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Eliacin J, Polsinelli A, Cameron KA, Saykin AJ, Wang S. Black Americans' perceptions of Alzheimer's disease, a healthy brain, and strategies for brain health promotion. PEC INNOVATION 2024; 4:100282. [PMID: 38706495 PMCID: PMC11066679 DOI: 10.1016/j.pecinn.2024.100282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024]
Abstract
Objectives Lack of awareness of Alzheimer's disease (AD) among Black Americans may undermine their ability to identify potential AD risk. We examined Black Americans' perceptions and knowledge of AD, and views of a healthy brain, which may contribute to the development of effective and culturally sensitive strategies to address racial disparities in AD. Methods We conducted a mixed-methods study, integrating a cross-sectional survey of 258 older (>55 years) Black participants and qualitative interviews with a sub-sample of N = 29. Both data sets were integrated to inform the results. Results Participants endorsed having little knowledge of AD. While most participants reported practicing a healthy lifestyle to promote a healthy brain, the range of activities listed were limited. Participants made several suggestions to increase AD awareness, which includes using AD educational materials containing information that would benefit the whole family, not only older adults. Outreach approaches that address both individual behaviors and structural factors were also encouraged. Conclusion Our findings identify ongoing needs to improve AD awareness among traditionally under-represented groups. Innovation The study utilized novel approaches to examine participants' perspectives of AD that included a diverse sample of research naïve participants, and integrated exploration of participants' views of AD and brain health.
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Affiliation(s)
- Johanne Eliacin
- National Center for PTSD, Boston VA Healthcare System, 150 South Huntington Street, Boston, MA 02130, USA
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, 1481 West 10th Street, Indianapolis, IN 46202, USA
- Regenstrief Institute, 1101 West 10th Street, Indianapolis, IN 46202, USA
- Department of General Internal Medicine and Geriatrics, Indiana University School of Medicine, 340 West 10 Street, Fairbanks Hall, Suite 6200, Indianapolis, IN 46202-3082, USA
- Alzheimer's Disease Research Center, Indiana University School of Medicine, 355 West 16th Street, Goodman Hall, Suite 4100, Indianapolis, IN 46202, USA
| | - Angelina Polsinelli
- Alzheimer's Disease Research Center, Indiana University School of Medicine, 355 West 16th Street, Goodman Hall, Suite 4100, Indianapolis, IN 46202, USA
- Department of Neurology, Indiana University School of Medicine. 355 W 16th Street, Suite 4700, Indianapolis, IN 46202 USA
| | - Kenzie A. Cameron
- Department of Medicine, Division of General Internal Medicine, Northwestern University, Feinberg School of Medicine, 750 N. Lake Shore Drive, 10 Floor, Chicago, IL 60611, USA
| | - Andrew J. Saykin
- Department of Psychiatry, Indiana University School of Medicine, 340 West 10th Street, Fairbanks Hall, Suite 6200, Indianapolis, IN 46202, USA
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 North University Blvd. Room 0663, Indianapolis, IN 46202, USA
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, 410 West 10th Street, HITS Building 4000, Indianapolis, IN 46202, USA
| | - Sophia Wang
- Alzheimer's Disease Research Center, Indiana University School of Medicine, 355 West 16th Street, Goodman Hall, Suite 4100, Indianapolis, IN 46202, USA
- Department of Psychiatry, Indiana University School of Medicine, 340 West 10th Street, Fairbanks Hall, Suite 6200, Indianapolis, IN 46202, USA
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Yu F, Pituch K, Maxfield M, Joseph RP, Pruzin JJ, Ashish D, Coon DW, Shaibi G. Relationships of Physical Activity and Type 2 Diabetes With Cognition in Mexican Americans and Non-Hispanic Whites. J Aging Phys Act 2024:1-20. [PMID: 39374912 DOI: 10.1123/japa.2023-0353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 05/16/2024] [Accepted: 07/04/2024] [Indexed: 10/09/2024]
Abstract
Problem, Research Strategy, and Findings: Low physical activity (PA) and Type 2 diabetes are associated with cognitive aging and Alzheimer's disease, but the evidence is inconsistent and particularly limited by ethnicity. The purpose of this study was to examine the relationships of PA and Type 2 diabetes with cognition in Mexican Americans and non-Hispanic Whites. The study was a cross-sectional analysis of the Health and Aging Brain Study-Health Disparities (n = 1,982-2,000 after removing outliers). Predictors included Rapid Assessment of Physical Activity and hemoglobin A1c (HbA1c). Episodic memory was assessed by Weschler Memory Scale-Third Edition Logical Memory and Spanish-English Verbal Learning Test, executive function by Weschler Memory Scale-Third Edition Digit Span and Digit Symbol Substitution Test, verbal fluency by FAS and animal naming, and global cognition by the Mini-Mental State Examination. Results show that aerobic PA and HbA1c were not associated with domain-specific, or global cognition, but strength/flexibility PA was associated with FAS (b = 0.404, 95% CI [0.023, 0.761]). Higher aerobic PA was associated with greater verbal fluency for Mexican Americans (b = 0.294, 95% CI [0.96, 0.497]) only. HbA1c was negatively associated with Mini-Mental State Examination (b = 0.838, 95% CI [0.008, 1.656]). For low HbA1c, the association between aerobic PA and Digit Symbol Substitution Test was significant for non-Hispanic Whites (b = 0.838, 95% CI [0.008, 1.656]) in comparison to Mexican Americans. Takeaway for Practice: The relationships between PA, Type 2 diabetes, and cognition vary by cognitive domains and ethnicity. Increasing aerobic activities may be particularly important for Mexican Americans who have elevated HbA1c to potentially improve fluency or executive function.
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Affiliation(s)
- Fang Yu
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Keenan Pituch
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Molly Maxfield
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Rodney P Joseph
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | | | | | - David W Coon
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Gabriel Shaibi
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
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D'Abreu A, Bankole A, Kapur J, Manning CA, Chernyavskiy P. Association of the Area Deprivation Index With Dementia Basic Workup and Diagnosis in Central and Western Virginia: A Cross-Sectional Study. Neurol Clin Pract 2024; 14:e200323. [PMID: 38919929 PMCID: PMC11195434 DOI: 10.1212/cpj.0000000000200323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/02/2024] [Indexed: 06/27/2024]
Abstract
Background and Objectives The Area Deprivation Index (ADI) provides a validated and multidimensional metric of areal disadvantage. Our goals were to determine if the ADI influences the likelihood of receiving workup based on published guidelines and an etiologic diagnosis of dementia in Central and Western Virginia. Methods We collected deidentified data from the electronic health record of individuals aged 50-105 years diagnosed with dementia at the University of Virginia (UVA) Medical Center (2016-2021) and at Carillion Clinic (2018-2021). Visit-specific ICD-10 codes were used to classify each dementia diagnosis as "disease-specific" (e.g., Alzheimer disease) or "general" (e.g., unspecified dementia). Following the American Academy of Neurology guidelines, we considered the evaluation performed as "adequate" if patients had vitamin B12, thyroid-stimulating hormone, and brain CT or magnetic resonance imaging within 6 months of the initial diagnosis. Census tract ADI was linked to study participants using the unique census tract identifier derived from the participants' home addresses at the time of diagnosis. Statistical modeling occurred under a Bayesian paradigm implemented using a standard code in R. Results The study included 13,431 individuals diagnosed with dementia at UVA (n = 7,152) and Carillion Clinic (n = 6,279). Of those, 32.5% and 20.4% received "disease-specific" diagnoses at UVA and Carillion Clinic and 8.2% and 20.4% underwent "adequate" workup, respectively. The adjusted relationship between census tract ADI and the likelihood of a disease-specific diagnosis was U-shaped: Residence in moderately disadvantaged areas was associated with the lowest likelihood of disease-specific diagnosis. Discussion Most patients diagnosed with dementia did not receive an adequate evaluation or an etiologic diagnosis. Those living in locations just above the national median ADI levels had the lowest likelihood of receiving an etiologic diagnosis, lower than those in the least and most deprived areas. Renewed awareness efforts among providers are needed to increase compliance with diagnostic guidelines.
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Affiliation(s)
- Anelyssa D'Abreu
- Departments of Neurology (ADA, CAM, JK), Neuroscience (JK), and Public Health Sciences (PC), University of Virginia, Charlottesville; Department of Psychiatry and Behavioral Health (AB), Virginia Tech Carilion School of Medicine, Roanoke
| | - Azziza Bankole
- Departments of Neurology (ADA, CAM, JK), Neuroscience (JK), and Public Health Sciences (PC), University of Virginia, Charlottesville; Department of Psychiatry and Behavioral Health (AB), Virginia Tech Carilion School of Medicine, Roanoke
| | - Jaideep Kapur
- Departments of Neurology (ADA, CAM, JK), Neuroscience (JK), and Public Health Sciences (PC), University of Virginia, Charlottesville; Department of Psychiatry and Behavioral Health (AB), Virginia Tech Carilion School of Medicine, Roanoke
| | - Carol A Manning
- Departments of Neurology (ADA, CAM, JK), Neuroscience (JK), and Public Health Sciences (PC), University of Virginia, Charlottesville; Department of Psychiatry and Behavioral Health (AB), Virginia Tech Carilion School of Medicine, Roanoke
| | - Pavel Chernyavskiy
- Departments of Neurology (ADA, CAM, JK), Neuroscience (JK), and Public Health Sciences (PC), University of Virginia, Charlottesville; Department of Psychiatry and Behavioral Health (AB), Virginia Tech Carilion School of Medicine, Roanoke
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Ryvicker M, Barrón Y, Song J, Zolnoori M, Shah S, Burgdorf J, Noble JM, Topaz M. Using Natural Language Processing to Identify Home Health Care Patients at Risk for Diagnosis of Alzheimer's Disease and Related Dementias. J Appl Gerontol 2024; 43:1461-1472. [PMID: 38556756 PMCID: PMC11368608 DOI: 10.1177/07334648241242321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024] Open
Abstract
This study aimed to: (1) validate a natural language processing (NLP) system developed for the home health care setting to identify signs and symptoms of Alzheimer's disease and related dementias (ADRD) documented in clinicians' free-text notes; (2) determine whether signs and symptoms detected via NLP help to identify patients at risk of a new ADRD diagnosis within four years after admission. This study applied NLP to a longitudinal dataset including medical record and Medicare claims data for 56,652 home health care patients and Cox proportional hazard models to the subset of 24,874 patients admitted without an ADRD diagnosis. Selected ADRD signs and symptoms were associated with increased risk of a new ADRD diagnosis during follow-up, including: motor issues; hoarding/cluttering; uncooperative behavior; delusions or hallucinations; mention of ADRD disease names; and caregiver stress. NLP can help to identify patients in need of ADRD-related evaluation and support services.
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Affiliation(s)
| | | | - Jiyoun Song
- University of Pennsylvania School of Nursing
| | | | - Shivani Shah
- Center for Home Care Policy & Research at VNS Health
| | | | | | - Maxim Topaz
- Center for Home Care Policy & Research at VNS Health
- Columbia University Medical Center
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5
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de Marco H. La Carga Desproporcionada Del Alzheimer En Las Comunidades Latinas. Health Aff (Millwood) 2024; 43:1355-1359. [PMID: 39374450 DOI: 10.1377/hlthaff.2024.00950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/09/2024]
Abstract
Los pacientes latinos con demencia se ven atrapados en una compleja red de desafíos, desde serias comorbilidades hasta diagnósticos retrasados y atención fragmentada.
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Affiliation(s)
- Heidi de Marco
- Heidi de Marco es una periodista especializada en políticas de salud basada en San Diego, California. Una versión en inglés de este artículo acompaña al artículo en la edición de octubre de 2024 de Health Affairs y está disponible en línea en https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2024.00526
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Bowman JK, Ritchie CS, Ouchi K, Tulsky JA, Teno JM. Patterns of national emergency department utilization by fee-for-service Medicare beneficiaries with dementia. J Am Geriatr Soc 2024; 72:3140-3148. [PMID: 38838377 DOI: 10.1111/jgs.19025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 04/11/2024] [Accepted: 05/04/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Individuals with Alzheimer's disease and related dementias (ADRD) often face high acute care clinical utilization and costs with unclear benefits in survival or quality of life. The emergency department (ED) is frequently the site of pivotal decisions in these acute care episodes. This study uses national Medicare data to explore this population's ED utilization. METHODS Retrospective cohort study of persons aged ≥66 years enrolled in traditional Medicare with a Chronic Condition Warehouse diagnosis of dementia. Primary 1-year outcome measures included ED visits with and without hospitalization, ED visits per 100 days alive, and health-care costs. A multivariate random effects regression model (clustered by county of residence), adjusted for sociodemographics and comorbidities, examined how place of care on January 1, 2018, was associated with subsequent ED utilization. RESULTS In 2018, 2,680,006 ADRD traditional Medicare patients (mean age 82.9, 64.2% female, 9.4% Black, 6.2% Hispanic) experienced a total of 3,234,767 ED visits. Over half (52.2%) of the cohort experienced one ED visit, 15.5% experienced three or more, and 37.1% of ED visits resulted in hospitalization. Compared with ADRD patients residing at home without services, the marginal difference in ED visits per 100 days alive varied by location of care. Highest differences were observed for those with hospitalizations (0.48 visits per 100 days alive, 95% confidence interval [CI] 0.47-0.49), skilled nursing facility (rehab/skilled nursing facility [SNF]) stays (0.27, 95% CI 0.27-0.28), home health stays (0.25, 95% CI 0.25-0.26), or observation stays (0.82, 95% CI 0.77-0.87). Similar patterns were observed with ED use without hospitalization and health-care costs. CONCLUSIONS Persons with ADRD frequently use the ED-particularly those with recent hospitalizations, rehab/SNF stays, or home health use-and may benefit from targeted interventions during or before the ED encounters to reduce avoidable utilization and ensure goal-concordant care.
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Affiliation(s)
- Jason K Bowman
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Christine S Ritchie
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kei Ouchi
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Joan M Teno
- Brown University School of Public Health, Providence, Rhode Island, USA
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Desai U, Gomes DA, Chandler J, Ye W, Daly M, Kirson N, Dennehy EB. Understanding the impact of slowing disease progression for individuals with biomarker-confirmed early symptomatic Alzheimer's disease. Curr Med Res Opin 2024; 40:1719-1725. [PMID: 39175422 DOI: 10.1080/03007995.2024.2394602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 08/13/2024] [Accepted: 08/16/2024] [Indexed: 08/24/2024]
Abstract
Recent advances in development of amyloid-targeting therapies support the potential to slow the rate of progression of Alzheimer's disease. We conducted a narrative review of published evidence identified through a targeted search of the MEDLINE and EMBASE databases (2020-2023), recent presentations at disease-specific conferences, and data updates from cohort studies in Alzheimer's disease to describe the trajectory of the progression of Alzheimer's disease. Our findings enable the interpretation of clinical trial results and the value associated with slowing disease progression across outcomes of relevance to patients, care partners, clinicians, researchers and policymakers. Even at the earliest stages, Alzheimer's disease imposes a substantial burden on individuals, care partners, and healthcare systems. The magnitude of the burden increases with the rate of disease progression and symptom severity, as worsening cognitive decline and physical impairment result in loss of functional independence. Data from cohort studies also indicate that slowing disease progression is associated with decreased likelihood of needing extensive clinical care over at least 5 years, decreased care partner burden, and substantial individual and societal cost savings. Slowed disease progression is of significant benefit to individuals with Alzheimer's disease, their loved ones, and the healthcare system. As clinicians and policymakers devise strategies to improve access to treatment earlier in the disease spectrum, they should carefully weigh the benefits of slowing progression early in the disease (e.g. preservation of cognitive and functional abilities, as well as relative independence) to individuals, their loved ones, and broader society.
