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Zhang Y, Lu J, Wang M, Zuo C, Jiang J. Influence of Gender on Tau Precipitation in Alzheimer's Disease According to ATN Research Framework. PHENOMICS (CHAM, SWITZERLAND) 2023; 3:565-575. [PMID: 38223687 PMCID: PMC10781910 DOI: 10.1007/s43657-022-00076-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 08/26/2022] [Accepted: 09/01/2022] [Indexed: 01/16/2024]
Abstract
Tau proteins accumulation and their spreading pattern were affected by gender in cognitive impairment patients, especially in the progression of Alzheimer's disease (AD). However, it was unclear whether the gender effects for tau deposition influenced by amyloid deposition. The aim of this study was to investigate gender differences for tau depositions in Aβ positive (A+) subjects. In this study, tau and amyloid positron emission tomography images, structural magnetic resonance imaging images, and demographic information were collected from 179 subjects in Alzheimer's Disease Neuroimaging Initiative (ADNI) database and 63 subjects from Huashan Hospital. Subjects were classified as T+ or T- according to the presence or absence of tau (T) biomarkers. We used two-sample t test and one-way analysis of variance test to analyze the effect of gender with adjusting for age, years of education, and Minimum Mental State Examination. In the ADNI cohort, we found differences in Tau deposition in fusiform gyrus, inferior temporal gyrus, middle temporal gyrus and parahippocampal gyrus between the female T+ (FT+) and male T+ (MT+) groups (p < 0.05). Tau deposition did not differ significantly between female T- (FT-) and male T- (MT-) subjects (p > 0.05). In the Huashan Hospital cohort, there was no difference in Tau deposition between FT+ and MT+ (p > 0.05). The results show that tau depositions significantly increased in females in above brain regions. Our findings suggest that tau deposition is influenced by gender in the A+ subjects. This result has important clinical implications for the development of gender-guided early interventions for patients with both Tau and Amyloid depositions. Supplementary Information The online version contains supplementary material available at 10.1007/s43657-022-00076-9.
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Affiliation(s)
- Ying Zhang
- School of Communication and Information Engineering, Shanghai University, Shanghai, 200444 China
| | - Jiaying Lu
- PET Center and National Research Center for Aging and Medicine and National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai, 201206 China
| | - Min Wang
- School of Communication and Information Engineering, Shanghai University, Shanghai, 200444 China
| | - Chuantao Zuo
- PET Center and National Research Center for Aging and Medicine and National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai, 201206 China
| | - Jiehui Jiang
- Institute of Biomedical Engineering, School of Life Science, Shanghai University, Shanghai, 200444 China
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Kiselica AM, Johnson E, Lewis KR, Trout K. Examining racial disparities in the diagnosis of mild cognitive impairment. APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:749-756. [PMID: 34554020 PMCID: PMC8940745 DOI: 10.1080/23279095.2021.1976778] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Black individuals are less likely to receive an accurate diagnosis of mild cognitive impairment (MCI) than their White counterparts, possibly because diagnoses are typically made by a physician, often without reference to objective neuropsychological test data. We examined racial differences in actuarial MCI diagnoses among individuals diagnosed with MCI via semi-structured clinical interview (the Clinical Dementia Rating) to examine for possible biases in the diagnostic process. Participants were drawn from the National Alzheimer's Coordinating Center Uniform Data Set and included 491 individuals self-identifying as Black and 2,818 individuals self-identifying as White. Chi-square tests were used to examine racial differences in rates of low scores for each cognitive test (domains assessed included attention, processing speed/executive functioning, memory, language, and visual skills). Next, we tested for racial differences in probability of meeting actuarial criteria for MCI by race. Compared to Black participants diagnosed with MCI via clinical interview, White individuals diagnosed with MCI via clinical interview demonstrated significantly higher rates of low demographically-adjusted z-scores on tests of memory, attention, processing speed, and verbal fluency. Furthermore, White individuals were significantly more likely to meet actuarial criteria for MCI (71.60%) than Black individuals (57.90%). Results suggest there may be bias in MCI classification based on semi-structured interview, leading to over diagnosis among Black individuals and/or under diagnosis among White individuals. Examination of neuropsychological test data and use of actuarial approaches may reduce racial disparities in the diagnosis of MCI. Nonetheless, issues related to race-based norming and differential symptom presentations complicate interpretation of results.
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Affiliation(s)
- Andrew M. Kiselica
- Department of Health Psychology, University of Missouri, Columbia, MO, USA
| | - Ellen Johnson
- Department of Health Psychology, University of Missouri, Columbia, MO, USA
- Department of Psychology, Ohio University, Athens, OH, USA
| | - Kaleea R. Lewis
- Department of Public Health, University of Missouri, Columbia, MO, USA
- Department of Women’s and Gender Studies, University of Missouri, Columbia, MO, USA
| | - Kate Trout
- Department of Health Sciences, University of Missouri, Columbia, MO, USA
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Jin HA, McMillan CT, Yannatos I, Fisher L, Rhodes E, Jacoby SF, Irwin DJ, Massimo L. Racial Differences in Clinical Presentation in Individuals Diagnosed With Frontotemporal Dementia. JAMA Neurol 2023; 80:1191-1198. [PMID: 37695629 PMCID: PMC10495924 DOI: 10.1001/jamaneurol.2023.3093] [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: 03/21/2023] [Accepted: 07/18/2023] [Indexed: 09/12/2023]
Abstract
Importance Prior research suggests there are racial disparities in the presentation of dementia, but this has not been investigated in the context of frontotemporal dementia (FTD). Objective To explore racial disparities in dementia severity, functional impairment, and neuropsychiatric symptoms in individuals with a diagnosis of FTD. Design, Setting, and Participants This exploratory cross-sectional study of National Alzheimer's Coordinating Center (NACC) data collected between June 2005 to August 2021 evaluated Asian, Black, and White individuals with a diagnosis of FTD (behavioral variant FTD or primary progressive aphasia). Excluded were races with limited data, including American Indian or Alaska Native (n = 4), Native Hawaiian or other Pacific Islander (n = 3), other (n = 13), and unknown (n = 24), and participants with symptom duration more than 4 SDs above the mean. Main Outcomes and Measures Racial differences at initial NACC visit were examined on Clinical Dementia Rating Dementia Staging Instrument plus NACC Frontotemporal Lobar Degeneration Behavior & Language Domains (FTLD-CDR), Functional Assessment Scale, and Neuropsychiatric Inventory using regression models. Matching was also performed to address the imbalance between racial groups. Results The final sample comprised 2478 individuals, of which 59 (2.4%) were Asian, 63 (2.5%) were Black, and 2356 (95.1%) were White. The mean (SD) age at initial visit was 65.3 (9.4) years and symptom duration at initial visit was 67.5 (35.6) months. Asian and Black individuals were considerably underrepresented, comprising a small percent of the sample. Black individuals had a higher degree of dementia severity on FTLD-CDR (β = 0.64; SE = 0.24; P = .006) and FTLD-CDR sum of boxes (β = 1.21; SE = 0.57; P = .03) and greater functional impairment (β = 3.83; SE = 1.49; P = .01). There were no differences on FTLD-CDR and Functional Assessment Scale between Asian and White individuals. Black individuals were found to exhibit a higher frequency of delusions, agitation, and depression (delusions: odds ratio [OR], 2.18; 95% CI, 1.15-3.93; P = .01; agitation: OR, 1.73; 95% CI, 1.03-2.93; P = .04; depression: OR, 1.75; 95% CI, 1.05-2.92; P = .03). Asian individuals were found to exhibit a higher frequency of apathy (OR, 1.89; 95% CI, 1.09-3.78; P = .03), nighttime behaviors (OR, 1.72; 95% CI, 1.01-2.91; P = .04), and appetite/eating (OR, 1.99; 95% CI, 1.17-3.47; P = .01) compared to White individuals. Conclusions and Relevance This exploratory study suggests there are racial disparities in dementia severity, functional impairment, and neuropsychiatric symptoms. Future work must address racial disparities and their underlying determinants as well as the lack of representation of racially minoritized individuals in nationally representative dementia registries.
