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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 JG, 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)
- Miriam Ryvicker
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA
| | - Yolanda Barrón
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA
| | - Jiyoun Song
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | | | - Shivani Shah
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA
| | - Julia G Burgdorf
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA
| | - James M Noble
- Columbia University Medical Center, New York, NY, USA
| | - Maxim Topaz
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA
- Columbia University Medical Center, New York, NY, USA
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Cantu P, Cho TC, Wyman M, Helppie-McFall B, Ajrouch KJ. Racial and Ethnic Disparities in the Monetary Value of Informal Caregiving for Non-Institutionalized People Living With Dementia. J Aging Health 2024; 36:570-582. [PMID: 38887015 PMCID: PMC11363470 DOI: 10.1177/08982643241262917] [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: 06/20/2024]
Abstract
OBJECTIVE To examine racial and ethnic differences in costs of informal caregiving among older adults with dementia in the United States. METHODS We used data from the 2002 to 2018 Health and Retirement Survey to estimate annual informal care hours for adults with dementia (n = 10,015). We used regression models to examine racial and ethnic differences in hours of informal care for activities of daily living (ADL) and instrumental ADL, controlling for demographic characteristics, education, and level of disability. RESULTS Our sample was 70% non-Hispanic White, 19% non-Hispanic Black, and 11% Hispanic. Hispanics received, on average, 35.8 hours of informal care each week, compared to 30.1 for Blacks and 20.1 for Whites. Racial and ethnic differences persisted when controlling for covariates. DISCUSSION Informal care is a greater cost to racial and ethnic minoritized families. Informal care was valued at a replacement cost of $44,656 for Hispanics, $37,508 for Blacks, and $25,121 for Whites.
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Affiliation(s)
- Phillip Cantu
- Department of Internal Medicine-Geriatrics, University of Texas Medical Branch, Galveston, TX, USA
| | - Tsai-Chin Cho
- Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mary Wyman
- Department of Psychology, School of Medicine and Public Health, University of Wisconsin, Madison, Madison, WI, USA
| | - Brooke Helppie-McFall
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Kristine J Ajrouch
- Department of Sociology, Anthropology, and Criminology, Eastern Michigan University, Ypsilanti, MI, USA
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Rigby T, Gregoire AM, Reader J, Kahsay Y, Fisher J, Kairys A, Bhaumik AK, Rahman-Filipiak A, Maher AC, Hampstead BM, Heidebrink JL, Kavcic V, Giordani B. Identification of amnestic mild cognitive impairment among Black and White community-dwelling older adults using NIH Toolbox Cognition tablet battery. J Int Neuropsychol Soc 2024:1-8. [PMID: 39291413 DOI: 10.1017/s1355617724000213] [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: 09/19/2024]
Abstract
OBJECTIVES Identify which NIH Toolbox Cognition Battery (NIHTB-CB) subtest(s) best differentiate healthy controls (HC) from those with amnestic mild cognitive impairment (aMCI) and compare the discriminant accuracy between a model using a priori "Norm Adjusted" scores versus "Unadjusted" standard scores with age, sex, race/ethnicity, and education controlled for within the model. Racial differences were also examined. METHODS Participants were Black/African American (B/AA) and White consensus-confirmed (HC = 96; aMCI = 62) adults 60-85 years old that completed the NIHTB-CB for tablet. Discriminant function analysis (DFA) was used in the Total Sample and separately for B/AA (n = 80) and White participants (n = 78). RESULTS Picture Sequence Memory (an episodic memory task) was the highest loading coefficient across all DFA models. When stratified by race, differences were noted in the pattern of the highest loading coefficients within the DFAs. However, the overall discriminant accuracy of the DFA models in identifying HCs and those with aMCI did not differ significantly by race (B/AA, White) or model/score type (Norm Adjusted versus Unadjusted). CONCLUSIONS Racial differences were noted despite the use of normalized scores or demographic covariates-highlighting the importance of including underrepresented groups in research. While the models were fairly accurate at identifying consensus-confirmed HCs, the models proved less accurate at identifying White participants with an aMCI diagnosis. In clinical settings, further work is needed to optimize computerized batteries and the use of NIHTB-CB norm adjusted scores is recommended. In research settings, demographically corrected scores or within model correction is suggested.
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Affiliation(s)
- Taylor Rigby
- Michigan Alzheimer's Disease Research Center, Ann Arbor, MI, USA
- Department of Veterans Affairs Medical Center, Geriatric Research Education and Clinical Center, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Allyson M Gregoire
- Michigan Alzheimer's Disease Research Center, Ann Arbor, MI, USA
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Johnathan Reader
- Michigan Alzheimer's Disease Research Center, Ann Arbor, MI, USA
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Yonatan Kahsay
- Michigan Alzheimer's Disease Research Center, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Jordan Fisher
- Michigan Alzheimer's Disease Research Center, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Anson Kairys
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Arijit K Bhaumik
- Michigan Alzheimer's Disease Research Center, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Annalise Rahman-Filipiak
- Michigan Alzheimer's Disease Research Center, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Amanda Cook Maher
- Michigan Alzheimer's Disease Research Center, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Benjamin M Hampstead
- Michigan Alzheimer's Disease Research Center, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Judith L Heidebrink
- Michigan Alzheimer's Disease Research Center, Ann Arbor, MI, USA
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Voyko Kavcic
- Institute of Gerontology, Wayne State University, Detroit, MI, USA
| | - Bruno Giordani
- Michigan Alzheimer's Disease Research Center, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Li K, Ghosal R, Zhang D, Li Y, Lohman MC, Brown MJ, Merchant AT, Yang CH, Neils-Strunjas J, Friedman DB, Wei J. The Associations of Sensory Impairment With 10-Year Risk of Dementia and Alzheimer's Disease: The Health and Retirement Study, 2010-2020. J Geriatr Psychiatry Neurol 2024:8919887241275042. [PMID: 39185851 DOI: 10.1177/08919887241275042] [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: 08/27/2024]
Abstract
BACKGROUND Studies have examined the association between dual sensory impairment and late-life cognitive outcomes in the U.S with inconsistent findings. OBJECTIVE To examine the associations between sensory impairment and 10-year risk of dementia or Alzheimer's disease among U.S. adults aged ≥ 50. METHODS A prospective cohort study based on the Health and Retirement Study from 2010 to 2020. Individuals aged ≥ 50 years without self-reported dementia and Alzheimer's disease in 2010 were included in the analysis. Self-reported visual and hearing impairments were measures in 2010. Main failure events included self-reported incident dementia and Alzheimer's disease over a 10-year follow-up period. Participants were categorized as having no visual or hearing impairment, visual impairment only, hearing impairment only, and dual sensory impairment. Fine-Gray competing risk regression model was applied to estimate the associations of sensory impairment with incident dementia and Alzheimer's disease, adjusted for demographic characteristics, health behaviors, and health conditions at baseline. RESULTS Of 20,248 identified individuals, 14.6% had visual impairment only, 11.2% had hearing impairment only, and 9.1% had dual impairment at baseline. After adjusting for all covariates, dual sensory impairment was associated with higher risk of dementia (HR = 1.46, 95% CI: 1.23-1.73) and Alzheimer's disease (HR = 1.35, 95% CI: 1.03-1.76). Visual impairment only was also associated with incident dementia and Alzheimer's disease among individuals <65 years. CONCLUSION Older adults in the U.S. with visual and hearing impairments simultaneously had a particularly greater risk of dementia and Alzheimer's disease, indicating the needs of targeted screening for timely treatment and further prevention of dementia and Alzheimer's disease.
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Affiliation(s)
- Kun Li
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- Duke-Margolis Institute for Health Policy, Duke University, Washington, DC, USA
| | - Rahul Ghosal
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Donglan Zhang
- Department of Foundations of Medicine, New York University Long Island School of Medicine, New York, NY, USA
| | - Yike Li
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew C Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- 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
- Office for the Study of Aging, 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
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Chih-Hsiang Yang
- 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
| | - Jean Neils-Strunjas
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Daniela B Friedman
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Jingkai Wei
- Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
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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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Breton J, Foret JT, Hamlin AM, Ortega N, Clark AL. Health insurance coverage moderates the relationship between metabolic syndrome and baseline memory outcomes in Latino older adults. Clin Neuropsychol 2024:1-16. [PMID: 39158158 DOI: 10.1080/13854046.2024.2392303] [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: 02/12/2024] [Accepted: 08/10/2024] [Indexed: 08/20/2024]
Abstract
Objective: Latino adults are at increased risk of metabolic syndrome (MetS) and have lower rates of health insurance (HI) coverage. Although inadequate HI coverage and MetS have been independently linked to poor cognition, their potential interactive effects have not yet been examined. The present study explored whether HI moderated the association between MetS and cognition. We hypothesized that Latinos with MetS that did not have HI would demonstrate poorer cognition than those with HI, whereas there would be minimal differences in cognition across HI status in those without MetS. Methods: Cross-sectional data from 805 Latino older adults enrolled in the Health and Aging Brain Study-Health Disparities was utilized. Analysis of covariance adjusting for sociodemographics examined MetS x HI interactions on memory and attention/executive functions composites. Results: Results revealed a significant MetS x HI interaction on memory (F = 4.33, p = 0.037, ηp2 = .01); Latino adults with MetS and no HI coverage had worse memory performance than those with MetS who had HI coverage (p = 0.022, ηp2 = .01), whereas there was no significant difference in memory between HI coverage groups in those without MetS (p > .05, ηp2 = .002). No MetS x HI interaction was observed for the attention/executive functions composite (F = 0.29, p = 0.588, ηp2 < .001). Conclusion: Latino older adults with MetS that do not have HI coverage may be at risk for poorer memory outcomes. Increasing the accessibility of HI coverage may help reduce cognitive health disparities in Latino older adults with vascular health comorbidities.
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Affiliation(s)
- Jordana Breton
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
| | - Janelle T Foret
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
| | - Abbey M Hamlin
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
| | - Nazareth Ortega
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
| | - Alexandra L Clark
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
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Verghese J, Chalmer R, Stimmel M, Weiss E, Zwerling J, Malik R, Rasekh D, Ansari A, Corriveau RA, Ehrlich AR, Wang C, Ayers E. Non-literacy biased, culturally fair cognitive detection tool in primary care patients with cognitive concerns: a randomized controlled trial. Nat Med 2024; 30:2356-2361. [PMID: 38834847 PMCID: PMC11333278 DOI: 10.1038/s41591-024-03012-8] [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: 11/20/2023] [Accepted: 04/22/2024] [Indexed: 06/06/2024]
Abstract
Dementia is often undiagnosed in primary care, and even when diagnosed, untreated. The 5-Cog paradigm, a brief, culturally adept, cognitive detection tool paired with a clinical decision support may reduce barriers to improving dementia diagnosis and care. We performed a randomized controlled trial in primary care patients experiencing health disparities (racial/ethnic minorities and socioeconomically disadvantaged). Older adults with cognitive concerns were assigned in a 1:1 ratio to the 5-Cog paradigm or control. Primary outcome was improved dementia care actions defined as any of the following endpoints within 90 days: new mild cognitive impairment syndrome or dementia diagnoses as well as investigations, medications or specialist referrals ordered for cognitive indications. Groups were compared using intention-to-treat principles with multivariable logistic regression. Overall, 1,201 patients (mean age 72.8 years, 72% women and 94% Black, Hispanic or Latino) were enrolled and 599 were assigned to 5-Cog and 602 to the control. The 5-Cog paradigm demonstrated threefold odds of improvement in dementia care actions over control (odds ratio 3.43, 95% confidence interval 2.32-5.07). No serious intervention-related adverse events were reported. The 5-Cog paradigm improved diagnosis and management in patients with cognitive concerns and provides evidence to promote practice change to improve dementia care actions in primary care.ClinicalTrials.gov: NCT03816644 .
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Affiliation(s)
- Joe Verghese
- Departments of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Rachel Chalmer
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Marnina Stimmel
- Departments of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Erica Weiss
- Departments of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jessica Zwerling
- Departments of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rubina Malik
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David Rasekh
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Asif Ansari
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Roderick A Corriveau
- Department of Neuroscience, National Institute of Neurological Disorders and Stroke, Bethesda, MA, USA
| | - Amy R Ehrlich
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Cuiling Wang
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
- Department of Neuroscience, National Institute of Neurological Disorders and Stroke, Bethesda, MA, USA
| | - Emmeline Ayers
- Departments of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
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Chen Y, Power MC, Grodstein F, Capuano AW, Lange‐Maia BS, Moghtaderi A, Stapp EK, Bhattacharyya J, Shah RC, Barnes LL, Marquez DX, Bennett DA, James BD. Correlates of missed or late versus timely diagnosis of dementia in healthcare settings. Alzheimers Dement 2024; 20:5551-5560. [PMID: 38934297 PMCID: PMC11350028 DOI: 10.1002/alz.14067] [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: 02/07/2024] [Revised: 05/16/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION There is limited evidence about factors related to the timeliness of dementia diagnosis in healthcare settings. METHODS In five prospective cohorts at Rush Alzheimer's Disease Center, we identified participants with incident dementia based on annual assessments and examined the timing of healthcare diagnoses in Medicare claims. We assessed sociodemographic, health, and psychosocial correlates of timely diagnosis. RESULTS Of 710 participants, 385 (or 54%) received a timely claims diagnosis within 3 years prior to or 1 year following dementia onset. In logistic regressions accounting for demographics, we found Black participants (odds ratio [OR] = 2.15, 95% confidence interval [CI]: 1.21 to 3.82) and those with better cognition at dementia onset (OR = 1.48, 95% CI: 1.10 to 1.98) were at higher odds of experiencing a diagnostic delay, whereas participants with higher income (OR = 0.89, 95% CI: 0.81 to 0.97) and more comorbidities (OR = 0.94, 95% CI: 0.89 to 0.98) had lower odds. DISCUSSION We identified characteristics of individuals who may miss the optimal window for dementia treatment and support. HIGHLIGHTS We compared the timing of healthcare diagnosis relative to the timing of incident dementia based on rigorous annual evaluation. Older Black adults with lower income, higher cognitive function, and fewer comorbidities were less likely to be diagnosed in a timely manner by the healthcare system.