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Affiliation(s)
| | | | - Julie Chandler
- Value, Evidence, and Outcomes, Eli Lilly and Company, Indianapolis, IN, USA
| | - Wenyu Ye
- Value, Evidence, and Outcomes, Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | - Ellen B Dennehy
- Value, Evidence, and Outcomes, Eli Lilly and Company, Indianapolis, IN, USA
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA
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de Marco H. The Disproportionate Burden Of Alzheimer's On Latino Communities. Health Aff (Millwood) 2024; 43:1350-1354. [PMID: 39374454 DOI: 10.1377/hlthaff.2024.00526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/09/2024]
Abstract
Latino patients with dementia face a complex web of challenges, from serious comorbidities to delayed diagnoses to fragmented care.
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Affiliation(s)
- Heidi de Marco
- Heidi de Marco is a health policy journalist based in San Diego, California. A version of this article in Spanish accompanies the article in the October 2024 issue of Health Affairs and is available online at https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2024.00950
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Stinchcombe A, Oueis J, Wilson K, Wright DK. Safer dementia care spaces: Perspectives from LGBTQ+ people with cognitive impairment and caregivers. DEMENTIA 2024:14713012241284691. [PMID: 39293818 DOI: 10.1177/14713012241284691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2024]
Abstract
The number of caregivers and people living with dementia and other related forms of cognitive impairment is increasing worldwide. Compared to heterosexual and cisgender individuals, studies suggest that lesbian, gay, bisexual, queer, or other sexual and/or gender minority people (LGBTQ+) are at a higher risk for known risk factors for cognitive impairment and dementia, stemming from minority stress experiences. Limited research has explored the distinct obstacles that LGBTQ+ people with cognitive impairment and caregivers encounter, especially within dementia care. The purpose of this study was to deepen our understanding regarding LGBTQ+ people with cognitive impairment and caregivers' experiences with dementia care spaces, and to identify the strategies that they perceive as effective in creating safer and more inclusive spaces. Fourteen LGBTQ+ participants aged 27-78 (M = 58.07), consisting of two individuals with cognitive impairment and 12 caregivers, were interviewed about the care needs of LGBTQ+ people with cognitive impairment and caregivers, and their experiences with dementia care spaces. Using reflexive thematic analysis, we identified three overarching themes from the data, indicating that LGBTQ+ people with cognitive impairment and caregivers feel left "on the margins" of dementia care and express a desire for their identities to be celebrated and recognized. Additionally, they proposed recommendations for policy change to foster safer and more inclusive spaces for dementia care. The findings call attention to the negative experiences of LGBTQ+ people with cognitive impairment and caregivers with dementia care, but also highlight the ways in which care practices can be transformed to effectively address their care needs.
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Affiliation(s)
| | - Jeremy Oueis
- School of Psychology, University of Ottawa, Canada
| | - Kimberley Wilson
- Department of Family Relations and Applied Nutrition, University of Guelph, Canada
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Schneider S, Livingston TN, Elliott L, Chrzanowski L, Abu-Samaha A, Singer J. Feelings of Empowerment Scale for Family Caregivers: Development, Exploratory, and Confirmative Analysis. Clin Gerontol 2024:1-17. [PMID: 39263858 DOI: 10.1080/07317115.2024.2399588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
OBJECTIVES This study aimed to validate a measure of feelings of empowerment among family caregivers of persons with life limiting illnesses. METHODS Family caregivers (N = 295) completed a survey on their feelings of empowerment and psychosocial constructs. RESULTS Utilizing exploratory and confirmatory factor analyses, the study validated the Empowerment in the Context of Caregiving scale, revealing a two-factor structure related to influencing the care recipient and controlling personal outcomes, with high reliability and validity. Convergent validity was supported by a strong association with an established measure of power. Discriminant validity was demonstrated through weak associations with theoretically less relevant constructs, confirming the scale's validity. CONCLUSIONS This scale provides a reliable tool to identify feelings of disempowerment among caregivers, with implications for theory and practice. Future research should explore predictive validity and consider cultural factors to enhance its applicability in diverse caregiving contexts. CLINICAL IMPLICATIONS This study provides a reliable tool to identify feelings of empowerment among family caregivers of persons with life limiting illnesses for clinicians. It also allows future studies to reliably investigate a theory-driven intervention target, feelings of power, and allows clinicians to tailor this into theory-driven intervention for family caregivers of persons with life limiting illnesses.
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Affiliation(s)
- Sydnie Schneider
- Department of Psychological Science, Texas Tech University, Lubbock, Texas, USA
| | - Tyler N Livingston
- Department of Psychology, Angelo State University, San Angelo, Texas, USA
| | - Lauren Elliott
- Department of Psychological Science, Texas Tech University, Lubbock, Texas, USA
| | - Lauren Chrzanowski
- Department of Psychological Science, Texas Tech University, Lubbock, Texas, USA
| | - Amir Abu-Samaha
- Department of Psychological Science, Texas Tech University, Lubbock, Texas, USA
| | - Jonathan Singer
- Department of Psychological Science, Texas Tech University, Lubbock, Texas, USA
- Department of Pharmacology and Neuroscience, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
- Center of Excellence for Translational Neuroscience and Therapeutics, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
- Garrison Institute on Aging, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
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Voigt RM, Ouyang B, Keshavarzian A. Outdoor nighttime light exposure (light pollution) is associated with Alzheimer's disease. Front Neurosci 2024; 18:1378498. [PMID: 39308948 PMCID: PMC11412842 DOI: 10.3389/fnins.2024.1378498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 07/09/2024] [Indexed: 09/25/2024] Open
Abstract
Introduction Alzheimer's disease (AD) prevalence has increased in the last century which can be attributed to increased lifespan, but environment is also important. Exposure to artificial light at night is one environmental factor that may influence AD. Methods This study evaluated the relationship between outdoor nighttime light exposure and AD prevalence in the United States using satellite acquired outdoor nighttime light intensity and Medicare data. Results Higher outdoor nighttime light was associated with higher prevalence of AD. While atrial fibrillation, diabetes, hyperlipidemia, hypertension, and stroke were associated more strongly with AD prevalence than nighttime light intensity, nighttime light was more strongly associated with AD prevalence than alcohol abuse, chronic kidney disease, depression, heart failure, and obesity. Startlingly, nighttime light exposure more strongly associated with AD prevalence in those under the age of 65 than any other disease factor examined. Discussion These data suggest light exposure at night may influence AD, but additional studies are needed.
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Affiliation(s)
- Robin M. Voigt
- Rush Medical College, Rush Center for Integrated Microbiome and Chronobiology Research, Rush University Medical Center, Chicago, IL, United States
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
- Department of Anatomy and Cell Biology, Rush University Medical Center, Chicago, IL, United States
| | - Bichun Ouyang
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Ali Keshavarzian
- Rush Medical College, Rush Center for Integrated Microbiome and Chronobiology Research, Rush University Medical Center, Chicago, IL, United States
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
- Department of Anatomy and Cell Biology, Rush University Medical Center, Chicago, IL, United States
- Department of Physiology, Rush University Medical Center, Chicago, IL, United States
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Zhou J, Li Y, Zhu L, Yue R. Association between frailty index and cognitive dysfunction in older adults: insights from the 2011-2014 NHANES data. Front Aging Neurosci 2024; 16:1458542. [PMID: 39301115 PMCID: PMC11410601 DOI: 10.3389/fnagi.2024.1458542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 08/27/2024] [Indexed: 09/22/2024] Open
Abstract
Background As the population ages, the occurrence of cognitive decline and dementia is continuously increasing. Frailty is a prevalent problem among older adults. Epidemiologic studies have shown a comorbidity between frailty and cognitive impairment. However, their relationship remains unclear. The frailty index is an important indicator for measuring frailty. This study aims to investigate the relationship between frailty index and cognitive dysfunction in older adults aged 60 years and older in the United States from the 2011-2014 National Health and Nutrition Examination Survey (NHANES). Methods Community-dwelling older adults aged 60 years or older from 2011 to 2014 were extracted from the NHANES database. The frailty index was calculated using the formula: frailty index = total number of deficits present/total number of deficits measured. The Animal Fluency (AF), the Digit Symbol Substitution Test (DSST), the Consortium to Establish a Registry for Alzheimer's disease Delayed Recall (CERAD-DR), and Word Learning (CERAD-WL) were used to evaluate cognitive dysfunction. Firstly, weighted logistic regression analysis was used to explore the relationship between frailty index and cognitive dysfunction. Secondly, the influence of covariates on the frailty index was evaluated by subgroup analysis and interaction. Finally, the non-linear relationship is discussed by using the restricted cubic spline regression model. Results Our study included a total of 2,574 patients, weighted logistic regression analysis, after adjusting for all covariates, showed that the frailty index was associated with every test score. The interaction showed that covariates had no significant effect on this association in AF. The association between the frailty index and AF in the restricted cubic spline regression model is non-linear. As the frailty index increased, the risk of AF reduction increased, suggesting a higher risk of cognitive dysfunction. Conclusion In general, a high frailty index appears to be associated with an increased risk of cognitive dysfunction in the elderly. Consequently, protecting against cognitive decline necessitates making geriatric frailty prevention and treatment top priorities.
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Affiliation(s)
- Jianlong Zhou
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Clinical Medical School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yadi Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Clinical Medical School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lv Zhu
- West China Center of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Rensong Yue
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Clinical Medical School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Bronas UG, Marquez DX, Fritschi C, Petrarca K, Kitsiou S, Ajilore O, Tintle N. Ecological Momentary Intervention to Replace Sedentary Time With Physical Activity to Improve Executive Function in Midlife and Older Latino Adults: Pilot Randomized Controlled Trial. J Med Internet Res 2024; 26:e55079. [PMID: 39235836 PMCID: PMC11413544 DOI: 10.2196/55079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 06/07/2024] [Accepted: 06/30/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Exercise interventions often improve moderate to vigorous physical activity, but simultaneously increase sedentary time due to a compensatory resting response. A higher level of sedentary time is associated with a lower level of executive function, while increased moderate to vigorous physical activity is associated with improved global cognition and working memory among Latino adults. Latino adults are the fastest-growing minority group in the United States and are at high risk for cognitive decline, spend more time sedentary compared to non-Hispanic populations, and engage in low levels of physical activity. Interventions that are culturally appropriate for Latino adults to replace sedentary time with physical activity are critically needed. OBJECTIVE This study aims to develop and test the feasibility and acceptability of an ecological momentary intervention (EMI; delivered in real time) that is individually designed to replace sedentary time with physical activity in Latino adults. METHODS This pilot study randomized 39 (n=26, 67% female; mean age 61, SD 5.8 years) community-dwelling, Spanish-speaking Latino adults (1:1 allocation) to either a 6-week EMI program designed to replace sitting time with physical activity (20/39, 51%) or physical activity guidelines education (19/39, 49%). The program was conducted on the web and in Spanish. The intervention was individualized based on individual interview responses. The intervention included the use of a Fitbit activity monitor, weekly didactic phone meetings, interactive tools (SMS text messages), and coach-delivered feedback. Feasibility and acceptability were assessed via study satisfaction (Likert scales), motivation (ecological momentary assessment), retention, and compliance. Sedentary time and physical activity were assessed via 7-day actigraphy. Cognitive performance was assessed via the trail making test part A and B (part B=executive function) and via the National Institutes of Health Toolbox remote cognitive assessment. Statistical analysis included a linear model on change score from baseline, adjusting for age, sex, and education, emphasizing effect size. RESULTS Participant satisfaction with EMI was high (9.4/10), with a high degree of motivation to replace sitting time with physical activity (9.8/10). The intervention compliance rate was 79% with low difficulty using the Fitbit (1.7/10). Weekly step count increased in the intervention group by 5543 steps (group difference: d=0.54; P=.05) and sedentary time decreased by a mean 348 (SD 485) minutes (group difference: d=0.47; P=.24) compared to controls, with moderately strong effect sizes. The trail making test part B improved in the intervention group (mean -35.26, SD 60.35 seconds), compared to the control group (mean 7.19, SD 46 seconds; group difference: d=0.74; P=.01). No group differences were observed in other cognitive measures. CONCLUSIONS An individualized EMI designed for midlife and older Latino adults has the potential to replace sitting time with physical activity and improve executive functioning. The intervention was feasible and well received with a high degree of satisfaction. TRIAL REGISTRATION ClinicalTrials.gov NCT04507464; https://tinyurl.com/44c4thk5.
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Affiliation(s)
- Ulf G Bronas
- School of Nursing, Columbia University, New York, NY, United States
- Division of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, United States
| | - David X Marquez
- Department of Biomedical and Health Information Sciences, University of Illinois Chicago, Chicago, IL, United States
| | - Cynthia Fritschi
- College of Nursing, University of Illinois Chicago, Chicago, IL, United States
| | - Katherine Petrarca
- College of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Spyros Kitsiou
- Department of Biomedical and Health Information Sciences, University of Illinois Chicago, Chicago, IL, United States
| | - Olu Ajilore
- College of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Nathan Tintle
- College of Nursing, University of Illinois Chicago, Chicago, IL, United States
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Márquez F, Tarraf W, Kuwayama S, Valencia DF, Stickel AM, Morlett-Paredes A, Guerrero LR, Perreira KM, Wassertheil-Smoller S, Gonzalez S, Salazar CR, Daviglus ML, Gallo LC, González HM. Subjective cognitive decline and cognitive change among diverse middle-aged and older Hispanic/Latino adults: Results from the Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA). Alzheimers Dement 2024. [PMID: 39234644 DOI: 10.1002/alz.14232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/02/2024] [Accepted: 08/09/2024] [Indexed: 09/06/2024]
Abstract
INTRODUCTION The potential utility of subjective cognitive decline (SCD) as an early risk marker of Alzheimer's disease and related dementias is under consideration. We examined associations between SCD and cognitive change among middle-aged and older Hispanic/Latino adults living in the United States. METHODS The short-form Everyday Cognition Scale (ECog-12) was assessed to generate global, executive function, and memory-related SCD scores. We used survey generalized regressions to model the change in learning, memory, verbal fluency, executive function, and global cognitive performance over 7 years as a function of SCD (at Visit 2). RESULTS The mean age was 56.37 ± 8.10 years at Visit 1 (n = 6225). Higher ECog-12 was associated with greater decline in global cognitive performance (ECog-12 global: B = -0.17, standard error [SE] = 0.02; ECog-12 executive: B = -0.15, SE = 0.02; ECog-12 memory: B = -0.14, SE = 0.02, p's < 0.001). DISCUSSION These results support the link between subjective reports of cognitive decline and objectively measured 7-year cognitive decline in community-dwelling, middle-aged, and older Hispanic/Latino adults. HIGHLIGHTS We found that nearly two-thirds of diverse middle-aged and older Hispanics/Latinos reported cognitive concerns in a large and representative population study. Self-reported subjective experiences of cognitive decline reflect objective cognitive decline in US Hispanics/Latinos. The relationship is stronger among men compared to women. The relationship between subjective and objective changes to memory are stronger in those with cognitive concerns, and remain even in cognitively healthy individuals.