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Affiliation(s)
- Hannah A. Jin
- Penn Frontotemporal Degeneration Center, Department of Neurology, School of Medicine, University of Pennsylvania, Philadelphia
| | - Corey T. McMillan
- Penn Frontotemporal Degeneration Center, Department of Neurology, School of Medicine, University of Pennsylvania, Philadelphia
| | - Isabel Yannatos
- Penn Frontotemporal Degeneration Center, Department of Neurology, School of Medicine, University of Pennsylvania, Philadelphia
| | - Lauren Fisher
- Penn Frontotemporal Degeneration Center, Department of Neurology, School of Medicine, University of Pennsylvania, Philadelphia
| | - Emma Rhodes
- Penn Frontotemporal Degeneration Center, Department of Neurology, School of Medicine, University of Pennsylvania, Philadelphia
| | - Sarah F. Jacoby
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia
| | - David J. Irwin
- Penn Frontotemporal Degeneration Center, Department of Neurology, School of Medicine, University of Pennsylvania, Philadelphia
| | - Lauren Massimo
- Penn Frontotemporal Degeneration Center, Department of Neurology, School of Medicine, University of Pennsylvania, Philadelphia
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia
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A Method for Bridging Population-Specific Genotypes to Detect Gene Modules Associated with Alzheimer's Disease. Cells 2022; 11:cells11142219. [PMID: 35883662 PMCID: PMC9319087 DOI: 10.3390/cells11142219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Genome-wide association studies have successfully identified variants associated with multiple conditions. However, generalizing discoveries across diverse populations remains challenging due to large variations in genetic composition. Methods that perform gene expression imputation have attempted to address the transferability of gene discoveries across populations, but with limited success. METHODS Here, we introduce a pipeline that combines gene expression imputation with gene module discovery, including a dense gene module search and a gene set variation analysis, to address the transferability issue. Our method feeds association probabilities of imputed gene expression with a selected phenotype into tissue-specific gene-module discovery over protein interaction networks to create higher-level gene modules. RESULTS We demonstrate our method's utility in three case-control studies of Alzheimer's disease (AD) for three different race/ethnic populations (Whites, African descent and Hispanics). We discovered 182 AD-associated genes from gene modules shared between these populations, highlighting new gene modules associated with AD. CONCLUSIONS Our innovative framework has the potential to identify robust discoveries across populations based on gene modules, as demonstrated in AD.
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Johnson EEH, Alexander C, Lee GJ, Angers K, Ndiaye D, Suhr J. Examination of race and gender differences in predictors of neuropsychological decline and development of Alzheimer's disease. Clin Neuropsychol 2022; 36:327-352. [PMID: 34218735 PMCID: PMC10496932 DOI: 10.1080/13854046.2021.1940299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/28/2021] [Accepted: 06/03/2021] [Indexed: 10/20/2022]
Abstract
ObjectiveBlack adults are diagnosed with Alzheimer's disease (AD) at higher rates than White adults. Biopsychosocial risk factors that differentially affect individuals by race, including health, education, and APOE e4, may explain these findings. Some research suggests that the risk for AD associated with the APOE e4 allele may differ by race. Gender differences in AD have also been identified but remain understudied. We examined race, APOE status, vascular risk factors, education, and the interaction of APOE e4 status and race as predictors of cognitive decline and the development of Alzheimer's disease between genders in a large longitudinal sample of older adults. Methods: Participants (N = 4336) were selected from the National Alzheimer's Coordinating Center's Uniform Data Set who completed measures of verbal fluency, naming, and immediate/delayed story memory across 5 years. Analyses were stratified by gender. Follow up interactions examined statistical significance of differences. Results: APOE e4 by race interactions were largely non-significant and dropped from most models. When controlling for health, education, referral source, and Uniform Data Set form (when applicable), few racial differences in cognitive performance over time emerged. Black participants obtained lower scores than White participants on a majority of baseline measures. Race findings did not differ by gender. Hypertension was more strongly predictive of decline in delayed memory among women. Conclusions: Analyses did not support that APOE e4 differentially affects Black individuals. Hypertension may be a more relevant risk factor among women. Results raise questions regarding the accuracy of baseline scores in predicting decline for Black individuals.