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Affiliation(s)
- Yi Chen
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
| | - Melinda C. Power
- Department of EpidemiologyGeorge Washington UniversityWashington, DCUSA
| | - Francine Grodstein
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Internal MedicineRush University Medical CenterChicagoIllinoisUSA
| | - Ana W. Capuano
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Brittney S. Lange‐Maia
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Family and Preventive MedicineRush University Medical CenterChicagoIllinoisUSA
| | - Ali Moghtaderi
- Department of Health Policy and ManagementGeorge Washington UniversityWashington, DCUSA
| | - Emma K. Stapp
- Department of EpidemiologyGeorge Washington UniversityWashington, DCUSA
| | | | - Raj C. Shah
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Family and Preventive MedicineRush University Medical CenterChicagoIllinoisUSA
| | - Lisa L. Barnes
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
- Department of Psychiatry and Behavioral SciencesRush University Medical CenterChicagoIllinoisUSA
| | - David X. Marquez
- Department of Kinesiology and NutritionUniversity of Illinois ChicagoChicagoIllinoisUSA
| | - David A. Bennett
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Bryan D. James
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Internal MedicineRush University Medical CenterChicagoIllinoisUSA
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10
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Lohse Y, Last K, Darici D, Becker SL, Papan C. Migration background, skin colour, gender, and infectious disease presentation in clinical vignettes. Lancet Digit Health 2024; 6:e539-e540. [PMID: 39059884 DOI: 10.1016/s2589-7500(24)00112-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/27/2024] [Accepted: 05/14/2024] [Indexed: 07/28/2024]
Affiliation(s)
- Yael Lohse
- Centre for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - Katharina Last
- Centre for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany; Institute for Hygiene and Public Health, University Hospital Bonn, Bonn 53127, Germany
| | - Dogus Darici
- Institute of Anatomy and Molecular Neurobiology, University of Münster, Münster, Germany
| | - Sören L Becker
- Centre for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - Cihan Papan
- Centre for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany; Institute for Hygiene and Public Health, University Hospital Bonn, Bonn 53127, Germany.
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Boza-Calvo C, Faustin A, Zhang Y, Briggs AQ, Bernard MA, Bubu OM, Rao JA, Gurin L, Tall SO, Osorio RS, Marsh K, Shao Y, Masurkar AV. Two-Year Longitudinal Outcomes of Subjective Cognitive Decline in Hispanics Compared to Non-hispanic Whites. J Geriatr Psychiatry Neurol 2024:8919887241263097. [PMID: 39043156 DOI: 10.1177/08919887241263097] [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: 07/25/2024]
Abstract
BACKGROUND Subjective cognitive decline (SCD), considered a preclinical dementia stage, is less understood in Hispanics, a high-risk group for dementia. We investigated SCD to mild cognitive impairment (MCI) progression risk, as well as baseline and longitudinal features of depressive symptoms, SCD complaints, and objective cognitive performance among Hispanics compared to non-Hispanic Whites (NHW). METHODS Hispanic (n = 23) and NHW (n = 165) SCD participants were evaluated at baseline and 2-year follow-up. Evaluations assessed function, depressive symptoms, SCD, and objective cognitive performance. RESULTS Hispanics were at increased risk of progression to MCI (OR: 6.10, 95% CI 1.09-34.20, P = .040). Hispanic participants endorsed more depressive symptoms at baseline (P = .048) that worsened more longitudinally (OR: 3.16, 95% CI 1.18-8.51, P = .023). Hispanic participants had increased SCD complaints on the Brief Cognitive Rating Scale (BCRS) (β = .40 SE: .17, P = .023), and in specific BCRS domains: concentration (β = .13, SE: .07, P = .047), past memory (β = .13, SE: .06, P = .039) and functional abilities (β = .10, SE: .05, P = .037). In objective cognitive performance, Hispanic ethnicity associated with decline in MMSE (β = -.27, SE: .13, P = .039), MoCA (β = -.80 SE: .34, P = .032), Trails A (β = 2.75, SE: .89, P = .002), Trails B (β = 9.18, SE: 2.71, P = .001) and Guild Paragraph Recall Delayed (β = -.80 SE: .28, P = .005). Conclusions: Hispanic ethnicity associated with a significantly increased risk of 2-year progression of SCD to MCI compared to NHW. This increased risk associated with increased depressive symptoms, distinctive SCD features, and elevated amnestic and non-amnestic objective cognitive decline. This supports further research to refine the assessment of preclinical dementia in this high-risk group.
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Affiliation(s)
- Carolina Boza-Calvo
- Centro de Investigación en Hematología y Trastornos Afines (CIHATA), Universidad de Costa Rica, San José, Costa Rica
- Escuela de Medicina, Universidad de Costa Rica, San José, Costa Rica
- NYU Alzheimer's Disease Research Center, NY, USA
| | - Arline Faustin
- NYU Alzheimer's Disease Research Center, NY, USA
- Department of Pathology, NYU Grossman School of Medicine, New York, NY, USA
| | - Yian Zhang
- NYU Alzheimer's Disease Research Center, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Anthony Q Briggs
- NYU Alzheimer's Disease Research Center, NY, USA
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | - Mark A Bernard
- NYU Alzheimer's Disease Research Center, NY, USA
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | - Omonigho M Bubu
- NYU Alzheimer's Disease Research Center, NY, USA
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
- Center for Sleep and Brain Health, New York, NY, USA
| | - Julia A Rao
- NYU Alzheimer's Disease Research Center, NY, USA
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | - Lindsey Gurin
- NYU Alzheimer's Disease Research Center, NY, USA
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | - Sakina Ouedraogo Tall
- NYU Alzheimer's Disease Research Center, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Ricardo S Osorio
- NYU Alzheimer's Disease Research Center, NY, USA
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
- Center for Sleep and Brain Health, New York, NY, USA
| | - Karyn Marsh
- NYU Alzheimer's Disease Research Center, NY, USA
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | - Yongzhao Shao
- NYU Alzheimer's Disease Research Center, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Arjun V Masurkar
- NYU Alzheimer's Disease Research Center, NY, USA
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
- Neuroscience Institute, NYU Grossman School of Medicine, New York, NY, USA
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12
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Wise EA, Yan H, Oh E, Leoutsakos J. Racial/ethnic differences in neuropsychiatric disturbances associated with incident dementia. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e12615. [PMID: 38974877 PMCID: PMC11224973 DOI: 10.1002/dad2.12615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 05/28/2024] [Accepted: 06/06/2024] [Indexed: 07/09/2024]
Abstract
INTRODUCTION Neuropsychiatric symptoms (NPS) are nearly universal in dementia; some cross-sectional studies of NPS in dementia have found racial/ethnic differences, though it is unknown if NPS prevalence differs among racial/ethnic groups before and after dementia diagnosis. METHODS Participants were followed annually at Alzheimer's Disease Centers and were assessed on the Neuropsychiatric Inventory-Questionnaire (NPI-Q) with at least one follow-up visit at which they were diagnosed with dementia. Descriptive statistics were generated by race/ethnicity. NPS were modeled over time as a function of race/ethnicity and with diagnosis date as the baseline. RESULTS NPS were present in 95% in at least one time point. After adjusting for covariates, there were no statistically significant differences in NPI-Q total scores among racial/ethnic groups at the time of and after dementia diagnosis. DISCUSSION Findings from our prospective cohort study suggest that when individuals are matched at the time of conversion to dementia, there are no racial/ethnic differences in NPS. Highlights Neuropsychiatric symptoms of dementia are frequent and increase caregiver burden.Prior studies reported more neuropsychiatric symptoms (NPS) in Black compared to White individuals with dementia.National Alzheimer's Coordinating Center Black, White, and Hispanic participants did not differ in NPS at the time of dementia diagnosis.
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Affiliation(s)
- Elizabeth A. Wise
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Haijuan Yan
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Esther Oh
- Department of MedicineDepartment of Psychiatry and Behavioral SciencesDepartment of PathologyJohns Hopkins University School of MedicineJohns Hopkins University School of NursingBaltimoreMarylandUSA
| | - Jeannie‐Marie Leoutsakos
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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13
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Xu S, Fouladi‐Nashta N, Chen Y, Zissimopoulos J. Dementia severity at incident diagnosis in a population representative sample of older Americans. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2024; 10:e12491. [PMID: 38988415 PMCID: PMC11231736 DOI: 10.1002/trc2.12491] [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: 03/25/2024] [Revised: 05/28/2024] [Accepted: 05/30/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION We provide the first analysis of distribution of dementia severity at incident diagnosis for a population representative sample of older Americans. METHODS Using data from the Aging, Demographics, and Memory Study (ADAMS), the Health Retirement Study (HRS), and traditional Medicare claims, we estimated the Clinical Dementia Rating Scale for ADAMS respondents and applied parameter estimates to predict dementia severity for HRS respondents with claims-based incident dementia diagnosis. RESULTS Seventy percent of older adults received a dementia diagnosis of mild cognitive impairment or mild dementia (early stages). Fewer individuals were diagnosed at early stages in years 2000 to 2008 (65%) compared to years 2009 to 2016 (76%). About 72% of non-Hispanic white persons were diagnosed at early stages, compared to 63% non-Hispanic black and 59% Hispanic persons. More males than females were diagnosed at early stages (75% vs 67%). DISCUSSION These data linkages allow population surveillance of early and equitable dementia detection in the older US population to assess clinical and policy levers to improve detection. Highlights For the US population 70 and older, 30% were diagnosed with dementia at a moderate or severe stage.Fewer were diagnosed at early stages in years 2000 to 2008 compared to 2009 to 2016 (65% vs 76%).A total of 72% of white persons were diagnosed at early stages, compared to 63% black and 59% Hispanic persons.More males than females were diagnosed at early stages (75% vs 67%).High wealth and education level were associated with diagnosis at early stages disease.
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Affiliation(s)
- Shengjia Xu
- Price School of Public PolicyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Leonard D. Schaeffer Center for Health Policy & EconomicsUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Niloofar Fouladi‐Nashta
- Leonard D. Schaeffer Center for Health Policy & EconomicsUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Yi Chen
- Rush Alzheimer's Disease CenterChicagoIllinoisUSA
| | - Julie Zissimopoulos
- Price School of Public PolicyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Leonard D. Schaeffer Center for Health Policy & EconomicsUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
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14
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Pereira-Osorio C, Brickell E, Lee B, Arredondo B, Sawyer RJ. Performance of the Modified Caregiver Strain Index in a Sample of Black and White Persons Living With Dementia and Their Caregivers. THE GERONTOLOGIST 2024; 64:gnae052. [PMID: 38769644 PMCID: PMC11181709 DOI: 10.1093/geront/gnae052] [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: 12/18/2023] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVES This study examined the performance of the Modified Caregiver Strain Index (MCSI) in a sample of Black and White caregivers of persons living with dementia. RESEARCH DESIGN AND METHODS Data on 153 dyads enrolled in the Care Ecosystem dementia care management program were analyzed, including sociodemographic variables, dementia severity, and caregiver burden and wellbeing. Factor structure, item-response patterns, and concurrent validity were assessed across racial groups. RESULTS Differences between Black and White caregivers included gender, dyad relation, and socioeconomic disadvantage. Factor structure and item loadings varied by racial cohort, with parameters supporting a 3-factor model. For Black caregivers, finances and work, emotional and physical strain, and family and personal adjustment items loaded together on individual factors. For White caregivers physical and emotional strain items loaded on separate factors, although personal and family adjustment items loaded with work and financial strain items. Item-level analysis revealed differences between groups, with Black caregivers endorsing physical strain to a greater degree (p = .003). Total MCSI scores were positively correlated with concurrent measures like the PHQ-9 (White: r = 0.67, Black: r = 0.54) and the GAD-2 (White: r = 0.47, Black: r = 0.4), and negatively correlated with self-efficacy ratings (White: r = -0.54, Black: r = -0.55), with a p < .001 for all validity analysis. DISCUSSION AND IMPLICATIONS The MCSI displayed acceptable statistical performance for Black and White caregivers of persons living with dementia and displayed a factor structure sensitive to cultural variations of the construct. Researchers results highlight the inherent complexity and the relevance of selecting inclusive measures to appropriately serve diverse populations.
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Affiliation(s)
| | - Emily Brickell
- Ochsner Health, Center for Brain Health, New Orleans, Louisiana, USA
| | - Bern Lee
- Ochsner Health, Center for Brain Health, New Orleans, Louisiana, USA
| | - Beth Arredondo
- Ochsner Health, Center for Brain Health, New Orleans, Louisiana, USA
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Silva-Rudberg JA, Carrión CI, Pérez-Palmer N, Li J, Mehta SK, Diab NS, Mecca AP, O'Dell RS. Assessment of disparities in timely diagnosis and comprehensive workup of cognitive impairment between English and Spanish speakers. Am J Geriatr Psychiatry 2024; 32:773-786. [PMID: 38336573 PMCID: PMC11162952 DOI: 10.1016/j.jagp.2024.01.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 01/13/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Previous studies have examined disparities in dementia care that affect the U.S. Hispanic/Latino population, including clinician bias, lack of cultural responsiveness, and less access to health care. However, there is limited research that specifically investigates the impact of language barriers to health disparities in dementia diagnosis. METHODS In this retrospective cross-sectional study, 12,080 English- or Spanish- speaking patients who received an initial diagnosis of mild cognitive impairment (MCI) or dementia between July 2017 and June 2019 were identified in the Yale New Haven Health (YNHH) electronic medical record. To evaluate the timeliness of diagnosis, an initial diagnosis of MCI was classified as "timely", while an initial diagnosis of dementia was considered "delayed." Comprehensiveness of diagnosis was assessed by measuring the presence of laboratory studies, neuroimaging, specialist evaluation, and advanced diagnostics six months before or after diagnosis. Binomial logistic regressions were calculated with and without adjustment for age, legal sex, ethnicity, neighborhood disadvantage, and medical comorbidities. RESULTS Spanish speakers were less likely to receive a timely diagnosis when compared with English speakers both before (unadjusted OR, 0.65; 95% CI, 0.53-0.80, p <0.0001) and after adjusting for covariates (adjusted OR, 0.55; 95% CI, 0.40-0.75, p = 0.0001). Diagnostic services were provided equally between groups, except for referrals to geriatrics, which were more frequent among Spanish-speaking patients. A subgroup analysis revealed that Spanish-speaking Hispanic/Latino patients were less likely to receive a timely diagnosis compared to English-speaking Hispanic/Latino patients (adjusted OR, 0.53; 95% CI, 0.38-0.73, p = 0.0001). CONCLUSIONS Non-English language preference is likely to be a contributing factor to timely diagnosis of cognitive impairment. In this study, Spanish language preference rather than Hispanic/Latino ethnicity was a significant predictor of a less timely diagnosis of cognitive impairment. Policy changes are needed to reduce barriers in cognitive disorders care for Spanish-speaking patients.
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Affiliation(s)
- Jason A Silva-Rudberg
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Medicine (JAS-R,), University of California, San Francisco, San Francisco, CA
| | - Carmen I Carrión
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Neurology (CIC), Yale University School of Medicine, New Haven, CT
| | - Nicolás Pérez-Palmer
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (NP-P), Veteran's Affairs Connecticut Healthcare System, West Haven, CT
| | - Judy Li
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT
| | - Sumarth K Mehta
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT
| | - Nicholas S Diab
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT
| | - Adam P Mecca
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT
| | - Ryan S O'Dell
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT.