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Affiliation(s)
- Freddie Márquez
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - Wassim Tarraf
- Institute of Gerontology & Department of Healthcare Sciences, Wayne State University, Detroit, Michigan, USA
| | - Sayaka Kuwayama
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - Deisha F Valencia
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - Ariana M Stickel
- Department of Psychology, San Diego State University, San Diego, California, USA
| | | | - Lourdes R Guerrero
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - Krista M Perreira
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, New York, USA
| | - Sara Gonzalez
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, New York, USA
| | - Christian R Salazar
- Institute for Memory Impairments and Neurological Disorders, University of California Irvine, Irvine, California, USA
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, College of Medicine, Chicago, Illinois, USA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Hector M González
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
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15
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de Havenon A, Gottesman RF, Willamson JD, Rost N, Sharma R, Li V, Littig L, Stulberg E, Falcone GJ, Prabhakaran S, Schneider ALC, Sheth KN, Pajewski NM, Brickman AM. White matter hyperintensity on MRI and plasma Aβ42/40 ratio additively increase the risk of cognitive impairment in hypertensive adults. Alzheimers Dement 2024. [PMID: 39229896 DOI: 10.1002/alz.14126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/04/2024] [Accepted: 06/18/2024] [Indexed: 09/05/2024]
Abstract
INTRODUCTION Dementia often involves comorbid Alzheimer's and vascular pathology, but their combined impact warrants additional study. METHODS We analyzed the Systolic Blood Pressure Intervention Trial and categorized white matter hyperintensity (WMH) volume into highest versus lowest/mid tertile and the amyloid beta (Aβ)42/40 ratio into lowest versus mid/highest ratio tertile. Using these binary variables, we created four exposure categories: (1) combined low risk, (2) Aβ risk, (3) WMH risk, and (4) combined high risk. RESULTS In the cohort of 467 participants (mean age 69.7 ± 7.1, 41.8% female, 31.9% nonwhite or Hispanic) during 4.8 years of follow-up and across the four exposure categories the rates of cognitive impairment were 5.3%, 7.8%, 11.8%, and 22.6%. Compared to the combined low-risk category, the adjusted hazard ratio for cognitive impairment was 4.12 (95% confidence interval, 1.71 to 9.94) in the combined high-risk category. DISCUSSION This study emphasizes the potential impact of therapeutic approaches to dementia prevention that target both vascular and amyloid pathology. HIGHLIGHTS White matter hyperintensity (WMH) and plasma amyloid (Aβ42/40) are additive risk factors for the development of cognitive impairment in the SPRINT MIND trial. Individuals in the high-risk categories of both WMH and Aβ42/40 had a near fivefold increase in risk of cognitive impairment during 4.8 years of follow-up on average. These findings suggest that treatment strategies targeting both vascular health and amyloid burden warrant further research.
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Affiliation(s)
- Adam de Havenon
- Department of Neurology, Center for Brain and Mind Health, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Rebecca F Gottesman
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Jeff D Willamson
- Department of Internal Medicine, Wake Forrest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Natalia Rost
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Richa Sharma
- Department of Neurology, Center for Brain and Mind Health, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Vivian Li
- Department of Neurology, Center for Brain and Mind Health, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Lauren Littig
- Department of Neurology, Center for Brain and Mind Health, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Eric Stulberg
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Guido J Falcone
- Department of Neurology, Center for Brain and Mind Health, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Shyam Prabhakaran
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Andrea L C Schneider
- Department of Neurology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kevin N Sheth
- Department of Neurology, Center for Brain and Mind Health, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Nicholas M Pajewski
- Department of Biostatistics and Data Science, Wake Forrest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Adam M Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, and the Department of Neurology, Columbia University, New York, New York, USA
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Huynh D, Sun K, Ghomi RH, Huang B. Comparing psychometric characteristics of a computerized cognitive test (BrainCheck Assess) against the Montreal cognitive assessment. Front Psychol 2024; 15:1428560. [PMID: 39291174 PMCID: PMC11407207 DOI: 10.3389/fpsyg.2024.1428560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 08/05/2024] [Indexed: 09/19/2024] Open
Abstract
Introduction Previous validation studies demonstrated that BrainCheck Assess (BC-Assess), a computerized cognitive test battery, can reliably and sensitively distinguish individuals with different levels of cognitive impairment (i.e., normal cognition (NC), mild cognitive impairment (MCI), and dementia). Compared with other traditional paper-based cognitive screening instruments commonly used in clinical practice, the Montreal Cognitive Assessment (MoCA) is generally accepted to be among the most comprehensive and robust screening tools, with high sensitivity/specificity in distinguishing MCI from NC and dementia. In this study, we examined: (1) the linear relationship between BC-Assess and MoCA and their equivalent cut-off scores, and (2) the extent to which they agree on their impressions of an individual's cognitive status. Methods A subset of participants (N = 55; age range 54-94, mean/SD = 80/9.5) from two previous studies who took both the MoCA and BC-Assess were included in this analysis. Linear regression was used to calculate equivalent cut-off scores for BC-Assess based on those originally recommended for the MoCA to differentiate MCI from NC (cut-off = 26), and dementia from MCI (cut-off = 19). Impression agreement between the two instruments were measured through overall agreement (OA), positive percent agreement (PPA), and negative percent agreement (NPA). Results A high Pearson correlation coefficient of 0.77 (CI = 0.63-0.86) was observed between the two scores. According to this relationship, MoCA cutoffs of 26 and 19 correspond to BC-Assess scores of 89.6 and 68.5, respectively. These scores are highly consistent with the currently recommended BC-Assess cutoffs (i.e., 85 and 70). The two instruments also show a high degree of agreement in their impressions based on their recommended cut-offs: (i) OA = 70.9%, PPA = 70.4%, NPA = 71.4% for differentiating dementia from MCI/NC; (ii) OA = 83.6%, PPA = 84.1%, NPA = 81.8% for differentiating dementia/MCI from NC. Discussion This study provides further validation of BC-Assess in a sample of older adults by showing its high correlation and agreement in impression with the widely used MoCA.
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Affiliation(s)
| | - Kevin Sun
- BrainCheck Inc., Austin, TX, United States
| | - Reza Hosseini Ghomi
- BrainCheck Inc., Austin, TX, United States
- Frontier Psychiatry, PLLC, Billings, MT, United States
| | - Bin Huang
- BrainCheck Inc., Austin, TX, United States
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Rubenstein E, Tewolde S, Michals A, Weuve J, Fortea J, Fox MP, Pescador Jimenez M, Scott A, Tripodis Y, Skotko BG. Alzheimer Dementia Among Individuals With Down Syndrome. JAMA Netw Open 2024; 7:e2435018. [PMID: 39312235 PMCID: PMC11420697 DOI: 10.1001/jamanetworkopen.2024.35018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 07/19/2024] [Indexed: 09/25/2024] Open
Abstract
Importance With the advancement in administrative data as a research tool and the reliance on public health insurance for individuals with Down syndrome, population-level trends in Alzheimer dementia in this population are beginning to be understood. Objective To comprehensively describe the epidemiology of Alzheimer dementia in adults with Down syndrome in a full US Medicare and Medicaid sample. Design, Setting, and Participants This cohort study included 132 720 adults aged 18 years or older with Medicaid and/or Medicare claims data with an International Statistical Classification of Diseases and Related Health Problems code for Down syndrome. Data were collected from January 1, 2011, to December 31, 2019, and analyzed from August 2023 to May 2024. Main Outcomes and Measures The main outcome was prevalence of Alzheimer dementia in each calendar year and during the 9-year period. Alzheimer dementia incidence rates by calendar year and age and stratified for race or ethnicity as well as time to death after Alzheimer dementia diagnosis were also assessed. Results There were 132 720 unique adults with Down syndrome from 2011 to 2019: 79 578 (53.2%) were male, 17 090 (11.7%) were non-Hispanic Black, 20 777 (15.7%) were Hispanic, 101 120 (68.8%) were non-Hispanic White, and 47 692 (23.3%) had ever had an Alzheimer dementia diagnosis. Incidence was 22.4 cases per 1000 person-years. The probability of an incident Alzheimer dementia diagnosis over 8 years was 0.63 (95% CI, 0.62-0.64) for those entering the study between ages 55 to 64 years. Mean (SD) age at incident diagnosis was 54.5 (7.4) years and median (IQR) age was 54.6 (9.3) years. Mean (SD) age at death among those with Alzheimer dementia was 59.2 (6.9) years (median [IQR], 59.0 [8.0] years). The mean (SD) age at onset for the Hispanic group was 54.2 (9.2) years, 52.4 (7.8) years for the American Indian or Alaska Native group, and 52.8 (8.2) years for the mixed race groups compared with 55.0 (7.8) years for the White non-Hispanic group. For age at death, there were no differences by sex. The mean (SD) age at death was later for the White non-Hispanic group (59.3 [6.8] years) compared with the Hispanic group (58.5 [7.8] years), Native American group (57.8 [7.1] years), and mixed race group (58.2 [7.0] years). Conclusions and Relevance In this cohort study of adults with Down syndrome who were enrolled in Medicaid and Medicare, Alzheimer dementia occurred at high rates. Consistency with clinical studies of dementia in Down syndrome supports the use of administrative data in Down syndrome-Alzheimer dementia research.
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Affiliation(s)
- Eric Rubenstein
- Boston University School of Public Health, Boston, Massachusetts
| | - Salina Tewolde
- Boston University School of Public Health, Boston, Massachusetts
| | - Amy Michals
- Boston University School of Public Health, Boston, Massachusetts
| | - Jennifer Weuve
- Boston University School of Public Health, Boston, Massachusetts
| | - Juan Fortea
- Sant Pau Memory Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Spain
| | - Matthew P. Fox
- Boston University School of Public Health, Boston, Massachusetts
| | | | - Ashley Scott
- Boston University School of Public Health, Boston, Massachusetts
| | - Yorghos Tripodis
- Boston University School of Public Health, Boston, Massachusetts
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18
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Apostolou A, Kennedy JL, Person MK, Jackson EMJ, Finke B, McGuire LC, Matthews KA. Alzheimer's disease and related dementia diagnoses among American Indian and Alaska Native adults aged ≥45 years, Indian Health Service System, 2016-2020. J Am Geriatr Soc 2024; 72:2834-2841. [PMID: 39115437 DOI: 10.1111/jgs.19058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 06/04/2024] [Accepted: 06/06/2024] [Indexed: 09/03/2024]
Abstract
BACKGROUND Alzheimer's disease is the most common type of dementia and is responsible for up to 80% of dementia diagnoses and is the sixth leading cause of death in the United States. An estimated 38,000 American Indian/Alaska Native (AI/AN) people aged ≥65 years were living with Alzheimer's disease and related dementias (ADRD) in 2020, a number expected to double by 2030 and quadruple by 2050. Administrative healthcare data from the Indian Health Service (IHS) were used to estimate ADRD among AI/AN populations. METHODS Administrative IHS healthcare data from federal fiscal years 2016 to 2020 from the IHS National Data Warehouse were used to calculate the count and rate per 100,000 AI/AN adults aged ≥45 years with at least one ADRD diagnosis code on their medical record. RESULTS This study identified 12,877 AI/AN adults aged ≥45 years with an ADRD diagnosis code, with an overall rate of 514 per 100,000. Of those, 1856 people were aged 45-64. Females were 1.2 times (95% confidence interval: 1.1-1.2) more likely than males to have a medical visit with an ADRD diagnosis code. CONCLUSIONS Many AI/AN people with ADRD rely on IHS, tribal, and urban Indian health programs. The high burden of ADRD in AI/AN populations aged 45-64 utilizing IHS health services highlights the need for implementation of ADRD risk reduction strategies and assessment and diagnosis of ADRD in younger AI/AN populations. This study provides a baseline to assess future progress for efforts addressing ADRD in AI/AN communities.
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Affiliation(s)
- Andria Apostolou
- Division of Epidemiology and Disease Prevention, Indian Health Service, Rockville, Maryland, USA
| | - Jordan L Kennedy
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marissa K Person
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Bruce Finke
- Office of Clinical and Preventive Services, Indian Health Service, Rockville, Maryland, USA
| | - Lisa C McGuire
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kevin A Matthews
- Office of Rural Health, National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and Workforce, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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19
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Fleury J, Komnenich P, Coon DW, Pituch K. Feasibility of the Remembering Warmth and Safeness Intervention in older ADRD caregivers. Geriatr Nurs 2024; 59:40-47. [PMID: 38986428 DOI: 10.1016/j.gerinurse.2024.06.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 06/19/2024] [Accepted: 06/27/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND The number of older adults in the U.S. living with ADRD is projected to increase dramatically by 2060. As older adults increasingly assume informal caregiving responsibilities, community-based intervention to sustain caregiver well-being is a dementia research priority. OBJECTIVE To evaluate the feasibility of the RWSI among older ADRD caregivers. The RWSI is informed by the Neurovisceral Integration Model, in which memories that engage safety signals cultivate feelings of safety and well-being. METHODS A within-subjects pre/post-intervention design with older ADRD caregivers to evaluate feasibility (acceptability, demand, fidelity) and empirical promise (well-being). RESULTS The feasibility of the RWSI, implemented with fidelity, was strongly endorsed, as participants attended each intervention session, after which reported experiencing feelings of warmth and safeness, and provided the highest possible acceptability ratings. Participant narratives provided corroboration. DISCUSSION Findings support the feasibility of the RWSI in older ADRD caregivers, providing the basis for continued research.
