Childhood Stress and Adversity is Associated with Late-Life Dementia in Aboriginal Australians

Health promotion for dementia risk reduction in Indigenous populations of Canada, Aotearoa New Zealand, United States of America, and Australia: Scoping review protocol

Health promotion programs and strategies have the potential to support people to live healthier lives. Dementia, a collective name for brain disorders that impact thinking and memory, affects over 55 million people worldwide. Currently, there is no cure for dementia, so prevention is critical. Health promotion has the potential to reduce dementia by targeting the twelve potentially modifiable risk factors. A project currently being undertaken by the research team aims to strengthen the quality of clinical care and health services that specifically address dementia risk for Australian Aboriginal and Torres Strait Islander peoples. One of the intended strategies supporting the project's aim is the need for appropriate and safe health promotion programs and resources that support dementia risk reduction. Consequently, the aim of this scoping review is to identify and determine the quality and appropriateness of existing health promotion programs and resources aimed at dementia risk reduction developed or modified for Indigenous populations of Canada, the USA, Aotearoa New Zealand, and Australia that could be incorporated into the broader project. The Joanna Briggs Institute method for scoping reviews will be used to identify programs and resources focussed on dementia risk reduction for Indigenous peoples. Searches will be limited to the English language and literature published since January 2010. Databases to be searched include: CINAHL, Medline, PsychInfo, PubMed, Scopus and Google. Data that answers the research questions will be extracted from the literature and recorded on a data charting form. A combination of quantitative and qualitative methods will be used to analyse the findings of the scoping review. Dissemination of the findings through continuing community engagement, conference presentations and publications will be led by Aboriginal and Torres Strait Islander members of the research team.

Gender differences in the associations of psychosocial trauma and acute medical stressors with immune system activation and dementia risk

Objective: The purpose of this article is to provide a narrative review synthesizing the literature on differences between women and men in relationships among certain stressors associated with immune system activation and their relationship to cognitive dysfunction and dementia. Method: We review the cycle of stress leading to neuroinflammation via cortisol and neurochemical alterations, cell-mediated immune system activation, and pro-inflammatory cytokines, and how this is implicated in the development of dementia. We follow this by discussing sex differences in stress physiology and immune function. We then review the work on early life adversity (ELA) and adverse childhood experiences (ACEs), post-traumatic stress disorder, acute medical stressors, and their associations with cognitive dysfunction and dementia. Throughout, we emphasize women's presentations and issues unique to women (e.g. trauma disorder prevalence). Conclusions: There is a need for more mechanistic and longitudinal studies that consider trauma accumulation, both physical and emotional, as well as a greater focus on traumas more likely to occur in women (e.g. sexual abuse), and their relationship to early cognitive decline and dementia.

Counting the Ways That Aboriginal and Torres Strait Islander Older People Participate in Their Communities and Culture

OBJECTIVES

This study aimed to determine the proportion of older Aboriginal and Torres Strait Islander peoples participating in cultural events and activities and determine the demographic and sociocultural characteristics associated with participation.

METHODS

The Australian Bureau of Statistics National Aboriginal and Torres Strait Islander Social Survey (2014-2015) was used to measure the prevalence of participation in cultural events and activities. Multivariate logistic regression models were used to measure associations. Sociocultural factors were selected by matching survey items to the 12 sociocultural factors described in the Good Spirit Good Life Framework, a culturally validated quality-of-life tool for older people.

RESULTS

The majority (62.0%) of survey respondents 45 years and older participated in cultural events (e.g., ceremonies, funerals/sorry business, NAIDOC week activities, sports carnivals, festivals/carnivals) or were involved in organizations. Many (58.5%) also participated in activities (e.g., fishing, hunting, gathering wild plants/berries, arts/crafts, music/dance/theater, writing/telling of stories). In regression models including demographic and cultural variables, participation in cultural events was highest among people living remotely (odds ratio [OR] = 2.71), reporting recognition of homelands (OR = 2.39), identifying with a cultural group (OR = 3.56), and those reporting having a say in their communities (OR = 1.57), with similar odds seen for participation in activities. Participation was inversely proportional to increasing age, with a greater proportion of females participating in events and males in activities.

DISCUSSION

The social lives of older Aboriginal and Torres Strait Islander people were characterized by widespread participation in cultural events and activities. These findings provide important insights into services as they support older people to live a good life.

The Role of the Neural Exposome as a Novel Strategy to Identify and Mitigate Health Inequities in Alzheimer's Disease and Related Dementias

With the continuous increase of the elderly population, there is an urgency to understand and develop relevant treatments for Alzheimer's disease and related dementias (ADRD). In tandem with this, the prevalence of health inequities continues to rise as disadvantaged communities fail to be included in mainstream research. The neural exposome poses as a relevant mechanistic approach and tool for investigating ADRD onset, progression, and pathology as it accounts for several different factors: exogenous, endogenous, and behavioral. Consequently, through the neural exposome, health inequities can be addressed in ADRD research. In this paper, we address how the neural exposome relates to ADRD by contributing to the discourse through defining how the neural exposome can be developed as a tool in accordance with machine learning. Through this, machine learning can allow for developing a greater insight into the application of transferring and making sense of experimental mouse models exposed to health inequities and potentially relate it to humans. The overall goal moving beyond this paper is to define a multitude of potential factors that can increase the risk of ADRD onset and integrate them to create an interdisciplinary approach to the study of ADRD and subsequently translate the findings to clinical research.

Prevalence and risk factors for Alzheimer's disease and related dementias in Ghana: Evidence from a cross-sectional population-based study

Alzheimer's disease and Related Dementia (ADRD) is a growing concern for low- and middle-income countries. Yet, studies on the prevalence and risk factors for dementia in sub-Saharan Africa are limited. This study estimated the prevalence and identified the risk factors for ADRD in Ghana. A cross-sectional design involving 384 participants aged 60 years or more completed the Brief Community Screening Instrument for Dementia (CSID) with an additional set of questions on risk factors. The prevalence of dementia was 16% (62/384). Age (AOR = 1.031 (95% CI 1.002-1.061, p=0.035), education (AOR = 0.689 (95% CI 0.517-0.919, p=0.011), and employment (AOR = 0.320 (95% CI 0.149-0.685, p=0.004) were associated with dementia. Also, "experience of stressful life event from age 16-64" (AOR = 1.325 (95% CI 1.034-1.698, p=0.024), "experience of stressful life event from age 65+" (AOR = 1.258 (95% CI 1.024-1.546, p=0.042), and "activities of daily living" (AOR = 0.925 (95% CI 0.868-0.986, p=0.037) identified as risk factors of dementia. The burden of ADRD was high. Urgent actions are needed to address this problem. There is a possibility that the burden of dementia may have been overestimated because of the study instrument. Findings should be interpreted in light of this limitation.

Experimental laboratory models as tools for understanding modifiable dementia risk

Experimental laboratory research has an important role to play in dementia prevention. Mechanisms underlying modifiable risk factors for dementia are promising targets for dementia prevention but are difficult to investigate in human populations due to technological constraints and confounds. Therefore, controlled laboratory experiments in models such as transgenic rodents, invertebrates and in vitro cultured cells are increasingly used to investigate dementia risk factors and test strategies which target them to prevent dementia. This review provides an overview of experimental research into 15 established and putative modifiable dementia risk factors: less early-life education, hearing loss, depression, social isolation, life stress, hypertension, obesity, diabetes, physical inactivity, heavy alcohol use, smoking, air pollution, anesthetic exposure, traumatic brain injury, and disordered sleep. It explores how experimental models have been, and can be, used to address questions about modifiable dementia risk and prevention that cannot readily be addressed in human studies. HIGHLIGHTS: Modifiable dementia risk factors are promising targets for dementia prevention. Interrogation of mechanisms underlying dementia risk is difficult in human populations. Studies using diverse experimental models are revealing modifiable dementia risk mechanisms. We review experimental research into 15 modifiable dementia risk factors. Laboratory science can contribute uniquely to dementia prevention.

Strength together: examining risk and protective factors associated with dementia and cognitive impairment in Aboriginal and Torres Strait Islander peoples through harmonisation of landmark studies

BACKGROUND

Rates of dementia for Aboriginal and Torres Strait Islander peoples are three to five times greater compared to non-Indigenous Australians, with earlier age of onset. However, the risk and protective factors that drive these higher rates vary across existing cohort studies, with minimal findings on the role of vascular risk factors beyond stroke. Harmonisation of data across studies may offer greater insights through enhanced diversity and strengthened statistical capabilities. This study aims to combine three landmark cohort studies of Aboriginal and Torres Strait Islander participants to better understand the determinants of cognitive health and dementia.