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Affiliation(s)
| | | | - Grace J Lee
- Psychology, Ohio University, Athens, OH00, USA
| | | | | | - Julie Suhr
- Psychology, Ohio University, Athens, OH00, USA
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Weiss J. Contribution of socioeconomic, lifestyle, and medical risk factors to disparities in dementia and mortality. SSM Popul Health 2021; 16:100979. [PMID: 34977324 PMCID: PMC8683757 DOI: 10.1016/j.ssmph.2021.100979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022] Open
Abstract
Extensive literature in the United States documents racial/ethnic and gender disparities in the incidence and prevalence of dementia yet few studies have examined how race/ethnicity and gender intersect to shape inequalities in the risk of dementia. Moreover, few studies have examined heterogeneity in the contribution of known risk factors to dementia across these demographic strata while properly accounting for the semi-competing risk of death. I calculated the proportion of dementia cases attributable to socioeconomic, lifestyle, and medical risk factors across demographic subgroups using nationally representative data from the US-based Health and Retirement Study for the years 2000-2016 and a multistate framework that accounts for the semi-competing risk of death. Socioeconomic resources contributed to the largest number of dementia cases but the magnitude of this contribution varied across strata defined by race/ethnicity and gender. The greatest potential for dementia prevention was observed among non-Hispanic black and Hispanic men and women, supporting an intersectionality approach, and underscoring the need for culturally sensitive intervention and public health initiatives to address the growing burden of dementia. Taken together, work demonstrates the potential benefit of taking an intersectional approach to understanding disparities in dementia.
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Affiliation(s)
- Jordan Weiss
- University of California, 2232 Piedmont Avenue, Berkeley, CA, 94720, USA
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Ferguson SA, Panos JJ, Sloper D, Varma V, Sarkar S. Alzheimer's disease: a step closer to understanding type 3 diabetes in African Americans. Metab Brain Dis 2021; 36:1803-1816. [PMID: 34021875 DOI: 10.1007/s11011-021-00754-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
Alzheimer's disease (AD) is the fourth leading cause of death in the United States and the most common cause of adult-onset dementia. Recent results suggest an increased prevalence and severity in African Americans compared to Caucasians. Our understanding of the potential mechanism(s) underlying this ethnicity difference is limited. We previously described ethnicity-related differences in levels of neurodegenerative proteins and cytokines/chemokines in the BA21 region of African Americans and Caucasians with AD. Here, similar multiplex assays were used to examine those endpoints in patient postmortem cerebrospinal fluid (CSF). Additionally, we measured levels of C-peptide, ghrelin, gastric inhibitory polypeptide (GIP), glucagon-like peptide-1 (GLP-1), glucagon, insulin, leptin, PAI-1, resistin, and visfatin using a human diabetes 10-plex assay. The cytokine and chemokine assays revealed that levels of 26 chemokines or cytokines differed significantly with ethnicity, and three of those were significantly associated with gender. The neurodegenerative disease panel indicated that levels of soluble RAGE were significantly elevated in African Americans compared to Caucasians. All measures in the diabetes disease panel assay were significantly elevated in African Americans: ghrelin, GIP, GLP-1, glucagon, insulin, and visfatin. Through peripheral sample analysis, these results provide further evidence that ethnicity is critically involved in the manifestation of AD.
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Affiliation(s)
- Sherry A Ferguson
- Division of Neurotoxicology, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR, 72079, USA
| | - John J Panos
- Division of Neurotoxicology, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR, 72079, USA
| | - Daniel Sloper
- Division of Systems Biology, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR, 72079, USA
| | - Vijayalakshmi Varma
- Division of Systems Biology, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR, 72079, USA
| | - Sumit Sarkar
- Division of Neurotoxicology, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR, 72079, USA.
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John SE, Evans SA, Hanfelt J, Loring DW, Goldstein FC. Subjective Memory Complaints in White and African American Participants. J Geriatr Psychiatry Neurol 2020; 33:135-143. [PMID: 31409180 PMCID: PMC7015770 DOI: 10.1177/0891988719868305] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Subjective memory complaints (SMCs) are associated with mild cognitive impairment and dementia but are understudied in African Americans (AAs). We compared SMC endorsement in white and AA participants and evaluated predictors of diagnostic progression. METHODS Initial visit variables, including SMC and memory performance, were compared within a cognitively normal race-matched sample of white and AA participants (Ntotal = 912; 456each race) to assess the presence and predictors of SMC, the predictors of future diagnostic progression, and the change in memory performance over time. RESULTS More white (32.9%) than AA (24.3%) participants reported SMC (P < .01, ϕ = -.10). Subjective memory complaint was predicted by memory performance (B = -0.03, standard error [SE] = 0.013, odds ratio [OR] = .968, P < .05) and race (B = -0.99, SE = 0.080, OR = .373, P < .001). Subjective memory complaints and memory performance were associated with progression, χ2 (3, n = 912) = 102.37, P < .001. African American race (-2.05 ± 0.24 SE) and SMC (-0.45 ± 0.21 SE) were associated with worse memory performance at baseline and over time, χ2(3) = 13.54, P < .01. CONCLUSIONS In contrast to previous research, our study found that SMC is associated with diagnostic progression and objective memory declines in both white and AA participants.
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Affiliation(s)
- Samantha E. John
- Department of Brain Health, University of Nevada, Las Vegas, Las Vegas, NV, USA,Population Health & Health Equity Initiative, University of Nevada, Las Vegas, Las Vegas, NV, USA,Corresponding author. (S.E.J.), 4505 S. Maryland Pkwy, MSM-407, Las Vegas, NV 89154, , Tel: (702) 895-4580
| | - Sarah A. Evans
- Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - John Hanfelt
- Emory Goizueta Alzheimer’s Disease Research Center, Atlanta, GA, USA,Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - David W. Loring
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Felicia C. Goldstein
- Emory Goizueta Alzheimer’s Disease Research Center, Atlanta, GA, USA,Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
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Ferguson SA, Varma V, Sloper D, Panos JJ, Sarkar S. Increased inflammation in BA21 brain tissue from African Americans with Alzheimer's disease. Metab Brain Dis 2020; 35:121-133. [PMID: 31823110 DOI: 10.1007/s11011-019-00512-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/25/2019] [Indexed: 12/21/2022]
Abstract
Chronic neuroinflammation is strongly associated with AD and altered peripheral and central levels of chemokines and cytokines have been frequently described in those with AD. Given the increasing evidence of ethnicity-related differences in AD, it was of interest to determine if those altered chemokine and cytokine levels are ethnicity-related. Because African Americans exhibit a higher incidence of AD and increased symptom severity, we explored chemokine and cytokine concentrations in post-mortem brain tissue from the BA21 region of African Americans and Caucasians with AD using multiplex assays. IL-1β, MIG, TRAIL, and FADD levels were significantly increased in African Americans while levels of IL-3 and IL-8 were significantly decreased. Those effects did not interact with gender; however, overall levels of CCL25, CCL26 and CX3CL1 were significantly decreased in women. The NLRP3 inflammasome is thought to be critically involved in AD. Increased activation of this inflammasome in African Americans is consistent with the current results.