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Affiliation(s)
- Julie Fleury
- Hanner Memorial Endowed Professor, Edson College of Nursing and Health Innovation, Center for Innovation in Healthy and Resilient Aging, Arizona State University, United States.
| | - Pauline Komnenich
- Professor, Edson College of Nursing and Health Innovation, Center for Innovation in Healthy and Resilient Aging, Arizona State University, United States
| | - David W Coon
- Professor, Edson College of Nursing and Health Innovation, Center for Innovation in Healthy and Resilient Aging, Arizona State University, United States
| | - Keenan Pituch
- Professor, Edson College of Nursing and Health Innovation, Center for Innovation in Healthy and Resilient Aging, Arizona State University, United States
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20
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Parada H, Hyde ET, Turyk ME, Persky V, López-Gálvez N, Gallo LC, Talavera GA, Sjodin A, González HM. Persistent organic pollutants and cognitive decline among middle-aged or older adults in the Hispanic Community Health Study/Study of Latinos. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 282:116697. [PMID: 39002382 DOI: 10.1016/j.ecoenv.2024.116697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 07/03/2024] [Accepted: 07/04/2024] [Indexed: 07/15/2024]
Abstract
Persistent organic pollutants may negatively impact cognition; however, associations between persistent organic pollutants and changes in cognition among United States Hispanic/Latino adults have not been investigated. Herein, we examined the associations between 33 persistent organic pollutants and cognitive changes among 1837 Hispanic/Latino adults. At baseline (2008-2011; Visit 1), participants provided biospecimens in which we measured levels of 5 persistent pesticides or pesticide metabolites, 4 polybrominated diphenyl ethers and 2,2',4,4',5,5'-hexabromobiphenyl, and 24 polychlorinated biphenyls. At Visit 1 and again at Visit 2 (2015-2018), a battery of neurocognitive tests was administered which included the Brief-Spanish English Verbal Learning Test, Word Fluency Test, and Digit Symbol Substitution Test. To estimate the adjusted associations between changes in cognition and each POP, we used linear regression for survey data. Each doubling in plasma levels of polychlorinated biphenyls 146, 178, 194, 199/206, and 209 was associated with steeper declines in global cognition (βs range:-0.053 to -0.061) with stronger associations for the Brief-Spanish English Verbal Learning Test. Persistent organic pollutants, in particular polychlorinated biphenyls, were associated with declines in cognition over 7 years and may be a concern for Hispanic/Latino adults.
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Affiliation(s)
- Humberto Parada
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA.
| | - Eric T Hyde
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA.
| | - Mary E Turyk
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA.
| | - Victoria Persky
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA.
| | - Nicolas López-Gálvez
- Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University, San Diego, CA, USA.
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA, USA.
| | - Gregory A Talavera
- Department of Psychology, San Diego State University, San Diego, CA, USA.
| | - Andreas Sjodin
- Centers for Disease Control and Prevention (CDC), National Center for Environmental Health (NCEH), Division of Laboratory Sciences (DLS), USA.
| | - Hector M González
- Department of Neurosciences, University of California, La Jolla, San Diego, CA 92093, USA.
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Lah JJ, Tian G, Risk BB, Hanfelt JJ, Wang L, Zhao L, Hales CM, Johnson ECB, Elmor MB, Malakauskas SJ, Heilman C, Wingo TS, Dorbin CD, Davis CP, Thomas TI, Hajjar IM, Levey AI, Parker MW. Lower Prevalence of Asymptomatic Alzheimer's Disease Among Healthy African Americans. Ann Neurol 2024; 96:463-475. [PMID: 38924596 DOI: 10.1002/ana.26960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 03/25/2024] [Accepted: 04/04/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE Alzheimer's disease (AD) is believed to be more common in African Americans (AA), but biomarker studies in AA populations are limited. This report represents the largest study to date examining cerebrospinal fluid AD biomarkers in AA individuals. METHODS We analyzed 3,006 cerebrospinal fluid samples from controls, AD cases, and non-AD cases, including 495 (16.5%) self-identified black/AA and 2,456 (81.7%) white/European individuals using cutoffs derived from the Alzheimer's Disease Neuroimaging Initiative, and using a data-driven multivariate Gaussian mixture of regressions. RESULTS Distinct effects of race were found in different groups. Total Tauand phospho181-Tau were lower among AA individuals in all groups (p < 0.0001), and Aβ42 was markedly lower in AA controls compared with white controls (p < 0.0001). Gaussian mixture of regressions modeling of cerebrospinal fluid distributions incorporating adjustments for covariates revealed coefficient estimates for AA race comparable with 2-decade change in age. Using Alzheimer's Disease Neuroimaging Initiative cutoffs, fewer AA controls were classified as biomarker-positive asymptomatic AD (8.0% vs 13.4%). After adjusting for covariates, our Gaussian mixture of regressions model reduced this difference, but continued to predict lower prevalence of asymptomatic AD among AA controls (9.3% vs 13.5%). INTERPRETATION Although the risk of dementia is higher, data-driven modeling indicates lower frequency of asymptomatic AD in AA controls, suggesting that dementia among AA populations may not be driven by higher rates of AD. ANN NEUROL 2024;96:463-475.
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Affiliation(s)
- James J Lah
- Department of Neurology, Emory University School of Medicine, Emory Brain Health Center, Atlanta, GA, USA
- Emory Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
- Center for Neurodegenerative Disease, Emory University, Atlanta, GA, USA
| | - Ganzhong Tian
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Benjamin B Risk
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - John J Hanfelt
- Emory Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Liangkang Wang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Liping Zhao
- Emory Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Chadwick M Hales
- Department of Neurology, Emory University School of Medicine, Emory Brain Health Center, Atlanta, GA, USA
- Emory Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
- Center for Neurodegenerative Disease, Emory University, Atlanta, GA, USA
| | - Erik C B Johnson
- Department of Neurology, Emory University School of Medicine, Emory Brain Health Center, Atlanta, GA, USA
- Emory Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
- Center for Neurodegenerative Disease, Emory University, Atlanta, GA, USA
| | - Morgan B Elmor
- Department of Neurology, Emory University School of Medicine, Emory Brain Health Center, Atlanta, GA, USA
- Emory Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
| | - Sarah J Malakauskas
- Department of Neurology, Emory University School of Medicine, Emory Brain Health Center, Atlanta, GA, USA
- Emory Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
| | - Craig Heilman
- Department of Neurology, Emory University School of Medicine, Emory Brain Health Center, Atlanta, GA, USA
- Emory Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
| | - Thomas S Wingo
- Department of Neurology, Emory University School of Medicine, Emory Brain Health Center, Atlanta, GA, USA
- Emory Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
- Center for Neurodegenerative Disease, Emory University, Atlanta, GA, USA
| | - Cornelya D Dorbin
- Department of Neurology, Emory University School of Medicine, Emory Brain Health Center, Atlanta, GA, USA
- Emory Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
| | - Crystal P Davis
- Department of Neurology, Emory University School of Medicine, Emory Brain Health Center, Atlanta, GA, USA
- Emory Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
| | - Tiffany I Thomas
- Department of Neurology, Emory University School of Medicine, Emory Brain Health Center, Atlanta, GA, USA
- Emory Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
| | - Ihab M Hajjar
- Department of Neurology, Emory University School of Medicine, Emory Brain Health Center, Atlanta, GA, USA
- Emory Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
| | - Allan I Levey
- Department of Neurology, Emory University School of Medicine, Emory Brain Health Center, Atlanta, GA, USA
- Emory Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
- Center for Neurodegenerative Disease, Emory University, Atlanta, GA, USA
| | - Monica W Parker
- Department of Neurology, Emory University School of Medicine, Emory Brain Health Center, Atlanta, GA, USA
- Emory Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
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22
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Chen J, Zhang M, Shen Z, Tang M, Zeng Y, Bai D, Zhao P, Jiang G. Low-dose diazepam improves cognitive function in APP/PS1 mouse models: Involvement of AMPA receptors. Brain Res 2024; 1845:149207. [PMID: 39214326 DOI: 10.1016/j.brainres.2024.149207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 08/25/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024]
Abstract
Previous studies have indicated a close association between cognitive impairment in patients with neurodegenerative diseases, such as Alzheimer's disease (AD), and synaptic damage. Diazepam (DZP), a benzodiazepine class drug, is used to control symptoms such as seizures, anxiety, and sleep disorders. These symptoms can potentially manifest throughout the entire course of AD. Therefore, DZP may be utilized in the treatment of AD to manage these symptoms. However, the specific role and mechanisms of DZP in AD remain unclear. In this study, we discovered that long-term administration of a low dose of DZP (0.5 mg/kg) improved cognitive function and protected neurons from damage in APP/PS1 mice. Mechanistic investigations revealed that DZP exerted its neuroprotective effects and reduced Aβ deposition by modulating GluA1 (glutamate AMPA receptor subunit) to influence synaptic function. In conclusion, these findings highlight the potential benefits of DZP as a novel therapeutic approach, suggesting that long-term use of low-dose DZP in early-stage AD patients may be advantageous in slowing disease progression.
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Affiliation(s)
- Junwen Chen
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Ming Zhang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Ziyi Shen
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Ming Tang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Yumei Zeng
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Dazhang Bai
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Peilin Zhao
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Guohui Jiang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, Sichuan, China.
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23
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Fernandez Cajavilca M, Squires A, Wu B, Sadarangani T. Barriers to Timely Dementia Diagnosis in Older Latinos With Limited English Proficiency: An Integrative Review. J Transcult Nurs 2024:10436596241268456. [PMID: 39177241 DOI: 10.1177/10436596241268456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024] Open
Abstract
INTRODUCTION Timely diagnosis is critical for persons with Alzheimer's disease and related dementias (ADRD) to ensure they receive adequate services; however, timely diagnosis may be prevented by a person's English language skills. The purpose of this integrative review was to understand how limited English proficiency (LEP) impacts older Latino's ability to access a timely ADRD diagnosis. METHODS Whittemore and Knafl's methodological approach guided the review. Searches in five databases yielded 12 articles for inclusion. RESULTS Lack of culturally congruent health care systems, health care providers, and knowledge of ADRD resulted in delays in obtaining a timely ADRD diagnosis among older Latinos with LEP. DISCUSSION Latinos with LEP and risk for ADRD benefit from language assistance and support in navigating the health care system. Nurses must be advocates, even when a language barrier is present, and recognize that interpreters are not a single source solution.
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Affiliation(s)
| | - Allison Squires
- New York University Rory Meyers College of Nursing, New York City, USA
| | - Bei Wu
- New York University Rory Meyers College of Nursing, New York City, USA
| | - Tina Sadarangani
- New York University Rory Meyers College of Nursing, New York City, USA
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24
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Shafer J, Harr E, Roth I, Williams S, Gaylord S, Faurot K. Telephone-based mindfulness intervention positively impacts family communication and stress within rural, African American dementia caregiving teams. Aging Ment Health 2024:1-7. [PMID: 39172043 DOI: 10.1080/13607863.2024.2392726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 08/09/2024] [Indexed: 08/23/2024]
Abstract
OBJECTIVES The objective of this paper is to explore how telephone-delivered mindfulness training impacts family conflict and communication within the informal dementia caregiving team, including primary caregivers, their care partner, and the care recipient. METHOD Primary caregivers and their care partners participated in an eight-week telephone-delivered mindfulness-based intervention (MBI). This study used mixed methods and a pre-post design to evaluate the intervention's effect on family satisfaction, perceived support, and family conflict. RESULTS Both family satisfaction and perceived informational support increased significantly, and qualitative analysis revealed four key themes illustrating how the mindfulness intervention served to positively impact family conflict and communication among participating caregivers. CONCLUSION This study provides preliminary evidence for the beneficial effects of an MBI on family functioning among rural African American caregivers of people with Alzheimer's disease and related dementias.
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Affiliation(s)
- J Shafer
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - E Harr
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - I Roth
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - S Williams
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - S Gaylord
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - K Faurot
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
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25
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Zhu CW, Choi J, Hung W, Sano M. Racial and ethnic disparities in potentially inappropriate medication use in patients with dementia. J Am Geriatr Soc 2024. [PMID: 39166851 DOI: 10.1111/jgs.19152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 07/17/2024] [Accepted: 07/30/2024] [Indexed: 08/23/2024]
Abstract
INTRODUCTION Racial and ethnic disparities in potentially inappropriate medication (PIM) use among older adults with dementia are unclear. METHODS Data were drawn from the baseline visits of participants who were ≥60 years old and diagnosed with dementia in the National Alzheimer's Coordinating Center Uniform Data Set (NACCUDS) recruited from National Institute on Aging (NIA)-funded Alzheimer's Disease Research Centers (ADCs) throughout the United States. PIM utilization was evaluated using the 2019 American Geriatrics Society Beers Criteria for PIM Use in Older Adults. We estimated the association between race and ethnicity and the following outcomes and estimation models: (1) any PIM use, any PIM in each drug class, and any PIM best avoided in dementia patients using logistic regression models, (2) total number of medications, total number of PIMs, and anticholinergic burden scale (ACBS) using Poisson or negative binomial regression models, and (3) proportion of total medications that were PIMs using generalized linear models (GLM). RESULTS Compared to White participants, Black, Hispanic, and Asian participants reported taking fewer total medications (incidence rate ratio [IRR] ± standard error[SE] = 0.903 ± 0.017, 0.875 ± 0.021, and 0.912 ± 0.041, respectively, all p < 0.01). Asian participants were less likely to be exposed to any PIM (odds ratio [OR] ± SE = 0.619 ± 0.118, p < 0.05). Compared to White participants, Black participants were less likely to be exposed to benzodiazepine (OR ± SE = 0.609 ± 0.094, p < 0.01) and antidepressant (OR ± SE = 0.416 ± 0.103, p < 0.001) PIMs, but greater antipsychotic (OR ± SE = 1.496 ± 0.204, p < 0.01), cardiovascular (OR ± SE = 2.193 ± 0.255, p < 0.001), and skeletal muscle relaxant (OR ± SE = 2.977 ± 0.860, p < 0.001) PIMs. Hispanic participants were exposed to greater skeletal muscle relaxant PIMs and had lower anticholinergic burden. Asian participants were exposed to fewer benzodiazepine PIMs. DISCUSSION Significant racial and ethnic disparities in exposure to PIMs and PIMs by medication category in dementia research participants who have access to dementia experts found in the study suggest that disparities may be wider in the larger community.
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Affiliation(s)
- Carolyn W Zhu
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- James J Peters VA Medical Center, Bronx, New York, USA
- Alzheimer Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Justin Choi
- SUNY Downstate College of Medicine, Brooklyn, New York, USA
| | - William Hung
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- James J Peters VA Medical Center, Bronx, New York, USA
| | - Mary Sano
- James J Peters VA Medical Center, Bronx, New York, USA
- Alzheimer Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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26
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Cockell S, Wang H, Benke KS, Ware EB, Bakulski KM. Exposures and conditions prior to age 16 are associated with dementia status among adults in the United States Health and Retirement Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.08.15.24312018. [PMID: 39185531 PMCID: PMC11343252 DOI: 10.1101/2024.08.15.24312018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
Background Dementia susceptibility likely begins years before symptoms. Early life has not been comprehensively tested for dementia associations. Method In the US Health and Retirement Study (normal baseline cognition; n=16,509; 2008-2018 waves), 31 exposures before age 16 were retrospectively assessed with ten-year incident cognitive status (dementia, impaired, normal). Using parallel logistic models, each exposure was tested with incident cognition, adjusting for sex, baseline age, follow-up, race/ethnicity, personal/parental education. Result 14.5% had incident impairment and 5.3% had dementia. Depression was associated with 1.71 (95%CI:1.28,2.26) times higher odds of incident impairment, relative to normal cognition. Headaches/migraines were associated with 1.63 (95%CI:1.18,2.22) times higher odds of incident impairment. Learning problems were associated with 1.75 (95%CI:1.05,2.79) times higher odds of incident impairment. Childhood self-rated health of fair (1.86, 95%CI:1.27,2.64) and poor (3.39, 95%CI:1.91,5.82) were associated with higher incident dementia odds, relative to excellent. Conclusion Early life factors may be important for impairment or dementia, extending the relevant risk window.
