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Elliot V, Kosteniuk J, O'Connell ME, Cameron C, Morgan D. Services for older adults in rural primary care memory clinic communities and surrounding areas: a qualitative descriptive study. BMC Health Serv Res 2024; 24:725. [PMID: 38872136 PMCID: PMC11170901 DOI: 10.1186/s12913-024-11167-w] [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: 02/13/2024] [Accepted: 06/03/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND/OBJECTIVES As part of a larger study, and in collaboration with rural primary health care teams, RaDAR (Rural Dementia Action Research) primary care memory clinics have evolved and continue to spread in communities across southeast Saskatchewan, Canada. This study focuses on the geographical areas of the four communities where RaDAR memory clinics were first developed and implemented and describes the services and supports available to older adults including memory clinic patients and families living in these areas. Our goal was to identify and describe existing programs and gaps, create inventories and maps, and explore the service experiences of family caregivers of people living with dementia in these rural areas. METHODS Using a qualitative descriptive design, an environmental scan of services was conducted from December 2020 to April 2021 using focus groups (n = 4) with health care providers/managers (n = 12), a secondary source (e.g., program brochures) review, and a systematic internet search targeting four RaDAR memory clinic communities and surrounding areas via community websites, online resources, and the 211 Saskatchewan service database. Data were analyzed using content analysis; findings informed semi-structured interviews with caregivers (n = 5) conducted from March to July 2022, which were analyzed thematically. Geographic areas explored in this study covered an area of approximately 5666 km2. RESULTS From the scan, 43 services were identified, categorized into 7 service types, and mapped by location. Seventeen services were dementia-related. Services included social/leisure activities (n = 14), general support/referrals (n = 13), transportation (n = 7), information/education (n = 4), respite (n = 2), in-home care (n = 2), and safety (n = 1). Service levels included local (n = 24), provincial (n = 17), and national (n = 2), and were offered in-person, remotely (or both) with 20 services across 4 service types offered remotely. In general, most services had no fees, involved self-referral, and providers had a range of education/training. Key interview themes reflected the need for locally available, accessible services that offer (i) individualized, flexible, needs-based approaches, (ii) in-home care and continuity of care, and (iii) both formal and informal supports. Key gaps were identified, including (i) locally accessible, available services and resources in general, (ii) dementia-related training and education for service providers, and (iii) awareness of available services. Benefits of services, consequences of gaps, and recommendations to address gaps were reported. In general, service providers and program participants were an even mix of females and males, and program content was gender neutral. CONCLUSIONS Findings highlight a range of available services, and a number of varied service-user experiences and perspectives, in these rural areas. Key service gaps were identified, and caregivers made some specific recommendations to address these gaps. Findings underscore multiple opportunities to inform service delivery and program participation for rural and remote people living with dementia and their families.
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Affiliation(s)
- Valerie Elliot
- Canadian Centre for Rural and Agricultural Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, Saskatchewan (SK), SK S7N 2Z4, Canada.
| | - Julie Kosteniuk
- Canadian Centre for Rural and Agricultural Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, Saskatchewan (SK), SK S7N 2Z4, Canada
| | - Megan E O'Connell
- Department of Psychology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Chelsie Cameron
- Canadian Centre for Rural and Agricultural Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, Saskatchewan (SK), SK S7N 2Z4, Canada
| | - Debra Morgan
- Canadian Centre for Rural and Agricultural Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, Saskatchewan (SK), SK S7N 2Z4, Canada
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Neale N, Lona-Durazo F, Ryten M, Gagliano Taliun SA. Leveraging sex-genetic interactions to understand brain disorders: recent advances and current gaps. Brain Commun 2024; 6:fcae192. [PMID: 38894947 PMCID: PMC11184352 DOI: 10.1093/braincomms/fcae192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/11/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
It is established that there are sex differences in terms of prevalence, age of onset, clinical manifestations, and response to treatment for a variety of brain disorders, including neurodevelopmental, psychiatric, and neurodegenerative disorders. Cohorts of increasing sample sizes with diverse data types collected, including genetic, transcriptomic and/or phenotypic data, are providing the building blocks to permit analytical designs to test for sex-biased genetic variant-trait associations, and for sex-biased transcriptional regulation. Such molecular assessments can contribute to our understanding of the manifested phenotypic differences between the sexes for brain disorders, offering the future possibility of delivering personalized therapy for females and males. With the intention of raising the profile of this field as a research priority, this review aims to shed light on the importance of investigating sex-genetic interactions for brain disorders, focusing on two areas: (i) variant-trait associations and (ii) transcriptomics (i.e. gene expression, transcript usage and regulation). We specifically discuss recent advances in the field, current gaps and provide considerations for future studies.