METHODS/DESIGN

Three cohort studies - the Kimberley Healthy Adults Project (KHAP, N = 363), Koori Growing Old Well Study (KGOWS, N = 336) and Torres Strait Dementia Prevalence Study (TSDPS, N = 274) - share a similar research methodology with demographic, medical history, psychosocial factors, cognitive tests and consensus clinical diagnoses of cognitive impairment and dementia. Associations between risk and protective factors of interest and the presence of dementia and/or cognitive impairment diagnoses will be evaluated by univariable and multivariable logistic regression in a harmonised cross-sectional cohort of 898 participants. Factors associated with incident dementia and/or cognitive impairment will be assessed in a subset of KHAP (n = 189) and KGOWS participants (n = 165) who were available in longitudinal follow-up, after exclusion of those with baseline dementia or cognitive impairment. Analyses in relation to outcome measure of death or dementia will be conducted to account for the competing risk of death. Logistic regression will be used to evaluate the association between the individual components of the 16-component Kimberley Indigenous Cognitive Assessment (KICA) tool and the presence of dementia and cognitive impairment determined by independent consensus diagnoses. Multivariable binary logistic regression will be used to adjust for the effect of confounding variables. Results will be reported as odds ratios (OR) with 95% confidence intervals (95% CI).

DISCUSSION

Greater understanding of risk and protective factors of dementia and cognitive impairment relevant to Aboriginal and Torres Strait Islander peoples may improve approaches across the life course to delay cognitive decline and reduce dementia risk.

Levels of frailty and frailty progression in older urban- and regional-living First Nations Australians

OBJECTIVES

To explore the prevalence of frailty, association between frailty and mortality, and transitions between frailty states in urban- and regional-living First Nations Australians.

STUDY DESIGN

Secondary analysis of longitudinal data from the Koori Growing Old Well Study. First Nations Australians aged 60 years or more from five non-remote communities were recruited in 2010-2012 and followed up six years later (2016-2018). Data collected at both visits were used to derive a 38-item Frailty Index (FI). The FI (range 0-1.0) was classified as robust (<0.1), pre-frail (0.1- < 0.2), mildly (0.2- < 0.3), moderately (0.3- < 0.4) or severely frail (≥0.4).

MAIN OUTCOME MEASURES

Association between frailty and mortality, examined using logistic regression and transitions in frailty (the percentage of participants who changed frailty category) during follow-up.

RESULTS

At baseline, 313 of 336 participants (93 %) had sufficient data to calculate a FI. Median FI score was 0.26 (interquartile range 0.21-0.39); 4.79 % were robust, 20.1 % pre-frail, 31.6 % mildly frail, 23.0 % moderately frail and 20.5 % severely frail. Higher baseline frailty was associated with mortality among severely frail participants (adjusted odds ratio 7.11, 95 % confidence interval 2.51-20.09) but not moderately or mildly frail participants. Of the 153 participants with a FI at both baseline and follow-up, their median FI score increased from 0.26 to 0.28.

CONCLUSIONS

Levels of frailty in this First Nations cohort are substantially higher than in similar-aged non-Indigenous populations. Screening for frailty before the age of 70 years may be warranted in First Nations Australians. Further research is urgently needed to determine the factors that are driving such high levels of frailty and propose solutions to prevent or manage frailty in this population.

Lifetime adversity predicts depression, anxiety, and cognitive impairment in a nationally representative sample of older adults in the United States

OBJECTIVE

Although life stress and adversity are well-known risk factors for mental health problems and cognitive impairment among older adults, limited research has comprehensively examined the impact of both childhood and adulthood adversity on psychiatric and cognitive impairment symptoms over a prolonged period. To address this issue, we investigated how lifetime adversity exposure is related to symptoms of depression, anxiety, and cognitive impairment in a nationally representative, longitudinal sample of older adults in the United States.

METHOD

We analyzed data from the Health and Retirement Study (1992-2016). The sample included 3496 individuals (59.9% female), aged ≥64 years old (Mage = 76.0 ± 7.6 years in 2016). We used the individual-level panel data and ordinary least squares regressions to estimate associations between childhood and adulthood adversities, and later-life depression, anxiety, and cognitive impairment.

RESULTS

Many participants experienced a significant early life (38%) or adulthood (79%) stressor. Moreover, experiencing one childhood adversity (vs. none) was associated with a 17.4% increased risk of adulthood adversity. Finally, as hypothesized, childhood adversity exposure was related to experiencing more depression and anxiety symptoms in later life, whereas adulthood stressor exposure predicted more cognitive impairment as well as more depression and anxiety symptoms.

DISCUSSION

These findings demonstrate significant associations between lifetime adversity and symptoms of depression, anxiety, and cognitive impairment in older adults. Screening for lifetime stressors may thus help healthcare professionals and policymakers identify individuals who could potentially benefit from interventions designed to reduce stress and enhance resilience.

Childhood trauma is associated with early-onset but not late-onset suicidal behavior in late-life depression

OBJECTIVES

To examine the relationship between childhood traumatic experiences and early and late-onset suicidal behavior among depressed older adults.

DESIGN

Cross-sectional study.

SETTING

Inpatient and outpatient psychiatric services in Pennsylvania.

PARTICIPANTS

Our sample included 224 adults aged 50+ (M ± SD = 62.5 ± 7.4) recruited into three depressed groups: (1) 84 suicide attempters, (2) 44 suicide ideators, and (3) 58 non-suicidal comparisons, and a non-psychiatric healthy comparison group (N = 38).

MEASUREMENTS

The Childhood Trauma Questionnaire measured experiences of childhood trauma such as emotional abuse, physical abuse, emotional neglect, physical neglect, and sexual abuse.

RESULTS

Attempters were separated into early- and late-onset based on age of first attempt using a statistical algorithm that identified a cutoff age of 30 years old. Overall, we found group differences in emotional and physical abuse and neglect in both genders and sexual abuse in females, but not in males. Early-onset attempters experienced more childhood emotional abuse and neglect than late-onset attempters and were more likely to have experienced multiple forms of abuse. They also experienced more emotional abuse and neglect than all comparison groups. Consistently, early-onset attempters more often met criteria for current or lifetime PTSD relative to late-onset attempters and most comparison groups. Late-onset attempters had similar levels of childhood trauma as other depressed groups.

CONCLUSIONS

Our study reaffirms that there are distinct pathways to suicidal behavior in older adults based on their age of first suicide attempt and that trauma experienced in childhood has long-lasting emotional and behavioral consequences, even into late life.

Frontal cortical volume deficits as enduring evidence of childhood abuse in community adults with AUD and HIV infection comorbidity

Background

Childhood abuse is an underappreciated source of stress, associated with adverse mental and physical health consequences. Childhood abuse has been directly associated with risky behavior thereby increasing the likelihood of alcohol misuse and risk of HIV infection, conditions associated with brain structural and functional deficits. Here, we examined the neural and behavioral correlates of childhood trauma history in alcohol use disorder (AUD), HIV infection (HIV), and their comorbidity (AUD+HIV).

Methods

Occurrence of childhood trauma was evaluated by retrospective interview. Cortical (frontal, temporal, parietal, and occipital), subcortical (hippocampus, amygdala), and regional frontal volumes were derived from structural MRI, adjusted for intracranial volume and age. Test scores of executive functioning, attention/working memory, verbal/visual learning, verbal/visual memory, and motor speed functional domains were standardized on age and education of a laboratory control group.

Results

History of childhood abuse was associated with smaller frontal lobe volumes regardless of diagnosis. For frontal subregional volumes, history of childhood abuse was selectively associated with smaller orbitofrontal and supplementary motor volumes. In participants with a child abuse history, poorer verbal/visual memory performance was associated with smaller orbitofrontal and frontal middle volumes, whereas in those without childhood abuse, poorer verbal/visual memory performance was associated with smaller orbitofrontal, frontal superior, and supplemental motor volumes.

Conclusions

Taken together, these results comport with and extend the findings that childhood abuse is associated with brain and behavioral sequelae in AUD, HIV, and AUD+HIV comorbidity. Further, these findings suggest that sequelae of abuse in childhood may be best conceptualized as a spectrum disorder as significant deficits may be present in those who may not meet criteria for a formal trauma-related diagnosis yet may be suffering enduring stress effects on brain structural and functional health.

Mechanisms underlying the association between adverse childhood experiences and racial disparities in later-life cognition

OBJECTIVE

Adverse childhood experiences (ACEs) may be a risk factor for later-life cognitive disorders such as dementia; however, few studies have investigated underlying mechanisms, such as cardiovascular health and depressive symptoms, in a health disparities framework.

METHOD

418 community-dwelling adults (50% nonHispanic Black, 50% nonHispanic White) aged 55+ from the Michigan Cognitive Aging Project retrospectively reported on nine ACEs. Baseline global cognition was a z-score composite of five factor scores from a comprehensive neuropsychological battery. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Cardiovascular health was operationalized through systolic blood pressure. A mediation model controlling for sociodemographics, childhood health, and childhood socioeconomic status estimated indirect effects of ACEs on global cognition via depressive symptoms and blood pressure. Racial differences were probed via t-tests and stratified models.

