Harvey Cohen

Overview:

Dr. Cohen's research program includes clinical research relating to aspects of the pathways to functional decline and reilience with aging, geriatric assessment, and cancer and anemia in the elderly.

Pathways to functional decline are being explored through the NIA funded Claude Pepper Older Americans Independence Center, and includes studies of the contributions of age related physiologic change, in particular changes in inflammatory parameters, comorbid diseases and conditions, environment, genetics, and the interactionas among them. Data are derived from several current studies as well as previously collected data sets from the Established Populations for Epidemiologic Studies of the Elderly (EPESE), National Long Term Care Survey, and the Chinese Longevity Study (with Dr. Zeng Yi). Previous work has demonstrated the important contributions of age related inflammation and coagulation activation to functional status. He is Co-PI of the Pepper Center Physical Performance Across the LifeSpan (PALS) study, which is a longitudinal cohort study of community dwelling adults from age 30-90+and includes functional measures and biomarkers on inflammation and metabolism.
 
Geriatric assessment approaches have been studied in a number of randomized and controlled studies and work is now concentrating on the application of Comprehensive Geriatric Assessment tools to the evaluation and treatment of elderly patients with cancer. This is an extension and continuation of a long standing interest in geriatric oncology. Previous studies have elucidated age-related patterns of disease presentation, treatment approaches, clinical trials, survivorship, quality of life, impact of comrobidities and functional outcomes. Dr. Cohen was co-chair, and now member of the Cancer in the Older Adult Committee of the Alliance for Clinical Trials in Oncology (ALLIANCE). A number of active studies and ongoing data bases aree being utilized to address these questions.


Anemia in the older adult is being addressed through an NIA funded U01 consortium (Dr. Cohen Co-PI). the current main study is an observational study followed by a pragmatic treatment trial for anemia in older adults with CHF, in collaboration with the Cardiovascular Research Network (CVRN) of the Health services research network (HSRN) 

Positions:

Professor of Medicine

Medicine, Geriatrics
School of Medicine

Walter Kempner Distinguished Professor of Medicine, in the School of Medicine

Medicine, Geriatrics
School of Medicine

Emeritus Director, Center for the Study of Aging & Human Development

Center for the Study of Aging and Human Development
School of Medicine

Faculty Research Scholar of DuPRI's Center for Population Health & Aging

Center for Population Health & Aging
Institutes and Provost's Academic Units

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1965

State University of New York at Brooklyn

Grants:

Quantifying the genomic consequences of chronic social stress for accelerated aging

Administered By
Institutes and Provost's Academic Units
Awarded By
National Institutes of Health
Role
Advisor
Start Date
End Date

IPA-Rick Sloane

Administered By
Center for the Study of Aging and Human Development
Role
Principal Investigator
Start Date
End Date

Mentoring Intervention Development in Fall and Fracture Prevention

Administered By
Medicine, Geriatrics
Awarded By
National Institutes of Health
Role
Advisor
Start Date
End Date

Cognitive Changes and Brain Connectivity in Age-Related Macular Degeneration

Administered By
Center for the Study of Aging and Human Development
Awarded By
National Institutes of Health
Role
Co Investigator
Start Date
End Date

PACTTE-Partnership for Anemia: Clinical and Translational Trials in the Elderly

Administered By
Duke Clinical Research Institute
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

Publications:

A proteomic clock for malignant gliomas: The role of the environment in tumorigenesis at the presymptomatic stage.

