Psychological and social support associations with mortality and cardiovascular disease in middle-aged American Indians: the Strong Heart Study

Cognitive reserve is associated with education, social determinants, and cognitive outcomes among older American Indians in the Strong Heart Study

Cognitive reserve, a component of resilience, may be conceptualized as the ability to overcome accumulating neuropathology and maintain healthy aging and function. However, research measuring and evaluating it in American Indians is needed. We recruited American Indians from 3 regional centers for longitudinal examinations (2010-13, n = 818; 2017-19, n = 403) including MRI, cognitive, clinical, and questionnaire data. We defined cognitive reserve by measuring the residual from individual regressions of cognitive tests over imaged brain volumes, adjusted for age and sex. Analyses examined three different metrics of cognitive reserve against sociodemographic, clinical, and longitudinal cognitive data in causal mediation models. Better cognitive reserve was significantly associated with more education, higher income, lower prevalence of depression, lower prevalence of diabetes, and lower prevalence of kidney disease, but we found no statistically significant evidence for an association with plasma biomarkers for Alzheimer's disease and related dementias, APOE e4 carrier status, alcohol use, body mass, or hypertension. Better cognitive reserve was associated with better cognitive function over mean 6.7 years follow-up (range 4-9 years); and the association for education with cognition over time was mediated in part (15-24%) by cognitive reserve. Cognitive reserve, although challenging to measure, appears important for understanding the range of cognitive aging in American Indians.

Association of different emotional support status with cardio-cerebrovascular diseases

BACKGROUND

Evidence suggests that emotional status affect physical health. We aimed to investigate the association of different emotional support sources with morbidity or mortality of cardio-cerebrovascular diseases (CVDs).

METHODS

We conducted a retrospective-cohort analysis using data in National Health and Nutrition Examination Survey from 1999 to 2004. 6183 participants were included and categorized into significant others support group (SOG, n = 2999) and experientially similar others support group (ESG, n = 3184) according to self-report questionnaire. Propensity score matching (PSM) was used to eliminate group difference. Pearson's Chi-square test, Kaplan-Meier survival analysis and generalized linear model were used to calculate and estimate associations between mortality, CVDs morbidity and emotional support sources.

RESULTS

Participants receiving more support from experientially similar others had significant lower morbidity of myocardial infarction (MI, OR = 0.86) and all-cause mortality (OR = 0.81) after PSM compared to SOG. Subgroup analysis after PSM also showed that more emotional support from experientially similar others can significantly reduce all-cause mortality, especially in women and people over 60 years old.

LIMITATIONS

Retrospective-cohort analysis and limited sample size.

CONCLUSION

Compared with participants receiving more emotional support from family members, receiving more emotional support from other relative, neighbors, co-workers, church and club members, professionals and friends significantly reduced all-cause mortality as well as MI morbidity.

Being Cynical Is Bad for Your Wellbeing: A Structural Equation Model of the Relationship Between Cynicism and Mental Health in First Responders in South Africa

Cynicism has been associated with adverse mental and physical health outcomes. This study investigated the role of cynicism in relation to indices of mental health among South African first responders. Research has highlighted that first responders are at increased risk of adverse mental health outcomes owing to the nature of their work. The sample consisted of 429 participants who completed a brief demographic questionnaire and several research instruments: Turner Cynicism Scale, Chalder Fatigue Scale, Patient Health Questionnaire-9, and Generalized Anxiety Disorder Scale-7. Structural equation modeling was used to explore the relationship between cynicism and mental health indicators. It included a measurement model, which identified four latent variables-cynicism, fatigue, depression, and anxiety-and their respective indicators, and a structural model, which defined the relationships among these latent variables. Path analysis was used to explore the potential mediating role of fatigue in the relationship between cynicism and indices of mental health. The results demonstrated significant associations between cynicism and anxiety, depression, and fatigue. Fatigue also mediated the relationship between cynicism and indices of mental health. The results underscore the importance of recognizing and addressing cynicism as a critical factor in the mental health of individuals working in high-stress occupations.

Epidemiology of Head Injury and Associations with Clinical and Neuropsychological Test Scores in Older American Indians: Data from the Strong Heart Study

BACKGROUND

American Indians have the highest mortality and hospitalizations from head injury of all US groups; however, little is known about prevalence, risk, or outcomes in this population.