RESULTS

A negative indirect effect of ACEs on cognition was observed through depressive symptoms [β = -.040, 95% CI (-.067, -.017)], but not blood pressure, for the whole sample. Black participants reported more ACEs (Cohen's d = .21), reported more depressive symptoms (Cohen's d = .35), higher blood pressure (Cohen's d = .41), and lower cognitive scores (Cohen's d = 1.35) compared to White participants. In stratified models, there was a negative indirect effect through depressive symptoms for Black participants [β = -.074, 95% CI (-.128, -.029)] but not for White participants.

CONCLUSIONS

These results highlight the need to consider racially patterned contextual factors across the life course. Such factors could exacerbate the negative impact of ACEs and related mental health consequences and contribute to racial disparities in cognitive aging.

Colonial drivers and cultural protectors of brain health among Indigenous peoples internationally

Despite relatively higher rates of dementia among Indigenous populations internationally, research into drivers of disparities in brain health and cognitive function has tended to focus on modifiable risk factors over cultural understandings and contextual determinants. By seeking to characterize social and cultural factors that shape brain health and cognition in Indigenous populations, this mini scoping review expands prevailing schools of thought to include Indigenous knowledge systems. This reveals important gaps in culturally aligned care. It also reclaims horizons for research important to Indigenous Peoples that have garnered diminished attention in biomedical approaches. Twenty-three sources were included for data extraction. This synthesis of 23 sources includes health communication about dementia, health provider knowledge about Indigenous health, culturally relevant screening and assessment tools, and culturally grounded care models. Much of the focus is currently still on modifiable risk factors that reside at individual factors, whereas attention to wider social factors that impact populations is needed, as stressors through isolation, discrimination, and unequal care are widely reported. Going forward, identifying structural barriers to living well and recognizing the importance of connection to culture will benefit both Indigenous and non-Indigenous understandings of brain health.

Clinicians' views on cognitive assessment with Aboriginal Australians

BACKGROUND

A shortage of standardised cognitive assessment tools for use with Aboriginal Australians is evident. Clinicians also miss the range of guidelines necessary to inform test selection and interpretation for all Aboriginal clients. This mixed methods study examines clinicians' confidence, views and current practices when conducting cognitive assessments with Aboriginal Australian clients.

METHODS

Clinicians were asked about factors that influence their likelihood of using standardised testing in Aboriginal vs non-Indigenous Australian people. Twenty-one health professionals with experience conducting cognitive assessments with Aboriginal and non-Aboriginal Australians participated. Clinicians were presented with a series of different scenarios per the client's level of education and language of origin via an online survey. Clinicians rated their likelihood and confidence using standardised cognitive assessment for each scenario. Open-ended questions captured clinicians' views and information about their current clinical practices.

RESULTS

Clients' age, education and language of origin influence the likelihood of clinicians' use of standardised cognitive assessment measures with Aboriginal people. Overall, clinicians reported feeling only slightly more confident working with non-Indigenous clients than Aboriginal clients. Qualitative data indicate a lack of consistency regarding test selection.

CONCLUSION

Clinicians expressed concerns about the validity of available cognitive assessment tools for use with Aboriginal Australians and the absence of evidence to assist decision-making. Cited barriers included language, educational attainment and cultural factors.

Time-lagged associations between two adverse childhood experiences and later-life cognitive function through educational attainment and stroke

OBJECTIVE

Adverse childhood experiences (ACEs) have been associated with worse cognitive health in older adulthood. This study aimed to extend findings on the specificity, persistence, and pathways of associations between two ACEs and cognition by using a comprehensive neuropsychological battery and a time-lagged mediation design.

METHOD

Participants were 3304 older adults in the Health and Retirement Study Harmonized Cognitive Assessment Protocol. Participants retrospectively reported whether they were exposed to parental substance abuse or experienced parental physical abuse before age 18. Factor scores derived from a battery of 13 neuropsychological tests indexed cognitive domains of episodic memory, executive functioning, processing speed, language, and visuospatial function. Structural equation models examined self-reported years of education and stroke as mediators, controlling for sociodemographics and childhood socioeconomic status.

RESULTS

Parental substance abuse in childhood was associated with worse later-life cognitive function across all domains, in part via pathways involving educational attainment and stroke. Parental physical abuse was associated with worse cognitive outcomes via stroke independent of education.

CONCLUSIONS

This national longitudinal study in the United States provides evidence for broad and persistent indirect associations between two ACEs and cognitive aging via differential pathways involving educational attainment and stroke. Future research should examine additional ACEs and mechanisms as well as moderators of these associations to better understand points of intervention.

Risk, protective, and biomarkers of dementia in Indigenous peoples: A systematic review

INTRODUCTION

Dementia is an emergent health priority for Indigenous peoples worldwide, yet little is known about disease drivers and protective factors.

METHODS

Database searches were conducted in March 2022 to identify original publications on risk, protective, genetic, neuroradiological, and biological factors related to dementia and cognitive impairment involving Indigenous peoples.

RESULTS

Modifiable risk factors featured across multiple studies include childhood adversity, hearing loss, low education attainment, unskilled work history, stroke, head injury, epilepsy, diabetes, hypertension, hyperlipidemia, depression, low BMI, poor mobility, and continence issues. Non-modifiable risk factors included increasing age, sex, and genetic polymorphisms. Education, ex-smoking, physical and social activity, and engagement with cultural or religious practices were highlighted as potential protective factors. There is a paucity of research on dementia biomarkers involving Indigenous peoples.

DISCUSSION

Greater understanding of modifiable factors and biomarkers of dementia can assist in strength-based models to promote healthy ageing and cognition for Indigenous peoples.

An overview of neurocognitive impairment in older people living with HIV

Background

With improved survival among People Living with HIV (PLHIV), many are confronted with age associated comorbidities and geriatric syndromes. Neurocognitive impairment is one of the three most frequent conditions that affects quality of life of PLHIV despite achieving viral suppression. Healthcare providers face challenges in early identification of neurocognitive impairment, performing comprehensive assessment and managing older PLHIV.

Objectives

This paper aims to review available evidence regarding aetiology and management of older PLHIV who develop neurocognitive impairment, suggest improvements on current management and postulate future study direction.

Methods

A PubMed search for original articles and Clinical Guidelines was conducted from September 2021 to August 2022 using a combination of keywords related to neurocognitive impairment in PLHIV. The citations from all selected articles were reviewed for additional studies.

Results

Older PLHIV tend to be frailer than their uninfected counterparts, are plagued with multi-morbidity and are at increased risk of cognitive impairment. The aetiologies for neurocognitive impairment are multifactorial, multi-dimensional and complex. The management of neurocognitive impairment in older PLHIV involves identifying and optimizing predisposing factors, physical function, social and psychological health with appropriate care navigation.

Conclusion

Identification and management of neurocognitive impairment in older PLHIV through interdisciplinary collaboration among stakeholders is important. This exemplifies an integrated model of care for older PLHIV and promotes the notion of living well beyond viral suppression.

Ethical issues in clinical neuropsychology: International diversity perspectives

OBJECTIVE

Much of the information about the ethical practice of clinical neuropsychology has focused on North America. Additionally, of the scholarly publications on the intersection of ethical issues and cultural diversity practices in neuropsychology, most have focused on North America. The extent to which practitioners in other parts of the world are aware of, and find useful, such information is largely unknown. Similarly, the extent to which North American neuropsychologists are familiar with ethical issues and challenges encountered around the world is unknown. The purpose of this article is to advance the discussion of ethical issues in clinical neuropsychology from an international diversity perspective.

METHOD

The article presents, via a panel interview format, the thoughts and experiences of a small sample of neuropsychologists who represent all continents except North America (and Antarctica).

RESULTS

Neuropsychologists across continents share an ethical commitment to providing services that are beneficial, and not harmful, to the recipients of the services. Professional competence is at the heart of such services.

CONCLUSIONS

Through continued and expanded dialogue about ethical issues with neuropsychology colleagues around the world, the potential exists for improvement in the provision of effective and compassionate care in our own towns.

What is the association between adverse childhood experiences and late-life cognitive decline? Study of Healthy Aging in African Americans (STAR) cohort study

OBJECTIVES

Adverse childhood experiences (ACEs) are associated with higher risk of chronic disease, but little is known about the association with late life cognitive decline. We examined the longitudinal association between ACEs and late-life cognitive decline in the Study of Healthy Aging in African Americans (STAR).

DESIGN

Linear mixed models with random intercepts and slope examined the association of individual and composite ACEs with cognitive change adjusting for years from baseline (timescale), baseline age, sex, parental education, childhood socioeconomic status and childhood social support. Participants reported whether they had experienced nine types of ACEs. Executive function and verbal episodic memory were measured up to three times over a 3-year period using the Spanish and English Neuropsychological Assessment Scales.