Malignant gliomas remain incurable with a poor prognosis despite of aggressive treatment. We have been studying the development of brain tumors in a glioma rat model, where rats develop brain tumors after prenatal exposure to ethylnitrosourea (ENU), and there is a sizable interval between when the first pathological changes are noted and tumors become detectable with MRI. Our aim to define a molecular timeline through proteomic profiling of the cerebrospinal fluid (CSF) such that brain tumor commitment can be revealed earlier than at the presymptomatic stage. A comparative proteomic approach was applied to profile CSF collected serially either before, at and after the time MRI becomes positive. Elastic net (EN) based models were developed to infer the timeline of normal or tumor development respectively, mirroring a chronology of precisely timed, "clocked", adaptations. These CSF changes were later quantified by longitudinal entropy analyses of the EN predictive metric. False discovery rates (FDR) were computed to control the expected proportion of the EN models that are due to multiple hypothesis testing. Our ENU rat brain tumor dating EN model indicated that protein content in CSF is programmed even before tumor MRI detection. The findings of the precisely timed CSF tumor microenvironment changes at presymptomatic stages, deviation from the normal development timeline, may provide the groundwork for the understanding of adaptation of the brain environment in tumorigenesis to devise effective brain tumor management strategies.
Authors
Zheng, L; Zhang, Y; Hao, S; Chen, L; Sun, Z; Yan, C; Whitin, JC; Jang, T; Merchant, M; McElhinney, DB; Sylvester, KG; Cohen, HJ; Recht, L; Yao, X; Ling, XB
MLA Citation
Zheng, Le, et al. “A proteomic clock for malignant gliomas: The role of the environment in tumorigenesis at the presymptomatic stage..” Plos One, vol. 14, no. 10, 2019. Pubmed, doi:10.1371/journal.pone.0223558.
URI
https://scholars.duke.edu/individual/pub1416906
PMID
31600288
Source
pubmed
Published In
Plos One
Volume
14
Published Date
Start Page
e0223558
DOI
10.1371/journal.pone.0223558

Phase I/IIa Trial of Atorvastatin in Patients with Acute Kawasaki Disease with Coronary Artery Aneurysm.

OBJECTIVES: To determine the safety, tolerability, pharmacokinetics, and immunomodulatory effects of a 6-week course of atorvastatin in patients with acute Kawasaki disease with coronary artery (CA) aneurysm (CAA). STUDY DESIGN: This was a Phase I/IIa 2-center dose-escalation study of atorvastatin (0.125-0.75 mg/kg/day) in 34 patients with Kawasaki disease (aged 2-17 years) with echocardiographic evidence of CAA. We measured levels of the brain metabolite 24(S)-hydroxycholesterol (24-OHC), serum lipids, acute-phase reactants, liver enzymes, and creatine phosphokinase; peripheral blood mononuclear cell populations; and CA internal diameter normalized for body surface area before atorvastatin treatment and at 2 and 6 weeks after initiation of atorvastatin treatment. RESULTS: A 6-week course of up to 0.75 mg/kg/day of atorvastatin was well tolerated by the 34 subjects (median age, 5.3 years; IQR, 2.6-6.4 years), with no serious adverse events attributable to the study drug. The areas under the curve for atorvastatin and its metabolite were larger in the study subjects compared with those reported in adults, suggesting a slower rate of metabolism in children. The 24-OHC levels were similar between the atorvastatin-treated subjects and matched controls. CONCLUSIONS: Atorvastatin was safe and well tolerated in our cohort of children with acute Kawasaki disease and CAA. A Phase III efficacy trial is warranted in this patient population, which may benefit from the known anti-inflammatory and immunomodulatory effects of this drug.
Authors
Tremoulet, AH; Jain, S; Jone, P-N; Best, BM; Duxbury, EH; Franco, A; Printz, B; Dominguez, SR; Heizer, H; Anderson, MS; Glodé, MP; He, F; Padilla, RL; Shimizu, C; Bainto, E; Pancheri, J; Cohen, HJ; Whitin, JC; Burns, JC
MLA Citation
Tremoulet, Adriana H., et al. “Phase I/IIa Trial of Atorvastatin in Patients with Acute Kawasaki Disease with Coronary Artery Aneurysm..” J Pediatr, vol. 215, Dec. 2019, pp. 107-117.e12. Pubmed, doi:10.1016/j.jpeds.2019.07.064.
URI
https://scholars.duke.edu/individual/pub1415411
PMID
31561960
Source
pubmed
Published In
J Pediatr
Volume
215
Published Date
Start Page
107
End Page
117.e12
DOI
10.1016/j.jpeds.2019.07.064

Geriatric oncology health services research: Cancer and Aging Research Group Infrastructure Core.

