Mr. And Mrs. Martin J. Dimmerman In Memory of Maria DiNapoli Mr. Raymond A. Machnik

In Memory of Claire Caplan Mr. & Mrs. Jules H. Caplan

In Memory of Carl Duzen Mr. John Freas Ms. Catherine Kuan-Chi Foo Ms. Susan Jewett Ms. Kelly Koscil Ms. Margaret M. Williams

In Memory of Janet Caplan Roberta Caplan, PhD

In Memory of Ada Lucille Ligget English Ms. Carole J. Peck

In Honor of Terrence Casey Mrs. Kathleen Casey

In Memory of Hiram Faktorow Mr. Sheldon Faktorow

In Honor of Mike Childs Mr. Lete M. Childs

In Honor of Nadine Flexer and Steven Rosengarten Ironwood Charitable Foundation Inc.

In Memory of Ruthe Buzby Mr. John S. Buzby, Sr.

In Memory of Dr. Richard Close Mr. Timothy M. Close Ms. Mary P. Metzker In Honor of Julia Moore Converse Ms. Amy Converse Ms. Peggy Melchior Mr. Donald Nowill Ms. Lucy Sorensen Dr. Adelaide H. Villmoare Ms. Barbara B. Wybar INSIGHT

In Memory of Patricia Gallagher Ms. Cindy C. Chiang Mr. David C. Cloak Mr. Richard Cuff Mr. Robert Duncan Mr. Fred Eckerr Mr. Anthony D. Falcone Mrs. Carissa Hazelton Ms. Kristin Johnson Mr. Robert Keith

the penn memory center annual magazine

Ms. Colette LeFever Ms. Jay Lender Mrs. Joyce Lender Mrs. Mary C. Naughton Ms. Andrea Smith Ms. Mary Walsh Mr. Thomas V. Zug, Jr. Bryn Mawr Fire Company Diesinger & Dolan Gladwyne Fire Company Hanna Associates, INC Lower Merion Township Firemen’s Relief Association McKay DeRito & Co., LLC Volunteer Medical Service Corps In Honor of Felicia Greenfield, LCSW Mrs. Geraldine Zeldin Fish Dr. Alan R. Cohen & Ms. Michele Langer In Honor of Mrs. Lillian Hackerman Ms. Barbara Patz In Memory of Katharine V. Harkins Ms. Heather H. Moyer Vanguard Group Foundation In Memory of Frank Hehman Mr. Daniel Noll Mrs. Cynthia Baczenas Mrs. SallyAnn Bagley Mr. & Mrs. Thomas H. Griffiths Ms. Laurie W. Hartman Mrs. Eileen M. Herring Mrs. Kim S. Kofira Ms. Ruth I. Murphy Ms. Rochelle Myers Mr. & Mrs. John R. Walsh Ms. Betty Winfield In Memory of Mrs. Mary Higgings Mr. Karl Heuser In Honor of David J. Irwin, MD Mr. & Mrs. Thomas Cloetingh In Memory of Mabel Jackson Ms. Barbara Jackson In Memory of Annie Ruth Jordan Ms. Melita J. Jordan In Honor of Megan Kalafsky Ms. Estelle Alexander 2019 / 2020

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In Honor of Mr. Joseph Kalkbrenner Mrs. Laurie Kalkbrenner

In Memory of Betty Joyce Liss Dr. And Mrs. Jerry Drew

In Memory of Stanley Morrison Dr. Gail Coffey Reichle

In Honor of Jason H. Karlawish, MD Mr. And Mrs. James C. Catrickes Mr. Graeme Clapp & Ms. Anne Wright Mr. & Mrs. James B. Crabtree Mrs. Ann Peirce Morris Thomas B. Morris, Jr., Esquire Ms. Norma L. Terrell