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16
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Rodriguez MJ, Mendoza L, Garcia P, Duarte A, Padron D, Marsiske M, Fiala J, Gonzalez J, Duara R. Functional measures and AD biomarkers among Hispanic and White non-Hispanic older adults. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e12632. [PMID: 39130803 PMCID: PMC11316142 DOI: 10.1002/dad2.12632] [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: 04/09/2024] [Revised: 07/04/2024] [Accepted: 07/14/2024] [Indexed: 08/13/2024]
Abstract
INTRODUCTION Poorer baseline functioning is associated with long-term cognitive decline among Hispanic older adults, but little is known about associations of these factors with Alzheimer's disease (AD) neuroimaging biomarkers. METHODS A total of 461 Hispanic and White non-Hispanic (NHW) older adults who are cognitively normal (n = 76), had impaired cognition without mild cognitive impairment (MCI) (n = 41), or carried a diagnosis of MCI (n = 253) or dementia (n = 91) completed neuropsychological and functional assessment, genetic testing, and brain magnetic resonance imaging (MRI). Structural equation modeling (SEM) was used to examine predictive associations between functional and cognitive measures of AD neuroimaging biomarkers. RESULTS MRI volumes significantly predicted functional limitations in both groups. Sex and amyloid load significantly predicted functional limitations among the Hispanic group only. Years of education and MRI regional volume were the strongest predictors of cognition among both groups. DISCUSSION Results indicate that functional performance is associated with early AD biomarkers among Hispanic older adults. Clinical implications are discussed. Highlights The current study addresses health disparities in Alzheimer's disease (AD) and related dementia assessment among Hispanics by identifying measures sensitive to early AD biomarkers.Associations of functional measures with AD genetic and neuroimaging biomarkers revealed that similarities in these associations exist between Hispanic and White non-Hispanic individuals, but biological sex and amyloid load significantly predicted functional limitations among the Hispanic group only.These results have clinical implications for physicians who treat Hispanic AD patients and indicate that when compared to traditional diagnostic assessments, functional assessments may better aid in AD diagnostic precision among Hispanics.
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Affiliation(s)
- Miriam J. Rodriguez
- Albizu University‐Miami CampusDoralFloridaUSA
- Indiana University‐BloomingtonBloomingtonIndianaUSA
| | | | | | | | - Dilianna Padron
- Albizu University‐Miami CampusDoralFloridaUSA
- Central Virginia VA Healthcare SystemRichmondVirginiaUSA
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Silvey S, Sterling RK, French E, Godschalk M, Gentili A, Patel N, Bajaj JS. A Possible Reversible Cause of Cognitive Impairment: Undiagnosed Cirrhosis and Potential Hepatic Encephalopathy in Patients with Dementia. Am J Med 2024:S0002-9343(24)00398-X. [PMID: 38942345 DOI: 10.1016/j.amjmed.2024.06.014] [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: 04/12/2024] [Revised: 06/13/2024] [Accepted: 06/19/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND Dementia and hepatic encephalopathy (HE) have symptom overlap and are challenging to differentiate. The presence of undiagnosed cirrhosis may lead to missed opportunities to treat HE, which was found in a veterans database. This needs validation in a non-veteran cohort. METHODS A retrospective cohort study was conducted between 2009 and 2019 using national non-Veteran patient data from the multi-center TriNetX database. Participants included 68,807 patients with a dementia diagnosis at ≥2 visits, no prior diagnosis of cirrhosis, and with sufficient laboratory test results to calculate the Fibrosis-4 (FIB-4) index, which indicates liver disease. Prevalences of high FIB-4 scores (>2.67 and >3.25) were measured within the cohort, and associations between high FIB-4 and comorbidities/demographics were examined. RESULTS Within the cohort (44.7% male, 78.0% White, mean age 72.73 years (±11.09), 7.6% (n = 5815) had a FIB-4 index > 3.25 and 12.8% (n = 8683) had FIB-4 > 2.67. In multivariable logistic regression models, FIB-4 > 3.25 was associated with male gender (OR: 1.42 [1.33-1.51]), congestive heart failure (OR: 1.73 [1.59-1.87]), viral hepatitis (OR: 2.23 [1.84-2.68]), alcohol use disorder (OR: 1.39 [1.22-1.58]), and chronic kidney disease (OR: 1.38 [1.28-1.48]), and inversely associated with White race (OR: 0.76 [0.71-0.82]) and diabetes (OR: 0.82 [0.77-0.88]). Similar findings were associated with the FIB-4 > 2.67 threshold. CONCLUSION The findings of this national cohort suggest that the FIB-4 index could be utilized to screen for potential undiagnosed cirrhosis in patients with dementia, and that hepatic encephalopathy might be misdiagnosed as dementia or cause worsening of cognitive function in patients with dementia.
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Affiliation(s)
- Scott Silvey
- Department of Population Health, Virginia Commonwealth University, Richmond, VA
| | - Richard K Sterling
- C. Kenneth and Dianne Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, VA; Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Richmond VA Medical Center, Richmond, VA
| | - Evan French
- C. Kenneth and Dianne Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, VA
| | - Michael Godschalk
- Division of Geriatrics, Virginia Commonwealth University and Richmond VA Medical Center, Richmond, VA
| | - Angela Gentili
- Division of Geriatrics, Virginia Commonwealth University and Richmond VA Medical Center, Richmond, VA
| | - Nilang Patel
- Division of Nephrology, Virginia Commonwealth University and Richmond VA Medical Center, Richmond, VA
| | - Jasmohan S Bajaj
- Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Richmond VA Medical Center, Richmond, VA.
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Leggins B, Hart DM, Jackson AJ, Levenson RW, Windon CC, Merrilees J, Chiong W. Perceptions about dementia clinical trials among underrepresented populations: A nationally representative survey of U.S. dementia caregivers. RESEARCH SQUARE 2024:rs.3.rs-4492550. [PMID: 38946950 PMCID: PMC11213196 DOI: 10.21203/rs.3.rs-4492550/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Background The research community has historically failed to enroll diverse groups of participants in dementia clinical trials. A unique aspect of dementia care research is the requirement of a study partner, who can attest to the care recipient's clinical and functional capacity. The aim of this study is to assess racial and ethnic differences and the importance of various trial considerations among dementia caregivers, in their decision to participate in clinical research as study partners. Method We embedded a vignette about a hypothetical dementia clinical trial in a nationally representative survey of U.S. dementia caregivers, oversampling non-Hispanic Black and Hispanic caregivers. Dementia caregivers were asked about their willingness to participate in the trial with their care recipient and rated the importance of nine considerations in hypothetical decisions to participate. Caregiver demographic characteristics were analyzed as predictors of trial participation in a base demographic model. In a second reasons model caregiver demographic characteristics and the rated importance of the nine considerations were separately analyzed as predictors; both models used survey-weighted logistic regression. Result The sample consisted of 610 dementia caregivers, including 156 non-Hispanic Black and 122 Hispanic caregiver participants. In the base demographic model, hypothetical trial participation was negatively associated with older caregiver age (OR (odds ratio) = 0.72, p = < 0.001). In the reasons model, the rated importance of a social responsibility to help others by participating in research was significantly associated with participation (OR = 1.56, p = 0.049), while the importance of the possibility of the care recipient experiencing serious side effects was negatively associated with participation (OR = 0.51, p = 0.003). In both models there was no significant difference in hypothetical participation between non-Hispanic Black and non-Hispanic White caregivers, or between Hispanic and non-Hispanic White caregivers. Conclusion Hispanic and non-Hispanic Black dementia caregivers were not less likely than non-Hispanic White dementia caregivers to participate in a hypothetical dementia clinical trial. Our study suggests that failures to recruit diverse populations in dementia clinical research are not attributable to less willingness among members of underrepresented groups but may instead reflect structural barriers and historic exclusion from trial participation.
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Estrada LV, Barcelona V, Dhingra L, Luchsinger JA, Dick AW, Glance LG, Stone PW. Potentially Avoidable Hospitalizations Among Historically Marginalized Nursing Home Residents. JAMA Netw Open 2024; 7:e249312. [PMID: 38696169 PMCID: PMC11066698 DOI: 10.1001/jamanetworkopen.2024.9312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 03/04/2024] [Indexed: 05/04/2024] Open
Abstract
Importance Nursing home (NH) transfers to hospitals are common and have been associated with cognitive decline; approximately 45% of NH hospital transfers are potentially avoidable hospitalizations (PAHs). Objective To determine PAH incidence for historically marginalized NH residents with severe cognitive impairment compared with non-Hispanic White residents. Design, Setting, and Participants This cross-sectional study merged 2018 Centers for Medicaid & Medicare Services datasets and LTCFocus, a public dataset on US NH care, for US NH residents aged 65 years and older who had a hospitalization. Analyses were performed from January to May 2022. Exposure Race and ethnicity of NH residents. Main Outcomes and Measures Racial and ethnic differences in resident-level annual rates of PAHs were estimated for residents with and without severe cognitive impairment (measured using the Cognitive Function Scale), controlling for resident characteristics, comorbidities, dual eligibility, and time at risk. PAHs were defined as NH hospital transfers that resulted from neglectful NH care or for which NH treatment would have been appropriate. Results Of 2 098 385 NH residents nationwide included in the study, 7151 (0.3%) were American Indian or Alaska Native, 39 873 (1.9%) were Asian, 229 112 (10.9%) were Black or African American, 99 304 (4.7%) were Hispanic, 2785 (0.1%) were Native Hawaiian or Pacific Islander, 1 713 670 (81.7%) were White, and 6490 (0.3%) were multiracial; 1 355 143 (64.6%) were female; 128 997 (6.2%) were severely cognitively impaired; and the mean (SD) age was 81.8 (8.7) years. PAH incidence rate ratios (IRRs) were significantly greater for residents with severe cognitive impairment compared with those without. In unadjusted analyses comparing historically marginalized residents with severe cognitive impairment vs non-Hispanic White residents with severe cognitive impairment, American Indian or Alaska Native residents had a 49% higher PAH incidence (IRR, 1.49 [95% CI, 1.10-2.01]), Black or African American residents had a 64% higher incidence (IRR, 1.64 [95% CI, 1.48-1.81]), and Hispanic residents had a 45% higher incidence (IRR, 1.45 [95% CI, 1.29-1.62]). Higher incidences persisted for historically marginalized residents with severe cognitive impairment vs non-Hispanic White residents with severe cognitive impairment in adjusted analyses. Asian residents had a 24% higher PAH incidence (IRR, 1.24 [95% CI, 1.06-1.45]), Black or African American residents had a 48% higher incidence (IRR, 1.48 [95% CI, 1.36-1.60]), and Hispanic residents had a 27% higher incidence (IRR, 1.27 [95% CI, 1.16-1.39]). Conclusions and Relevance In this cross-sectional study of PAHs, compared with non-Hispanic White NH residents, historically marginalized residents had increased PAH incidence. In the presence of severe cognitive impairment, incidence rates increased significantly compared with rates for residents without severe cognitive impairment. These results suggest that identification of residents with severe cognitive impairment and proper NH care may help prevent further cognitive decline by avoiding PAHs.
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Affiliation(s)
- Leah V. Estrada
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Lara Dhingra
- MJHS Institute for Innovation in Palliative Care, New York, New York
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - José A. Luchsinger
- Departments of Medicine and Epidemiology, Columbia University Irving Medical Center
| | | | - Laurent G. Glance
- RAND Corporation, Boston, Massachusetts
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York
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20
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2024 Alzheimer's disease facts and figures. Alzheimers Dement 2024; 20:3708-3821. [PMID: 38689398 PMCID: PMC11095490 DOI: 10.1002/alz.13809] [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: 05/02/2024]
Abstract
This article describes the public health impact of Alzheimer's disease (AD), including prevalence and incidence, mortality and morbidity, use and costs of care and the ramifications of AD for family caregivers, the dementia workforce and society. The Special Report discusses the larger health care system for older adults with cognitive issues, focusing on the role of caregivers and non-physician health care professionals. An estimated 6.9 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060, barring the development of medical breakthroughs to prevent or cure AD. Official AD death certificates recorded 119,399 deaths from AD in 2021. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death in the United States. Official counts for more recent years are still being compiled. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2021, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 140%. More than 11 million family members and other unpaid caregivers provided an estimated 18.4 billion hours of care to people with Alzheimer's or other dementias in 2023. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $346.6 billion in 2023. Its costs, however, extend to unpaid caregivers' increased risk for emotional distress and negative mental and physical health outcomes. Members of the paid health care and broader community-based workforce are involved in diagnosing, treating and caring for people with dementia. However, the United States faces growing shortages across different segments of the dementia care workforce due to a combination of factors, including the absolute increase in the number of people living with dementia. Therefore, targeted programs and care delivery models will be needed to attract, better train and effectively deploy health care and community-based workers to provide dementia care. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2024 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $360 billion. The Special Report investigates how caregivers of older adults with cognitive issues interact with the health care system and examines the role non-physician health care professionals play in facilitating clinical care and access to community-based services and supports. It includes surveys of caregivers and health care workers, focusing on their experiences, challenges, awareness and perceptions of dementia care navigation.
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21
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Robison RD, Butz N, Gustafson S, Wang S, Falvey J, Mackowicz-Torres M, Rogus-Pulia N, Kind A. Ready for Discharge, but Are They Ready to Go Home? Examining Neighborhood-Level Disadvantage as a Marker of the Social Exposome and the Swallowing Care Process in a Retrospective Cohort of Inpatients With Dementia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1536-1547. [PMID: 38502719 PMCID: PMC11081526 DOI: 10.1044/2024_ajslp-23-00332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/12/2023] [Accepted: 01/30/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE Socioeconomically disadvantaged areas are more resource poor, impacting adherence to swallowing care recommendations. Neighborhood-level disadvantage metrics, such as the Area Deprivation Index (ADI), allow for examination of social determinants of health (SDOH) in a precise region. We examined ADI in a cohort of persons living with dementia (PLWD) to determine representation of those residing in areas of socioeconomic disadvantage (high ADI), distribution of swallowing care provided, and frequency of SDOH-related counseling or resource linking prior to discharge. METHOD A retrospective chart abstraction was performed for all inpatients with a diagnosis of dementia (N = 204) seen by the Swallow Service at a large academic hospital in 2014. State ADI Deciles 1 (least) to 10 (most socioeconomic disadvantage) and decile groups (1-3, 4-7, and 8-10) were compared with the surrounding county. Frequency of videofluoroscopic swallowing evaluations (VFSEs) based on ADI deciles was recorded. To determine whether SDOH-related counseling or resource linking occurred for those in high ADI (8-10) neighborhoods, speech-language pathology notes, and discharge summaries were reviewed. Descriptive statistics, independent samples t tests, and one-way analysis of variance were calculated. RESULTS ADI was significantly higher in this cohort (M = 3.84, SD = 2.58) than in the surrounding county (M = 2.79, SD = 1.88, p = .000). There was no significant difference in utilization of swallowing services across decile groups (p = .88). Although the majority (85%) in high ADI areas was recommended diet modifications or alternative nutrition likely requiring extra resources, there was no documentation indicating that additional SDOH resource linking or counseling was provided. CONCLUSIONS These findings raise important questions about the role and responsibility of speech-language pathologists in tailoring swallowing services to challenges posed by the lived environment, particularly in socioeconomically disadvantaged areas. This underscores the need for further research to understand and address gaps in postdischarge support for PLWD in high-ADI regions and advocate for more equitable provision of swallowing care.