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Affiliation(s)
- Nikita Neale
- Faculty of Medicine, Université de Montréal, Québec, H3C 3J7 Canada
| | - Frida Lona-Durazo
- Faculty of Medicine, Université de Montréal, Québec, H3C 3J7 Canada
- Research Centre, Montreal Heart Institute, Québec, H1T 1C8 Canada
| | - Mina Ryten
- Department of Genetics and Genomic Medicine, Great Ormond Street Institute of Child Health, WC1N 1EH London, UK
- Aligning Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, 20815 MD, USA
- NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health, Bloomsbury, WC1N 1EH London, UK
| | - Sarah A Gagliano Taliun
- Research Centre, Montreal Heart Institute, Québec, H1T 1C8 Canada
- Department of Medicine & Department of Neurosciences, Faculty of Medicine, Université de Montréal, Québec, H3C 3J7 Canada
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Bohn L, Drouin SM, McFall GP, Rolfson DB, Andrew MK, Dixon RA. Machine learning analyses identify multi-modal frailty factors that selectively discriminate four cohorts in the Alzheimer's disease spectrum: a COMPASS-ND study. BMC Geriatr 2023; 23:837. [PMID: 38082372 PMCID: PMC10714519 DOI: 10.1186/s12877-023-04546-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Frailty indicators can operate in dynamic amalgamations of disease conditions, clinical symptoms, biomarkers, medical signals, cognitive characteristics, and even health beliefs and practices. This study is the first to evaluate which, among these multiple frailty-related indicators, are important and differential predictors of clinical cohorts that represent progression along an Alzheimer's disease (AD) spectrum. We applied machine-learning technology to such indicators in order to identify the leading predictors of three AD spectrum cohorts; viz., subjective cognitive impairment (SCI), mild cognitive impairment (MCI), and AD. The common benchmark was a cohort of cognitively unimpaired (CU) older adults. METHODS The four cohorts were from the cross-sectional Comprehensive Assessment of Neurodegeneration and Dementia dataset. We used random forest analysis (Python 3.7) to simultaneously test the relative importance of 83 multi-modal frailty indicators in discriminating the cohorts. We performed an explainable artificial intelligence method (Tree Shapley Additive exPlanation values) for deep interpretation of prediction effects. RESULTS We observed strong concurrent prediction results, with clusters varying across cohorts. The SCI model demonstrated excellent prediction accuracy (AUC = 0.89). Three leading predictors were poorer quality of life ([QoL]; memory), abnormal lymphocyte count, and abnormal neutrophil count. The MCI model demonstrated a similarly high AUC (0.88). Five leading predictors were poorer QoL (memory, leisure), male sex, abnormal lymphocyte count, and poorer self-rated eyesight. The AD model demonstrated outstanding prediction accuracy (AUC = 0.98). Ten leading predictors were poorer QoL (memory), reduced olfaction, male sex, increased dependence in activities of daily living (n = 6), and poorer visual contrast. CONCLUSIONS Both convergent and cohort-specific frailty factors discriminated the AD spectrum cohorts. Convergence was observed as all cohorts were marked by lower quality of life (memory), supporting recent research and clinical attention to subjective experiences of memory aging and their potentially broad ramifications. Diversity was displayed in that, of the 14 leading predictors extracted across models, 11 were selectively sensitive to one cohort. A morbidity intensity trend was indicated by an increasing number and diversity of predictors corresponding to clinical severity, especially in AD. Knowledge of differential deficit predictors across AD clinical cohorts may promote precision interventions.
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Affiliation(s)
- Linzy Bohn
- Department of Psychology, University of Alberta, P217 Biological Sciences Building, Edmonton, AB, T6G 2E9, Canada.
- Neuroscience and Mental Health Institute, University of Alberta, 2-132 Li Ka Shing Center for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada.
| | - Shannon M Drouin
- Department of Psychology, University of Alberta, P217 Biological Sciences Building, Edmonton, AB, T6G 2E9, Canada
- Neuroscience and Mental Health Institute, University of Alberta, 2-132 Li Ka Shing Center for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada
| | - G Peggy McFall
- Department of Psychology, University of Alberta, P217 Biological Sciences Building, Edmonton, AB, T6G 2E9, Canada
- Neuroscience and Mental Health Institute, University of Alberta, 2-132 Li Ka Shing Center for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada
| | - Darryl B Rolfson
- Department of Medicine, Division of Geriatric Medicine, University of Alberta, 13-135 Clinical Sciences Building, Edmonton, AB, T6G 2G3, Canada
| | - Melissa K Andrew
- Department of Medicine, Division of Geriatric Medicine, Dalhousie University, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada
| | - Roger A Dixon
- Department of Psychology, University of Alberta, P217 Biological Sciences Building, Edmonton, AB, T6G 2E9, Canada
- Neuroscience and Mental Health Institute, University of Alberta, 2-132 Li Ka Shing Center for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada
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Hu S, Patten S, Charlton A, Fischer K, Fick G, Smith EE, Ismail Z. Validating the Mild Behavioral Impairment Checklist in a Cognitive Clinic: Comparisons With the Neuropsychiatric Inventory Questionnaire. J Geriatr Psychiatry Neurol 2023; 36:107-120. [PMID: 35430902 PMCID: PMC9941652 DOI: 10.1177/08919887221093353] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To compare the utility of the Mild Behavioral Impairment-Checklist (MBI-C) and Neuropsychiatric Inventory Questionnaire (NPI-Q) to capture NPS in subjective cognitive decline (SCD), mild cognitive impairment (MCI), and dementia. METHODS In this cross-sectional memory clinic study, linear regression models compared MBI-C (n = 474) and NPI-Q (n = 1040) scores in relation to Montreal Cognitive Assessment (MoCA) score. RESULTS MBI prevalence was 37% in subjective cognitive decline, 54% in mild cognitive impairment, and 62% in dementia. Worse diagnostic status was associated with higher MBI-C and NPI-Q score (P < .001), lower MoCA (P < .001), and greater age (P < .001). Higher MBI-C (β -.09; 95% CI -.13, -.05) and NPI-Q (β -.17; 95% CI -.23, -.10) scores were associated with lower MoCA scores, with psychosis most strongly associated (β -1.11; 95% CI -1.56, -.65 vs β -1.14; 95% CI -1.55, -.73). CONCLUSIONS The MBI-C captures global and domain-specific NPS across cognitive stages. Both the MBI-C and NPI-Q have utility in characterizing NPS.
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Affiliation(s)
- Sophie Hu
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Scott Patten
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Anna Charlton
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Karyn Fischer
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Gordon Fick
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Eric E. Smith
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Zahinoor Ismail
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Zahinoor Ismail, MD, Hotchkiss Brain Institute, University of Calgary, 3280 Hospital Drive NW, TRW Building 1st Floor Calgary, AB T2N 4Z6, Canada.