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27
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Ramirez KA, Gigliotti C, Little EA, Peavy GM, Evans C, Paredes AM, Pacheco-Cole L, Zlatar ZZ, Jacobs DM, Gollan TH, González HM, Soria-Lopez JA, Huisa BN, Brewer JB, Galasko D, Salmon DP. Overcoming Barriers to Latino Participation in Alzheimer's Disease Research. Int J Aging Hum Dev 2024:914150241268259. [PMID: 39149977 DOI: 10.1177/00914150241268259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
There is a critical need to increase Latino participation in research on Alzheimer's disease and related disorders (ADRD). Applying principles of community-based participatory research, we convened a community advisory board (CAB) to identify barriers and recommend strategies to increase participation of older Latinos in a longitudinal observational research study of ADRD at the Shiley-Marcos Alzheimer's Disease Research Center. Six major barriers were identified and programmatic changes to overcome them were implemented. Changes resulted in a nearly three-fold increase in the number of Latino individuals recruited, with the proportion of all newly recruited participants who were Latino increasing from 12.2% to 57.4%. Newer Latino recruits were more representative of the elderly Latino population in San Diego County than those recruited pre-CAB and remained highly agreeable to blood draw and neuroimaging, though less so to lumbar puncture and autopsy. Results demonstrate the value of CAB involvement in enhancing diversity in ADRD research.
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Affiliation(s)
- Kevyn A Ramirez
- Shiley-Marcos Alzheimer's Disease Research Center, La Jolla, CA, USA
| | - Christina Gigliotti
- Shiley-Marcos Alzheimer's Disease Research Center, La Jolla, CA, USA
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Emily A Little
- Shiley-Marcos Alzheimer's Disease Research Center, La Jolla, CA, USA
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Guerry M Peavy
- Shiley-Marcos Alzheimer's Disease Research Center, La Jolla, CA, USA
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Carol Evans
- Shiley-Marcos Alzheimer's Disease Research Center, La Jolla, CA, USA
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Alejandra Morlett Paredes
- Shiley-Marcos Alzheimer's Disease Research Center, La Jolla, CA, USA
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Lillian Pacheco-Cole
- Shiley-Marcos Alzheimer's Disease Research Center, La Jolla, CA, USA
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Zvinka Z Zlatar
- Shiley-Marcos Alzheimer's Disease Research Center, La Jolla, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Diane M Jacobs
- Shiley-Marcos Alzheimer's Disease Research Center, La Jolla, CA, USA
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Tamar H Gollan
- Shiley-Marcos Alzheimer's Disease Research Center, La Jolla, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Hector M González
- Shiley-Marcos Alzheimer's Disease Research Center, La Jolla, CA, USA
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Jose A Soria-Lopez
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
- The Neuron Clinic, Chula Vista, CA, USA
| | | | - James B Brewer
- Shiley-Marcos Alzheimer's Disease Research Center, La Jolla, CA, USA
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Douglas Galasko
- Shiley-Marcos Alzheimer's Disease Research Center, La Jolla, CA, USA
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - David P Salmon
- Shiley-Marcos Alzheimer's Disease Research Center, La Jolla, CA, USA
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
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28
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Stradford J, Heyworth NC, Jackson M, Norman M, Banks SJ, Sundermann EE, Thames AD. Increasing research study engagement in minoritized populations: An example from the Black Women Inflammation and Tau Study. Alzheimers Dement 2024. [PMID: 39140387 DOI: 10.1002/alz.14177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/12/2024] [Accepted: 07/16/2024] [Indexed: 08/15/2024]
Abstract
Black women are sorely underrepresented in studies of Alzheimer's disease and related dementias (ADRD) despite higher rates of ADRD diagnoses than in non-Hispanic White women. There are many reasons for underrepresentation, including medical mistrust, limited access to clinical studies, and restrictive study inclusion criteria. These pervasive barriers to research participation are often not considered during study development and, if eventually thought of tend to be after the fact. Community-engaged research (CER) approaches are an effective method for reducing participation barriers. This article describes how CER approaches were used to develop the Black Women Inflammation and Tau Study (BWITS), a prospective study to identify biopsychosocial risk factors for ADRD in Black women. Guidelines discussed here for future ADRD research in diverse populations are informed by Community-Based Participatory Research (CBPR), the National Institute on Minority Health and Health Disparities (NIMHD), and the Patient-Centered Outcomes Research Institute (PCORI). HIGHLIGHTS: Understand the historical tragedies related to medical practices and research designs that may contribute to the underrepresentation of Black Americans in research studies today. Highlight community-engaged research approaches that effectively reduce participation barriers in minoritized groups. Review Community-Based Participatory Research, National Institute of Minority Health and Health Disparities, and the Patient-Centered Outcomes Research Institute guidelines for conducting research with minoritized communities. Describe using the three frameworks to inform the study development protocol for the Black Women Inflammation and Tau Study. Conclude by offering study design considerations that we hope can be a helpful starting point for others conducting research with minoritized communities.
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Affiliation(s)
- Joy Stradford
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Nadine C Heyworth
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Michelle Jackson
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Marc Norman
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Sarah J Banks
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Erin E Sundermann
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - April D Thames
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
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29
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Liu R, Durbin-Johnson B, Paciotti B, Liu AT, Weakley A, Liu X, Wan YJY. Metabolic dysfunctions predict the development of Alzheimer's disease: Statistical and machine learning analysis of EMR data. Alzheimers Dement 2024. [PMID: 39140368 DOI: 10.1002/alz.14101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 06/04/2024] [Accepted: 06/06/2024] [Indexed: 08/15/2024]
Abstract
INTRODUCTION The incidence of Alzheimer's disease (AD) and obesity rise concomitantly. This study examined whether factors affecting metabolism, race/ethnicity, and sex are associated with AD development. METHODS The analyses included patients ≥ 65 years with AD diagnosis in six University of California hospitals between January 2012 and October 2023. The controls were race/ethnicity, sex, and age matched without dementia. Data analyses used the Cox proportional hazards model and machine learning (ML). RESULTS Hispanic/Latino and Native Hawaiian/Pacific Islander, but not Black subjects, had increased AD risk compared to White subjects. Non-infectious hepatitis and alcohol abuse were significant hazards, and alcohol abuse had a greater impact on women than men. While underweight increased AD risk, overweight or obesity reduced risk. ML confirmed the importance of metabolic laboratory tests in predicting AD development. DISCUSSION The data stress the significance of metabolism in AD development and the need for racial/ethnic- and sex-specific preventive strategies. HIGHLIGHTS Hispanics/Latinos and Native Hawaiians/Pacific Islanders show increased hazards of Alzheimer's disease (AD) compared to White subjects. Underweight individuals demonstrate a significantly higher hazard ratio for AD compared to those with normal body mass index. The association between obesity and AD hazard differs among racial groups, with elderly Asian subjects showing increased risk compared to White subjects. Alcohol consumption and non-infectious hepatitis are significant hazards for AD. Machine learning approaches highlight the potential of metabolic panels for AD prediction.
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Affiliation(s)
- Rex Liu
- Department of Computer Science, University of California, Davis, Sacramento, California, USA
| | - Blythe Durbin-Johnson
- Department of Public Health Sciences, University of California, Davis, Sacramento, California, USA
| | - Brian Paciotti
- Data Center of Excellence, University of California, Davis, Sacramento, California, USA
| | - Albert T Liu
- Department of Obstetrics/Gynecology, University of California, Davis, Sacramento, California, USA
| | - Alyssa Weakley
- Department of Neurology, University of California, Davis, Sacramento, California, USA
| | - Xin Liu
- Department of Computer Science, University of California, Davis, Sacramento, California, USA
| | - Yu-Jui Yvonne Wan
- Department of Medical Pathology and Laboratory Medicine, University of California, Davis, Sacramento, California, USA
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30
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Lima VDS, Ferreira YG, de Oliveira JC, Raia VDA, Rodrigues Emerick LBB, Albiero LR, Sinhorin VDG, Emerick GL. Alzheimer's Disease Mortality Rate: Correlation with Socio-Economic and Environmental Factors. TOXICS 2024; 12:586. [PMID: 39195688 PMCID: PMC11359452 DOI: 10.3390/toxics12080586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 08/01/2024] [Accepted: 08/09/2024] [Indexed: 08/29/2024]
Abstract
The progressive increase in the number of deaths caused by Alzheimer's disease (AD) in Brazil and around the world between 2010 and 2020 raises questions in scientific society. At the same time, there is also an increase in life expectancy at birth (LEB). Thus, the aim of this study was, for the first time, to compare the increase in AD mortality rate (ADMR) in Brazilian regions over the years 2010 to 2020 with the increase in LEB, and investigate the possible correlation between these demographic transition phenomena and pesticide sales and exposure during this period. Data were extracted from the Brazilian Institute of Geography and Statistics (IBGE), from the Department of Informatics and Technology of the Brazilian Ministry of Health (DATASUS) and from the Brazilian Institute of the Environment and Renewable Natural Resources (IBAMA). There was a significant increase in life expectancy at birth and in ADMR over the years between 2010 and 2020 in all Brazilian regions, with the female population in the South region being the most affected. In conclusion, there is a strong positive correlation between the increase in ADMR and LEB; ADMR and Human Development Index (HDI) and ADMR and pesticide sales and exposure in Brazil over the years studied.
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Affiliation(s)
- Valfran da Silva Lima
- Instituto de Ciências da Saúde, Universidade Federal de Mato Grosso—ICS/CUS/UFMT, Campus Sinop, Avenida Alexandre Ferronato, 1200, Cidade Jardim, Sinop 78550-728, MT, Brazil; (V.d.S.L.); (Y.G.F.); (J.C.d.O.); (V.d.A.R.); (L.B.B.R.E.); (L.R.A.)
- Programa de Pós-Graduação em Ciências em Saúde, Instituto de Ciências da Saúde, Universidade Federal de Mato Grosso—ICS/CUS/UFMT, Sinop 78550-728, MT, Brazil
| | - Yasmin Gabriele Ferreira
- Instituto de Ciências da Saúde, Universidade Federal de Mato Grosso—ICS/CUS/UFMT, Campus Sinop, Avenida Alexandre Ferronato, 1200, Cidade Jardim, Sinop 78550-728, MT, Brazil; (V.d.S.L.); (Y.G.F.); (J.C.d.O.); (V.d.A.R.); (L.B.B.R.E.); (L.R.A.)
| | - Júlio Cezar de Oliveira
- Instituto de Ciências da Saúde, Universidade Federal de Mato Grosso—ICS/CUS/UFMT, Campus Sinop, Avenida Alexandre Ferronato, 1200, Cidade Jardim, Sinop 78550-728, MT, Brazil; (V.d.S.L.); (Y.G.F.); (J.C.d.O.); (V.d.A.R.); (L.B.B.R.E.); (L.R.A.)
- Programa de Pós-Graduação em Ciências em Saúde, Instituto de Ciências da Saúde, Universidade Federal de Mato Grosso—ICS/CUS/UFMT, Sinop 78550-728, MT, Brazil
| | - Vanessa de Almeida Raia
- Instituto de Ciências da Saúde, Universidade Federal de Mato Grosso—ICS/CUS/UFMT, Campus Sinop, Avenida Alexandre Ferronato, 1200, Cidade Jardim, Sinop 78550-728, MT, Brazil; (V.d.S.L.); (Y.G.F.); (J.C.d.O.); (V.d.A.R.); (L.B.B.R.E.); (L.R.A.)
| | - Ludmila Barbosa Bandeira Rodrigues Emerick
- Instituto de Ciências da Saúde, Universidade Federal de Mato Grosso—ICS/CUS/UFMT, Campus Sinop, Avenida Alexandre Ferronato, 1200, Cidade Jardim, Sinop 78550-728, MT, Brazil; (V.d.S.L.); (Y.G.F.); (J.C.d.O.); (V.d.A.R.); (L.B.B.R.E.); (L.R.A.)
- Programa de Pós-Graduação em Ciências em Saúde, Instituto de Ciências da Saúde, Universidade Federal de Mato Grosso—ICS/CUS/UFMT, Sinop 78550-728, MT, Brazil
| | - Lucinéia Reuse Albiero
- Instituto de Ciências da Saúde, Universidade Federal de Mato Grosso—ICS/CUS/UFMT, Campus Sinop, Avenida Alexandre Ferronato, 1200, Cidade Jardim, Sinop 78550-728, MT, Brazil; (V.d.S.L.); (Y.G.F.); (J.C.d.O.); (V.d.A.R.); (L.B.B.R.E.); (L.R.A.)
| | | | - Guilherme Luz Emerick
- Instituto de Ciências da Saúde, Universidade Federal de Mato Grosso—ICS/CUS/UFMT, Campus Sinop, Avenida Alexandre Ferronato, 1200, Cidade Jardim, Sinop 78550-728, MT, Brazil; (V.d.S.L.); (Y.G.F.); (J.C.d.O.); (V.d.A.R.); (L.B.B.R.E.); (L.R.A.)
- Programa de Pós-Graduação em Ciências em Saúde, Instituto de Ciências da Saúde, Universidade Federal de Mato Grosso—ICS/CUS/UFMT, Sinop 78550-728, MT, Brazil
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Yuan Y, Dube CE, Xu S, Lim E, Qu S, McPhillips E, Lapane KL. Exploring the social and cultural aspects of Chinese family caregivers' experience as they support loved ones with dementia transitioning into nursing homes: a qualitative study protocol. BMJ Open 2024; 14:e085731. [PMID: 39134432 PMCID: PMC11331904 DOI: 10.1136/bmjopen-2024-085731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 07/29/2024] [Indexed: 08/21/2024] Open
Abstract
INTRODUCTION Asian American caregivers supporting loved ones with dementia experience greater burden and more stress than other racial/ethnic groups, warranting the need for more culturally and linguistically appropriate formal support, such as in nursing homes. Transitioning loved ones into nursing homes with dementia care units is a complex process that can be impacted by a multitude of factors. Employing several established frameworks, including the socioecological model, this qualitative study will focus on the largest Asian American subgroup (people of Chinese descent) and explore the experience of family caregivers as they support the transition of their loved ones with dementia into nursing homes in the USA. Our focus will be on the nuanced influences of the Chinese language and culture and COVID-19-related social isolation and racial discrimination. METHODS AND ANALYSIS Recruitment will take place starting in January 2024. Current or former Chinese caregivers for Chinese loved ones with dementia, able to communicate in Mandarin Chinese or English, and currently residing in the USA will be eligible. Key informants with intimate understanding and experience with this population will also be included. Data will be collected through 2024 using semistructured, in-depth interviews with each participant. Depending on participants' preferences, interviews will be conducted in either Mandarin Chinese or English and either in person, via Zoom or by phone. Interviews will be transcribed verbatim. Iterative thematic analysis will be employed. A coding structure will be developed based on interview questions and themes and patterns that are revealed through data immersion. Transcripts, prepared in their original language, will be dual-coded by bilingual researchers using NVivo 14. Consensus summaries of themes will be prepared. Relevant direct quotes for each thematic area will be identified (those in Chinese will be translated into English) and cited in reports and manuscripts. ETHICS AND DISSEMINATION The study is approved by the UMass Chan Medical School Institutional Review Board (ID: STUDY00001376). Findings will be published in peer-review journals following the consolidated criteria for reporting qualitative research.