SETTINGS

Kaiser Permanente Northern California members living in the Bay Area.

PARTICIPANTS

STAR is a cohort study of cognitive ageing launched in 2018 that has enrolled 764 black Americans ages ≥50 years (mean age=67.5; SD=8.5).

RESULTS

Twenty-one per cent of participants reported no ACEs, 24% one ACE, 20% two ACEs, 17% three ACEs and 17% four or more ACEs. Compared with no ACEs, two ACEs (β=0.117; 95% CI 0.052 to 0.182), three ACEs (β=0.075; 95% CI 0.007 to 0.143) and four or more ACEs (β=0.089; 95% CI 0.002 to 0.158) were associated with less decline in executive function. There were no significant associations between number of ACEs and baseline or longitudinal verbal episodic memory or between individual ACEs and executive function or verbal episodic memory.

CONCLUSION

In this cohort of older black Americans, there was no association between ACEs and baseline cognition or cognitive change in verbal episodic memory; however, experiencing ≥ 2 ACEs was associated with less decline in executive function. These results may indicate that participants who survived to age 50+ and experienced ACEs may have cognitive resilience that warrants further investigation.

Association between adverse childhood experiences and social integration among older people in Japan: Results from the JAGES study

Social integration, network, and support are beneficial to health. However, there is little evidence of the association between adverse childhood experiences (ACEs) and social integration in later life. This study investigates the association between ACE history and social integration in older people. We used data from the Japan Gerontological Evaluation Study (JAGES) 2013, which conducted a self-reported survey of functionally independent people aged ≥ 65 years from 30 municipalities across Japan and yielded information on ACE history. We conducted a Poisson regression analysis with robust error variances to assess the association between ACE history and social integration, adjusting for sex, age, childhood economic hardship, adult socioeconomic status, health status, living status, and trust in others. The number of respondents with at least one incident of ACE was approximately 36.8%. The prevalence ratios for those who reported a history of ACEs were as follows: housebound 1.495 (95% confidence interval [CI]: 1.19-1.88), small network size 1.146 (95% CI: 1.10-1.19), low network contact 1.059 (95% CI: 1.00-1.059), non-membership sports group 1.038 (95% CI: 1.00-1.07), and non-membership hobby group 1.06 (95% CI: 1.03-1.09). Among older people in Japan, a history of ACEs is inversely associated with social integration. These findings support the life course approach and suggest that adverse events in early life may have an impact on social life in old age. In order to promote healthy aging, it is important to recognize the significant impact of early-life adversities that can extend into later life.

Childhood Sexual Trauma and Subjective Cognitive Decline: An Assessment of Racial/Ethnic and Sexual Orientation Disparities

Prior studies examining the association between childhood sexual abuse (CSA) and subjective cognitive decline (SCD) are limited. The aim of this study was to examine the racial/ethnic and sexual orientation disparities in the association between CSA and SCD. Using data from the 2019 Behavioral Risk Factor Surveillance System Survey, crude and multivariable logistic regression models were used to determine the association between CSA and SCD adjusting for sociodemographic characteristics, diabetes, hypertension, and depression. There were statistically significant differences in CSA status by age, gender, income, education, employment, and health status (depression). Black and Hispanic/Latine respondents had a stronger relationship between CSA and SCD compared to White populations. Also, sexual minority populations had a stronger relationship between CSA and SCD compared to heterosexual populations. Health disparities exist in the association between CSA and SCD. Trauma-informed interventions should be implemented among affected populations.

The Black radical imagination: a space of hope and possible futures

The radical imagination entails stepping outside the confines of the now and into the expansiveness of what could be. It has been described as the ability to dream of possible futures and bring these possibilities back to the present to drive social transformation. This perspective paper seeks to provide an overview of the radical imagination and its intersections with Afrofuturism, a framework and artistic epistemology that expresses the Black cultural experience through a space of hope where Blackness is integral. In this paper, I propose three processes that comprise the radical imagination: (1) imagining alternative Black futures, (2) radical hope, and (3) collective courage. I consider the neural networks that underlie each process and consider how the Black radical imagination is a portal through which aging Black adults experience hope and envision futures that drive social change. I conclude with considerations of what brain health and healing justice looks like for aging Black Americans- specifically, how invocation of the Black radical imagination may have positive brain health effects for a demographic group at increased risk for Alzheimer's disease and related dementias.

Childhood Bullying as a Risk Factor for Late-Life Psychological Distress and Cognitive Impairment

In the United States, non-Hispanic Black (19%) older adults are more likely to develop dementia than White older adults (10%). As genetics alone cannot account for these differences, the impact of historical social factors is considered. This study examined whether childhood and late-life psychological distress associated with dementia risk could explain part of these disparities. Using longitudinal data from 379 White and 141 Black respondents from the Panel Study of Income Dynamics, we assessed the association between childhood bullying and late-life dementia risk, testing for mediation effects from late-life psychological distress. Mediation analysis was computed via negative binomial regression modeling, stratified by race (White/Black), type of bullying experience (target, bully, and bully-target), and the age range at which the experience occurred (6-12, 13-16). The results indicated that late-life psychological distress fully mediated the association between Black respondents who were bullies and dementia risk. However, no significant association was observed among White respondents. These results suggest that interventions aimed at preventing and treating psychological distress throughout the lifespan could be crucial in mitigating the development and progression of dementia risk.

Potentially modifiable dementia risk factors in all Australians and within population groups: an analysis using cross-sectional survey data

BACKGROUND

Dementia is the second leading cause of disease burden in Australia. We aimed to calculate the population attributable fractions (PAFs) of dementia attributable to 11 of 12 previously identified potentially modifiable health and social risk factors (less education, hearing loss, hypertension, obesity, smoking, depression, social isolation, physical inactivity, diabetes, alcohol excess, air pollution, and traumatic brain injury), for Australians overall and three population groups (First Nations, and those of European and Asian ancestry).

METHODS

We calculated the prevalence of dementia risk factors (excluding traumatic brain injury) and PAFs, adjusted for communality, from the cross-sectional National Aboriginal and Torres Strait Islander Health Survey (2018-19), National Aboriginal and Torres Strait Islander Social Survey (2014-15), National Health Survey (2017-18), and General Social Survey (2014) conducted by the Australian Bureau of Statistics. We conducted sensitivity analyses using proxy estimates for traumatic brain injury (12th known risk factor) for which national data were not available.

FINDINGS

A large proportion (38·2%, 95% CI 37·2-39·2) of dementia in Australia was theoretically attributable to the 11 risk factors; 44·9% (43·1-46·7) for First Nations Australians, 36·4% (34·8-38·1) for European ancestry, and 33·6% (30·1-37·2) for Asian ancestry. Including traumatic brain injury increased the PAF to 40·6% (39·6-41·6) for all Australians. Physical inactivity (8·3%, 7·5-9·2), hearing loss (7·0%, 6·4-7·6), and obesity (6·6%, 6·0-7·3) accounted for approximately half of the total PAF estimates across Australia, and for all three population groups.

INTERPRETATION

Our PAF estimates indicate a substantial proportion of dementia in Australia is potentially preventable, which is broadly consistent with global trends and results from other countries. The highest potential for dementia prevention was among First Nations Australians, reflecting the enduring effect of upstream social, political, environmental, and economic disadvantage, leading to greater life-course exposure to dementia risk factors. Although there were common dementia risk factors across different population groups, prevention strategies should be informed by community consultation and be culturally and linguistically appropriate.

FUNDING

Australian National Health and Medical Research Council and University College London Hospitals' National Institute for Health Research (NIHR) Biomedical Research Centre, and North Thames NIHR Applied Research Collaboration.

Effect modifications of BMI transition and trajectory in the associations of adverse childhood experiences with new-onset dementia and its subtypes in older US adults

Background

Adverse childhood experiences (ACEs) and dementia are associated and comorbid with obesity. However, according to emerging research, the role of obesity in the association between ACEs and dementia seems controversial.

Aims

This analysis aimed to explore the associations between ACEs and different dementia subtypes and the effect modification of long-term body mass index (BMI).

Methods

Data were obtained from the US Health and Retirement Study. Six ACEs were categorised as 0, 1 and 2 or more. All-cause dementia, Alzheimer's disease (AD) and other dementias were defined by self-reported or proxy-reported physician diagnosis. Cox proportional hazards regression was used to explore the associations of ACEs with new-onset all-cause dementia, AD and other dementias from 2010 to 2020. Effect modification of BMI in 2010 and BMI transition and trajectory (fitted by group-based trajectory modelling) from 2004 to 2010 were assessed.