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Reavis KM, Bisgaard N, Canlon B, Dubno JR, Frisina RD, Hertzano R, Humes LE, Mick P, Phillips NA, Pichora-Fuller MK, Shuster B, Singh G. Sex-Linked Biology and Gender-Related Research Is Essential to Advancing Hearing Health. Ear Hear 2023; 44:10-27. [PMID: 36384870 PMCID: PMC10234332 DOI: 10.1097/aud.0000000000001291] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
There is robust evidence that sex (biological) and gender (behavioral/social) differences influence hearing loss risk and outcomes. These differences are noted for animals and humans-in the occurrence of hearing loss, hearing loss progression, and response to interventions. Nevertheless, many studies have not reported or disaggregated data by sex or gender. This article describes the influence of sex-linked biology (specifically sex-linked hormones) and gender on hearing and hearing interventions, including the role of sex-linked biology and gender in modifying the association between risk factors and hearing loss, and the effects of hearing loss on quality of life and functioning. Most prevalence studies indicate that hearing loss begins earlier and is more common and severe among men than women. Intrinsic sex-linked biological differences in the auditory system may account, in part, for the predominance of hearing loss in males. Sex- and gender-related differences in the effects of noise exposure or cardiovascular disease on the auditory system may help explain some of these differences in the prevalence of hearing loss. Further still, differences in hearing aid use and uptake, and the effects of hearing loss on health may also vary by sex and gender. Recognizing that sex-linked biology and gender are key determinants of hearing health, the present review concludes by emphasizing the importance of a well-developed research platform that proactively measures and assesses sex- and gender-related differences in hearing, including in understudied populations. Such research focus is necessary to advance the field of hearing science and benefit all members of society.
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Affiliation(s)
- Kelly M Reavis
- VA RR&D National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon, USA.,OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Barbara Canlon
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Judy R Dubno
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Robert D Frisina
- Department of Medical Engineering and Communication Sciences & Disorders, University of South Florida, Tampa, Florida, USA
| | - Ronna Hertzano
- Department of Otorhinolaryngology Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Institute for Genome Science, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Larry E Humes
- Department of Speech, Language and Hearing Sciences, Indiana University, Bloomington, Indiana, USA
| | - Paul Mick
- Department of Surgery, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Natalie A Phillips
- Department of Psychology, Concordia University, Montréal, Québec, Canada
| | | | - Benjamin Shuster
- Department of Otorhinolaryngology Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Does the Gut Microbial Metabolome Really Matter? The Connection between GUT Metabolome and Neurological Disorders. Nutrients 2022; 14:nu14193967. [PMID: 36235622 PMCID: PMC9571089 DOI: 10.3390/nu14193967] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/30/2022] Open
Abstract
Herein we gathered updated knowledge regarding the alterations of gut microbiota (dysbiosis) and its correlation with human neurodegenerative and brain-related diseases, e.g., Alzheimer’s and Parkinson’s. This review underlines the importance of gut-derived metabolites and gut metabolic status as the main players in gut-brain crosstalk and their implications on the severity of neural conditions. Scientific evidence indicates that the administration of probiotic bacteria exerts beneficial and protective effects as reduced systemic inflammation, neuroinflammation, and inhibited neurodegeneration. The experimental results performed on animals, but also human clinical trials, show the importance of designing a novel microbiota-based probiotic dietary supplementation with the aim to prevent or ease the symptoms of Alzheimer’s and Parkinson’s diseases or other forms of dementia or neurodegeneration.
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Heal M, McFall GP, Vergote D, Jhamandas JH, Westaway D, Dixon RA. Bridging Integrator 1 (BIN1, rs6733839) and Sex Are Moderators of Vascular Health Predictions of Memory Aging Trajectories. J Alzheimers Dis 2022; 89:265-281. [DOI: 10.3233/jad-220334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: A promising risk loci for sporadic Alzheimer’s disease (AD), Bridging Integrator 1 (BIN1), is thought to operate through the tau pathology pathway. Objective: We examine BIN1 risk for a moderating role with vascular health (pulse pressure; PP) and sex in predictions of episodic memory trajectories in asymptomatic aging adults. Methods: The sample included 623 participants (Baseline Mean age = 70.1; 66.8% female) covering a 44-year longitudinal band (53–97 years). With an established memory latent variable arrayed as individualized trajectories, we applied Mplus 8.5 to determine the best fitting longitudinal growth model. Main analyses were conducted in three sequential phases to investigate: 1) memory trajectory prediction by PP, 2) moderation by BIN1 genetic risk, and 3) stratification by sex. Results: We first confirmed that good vascular health (lower PP) was associated with higher memory level and shallower decline and males were more severely affected by worsening PP in both memory performance and longitudinal decline. Second, the PP prediction of memory trajectories was significant for BIN1 C/C and C/T carriers but not for persons with the highest AD risk (T/T homozygotes). Third, when further stratified by sex, the BIN1 moderation of memory prediction by PP was selective for females. Conclusion: We observed a novel interaction whereby BIN1 (linked with tauopathy in AD) and sex sequentially moderated a benchmark PP prediction of differential memory decline in asymptomatic aging. This multi-modal biomarker interaction approach, disaggregated by sex, can be an effective method for enhancing precision of AD genetic risk assessment.
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Affiliation(s)
- Mackenzie Heal
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
| | - G. Peggy McFall
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
- Department of Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - David Vergote
- Faculté Saint-Jean, University of Alberta, Edmonton, Alberta, Canada
| | - Jack H. Jhamandas
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada
| | - David Westaway
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
- Center for Prions and Protein Folding Diseases, University of Alberta, Edmonton, Alberta, Canada
| | - Roger A. Dixon
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
- Department of Psychology, University of Alberta, Edmonton, Alberta, Canada
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Dadar M, Camicioli R, Duchesne S. Multi sequence average templates for aging and neurodegenerative disease populations. Sci Data 2022; 9:238. [PMID: 35624290 PMCID: PMC9142602 DOI: 10.1038/s41597-022-01341-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 05/03/2022] [Indexed: 11/20/2022] Open
Abstract
Magnetic resonance image (MRI) processing pipelines use average templates to enable standardization of individual MRIs in a common space. MNI-ICBM152 is currently used as the standard template by most MRI processing tools. However, MNI-ICBM152 represents an average of 152 healthy young adult brains and is vastly different from brains of patients with neurodegenerative diseases. In those populations, extensive atrophy might cause inevitable registration errors when using an average template of young healthy individuals for standardization. Disease-specific templates that represent the anatomical characteristics of the populations can reduce such errors and improve downstream driven estimates. We present multi-sequence average templates for Alzheimer's Dementia (AD), Fronto-temporal Dementia (FTD), Lewy Body Dementia (LBD), Mild Cognitive Impairment (MCI), cognitively intact and impaired Parkinson's Disease patients (PD-CIE and PD-CI, respectively), individuals with Subjective Cognitive Impairment (SCI), AD with vascular contribution (V-AD), Vascular Mild Cognitive Impairment (V-MCI), Cognitively Intact Elderly (CIE) individuals, and a human phantom. We also provide separate templates for males and females to allow better representation of the diseases in each sex group.