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Affiliation(s)
- Sherry A Ferguson
- Division of Neurotoxicology, National Center for Toxicological Research/Food and Drug Administration, 3900 NCTR Road, Jefferson, AR, 72079, USA.
| | - Vijayalakshmi Varma
- Division of Systems Biology, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR, 72079, USA
| | - Daniel Sloper
- Division of Systems Biology, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR, 72079, USA
| | - John J Panos
- Division of Neurotoxicology, National Center for Toxicological Research/Food and Drug Administration, 3900 NCTR Road, Jefferson, AR, 72079, USA
| | - Sumit Sarkar
- Division of Neurotoxicology, National Center for Toxicological Research/Food and Drug Administration, 3900 NCTR Road, Jefferson, AR, 72079, USA
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Canevelli M, Bruno G, Grande G, Quarata F, Raganato R, Remiddi F, Valletta M, Zaccaria V, Vanacore N, Cesari M. Race reporting and disparities in clinical trials on Alzheimer's disease: A systematic review. Neurosci Biobehav Rev 2019; 101:122-128. [PMID: 30946856 DOI: 10.1016/j.neubiorev.2019.03.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 02/24/2019] [Accepted: 03/24/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Race is an important health determinant and should adequately be considered in research and drug development protocols targeting Alzheimer's disease (AD). METHODS A systematic review of available randomized controlled trials (RCTs) on the currently marketed treatments for AD was conducted with the aim of 1) documenting the reporting of race, and 2) exploring the impact of race on the efficacy and safety/tolerability of the considered medications. RESULTS Overall, 59.2% of the 49 retained RCTs reported information concerning the race of participants. Only a striking minority of enrolled patients was constituted of blacks and Hispanics. None on the retained studies reported results on the efficacy and safety/tolerability of the tested treatment separately for racial groups nor performed sensitivity analyses accounting for the race of participants. DISCUSSION Race has insufficiently been reported in previous interventional studies on AD. Its potential association with the effectiveness and safety/tolerability of the tested medications has completely been neglected.
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Affiliation(s)
- Marco Canevelli
- Department of Human Neuroscience, "Sapienza" University, Rome, Italy; National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy.
| | - Giuseppe Bruno
- Department of Human Neuroscience, "Sapienza" University, Rome, Italy
| | - Giulia Grande
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Federica Quarata
- Department of Human Neuroscience, "Sapienza" University, Rome, Italy
| | - Riccardo Raganato
- Department of Human Neuroscience, "Sapienza" University, Rome, Italy
| | - Francesca Remiddi
- Department of Human Neuroscience, "Sapienza" University, Rome, Italy
| | - Martina Valletta
- Department of Human Neuroscience, "Sapienza" University, Rome, Italy
| | - Valerio Zaccaria
- Department of Human Neuroscience, "Sapienza" University, Rome, Italy
| | - Nicola Vanacore
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Matteo Cesari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Geriatric Unit, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
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Ferguson SA, Panos JJ, Sloper D, Varma V. Neurodegenerative Markers are Increased in Postmortem BA21 Tissue from African Americans with Alzheimer's Disease. J Alzheimers Dis 2018; 59:57-66. [PMID: 28582866 DOI: 10.3233/jad-170204] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) presents with an earlier onset age and increased symptom severity in African Americans and Hispanics. OBJECTIVE Although the prevalence of plaques and tangles may not exhibit ethnicity-related differences, levels of neurodegenerative proteins have not been described. METHODS Here, levels of five proteins (i.e., S100B, sRAGE, GDNF, Aβ40, and Aβ42) and the Aβ42/Aβ40 ratio were measured in postmortem samples of the middle temporal gyrus (BA21) from age-matched African Americans and Caucasians with AD (n = 6/gender/ethnicity). RESULTS S100B levels were increased 17% in African Americans (p < 0.003) while sRAGE was mildly decreased (p < 0.09). Aβ42 levels were increased 121% in African Americans (p < 0.02), leading to a 493% increase in the Aβ42/Aβ40 ratio (p < 0.002). Analysis of GDNF levels did not indicate any significant effects. There were no significant effects of gender and no significant ethnicity with gender interactions on any analyte. Effect size calculations indicated "medium" to "very large" effects. CONCLUSION S100B is typically elevated in AD cases; however, the increased levels in African Americans here may be indicative of increased severity in specific populations. Increased Aβ42/Aβ40 ratios in the current study are compatible with increased disease severity and might indicate increased AD pathogenesis in African Americans. Overall, these results are compatible with a hypothesis of increased neuroinflammation in African Americans with AD.
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Affiliation(s)
- Sherry A Ferguson
- Division of Neurotoxicology, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR, USA
| | - John J Panos
- Division of Neurotoxicology, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR, USA
| | - Daniel Sloper
- Division of Systems Biology, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR, USA
| | - Vijayalakshmi Varma
- Division of Systems Biology, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR, USA
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12
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McDonough IM. Beta-amyloid and Cortical Thickness Reveal Racial Disparities in Preclinical Alzheimer's Disease. Neuroimage Clin 2017; 16:659-667. [PMID: 29868439 PMCID: PMC5984571 DOI: 10.1016/j.nicl.2017.09.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/13/2017] [Accepted: 09/20/2017] [Indexed: 01/06/2023]
Abstract
African Americans are two to four times more likely to develop dementia as Non-Hispanic Whites. This increased risk among African Americans represents a critical health disparity that affects nearly 43 million Americans. The present study tested the hypothesis that older African Americans with elevated beta-amyloid would show greater neurodegeneration (smaller hippocampal volumes and decreased cortical thickness) than older Non-Hispanic Whites with elevated beta-amyloid. Data from the Harvard Aging Brain Study (HABS) were used to form a group of older African Americans and two matched groups of Non-Hispanic White adults. Amyloid-positive African Americans had decreased cortical thickness in most of the Alzheimer's disease (AD) signature regions compared with amyloid-positive Non-Hispanic Whites. This factor was negatively correlated with age and white matter hypointensities. Using support vector regression, we also found some evidence that African Americans have an older "brain age" than Non-Hispanic Whites. These findings suggest that African Americans might be more susceptible to factors causing neurodegeneration, which then might accelerate the rate of a diagnosis of AD.