Results

15 282 participants with a mean age of 67.0 years (58.0-75.0) were included in the 2010 data analysis. Significant interactions of ACEs with baseline BMI, BMI transition and BMI trajectory in their associations with new-onset all-cause dementia and AD were observed (all p<0.05). For instance, positive associations of two or more ACEs (vs none) with all-cause dementia and AD were found in those with a BMI trajectory of maintaining ≥30 kg/m2 (maintain obesity) rather than a decline to or maintaining <25 kg/m2 (decline to or maintain normal weight), with hazard ratios (HRs) of 1.87 (95% confidence interval (CI): 1.45 to 2.42) and 1.85 (95% CI: 1.22 to 2.80), respectively.

Conclusions

ACEs were associated with dementia and AD in US adults with long-term abnormally elevated BMI but not with long-term normal or decreasing BMI. Integrated weight management throughout life could prevent dementia among those with childhood adversity.

Erratum: Potentially preventable dementia in a First Nations population in the Torres Strait and Northern Peninsula Area of North Queensland, Australia: a cross sectional analysis using population attributable fractions

[This corrects the article DOI: 10.1016/j.lanwpc.2023.100855.][This corrects the article DOI: 10.1016/j.lanwpc.2022.100532.].

Adverse events in older adults and the risk of dementia and cognitive decline

Background

Increasing evidence suggests that stress could be a risk factor for dementia but this might vary by gender. This study investigated whether adverse life events were associated with cognitive decline and dementia in later-life, separately in men and women.

Methods

Participants were 12,789 community-dwelling Australians aged ≥ 70 years. Ten common adverse events in later-life were self-reported. Cognitive decline was defined as a 1.5 SD decline from participants' baseline score in tests of global cognition, psychomotor speed, episodic memory, and executive functioning, which were assessed regularly over a maximum of 10.3 years. Dementia was diagnosed according to DSM-IV criteria.

Results

An increased risk of dementia was observed in participants who experienced the death of a spouse/partner (HR: 1.72, 95% CI: 1.17 - 2.52) and for individuals who experienced major financial problems (HR: 1.53, 95% CI: 1.05 - 2.23). The latter also increased the risk of cognitive decline in men specifically (HR: 1.43, 95% CI: 1.10 - 1.86). In contrast, some events for women were associated with a reduced risk of dementia (e.g. close family or friends lost their job/retired (HR: 0.62, 95% CI: 0.40-0.95)).

Limitations

Events including major money problems may result from prodromal dementia symptoms, thus reverse causation needs to be considered.

Conclusions

Adverse life events may influence dementia risk in older adults, but associations vary depending on the nature of the event, and across genders. These findings support the need for early interventions in older people who have experienced adversities, particularly for the death of a loved one.

Is Stress an Overlooked Risk Factor for Dementia? A Systematic Review from a Lifespan Developmental Perspective

Stress exposure and stress reactivity may be potent factors associated with increased risk of dementia. The 2017 Lancet Commission on Dementia and its 2020 update reviewed modifiable risk factors associated with dementia, but stress was not addressed directly. The present study provides a focused review of the association between stress and dementia across the lifespan, with measures of stress including stress exposure, psychological stress, posttraumatic stress disorder (PTSD), and biological markers of stress. Published research articles were identified in the American Psychological Association PsycINFO database (1887-2021), Web of Science database, and Google Scholar. A total of 53 samples from 40 studies published from 1985 to 2020 met inclusion criteria. Results suggest that stressful life events that occur earlier in the lifespan, such as loss of a parent, psychological stress experienced in midlife, and extreme stress responses, i.e., PTSD, correlate with higher risk of dementia. Although results generally are mixed, a consistent theme is that stress experienced earlier in the lifespan and chronic stress portend the greatest risk of dementia. Reducing stress exposure and improving stress management when stress exposure cannot be changed are thus relevant strategies in dementia risk reduction.

Early life adversity as a risk factor for cognitive impairment and Alzheimer's disease

Neurological conditions, including cognitive impairment and Alzheimer's disease (AD), impose a huge burden on society, affecting millions of people globally. In addition to genetic factors, recent studies indicate that environmental and experiential factors may contribute to the pathogenesis of these diseases. Early life adversity (ELA) has a profound impact on brain function and health later in life. In rodent models, exposure to ELA results in specific cognitive deficits and aggravated AD pathology. Extensive concerns have been raised regarding the higher risk of developing cognitive impairments in people with a history of ELA. In this review, we scrutinize findings from human and animal studies focusing on the connection of ELA with cognitive impairment and AD. These discoveries suggest that ELA, especially at early postnatal stages, increases susceptibility to cognitive impairment and AD later in life. In terms of mechanisms, ELA could lead to dysregulation of the hypothalamus-pituitary-adrenal axis, altered gut microbiome, persistent inflammation, oligodendrocyte dysfunction, hypomyelination, and aberrant adult hippocampal neurogenesis. Crosstalks among these events may synergistically contribute to cognitive impairment later in life. Additionally, we discuss several interventions that may alleviate adverse consequences of ELA. Further investigation into this crucial area will help improve ELA management and reduce the burden of related neurological conditions.

Adolescent neurodevelopment and psychopathology: The interplay between adversity exposure and genetic risk for accelerated brain ageing

In adulthood, stress exposure and genetic risk heighten psychological vulnerability by accelerating neurobiological senescence. To investigate whether molecular and brain network maturation processes play a similar role in adolescence, we analysed genetic, as well as longitudinal task neuroimaging (inhibitory control, incentive processing) and early life adversity (i.e., material deprivation, violence) data from the Adolescent Brain and Cognitive Development study (N = 980, age range: 9-13 years). Genetic risk was estimated separately for Major Depressive Disorder (MDD) and Alzheimer's Disease (AD), two pathologies linked to stress exposure and allegedly sharing a causal connection (MDD-to-AD). Adversity and genetic risk for MDD/AD jointly predicted functional network segregation patterns suggestive of accelerated (GABA-linked) visual/attentional, but delayed (dopamine [D2]/glutamate [GLU5R]-linked) somatomotor/association system development. A positive relationship between brain maturation and psychopathology emerged only among the less vulnerable adolescents, thereby implying that normatively maladaptive neurodevelopmental alterations could foster adjustment among the more exposed and genetically more stress susceptible youths. Transcriptomic analyses suggested that sensitivity to stress may underpin the joint neurodevelopmental effect of adversity and genetic risk for MDD/AD, in line with the proposed role of negative emotionality as a precursor to AD, likely to account for the alleged causal impact of MDD on dementia onset.

Understanding the relationships between physiological and psychosocial stress, cortisol and cognition

Stress is viewed as a state of real or perceived threat to homeostasis, the management of which involves the endocrine, nervous, and immune systems. These systems work independently and interactively as part of the stress response. The scientific stress literature, which spans both animal and human studies, contains heterogeneous findings about the effects of stress on the brain and the body. This review seeks to summarise and integrate literature on the relationships between these systems, examining particularly the roles of physiological and psychosocial stress, the stress hormone cortisol, as controlled by the hypothalamic-pituitary-adrenal (HPA) axis, and the effects of stress on cognitive functioning. Health conditions related to impaired HPA axis functioning and their associated neuropsychiatric symptoms will also be considered. Lastly, this review will provide suggestions of clinical applicability for endocrinologists who are uniquely placed to measure outcomes related to endocrine, nervous and immune system functioning and identify areas of intervention.

Race-Discordant School Attendance and Cognitive Function in Later Life

Early schooling plays an important role in shaping cognitive development. This study explored benefits of cognitive functioning in later life related to attending diverse schools in early life. Specifically, we explored the effects of having attended schools composed primarily of different race peers-race discordant schools (RDS)-among Black and White older adults. Using retrospective and prospective data from the Health and Retirement Study, we examined the association between RDS exposure and two measures of cognitive function (working memory, episodic memory) at age 55 and at age 70. We found that RDS exposed Blacks experienced significant benefits in cognitive function at age 55 and at age 70. In general, RDS exposed Whites did not experience cognitive benefits or deficits. Results suggest that exposure to more racially diverse school environments provides potentially beneficial effects for cognitive function, particularly in later phases of the life course.

Overlapping brain correlates of superior cognition among children at genetic risk for Alzheimer's disease and/or major depressive disorder

Early life adversity (ELA) tends to accelerate neurobiological ageing, which, in turn, is thought to heighten vulnerability to both major depressive disorder (MDD) and Alzheimer's disease (AD). The two conditions are putatively related, with MDD representing either a risk factor or early symptom of AD. Given the substantial environmental susceptibility of both disorders, timely identification of their neurocognitive markers could facilitate interventions to prevent clinical onset. To this end, we analysed multimodal data from the Adolescent Brain and Cognitive Development study (ages 9-10 years). To disentangle genetic from correlated genetic-environmental influences, while also probing gene-adversity interactions, we compared adoptees, a group generally exposed to substantial ELA, with children raised by their biological families via genetic risk scores (GRS) from genome-wide association studies. AD and MDD GRSs predicted overlapping and widespread neurodevelopmental alterations associated with superior fluid cognition. Specifically, among adoptees only, greater AD GRS were related to accelerated structural maturation (i.e., cortical thinning) and higher MDD GRS were linked to delayed functional neurodevelopment, as reflected in compensatory brain activation on an inhibitory control task. Our study identifies compensatory mechanisms linked to MDD risk and highlights the potential cognitive benefits of accelerated maturation linked to AD vulnerability in late childhood.