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Affiliation(s)
- Raele Donetha Robison
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin–Madison
- Center for Health Disparities Research, University of Wisconsin–Madison
| | - Nicole Butz
- Department of Integrative Biology, College of Letters and Sciences, University of Wisconsin–Madison
| | - Sara Gustafson
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin–Madison
| | - Steven Wang
- Department of Otolaryngology, Tulane University, New Orleans, LA
| | - Jason Falvey
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Meredith Mackowicz-Torres
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin–Madison
| | - Nicole Rogus-Pulia
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin–Madison
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI
| | - Amy Kind
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin–Madison
- Center for Health Disparities Research, University of Wisconsin–Madison
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22
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Chyr LC, Wolff JL, Zissimopoulos JM, Drabo EF. Analysis of agreement between measures of subjective cognitive impairment and probable dementia in the National Health and Aging Trends Study. Alzheimers Dement 2024; 20:2817-2829. [PMID: 38426381 PMCID: PMC11032562 DOI: 10.1002/alz.13758] [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: 07/21/2023] [Revised: 01/03/2024] [Accepted: 01/29/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Subjective cognitive impairment (SCI) measures in population-based surveys offer potential for dementia surveillance, yet their validation against established dementia measures is lacking. METHODS We assessed agreement between SCI and a validated probable dementia algorithm in a random one-third sample (n = 1936) of participants in the 2012 National Health and Aging Trends Study (NHATS). RESULTS SCI was more prevalent than probable dementia (12.2% vs 8.4%). Agreement between measures was 90.0% and of substantial strength. Misclassification rates were higher among older and less-educated subgroups due to higher prevalence of false-positive misclassification but did not vary by sex or race and ethnicity. DISCUSSION SCI sensitivity (63.4%) and specificity (92.5%) against dementia were comparable with similar metrics for the NHATS probable dementia measure against the "gold-standard" Aging, Demographics, and Memory Study-based dementia criteria, implying that population-based surveys may afford cost-effective opportunities for dementia surveillance to assess risk and inform policy. HIGHLIGHTS The prevalence of subjective cognitive impairment (SCI) is generally higher than that of a validated measure of probable dementia, particularly within the youngest age group, females, Whites, and persons with a college or higher degree. Percent agreement between SCI and a validated measure of probable dementia was 90.0% and of substantial strength (prevalence- and bias-adjusted kappa, 0.80). Agreement rates were higher in older and less-educated subgroups, driven by the higher prevalence of false-positive disagreement, but did not vary significantly by sex or race and ethnicity. SCI's overall sensitivity and specificity were 63.4% and 92.5%, respectively, against a validated measure of probable dementia, suggesting utility as a low-cost option for dementia surveillance. Heterogeneity in agreement quality across subpopulations warrants caution in its use for subgroup analyses.
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Affiliation(s)
- Linda C. Chyr
- Enterprise Analytics Core, Elevance Health, Inc.WilmingtonDelawareUSA
| | - Jennifer L. Wolff
- Department of Health Policy and ManagementJohn Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Julie M. Zissimopoulos
- Sol Price School of Public PolicyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Leonard D. Schaeffer Center for Health PolicyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Emmanuel F. Drabo
- Department of Health Policy and ManagementJohn Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
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23
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Maestre G, Hill C, Griffin P, Hall S, Hu W, Flatt J, Babulal G, Thorpe R, Henderson JN, Buchwald D, Manson S, Cicero E, Gilmore‐Bykovskyi A, Gamaldo A, Glover C, Barnes L, Kind A, James B, Zeki Al Hazzouri A, Wharton W, Caramelli P, Szanton S, Whitmer R, Benn Torres J, Deters K, Okonkwo O, Das R, Martinez‐Gonzalez K, Carrillo M. Promoting diverse perspectives: Addressing health disparities related to Alzheimer's and all dementias. Alzheimers Dement 2024; 20:3099-3107. [PMID: 38460119 PMCID: PMC11032522 DOI: 10.1002/alz.13752] [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: 11/10/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 03/11/2024]
Abstract
Dementia research lacks appropriate representation of diverse groups who often face substantial adversity and greater risk of dementia. Current research participants are primarily well-resourced, non-Hispanic White, cisgender adults who live close to academic medical centers where much of the research is based. Consequently, the field faces a knowledge gap about Alzheimer's-related risk factors in those other groups. The Alzheimer's Association hosted a virtual conference on June 14-16, 2021, supported in part by the National Institute on Aging (R13 AG072859-01), focused on health disparities. The conference was held entirely online and consisted of 2 days of core programming and a day of focused meetings centered on American Indian and Alaska Natives and on LGBTQIA+ populations. Over 1300 registrants attended discussions focused on the structural and systemic inequities experienced across diverse groups, as well as ways to investigate and address these inequities.
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Affiliation(s)
- Gladys Maestre
- School of MedicineAlzheimer's Disease Resource Center for Minority Aging ResearchUniversity of Texas Rio Grande ValleyBrownsvilleTexasUSA
| | - Carl Hill
- Medical & Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
| | - Percy Griffin
- Medical & Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
| | - Stephen Hall
- Medical & Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
| | - William Hu
- Rutgers Robert Wood Johnson Medical School and Rutgers Institute for HealthHealth Care Policy, and Aging ResearchNew BrunswickNew JerseyUSA
| | - Jason Flatt
- Department of Social and Behavioral HealthSchool of Public HealthUniversity of Nevada Las VegasLas VegasNevadaUSA
| | - Ganesh Babulal
- Department of NeurologySchool of MedicineWashington University in St. LouisSt. LouisMissouriUSA
| | - Roland Thorpe
- Center on AgingCenter on Health Disparities SolutionsHopkins Population CenterAlzheimer's Disease Resource Center for Minority Aging ResearchJohns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUSA
| | | | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health Elson S Floyd College of Medicine Washington State UniversitySeattleWashingtonUSA
| | - Spero Manson
- Centers for American Indian and Alaska Native HealthUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Ethan Cicero
- Nell Hodgson Woodruff School of NursingEmory UniversityAtlantaGeorgiaUSA
| | - Andrea Gilmore‐Bykovskyi
- BerbeeWalsh Department of Emergency MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWisconsinUSA
| | - Alyssa Gamaldo
- Pennsylvania State UniversityState CollegePennsylvaniaUSA
| | | | - Lisa Barnes
- Rush University Medical CenterChicagoIllinoisUSA
| | - Amy Kind
- BerbeeWalsh Department of Emergency MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWisconsinUSA
| | - Bryan James
- Rush University Medical CenterChicagoIllinoisUSA
| | - Adina Zeki Al Hazzouri
- Mailman School of Public HealthDepartment of EpidemiologyColumbia UniversityNew YorkNew YorkUSA
| | - Whitney Wharton
- Nell Hodgson Woodruff School of NursingEmory UniversityAtlantaGeorgiaUSA
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Unit, Faculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteBrazil
| | - Sarah Szanton
- Johns Hopkins University School of NursingBaltimoreMarylandUSA
| | - Rachel Whitmer
- Department of Public Health SciencesDepartment of NeurologyUniversity of California DavisDavisCaliforniaUSA
| | | | - Kacie Deters
- Department of NeurosciencesUniversity of California San Diego School of MedicineLa JollaCaliforniaUSA
| | - Ozioma Okonkwo
- Department of Medicine and the Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Rina Das
- National Institute on Minority Health and Health DisparitiesBethesdaMarylandUSA
| | | | - Maria Carrillo
- Medical & Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
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24
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Olchanski N, Zhu Y, Liang L, Cohen JT, Faul JD, Fillit HM, Freund KM, Lin PJ. Racial and ethnic differences in disease course Medicare expenditures for beneficiaries with dementia. J Am Geriatr Soc 2024; 72:1223-1233. [PMID: 38504583 PMCID: PMC11018481 DOI: 10.1111/jgs.18822] [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: 06/26/2023] [Revised: 01/16/2024] [Accepted: 01/28/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Research on racial and ethnic disparities in costs of care during the course of dementia is sparse. We analyzed Medicare expenditures for beneficiaries with dementia to identify when during the course of care costs are the highest and whether they differ by race and ethnicity. METHODS We analyzed data from the 2000-2016 Health and Retirement Study (HRS) linked with corresponding Medicare claims to estimate total Medicare expenditures for four phases: (1) the year before a dementia diagnosis, (2) the first year following a dementia diagnosis, (3) ongoing care for dementia after the first year, and (4) the last year of life. We estimated each patient's phase-specific and disease course Medicare expenditures by using a race-specific survival model and monthly expenditures adjusted for patient characteristics. We investigated healthcare utilization by service type across races/ethnicities and phases of care. RESULTS Adjusted mean total Medicare expenditures for non-Hispanic (NH) Black ($165,730) and Hispanic beneficiaries with dementia ($160,442) exceeded corresponding expenditures for NH Whites ($136,326). In the year preceding and immediately following initial dementia diagnosis, mean Medicare expenditures for NH Blacks ($26,337 and $20,429) exceeded expenditures for Hispanics and NH Whites ($21,399-23,176 and 17,182-18,244). The last year of life was responsible for the greatest cost contribution: $51,294 (NH Blacks), $47,469 (Hispanics), and $39,499 (NH Whites). These differences were driven by greater use of high-cost services (e.g., emergency department, inpatient and intensive care), especially during the last year of life. CONCLUSIONS NH Black and Hispanic beneficiaries with dementia had higher disease course Medicare expenditures than NH Whites. Expenditures were highest for NH Black beneficiaries in every phase of care. Further research should address mechanisms of such disparities and identify methods to improve communication, shared decision-making, and access to appropriate services for all populations.
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Affiliation(s)
- Natalia Olchanski
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Yingying Zhu
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | - Lichen Liang
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | - Joshua T Cohen
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Jessica D Faul
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Howard M Fillit
- Alzheimer's Drug Discovery Foundation, New York, New York, USA
| | - Karen M Freund
- Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Pei-Jung Lin
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
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25
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Hinton L, Tran D, Peak K, Meyer OL, Quiñones AR. Mapping racial and ethnic healthcare disparities for persons living with dementia: A scoping review. Alzheimers Dement 2024; 20:3000-3020. [PMID: 38265164 PMCID: PMC11032576 DOI: 10.1002/alz.13612] [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: 03/28/2023] [Revised: 08/25/2023] [Accepted: 11/25/2023] [Indexed: 01/25/2024]
Abstract
INTRODUCTION We set out to map evidence of disparities in Alzheimer's disease and Alzheimer's disease related dementias healthcare, including issues of access, quality, and outcomes for racial/ethnic minoritized persons living with dementia (PLWD) and family caregivers. METHODS We conducted a scoping review of the literature published from 2000 to 2022 in PubMed, PsycINFO, and CINAHL. The inclusion criteria were: (1) focused on PLWD and/or family caregivers, (2) examined disparities or differences in healthcare, (3) were conducted in the United States, (4) compared two or more racial/ethnic groups, and (5) reported quantitative or qualitative findings. RESULTS Key findings include accumulating evidence that minoritized populations are less likely to receive an accurate and timely diagnosis, be prescribed anti-dementia medications, and use hospice care, and more likely to have a higher risk of hospitalization and receive more aggressive life-sustaining treatment at the end-of-life. DISCUSSION Future studies need to examine underlying processes and develop interventions to reduce disparities while also being more broadly inclusive of diverse populations.
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Affiliation(s)
- Ladson Hinton
- School of MedicineUniversity of CaliforniaDavisSacramentoCaliforniaUSA
| | - Duyen Tran
- School of MedicineUniversity of CaliforniaDavisSacramentoCaliforniaUSA
| | - Kate Peak
- Department of Family MedicineOregon Health & Science University (OHSU)PortlandOregonUSA
| | - Oanh L. Meyer
- School of MedicineUniversity of CaliforniaDavisSacramentoCaliforniaUSA
| | - Ana R. Quiñones
- Department of Family MedicineOregon Health & Science University (OHSU)PortlandOregonUSA
- OHSU‐PSU School of Public HealthOregon Health & Science UniversityPortlandOregonUSA
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26
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Hoang MT, Kåreholt I, Lindgren E, von Koch L, Xu H, Tan EC, Johnell K, Nägga K, Eriksdotter M, Garcia-Ptacek S. Immigration and access to dementia diagnostics and treatment: A nationwide study in Sweden. SSM Popul Health 2024; 25:101573. [PMID: 38162224 PMCID: PMC10755485 DOI: 10.1016/j.ssmph.2023.101573] [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: 08/14/2023] [Revised: 10/08/2023] [Accepted: 11/28/2023] [Indexed: 01/03/2024] Open
Abstract
•Compared to Swedish-born people, foreign-born people were less likely to receive dementia diagnostic tests.•Being born in Africa or Europe was associated with lower chance of receiving cholinesterase inhibitors.•Asian-born people had higher chance of receiving cholinesterase inhibitors, but were less likely to receive memantine.•Disparities existed in dementia diagnostics and treatment between Swedish-born and foreign-born people, but were not consistent after adjusting for MMSE scores.
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Affiliation(s)
- Minh Tuan Hoang
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ingemar Kåreholt
- Institute of Gerontology, School of Health Welfare, Aging Research Network – Jönköping (ARN-J), Jönköping University, Jönköping, Sweden
- Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Emma Lindgren
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Lena von Koch
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Hong Xu
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Edwin C.K. Tan
- Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, New South Wales, Australia
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Katarina Nägga
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Acute Internal Medicine and Geriatrics, Linköping University, Linköping, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
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27
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Xu H, Bayless TM, Østbye T, Dupre ME. Care sequences leading to the diagnosis of Alzheimer's disease and related dementias: An analysis of electronic health records. Alzheimers Dement 2024; 20:2155-2164. [PMID: 38270269 PMCID: PMC10984433 DOI: 10.1002/alz.13669] [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: 06/14/2023] [Revised: 10/24/2023] [Accepted: 12/03/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND We examined the sequences of clinical care leading to diagnoses of Alzheimer's disease and related dementias (ADRD) using electronic health records from a large academic medical center. METHODS We included patients aged 65+ with their first ADRD diagnoses from January 1, 2014 to December 31, 2019. Using state sequence analysis, care sequences were defined by the ordering of healthcare utilizations occurred in the 2 years before ADRD diagnosis. RESULTS Of 3621 patients (median age 80), nearly half followed a care sequence of having one primary care visit close to their ADRD diagnosis. Additional care sequences included periodic (n = 322, 8.9%) and multiple (n = 416, 11.5%) outpatient visits to primary care and having one (n = 395, 10.9%), multiple (n = 469, 13.0%), or highly frequent (n = 357, 10.7%) outpatient visits to other specialties. Patients' sociodemographic traits contributed to the variability in care sequences. CONCLUSIONS Several distinct patterns of care leading to ADRD diagnoses were identified. Integrated care models are needed to promote early identification of ADRD. HIGHLIGHTS Dementia patients followed distinct care pathways prior to their dementia diagnoses. Key sociodemographic traits contributed to the variation in the sequences of care. Racial differences in the sequencing of care were also found, but only in women.