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Affiliation(s)
- Ian M. McDonough
- Department of Psychology, The University of Alabama, Tuscaloosa, AL 35487, USA
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Stevnsborg L, Jensen-Dahm C, Nielsen TR, Gasse C, Waldemar G. Inequalities in Access to Treatment and Care for Patients with Dementia and Immigrant Background: A Danish Nationwide Study. J Alzheimers Dis 2016; 54:505-14. [DOI: 10.3233/jad-160124] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Lea Stevnsborg
- Danish Dementia Research Centre (DDRC), Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christina Jensen-Dahm
- Danish Dementia Research Centre (DDRC), Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thomas R. Nielsen
- Danish Dementia Research Centre (DDRC), Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christiane Gasse
- National Centre for Register-Based Research, Aarhus University, School of Business and Social Sciences, Aarhus, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre (DDRC), Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Gleason CE, Dowling NM, Benton SF, Kaseroff A, Gunn W, Edwards DF. Common Sense Model Factors Affecting African Americans' Willingness to Consult a Healthcare Provider Regarding Symptoms of Mild Cognitive Impairment. Am J Geriatr Psychiatry 2016; 24:537-46. [PMID: 26809602 PMCID: PMC4791203 DOI: 10.1016/j.jagp.2015.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 08/14/2015] [Accepted: 08/27/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Although at increased risk for developing dementia compared with white patients, older African Americans are diagnosed later in the course of dementia. Using the common sense model (CSM) of illness perception, we sought to clarify processes promoting timely diagnosis of mild cognitive impairment (MCI) for African American patients. DESIGN, SETTING, PARTICIPANTS In-person, cross-sectional survey data were obtained from 187 African American (mean age: 60.44 years). Data were collected at social and health-focused community events in three southern Wisconsin cities. MEASUREMENTS The survey represented a compilation of published surveys querying CSM constructs focused on early detection of memory disorders, and willingness to discuss concerns about memory loss with healthcare providers. Derived CSM variables measuring perceived causes, consequences, and controllability of MCI were included in a structural equation model predicting the primary outcome: Willingness to discuss symptoms of MCI with a provider. RESULTS Two CSM factors influenced willingness to discuss symptoms of MCI with providers: Anticipation of beneficial consequences and perception of low harm associated with an MCI diagnosis predicted participants' willingness to discuss concerns about cognitive changes. No association was found between perceived controllability and causes of MCI, and willingness to discuss symptoms with providers. CONCLUSIONS These data suggest that allaying concerns about the deleterious effects of a diagnosis, and raising awareness of potential benefits, couldinfluence an African American patient's willingness to discuss symptoms of MCI with a provider. The findings offer guidance to designers of culturally congruent MCI education materials, and healthcare providers caring for older African Americans. .
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Affiliation(s)
- Carey E. Gleason
- Wisconsin Alzheimer’s Disease Research Center, Madison, WI,Division of Geriatrics, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI,Geriatric Research, Education, and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI
| | - N. Maritza Dowling
- Wisconsin Alzheimer’s Disease Research Center, Madison, WI,Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Susan Flowers Benton
- Department of Rehabilitation Psychology and Special Education, School of Education, University of Wisconsin, Madison, WI
| | - Ashley Kaseroff
- Department of Rehabilitation Psychology and Special Education, School of Education, University of Wisconsin, Madison, WI
| | - Wade Gunn
- Department of Kinesiology and Occupational Therapy, School of Education, University of Wisconsin, Madison, WI
| | - Dorothy Farrar Edwards
- Wisconsin Alzheimer’s Disease Research Center, Madison, WI,Department of Kinesiology and Occupational Therapy, School of Education, University of Wisconsin, Madison, WI
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Pogue AI, Lukiw WJ. Aluminum, the genetic apparatus of the human CNS and Alzheimer's disease (AD). Morphologie 2016; 100:56-64. [PMID: 26969391 DOI: 10.1016/j.morpho.2016.01.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/13/2016] [Accepted: 01/19/2016] [Indexed: 06/05/2023]
Abstract
The genomes of eukaryotes orchestrate their expression to ensure an effective, homeostatic and functional gene signaling program, and this includes fundamentally altered patterns of transcription during aging, development, differentiation and disease. These actions constitute an extremely complex and intricate process as genetic operations such as transcription involve the very rapid translocation and polymerization of ribonucleotides using RNA polymerases, accessory transcription protein complexes and other interrelated chromatin proteins and genetic factors. As both free ribonucleotides and polymerized single-stranded RNA chains, ribonucleotides are highly charged with phosphate, and this genetic system is extremely vulnerable to disruption by a large number of electrostatic forces, and primarily by cationic metals such as aluminum. Aluminum has been shown by independent researchers to be particularly genotoxic to the genetic apparatus, and it has become reasonably clear that aluminum disturbs genetic signaling programs in the CNS that bear a surprising resemblance to those observed in Alzheimer's disease (AD) brain. This paper will focus on a discussion of two molecular-genetic aspects of aluminum genotoxicity: (1) the observation that micro-RNA (miRNA)-mediated global gene expression patterns in aluminum-treated transgenic animal models of AD (Tg-AD) strongly resemble those found in AD; and (2) the concept of "human biochemical individuality" and the hypothesis that individuals with certain gene expression patterns may be especially sensitive and perhaps predisposed to aluminum genotoxicity.
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Affiliation(s)
- A I Pogue
- Alchem Biotech, Toronto, ON M5S 1A8, Canada
| | - W J Lukiw
- Alchem Biotech, Toronto, ON M5S 1A8, Canada; Neuroscience Center and the Departments of Neurology and Ophthalmology, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA.