In Memory of Mrs. Lillian Ludwig Mr. Brian Hausner & Ms. Patricia J. Ludwig

In Memory of Dr. Allen Myers Mr. & Mrs. Arnold M. Applefeld Mr. Brad K. Ballantine Lester V. Baum, Esq. Mr. Kenneth G. Biehn Ms. Deanne S. Comer Mr. Eric Dichter & Dr. Leigh-Ann Matlz-Dichter Mrs. Colleen Dixon Mrs. Victoria Dorick Mr. Robert Ebby & Dr. Caroline Brayer Ebby Mr. Stuart Ebby & Dr. Judith Ebby Mr. & Mrs. Alan J. Gold Ms. Jill Heller Mr. Martin Katz Mrs. Judith Kramer Mr. Lee Kress Paul N. Lanken, MD & Mrs. Mary Lanken Mr. Jerome B. Makowsky Mrs. Evelyn E. Makowsky Mr. David Myers Mrs. Rosalind Nathanson Dr. Gerald J. Porter Ms. Cynthia M. Rosenwald Ms. Freda Samuels Mr. William F. Schulze Dr. & Mrs. Barry M. Schimmer Dr. & Mrs. Jack L. Solomon The Hon. C. H. Williams & Dr. S. V. Williams Ms. Suzanne Wolfson

In Honor of Mrs. Doris Katz-Levy Mrs. Robin K. Cudrin In Memory of Eleanor Krans Trimpi Associates, INC In Memory of Betty Kraus Ms. Angela Crippen In Memory of Doris S. Keating Mr. John J. Keating In Memory of Ms. Constance Keefe Ms. Margaret A. Bergman Ms. Kathryn Brugler Ms. Judith C. Burns In Memory of Barbara Lamberg Mr. Richard Ost & Ms. Beth Ost In Memory of Mr. Robert Latimer Ms. Kathleen Leahy In Memory of Ms. Rita Lifson Mr. Stephen Rosengarten & Ms. Nadine Flexer

In Memory of Joseph Lubin Mrs. Dolores A. Lubin In Honor of Alison Lynn, MSW, LCSW Dr. Alan R. Cohen & Ms. Michele Langer Dr. & Mrs. Robert Schwab In Memory of Charlotte Mark Ms. Patricia Brown In Memory of Jack McNichol Mr. John E. McNichol In Memory of James Metzinger Mr. & Mrs. Stephen Metzinger In Memory of Mrs. Helen Foster Morgan Ms. Natalie M. Macie In Memory of Linda Anderson Morgan Mrs. Carol Choclos In Memory of William Morgan Ms. Sarah Brummett Ms. Erin Kelly Ms. Alison Maffey Mr. Lee Nester In Honor of Thomas B. Morris, Jr. Mrs. Nancy O. Prior

Introducing the Christopher M. Clark Scholars Program Fund Anne Clark remembers her husband as a problem solver. Even if it was putting a light fixture on the deck, she recalls standing by him as he tried until it was fixed.

“It applied to his work as well,” she said. “I think being a tenacious problem solver is one of the things that makes successful people. So, I hope all these young scholars at the PMC will be tenacious problem solvers too.”

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In June 2020, the Penn Memory Center’s Scholars Program was renamed as The Christopher M. Clark Scholars Program at the Penn Memory Center, in honor of the late Dr. Christopher Clark.

ability to detect brain deposits of beta-amyloid. He died on Jan. 12, 2012 of an abdominal sarcoma.

Anne’s donation to the program supports the goal to bring diverse perspectives together from a wide range of backgrounds to work on Alzheimer’s disease research.

Dr. Clark was a neurologist and the founding director of the Penn Memory Center. He co-developed the Dementia Severity Rating Scale “My goal is very personal,” Anne and was a member of the team that said. “It is just to support the work displayed a florbetapir PET scan’s that he loved so much.”