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Affiliation(s)
- Mahsa Dadar
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada.
| | - Richard Camicioli
- Department of Medicine, Division of Neurology, University of Alberta, Edmonton, AB, Canada
| | - Simon Duchesne
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada
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Factors influencing sustainability and scale-up of rural primary healthcare memory clinics: perspectives of clinic team members. BMC Health Serv Res 2022; 22:148. [PMID: 35120516 PMCID: PMC8814777 DOI: 10.1186/s12913-022-07550-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 01/24/2022] [Indexed: 12/03/2022] Open
Abstract
Background The aging of rural populations contributes to growing numbers of people with dementia in rural areas. Despite the key role of primary healthcare in rural settings there is limited research on effective models for dementia care, or evidence on sustaining and scaling them. The purpose of this study was to identify factors influencing sustainability and scale-up of rural primary care based memory clinics from the perspective of healthcare providers involved in their design and delivery. Methods Participants were members of four interdisciplinary rural memory clinic teams in the Canadian province of Saskatchewan. A qualitative cross-sectional and retrospective study design was conducted. Data were collected via 6 focus groups (n = 40) and 16 workgroup meetings held with teams over 1 year post-implementation (n = 100). An inductive thematic analysis was used to identify themes. Results Eleven themes were identified (five that influenced both sustainability and scale-up, three related to sustainability, and three related to scale-up), encompassing team, organizational, and intervention-based factors. Factors that influenced both sustainability and scale-up were positive outcomes for patients and families, access to well-developed clinic processes and tools, a confident clinic leader-champion, facilitation by local facilitators and the researchers, and organizational and leadership support. Study findings revealed the importance of particular factors in the rural context, including facilitation to support team activities, a proven ready-to-use model, continuity of team members, and mentoring. Conclusions Interdisciplinary models of dementia care are feasible in rural settings if the right conditions and supports are maintained. Team-based factors were key to sustaining and scaling the innovation. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07550-0.
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Drouin SM, McFall GP, Dixon RA. Subjective memory concerns, poor vascular health, and male sex predict exacerbated memory decline trajectories: An integrative data-driven class and prediction analysis. Neuropsychology 2022; 36:128-139. [PMID: 34793183 PMCID: PMC9991483 DOI: 10.1037/neu0000784] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Subjective memory decline (SMD) has been identified as a potential early marker of nonnormal and accelerated cognitive decline. We performed data-driven analyses that integrated trajectory classification with prediction modeling to test declining trajectory class prediction by SMD facets, pulse pressure (PP; i.e., a robust proxy for vascular health), and sex. METHOD The longitudinal design featured memory trajectories across a 40-year band (55-95 years) of nondemented aging (N = 580; Mage = 70.2 years; 65% female) from the Victoria Longitudinal Study. First, latent class growth analyses identified distinct classes of memory trajectories. Second, we used the three-step method (R3STEP) to predict membership in the declining memory classes using six measures: memory complaints, memory concerns, memory compensation, memory self-efficacy, PP, and sex. RESULTS First, we identified four classes of memory aging trajectories: (a) stable memory aging (STABLE), (b) typical memory aging (TYPICAL), (c) slowly declining memory aging (SLOW), and (d) rapidly declining memory aging (RAPID). Second, more memory concerns predicted membership in the SLOW and RAPID classes. Higher PP predicted membership in the SLOW class. Male sex predicted membership in the declining (TYPICAL, SLOW, RAPID) classes. CONCLUSION Among SMD facets, memory concerns represent the most severe degree of apprehension about subjectively experienced memory losses. The present integrative data-driven analysis indicated that such concerns predicted membership in declining memory trajectory classes in addition to worse vascular health (higher PP) and sex (male). In nondemented aging, concerns about increasing memory failures may be veridical indicators of memory loss, especially when coupled with vascular comorbidity and being male. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Shannon M. Drouin
- Department of Psychology, University of Alberta, Edmonton AB T6G 2E1 Canada
| | - G. Peggy McFall
- Department of Psychology, University of Alberta, Edmonton AB T6G 2E1 Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton AB T6G 2E1 Canada
| | - Roger A. Dixon
- Department of Psychology, University of Alberta, Edmonton AB T6G 2E1 Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton AB T6G 2E1 Canada
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Sapkota S, McFall GP, Masellis M, Dixon RA. A Multimodal Risk Network Predicts Executive Function Trajectories in Non-demented Aging. Front Aging Neurosci 2021; 13:621023. [PMID: 34603005 PMCID: PMC8482841 DOI: 10.3389/fnagi.2021.621023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 08/24/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Multiple modalities of Alzheimer's disease (AD) risk factors may operate through interacting networks to predict differential cognitive trajectories in asymptomatic aging. We test such a network in a series of three analytic steps. First, we test independent associations between three risk scores (functional-health, lifestyle-reserve, and a combined multimodal risk score) and cognitive [executive function (EF)] trajectories. Second, we test whether all three associations are moderated by the most penetrant AD genetic risk [Apolipoprotein E (APOE) ε4+ allele]. Third, we test whether a non-APOE AD genetic risk score further moderates these APOE × multimodal risk score associations. Methods: We assembled a longitudinal data set (spanning a 40-year band of aging, 53-95 years) with non-demented older adults (baseline n = 602; Mage = 70.63(8.70) years; 66% female) from the Victoria Longitudinal Study (VLS). The measures included for each modifiable risk score were: (1) functional-health [pulse pressure (PP), grip strength, and body mass index], (2) lifestyle-reserve (physical, social, cognitive-integrative, cognitive-novel activities, and education), and (3) the combination of functional-health and lifestyle-reserve risk scores. Two AD genetic risk markers included (1) APOE and (2) a combined AD-genetic risk score (AD-GRS) comprised of three single nucleotide polymorphisms (SNPs; Clusterin[rs11136000], Complement receptor 1[rs6656401], Phosphatidylinositol binding clathrin assembly protein[rs3851179]). The analytics included confirmatory factor analysis (CFA), longitudinal invariance testing, and latent growth curve modeling. Structural path analyses were deployed to test and compare prediction models for EF performance and change. Results: First, separate analyses showed that higher functional-health risk scores, lifestyle-reserve risk scores, and the combined score, predicted poorer EF performance and steeper decline. Second, APOE and AD-GRS moderated the association between functional-health risk score and the combined risk score, on EF performance and change. Specifically, only older adults in the APOEε4- group showed steeper EF decline with high risk scores on both functional-health and combined risk score. Both associations were further magnified for adults with high AD-GRS. Conclusion: The present multimodal AD risk network approach incorporated both modifiable and genetic risk scores to predict EF trajectories. The results add an additional degree of precision to risk profile calculations for asymptomatic aging populations.