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Affiliation(s)
- Hanzhang Xu
- Department of Family Medicine and Community HealthDuke UniversityDurhamNorth CarolinaUSA
- Duke University School of NursingDuke UniversityDurhamNorth CarolinaUSA
- Center for the Study of Aging and Human DevelopmentDuke UniversityDurhamNorth CarolinaUSA
| | - Teah M. Bayless
- Department of Family Medicine and Community HealthDuke UniversityDurhamNorth CarolinaUSA
| | - Truls Østbye
- Department of Family Medicine and Community HealthDuke UniversityDurhamNorth CarolinaUSA
- Duke University School of NursingDuke UniversityDurhamNorth CarolinaUSA
- Center for the Study of Aging and Human DevelopmentDuke UniversityDurhamNorth CarolinaUSA
| | - Matthew E. Dupre
- Center for the Study of Aging and Human DevelopmentDuke UniversityDurhamNorth CarolinaUSA
- Department of Population Health SciencesDuke UniversityDurhamNorth CarolinaUSA
- Duke Clinical Research InstituteDuke UniversityDurhamNorth CarolinaUSA
- Department of SociologyDuke UniversityDurhamNorth CarolinaUSA
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28
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Hill-Jarrett TG, Choi M, Buto PT, Miramontes S, Thomas MD, Yang Y, Kim MH, Sims KD, Glymour MM. Associations of Everyday and Lifetime Experiences of Discrimination With Willingness to Undergo Alzheimer Disease Predictive Testing. Neurology 2024; 102:e208005. [PMID: 38266219 PMCID: PMC11383877 DOI: 10.1212/wnl.0000000000208005] [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: 06/27/2023] [Accepted: 10/13/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Rapid developments in Alzheimer disease (AD) biomarker research suggest that predictive testing may become widely available. To ensure equal access to AD predictive testing, it is important to understand factors that affect testing interest. Discrimination may influence attitudes toward AD testing, particularly among racially and ethnically minoritized populations, because of structural racism in health care systems. This study examined whether everyday or lifetime discrimination experiences shape interest in AD predictive testing. METHODS In the 2010 and 2012 biennial Health and Retirement Study waves, respondents were randomly selected to complete questions on interest in receiving free testing that could determine whether they would develop AD in the future. The exposures were everyday discrimination (6 items) and lifetime discrimination (7 items); both were transformed into a binary variable. Logistic regression models predicting interest in AD testing were controlled for deciles of propensity scores for each discrimination measure. Odds ratios were re-expressed as risk differences (RDs). RESULTS Our analytic sample included 1,499 respondents. The mean age was 67 (SD = 10.2) years, 57.4% were women, 65.7% were White, and 80% endorsed interest in AD predictive testing. Most of the participants (54.7%) experienced everyday discrimination in at least one domain; 24.1% experienced major lifetime discrimination in at least one domain. Those interested in predictive testing were younger (66 vs 70 years) and more likely to be Black (20% vs 15%) or Latinx (14% vs 8%) than participants uninterested in testing. The probability of wanting an AD test was not associated with discrimination for Black (RD everyday discrimination = -0.026; 95% CI [-0.081 to 0.029]; RD lifetime discrimination = -0.012; 95% CI [-0.085 to 0.063]) or Latinx (RD everyday discrimination = -0.023, 95% CI [-0.082 to 0.039]; RD lifetime discrimination = -0.011; 95% CI [-0.087 to 0.064]) participants. DISCUSSION Despite historical and contemporary experiences of discrimination, Black and Latinx individuals express interest in AD testing. However, Black and Latinx individuals remain underrepresented in AD research, including research on AD testing. Interest in personalized information about dementia risk may be a pathway to enhance their inclusion in research and clinical trials.
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Affiliation(s)
- Tanisha G Hill-Jarrett
- From the Department of Neurology (T.G.H.-.J), Memory and Aging Center; Department of Epidemiology and Biostatistics (M.C., P.T.B.); Bakar Computational Health Sciences Institute (S.M.); Department of Psychiatry and Behavioral Sciences (M.D.T.), Weill Institute for Neurosciences; Department of Epidemiology and Biostatistics (Y.Y., K.D.S., M.M.G.); and Institute for Health Policy Studies (M.H.K.), University of California San Francisco
| | - Minhyuk Choi
- From the Department of Neurology (T.G.H.-.J), Memory and Aging Center; Department of Epidemiology and Biostatistics (M.C., P.T.B.); Bakar Computational Health Sciences Institute (S.M.); Department of Psychiatry and Behavioral Sciences (M.D.T.), Weill Institute for Neurosciences; Department of Epidemiology and Biostatistics (Y.Y., K.D.S., M.M.G.); and Institute for Health Policy Studies (M.H.K.), University of California San Francisco
| | - Peter T Buto
- From the Department of Neurology (T.G.H.-.J), Memory and Aging Center; Department of Epidemiology and Biostatistics (M.C., P.T.B.); Bakar Computational Health Sciences Institute (S.M.); Department of Psychiatry and Behavioral Sciences (M.D.T.), Weill Institute for Neurosciences; Department of Epidemiology and Biostatistics (Y.Y., K.D.S., M.M.G.); and Institute for Health Policy Studies (M.H.K.), University of California San Francisco
| | - Silvia Miramontes
- From the Department of Neurology (T.G.H.-.J), Memory and Aging Center; Department of Epidemiology and Biostatistics (M.C., P.T.B.); Bakar Computational Health Sciences Institute (S.M.); Department of Psychiatry and Behavioral Sciences (M.D.T.), Weill Institute for Neurosciences; Department of Epidemiology and Biostatistics (Y.Y., K.D.S., M.M.G.); and Institute for Health Policy Studies (M.H.K.), University of California San Francisco
| | - Marilyn D Thomas
- From the Department of Neurology (T.G.H.-.J), Memory and Aging Center; Department of Epidemiology and Biostatistics (M.C., P.T.B.); Bakar Computational Health Sciences Institute (S.M.); Department of Psychiatry and Behavioral Sciences (M.D.T.), Weill Institute for Neurosciences; Department of Epidemiology and Biostatistics (Y.Y., K.D.S., M.M.G.); and Institute for Health Policy Studies (M.H.K.), University of California San Francisco
| | - Yulin Yang
- From the Department of Neurology (T.G.H.-.J), Memory and Aging Center; Department of Epidemiology and Biostatistics (M.C., P.T.B.); Bakar Computational Health Sciences Institute (S.M.); Department of Psychiatry and Behavioral Sciences (M.D.T.), Weill Institute for Neurosciences; Department of Epidemiology and Biostatistics (Y.Y., K.D.S., M.M.G.); and Institute for Health Policy Studies (M.H.K.), University of California San Francisco
| | - Min Hee Kim
- From the Department of Neurology (T.G.H.-.J), Memory and Aging Center; Department of Epidemiology and Biostatistics (M.C., P.T.B.); Bakar Computational Health Sciences Institute (S.M.); Department of Psychiatry and Behavioral Sciences (M.D.T.), Weill Institute for Neurosciences; Department of Epidemiology and Biostatistics (Y.Y., K.D.S., M.M.G.); and Institute for Health Policy Studies (M.H.K.), University of California San Francisco
| | - Kendra D Sims
- From the Department of Neurology (T.G.H.-.J), Memory and Aging Center; Department of Epidemiology and Biostatistics (M.C., P.T.B.); Bakar Computational Health Sciences Institute (S.M.); Department of Psychiatry and Behavioral Sciences (M.D.T.), Weill Institute for Neurosciences; Department of Epidemiology and Biostatistics (Y.Y., K.D.S., M.M.G.); and Institute for Health Policy Studies (M.H.K.), University of California San Francisco
| | - M Maria Glymour
- From the Department of Neurology (T.G.H.-.J), Memory and Aging Center; Department of Epidemiology and Biostatistics (M.C., P.T.B.); Bakar Computational Health Sciences Institute (S.M.); Department of Psychiatry and Behavioral Sciences (M.D.T.), Weill Institute for Neurosciences; Department of Epidemiology and Biostatistics (Y.Y., K.D.S., M.M.G.); and Institute for Health Policy Studies (M.H.K.), University of California San Francisco
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Sperling SA, Acheson SK, Fox-Fuller J, Colvin MK, Harder L, Cullum CM, Randolph JJ, Carter KR, Espe-Pfeifer P, Lacritz LH, Arnett PA, Gillaspy SR. Tele-Neuropsychology: From Science to Policy to Practice. Arch Clin Neuropsychol 2024; 39:227-248. [PMID: 37715508 DOI: 10.1093/arclin/acad066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE The primary aim of this paper is to accelerate the number of randomized experimental studies of the reliability and validity in-home tele-neuropsychological testing (tele-np-t). METHOD We conducted a critical review of the tele-neuropsychology literature. We discuss this research in the context of the United States' public and private healthcare payer systems, including the Centers for Medicare & Medicaid Services (CMS) and Current Procedural Terminology (CPT) coding system's telehealth lists, and existing disparities in healthcare access. RESULTS The number of tele-np publications has been stagnant since the onset of the COVID-19 pandemic. There are less published experimental studies of tele-neuropsychology (tele-np), and particularly in-home tele-np-t, than other tele-np publications. There is strong foundational evidence of the acceptability, feasibility, and reliability of tele-np-t, but relatively few studies of the reliability and validity of in-home tele-np-t using randomization methodology. CONCLUSIONS More studies of the reliability and validity of in-home tele-np-t using randomization methodology are necessary to support inclusion of tele-np-t codes on the CMS and CPT telehealth lists, and subsequently, the integration and delivery of in-home tele-np-t services across providers and institutions. These actions are needed to maintain equitable reimbursement of in-home tele-np-t services and address the widespread disparities in healthcare access.
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Affiliation(s)
- Scott A Sperling
- Department of Neurology, Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
| | | | - Joshua Fox-Fuller
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Mary K Colvin
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lana Harder
- Children's Health, Children's Medical Center, Dallas, TX, USA
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - C Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John J Randolph
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Randolph Neuropsychology Associates, PLLC, Lebanon, NH, USA
| | | | - Patricia Espe-Pfeifer
- Department of Psychiatry and Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Laura H Lacritz
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peter A Arnett
- Department of Psychology, The Pennsylvania State University, State College, PA, USA
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John London A, Karlawish J, Largent EA, Phillips Hey S, McCarthy EP. Algorithmic identification of persons with dementia for research recruitment: ethical considerations. Inform Health Soc Care 2024; 49:28-41. [PMID: 38196387 PMCID: PMC11001531 DOI: 10.1080/17538157.2023.2299881] [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: 01/11/2024]
Abstract
Underdiagnosis, misdiagnosis, and patterns of social inequality that translate into unequal access to health systems all pose barriers to identifying and recruiting diverse and representative populations into research on Alzheimer's disease and Alzheimer's disease related dementias. In response, some have turned to algorithms to identify patients living with dementia using information that is associated with this condition but that is not as specific as a diagnosis. This paper explains six ethical issues associated with the use of such algorithms including the generation of new, sensitive, identifiable medical information for research purposes without participant consent, issues of justice and equity, risk, and ethical communication. It concludes with a discussion of strategies for addressing these issues and prompting valuable research.
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Affiliation(s)
- Alex John London
- Center for Ethics and Policy, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Jason Karlawish
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Emily A. Largent
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Ellen P. McCarthy
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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31
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Erickson CM, Wexler A, Largent EA. Alzheimer's in the modern age: Ethical challenges in the use of digital monitoring to identify cognitive changes. Inform Health Soc Care 2024; 49:1-13. [PMID: 38116960 PMCID: PMC11001527 DOI: 10.1080/17538157.2023.2294203] [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: 12/21/2023]
Abstract
Pushes toward earlier detection of Alzheimer's disease (AD)-related cognitive changes are creating interest in leveraging technologies, like cellphones, that are already widespread and well-equipped for data collection to facilitate digital monitoring for AD. Studies are ongoing to identify and validate potential "digital biomarkers" that might indicate someone has or is at risk of developing AD dementia. Digital biomarkers for AD have potential as a tool in aiding more timely diagnosis, though more robust research is needed to support their validity and utility. While there are grounds for optimism, leveraging digital monitoring and informatics for cognitive changes also poses ethical challenges, related to topics such as algorithmic bias, consent, and data privacy and security. As we confront the modern era of Alzheimer's disease, individuals, companies, regulators and policymakers alike must prepare for a future in which our day-to-day interactions with technology in our daily life may identify AD-related cognitive changes.
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Affiliation(s)
- Claire M Erickson
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Anna Wexler
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Emily A Largent
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Churchill N, Barnes DE, Habib M, Nianogo RA. Forecasting the 20-Year Incidence of Dementia by Socioeconomic Status, Race/Ethnicity, and Region Based on Mid-Life Risk Factors in a U.S. Nationally Representative Sample. J Alzheimers Dis 2024; 99:1225-1234. [PMID: 38788068 DOI: 10.3233/jad-231133] [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: 05/26/2024]
Abstract
Background Alzheimer's disease and related dementias (ADRD) incidence varies based on demographics, but mid-life risk factor contribution to this variability requires more research. Objective The purpose of this study is to forecast the 20-year incidence of dementia in the U.S. overall and stratified by race/ethnicity, socioeconomic status (SES), and U.S. geographic region given prior mid-life risk factor prevalence and to examine the extent to which risk factor differences 20 years ago may explain current SES, race/ethnicity, or regional disparities in dementia incidence. Methods We applied the Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) prediction model to the 2006 wave of the Health and Retirement Study (HRS) in participants aged 45 to 64 to estimate the 20-year risk of incident ADRD. Results The 20-year risk of dementia among middle-aged Americans was 3.3% (95% CI: 3.2%, 3.4%). Dementia incidence was forecast to be 1.51 (95% CI: 1.32, 1.71) and 1.27 (95% CI: 1.14, 1.44) times that in Hispanic and Non-Hispanic Black individuals respectively compared statistically to Non-Hispanic White individuals given mid-life risk factors. There was a progressive increase in dementia risk from the lowest versus highest SES quintile. For geographic region, dementia incidence was forecast to be 1.17 (95% CI: 1.06, 1.30) and 1.27 (95% CI: 1.14, 1.43) times that in Midwestern and Southern individuals respectively compared statistically to Western individuals. Conclusions Some disparities in dementia incidence could be explained by differences in mid-life risk factors and may point toward policy interventions designed to lessen the ADRD disease burden through early prevention.
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Affiliation(s)
- Nicola Churchill
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Deborah E Barnes
- Department of Psychiatry and Behavioral SciencesUniversity of California San Francisco (UCSF), San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Mina Habib
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Roch A Nianogo
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, CA, USA
- California Center for Population Research, University of California Los Angeles (UCLA), Los Angeles, CA, USA
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Brar M, Mc Ardle R, Hagan A, Al-Oraibi A, Hanjari M, Stephan B, Brayne C, Lafortune L, Bains M, Qureshi N, Robinson L. Attitudes and Preferences Towards Screening for Dementia with a Focus on Ethnic Minority and Low Socio-Economic Groups: A Systematic Review of Research Studies Written in the English Language. J Alzheimers Dis 2024; 100:1315-1331. [PMID: 39031361 PMCID: PMC11380224 DOI: 10.3233/jad-240315] [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: 07/22/2024]
Abstract
Background Increased understanding of dementia risk-reduction and early detection of Alzheimer's disease and related disorders has spurred interest in the identification of risks for dementia, underlying putative biologies, or dementia itself. Implementation of such approaches require acceptability to the public. Research prior to 2012 indicated limited acceptability for population dementia screening. The changing landscape of dementia prevention research may influence recent perceptions. Additionally, perspectives from underserved populations, such as ethnic minorities and low socio-economic groups, are lacking. Objective In this systematic review, we sought published studies since 2012 on attitudes and preferences of people with dementia, carers and the general public from ethnic minorities and low socio-economic groups regarding dementia screening. Methods This review was preregistered on PROSPERO (CRD42023384115) and followed PRISMA guidelines. Key search terms were entered into five databases. Articles were included if they focused on population or risk screening for dementia via primary/community care-based assessments, and which included majority ethnic minority or low socio-economic groups or discretely considered these groups in data analysis. Data were synthesized narratively. Results Seven studies reported perspectives of ethnic minorities regarding dementia screening; one study included people from low socio-economic groups. Results indicated that participants from ethnic minorities were willing to undergo dementia screening. Predictors of willingness included belief in benefits, desire to boost diversity, and to implement lifestyle changes. Unwillingness was associated with anxiety regarding results. Conclusions Although there seems to be high acceptability for screening in the studied groups, more research is necessary to explore the practical considerations for screening such as cultural and economic barriers, trust, and post-screening actions.