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In Honor of Mrs. Theresa Nicoletti Ms. Cristin Nicoletti Ms. Bridget Capizzi In Memory of Mr. Thomas Oeffinger Ms. Cheryl Adkinson Mr. Brian Oeffinger Ms. Linda Oeffinger Dr. Shahzad Siddiqi In Memory of Robert Palmer Ms. Maureen Campbell Ms. Lisa Jones Mrs. Pamela Marino Ms. Cheryl L. O’Donnell Mr. Robert Maxwell Mr. Christopher Sapienza Ms. Gwen Socoloski Mrs. Lynn M. Socoloski In Memory of Janet Perkins Mrs. Christine B. Carlson In Memory of Janice Perkins Mrs. Debora D. Schmidt In Memory of Joseph E. Platt Mr. & Mrs. Edward B. Ganley, Jr. In Memory of Edith Potts Mr. & Mrs. Thomas Potts In Honor of Annie Mae Pyatt Mrs. Lorie Mikes In Honor Mr. Stephen Rosengarten Mr. And Mrs. Bruce Goldenberg In Honor of Mrs. Edith Roberts Mrs. Anita L. Murphy In Memory of Rose Rudolph Mr. John N. Rudolph, Jr. In Memory of Mrs. Carol Schillinger Mr. Dave Cronomiz

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In Memory of Mrs. Dolores Smith Ms. Madeline Christenson Mr. Michael J. Daly III Mr. & Mrs. James W. Davis Mr. Joe Evancich & Mrs. Linda Gattinella Ms. Nancy C. Frock Ms. Frances Haber Mr. Scott A. Holland Mr. Joseph Hudson Mr. Michael D. Jamison Ms. M A. Kau Mr. & Mrs. Henry Kirsch Mr. Richard Lawrence Mr. John B. Maydonovitch Mr. Craig McAnally Mrs. Annette McKinney Ms. Suzanne Murphy Mrs. Carol S. Ohlson Dr. Terence E. Patterson Mrs. Debra S. Pook Mr. Jr Raebiger Mr. Dennis S. Riley Mr. Joseph Rodgers Ms. Lauren Schenkel Mr. & Mrs. Willard Scott Mr. & Mrs. Michael J. Stevko Mrs. Kathleen R. Wolfe Mrs. Yvonne M. Yohe Mr. & Mrs. Michael F. Young Kelly Anne Dolan Memorial Fund Our Lady of Mercy Regional Catholic School In Memory of Eugenia Steelman Ms. Laura Dougherty Ms. Cherryl Leone Ms. Deborah A. Smith

In Honor of Grace Stockbower, MPH Dr. Alan R. Cohen & Ms. Michele Langer In Honor of Susan Strohmetz Mr. Bill Manzi In Memory of Gerard Thomas Peter Thomas, DO In Memory of Patsy & Aunt Tot Ms. Janifer M. Burns In Honor of Sanjeev Vaishnavi, MD, PhD Mr. & Mrs. Thomas Cloetingh In Memory of Mr. William Webster, Jr. Ms. Lisa C. Webster In Memory of Edith Wells Bristol Ms. Thea G. Scotti In Memory of Mrs. Kathryn M. Wilks Joshua Liez, MD In Memory of Mrs. Florence M. Williams Ms. Celestine F. Welcome In Memory of Jacqueline Witzman Mr. John J. Witzman In Honor of David A. Wolk, MD Mr. Brian Bergin Rigney Dr. Alan R. Cohen & Ms. Michele Langer In Memory of Betsy James Wyeth Mr. Carrie A. Lepofsky

In Memory of Mrs. Gene Steelman Ms. Betsy Steelman In Memory of Betty Stephen Mr. and Mrs. Harry M. Stephey, Jr.

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PENN MEMORY CENTER C/O TERRENCE CASEY 3615 CHESTNUT STREET, ROOM 242 PHILADELPHIA, PA 19104

NON-PROFIT ORG U.S. POSTAGE PAID PERMIT NO. 2563 PHILA, PA. 19104

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