METHODS

The Strong Heart Study recruited American Indians representing 11 tribes and communities across three regions for two sequential examinations in 2010-2019. Participants were asked to self-report prior head injury, loss of consciousness (LOC), cause, sociodemographics, and behaviors (age, sex, education, bilingual, smoking, alcohol use, stroke). Cognitive testing covered executive function, phonemic fluency, processing speed, and memory. Analyses tabulated summaries and multivariate logistic regressions estimated risk associations.

RESULTS

This older cohort of American Indians (visit 1 N = 818, follow-up visit 2 N = 403) was mean age 73 at intake, with mean 6.7 years between exams. At visit 1, 40% reported prior head injury, majority with LOC; 4-6% reported injury with LOC > 20 min. Incidence analysis estimated 3.5 cases per 100 person-years. Primary causes were falls, motor vehicles, sports, fight or assault, military (bullet, blast, fragment), and horse-riding incidents. Male sex and prior stroke were independently associated with higher risk, but age, education, bilingual, smoking, and alcohol use were not associated with risk. Those with previous head injury had significantly worse depressive symptoms, quality of life, fatigue, social functioning, pain, general health, and processing speed.

CONCLUSION

These findings suggest very high prevalence, incidence, and risk of head injury in older American Indians, with substantial impacts on quality of life and well-being. Future research should prospectively evaluate risk and prevention opportunities in this population.

Epidemiology and prevalence of dementia and Alzheimer's disease in American Indians: Data from the Strong Heart Study

INTRODUCTION

Accurate epidemiologic estimates for dementia are lacking for American Indians, despite substantive social and health disparities.

METHODS

The Strong Heart Study, a population-based cohort of 11 American Indian tribes, conducted detailed cognitive testing and examinations over two visits approximately 7 years apart. An expert panel reviewed case materials for consensus adjudication of cognitive status (intact; mild cognitive impairment [MCI]; dementia; other impaired/not MCI) and probable etiology (Alzheimer's disease [AD], vascular bain injury [VBI], traumatic brain injury [TBI], other).

RESULTS

American Indians aged 70-95 years had 54% cognitive impairment including 10% dementia. VBI and AD were primary etiology approximately equal proportions (>40%). Apolipoprotein (APO) Eε4 carriers were more common among those with dementia (p = 0.040). Plasma pTau, glial fibrillary acidic protein (GFAP), and neurofilament light chain (NfL) were higher among those with cognitive impairment, but not amyloid beta (Aβ). Cognitive intact had mean 3MSE 92.2 (SD 6.4) and mean Montreal Cognitive Assessment (MoCA) score of 21.3 (SD 3.2).

DISCUSSION

This is the first population-based study to estimate the prevalence of vascular and Alzheimer's dementias in a population-based study of American Indians.

HIGHLIGHTS

The Strong Heart Study is a population-based cohort of American Indian tribes, conducted over 30+ years and three US geographic regions (Northern Plains, Southern Plains, Southwest). Our teams conducted detailed cognitive testing, neurological examination, and brain imaging over two visits approximately 7 years apart. An expert panel reviewed collected materials for consensus-based adjudication of cognitive status (intact; MCI; dementia; other impaired/not MCI) and probable underlying etiology (AD; VBI; TBI; other). In this cohort of American Indians aged 70-95, 54% were adjudicated with cognitive impairment, including approximately 35% MCI and 10% dementia. These data expand on prior reports from studies using electronic health records, which had suggested prevalence, and incidence of dementia in American Indians to be more comparable to the majority population or non-Hispanic White individuals, perhaps due to latent case undercounts in clinical settings. Vascular and neurodegenerative injuries were approximately equally responsible for cognitive impairment, suggesting that reduction of cardiovascular disease is needed for primary prevention. Traumatic injury was more prevalent than in other populations, and common among those in the "other/not MCI" cognitive impairment category. Mean scores for common dementia screening instruments-even among those adjudicated as unimpaired-were relatively low compared to other populations (mean unimpaired 3MSE 92.2, SD 6.4; mean unimpaired MoCA 21.3, SD 3.2), suggesting the need for cultural and environmental adaptation of common screening and evaluation instruments.