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Affiliation(s)
- Shraddha Sapkota
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - G. Peggy McFall
- Department of Psychology, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Mario Masellis
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada
| | - Roger A. Dixon
- Department of Psychology, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
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12
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Leung E, Hazrati LN. Breast cancer type 1 and neurodegeneration: consequences of deficient DNA repair. Brain Commun 2021; 3:fcab117. [PMID: 34222870 PMCID: PMC8242133 DOI: 10.1093/braincomms/fcab117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 12/20/2022] Open
Abstract
Numerous cellular processes, including toxic protein aggregation and oxidative stress, have been studied extensively as potential mechanisms underlying neurodegeneration. However, limited therapeutic efficacy targeting these processes has prompted other mechanisms to be explored. Previous research has emphasized a link between cellular senescence and neurodegeneration, where senescence induced by excess DNA damage and deficient DNA repair results in structural and functional changes that ultimately contribute to brain dysfunction and increased vulnerability for neurodegeneration. Specific DNA repair proteins, such as breast cancer type 1, have been associated with both stress-induced senescence and neurodegenerative diseases, however, specific mechanisms remain unclear. Therefore, this review explores DNA damage-induced senescence in the brain as a driver of neurodegeneration, with particular focus on breast cancer type 1, and its potential contribution to sex-specific differences associated with neurodegenerative disease.
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Affiliation(s)
- Emily Leung
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 Kings College Cir, Toronto, ON M5S 1A8, Canada
- The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada
| | - Lili-Naz Hazrati
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 Kings College Cir, Toronto, ON M5S 1A8, Canada
- The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada
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13
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Bayly M, O'Connell ME, Kortzman A, Peacock S, Morgan DG, Kirk A. Family carers' narratives of the financial consequences of young onset dementia. DEMENTIA 2021; 20:2708-2724. [PMID: 33877946 PMCID: PMC8670747 DOI: 10.1177/14713012211009341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Individuals with young onset dementia and their families face unique challenges, such as disruptions to their life cycle and relationships and a dearth of appropriate supports. Financial consequences have also been noted in the literature yet have not been explored in-depth. The purpose of this research was to qualitatively explore carers’ experiences of financial consequences resulting from the young onset dementia of a family member and how these consequences may be managed. Eight carers (7 women and 1 man) provided a written online narrative about their journey with young onset dementia and any financial consequences experienced, with open-ended prompts to elicit details not yet shared. Narratives were inductively coded and analyzed using a thematic narrative approach. Carers described a voluntary or involuntary end to employment for the person with young onset dementia around the time of diagnosis. This engendered ongoing and anticipated financial consequences, combined with the need for carers to balance employment with the provision of care (which often meant early retirement for spousal carers). Common themes were tension between the needs to provide care and earn income, altered financial prospects, costs of care, and lack of available and accessible supports to ameliorate financial consequences. Findings illustrate the reality of financial consequences across the trajectory of young onset dementia. These consequences may manifest differently for spousal and child carers and are not being adequately addressed by existing supports.
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Affiliation(s)
- Melanie Bayly
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, 7235University of Saskatchewan, Saskatoon, Canada
| | - Megan E O'Connell
- Department of Psychology, 7235University of Saskatchewan, Saskatoon, Canada
| | - August Kortzman
- Department of Psychology, 7235University of Saskatchewan, Saskatoon, Canada
| | - Shelley Peacock
- College of Nursing, 7235University of Saskatchewan, Saskatoon, Canada
| | - Debra G Morgan
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, 7235University of Saskatchewan, Saskatoon, Canada
| | - Andrew Kirk
- College of Medicine, 7235University of Saskatchewan, Saskatoon, Canada
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Bohn L, Zheng Y, McFall GP, Dixon RA. Portals to frailty? Data-driven analyses detect early frailty profiles. Alzheimers Res Ther 2021; 13:1. [PMID: 33397495 PMCID: PMC7780374 DOI: 10.1186/s13195-020-00736-w] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 11/29/2020] [Indexed: 03/21/2023]
Abstract
BACKGROUND Frailty is an aging condition that reflects multisystem decline and an increased risk for adverse outcomes, including differential cognitive decline and impairment. Two prominent approaches for measuring frailty are the frailty phenotype and the frailty index. We explored a complementary data-driven approach for frailty assessment that could detect early frailty profiles (or subtypes) in relatively healthy older adults. Specifically, we tested whether (1) modalities of early frailty profiles could be empirically determined, (2) the extracted profiles were differentially related to longitudinal cognitive decline, and (3) the profile and prediction patterns were robust for males and females. METHODS Participants (n = 649; M age = 70.61, range 53-95) were community-dwelling older adults from the Victoria Longitudinal Study who contributed data for baseline multi-morbidity assessment and longitudinal cognitive trajectory analyses. An exploratory factor analysis on 50 multi-morbidity items produced 7 separable health domains. The proportion of deficits in each domain was calculated and used as continuous indicators in a data-driven latent profile analysis (LPA). We subsequently examined how frailty profiles related to the level and rate of change in a latent neurocognitive speed variable. RESULTS LPA results distinguished three profiles: not-clinically-frail (NCF; characterized by limited impairment across indicators; 84%), mobility-type frailty (MTF; characterized by impaired mobility function; 9%), and respiratory-type frailty (RTF; characterized by impaired respiratory function; 7%). These profiles showed differential neurocognitive slowing, such that MTF was associated with the steepest decline, followed by RTF, and then NCF. The baseline frailty index scores were the highest for MTF and RTF and increased over time. All observations were robust across sex. CONCLUSIONS A data-driven approach to early frailty assessment detected differentiable profiles that may be characterized as morbidity-intensive portals into broader and chronic frailty. Early inventions targeting mobility or respiratory deficits may have positive downstream effects on frailty progression and cognitive decline.