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Zahodne LB, Meyer OL, Choi E, Thomas ML, Willis SL, Marsiske M, Gross AL, Rebok GW, Parisi JM. External locus of control contributes to racial disparities in memory and reasoning training gains in ACTIVE. Psychol Aging 2015; 30:561-72. [PMID: 26237116 DOI: 10.1037/pag0000042] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Racial disparities in cognitive outcomes may be partly explained by differences in locus of control. African Americans report more external locus of control than non-Hispanic Whites, and external locus of control is associated with poorer health and cognition. The aims of this study were to compare cognitive training gains between African American and non-Hispanic White participants in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study and determine whether racial differences in training gains are mediated by locus of control. The sample comprised 2,062 (26% African American) adults aged 65 and older who participated in memory, reasoning, or speed training. Latent growth curve models evaluated predictors of 10-year cognitive trajectories separately by training group. Multiple group modeling examined associations between training gains and locus of control across racial groups. Compared to non-Hispanic Whites, African Americans evidenced less improvement in memory and reasoning performance after training. These effects were partially mediated by locus of control, controlling for age, sex, education, health, depression, testing site, and initial cognitive ability. African Americans reported more external locus of control, which was associated with smaller training gains. External locus of control also had a stronger negative association with reasoning training gain for African Americans than for Whites. No racial difference in training gain was identified for speed training. Future intervention research with African Americans should test whether explicitly targeting external locus of control leads to greater cognitive improvement following cognitive training.
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Affiliation(s)
- Laura B Zahodne
- Cognitive Neuroscience Division, Department of Neurology and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University
| | - Oanh L Meyer
- Alzheimer's Disease Center, Department of Neurology, University of California, Davis
| | - Eunhee Choi
- School of Social Work, Health and Human Sciences, Colorado State University
| | | | - Sherry L Willis
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida
| | - Alden L Gross
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
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McDougall GJ, Simpson G, Friend ML. Strategies for research recruitment and retention of older adults of racial and ethnic minorities. J Gerontol Nurs 2015; 41:14-23; quiz 24-5. [PMID: 25849063 PMCID: PMC6415923 DOI: 10.3928/00989134-20150325-01] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 02/20/2015] [Indexed: 11/20/2022]
Abstract
HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.4 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Strategies for Research Recruitment and Retention of Older Adults of Racial and Ethnic Minorities" found on pages 14-23, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until April 30, 2018. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVE 1. Identify strategies and barriers for the recruitment and retention of older adults of racial and ethnic minorities in cognitive aging research. DISCLOSURE STATEMENT Neither the planners nor the authors have any conflicts of interest to disclose. The numbers of Hispanic and African American older adults in the United States are expected to increase by 86% and more than 31%, respectively. African American and Hispanic American individuals are more likely than Caucasian individuals to have chronic health conditions, and researchers have argued that these health disparities may contribute to their higher rates of dementia-related illnesses. The current article explores strategies to improve participation in cognitive aging research by older adults, particularly minority older adults. The cultural aspects of cognitive aging are examined, especially the role of stigma and stereotype threat. The perceptions of cognitive aging of African American and Hispanic older adults are also described. Specific strategies are presented that have been successfully implemented to improve recruitment and retention in research targeting minority older adults. Strategies that yielded retention of minority older adults included advertising and marketing a randomized clinical trial, media relations, intervention tailoring, and adaptation of psychometric instruments.
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Lukiw WJ. Variability in micro RNA (miRNA) abundance, speciation and complexity amongst different human populations and potential relevance to Alzheimer's disease (AD). Front Cell Neurosci 2013; 7:133. [PMID: 23986657 PMCID: PMC3753559 DOI: 10.3389/fncel.2013.00133] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 08/06/2013] [Indexed: 12/23/2022] Open
Affiliation(s)
- Walter J Lukiw
- Department of Neurology, Neuroscience and Ophthalmology, LSU Neuroscience Center, Louisiana State University Health Sciences Center New Orleans, LA, USA
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Gilligan AM, Malone DC, Warholak TL, Armstrong EP. Health disparities in cost of care in patients with Alzheimer's disease: an analysis across 4 state Medicaid populations. Am J Alzheimers Dis Other Demen 2013; 28:84-92. [PMID: 23196405 PMCID: PMC10697230 DOI: 10.1177/1533317512467679] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
OBJECTIVES To investigate health disparities with respect to cost of care across 4 state Medicaid populations. METHODS Data were obtained from Centers for Medicare and Medicaid Services (CMS) for this retrospective study. Patients were enrolled in a California, Florida, New Jersey, or New York Medicaid programs during 2004, with a diagnosis of Alzheimer's disease (International Classification of Diseases, Ninth Revision 331.0). Outcome of interest was cost of care. Decomposition of cost to calculate disparities was estimated using the Oaxaca-Blinder model. An a priori α level of .01 was used. RESULTS Approximately 158 974 individuals qualified for this study. Disparities were found to exist between blacks and whites (with blacks having higher costs; P < .0001), whites and others (with whites having higher costs; P < .0001), blacks and Hispanics (with blacks having higher costs; P < .0001), blacks and others (with blacks having higher costs; P < .0001), and Hispanics and others (with Hispanics having higher costs; P < .0001). CONCLUSIONS Disparities in cost among minority-to-minority populations were just as prevalent, if not higher, than minority-white disparities.
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Lee HB, Richardson AK, Black BS, Shore AD, Kasper JD, Rabins PV. Race and cognitive decline among community-dwelling elders with mild cognitive impairment: findings from the Memory and Medical Care Study. Aging Ment Health 2012; 16:372-7. [PMID: 21999809 PMCID: PMC3302954 DOI: 10.1080/13607863.2011.609533] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Previous studies have reported conflicting findings on the relationship between race and cognitive decline in elders with dementia. Few studies have examined the role of race in cognitive decline in mild cognitive impairment (MCI). We investigate the relationship between race and cognitive decline in participants with MCI in a community-based, longitudinal study of cognitively impaired elders. METHOD Based on a validated method utilizing a neuropsychiatric battery, 133 subjects [mean age: 78.7 years (SD = 6.5); female: 112 (76.7%); black: 59 (44.4%)] out of 512 participants in the Memory and Medical Care Study were diagnosed with MCI. The main outcome measure was the Telephone Interview for Cognitive Status (TICS) score over three years. Other baseline subject characteristics (demographics, health-related variables, behavioral, and psychiatric symptoms) were included in the analysis. RESULTS Overall, the three-year decline in mean TICS score was significantly higher among African Americans than non-African Americans [3.31 (SD: 7.5) versus 0.96 (SD: 3.0), t-value = 1.96, p-value = 0.05]. General estimating equation analyses revealed that African American race was associated with a faster rate of cognitive decline in all models. CONCLUSION The rate of cognitive decline in MCI appears to be faster in African Americans than non-African Americans in the community. Diagnosis of MCI among African American elders could lead to early interventions to prevent or delay cognitive decline in the future.