Childhood Maltreatment and Dementia Risk Factors in Midlife: A Prospective Investigation

BACKGROUND

Previous studies have linked childhood adversities to dementia risk, yet most studies are cross-sectional in design and utilize retrospective self-reports to assess childhood experiences. These design characteristics make it difficult to establish temporal order and draw firm conclusions.

OBJECTIVES

Using a longitudinal design, we sought to determine whether childhood maltreatment predicts dementia risk factors in middle adulthood.

METHODS

Data have been obtained from a prospective cohort design study of children with documented cases of childhood maltreatment (ages 0-11 years at case identification) and demographically matched controls who were followed up and interviewed in middle adulthood. Outcomes were assessed through a medical examination and interview, and 807 of the cases that included blood collection at mean age 41. Dementia risk were investigated using 11 potentially modifiable risk factors.

RESULTS

Compared to controls, individuals with histories of childhood maltreatment had a higher risk of low educational attainment, low social contact, smoking, and clinical depression, and a higher total number of dementia risk factors. In general, childhood maltreatment predicted a higher risk of dementia for females, males, and Black and White participants. Black maltreated participants had a greater risk for traumatic brain injury compared to Black controls. Physical abuse, sexual abuse, and neglect, each predicted a higher number of dementia risk factors in mid-life.

CONCLUSION

These findings provide evidence that childhood maltreatment increases the risk for dementia in mid-life and has a demonstrable impact lasting over 30 years. Reducing the prevalence of mid-life dementia risk factors could reduce the risk of later-life dementia.

Could Country-Level Factors Explain Sex Differences in Dementia Incidence and Prevalence? A Systematic Review and Meta-Analysis

BACKGROUND

Despite rising interest in sex differences in dementia, it is unclear whether sex differences in dementia incidence and prevalence are apparent globally.

OBJECTIVE

We examine sex differences in incidence and prevalence of Any dementia, Alzheimer's disease (AD), and vascular dementia (VaD), and evaluate whether country-level indicators of gender inequality account for differences.

METHODS

Systematic review with meta-analysis was used to obtain estimates of incidence and prevalence of Any dementia, AD, and VaD using random effects meta-analysis, and population-based studies with clinical or validated dementia measures. Meta-regression was used to evaluate how country-specific factors of life expectancy, education, and gender differences in development, unemployment, and inequality indices influenced estimates.

RESULTS

We identified 205 eligible studies from 8,731 articles, representing 998,187 participants across 43 countries. There were no sex differences in the incidence of Any dementia, AD, or VaD, except in the 90+ age group (women higher). When examined by 5-year age bands, the only sex difference in prevalence of Any dementia was in the 85+ group and there was no sex difference in VaD. AD was more prevalent in women at most ages. Globally, the overall prevalence of dementia in adults 65 + was higher for women (80.22/1000, 95% CI 62.83-97.61) than men (54.86/1000, 95% CI 43.55-66.17). Meta-regression revealed that sex differences in Any dementia prevalence were associated with gender differences in life expectancy and in education.

CONCLUSION

Globally, there are no sex differences in age-specific dementia incidence, but prevalence of AD is higher in women. Country-level factors like life expectancy and gender differences in education may explain variability in sex differences.

The mediating and moderating effects of resilience between childhood trauma and geriatric depressive symptoms among Chinese community-dwelling older adults

Objective

This study aims to examine the association between childhood traumatic events (CTEs), childhood trauma severity, and depressive symptoms, as well as to examine the mediating and moderating roles of resilience in these associations.

Methods

We conducted a cross-sectional study of 1,091 community-dwelling older adults in Jinan, China. The trauma history questionnaire (THQ) was used to measure CTEs and childhood trauma severity. CTEs were defined as the number of traumatic events before the age of 18. We calculated childhood trauma severity by multiplying the number of CTEs by the participants' self-perceived impact level of the events from the THQ. We then applied the 15-item Geriatric Depression Scale and 10-item Connor-Davidson Resilience Scale to assess participants' depressive symptoms and resilience, respectively. Linear regression models were used to examine the associations, and structural equation modeling was used to examine the mediating and moderating roles of resilience.

Results

Childhood traumatic events, childhood trauma severity, and resilience were all associated with depressive symptoms in older adults. Resilience mediated the relationship between childhood trauma severity and depressive symptoms (β = 0.082, 95% CI = 0.045-0.123), accounting for 26.6% of the overall effect (β = 0.308, 95% CI = 0.190-0.422). However, there was no evidence that resilience mediated the association between CTEs and depressive symptoms. In addition, we did not find that resilience played a moderating role in the associations of CTEs, childhood trauma severity with depressive symptoms.

Conclusion

Resilience plays a mediating role in the relationship between childhood trauma severity and depressive symptoms. Intervention measures on improving resilience may reduce childhood trauma severity associated with depression risk in older Chinese adults.

Psychosocial factors and hippocampal subfields: The Medea-7T study

Specific subfields within the hippocampus have shown vulnerability to chronic stress, highlighting the importance of looking regionally within the hippocampus to understand the role of psychosocial factors in the development of neurodegenerative diseases. A systematic review on psychosocial factors and hippocampal subfield volumes was performed and showed inconsistent results, highlighting the need for future studies to explore this relationship. The current study aimed to explore the association of psychosocial factors with hippocampal (subfield) volumes, using high-field 7T MRI. Data were from the Memory Depression and Aging (Medea)-7T study, which included 333 participants without dementia. Hippocampal subfields were automatically segmented from T2-weighted images using ASHS software. Generalized linear models accounting for correlated outcomes were used to assess the association between subfields (i.e., entorhinal cortex, subiculum, Cornu Ammonis [CA]1, CA2, CA3, dentate gyrus, and tail) and each psychosocial factor (i.e., depressive symptoms, anxiety symptoms, childhood maltreatment, recent stressful life events, and social support), adjusted for age, sex, and intracranial volume. Neither depression nor anxiety was associated with specific hippocampal (subfield) volumes. A trend for lower total hippocampal volume was found in those reporting childhood maltreatment, and a trend for higher total hippocampal volume was found in those who experienced a recent stressful life event. Among subfields, low social support was associated with lower volume in the CA3 (B = -0.43, 95% CI: -0.72; -0.15). This study suggests possible differential effects among hippocampal (subfield) volumes and psychosocial factors.

Prevalence of neuropsychiatric conditions and cognitive impairment in two parallel, aging study cohorts from rural and urban India

INTRODUCTION

With the rising proportion of the elderly in India, the burden of neuropsychiatric conditions and cognitive impairment is escalating.

METHODS

Baseline data of cognitively healthy subjects ≥45 years of age, from two longitudinal, aging cohorts in rural (n = 3262) and urban (n = 693) India, were used to calculate prevalence of depression, early-life stressful events, stroke, head injury, and cognitive impairment.

RESULTS

Depression prevalence was significantly higher in rural than urban subjects, with female preponderance in both groups. Early life stressor (parental death) and head injury were significantly more common in rural than in urban India, whereas stroke was more in urban India. There was no significant difference in overall prevalence of cognitive impairment between the rural and urban cohorts; however, women had higher prevalence than men in rural, whereas this was reverse in urban subjects. Depression and stroke were significantly associated with cognitive impairment in the rural cohort.

DISCUSSION

Longitudinal assessment of these neuropsychiatric conditions, with parallel cognitive monitoring, will help identify their causal relationship with dementia.

Early-life stress lastingly impacts microglial transcriptome and function under basal and immune-challenged conditions

Early-life stress (ELS) leads to increased vulnerability to psychiatric disorders including depression later in life. Neuroinflammatory processes have been implicated in ELS-induced negative health outcomes, but how ELS impacts microglia, the main tissue-resident macrophages of the central nervous system, is unknown. Here, we determined the effects of ELS-induced by limited bedding and nesting material during the first week of life (postnatal days [P]2-9) on microglial (i) morphology; (ii) hippocampal gene expression; and (iii) synaptosome phagocytic capacity in male pups (P9) and adult (P200) mice. The hippocampus of ELS-exposed adult mice displayed altered proportions of morphological subtypes of microglia, as well as microglial transcriptomic changes related to the tumor necrosis factor response and protein ubiquitination. ELS exposure leads to distinct gene expression profiles during microglial development from P9 to P200 and in response to an LPS challenge at P200. Functionally, synaptosomes from ELS-exposed mice were phagocytosed less by age-matched microglia. At P200, but not P9, ELS microglia showed reduced synaptosome phagocytic capacity when compared to control microglia. Lastly, we confirmed the ELS-induced increased expression of the phagocytosis-related gene GAS6 that we observed in mice, in the dentate gyrus of individuals with a history of child abuse using in situ hybridization. These findings reveal persistent effects of ELS on microglial function and suggest that altered microglial phagocytic capacity is a key contributor to ELS-induced phenotypes.