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Affiliation(s)
- Linzy Bohn
- Department of Psychology, University of Alberta, P217 Biological Sciences Building, Edmonton, AB, T6G 2E9, Canada.
| | - Yao Zheng
- Department of Psychology, University of Alberta, P217 Biological Sciences Building, Edmonton, AB, T6G 2E9, Canada
| | - G Peggy McFall
- Department of Psychology, University of Alberta, P217 Biological Sciences Building, Edmonton, AB, T6G 2E9, Canada
- Neuroscience and Mental Health Institute, University of Alberta, 2-132 Li Ka Shing Center for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada
| | - Roger A Dixon
- Department of Psychology, University of Alberta, P217 Biological Sciences Building, Edmonton, AB, T6G 2E9, Canada
- Neuroscience and Mental Health Institute, University of Alberta, 2-132 Li Ka Shing Center for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada
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15
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Holingue C, Budavari AC, Rodriguez KM, Zisman CR, Windheim G, Fallin MD. Sex Differences in the Gut-Brain Axis: Implications for Mental Health. Curr Psychiatry Rep 2020; 22:83. [PMID: 33216233 PMCID: PMC7717677 DOI: 10.1007/s11920-020-01202-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW The purpose of this article is to highlight how sex differences in the gut-brain axis may contribute to the discrepancies in incidence of neurodevelopmental, psychiatric, and neurodegenerative disorders between females and males. We focus on autism spectrum disorder, psychotic disorders, stress and anxiety disorders, depression, Alzheimer's disease, and Parkinson's disease and additionally discuss the comorbidity between inflammatory bowel disorder and mental health disorders. RECENT FINDINGS Human and animal studies show that sex may modify the relationship between the gut or immune system and brain and behavior. Sex also appears to modify the effect of microbial treatments such as probiotics and antibiotics on brain and behavior. There is emerging evidence that assessing the role of sex in the gut-brain axis may help elucidate the etiology of and identify effective treatments for neurodevelopmental, psychiatric, and neurodegenerative disorders.
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Affiliation(s)
- Calliope Holingue
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA.
- , Baltimore, USA.
| | - Alexa Curhan Budavari
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Katrina M Rodriguez
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Corina R Zisman
- Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA
| | - Grace Windheim
- Public Health Studies, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - M Daniele Fallin
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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16
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Drouin SM, McFall GP, Dixon RA. In multiple facets of subjective memory decline sex moderates memory predictions. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12089. [PMID: 32875056 PMCID: PMC7447903 DOI: 10.1002/dad2.12089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/19/2020] [Accepted: 07/22/2020] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Two established subjective memory decline facets (SMD; complaints, concerns) are early indicators of memory decline and Alzheimer's disease. We report (1) a four-facet SMD inventory (memory complaints, concerns, compensation, self-efficacy) and (2) prediction of memory change and moderation by sex. METHODS The longitudinal design featured 40 years (53 to 97) of non-demented aging (n = 580) from the Victoria Longitudinal Study. Statistical analyses included confirmatory factor analyses and conditional latent growth modeling. RESULTS The four-facet SMD Inventory was psychometrically confirmed. Longitudinal analyses revealed significant variability in level and change for SMD and memory. Prediction analyses showed complaints and concerns predicted lower level and steeper memory decline; however, follow-up moderation analyses revealed selective predictions for females. Memory compensation predicted decline overall. Lower memory self-efficacy predicted steeper decline selectively for males. DISCUSSION Although traditional and novel SMD facets predicted memory decline, differential sex moderation was observed. SMD research benefits from conceptual complementarity and precision prediction.