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Affiliation(s)
- Yiyang Yuan
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Catherine E Dube
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Shu Xu
- Demography of Aging, Disability and Care Program, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Emily Lim
- Department of Gerontology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Shan Qu
- Department of Gerontology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Emily McPhillips
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Kate L Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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Cagle JG, Reiff JS, Smith A, Echavarria D, Scerpella D, Zhang T, Roth DL, Hanna V, Boyd CM, Hussain NA, Wolff JL. Assessing Advance Care Planning Fidelity within the Context of Cognitive Impairment: The SHARE Trial. J Pain Symptom Manage 2024; 68:180-189. [PMID: 38754769 PMCID: PMC11334724 DOI: 10.1016/j.jpainsymman.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 05/01/2024] [Accepted: 05/07/2024] [Indexed: 05/18/2024]
Abstract
CONTEXT Advance care planning (ACP) is critical among primary care patients with cognitive impairment, but few interventions have tested ACP with this population. OBJECTIVE Describe the development and evaluation of a tool for assessing ACP fidelity within the context of cognitive impairment, including inter-rater reliability, convergent validity, and overall fidelity using clinical trial data. DESIGN SHARE is a multicomponent intervention inclusive of facilitated ACP conversations. From a two group, single blind, randomized controlled trial, recorded ACP conversations were rated for fidelity. 145 primary care patients and their care partners were randomized to receive the intervention. Participating patients were 80+ years, had a care partner, and indications of cognitive impairment. An ACP Fidelity Checklist was developed with three subscales: Meeting Set-Up; ACP Meeting Topics; and Communication Skills. Scores were converted to percentages (100% = perfect fidelity) with a target of ≥80% fidelity. A post-ACP meeting report completed by ACP facilitators was used to assess convergent validity of the checklist. Intra-class correlation (ICC) was to evaluate inter-rater reliability. RESULTS ACP conversations averaged 33.6 minutes (SD = 14.1). The mean fidelity score across N = 91 rated meetings was 82.9%, with a range of 77.3%-90.6% for subscales. 63.7% of meetings achieved a rating of ≥80%. Cognitive function was positively associated with patient participation (rho = .59, P < 0.001). For checklist items, ICC scores ranged from 0.43-0.96. Post-ACP meeting form scores were correlated with the checklist Meeting Topics subscale (r = 0.36, P = 0.001). CONCLUSIONS Assessing the fidelity of ACP conversations involving primary care patients living with cognitive impairment and their care partners is feasible.
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Affiliation(s)
- John G Cagle
- School of Social Work (J.G.C.), University of Maryland, Baltimore, Maryland, USA.
| | - Jenni S Reiff
- Department of Health Policy and Management (J.S.R., D.E., D.S., V.H., J.L.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ambrym Smith
- MedStar Union Memorial Hospital (A.S.), Baltimore, Maryland, USA
| | - Diane Echavarria
- Department of Health Policy and Management (J.S.R., D.E., D.S., V.H., J.L.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Danny Scerpella
- Department of Health Policy and Management (J.S.R., D.E., D.S., V.H., J.L.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Talan Zhang
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology (T.Z., D.L.R.), Johns Hopkins University, Baltimore, Maryland, USA
| | - David L Roth
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology (T.Z., D.L.R.), Johns Hopkins University, Baltimore, Maryland, USA
| | - Valecia Hanna
- Department of Health Policy and Management (J.S.R., D.E., D.S., V.H., J.L.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology (C.M.B.), Johns Hopkins University, Baltimore, Maryland, USA
| | - Naaz A Hussain
- Johns Hopkins Community Physicians (N.A.H.), Frederick, Maryland, USA
| | - Jennifer L Wolff
- Department of Health Policy and Management (J.S.R., D.E., D.S., V.H., J.L.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Gutiérrez Á, Cronin CE, Franz B, Muniz-Terrera G. Alzheimer's Centers in US Hospitals: Enough to Adequately Address Dementia Care Nationwide? J Aging Health 2024; 36:458-470. [PMID: 37699204 DOI: 10.1177/08982643231200691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
Objectives: To investigate the availability of Alzheimer's Centers (ACs) in US hospitals. Methods: Utilizing the American Hospital Association Annual Survey, Area Health Resource File, and US Census (n = 3251), we employed multivariable logistic regression to examine hospital, county, and regional predictors of AC availability. Results: Large hospitals (>399 beds) had approximately 14 times higher odds of having an AC than small hospitals (<50 beds; OR = 14.0; 95% CI = 6.44 - 30.46). Counties with a higher proportion of Latino residents, relative to non-Latino Whites, had lower odds of having an AC (OR = .05; 95% CI = .01 - .41). Northeastern (OR = 1.92; 95% CI = 1.15 - 3.22) and Midwestern (OR = 2.12; 95% CI = 1.34 - 3.37) hospitals had higher odds of having an AC than Southern hospitals. Discussion: To address dementia needs and disparities, investment in a national infrastructure is critical.
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Affiliation(s)
- Ángela Gutiérrez
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Athens OH, USA
| | - Cory E Cronin
- College of Health Sciences and Professions, Ohio University, Athens OH, USA
| | - Berkeley Franz
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Athens OH, USA
| | - Graciela Muniz-Terrera
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Athens OH, USA
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Hamm JM, Parker K, Lachman ME, Mogle JA, Duggan KA, McGrath R. Increased frequency of light physical activity during midlife and old age buffers against cognitive declines. J Behav Med 2024; 47:622-634. [PMID: 38429599 PMCID: PMC11290996 DOI: 10.1007/s10865-024-00478-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/06/2024] [Indexed: 03/03/2024]
Abstract
Although it is well established that moderate-to-vigorous physical activity (MVPA) buffers against declines in cognitive health, less is known about the benefits of light physical activity (LPA). Research on the role of LPA is crucial to advancing behavioral interventions to improve late life health outcomes, including cognitive functioning, because this form of physical activity remains more feasible and amenable to change in old age. Our study examined the extent to which increases in LPA frequency protected against longitudinal declines in cognitive functioning and whether such a relationship becomes pronounced in old age when opportunities for MVPA are typically reduced. We analyzed 9-year data from the national Midlife in the United States Study (n = 2,229; Mage = 56 years, range = 33-83; 56% female) using autoregressive models that assessed whether change in LPA frequency predicted corresponding changes in episodic memory and executive functioning in middle and later adulthood. Increases in LPA frequency predicted less decline in episodic memory (β = 0.06, p = .004) and executive functioning (β = 0.14, p < .001) over the 9-year follow-up period, even when controlling for moderate and vigorous physical activity. Effect sizes for moderate and vigorous physical activity were less than half that observed for LPA. Moderation models showed that, for episodic memory, the benefits of increases in LPA frequency were more pronounced at older ages. Findings suggest that increases in LPA over extended periods of time may help slow age-related cognitive declines, particularly in later life when opportunities for MVPA are often diminished.
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Affiliation(s)
- Jeremy M Hamm
- Department of Psychology, North Dakota State University, Fargo, ND, USA.
| | - Kelly Parker
- Department of Psychology, North Dakota State University, Fargo, ND, USA
| | | | | | | | - Ryan McGrath
- Department of Kinesiology, North Dakota State University, Fargo, ND, USA
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Clouston SAP, Hanes DW, Smith DM, Richmond LL, Richards M, Link B. Inequalities in accelerated cognitive decline: Resolving observational window bias using nested non-linear regression. Alzheimers Dement 2024; 20:5540-5550. [PMID: 39001609 PMCID: PMC11350020 DOI: 10.1002/alz.14053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 08/29/2024]
Abstract
INTRODUCTION Limited observational windows lead to conflicting results in studies examining educational differences in Alzheimer's disease and related dementias (ADRD) risk, due to observational window bias relative to onset of accelerated cognitive decline. This study tested a novel model to address observational window bias and tested for the presence and sources of disparities in accelerated cognitive declines due to ADRD. METHODS The sample examined 167,314 cognitive assessments from 32,441 Health and Retirement Study participants. We implemented a parametric non-linear nested longitudinal regression and reported multivariable-adjusted nodal incidence ratios (aNIR). RESULTS University degrees were associated with lower incidence (aNIR = 0.253, 95% confidence interval [CI] = [0.221 to 0.289], p < 0.001), while black participants had a higher incidence (aNIR = 1.995, [1.858 to 2.141], p < 0.001) of accelerated cognitive decline, adjusting for demographic, sociobehavioral, and medical risk factors. Sex-stratified analyses identified diminished educational returns for women and increased incidence among minoritized women. DISCUSSION Addressing observational window bias reveals large social inequalities in the onset of accelerated cognitive declines indicative of ADRD. HIGHLIGHTS This study identifies observational window bias as a source of conflicting results among previous studies of educational achievement in Alzheimer's disease and related dementias (ADRD) disparities. The study locates preclinical accelerated cognitive decline, which is indicative of ADRD while occurring 10+ years prior to symptom onset, as a site to study ADRD disparities that mitigates observational window bias. A novel method, nested non-linear regression, is developed to test for differences in the onset of accelerated cognitive decline. Educational and racial/ethnic disparities are demonstrated in the onset of accelerated cognitive decline, as are their intersecting differences with sex/gender.
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Affiliation(s)
- Sean A. P. Clouston
- Program in Public Health, Renaissance School of MedicineStony Brook UniversityStony BrookNew YorkUSA
- Department of Family, Population, and Preventive Medicine, Renaissance School of MedicineStony Brook UniversityStony BrookNew YorkUSA
| | - Douglas W. Hanes
- Program in Public Health, Renaissance School of MedicineStony Brook UniversityStony BrookNew YorkUSA
| | - Dylan M. Smith
- Program in Public Health, Renaissance School of MedicineStony Brook UniversityStony BrookNew YorkUSA
- Department of Family, Population, and Preventive Medicine, Renaissance School of MedicineStony Brook UniversityStony BrookNew YorkUSA
| | | | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCLUniversity College LondonLondonUK
| | - Bruce Link
- Department of SociologyUniversity of California at RiversideRiversideCaliforniaUSA
- Department of Public PolicyUniversity of California at RiversideRiversideCaliforniaUSA
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Tan ZS, Qureshi N, Spivack E, Rhinehart D, Gatmaitan D, Guinto A, Kremen S, Sicotte NL. Pragmatic implementation of comprehensive dementia care management: The Cedars-Sinai C.A.R.E.S. Program preliminary data. J Am Geriatr Soc 2024; 72:2532-2543. [PMID: 38526042 DOI: 10.1111/jgs.18891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/15/2024] [Accepted: 03/05/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND The United States faces a growing challenge with over 6.5 million people living with dementia (PLwD). PLwD and their caregivers struggle with cognitive, functional, behavioral, and psychosocial issues. As dementia care shifts to home settings, caregivers receive inadequate support but bear increasing responsibilities, leading to higher healthcare costs. In response, the Centers for Medicare & Medicaid Services (CMS) introduced the Guiding an Improving Dementia Experience (GUIDE) Model. The study explores the real-world implementation of the Cedars-Sinai C.A.R.E.S. Program, a pragmatic dementia care model, detailing its recruitment process and initial outcomes. METHODS The Cedars-Sinai C.A.R.E.S. Program was integrated into the Epic electronic health record system and focused on proactive patient identification, engagement, interdisciplinary collaboration, care transitions, and ongoing care management. Eligible patients with a dementia diagnosis were identified through electronic health record and invited to join the program. Nurse practitioners with specialized training in dementia care performed comprehensive assessments using the CEDARS-6 tool, leading to personalized care plans developed in consultation with primary care providers. Patients benefited from a multidisciplinary team and support from care navigators. RESULTS Of the 781 eligible patients identified, 431 were enrolled in the C.A.R.E.S. PROGRAM Enrollees were racially diverse, with lower caregiver strain and patient behavioral and psychological symptoms of dementia (BPSD) severity compared to other programs dementia care programs. Healthcare utilization, including hospitalizations, emergency department (ED) admissions, and urgent care visits showed a downward trend over time. Completion of advanced directives and Physician Order of Life-Sustaining Treatment (POLST) increased after enrollment. CONCLUSION The Cedars-Sinai C.A.R.E.S. Program offers a promising approach to dementia care. Its real-world implementation demonstrates the feasibility of enrolling a diverse population and achieving positive outcomes for PLwD and their caregivers, supporting the goals of national dementia care initiatives.
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Affiliation(s)
- Zaldy S Tan
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nabeel Qureshi
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
- RAND Corporation, Santa Monica, California, USA
| | - Erica Spivack
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Deana Rhinehart
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dyane Gatmaitan
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Augustine Guinto
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Sarah Kremen
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nancy L Sicotte
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Mielke MM, Fowler NR. Alzheimer disease blood biomarkers: considerations for population-level use. Nat Rev Neurol 2024; 20:495-504. [PMID: 38862788 PMCID: PMC11347965 DOI: 10.1038/s41582-024-00989-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 06/13/2024]
Abstract
In the past 5 years, we have witnessed the first approved Alzheimer disease (AD) disease-modifying therapy and the development of blood-based biomarkers (BBMs) to aid the diagnosis of AD. For many reasons, including accessibility, invasiveness and cost, BBMs are more acceptable and feasible for patients than a lumbar puncture (for cerebrospinal fluid collection) or neuroimaging. However, many questions remain regarding how best to utilize BBMs at the population level. In this Review, we outline the factors that warrant consideration for the widespread implementation and interpretation of AD BBMs. To set the scene, we review the current use of biomarkers, including BBMs, in AD. We go on to describe the characteristics of typical patients with cognitive impairment in primary care, who often differ from the patient populations used in AD BBM research studies. We also consider factors that might affect the interpretation of BBM tests, such as comorbidities, sex and race or ethnicity. We conclude by discussing broader issues such as ethics, patient and provider preference, incidental findings and dealing with indeterminate results and imperfect accuracy in implementing BBMs at the population level.
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Affiliation(s)
- Michelle M Mielke
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Nicole R Fowler
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Center for Aging Research, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
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Rojas‐Saunero LP, Hughes TM, Mayeda ER, Jimenez MP. Racial and ethnic differences in the risk of dementia diagnosis under hypothetical blood pressure-lowering interventions: The Multi-Ethnic Study of Atherosclerosis. Alzheimers Dement 2024; 20:5271-5280. [PMID: 38984649 PMCID: PMC11350054 DOI: 10.1002/alz.13894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 04/08/2024] [Accepted: 04/22/2024] [Indexed: 07/11/2024]
Abstract
INTRODUCTION Substantial racial and ethnic disparities in hypertension and dementia exist in the United States. We evaluated the effect of maintaining systolic blood pressure (SBP) below clinical thresholds on dementia incidence. METHODS We included 6806 Multi-Ethnic Study of Atherosclerosis participants (44 to 84 years old). We implemented the parametric g-formula to simulate the hypothetical interventions to reduce SBP below 120 and 140 mmHg over time, accounting for time-varying confounding. We estimated risk ratios (RRs) and risk differences for dementia incidence at 19 years. RESULTS The RRs (95% confidence intervals [CIs]) comparing an intervention reducing SBP below 120 mmHg to no intervention were 0.93 (0.87 to 0.99) for total sample, 0.95 (0.88 to 1.02) for White, 0.90 (0.79 to 1.02) for Black, 0.90 (0.78 to 1.05) for Latino, and 1.16 (0.83 to 1.55) for Chinese American participants. Results for lowering SBP below 140 mmHg and with death as competing event were attenuated. DISCUSSION The reduction of SBP below 120 mmHg over time has modest effects on reducing dementia incidence. More work is needed to understand the heterogeneity across racial and ethnic groups. HIGHLIGHTS There is a potential beneficial effect in lowering SBP to reduce the risk of dementia, which may vary by race and ethnicity. The percentage of participants who would need intervention on blood pressure to meet clinical thresholds is greater for Black and Latino communities. Results are sensitive to the way that death is specified in the research question and analysis.