Childhood socio-economic circumstances and dementia: prospective register-based cohort study of adulthood socio-economic and cardiovascular health mediators

Background

This study analysed the association between childhood socio-economic circumstances and the risk of dementia, and investigated the mediating role of potentially modifiable risk factors including adulthood socio-economic position and cardiovascular health.

Methods

We used a 10% sample of the 1950 Finnish population census linked with subsequent population and health registers (n = 95 381). Information of socio-economic characteristics, family structure and housing conditions at the age of 0–15 years was obtained from the 1950 census. We identified cohort members who developed dementia in 2000–2018 using national hospital, medication and death registers. Discrete time survival analysis using logistic regression and mediation analysis applying the Karlson–Holm–Breen (KHB) method were employed.

Results

An excess risk of dementia was observed for household crowding [odds ratio (OR) = 1.10; 95% CI 1.02–1.18 for 3 to &lt;4 persons per heated room; OR = 1.19; 95% CI 1.11–1.27 for ≥4 persons], single-father family (OR = 1.27; 95% CI 1.07–1.51) and eastern and northern region of residence (OR = 1.19; 95% CI 1.10–1.28). The effects of single-father family and region of residence were mostly direct with adulthood characteristics mediating 14% and 29% of the total effect, respectively. The largest indirect effect was observed for household crowding mediated through adulthood socio-economic position (47–65%).

Conclusions

The study shows that childhood socio-economic circumstances are associated with dementia, and that the underlying mechanisms only partly relate to adulthood socio-economic position and cardiovascular health. Socio-economic and health interventions targeted at families with children may carry long-term benefits by contributing to a lower dementia risk in later life.

Association of adverse childhood experiences with subjective cognitive decline in adulthood: Findings from a population-based study

OBJECTIVE

Adverse childhood experiences have been found to be associated with negative outcomes during adulthood. Emerging research indicates that adverse childhood experiences may elevate the risk for Alzheimer's disease. Yet, few studies have investigated the association between adverse childhood experiences and subjective cognitive decline among middle-aged and older adults in the United States. The objective of this study was to investigate the association between adverse childhood experiences and subjective cognitive decline among middle-aged and older adults in the United States.

METHODS

Data for this study were obtained from the 2019 Behavioral Risk Factor Surveillance Survey. An analytic sample of 50,277 adults aged 45 to 79 years (53.3% female) from 15 states was analyzed using binary logistic regression. The outcome variable investigated in this study was subjective cognitive decline, and the main explanatory variable was adverse childhood experiences.

RESULTS

Of the 50,277 respondents, 10.3% reported experiencing subjective cognitive decline during the past year, and 14.5% had four or more adverse childhood experiences. We found a dose-response association between adverse childhood experiences and subjective cognitive decline. Respondents who had four or more adverse childhood experiences had 2.98 times higher odds of having subjective cognitive decline when compared to respondents with no adverse childhood experiences (aOR = 2.98, 95% CI = 2.56-3.48). Other factors associated with subjective cognitive decline have been identified and discussed.

CONCLUSION

The findings of this study provide evidence indicating that early life factors may be linked with cognitive decline in later adulthood. The findings of this study are discussed with implications for practice and research.

Lifecourse Traumatic Events and Cognitive Aging in the Health and Retirement Study

INTRODUCTION

Much of the heterogeneity in the rate of cognitive decline and the age of dementia onset remains unexplained, and there is compelling data supporting psychosocial stressors as important risk factors. However, the literature has yet to come to a consensus on whether there is a causal relationship and, if there is, its direction and strength. This study estimates the relationship between lifecourse traumatic events and cognitive trajectories and predicted dementia incidence.

METHODS

Using data on 7,785 participants aged ≥65 years from the Health and Retirement Study, this study estimated the association between lifecourse experience of 10 traumatic events (e.g., losing a child) and trajectories of Telephone Interview for Cognitive Status from 2006 to 2016 using linear mixed-effects models and predicted incident dementia from 2006 to 2014 using cumulative incidence functions (data analysis was in 2020-2022). Inverse probability weights accounted for loss to follow-up and confounding by sex, education, race/ethnicity, and age.

RESULTS

Experiencing 1 or more traumatic events over the lifecourse was associated with accelerated decline compared with experiencing no events (e.g., β= -0.05 [95% CI= -0.07, -0.02] Health and Retirement Study-Telephone Interview for Cognitive Status units/year; 1 vs 0 events). In contrast, experiencing traumatic events was associated with better cognitive function cross-sectionally. Furthermore, the impact of trauma on cognitive decline was of greater magnitude when it occurred after the age of 64 years. However, the magnitude and direction of association varied by the specific traumatic event. There were no associations with predicted incident dementia.

CONCLUSIONS

These results suggest that researchers and clinicians should not aggregate traumatic events for understanding the risk of accelerated cognitive decline.

Early-life stress and dietary fatty acids impact the brain lipid/oxylipin profile into adulthood, basally and in response to LPS

Brain lipid dysregulation is a hallmark of depression and Alzheimer's disease, also marked by chronic inflammation. Early-life stress (ELS) and dietary intake of polyunsaturated fatty acids (PUFAs) are risk factors for these pathologies and are known to impact inflammatory processes. However, if these early-life factors alter brain lipid homeostasis on the long-term and thereby contribute to this risk remains to be elucidated. We have recently shown that an early diet enriched in omega(ω)-3 PUFAs protected against the long-term negative effects of ELS on cognition and neuroinflammation. Here, we aim to understand if modulation of brain lipid and oxylipin profiles contributes to the detrimental effects of ELS and the protective ones of the diet. We therefore studied if and how ELS and early dietary PUFAs modulate the brain lipid and oxylipin profile, basally as well as in response to an inflammatory challenge, to unmask possible latent effects. Male mice were exposed to ELS via the limited bedding and nesting paradigm, received an early diet with high or low ω6/ω3 ratio (HRD and LRD) and were injected with saline or lipopolysaccharide (LPS) in adulthood. Twenty-four hours later plasma cytokines (Multiplex) and hypothalamic lipids and oxylipins (liquid chromatography tandem mass spectrometry) were measured. ELS exacerbated the LPS-induced increase in IL-6, CXCL1 and CCL2. Both ELS and diet affected the lipid/oxylipin profile long-term. For example, ELS increased diacylglycerol and LRD reduced triacylglycerol, free fatty acids and ceramides. Importantly, the ELS-induced alterations were strongly influenced by the early diet. For example, the ELS-induced decrease in eicosapentaenoic acid was reversed when fed LRD. Similarly, the majority of the LPS-induced alterations were distinct for control and ELS exposed mice and unique for mice fed with LRD or HRD. LPS decreased ceramides and lysophosphotidylcholine, increased hexosylceramides and prostaglandin E₂, reduced triacylglycerol species and ω6-derived oxylipins only in mice fed LRD and ELS reduced the LPS-induced increase in phosphatidylcholine. These data give further insights into the alterations in brain lipids and oxylipins that might contribute to the detrimental effects of ELS, to the protective ones of LRD and the possible early-origin of brain lipid dyshomeostasis characterizing ELS-related psychopathologies.

Perspectives, understandings of dementia and lived experiences from Australian Aboriginal people in Western Australia

OBJECTIVE

We explored understandings about dementia and lived experiences from carers among community-dwelling Aboriginal people in Western Australia (WA).

METHODS

In partnership with Aboriginal medical services in WA, we conducted semi-structured interviews with Aboriginal people in Perth and Bunbury. All interviews were transcribed verbatim and coded thematically.

RESULTS

We conducted 39 interviews. Dementia was associated with 'losing your memory', a 'change in behaviour' and unhealthy lifestyles. Increasing awareness about dementia in the community was noted particularly to enable people to recognise the early signs, feel safe to ask for help and know how to best support families. Families were primarily responsible for caring for people with dementia and were finding it difficult to manage. They expressed negative experiences with currently available aged care facilities.

CONCLUSIONS

Increased awareness of dementia in the community through public health messaging and by health professionals and culturally secure services focussing on dementia care is required.

Potentially preventable dementia in a First Nations population in the Torres Strait and Northern Peninsula Area of North Queensland, Australia: A cross sectional analysis using population attributable fractions

Background

Dementia is highly prevalent among Australia's First Nations peoples, including Torres Strait Islander and Aboriginal peoples in Far North Queensland (FNQ). It is likely that historically recent exposure to modifiable risk factors underlies these rates, and a large proportion of dementia may be potentially preventable.