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Affiliation(s)
| | - G. Peggy McFall
- Department of PsychologyUniversity of AlbertaEdmontonCanada
- Neuroscience and Mental Health InstituteUniversity of AlbertaEdmontonCanada
| | - Roger A. Dixon
- Department of PsychologyUniversity of AlbertaEdmontonCanada
- Neuroscience and Mental Health InstituteUniversity of AlbertaEdmontonCanada
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17
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McFall GP, Bäckman L, Dixon RA. Nuances in Alzheimer's Genetic Risk Reveal Differential Predictions of Non-demented Memory Aging Trajectories: Selective Patterns by APOE Genotype and Sex. Curr Alzheimer Res 2020; 16:302-315. [PMID: 30873923 DOI: 10.2174/1567205016666190315094452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/01/2019] [Accepted: 03/13/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Apolipoprotein E (APOE) is a prominent genetic risk factor for Alzheimer's disease (AD) and a frequent target for associations with non-demented and cognitively impaired aging. APOE offers a unique opportunity to evaluate two dichotomous comparisons and selected gradations of APOE risk. Some evidence suggests that APOE effects may differ by sex and emerge especially in interaction with other AD-related biomarkers (e.g., vascular health). METHODS Longitudinal trajectories of non-demented adults (n = 632, 67% female, Mage = 68.9) populated a 40-year band of aging. Focusing on memory performance and individualized memory trajectories, a sequence of latent growth models was tested for predictions of (moderation between) APOE and pulse pressure (PP) as stratified by sex. The analyses (1) established robust benchmark PP effects on memory trajectories, (2) compared predictions of alternative dichotomous groupings (ε4- vs ε4+, ε2- vs ε2+), and (3) examined precision-based predictions by disaggregated APOE genotypes. RESULTS Healthier (lower) PP was associated with better memory performance and less decline. Therefore, all subsequent analyses were conducted in the interactive context of PP effects and sex stratification. The ε4-based dichotomization produced no differential genetic predictions. The ε2-based analyses showed sex differences, including selective protection for ε2-positive females. Exploratory follow-up disaggregated APOE genotype analyses suggested selective ε2 protection effects for both homozygotic and heterozygotic females. CONCLUSION Precision analyses of AD genetic risk will advance the understanding of underlying mechanisms and improve personalized implementation of interventions.
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Affiliation(s)
- G Peggy McFall
- Department of Psychology, University of Alberta, Edmonton, Canada.,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | | | - Roger A Dixon
- Department of Psychology, University of Alberta, Edmonton, Canada.,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
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18
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Bohn L, McFall GP, Wiebe SA, Dixon RA. Body mass index predicts cognitive aging trajectories selectively for females: Evidence from the Victoria Longitudinal Study. Neuropsychology 2020; 34:388-403. [PMID: 31999164 DOI: 10.1037/neu0000617] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Elevated body weight in midlife is an established risk factor for accelerated cognitive decline, impairment, and dementia. Research examining the impact of later-life body mass index (BMI) on normal cognitive aging has produced mixed results. There is a need for longitudinal designs, replication across multiple cognitive domains, and consideration of BMI effects in the context of important moderators. The present research examined (a) BMI prediction of neuropsychological performance and decline in executive function (EF), neurocognitive speed, and memory and (b) sex stratification of BMI effects. METHOD Participants (n = 869; 573 females; M age = 71.75, range = 53-85 years) were older adults from the Victoria Longitudinal Study. Latent growth modeling was used to examine BMI as a predictor of level and change in three latent variables of cognition. The data were then stratified by sex to test whether BMI effects differed for females and males. We adjusted for selected medical, psychosocial, and demographic characteristics. RESULTS Higher BMI predicted less decline in EF, neurocognitive speed, and memory. Interestingly, when the data were stratified by sex, higher BMI predicted less neuropsychological decline across domains for females only. BMI was unrelated to cognitive aging trajectories for males. CONCLUSIONS We found that elevated BMI was a risk-reducing factor for cognitive decline only for females. Results may be used to enhance the precision with which intervention protocols may target specific subgroups of older adults. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Abstract
Questionnaires like the Metamemory in Adulthood Questionnaire (MIA; Dixon, Hultsch, & Hertzog, 1988) have been used to examine longitudinal changes and cross-sectional age differences in multiple metamemory facets (e.g., memory self-efficacy). This study used 3 independent cross-sectional samples (N = 1,555; ages 55-85) from the Victoria Longitudinal Study collected in 1986, 1992, and 2000 to evaluate period and cohort effects on 8 MIA scales. Alternative general linear models analyzed age, cohort, and period effects, while subsequently assessing gender differences in metamemory beliefs. Period effects were detected on the MIA Internal Strategy and External Strategy scales; self-reported use of internal strategies decreased while use of external memory aids increased over the historical period. Reliable cohort (generational) differences were found for MIA Change, with the lowest levels of perceived change in individuals born between 1916 and 1925. MIA Task, measuring knowledge about memory, produced small age and cohort effects. Gender differences emerged in metamemory, especially for the Internal Strategy and External Strategy scales (women reporting higher strategy use). Gender differences were also seen for the Capacity, Locus, Anxiety, and Achievement scales, with women reporting higher perceived memory efficacy, control, memory anxiety, and greater motivation to have better memory, respectively. The historical trends in metamemory beliefs should be replicated with other measures and other populations; however, the results generally confirm conclusions from earlier cross-sectional studies regarding age sensitivity of metamemory beliefs from middle age to old age. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Brent J Small
- School of Aging Studies, University of South Florida
| | - G Peggy McFall
- Department of Psychology and Neuroscience and Mental Health Institute, University of Alberta
| | - Roger A Dixon
- Department of Psychology and Neuroscience and Mental Health Institute, University of Alberta
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Morgan D, Kosteniuk J, O’Connell ME, Kirk A, Stewart NJ, Seitz D, Bayly M, Froehlich Chow A, Elliot V, Daku J, Hack T, Hoium F, Kennett-Russill D, Sauter K. Barriers and facilitators to development and implementation of a rural primary health care intervention for dementia: a process evaluation. BMC Health Serv Res 2019; 19:709. [PMID: 31623609 PMCID: PMC6798332 DOI: 10.1186/s12913-019-4548-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/20/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND With rural population aging there are growing numbers of people with dementia in rural and remote settings. The role of primary health care (PHC) is critical in rural locations, yet there is a lack of rural-specific PHC models for dementia, and little is known about factors influencing the development, implementation, and sustainability of rural PHC interventions. Using a community-based participatory research approach, researchers collaborated with a rural PHC team to co-design and implement an evidence-based interdisciplinary rural PHC memory clinic in the Canadian province of Saskatchewan. This paper reports barriers and facilitators to developing, implementing, and sustaining the intervention. METHODS A qualitative longitudinal process evaluation was conducted over two and half years, from pre- to post-implementation. Data collection and analyses were guided by the Consolidated Framework for Implementation Research (CFIR) which consists of 38 constructs within five domains: innovation characteristics, outer setting, inner setting, individual characteristics, and process. Data were collected via focus groups with the PHC team and stakeholders, smaller team workgroup meetings, and team member interviews. Analysis was conducted using a deductive approach to apply CFIR codes to the data and an inductive analysis to identify barriers and facilitators. RESULTS Across all domains, 14 constructs influenced development and implementation. Three domains (innovation characteristics, inner setting, process) were most important. Facilitators were the relative advantage of the intervention, ability to trial on a small scale, tension for change, leadership engagement, availability of resources, education and support from researchers, increased self-efficacy, and engagement of champions. Barriers included the complexity of multiple intervention components, required practice changes, lack of formal incentive programs, time intensiveness of modifying the EMR during iterative development, lack of EMR access by all team members, lack of co-location of team members, workload and busy clinical schedules, inability to justify a designated dementia care manager role, and turnover of PHC team members. CONCLUSIONS The study identified key factors that supported and hindered the development and implementation of a rural-specific strategy for dementia assessment and management in PHC. Despite challenges related to the rural context, the researcher-academic partnership was successful in developing and implementing the intervention.