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Affiliation(s)
- Hochang B. Lee
- Department of Psychiatry & Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, Maryland,Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Amanda K. Richardson
- Department of Health, Society & Behavior, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Betty S. Black
- Department of Psychiatry & Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, Maryland,Department of Health, Society & Behavior, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland,Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Andrew D. Shore
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Judith D. Kasper
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Peter V. Rabins
- Department of Psychiatry & Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, Maryland,Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland,Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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McCubbin JA, Merritt MM, Sollers JJ, Evans MK, Zonderman AB, Lane RD, Thayer JF. Cardiovascular-emotional dampening: the relationship between blood pressure and recognition of emotion. Psychosom Med 2011; 73:743-50. [PMID: 22042880 PMCID: PMC3210914 DOI: 10.1097/psy.0b013e318235ed55] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Persons with elevated blood pressure (BP) show dampened emotional responses to affect-laden stimuli. We sought to further examine cardiovascular-emotional dampening by examination of the relationship between resting hemodynamic measures and recognition of emotion in an African American community-based sample. METHODS Participants were 106 African American men and women (55 women; mean age = 52.8 years), mainly low in socioeconomic status, and part of the Healthy Aging in Nationally Diverse Longitudinal Samples pilot study. Participants evaluated emotional expressions in faces and sentences using the Perception of Affect Test (PAT). Resting BP, total peripheral resistance (TPR), cardiac output, and heart rate were obtained continuously using a Portapres BP monitor. RESULTS Total PAT scores were inversely related to systolic (r = -0.30) and diastolic (r = -0.24) BPs, TPR (r = -0.36), and age (r = -0.31; p values < .01) and were positively related to cardiac output (r = 0.27) and education (r = 0.38; p values < .01), as well as with mental state (r = 0.25) and body mass index (r = -0.20; p values < .05). Accuracy of emotion recognition on the PAT tasks remained inversely related to TPR and BP after adjustment for demographic variables, medication, mental state, and body mass index. CONCLUSIONS Elevated BP and TPR were associated with reduced perception of affect. TPR was the most consistent independent hemodynamic correlate of emotional dampening for the PAT scores. These results suggest potentially important links among central nervous system regulation of emotions, hemodynamic processes, and hypertension development.
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Affiliation(s)
- James A McCubbin
- Department of Psychology, Clemson University, Clemson, SC 29634, USA.
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Schrauf RW, Iris M. Very long pathways to diagnosis among African Americans and Hispanics with memory and behavioral problems associated with dementia. DEMENTIA 2011. [DOI: 10.1177/1471301211416615] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Research shows that African Americans and Hispanics experience longer delays in dementia diagnosis than do whites. This study focuses on the duration and direction of help-seeking pathways among individuals who had either very short (median: 1 year, 9 months) or very long (median: 9 years, 2 months) times-to-diagnosis. Participants reported the frequencies of events, actions, outcomes, and results around four key time points in the pathway: First Notice of a Problem, Recognition of a Pattern, First Doctor Visit, and Final Diagnosis. Using reported frequencies of events, actions, and outcomes around these events, we constructed the modal pathway or ‘canonical narrative’ and then used correspondence analysis of the data to model short and long pathways. Short pathways were dominated by stepwise movement toward diagnosis (84.5% of inertia or variance) and some ambivalence around symptom recognition (10%). Long pathways were marked by a shift away from movement toward diagnosis (44.5%) but toward the family's taking over key quotidian tasks (55.5%). We suggest that Hispanic and African American caregivers effectively provide a kind of ‘scaffolding’ for the patient, which may in fact be adaptive rather than dysfunctional. Thus, delayed diagnoses and non-diagnosis may reflect ‘active’ choices for dealing with the disease rather than avoidance of the problem.
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Parikh NM, Morgan RO, Kunik ME, Chen H, Aparasu RR, Yadav RK, Schulz PE, Johnson ML. Risk factors for dementia in patients over 65 with diabetes. Int J Geriatr Psychiatry 2011; 26:749-57. [PMID: 20891020 DOI: 10.1002/gps.2604] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Accepted: 06/10/2010] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study identified factors in patients with diabetes associated with risk of developing dementia. RESEARCH DESIGN AND METHODS This retrospective, longitudinal study used a national cohort of US Veterans with diabetes 65 years or older to examine incidence of dementia over 2 years. A multivariable Cox regression model was used to estimate risk of developing dementia associated with sociodemographic factors, use of diabetes medications, and duration of diabetes. RESULTS In all, 377,838 patients (average age, 75.53 ± 6.07 years) were studied. Over the 2 year follow-up, 14,580 (3.85%) were diagnosed with dementia. Major risk factors for dementia were age >75 years (75-85 years, hazard ratio [HR] 2.092, 95% confidence interval [CI] 2.017-2.169; ≥85 years, HR 3.468, CI 3.274-3.672), race black versus white, HR 1.218, CI 1.164-1.274), Southern residence (HR = 1.181, CI 1.133-1.232), and diabetes duration (HR for 5 years or more, 1.428, CI 1.357-1.504). There was a reduced HR for dementia with use of an oral hypoglycemic agent (HR 0.940, CI 0.909-0.972) and HMG-CoA reductase inhibitors (HR, 0.875, CI 0.846-0.906). There was no change in HR with insulin use (HR 1.024, CI 0.983-1.067). CONCLUSIONS Several important factors were identified that are associated with increased dementia risk, and two factors were identified that are associated with reduced risk. It will be important to ascertain whether risk-factor modification reduces the HR for dementia in persons with diabetes, and to further examine effects of medication use for comorbid conditions.