Methods

Data from two adult community health checks (2015-2018) were analyzed to determine the prevalence of 11 modifiable dementia risk factors among the First Nations residents of the Torres Strait and Northern Peninsula Area of FNQ. Population attributable fractions (PAF%) for dementia were calculated using age-standardized prevalence estimates derived from these health checks and relative risks obtained from previous meta-analyses in other populations. PAF% estimates were weighted for communality to account for overlap of risk factors.

Findings

Half (52·1%) of the dementia burden in this population may be attributed to 11 potentially modifiable risk factors. Hypertension (9·4%), diabetes mellitus (9·0%), obesity (8·0%), and smoking (5·3%) were the highest contributing risk factors. The contribution of depression (2·0%) and alcohol (0·3%) was lower than other global and national estimates. While the adjusted PAF% for social isolation was low based on the adult community health check data (1·6%), it was higher (4·2%) when official census data were analyzed.

Interpretation

These results suggest that a substantial proportion of dementia in FNQ First Nations peoples could potentially be prevented. Government investment in preventative health now is essential to reduce the future burden of dementia.

Funding

National Health and Medical Research Council (NHMRC, GNT1107140, GNT1191144, GNT1106175, GNT0631947).

The Association Between Adverse Childhood Experiences and Positive Dementia Screen in American Older Adults

BACKGROUND

Adverse childhood experiences (ACEs) are linked to higher risk of common conditions driving mortality in adulthood, but little evidence exists on whether ACEs are associated with risk of dementia, a leading cause of death in the USA.

OBJECTIVE

To estimate the relationship between US adults' reported ACE scores and a positive screen for dementia.

DESIGN

Cross-sectional analysis of a longitudinal, national population-based survey of US older adults.

PARTICIPANTS

Survey respondents aged ≥ 65 years with dementia screening data from the 2017 wave of the Panel Study of Income Dynamics (PSID) and ACE scores from the 2014 PSID Childhood Retrospective Circumstances Survey supplement (1,488 eligible participants unweighted).

MAIN MEASURES

Dementia screening data was collected in the 2017 wave of the PSID using the 8-item informant interview to differentiate normal cognition and dementia (AD8). Mean change in AD8 score and probability of a positive dementia screen by ACE score were calculated using adjusted regression models with post-estimation. Analyses were stratified by age group. Measures were analyzed in 2020.

RESULTS

Complete data were available for 1,223 (82%) participants, with a mean age of 73.4 years (SD 7.1, range 65 to 96 years). Adjusted estimated probability of a positive dementia screen increased with each additional adverse childhood experience reported. Older adults with ≥ 4 ACEs had higher rates of a positive dementia screen (AD8 score ≥ 2 points) compared to those with no ACEs (adjusted rate 26.6% versus 16.3%, p = 0.034). Compared to those with no ACE history, respondents with ≥ 4 ACEs had higher odds of a 1-point increase in AD8 score across all intervals of the AD8 scale (aOR 1.79, 95% CI 1.05-3.04). The ACE-positive dementia screen associations were strongest among those aged 65-75.

CONCLUSIONS

Greater exposure to ACEs is independently associated with higher probability of a positive dementia screen in older adulthood.

Childhood deprivations predict late-life cognitive impairment among older adults in India

Large population-based studies on the associations of childhood factors with late-life cognition are lacking in many low and middle income countries including India. In this study, we assessed the prevalence of late-life cognitive impairment and examined the associations of childhood socioeconomic status (SES) and health conditions with cognitive impairment among older adults in India. Data for this study were derived from the Longitudinal Ageing Study in India conducted in 2017–18. The effective sample size was 31,464 older adults aged 60 years and above. Cognitive functioning was measured through five global domains (memory, orientation, arithmetic function, executive function, and object naming). The overall score ranged between 0 and 43, and the score was reversed indicating cognitive impairment. Descriptive statistics along with mean scores of cognitive impairment were presented. Additionally, moderated multivariable linear regression models were employed to examine the association between explanatory variables, including childhood SES and health conditions and late-life cognitive impairment. The mean score of cognitive functioning among the study participants was 21.72 (CI 2.64–21.80). About 15% of older adults had poor health conditions, and 44% had lower financial status during their childhood. Older adults who had a fair health during their childhood were more likely to suffer from cognitive impairment in comparison to older adults who had good health during their childhood (Coef: 0.60; CI 0.39, 0.81). In comparison to older adults who had good childhood financial status, those who had poor childhood financial status were more likely to suffer from cognitive impairment (Coef: 0.81; CI 0.56, 1.07). Older adults who had fair childhood health status and poor childhood financial status were more likely to suffer from cognitive impairment in comparison to older adults who had good childhood health and good financial status (Coef: 1.26; CI 0.86, 1.66). Social policies such as improving educational and financial resources in disadvantaged communities and socioeconomically poor children and their families, would help to enhance a better cognitive ageing and a healthy and dignified life in old age.

Impact of War and Resettlement on Vietnamese Families Facing Dementia: A Qualitative Study

OBJECTIVES

Most Vietnamese immigrants in the U.S. today arrived as political refugees due to the Vietnam War in the late 20th century. Refugees are disproportionally affected by health and mental health disparities as a result of experiencing distress and potentially traumatic experiences before, during, and after their migration processes. This study involved Vietnamese families facing dementia and used a qualitative approach to investigate participants' experiences before, during, and right after their resettlement in the U.S.

METHODS

In-person interviews were conducted with 11 Vietnamese adults who cared for their family member with dementia. A descriptive analysis approach was used.

RESULTS

Five major themes emerged from the interviews:1) immigrating separately from family members, 2) difficult and unsafe journeys, 3) experiences of loss, 4) lack of support systems in the U.S., and 5) feelings of unhappiness, sadness, or signs of depression.

CONCLUSIONS

This study provides a close examination of Vietnamese refugees' unique backgrounds and how individuals with dementia and their caregivers from this population may be disproportionally impacted by stress.

CLINICAL IMPLICATIONS

To reduce health disparities, we recommend that providers and policymakers allocate more resources for culturally appropriate routine assessment, treatment, and referrals of those with dementia and their caregivers.

Heterogeneous adverse childhood experiences and cognitive function in an elderly Chinese population: a cohort study

OBJECTIVE

To identify the heterogeneity of adverse childhood experiences (ACEs) as well as their association with cognitive function in an elderly Chinese population.

DESIGN

A retrospective cohort study.

PARTICIPANTS

The data were from the latest wave of the China Health and Retirement Longitudinal Study and a total of 7222 participants aged ≥60 were included.

PRIMARY AND SECONDARY OUTCOME MEASURES

Latent class analysis was used to identify the classes characterised by 11 types of ACEs. Cognitive function was measured by the Mini-Mental State Examination (MMSE) and cognitive impairment was defined by education-specific threshold MMSE scores. Logistic models were constructed to examine the relationship between ACE classes and cognitive impairment. Several childhood and adulthood confounding factors were considered.

RESULTS

Three ACE latent classes were identified. Of them, 76.09% were in the 'Low ACEs' class, 15.43% were in the 'Household dysfunction' class and 8.49% were in the 'Child maltreatment' class. The people in the 'Low ACEs' class seemed to have better childhood family financial situations and higher education levels. The population in the 'Household dysfunction' class tended to live in rural areas and have a higher proportion of men, whereas people in the 'Child maltreatment' class showed a significantly higher proportion of women and higher levels of chronic diseases. 'Child maltreatment' was related to a higher risk of cognitive impairment (OR=1.37, 95% CI: 1.12 to 1.68), while the risk of 'Household dysfunction' was not significantly different from that of the 'Low ACEs' participants (OR=1.06, 95% CI: 0.90 to 1.26).

CONCLUSIONS

The findings supported differences in cognitive function in elderly Chinese people exposed to different types of ACEs.

A Collaborative Approach to Dementia Inclusion in Social Work Education: The Dementia Intensive

There are 5.8 million Americans with Alzheimer's disease and this number is rising. Social Work can play a key role. Yet, like other disciplines, the field is ill prepared for the growing number of individuals and family members who are impacted physically, emotionally and financially. Compounding the challenge, the number of social work students identifying interest in the field is low. This mixed methods concurrent study assessed the preliminary efficacy of a day-long education event among social work students from eight social work programs. Pre- post-training survey included: 1) dementia knowledge, assessed with the Dementia Knowledge Assessment Scale, and 2) negative attitudes towards dementia, assessed by asking students to identify three words that reflected their thoughts on dementia, which were later rated as positive, negative or neutral by three external raters. Bivariate analyses showed that dementia knowledge (mean difference= 9.9) and attitudes (10% lower) improved from pre- to post-training (p<0.05). Collaboration between social work programs can increase student access to strength-based dementia education. Such programs hold the potential of improving dementia capability within the field of Social Work.