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Affiliation(s)
- Debra Morgan
- Canadian Centre for Health & Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4 Canada
| | - Julie Kosteniuk
- Canadian Centre for Health & Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4 Canada
| | - Megan E. O’Connell
- Department of Psychology, University of Saskatchewan, Arts 182, 9 Campus Drive, Saskatoon, SK S7N 5A5 Canada
| | - Andrew Kirk
- Department of Medicine, Neurology Division, University of Saskatchewan, Saskatoon, SK Canada
| | - Norma J. Stewart
- College of Nursing, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK Canada
| | - Dallas Seitz
- Department of Psychiatry, Providence Care - Mental Health Services, Queen’s University, 752 King Street West, Kingston, ON K7L 4X3 Canada
- Cumming School of Medicine and Hotchkiss Brain Institute, University of Calgary, 2919 Health Sciences Centre, 3330 Hospital Drive NWt, Calgary, AB T2N 4N1 Canada
| | - Melanie Bayly
- Canadian Centre for Health & Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4 Canada
| | - Amanda Froehlich Chow
- Canadian Centre for Health & Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4 Canada
| | - Valerie Elliot
- Canadian Centre for Health & Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4 Canada
| | - Jean Daku
- Saskatchewan Health Authority, Kipling, SK Canada
| | - Tracy Hack
- Saskatchewan Health Authority, Kipling, SK Canada
| | - Faye Hoium
- Saskatchewan Health Authority, Kipling, SK Canada
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Abstract
Nonclinical studies form the basis for the decision whether to take a therapeutic candidate into the clinic. These studies need to exhibit translational robustness for both ethical and economic reasons. Key findings confirmed in multiple species have a greater chance to also occur in humans. Given the heterogeneity of patient populations, preclinical studies or at least programs comprising multiple studies need to reflect such heterogeneity, e.g., regarding strains, sex, age, and comorbidities of experimental animals. However, introducing such heterogeneity requires larger studies/programs to maintain statistical power in the face of greater variability. In addition to classic sources of bias, e.g., related to lack of randomization and concealment, translational studies face specific sources of potential bias such as that introduced by a model that may not reflect the full spectrum of underlying pathophysiology in patients, that defined by timing of treatment, or that implied in dosing decisions and interspecies differences in pharmacokinetic profiles. The balance of all these factors needs to be considered carefully for each study and program.
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McFall GP, McDermott KL, Dixon RA. Modifiable Risk Factors Discriminate Memory Trajectories in Non-Demented Aging: Precision Factors and Targets for Promoting Healthier Brain Aging and Preventing Dementia. J Alzheimers Dis 2019; 70:S101-S118. [PMID: 30775975 PMCID: PMC6700610 DOI: 10.3233/jad-180571] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Non-demented cognitive aging trajectories are characterized by vast level and slope differences and a spectrum of outcomes, including dementia. OBJECTIVE The goal of AD risk management (and its corollary, promoting healthy brain aging) is aided by two converging objectives: 1) classifying dynamic distributions of non-demented cognitive trajectories, and 2) identifying modifiable risk-elevating and risk-reducing factors that discriminate stable or normal trajectory patterns from declining or pre-impairment patterns. METHOD Using latent class growth analysis we classified three episodic memory aging trajectories for n = 882 older adults (baseline Mage=71.6, SD=8.9, range = 53-95, female=66%): Stable (SMA; above average level, sustained slope), Normal (NMA; average level, moderately declining slope), and Declining (DMA; below average level, substantially declining slope). Using random forest analyses, we simultaneously assessed 17 risk/protective factors from non-modifiable demographic, functional, psychological, and lifestyle domains. Within two age strata (Young-Old, Old-Old), three pairwise prediction analyses identified important discriminating factors. RESULTS Prediction analyses revealed that different modifiable risk predictors, both shared and unique across age strata, discriminated SMA (i.e., education, depressive symptoms, living status, body mass index, heart rate, social activity) and DMA (i.e., lifestyle activities [cognitive, self-maintenance, social], grip strength, heart rate, gait) groups. CONCLUSION Memory trajectory analyses produced empirical classes varying in level and slope. Prediction analyses revealed different predictors of SMA and DMA that also varied by age strata. Precision approaches for promoting healthier memory aging-and delaying memory impairment-may identify modifiable factors that constitute specific targets for intervention in the differential context of age and non-demented trajectory patterns.
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Affiliation(s)
- G. Peggy McFall
- Department of Psychology, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Kirstie L. McDermott
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Roger A. Dixon
- Department of Psychology, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
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Kreiner G. What have we learned recently from transgenic mouse models about neurodegeneration? The most promising discoveries of this millennium. Pharmacol Rep 2018; 70:1105-1115. [DOI: 10.1016/j.pharep.2018.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 09/05/2018] [Accepted: 09/10/2018] [Indexed: 12/14/2022]
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