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The Covid-19 pandemic forced providers to alter their delivery of care to special populations, including older adults with cognitive impairment. The Montefiore–Einstein Center for the Aging Brain, a specialty multidisciplinary center for the evaluation and management of patients with neurodegenerative disorders, developed a coordinated approach (Coordinated Care At Risk/Remote Elderly program [CCARRE]) to reach our diverse population during the initial Covid-19 crisis in New York City, USA. In the tele-evaluation of the first 85 patients seen with CCARRE, we recognized unique factors that could improve patient care, lessen burden and optimize access to community resources. Lessons learned from the experience are shared.

Stress is a potentially remediable risk factor for amnestic Mild Cognitive Impairment (aMCI). Our objective is to determine whether perceived stress predicts incident aMCI and to determine the influence of stress on aMCI is independent of known aMCI risk factors, particularly demographic variables, depression and apolipoprotein (APOE) genotype. The Einstein Aging Study (EAS) is a longitudinal community based study of older adults. The Perceived Stress Scale (PSS) was administered annually in the EAS to participants (N=507; 71 developed incident aMCI; mean follow-up time = 3.6 years S.D. = 2.0) who were aged ≥ 70 years, free of aMCI and dementia at baseline PSS administration and had at least one subsequent annual follow-up. Cox hazard models were used to examine time to aMCI onset adjusting for covariates. High levels of perceived stress are associated with a 30% greater risk of incident aMCI (per 5 point increase in PSS: HR=1.30; 95% CI: 1.08–1.58) independent of covariates. The consistency of results after covariate adjustment and the lack of evidence for reverse causation in longitudinal analyses suggest that these findings are robust. Understanding of the effect of perceived stress on cognition may lead to intervention strategies that prevention the onset of aMCI and AD.