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Affiliation(s)
| | - Timothy M. Hughes
- Department of Internal MedicineSection on Gerontology and Geriatric MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Elizabeth Rose Mayeda
- Department of EpidemiologyUCLA Fielding School of Public HealthLos AngelesCaliforniaUSA
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Malena K, Rao S, Mosler C. Review of Current Clinical Options for the Management of Behavioral and Psychological Symptoms of Dementia. Sr Care Pharm 2024; 39:300-310. [PMID: 39080869 DOI: 10.4140/tcp.n.2024.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Dementia is a disease most prevalent in the older adult population. The cognitive symptoms of dementia include impairments in problem-solving, memory, and language. Some patients experience noncognitive symptoms in addition to the cognitive symptoms of dementia. These noncognitive symptoms are called behavioral and psychological symptoms of dementia or BPSD. The primary objective of our study was to examine the therapeutic options, guidelines, and clinical considerations for the management of BPSD. The existing literature about BPSD was reviewed with searches in PubMed, MEDLINE, and online search platforms. Dysregulation of neurotransmission involving acetylcholine, dopamine, and serotonin has been shown to cause behavioral and psychological symptoms of Alzheimer's disease. BPSD can include hallucinations, agitation, delusions, anxiety, apathy, abnormal body movements, irritability, depression, disinhibition, and sleep or appetite changes. Pharmacologic therapies used in the treatment of BPSD include antidepressants, antipsychotics, anxiolytics, and anticonvulsants. Treatment can be tailored to the specific noncognitive symptoms that are experienced. The use of these agents may be limited based on recommendations from the Beers Criteria®, STOPP criteria, treatment guidelines, and FDA warnings.
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Ch'en P, Patel PB, Ramirez M. Caregivers' and Health Care Providers' Cultural Perceptions of and Experiences With Latino Patients With Dementia. Neurol Clin Pract 2024; 14:e200307. [PMID: 38855714 PMCID: PMC11157425 DOI: 10.1212/cpj.0000000000200307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/09/2024] [Indexed: 06/11/2024]
Abstract
Background and Objectives The prevalence of Alzheimer dementia in the US Latino population in 2060 is projected to increase 7-fold, the highest among any other major ethnic/racial group. One vital question is how clinicians can tailor their care for Latinos. Given this rapidly growing prevalence, we sought to characterize the experiences and perspectives of Latino caregivers by analyzing interview data from both caregivers and experienced providers that specifically work with Latino populations. In this study, we present 6 themes that emerged along with tailored solutions and recommendations to implement in clinical practice to improve patient care and outcomes. Methods This qualitative analysis uses coded interview transcripts from 2 studies, one in Southern California and another in Washington State. The combined dataset included interview transcripts with 51 caregivers and 20 providers. A thematic analysis was performed on the coded interview transcripts to identify themes related to tailoring care for Latino populations. Results Six themes emerged from the analysis: (1) multiple caregivers involved within a family-oriented Latino household; (2) need for encouragement in advocating for loved ones in the clinician's office; (3) challenges in reaching and communicating with the Latino population; (4) increasing use of technology by patients and caregivers despite some challenges; (5) stigma associated with mental health issues within the Latino culture; and (6) limited understating of dementia leading to a delay in care in the Latino population. Discussion Many Latino households have a strong sense of familism, thus care coordination with multiple caregivers is essential to high-quality care. Improved shared decision-making strategies tailored to a population that may be culturally deferential to authoritative figures can aid caregiver understanding and engagement with the provider. These interactions can often be more authentic when communicating with a member of the care team in Spanish. A cultural stigma of mental illness was also identified; clinicians can work toward normalizing discussion of mental illness and its treatment by openly discussing mental health during annual visits. Through these themes, we demonstrate some of the strengths and weaknesses of the current care delivery model within a sociocultural context to improve patient care and outcomes for Latino families caring for individuals living with dementia.
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Affiliation(s)
- Peter Ch'en
- Albert Einstein College of Medicine (PC), Bronx, NY; Department of Neurology (PBP); and Department of Health Systems and Population Health (MR), University of Washington, Seattle
| | - Payal B Patel
- Albert Einstein College of Medicine (PC), Bronx, NY; Department of Neurology (PBP); and Department of Health Systems and Population Health (MR), University of Washington, Seattle
| | - Magaly Ramirez
- Albert Einstein College of Medicine (PC), Bronx, NY; Department of Neurology (PBP); and Department of Health Systems and Population Health (MR), University of Washington, Seattle
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Farmer HR, Thierry AD, Sherman-Wilkins K, Thorpe RJ. An exploration of neighborhood characteristics, psychosocial resilience resources, and cognitive functioning among midlife and older black adults. ETHNICITY & HEALTH 2024; 29:597-619. [PMID: 38932579 DOI: 10.1080/13557858.2024.2369871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 06/06/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES While existing research has shown that Black adults have worse cognitive functioning than their White counterparts, the psychosocial correlates of cognitive functioning for Black older adults are understudied. The objective of this study was to investigate the relationships among perceived neighborhood characteristics, psychosocial resilience resources, and cognitive functioning among midlife and older Black adults. METHODS Data were from 3,191 Black adults ages 51+ in the 2008-2016 waves of the Health and Retirement Study to examine associations among neighborhood characteristics, psychosocial resilience (sense of purpose, mastery, and social support), and cognitive functioning among Black adults. Multilevel linear regression models assessed direct effects of neighborhood characteristics and psychosocial resources on cognitive functioning. We then tested whether psychosocial resources moderated the association between neighborhood characteristics and cognitive functioning. RESULTS Mean levels of cognitive functioning, sense of purpose, social support, and mastery were significantly related to neighborhood disorder and discohesion. Regression results showed that levels of neighborhood disorder and high discohesion were significantly associated with cognitive functioning. Sense of purpose was positively associated with cognitive functioning, net of neighborhood characteristics. However, only social support moderated the association between neighborhood discohesion and cognition. CONCLUSIONS These findings demonstrate the importance of examining psychosocial and contextual risk and resilience resources among midlife and older Black adults. This work may inform the development of cognitive behavioral interventions aimed at increasing sense of purpose to promote and enhance cognitive resiliency among Black adults. Altogether, this work may have implications for policy aimed at advancing cognitive health equity.
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Affiliation(s)
- Heather R Farmer
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Amy D Thierry
- Department of Public Health Sciences, Xavier University of Louisiana, New Orleans, LA, USA
| | - Kyler Sherman-Wilkins
- Department of Sociology, Anthropology, and Gerontology, Missouri State University, Springfield, MO, USA
| | - Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Zhu Y, Williams J, Beyene K, Trani JF, Babulal GM. Traumatic Brain Injury, Seizures, and Cognitive Impairment Among Older Adults. JAMA Netw Open 2024; 7:e2426590. [PMID: 39115844 PMCID: PMC11310819 DOI: 10.1001/jamanetworkopen.2024.26590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 06/11/2024] [Indexed: 08/11/2024] Open
Abstract
Importance Traumatic brain injury (TBI), seizures, and dementia increase with age. There is a gap in understanding the associations of TBI, seizures, and medications such as antiseizure and antipsychotics with the progression of cognitive impairment across racial and ethnic groups. Objective To investigate the association of TBI and seizures with the risk of cognitive impairment among cognitively normal older adults and the role of medications in moderating the association. Design, Setting, and Participants This multicenter cohort study was a secondary analysis of the Uniform Data Set collected between June 1, 2005, and June 30, 2020, from the National Alzheimer's Coordination Center. Statistical analysis was performed from February 1 to April 3, 2024. Data were collected from participants from 36 Alzheimer's Disease Research Centers in the US who were 65 years or older at baseline, cognitively normal at baseline (Clinical Dementia Rating of 0 and no impairment based on a presumptive etiologic diagnosis of AD), and had complete information on race and ethnicity, age, sex, educational level, and apolipoprotein E genotype. Exposure Health history of TBI, seizures, or both conditions. Main Outcomes and Measures Progression to cognitive impairment measured by a Clinical Dementia Rating greater than 0. Results Among the cohort of 7180 older adults (median age, 74 years [range, 65-102 years]; 4729 women [65.9%]), 1036 were African American or Black (14.4%), 21 were American Indian or Alaska Native (0.3%), 143 were Asian (2.0%), 332 were Hispanic (4.6%), and 5648 were non-Hispanic White (78.7%); the median educational level was 16.0 years (range, 1.0-29.0 years). After adjustment for selection basis using propensity score weighting, seizure was associated with a 40% higher risk of cognitive impairment (hazard ratio [HR], 1.40; 95% CI, 1.19-1.65), TBI with a 25% higher risk of cognitive impairment (HR, 1.25; 95% CI, 1.17-1.34), and both seizure and TBI were associated with a 57% higher risk (HR, 1.57; 95% CI, 1.23-2.01). The interaction models indicated that Hispanic participants with TBI and seizures had a higher risk of cognitive impairment compared with other racial and ethnic groups. The use of antiseizure medications (HR, 1.23; 95% CI, 0.99-1.53), antidepressants (HR, 1.32; 95% CI, 1.17-1.50), and antipsychotics (HR, 2.15; 95% CI, 1.18-3.89) was associated with a higher risk of cognitive impairment, while anxiolytic, sedative, or hypnotic use (HR, 0.88; 95% CI, 0.83-0.94) was associated with a lower risk. Conclusions and Relevance This study highlights the importance of addressing TBI and seizures as risk factors for cognitive impairment among older adults. Addressing the broader social determinants of health and bridging the health divide across various racial and ethnic groups are essential for the comprehensive management and prevention of dementia.
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Affiliation(s)
- Yiqi Zhu
- School of Social Work, Adelphi University, Garden City, New York
| | - Jonathan Williams
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Kebede Beyene
- Department of Pharmaceutical and Administrative Sciences, University of Health Sciences and Pharmacy in St Louis, St Louis, Missouri
| | - Jean-Francois Trani
- National Conservatory of Arts and Crafts, Paris, France
- Institute of Public Health, Washington University School of Medicine, St Louis, Missouri
- Department of Psychology, Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
- Brown School of Social Work, Washington University in St Louis, St Louis, Missouri
| | - Ganesh M. Babulal
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
- Institute of Public Health, Washington University School of Medicine, St Louis, Missouri
- Department of Psychology, Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, DC
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Smagula SF, Zhang G, Krafty RT, Ramos A, Sotres-Alvarez D, Rodakowski J, Gallo LC, Lamar M, Gujral S, Fischer D, Tarraf W, Mossavar-Rahmani Y, Redline S, Stone KL, Gonzalez HM, Patel SR. Sleep-wake behaviors associated with cognitive performance in middle-aged participants of the Hispanic Community Health Study/Study of Latinos. Sleep Health 2024; 10:500-507. [PMID: 38693044 PMCID: PMC11309910 DOI: 10.1016/j.sleh.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/26/2024] [Accepted: 02/20/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVES Many sleep-wake behaviors have been associated with cognition. We examined a panel of sleep-wake/activity characteristics to determine which are most robustly related to having low cognitive performance in midlife. Secondarily, we evaluate the predictive utility of sleep-wake measures to screen for low cognitive performance. METHODS The outcome was low cognitive performance defined as being >1 standard deviation below average age/sex/education internally normalized composite cognitive performance levels assessed in the Hispanic Community Health Study/Study of Latinos. Analyses included 1006 individuals who had sufficient sleep-wake measurements about 2years later (mean age=54.9, standard deviation= 5.1; 68.82% female). We evaluated associations of 31 sleep-wake variables with low cognitive performance using separate logistic regressions. RESULTS In individual models, the strongest sleep-wake correlates of low cognitive performance were measures of weaker and unstable 24-hour rhythms; greater 24-hour fragmentation; longer time-in-bed; and lower rhythm amplitude. One standard deviation worse on these sleep-wake factors was associated with ∼20%-30% greater odds of having low cognitive performance. In an internally cross-validated prediction model, the independent correlates of low cognitive performance were: lower Sleep Regularity Index scores; lower pseudo-F statistics (modellability of 24-hour rhythms); lower activity rhythm amplitude; and greater time in bed. Area under the curve was low/moderate (64%) indicating poor predictive utility. CONCLUSION The strongest sleep-wake behavioral correlates of low cognitive performance were measures of longer time-in-bed and irregular/weak rhythms. These sleep-wake assessments were not useful to identify previous low cognitive performance. Given their potential modifiability, experimental trials could test if targeting midlife time-in-bed and/or irregular rhythms influences cognition.
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Affiliation(s)
- Stephen F Smagula
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | - Gehui Zhang
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert T Krafty
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Alberto Ramos
- Department of Neurology, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Daniela Sotres-Alvarez
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Juleen Rodakowski
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Linda C Gallo
- Department of Psychology, University of California San Diego, San Diego, California, USA
| | - Melissa Lamar
- Institute of Minority Health Research, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA; Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Swathi Gujral
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Dorothee Fischer
- Department of Sleep and Human Factors Research, Institute for Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Wassim Tarraf
- Institute of Gerontology, Wayne State University, Detroit, Michigan, USA
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, New York, New York, USA
| | - Susan Redline
- Division of Sleep Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Katie L Stone
- California Pacific Medical Center Research Institute, San Francisco, California, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Hector M Gonzalez
- Department of Neurosciences and the Shiley-Marcos Alzheimer's Disease Research Center, UC San Diego, San Diego, California, USA
| | - Sanjay R Patel
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Ajrouch KJ, Tarraf W, Brauer S, Zahodne LB, Antonucci TC. Adapted MoCA for Use among Arabic-Speaking Immigrants in the United States. J Cross Cult Gerontol 2024:10.1007/s10823-024-09513-w. [PMID: 39083173 DOI: 10.1007/s10823-024-09513-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2024] [Indexed: 09/18/2024]
Abstract
OBJECTIVE Neuropsychological assessment among U.S. Arabic-speaking older adults is virtually non-existent due to lack of translated measures and normative data, as well as researchers' limited access to Middle Eastern/Arab Americans. The Montreal Cognitive Assessment (MoCA) is the only validated, widely-used dementia screen with Arabic language norms/cutoffs, yet, Arabic MoCA translations vary across countries and studies. We examined utility of a modified translation among Arabic-speaking immigrants in metro-Detroit. METHODS The Arabic MoCA was modified to reflect consistency with the original English version while remaining meaningful in the Arabic language. The MoCA was then administered to 32 Arabic-speaking adults age 65 + living in metro-Detroit. Eight (25%) had an Alzheimer's disease or related dementia (ADRD) diagnosis. Each item was standardized and Cronbach's alpha assessed reliability. Ordinary least squares models examined whether an ADRD diagnosis predicts the total MoCA score and each item, adjusting for demographics. RESULTS The mean age of the sample was 73 years old. The alpha was acceptably high at 0.87. Bivariate analyses show those with ADRD diagnosis scored lower overall on the MoCA. However, probability of diagnosis and age were confounded in the sample such that in multivariate analyses ADRD diagnosis did not explain additional variation beyond what is explained by age. Orientation, cube-copy test and serial 7s best distinguished those with ADRD. CONCLUSION The modified Arabic language MoCA shows promise distinguishing those with an ADRD diagnosis. This translation provides a resource for neuropsychologists looking for translated tests when working with Arabic-speaking patients in the U.S.