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Affiliation(s)
- Manjot Brar
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ríona Mc Ardle
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alexander Hagan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Amani Al-Oraibi
- PRISM Research Group, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Development Centre for Population Health, University of Leicester, Leicester, UK
| | - Matilda Hanjari
- PRISM Research Group, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- Faculty of Health and Life Sciences, Institute for Allied Health Sciences Research, De Montfort University, Leicester, UK
| | - Blossom Stephan
- Dementia Centre of Excellence, enAble Institute, Curtin University, Bentley, Australia
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | | | - Manpreet Bains
- PRISM Research Group, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Nadeem Qureshi
- PRISM Research Group, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Armstrong MJ, Barnes LL. Under-Diagnosis of Dementia with Lewy Bodies in Individuals Racialized as Black: Hypotheses Regarding Potential Contributors. J Alzheimers Dis 2024; 97:1571-1580. [PMID: 38277299 PMCID: PMC10894581 DOI: 10.3233/jad-231177] [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] [Accepted: 12/07/2023] [Indexed: 01/28/2024]
Abstract
Dementia with Lewy bodies (DLB) is one of the most common degenerative dementias after Alzheimer's disease (AD) dementia. DLB is under-diagnosed across populations but may be particularly missed in older Black adults. The object of this review was to examine key features of DLB and potential associations with race in order to hypothesize why DLB may be under-diagnosed in Black adults in the U.S. In terms of dementia, symptoms associated with high rates of co-pathology (e.g., AD, vascular disease) in older Black adults may obscure the clinical picture that might suggest Lewy body pathology. Research also suggests that clinicians may be predisposed to give AD dementia diagnoses to Black adults, potentially missing contributions of Lewy body pathology. Hallucinations in Black adults may be misattributed to AD or primary psychiatric disease rather than Lewy body pathology. Research on the prevalence of REM sleep behavior in diverse populations is lacking, but REM sleep behavior disorder could be under-diagnosed in Black adults due to sleep patterns or reporting by caregivers who are not bed partners. Recognition of parkinsonism could be reduced in Black adults due to clinician biases, cultural effects on self-report, and potentially underlying differences in the frequency of parkinsonism. These considerations are superimposed on structural and systemic contributions to health (e.g., socioeconomic status, education, structural racism) and individual-level social exposures (e.g., social interactions, discrimination). Improving DLB recognition in Black adults will require research to investigate reasons for diagnostic disparities and education to increase identification of core symptoms in this population.
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Affiliation(s)
- Melissa J. Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
- 1Florida Alzheimer Disease Research Center, Gainesville, FL, USA
| | - Lisa L. Barnes
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
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Pajewski NM, Donohue MC, Raman R, Espeland MA. Ascertainment and Statistical Issues for Randomized Trials of Cardiovascular Interventions for Cognitive Impairment and Dementia. Hypertension 2024; 81:45-53. [PMID: 37732473 PMCID: PMC10840823 DOI: 10.1161/hypertensionaha.123.19941] [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: 09/22/2023]
Abstract
There has been considerable progress in the prevention and treatment of cardiovascular disease, reducing the population burden of cardiovascular morbidity and mortality. Recently, some randomized trials, including the SPRINT (Systolic Blood Pressure Intervention Trial), have suggested that improvements in cardiovascular risk factors may also slow cognitive decline and reduce the eventual development of dementia. Unfortunately, the randomized trial template that has been used repeatedly to successfully demonstrate reductions in major adverse cardiac events faces several design and analytic obstacles when applied in the context of cognitive decline and dementia. Here, we review these obstacles, motivated by SPRINT and the context of selecting an appropriate cognitive end point for future preventive randomized trials. A few options are available, spanning neuropsychological test scores or composites reflecting specific domains of cognitive function, adjudicated cognitive impairment, or potentially physiological biomarkers. This choice entails considerations around statistical power, modes of ascertainment, the clinical relevance of treatment effects, a myriad of statistical issues (interval censoring, missing data, the competing risk of death, practice effects, etc), as well as ethical considerations around equipoise. Collectively, these considerations indicate that trials aiming to mitigate the cardiovascular contribution to cognitive decline and dementia will generally need to be large, inclusive of a wide age range of older adults, and with multiple years of follow-up.
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Affiliation(s)
- Nicholas M. Pajewski
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Michael C. Donohue
- Alzheimer’s Therapeutic Research Institute, Keck School of Medicine of the University of Southern California, San Diego, CA
| | - Rema Raman
- Alzheimer’s Therapeutic Research Institute, Keck School of Medicine of the University of Southern California, San Diego, CA
| | - Mark A. Espeland
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC
- Section of Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
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Arenson M, Bahorik A, Xia F, Peltz C, Cohen B, Yaffe K. Understanding Racial Disparities in Dementia Prevalence Among Veterans. J Alzheimers Dis 2024; 100:1075-1082. [PMID: 38995788 DOI: 10.3233/jad-240181] [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: 07/14/2024]
Abstract
Background Black and Hispanic older adults have greater incidence of Alzheimer's disease and related dementias relative to White adults, but factors underlying these disparities are not well understood, limiting the ability to address them. Objective To determine the impact of demographics, cardiovascular disease (CVD) and risk factors, social determinants of health (SDOH), and neuropsychiatric risk factors on racial/ethnic disparities in dementia risk among Veterans. Methods We examined a random sample of 1,579,919 older Veterans (age ≥55) without dementia who received care from the VHA from October 1, 1999 to September 30, 2021. All variables were extracted from national VHA data. We used Cox proportional hazard regression models to examine change in variance in risk of dementia across racial/ethnic groups. Results During follow up (mean 11.1 years), 13% of Veterans developed dementia. Relative to White Veterans, the adjusted hazard ratios (AHRs) for developing dementia in sex-adjusted models with age as timescale were 1.65 (95% CI, 1.63-1.67) for Black Veterans and 1.50 (95% CI, 1.44-1.56) for Hispanic Veterans. In the model examining CVD and risk factors, AHRs were 1.53 (95% CI, 1.50-1.55) for Black Veterans and 1.38 (95% CI, 1.33-1.44) for Hispanic Veterans. In the model examining SDOH, AHRs were 1.46 (95% CI, 1.43-1.49) for Black Veterans and 1.34 (95% CI, 1.29-1.40) for Hispanic Veterans. Conclusions SDOH and CVD and risk factors accounted for the greatest amount of variance in racial/ethnic disparities in dementia risk. Cardiovascular disease and SDOH are strong possible targets for interventions designed to reduce these disparities.
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Affiliation(s)
- Melanie Arenson
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | | | - Feng Xia
- San Francisco Veterans Healthcare System, San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Carrie Peltz
- San Francisco Veterans Healthcare System, San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Beth Cohen
- University of California, San Francisco, CA, USA
- San Francisco Veterans Healthcare System, San Francisco, CA, USA
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Tibiriçá L, Jester DJ, Kohn JN, Williams AP, McEvoy LK, Palmer BW. Perceived discrimination and nativity status: risk of cognitive impairment among Latin American older adults. Int Psychogeriatr 2023:1-13. [PMID: 38037791 DOI: 10.1017/s1041610223004374] [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: 12/02/2023]
Abstract
OBJECTIVES We examined the association between perceived discrimination and the risk of cognitive impairment with no dementia (CIND) and Alzheimer's disease and related dementias (ADRD) while considering the potential effects of nativity status. DESIGN A prospective analysis of discrimination and nativity status with dementia and cognitive impairment was conducted among Latinx adults aged 51 years and older who participated in the Health and Retirement Study. SETTING A national representative sample. PARTICIPANTS A sample of 1,175 Latinx adults aged 51 years and older. MEASUREMENTS Demographics, cognitive functioning, perceived discrimination, and nativity status (US-born vs. non-US born) were assessed. Traditional survival analysis methods (Fine and gray models) were used to account for the semi-competing risk of death with up to 10 years of follow-up. RESULTS According to our results, neither everyday discrimination nor nativity status on their own had a statistically significant association with CIND/ADRD; however, non-US-born Latinx adults who reported no discrimination had a 42% lower risk of CIND/ADRD (SHR = 0.58 [0.41, 0.83], p = .003) than US-born adults. CONCLUSIONS These results highlight the need for healthcare providers to assess for discrimination and provide support and resources for those experiencing discrimination. It also highlights the need for better policies that address discrimination and reduce health disparities.
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Affiliation(s)
- Lize Tibiriçá
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Dylan J Jester
- Women's Operational Military Exposure Network (WOMEN), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Jordan N Kohn
- Department of Psychiatry, University of California, San Diego, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, USA
| | - Allison P Williams
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Linda K McEvoy
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Barton W Palmer
- Department of Psychiatry, University of California, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, Mental Illness Research, Education and Clinical Center (MIRECC), San Diego, CA, USA
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Langmann E, Weßel M. Leaving no one behind: successful ageing at the intersection of ageism and ableism. Philos Ethics Humanit Med 2023; 18:22. [PMID: 38001533 PMCID: PMC10668457 DOI: 10.1186/s13010-023-00150-8] [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: 03/31/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The concept of 'successful ageing' has been a prominent focus within the field of gerontology for several decades. However, despite the widespread attention paid to this concept, its intersectional implications have not been fully explored yet. This paper aims to address this gap by analyzing the potential ageist and ableist biases in the discourse of successful ageing through an intersectional lens. METHOD A critical feminist perspective is taken to examine the sensitivity of the discourse of successful ageing to diversity in societies. The paper analyzes how ageist and ableist biases can manifest in the ways we conceptualize ageing, drawing on examples in the context of mental health. RESULTS We argue that the conventional approach to successful ageing is limited in its ability to account for the experiences of people who have faced intersectional discrimination throughout their lives. Drawing on examples in the context of mental health, we explore among others the link between depression and disabilities. Furthermore, we shed light on the negative impact of ageist and ableist attitudes concerning the diagnosis and treatment of dementia. DISCUSSION We demonstrate how diversity is often overlooked in discussions of ageing well, and how ageist and ableist biases can manifest in the ways we conceptualize ageing. We argue that focusing solely on the health status as a means of achieving success fails to adequately counter ageism for all people. We further emphasize the role of structural factors, such as ageist attitudes, in shaping the experience of ageing and exacerbating health inequalities. CONCLUSION Overall, our findings emphasize the need for a more nuanced and inclusive understanding of ageing and therefore an intersectional approach to conceptions of ageing well that recognizes and addresses the biases and limitations of current discourses. Thereby, this paper offers valuable insights into the complex intersections between age and disabilities from a bioethical perspective, highlighting the need for a more inclusive and intersectional approach to ageing.
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Affiliation(s)
- Elisabeth Langmann
- Institute of Ethics and History of Medicine, University of Tübingen, Gartenstraße 47, Tübingen, 72074, Germany.
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Chary AN, Cameron-Comasco L, Shankar KN, Samuels-Kalow ME. Diversity, Equity, and Inclusion: Considerations in the Geriatric Emergency Department Patient. Clin Geriatr Med 2023; 39:673-686. [PMID: 37798072 PMCID: PMC10775156 DOI: 10.1016/j.cger.2023.04.009] [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: 10/07/2023]
Abstract
This article introduces core topics in health equity scholarship and provides examples of how diversity, equity, and inclusion impact the aging population and emergency care of older adults. It offers strategies for promoting diversity, equity, and inclusion to both strengthen the patient-clinician therapeutic relationship and to address operations and systems that impact care of the geriatric emergency department patient.
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Affiliation(s)
- Anita N Chary
- Department of Emergency Medicine, Baylor College of Medicine, 2450 Holcombe Boulevard, Suite 01Y, Houston, TX 77021, USA; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, 2450 Holcombe Boulevard, Suite 01Y, Houston, TX 77021, USA.
| | - Lauren Cameron-Comasco
- Department of Emergency Medicine, Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, MI 48073, USA
| | - Kalpana N Shankar
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Neville House, Boston, MA 02115, USA
| | - Margaret E Samuels-Kalow
- Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua Street, Suite 9206, Boston, MA 02114, USA
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Grasso SM, Clark AL, Petersen M, O'Bryant S. Bilingual neurocognitive resiliency, vulnerability, and Alzheimer's disease biomarker correlates in Latino older adults enrolled in the Health and Aging Brain Study - Health Disparities (HABS-HD). ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12509. [PMID: 38089652 PMCID: PMC10711150 DOI: 10.1002/dad2.12509] [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: 06/05/2023] [Revised: 09/03/2023] [Accepted: 10/27/2023] [Indexed: 02/01/2024]
Abstract
INTRODUCTION The effects of bilingualism on neuropsychological test performance in bilinguals with and without cognitive impairment are not well-understood and are relatively limited by small sample sizes of Latinos. METHODS Using analysis of covariance (ANCOVA), we explored patterns of cognitive performance and impairment across a large sample of community-dwelling bilingual and monolingual Latino older adults with (n = 180) and without (n = 643) mild cognitive impairment (MCI) enrolled in HABS-HD. RESULTS Bilinguals demonstrated cognitive resiliency in the form of significantly better performance on the Trail Making Test and Digit Symbol Substitution Test, observed across the cognitively unimpaired and MCI groups. In contrast, bilinguals demonstrated cognitive vulnerability in the form of significantly poorer performance and higher impairment rates on phonemic fluency in the MCI phase, only. Follow-up analyses revealed less balanced bilinguals demonstrated poorer performance and higher impairment rates on this measure, supported by lower levels of plasma Aβ 42/40. DISCUSSION Patterns of cognitive performance and impairment differ as a function of bilingualism. Bilingualism must be considered when evaluating cognitive and biomarker outcomes in Latino older adults. Highlights Latino bilinguals perform better on measures of processing speed and coding.Latino bilinguals with MCI demonstrate cognitive vulnerability in verbal fluency.Less balanced bilinguals demonstrate greatest vulnerability anchored by Aβ 42/40.