Authors
Wong, ML; Lichtman, SM; Morrow, GR; Simmons, J; Hargraves, T; Gross, CP; Lund, JL; Lowenstein, LM; Walter, LC; McDermott, CL; Mohile, SG; Cohen, HJ
MLA Citation
Wong, Melisa L., et al. “Geriatric oncology health services research: Cancer and Aging Research Group Infrastructure Core..” J Geriatr Oncol, July 2019. Pubmed, doi:10.1016/j.jgo.2019.07.012.
URI
https://scholars.duke.edu/individual/pub1398421
PMID
31326392
Source
pubmed
Published In
J Geriatr Oncol
Published Date
DOI
10.1016/j.jgo.2019.07.012

Going Far Together: A Tribute to Arti Hurria, MD.

Authors
MLA Citation
Wong, Melisa L., and Harvey Jay Cohen. “Going Far Together: A Tribute to Arti Hurria, MD..” J Am Geriatr Soc, vol. 67, no. 3, Mar. 2019, pp. 620–21. Pubmed, doi:10.1111/jgs.15776.
URI
https://scholars.duke.edu/individual/pub1368323
PMID
30707760
Source
pubmed
Published In
Journal of the American Geriatrics Society
Volume
67
Published Date
Start Page
620
End Page
621
DOI
10.1111/jgs.15776

Automated versus Manual Data Extraction of the Padua Prediction Score for Venous Thromboembolism Risk in Hospitalized Older Adults.

OBJECTIVE: Venous thromboembolism (VTE) prophylaxis is an important consideration for hospitalized older adults, and the Padua Prediction Score (PPS) is a risk prediction tool used to prioritize patient selection. We developed an automated PPS (APPS) algorithm using electronic health record (EHR) data. This study examines the accuracy of APPS and its individual components versus manual data extraction. METHODS: This is a retrospective cohort study of hospitalized general internal medicine patients, aged 70 and over. Fourteen clinical variables were collected to determine their PPS; APPS used EHR data exports from health system databases, and a trained abstractor performed manual chart abstractions. We calculated sensitivity and specificity of the APPS, using manual PPS as the gold standard for classifying risk category (low vs. high). We also examined performance characteristics of the APPS for individual variables. RESULTS: PPS was calculated by both methods on 311 individuals. The mean PPS was 3.6 (standard deviation, 1.8) for manual abstraction and 2.8 (1.4) for APPS. In detecting patients at high risk for VTE, the sensitivity and specificity of the APPS algorithm were 46 and 94%, respectively. The sensitivity for APPS was poor (range: 6-34%) for detecting acute conditions (i.e., acute myocardial infarction), moderate (range: 52-74%) for chronic conditions (i.e., heart failure), and excellent (range: 94-98%) for conditions of obesity and restricted mobility. Specificity of the automated extraction method for each PPS variable was > 87%. CONCLUSION: APPS as a stand-alone tool was suboptimal for classifying risk of VTE occurrence. The APPS accurately identified high risk patients (true positives), but lower scores were considered indeterminate.
Authors
Pavon, JM; Sloane, RJ; Pieper, CF; Colón-Emeric, CS; Cohen, HJ; Gallagher, D; Morey, MC; McCarty, M; Ortel, TL; Hastings, SN
MLA Citation
Pavon, Juliessa M., et al. “Automated versus Manual Data Extraction of the Padua Prediction Score for Venous Thromboembolism Risk in Hospitalized Older Adults..” Appl Clin Inform, vol. 9, no. 3, July 2018, pp. 743–51. Pubmed, doi:10.1055/s-0038-1670678.
URI
https://scholars.duke.edu/individual/pub1353197
PMID
30257260
Source
pubmed
Published In
Applied Clinical Informatics
Volume
9
Published Date
Start Page
743
End Page
751
DOI
10.1055/s-0038-1670678