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Affiliation(s)
- Kristine J Ajrouch
- Institute for Social Research, University of Michigan, Ann Arbor, MI, 48104, USA.
- Department of Sociology, Anthropology and Criminology, Eastern Michigan University, Ypsilanti, MI, 48197, USA.
| | - Wassim Tarraf
- Institute of Gerontology & Department of Healthcare Sciences, Wayne State University, Detroit, MI, 48202, USA
| | - Simon Brauer
- Institute for Social Research, University of Michigan, Ann Arbor, MI, 48104, USA
| | - Laura B Zahodne
- Institute for Social Research, University of Michigan, Ann Arbor, MI, 48104, USA
- Department of Psychology, University of Michigan, Ann Arbor, MI, 48104, USA
| | - Toni C Antonucci
- Institute for Social Research, University of Michigan, Ann Arbor, MI, 48104, USA
- Department of Psychology, University of Michigan, Ann Arbor, MI, 48104, USA
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Seo DH, Kim M, Cho Y, Ahn SH, Hong S, Kim SH. Association between Age at Diagnosis of Type 2 Diabetes and Subsequent Risk of Dementia and Its Major Subtypes. J Clin Med 2024; 13:4386. [PMID: 39124653 PMCID: PMC11313191 DOI: 10.3390/jcm13154386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 07/01/2024] [Accepted: 07/12/2024] [Indexed: 08/12/2024] Open
Abstract
Background/Objectives: Type 2 diabetes mellitus (T2DM) is a major contributor to cognitive decline and dementia in older adults; however, the role of the age of onset of T2DM in younger patients remains uncertain. We explored the association between the risk of dementia and its subtypes in relation to the age at T2DM diagnosis. Methods: This population cohort study included a total of 612,201 newly diagnosed T2DM patients. The controls were randomly selected from the general population and matched at a 1:2 ratio based on the propensity score. The outcomes of interest were all-cause dementia, Alzheimer's disease (AD), and vascular dementia (VD). The association of T2DM with dementia was stratified by the age at diagnosis of T2DM. Results: The mean ages of the subjects in the T2DM and control groups were 55.7 ± 13.0 and 55.7 ± 13.0. The patients with T2DM diagnosed at <50 years had the highest excess risk for most outcomes relative to the controls, with a hazard ratio (HR) (95% CI) of 3.29 (3.11-3.49) for all-cause dementia, 4.08 (3.18-5.24) for AD, and 5.82 (3.84-8.81) for VD. All risks were attenuated progressively with each increasing decade at the diagnostic age, but remained significant; for T2DM diagnosed at ≥80 years, the HR (95% CI) was 1.38 (1.34-1.41) for all-cause dementia, 1.35 (1.31-1.40) for AD, and 1.98 (1.70-2.30) for VD. Conclusions: We need to stratify T2DM management according to the age of diagnosis. Physicians should closely monitor cognitive function in patients with T2DM, especially in younger individuals.
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Affiliation(s)
- Da Hea Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon 22332, Republic of Korea; (D.H.S.); (Y.C.)
| | - Mina Kim
- Department of Data Science, Hanmi Pharmaceutical Company Limited, Seoul 05545, Republic of Korea;
| | - Yongin Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon 22332, Republic of Korea; (D.H.S.); (Y.C.)
| | - Seong Hee Ahn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon 22332, Republic of Korea; (D.H.S.); (Y.C.)
| | - Seongbin Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon 22332, Republic of Korea; (D.H.S.); (Y.C.)
| | - So Hun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon 22332, Republic of Korea; (D.H.S.); (Y.C.)
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Magana-Ramirez CM, Irizarry-Martinez G, Gillen DL, Grill JD. Reasons for undergoing amyloid imaging among diverse enrollees in the A4 study. Alzheimers Dement 2024. [PMID: 39041310 DOI: 10.1002/alz.14077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Understanding attitudes toward participation among diverse preclinical Alzheimer's disease (AD) trial participants could yield insights to instruct future recruitment. METHODS Using data from the Anti-Amyloid Treatment in Asymptomatic AD (A4) Study, we examined differences among mutually exclusive racial and ethnic groups in views and perceptions of amyloid imaging (VPAI), a measure of motivations to undergo amyloid biomarker testing in the setting of preclinical AD. We used linear regression to quantify differences at baseline. RESULTS Compared to non-Hispanic or Latino (NH) White participants, Hispanic or Latino (3.52 points, 95% confidence interval [CI]: [2.61, 4.42]); NH Asian (2.97 points, 95% CI: [1.71, 4.22]); and NH Black participants (2.79 points, 95% CI: [1.96, 3.63]) participants demonstrated higher levels of endorsement of the VPAI items at baseline. DISCUSSION Differences may exist among participants from differing ethnic and racial groups in motivations to undergo biomarker testing in the setting of a preclinical AD trial. HIGHLIGHTS Representative samples in AD clinical trials are vital to result in generalizability. We assessed motivations to undergo amyloid imaging in a preclinical AD trial. Racial and ethnic minority groups showed higher endorsement of VPAI items. Differences were driven by perceived risk, plan/prepare, and curiosity domains. Few observations among racial and ethnic groups changed after biomarker disclosure.
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Affiliation(s)
- Christina M Magana-Ramirez
- Department of Statistics, Donald Bren School of Information and Computer Sciences, University of California, Irvine, California, USA
| | | | - Daniel L Gillen
- Department of Statistics, Donald Bren School of Information and Computer Sciences, University of California, Irvine, California, USA
- Alzheimer's Disease Research Center, University of California, Irvine, California, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, California, USA
| | - Joshua D Grill
- Department of Neurobiology and Behavior, University of California, Irvine, California, USA
- Alzheimer's Disease Research Center, University of California, Irvine, California, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, California, USA
- Department of Psychiatry and Human Behavior, University of California, Irvine, California, USA
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Wei J, Lohman MC, Brown MJ, Hardin JW, Yang CH, Merchant AT, Friedman DB. Modifiable and Non-Modifiable Risk Factors for Dementia Among Non-Hispanic White and Black Populations Aged 50-64 in the United States, 2006-2016. J Geriatr Psychiatry Neurol 2024:8919887241267315. [PMID: 39037016 DOI: 10.1177/08919887241267315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
BACKGROUND AND OBJECTIVES Non-Hispanic Black populations (NHB) have a significantly higher prevalence of dementia than non-Hispanic Whites in the U.S., and the underlying risk factors may play a role in this racial disparity. We aimed to calculate risk scores for dementia among non-Hispanic White (NHW) and non-Hispanic Black populations aged 50-64 years over a period of 10 years, and to estimate potential differences of scores between NHW and NHB. RESEARCH DESIGN AND METHODS The Health and Retirement Study from 2006 to 2016 was used to calculate the Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) risk score, a validated score for predicting dementia risk. Weighted average CAIDE score, as well as CAIDE score for modifiable factors hypertension, obese, hypercholesterolemia, physical inactivity), and non-modifiable factors (age, sex, education) were calculated for adults aged 50-64 years with normal cognition for 2006-2008, 2010-2012, 2014-2016. The associations of race with CAIDE score and elevated CAIDE score were examined. RESULTS A total of 10,871 participants were included in the analysis. The CAIDE score showed declining trends for NHB from 2006 to 2016, while NHB consistently had a higher total CAIDE score and CAIDE score for modifiable factors from 2006 to 2016, but not for non-modifiable factors. DISCUSSION AND IMPLICATIONS NHB had a higher level of dementia risk factors than NHW among adults aged 50-64 years in the U.S. from 2006 to 2016, and the difference is attributable to modifiable risk factors, which holds promise for risk reduction of dementia.
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Affiliation(s)
- Jingkai Wei
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- The Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Matthew C Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- The Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Monique J Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- The Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - James W Hardin
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Chih-Hsiang Yang
- The Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- The Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Daniela B Friedman
- The Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Health Promotion, Education, Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Sundman MH, Green JM, Fuglevand AJ, Chou YH. TMS-derived short afferent inhibition discriminates cognitive status in older adults without dementia. AGING BRAIN 2024; 6:100123. [PMID: 39132326 PMCID: PMC11315225 DOI: 10.1016/j.nbas.2024.100123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 06/29/2024] [Accepted: 07/14/2024] [Indexed: 08/13/2024] Open
Abstract
Aging is a complex and diverse biological process characterized by progressive molecular, cellular, and tissue damage, resulting in a loss of physiological integrity and heightened vulnerability to pathology. This biological diversity corresponds with highly variable cognitive trajectories, which are further confounded by genetic and environmental factors that influence the resilience of the aging brain. Given this complexity, there is a need for neurophysiological indicators that not only discern physiologic and pathologic aging but also closely align with cognitive trajectories. Transcranial Magnetic Stimulation (TMS) may have utility in this regard as a non-invasive brain stimulation tool that can characterize features of cortical excitability. Particularly, as a proxy for central cholinergic function, short-afferent inhibition (SAI) dysfunction is robustly associated with cognitive deficits in the latter stages of Alzheimer's Disease and Related Dementia (ADRD). In this study, we evaluated SAI in healthy young adults and older adults who, though absent clinical diagnoses, were algorithmically classified as cognitively normal (CN) or cognitively impaired (CI) according to the Jak/Bondi actuarial criteria. We report that SAI is preserved in the Old-CN cohort relative to the young adults, and SAI is significantly diminished in the Old-CI cohort relative to both young and CN older adults. Additionally, diminished SAI was significantly associated with impaired sustained attention and working memory. As a proxy measure for central cholinergic deficits, we discuss the potential value of SAI for discerning physiological and pathological aging.
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Affiliation(s)
- Mark H. Sundman
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
| | - Jacob M. Green
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
| | - Andrew J. Fuglevand
- Department of Physiology, College of Medicine, University of Arizona, Tucson, AZ 85721, USA
- Department of Neuroscience, College of Medicine, University of Arizona, Tucson, AZ 85721, USA
| | - Ying-hui Chou
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
- Evelyn F McKnight Brain Institute, Arizona Center on Aging, and BIO5 Institute, University of Arizona, Tucson, AZ 85721, USA
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Cho H, Kim KM, Kim JY, Youn BY. Twitter Discussions on #digitaldementia: Content and Sentiment Analysis. J Med Internet Res 2024; 26:e59546. [PMID: 39012679 PMCID: PMC11289583 DOI: 10.2196/59546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/30/2024] [Accepted: 06/24/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Digital dementia is a term that describes a possible decline in cognitive abilities, especially memory, attributed to the excessive use of digital technology such as smartphones, computers, and tablets. This concept has gained popularity in public discourse and media lately. With the increasing use of social media platforms such as Twitter (subsequently rebranded as X), discussions about digital dementia have become more widespread, which offer a rich source of information to understand public perceptions, concerns, and sentiments regarding this phenomenon. OBJECTIVE The aim of this research was to delve into a comprehensive content and sentiment analysis of Twitter discussions regarding digital dementia using the hashtag #digitaldementia. METHODS Retrospectively, publicly available English-language tweets with hashtag combinations related to the topic of digital dementia were extracted from Twitter. The tweets were collected over a period of 15 years, from January 1, 2008, to December 31, 2022. Content analysis was used to identify major themes within the tweets, and sentiment analysis was conducted to understand the positive and negative emotions associated with these themes in order to gain a better understanding of the issues surrounding digital dementia. A one-way ANOVA was performed to gather detailed statistical insights regarding the selected tweets from influencers within each theme. RESULTS This study was conducted on 26,290 tweets over 15 years by 5123 Twitter users, mostly female users in the United States. The influencers had followers ranging from 20,000 to 1,195,000 and an average of 214,878 subscribers. The study identified four themes regarding digital dementia after analyzing tweet content: (1) cognitive decline, (2) digital dependency, (3) technology overload, and (4) coping strategies. Categorized according to Glaser and Strauss's classifications, most tweets (14,492/26,290, 55.12%) fell under the categories of wretched (purely negative) or bad (mostly negative). However, only a small proportion of tweets (3122/26,290, 11.86%) were classified as great (purely positive) or swell sentiment (mostly positive). The ANOVA results showed significant differences in mean sentiment scores among the themes (F3,3581=29.03; P<.001). The mean sentiment score was -0.1072 (SD 0.4276). CONCLUSIONS Various negative tweets have raised concerns about the link between excessive use of digital devices and cognitive decline, often known as digital dementia. Of particular concern is the rapid increase in digital device use. However, some positive tweets have suggested coping strategies. Engaging in digital detox activities, such as increasing physical exercise and participating in yoga and meditation, could potentially help prevent cognitive decline.
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Affiliation(s)
- Hyeongchan Cho
- Department of Business Administration, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Kyu-Min Kim
- Department of Health Administration, Gyeonggi University of Science and Technology, Gyeonggi-do, Republic of Korea
| | - Jee-Young Kim
- Medical R&D Center, Bodyfriend Co Ltd, Seoul, Republic of Korea
| | - Bo-Young Youn
- Department of Bio-Healthcare, Hwasung Medi-Science University, Gyeonggi-do, Republic of Korea
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Jiang JW, Jian ZC, Waye MMY, Liang WC, Li MX, Shen XP, Rao ST. Editorial: Decipherment of genetic architecture of psychiatric disorders via combination of multi-omics data. Front Genet 2024; 15:1430517. [PMID: 39045322 PMCID: PMC11263200 DOI: 10.3389/fgene.2024.1430517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 06/26/2024] [Indexed: 07/25/2024] Open
Affiliation(s)
- Jian-Wei Jiang
- Department of Bioinformatics, Fujian Key Laboratory of Medical Bioinformatics, Institute of Precision Medicine, School of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
| | - Zhong-Cheng Jian
- Department of Pediatrics, Longyan People Hospital of Fujian, Longyan, China
| | - Mary Miu Yee Waye
- Croucher Laboratory for Human Genomics, The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Wei-Cheng Liang
- Vaccine Research Institute, The Third Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China
| | - Miao-Xin Li
- Zhongshan School of Medicine, Center for Precision Medicine, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Tropical Disease Control (SYSU), Ministry of Education, Guangzhou, China
| | - Xiao-Pei Shen
- Department of Bioinformatics, Fujian Key Laboratory of Medical Bioinformatics, Institute of Precision Medicine, School of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
| | - Shi-Tao Rao
- Department of Bioinformatics, Fujian Key Laboratory of Medical Bioinformatics, Institute of Precision Medicine, School of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
- School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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