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Affiliation(s)
- Stephanie M Grasso
- Department of Speech, Language, & Hearing Sciences Moody College of Communication The University of Texas (UT) at Austin Austin Texas USA
| | - Alexandra L Clark
- Department of Psychology College of Liberal Arts UT Austin Austin Texas USA
| | - Melissa Petersen
- Institute for Translational Research University of North Texas Health Science Center Fort Worth Texas USA
- Department of Family Medicine University of North Texas Health Science Center Fort Worth Texas USA
| | - Sid O'Bryant
- Institute for Translational Research University of North Texas Health Science Center Fort Worth Texas USA
- Department of Family Medicine University of North Texas Health Science Center Fort Worth Texas USA
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Goldstein FC, Okafor M, Yang Z, Thomas T, Saleh S, Hajjar I. Subjective cognitive complaints in White and African American older adults: associations with demographic, mood, cognitive, and neuroimaging features. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2023; 30:957-970. [PMID: 37602758 PMCID: PMC10843657 DOI: 10.1080/13825585.2023.2249181] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 07/03/2023] [Indexed: 08/22/2023]
Abstract
Subjective cognitive complaints (SCC) in cognitively intact older adults have been investigated as a clinically important symptom that may portend the onset of a neurodegenerative disorder such as Alzheimer's disease. Few studies have concurrently incorporated demographic features, depressive symptoms, neuropsychological status, and neuroimaging correlates of SCC and evaluated whether these differ in White and African American older adults. In the current study, 131 (77 White, 54 African American) healthy participants ≥50 years old completed the Cognitive Function Instrument (CFI) to assess SCC, and they underwent objective cognitive testing, assessment of mood, and brain magnetic resonance imaging. Pearson Product Moment correlations were performed to evaluate associations of the CFI self-ratings with the above measures for the combined group and separately for White and African American participants. SCC were associated with greater depressive symptoms in both White and African American participants in adjusted models controlling for overall cognitive status, education, and hypertension. Greater white matter hyperintensities, lower cortical thickness, older age, and slower set shifting speed were associated with increased SCC in White participants. Although the correlations were not significant for African Americans, the strength of the associations were comparable to White participants. Hippocampal volume was not associated with either total SCC or items specific to memory functioning in the entire group. Longitudinal studies are needed to further evaluate the clinical significance of these associations with risk of conversion to mild cognitive impairment and dementia.
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Affiliation(s)
| | - Maureen Okafor
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Zhiyi Yang
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Tiffany Thomas
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Sabria Saleh
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Ihab Hajjar
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
- Department of Neurology, University of Texas Southwestern, Dallas Texas
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Mattke S, Batie D, Chodosh J, Felten K, Flaherty E, Fowler NR, Kobylarz FA, O'Brien K, Paulsen R, Pohnert A, Possin KL, Sadak T, Ty D, Walsh A, Zissimopoulos JM. Expanding the use of brief cognitive assessments to detect suspected early-stage cognitive impairment in primary care. Alzheimers Dement 2023; 19:4252-4259. [PMID: 37073874 DOI: 10.1002/alz.13051] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 04/20/2023]
Abstract
INTRODUCTION Mild cognitive impairment remains substantially underdiagnosed, especially in disadvantaged populations. Failure to diagnose deprives patients and families of the opportunity to treat reversible causes, make necessary life and lifestyle changes and receive disease-modifying treatments if caused by Alzheimer's disease. Primary care, as the entry point for most, plays a critical role in improving detection rates. METHODS We convened a Work Group of national experts to develop consensus recommendations for policymakers and third-party payers on ways to increase the use of brief cognitive assessments (BCAs) in primary care. RESULTS The group recommended three strategies to promote routine use of BCAs: providing primary care clinicians with suitable assessment tools; integrating BCAs into routine workflows; and crafting payment policies to encourage adoption of BCAs. DISSCUSSION Sweeping changes and actions of multiple stakeholders are necessary to improve detection rates of mild cognitive impairment so that patients and families may benefit from timely interventions.
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Affiliation(s)
- Soeren Mattke
- Brief Cognitive Assessment Work Group, District of Columbia, USA
- Center for Improving Chronic Illness Care, University of Southern California, Los Angeles, California, USA
| | - Donnie Batie
- Brief Cognitive Assessment Work Group, District of Columbia, USA
- Baton Rouge General Medical Center, Baton Rouge, Louisiana, USA
| | - Joshua Chodosh
- Brief Cognitive Assessment Work Group, District of Columbia, USA
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University School of Medicine, New York, New York, USA
- NYU School of Medicine, New York Harbor VA Healthcare System, New York, New York, USA
| | - Kristen Felten
- Brief Cognitive Assessment Work Group, District of Columbia, USA
- Wisconsin Department of Health Services, Office on Aging, Madison, Wisconsin, USA
| | - Ellen Flaherty
- Brief Cognitive Assessment Work Group, District of Columbia, USA
- Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
- Dartmouth Centers for Health and Aging, Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Nicole R Fowler
- Brief Cognitive Assessment Work Group, District of Columbia, USA
- Indiana University Center for Aging Research, Indiana University School of Medicine and the Regenstrief Institute, Indianapolis, Indiana, USA
- Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Center for Health Innovation and Implementation Science, Indiana University, Indianapolis, Indiana, USA
| | - Fred A Kobylarz
- Brief Cognitive Assessment Work Group, District of Columbia, USA
- Department of Family Medicine and Community Health, Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey, USA
| | - Kelly O'Brien
- UsAgainstAlzheimer's, Washington, District of Columbia, USA
| | - Russ Paulsen
- UsAgainstAlzheimer's, Washington, District of Columbia, USA
| | - Anne Pohnert
- Brief Cognitive Assessment Work Group, District of Columbia, USA
- CVS Health MinuteClinic, Woonsocket, Rhode Island, USA
| | - Katherine L Possin
- Brief Cognitive Assessment Work Group, District of Columbia, USA
- Department of Neurology, University of California, San Francisco Memory and Aging Center, San Francisco, California, USA
| | - Tatiana Sadak
- Brief Cognitive Assessment Work Group, District of Columbia, USA
- University of Washington School of Nursing, Seattle, Washington, USA
| | - Diane Ty
- Brief Cognitive Assessment Work Group, District of Columbia, USA
- Alliance to Improve Dementia Care, Milken Institute Center for the Future of Aging, Washington, District of Columbia, USA
| | - Amy Walsh
- Brief Cognitive Assessment Work Group, District of Columbia, USA
- Age-Friendly Health Systems, Institute for Healthcare Improvement, Boston, Massachusetts, USA
| | - Julie M Zissimopoulos
- Brief Cognitive Assessment Work Group, District of Columbia, USA
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California, USA
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Perfect CR, Lindquist J, Smith VA, Stanwyck C, Seidenfeld J, Van Houtven CH, Hastings SN. Are Geriatrics-Focused Primary Care Clinics Better at Diagnosing Dementia Than Traditional Clinics? A Matched Cohort Study. J Gen Intern Med 2023; 38:2710-2717. [PMID: 36941424 PMCID: PMC10506971 DOI: 10.1007/s11606-023-08136-0] [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: 11/03/2022] [Accepted: 03/01/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Dementia and mild cognitive impairment (MCI) are prevalent but underdiagnosed. OBJECTIVE To compare new dementia/MCI diagnosis rates in geriatrics-focused primary care clinics and traditional primary care clinics. DESIGN Secondary analysis of a prospective matched cohort study that spanned 2017-2021. PARTICIPANTS Community-dwelling Veterans over 65 receiving primary care in a geriatrics-focused medical home (GeriPACT) or traditional primary care home (PACT) at one of 57 Veterans Affairs sites. We excluded individuals with a documented diagnosis of dementia or MCI in the year prior to enrollment. MAIN MEASURES Diagnoses obtained from EHR. Cognitive status was assessed using modified Telephone Interview for Cognitive Status (mTICS) tool. KEY RESULTS The 470 participants included in this analysis were predominantly white, non-Hispanic males with an average age of 80.3 years. 9.4% of participants received a diagnosis of dementia/MCI after 24 months: 11.5% in GeriPACT and 7.2% in PACT. Adjusted OR for dementia/MCI diagnosis based on GeriPACT exposure was 1.47 (95% CI 0.65-3.29). Low mTICS score (≤ 27) (OR 4.89, 95% CI 2.36-10.13) and marital status (married/partnered) (OR 1.89, CI 0.99-3.59) were independent predictors of dementia/MCI diagnosis. When stratified by cognitive status: diagnosis rates were 20.8% in GeriPACT and 16.7% in PACT among those who scored lower on the cognitive assessment (mTICS ≤ 27); 7.4% in GeriPACT and 3.6% in PACT among those who scored higher (mTICS > 27). The OR for new dementia/MCI diagnosis in GeriPACT was 1.19 (95% CI 0.49-2.91) among those with a low mTICS score and 1.85 (95% CI 0.70-4.88) among those with a higher mTICS score. CONCLUSIONS Observed rates of new dementia/MCI diagnosis were higher in GeriPACT, but with considerable uncertainty around estimates. Geriatrics-focused primary care clinics may be a promising avenue for improving the detection of dementia in older adults, but further larger studies are needed to confirm this relationship.
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Affiliation(s)
- Chelsea R Perfect
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - J Lindquist
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - V A Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of General Internal Medicine, Duke University, Durham, NC, USA
| | - C Stanwyck
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Medicine, Division of Geriatrics, Duke University School of Medicine, Durham, NC, USA
| | - J Seidenfeld
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Emergency Medicine, Durham VA Health Care System, Durham, NC, USA
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, USA
| | - C H Van Houtven
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Durham, NC, USA
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
| | - S N Hastings
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Division of Geriatrics, Duke University School of Medicine, Durham, NC, USA
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
- Geriatrics Research Education and Clinical Center (GRECC), Durham Veterans Affairs Health Care System, Durham, NC, USA
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Johnston KJ, Loux T, Joynt Maddox KE. Risk Selection and Care Fragmentation at Medicare Accountable Care Organizations for Patients With Dementia. Med Care 2023; 61:570-578. [PMID: 37411003 PMCID: PMC10328553 DOI: 10.1097/mlr.0000000000001876] [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: 07/08/2023]
Abstract
BACKGROUND Patients with dementia are a growing and vulnerable population within Medicare. Accountable care organizations (ACOs) are becoming Medicare's dominant care model, but ACO enrollment and care patterns for patients with dementia are unknown. OBJECTIVE The aim of this study was to compare differences in ACO enrollment for patients with versus without dementia, and in risk profiles and ambulatory care among patients with dementia by ACO enrollment status. RESEARCH DESIGN Cohort study assessing the relationships between patient dementia, following-year ACO enrollment, and ambulatory care patterns. SUBJECTS A total of 13,362 (weighted: 45, 499,049) person-years for patients [2761 (weighted: 6,312,304) for dementia patients] ages 65 years and above in the 2015-2019 Medicare Current Beneficiary Survey. MEASURES We assessed differences in ACO enrollment rates for patients with versus without dementia, and in dementia-relevant ambulatory care visit rates and validated care fragmentation indices among patients with dementia by ACO enrollment status. RESULTS Patients with versus without dementia were less likely to be enrolled in (38.3% vs. 44.6%, P<0.001), and more likely to exit (21.1% vs. 13.7%, P<0.01) ACOs. Among patients with dementia, those enrolled versus not enrolled in ACOs had a more favorable social and health risk profile on 6 of 16 measures (P<0.05). There were no differences in rates of dementia-relevant, primary, or specialty care visits. ACO enrollment was associated with 45.7% higher wellness visit rates (P<0.001), and 13.4% more fragmented primary care (P<0.01) spread across 8.7% more distinct physicians (P<0.05). CONCLUSION Medicare ACOs are less likely to enroll and retain patients with dementia than other patients and provide more fragmented primary care without providing additional dementia-relevant ambulatory care visits.
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Affiliation(s)
- Kenton J Johnston
- General Medical Sciences Division, Washington University School of Medicine
| | - Travis Loux
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University
| | - Karen E Joynt Maddox
- Cardiovascular Division, Washington University School of Medicine, St. Louis, MO
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Becerril A, Pfoh ER, Hashmi AZ, Mourany L, Gunzler DD, Berg KA, Krieger NI, Krishnan K, Moore SE, Kahana E, Dawson NV, Luezas Shamakian L, Campbell JW, Perzynski AT, Dalton JE. Racial, ethnic and neighborhood socioeconomic differences in incidence of dementia: A regional retrospective cohort study. J Am Geriatr Soc 2023; 71:2406-2418. [PMID: 36928611 DOI: 10.1111/jgs.18322] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Evidence on the effects of neighborhood socioeconomic disadvantage on dementia risk in racially and ethically diverse populations is limited. Our objective was to evaluate the relative extent to which neighborhood disadvantage accounts for racial/ethnic variation in dementia incidence rates. Secondarily, we evaluated the spatial relationship between neighborhood disadvantage and dementia risk. METHODS In this retrospective study using electronic health records (EHR) at two regional health systems in Northeast Ohio, participants included 253,421 patients aged >60 years who had an outpatient primary care visit between January 1, 2005 and December 31, 2015. The date of the first qualifying visit served as the study baseline. Cumulative incidence of composite dementia outcome, defined as EHR-documented dementia diagnosis or dementia-related death, stratified by neighborhood socioeconomic deprivation (as measured by Area Deprivation Index) was determined by competing-risk regression analysis, with non-dementia-related death as the competing risk. Fine-Gray sub-distribution hazard ratios were determined for neighborhood socioeconomic deprivation, race/ethnicity, and clinical risk factors. The degree to which neighborhood socioeconomic position accounted for racial/ethnic disparities in the incidence of composite dementia outcome was evaluated via mediation analysis with Poisson rate models. RESULTS Increasing neighborhood disadvantage was associated with increased risk of EHR-documented dementia diagnosis or dementia-related death (most vs. least disadvantaged ADI quintile HR = 1.76, 95% confidence interval = 1.69-1.84) after adjusting for age and sex. The effect of neighborhood disadvantage on this composite dementia outcome remained after accounting for known medical risk factors of dementia. Mediation analysis indicated that neighborhood disadvantage accounted for 34% and 29% of the elevated risk for composite dementia outcome in Hispanic and Black patients compared to White patients, respectively. CONCLUSION Neighborhood disadvantage is related to the risk of EHR-documented dementia diagnosis or dementia-related death and accounts for a portion of racial/ethnic differences in dementia burden, even after adjustment for clinically important confounders.