Psychometric Properties of Controlled Oral Word Association (COWA) Test and Associations With Education and Bilingualism in American Indian Adults: The Strong Heart Study

The Controlled Oral Word Association (COWA) test is used to assess phonemic fluency and executive function. Formal validation of test scores is important for accurate cognitive evaluation. However, there is a dearth of psychometric validation among American Indian adults. Given high burden of dementia risk and key contextual factors associated with cognitive assessments, this represents a critical oversight. In a large, longitudinal population-based cohort study of adult American Indians, we examined several validity inferences for COWA, including scoring, generalization, and extrapolation inferences, by investigation of factor structure, internal consistency, test-retest reliability, and differential test functioning. We found adequate unidimensional model fit, with high factor loadings. Internal consistency reliability and test-retest reliability were 0.88 and 0.77, respectively, for the full group. COWA scores were lowest among the oldest, lowest education, bilingual speakers; group effects for sex and bilingual status were small; age effect was medium; and education effect was largest. However, Wide Range Achievement Test (WRAT) score effect was stronger than education effect, suggesting better contextualization may be needed. These results support interpretation of total COWA score, including across sex, age, or language use strata.

The protective effect of social support on all-cause and cardio-cerebrovascular mortality among middle-aged and older adults in the US

The relationship between social support and mortality, especially cardio-cerebrovascular mortality, still has some limitations in the assessment of social support, sample selection bias, and short follow-up time. We used the data from 2005 to 2008 National Health and Nutrition Examination Survey to examine this relationship. The study analyzed a total of 6776 participants, divided into Group 1, Group 2, and Group 3 according to the social support score (0-1; 2-3; 4-5). Multivariable adjusted COX regression analyses of our study showed that Group 3 and Group 2 had a reduced risk of all-cause and cardio-cerebrovascular mortality (Group 3 vs 1, HR: 0.55, P < 0.001; HR: 0.4, P < 0.001; Group 2 vs 1, HR: 0.77, P = 0.017; HR: 0.58, P = 0.014) compared with Group 1. The same results were observed after excluding those who died in a relatively short time. Additionally, having more close friends, being married or living as married, and enough attending religious services were significantly related to a lower risk of mortality after adjustment. In brief, adequate social support is beneficial in reducing the risk of all-cause mortality and cardio-cerebrovascular mortality in middle-aged and older adults, especially in terms of attending religious services frequency, the number of close friends, and marital status.

Nurse-led models of care for metabolic syndrome in primary care: A scoping review

AIM

To identify and map out existing nurse-led models of care for treatment and prevention of metabolic syndrome in primary care settings.

DESIGN

A scoping review.

METHODS

Conducted in accordance with the JBI methodology.

DATA SOURCES

A search of the databases PubMed, CINAHL Complete, Cochrane Library, Scopus, handsearch and a grey literature search was conducted in June 2022 and updated in March 2023.

RESULTS

Title and abstract screening was performed on 926 articles resulting in 40 articles for full text screening. Full text screening yielded seven articles that met inclusion criteria.

CONCLUSION

Additional research is needed on nursing models of care to prevent and treat metabolic syndrome. Future studies should concentrate on rigour with clearly defined objective inclusion criteria.

IMPLICATIONS TO CLINICAL PRACTICE

This review contributes a synthesis of the evidence on nurse-led models for metabolic syndrome in primary care.

IMPACT

This scoping review addresses metabolic syndrome, the precursor to non-communicable disease. The review mapped the evidence for nurse-led models of care for metabolic syndrome in the primary care setting. These findings promote the development and evaluation of novel nurse-led models of care which can mitigate the effect of the current epidemic.

REPORTING METHOD

PRISMA checklist for scoping reviews. No patient or public contribution was part of this study.

PROTOCOL REGISTRATION

Open Science Framework accessible at: https://osf.io/jfpw7/.

Volume atrophy in medial temporal cortex and verbal memory scores in American Indians: Data from the Strong Heart Study

INTRODUCTION

Distinguishing Alzheimer's disease (AD) patient subgroups may optimize positive clinical outcomes. Cortical atrophy is correlated with memory deficits, but these associations are understudied in American Indians.

METHODS

We collected imaging and cognition data in the Strong Heart Study (SHS), a cohort of 11 tribes across three regions. We processed 1.5T MRI using FreeSurfer and iterative principal component analysis. Linear mixed models estimated volumetric associations with diabetes.

RESULTS

Over mean 7 years follow-up (N = 818 age 65-89 years), overall volume loss was 0.5% per year. Significant losses associated with diabetes were especially strong in the right hemisphere. Annualized hippocampal, parahippocampal, entorhinal atrophy were worse for men, older age, diabetes, hypertension, stroke; and associated with both encoding and retrieval memory losses.

DISCUSSION

Our findings suggest that diabetes is an important risk factor in American Indians for cortical atrophy and memory loss. Future research should examine opportunities for primary prevention in this underserved population.