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Affiliation(s)
- Alissa Becerril
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Elizabeth R Pfoh
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ardeshir Z Hashmi
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Center for Geriatric Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lyla Mourany
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Douglas D Gunzler
- Center for Healthcare Research and Policy, Case Western Reserve University at MetroHealth, Cleveland, Ohio, USA
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Kristen A Berg
- Center for Healthcare Research and Policy, Case Western Reserve University at MetroHealth, Cleveland, Ohio, USA
| | - Nikolas I Krieger
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kamini Krishnan
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, Ohio, USA
| | - Scott Emory Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Eva Kahana
- Sociology Department, Case Western Reserve University, Cleveland, Ohio, USA
| | - Neal V Dawson
- Center for Healthcare Research and Policy, Case Western Reserve University at MetroHealth, Cleveland, Ohio, USA
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | - Adam T Perzynski
- Center for Healthcare Research and Policy, Case Western Reserve University at MetroHealth, Cleveland, Ohio, USA
| | - Jarrod E Dalton
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
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Mattke S, Jun H, Chen E, Liu Y, Becker A, Wallick C. Expected and diagnosed rates of mild cognitive impairment and dementia in the U.S. Medicare population: observational analysis. Alzheimers Res Ther 2023; 15:128. [PMID: 37481563 PMCID: PMC10362635 DOI: 10.1186/s13195-023-01272-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/11/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND With the emergence of disease-modifying Alzheimer's treatments, timely detection of early-stage disease is more important than ever, as the treatment will not be indicated for later stages. Contemporary population-level data for detection rates of mild cognitive impairment (MCI), the stage at which treatment would ideally start, are lacking, and detection rates for dementia are only available for subsets of the Medicare population. We sought to compare documented diagnosis rates of MCI and dementia in the full Medicare population with expected rates based on a predictive model. METHODS We performed an observational analysis of Medicare beneficiaries aged 65 and older with a near-continuous enrollment over a 3-year observation window or until death using 100% of the Medicare fee-for-service or Medicare Advantage Plans beneficiaries from 2015 to 2019. Actual diagnoses for MCI and dementia were derived from ICD-10 codes documented in those data. We used the 2000-2016 data of the Health and Retirement Study to develop a prediction model for expected diagnoses for the included population. The ratios between actually diagnosed cases of MCI and dementia over number of cases expected, the observed over expected ratio, reflects the detection rate. RESULTS Although detection rates for MCI cases increased from 2015 to 2019 (0.062 to 0.079), the results mean that 7.4 of 8 million (92%) expected MCI cases remained undiagnosed. The detection rate for MCI was 0.039 and 0.048 in Black and Hispanic beneficiaries, respectively, compared with 0.098 in non-Hispanic White beneficiaries. Individuals dually eligible for Medicare and Medicaid had lower estimated detection rates than their Medicare-only counterparts for MCI (0.056 vs 0.085). Dementia was diagnosed more frequently than expected (1.086 to 1.104) from 2015 to 2019, mostly in non-Hispanic White beneficiaries (1.367) compared with 0.696 in Black beneficiaries and 0.758 in Hispanic beneficiaries. CONCLUSIONS These results highlight the need to increase the overall detection rates of MCI and of dementia particularly in socioeconomically disadvantaged groups.
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Affiliation(s)
- Soeren Mattke
- Center for Improving Chronic Illness Care, USC Dornsife, University of Southern California, 635 Downey Way, #505N, Los Angeles, CA, 90089, USA.
| | - Hankyung Jun
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Emily Chen
- Center for Improving Chronic Illness Care, USC Dornsife, University of Southern California, 635 Downey Way, #505N, Los Angeles, CA, 90089, USA
| | - Ying Liu
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
| | - Andrew Becker
- Center for Improving Chronic Illness Care, USC Dornsife, University of Southern California, 635 Downey Way, #505N, Los Angeles, CA, 90089, USA
| | - Christopher Wallick
- US Medical Affairs, Genentech, Inc., Roche Group, South San Francisco, CA, USA
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Flaherty CN, Carter PA, Smith L, Lerner N, Hooper G, Bail JR. Community-based early dementia advance care planning in the United States: A scoping review. Geriatr Nurs 2023; 52:63-72. [PMID: 37247492 DOI: 10.1016/j.gerinurse.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/31/2023]
Affiliation(s)
- Christine Noelle Flaherty
- Joint Nursing Science Ph.D. Program, The University of Alabama in Huntsville, Huntsville, Alabama, USA; The University of Alabama, Tuscaloosa, Alabama, USA.
| | - Patricia A Carter
- The University of Alabama Capstone College of Nursing, Tuscaloosa, Alabama, USA.
| | - Lenora Smith
- The University of Alabama in Huntsville College of Nursing, Huntsville, Alabama, USA.
| | - Nancy Lerner
- The University of Maryland School of Nursing, Baltimore, Maryland, USA.
| | - Gwendolyn Hooper
- The University of Alabama Capstone College of Nursing, Tuscaloosa, Alabama, USA.
| | - Jennifer R Bail
- The University of Alabama in Huntsville College of Nursing, Huntsville, Alabama, USA.
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Simon SS, Brucki SMD, Fonseca LM, Becker J, Cappi C, Marques AH, Heyn PC, Gonçalves PD, Martins SS, Busatto G, Bertola L, Suemoto CK, Nitrini R, Caramelli P, Yassuda MS, Miotto EC, Grinberg LT, Arce Renteria M, Alegria M, Stern Y, Rivera‐Mindt M. The (in)visible Brazilians: A perspective review on the need for brain health and dementia research with Brazilian immigrants in the United States. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2023; 9:e12425. [PMID: 37744309 PMCID: PMC10517444 DOI: 10.1002/trc2.12425] [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: 06/21/2023] [Revised: 08/23/2023] [Accepted: 08/26/2023] [Indexed: 09/26/2023]
Abstract
Introduction The Brazilian population in the United States (U.S.), a Latinx subgroup, is rapidly growing and aging but remains underrepresented in U.S. health research. In addition to group-specific genetic and environmental risks, Brazilian immigrants and their offspring in the U.S. likely have cumulative risks for health inequities.It is estimated that 71% of Brazilian immigrants in the U.S. are undocumented, which may limit healthcare access/utilization. Furthermore, mental health is reported as a health priority by Brazilian immigrants in the U.S., and there is a lack of research on Alzheimer's disease and related dementia (AD/ADRD) in this population. Methods We reviewed the scientific literature using traditional (e.g., PubMed) sources and databases generated by U.S. and Brazilian governments, as well as international organizations, and press articles. Results This perspective review lists recommendations for researchers, health providers, and policymakers to promote greater inclusion of U.S. Brazilian populations in health research and care. The review identifies research areas in need of attention to address health inequities and promote mental/brain health in Brazilian immigrants and their offspring living in the U.S. These research areas are: 1) epidemiological studies to map the prevalence and incidence of mental/brain health conditions; 2) research on aging and AD/ADRD risk factors among Brazilian populations in the U.S.; and 3) the need for greater representation of U.S-residing Brazilian population in other relevant research areas involving genetics, neuropathology, and clinical trials. Conclusions The recommendation and research efforts proposed should help to pave the way for the development of community-engagement research and to promote mental/brain health education, improvement of mental/brain health and AD/ADRD services, and the development of culturally-informed intervention to the U.S.-residing Brazilian communities. HIGHLIGHTS The Brazilian population in the United States is growing but is underrepresented in U.S. health research.Approximately 71% of Brazilian immigrants in the United States are undocumented, with an increased risk for health inequities.Mental health is reported as a central health priority by Brazilian immigrants in the United States.There is a lack of research on Alzheimer's disease and other dementias (ADRD) in Brazilian immigrants in the United States.Epidemiological research is needed to map the prevalence/incidence of mental health conditions and ADRD risk factors among Brazilian immigrants in the United States.
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Affiliation(s)
- Sharon Sanz Simon
- Cognitive Neuroscience DivisionDepartment of NeurologyColumbia UniversityVagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of NeurologyColumbia UniversityVagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
- Old Age Research Group, Department of PsychiatryUniversity of São Paulo Medical SchoolSão PauloSão PauloBrazil
| | | | - Luciana Mascarenhas Fonseca
- Old Age Research Group, Department of PsychiatryUniversity of São Paulo Medical SchoolSão PauloSão PauloBrazil
- Department of Community and Behavioral HealthElson S. Floyd College of MedicineWashington State UniversitySpokaneWashingtonUSA
| | - Jacqueline Becker
- Division of General Internal MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Carolina Cappi
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Seaver Autism Center for Research and TreatmentIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of PsychiatryClinics HospitalUniversity of São PauloSchool of MedicineSão PauloSão PauloBrazil
| | - Andrea Horvath Marques
- Elliott School International AffairsThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Patricia C. Heyn
- Center for Optimal AgingDepartment of Physical TherapyMarymount UniversityArlingtonVirginiaUSA
| | - Priscila Dib Gonçalves
- Department of EpidemiologyColumbia University Mailman School of Public HealthNew YorkNew YorkUSA
| | - Silvia S. Martins
- Department of EpidemiologyColumbia University Mailman School of Public HealthNew YorkNew YorkUSA
| | - Geraldo Busatto
- Laboratory of Psychiatric Neuroimaging (LIM‐21)Department of PsychiatryUniversity of São Paulo Medical SchoolSão PauloSão PauloBrazil
| | - Laiss Bertola
- Department of PsychiatryEscola Paulista de Medicina, Universidade Federal de São PauloSão PauloBrazil
| | - Claudia Kimie Suemoto
- Division of GeriatricsDepartment of Clinical MedicineUniversity of São Paulo Medical SchoolSão PauloSão PauloBrazil
| | - Ricardo Nitrini
- Old Age Research Group, Department of PsychiatryUniversity of São Paulo Medical SchoolSão PauloSão PauloBrazil
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Research GroupFaculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMinas GeraisBrazil
| | - Monica Sanches Yassuda
- Department of NeurologyUniversity of São Paulo Medical SchoolSão PauloSão PauloBrazil
- Gerontology, School of Arts, Sciences, and HumanitiesUniversity of São PauloSão PauloSão PauloBrazil
| | - Eliane Correa Miotto
- Old Age Research Group, Department of PsychiatryUniversity of São Paulo Medical SchoolSão PauloSão PauloBrazil
| | - Lea Tenenholz Grinberg
- Memory and Aging CenterDepartment of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of PathologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- LIM‐22Department of PathologyUniversity of São Paulo Medical SchoolSão PauloSão PauloBrazil
- Global Brain Health InstituteUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Miguel Arce Renteria
- Cognitive Neuroscience DivisionDepartment of NeurologyColumbia UniversityVagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of NeurologyColumbia UniversityVagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Margarita Alegria
- Disparities Research UnitDepartment of MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
| | - Yaakov Stern
- Cognitive Neuroscience DivisionDepartment of NeurologyColumbia UniversityVagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of NeurologyColumbia UniversityVagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Monica Rivera‐Mindt
- Department of PsychologyFordham UniversityNew YorkNew YorkUSA
- Department of NeurologyIcahn School of MedicineNew YorkNew YorkUSA
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Zacher M, Brady S, Short S. Geographic Patterns of Dementia in the United States: Variation by Place of Residence, Place of Birth, and Subpopulation. J Gerontol B Psychol Sci Soc Sci 2023; 78:1192-1203. [PMID: 36891976 PMCID: PMC10292838 DOI: 10.1093/geronb/gbad045] [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: 06/21/2022] [Indexed: 03/10/2023] Open
Abstract
OBJECTIVES The prevalence of dementia varies geographically in the United States. However, the extent to which this variation reflects contemporary place-based experiences versus embodied exposures from earlier in the life course remains unclear, and little is known regarding the intersection of place and subpopulation. This study, therefore, evaluates whether and how risk for assessed dementia varies by place of residence and birth, overall and by race/ethnicity and education. METHODS We pool data from the 2000 to 2016 waves of the Health and Retirement Study, a nationally representative panel survey of older U.S. adults (n = 96,848 observations). We estimate the standardized prevalence of dementia by Census division of residence and birth. We then fit logistic regression models of dementia on region of residence and birth, adjusting for sociodemographic characteristics, and examine interactions between region and subpopulation. RESULTS The standardized prevalence of dementia ranges from 7.1% to 13.6% by division of residence and from 6.6% to 14.7% by division of birth, with rates highest throughout the South and lowest in the Northeast and Midwest. In models accounting for region of residence, region of birth, and sociodemographic covariates, Southern birth remains significantly associated with dementia. Adverse relationships between Southern residence or birth and dementia are generally largest for Black and less-educated older adults. As a result, sociodemographic disparities in predicted probabilities of dementia are largest for those residing or born in the South. DISCUSSION The sociospatial patterning of dementia suggests its development is a lifelong process involving cumulated and heterogeneous lived experiences embedded in place.
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Affiliation(s)
- Meghan Zacher
- Population Studies and Training Center, Brown University, Providence, Rhode Island, USA
| | - Samantha Brady
- Population Studies and Training Center, Brown University, Providence, Rhode Island, USA
- Department of Sociology, Brown University, Providence, Rhode Island, USA
| | - Susan E Short
- Population Studies and Training Center, Brown University, Providence, Rhode Island, USA
- Department of Sociology, Brown University, Providence, Rhode Island, USA
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50
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Qin Q, Veazie P, Temkin-Greener H, Makineni R, Cai S. Racial/Ethnic Differences in Risk Factors Associated With Severe COVID-19 Among Older Adults With ADRD. J Am Med Dir Assoc 2023; 24:855-861.e7. [PMID: 37015322 PMCID: PMC9995316 DOI: 10.1016/j.jamda.2023.02.111] [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: 11/14/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To examine racial/ethnic differences in risk factors, and their associations with COVID-19-related outcomes among older adults with Alzheimer's disease and related dementias (ADRD). DESIGN Observational study. SETTING AND PARTICIPANTS National Medicare claims data and the Minimum Data Set 3.0 from April 1, 2020, to December 31, 2020, were linked in this study. We included community-dwelling fee-for-service Medicare beneficiaries with ADRD, diagnosed with COVID-19 between April 1, 2020, and December 1, 2020 (N = 138,533). METHODS Two outcome variables were defined: hospitalization within 14 days and death within 30 days of COVID-19 diagnosis. We obtained information on individual sociodemographic characteristics, chronic conditions, and prior health care utilization based on the Medicare claims and the Minimum Dataset. Machine learning methods, including lasso regression and discriminative pattern mining, were used to identify risk factors in racial/ethnic subgroups (ie, White, Black, and Hispanic individuals). The associations between identified risk factors and outcomes were evaluated using logistic regression and compared across racial/ethnic subgroups using the coefficient comparison approach. RESULTS We found higher risks of COVID-19-related outcomes among Black and Hispanic individuals. The areas under the curve of the models with identified risk factors were 0.65 to 0.68 for mortality and 0.61 to 0.62 for hospitalization across racial/ethnic subgroups. Although some identified risk factors (eg, age, gender) for COVID-19-related outcomes were common among all racial/ethnic subgroups, other risk factors (eg, hypertension, obesity) varied by racial/ethnic subgroups. Furthermore, the associations between some common risk factors and COVID-19-related outcomes also varied by race/ethnicity. Being male was related to 138.2% (95% CI: 1.996-2.841), 64.7% (95% CI: 1.546-1.755), and 37.1% (95% CI: 1.192-1.578) increased odds of death among Hispanic, White, and Black individuals, respectively. In addition, the racial/ethnic disparity in COVID-19-related outcomes could not be completely explained by the identified risk factors. CONCLUSIONS AND IMPLICATIONS Racial/ethnic differences were detected in the likelihood of having COVID-19-related outcomes, specific risk factors, and relationships between specific risk factors and COVID-19-related outcomes. Future research is needed to elucidate the reasons for these differences.
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Affiliation(s)
- Qiuyuan Qin
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.
| | - Peter Veazie
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Helena Temkin-Greener
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Rajesh Makineni
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Shubing Cai
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
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