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Palmqvist S, Minthon L, Wattmo C, Londos E, Hansson O. A Quick Test of cognitive speed is sensitive in detecting early treatment response in Alzheimer's disease. ALZHEIMERS RESEARCH & THERAPY 2010; 2:29. [PMID: 20950460 PMCID: PMC2983438 DOI: 10.1186/alzrt53] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 10/15/2010] [Indexed: 11/10/2022]
Abstract
INTRODUCTION There is a great need for quick tests that identify treatment response in Alzheimer's disease (AD) to determine who benefits from the treatment. In this study, A Quick Test of cognitive speed (AQT) was compared with the mini-mental state examination (MMSE) in the evaluation of treatment outcome in AD. METHODS 75 patients with mild to moderate AD at a memory clinic were assessed with AQT and the MMSE at a pretreatment visit, at baseline and after 8 weeks of treatment with cholinesterase inhibitors (ChEI) initiated at baseline. Changes in the mean test scores before and after treatment were compared, as well as the number of treatment responders detected by each test, according to a reliable change index (RCI). RESULTS After 8 weeks of treatment, the AQT improvement, expressed as a percentage, was significantly greater than that of the MMSE (P = 0.026). According to the RCI, the cut-offs to define a responder were ≥16 seconds improvement on AQT and ≥3 points on the MMSE after 8 weeks. With these cut-offs, both tests falsely classified ≤5% as responders during the pretreatment period. After 8 weeks of treatment, AQT detected significantly more responders than the MMSE (34% compared with 17%; P = 0.024). After 6 months of treatment, the 8-week AQT responders still showed a significantly better treatment response than the AQT nonresponders (22.3 seconds in mean difference; P < 0.001). CONCLUSIONS AQT detects twice as many treatment responders as the MMSE. It seems that AQT can, already after 8 weeks, identify the AD patients who will continue to benefit from ChEI treatment.
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Affiliation(s)
- Sebastian Palmqvist
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, S-205 02 Malmö, Sweden.
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McDougall GJ, Becker H, Pituch K, Acee TW, Vaughan PW, Delville CL. Differential benefits of memory training for minority older adults in the SeniorWISE study. THE GERONTOLOGIST 2010; 50:632-45. [PMID: 20203096 DOI: 10.1093/geront/gnq017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE Cognitive training improves mental abilities in older adults, but the benefit to minority elders is unclear. We conducted a subgroup analysis of subjects in the SeniorWISE (Wisdom Is Simply Exploration) trial to examine this issue. DESIGN AND METHODS SeniorWISE was a Phase 3 randomized trial that enrolled 265 nondemented community-dwelling older adults aged 65 years and older between 2001 and 2006. Participants were randomly assigned to 12 hr of either memory or health training. RESULTS The sample was 79% female, 71% Caucasian, 17% Hispanic, and 12% African American. On the Rivermead Behavioural Memory Test (RBMT), 28% of the sample scored normal, 47% scored poor, and 25% impaired. Memory performance changed differently over time depending on the demographic characteristics of participants. Both Hispanics and Blacks performed better than Whites on visual memory, and Blacks performed better over time on instrumental activities of daily living. On all performance measures, lower pretest scores were associated with relatively greater improvements over time. IMPLICATIONS Our analyses suggested that minority participants received differential benefits from the memory training; however, this remains speculative because the 3 ethnic groups in the sample were not equivalent in size. The question of why Black and Hispanic participants often made greater improvements needs further exploration.
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Affiliation(s)
- Graham J McDougall
- School of Nursing, The University of Texas at Austin, Austin, TX 78701, USA.
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Souder E, Terry TL. Use of Lay Educators to Overcome Barriers to Research with Black Older Adults: A Case Study Using an Alzheimer’s Disease Center. Res Gerontol Nurs 2009; 2:235-42. [DOI: 10.3928/19404921-20090731-04] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Accepted: 06/23/2009] [Indexed: 11/20/2022]
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Abstract
Despite the significance of an early diagnosis of Alzheimer's disease (AD), African Americans are diagnosed in later stages of the disease and present with greater cognitive impairment at the time of diagnosis when compared to Euro-Americans. To this end, there exists a paucity of research on diagnostic pathways among African Americans with dementia. More specifically, few studies have explored help-seeking pathways from the initial manifestation of symptoms until an actual diagnosis of Alzheimer's disease was received from the perspective of African American caregivers. Thus, the present study examined the retrospective experiences of 17 African American caregivers who were given a diagnosis of Alzheimer's disease for a family member with dementia. Participants completed face-to-face semi-structured interviews. Study findings revealed a complex interplay between the patient with dementia, entities that comprise their social support network, and clinicians.
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Affiliation(s)
| | | | - Deborah Danner
- University of Kentucky College of Preventive Medicine/Family
Practice and Sanders-Brown Center on Aging, USA,
| | - Adah Carter
- University of Kentucky School of Public Health, USA,
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Krishnan LL, Petersen NJ, Snow AL, Cully JA, Schulz PE, Graham DP, Morgan RO, Braun U, Moffett ML, Yu HJ, Kunik ME. Prevalence of dementia among Veterans Affairs medical care system users. Dement Geriatr Cogn Disord 2005; 20:245-53. [PMID: 16088141 DOI: 10.1159/000087345] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2005] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES In an aging population, the number of veterans diagnosed with dementia is likely to increase. Knowledge of existing dementia prevalence will be beneficial in planning for future patient care needs. Our objectives were to assess the prevalence of the dementia diagnosis among those treated at Veterans Affairs (VA) medical centers and determine how it varies across race and Veterans Integrated Service Network (VISN). MATERIALS AND METHODS Data were collected on all veterans seen within the VA medical system from 1997 through the first half of 2001. Only veterans aged 65 and over were included in the study. Veterans were included if they had one of the following dementia ICD-9 codes: 290.XX, 291.2, 294.XX, 331.XX, 046.1, or 046.3. RESULTS The overall prevalence of dementia was 7.3%. The prevalence of dementia was similar among white patients and patients of other races, except African-American patients, in whom it was 50% higher. Across VISNs, the prevalence of dementia ranged from 5.8 to 9.4%. Alzheimer's disease was the most frequently diagnosed type of dementia within the VA, and inpatient service utilization and outpatient psychiatry visits by individuals with dementia were high relative to other VA patients. DISCUSSION The overall prevalence identified is consistent with that reported in the literature, as is the elevated prevalence in African-Americans versus whites. The data on prevalence by VISN may identify regional variation in either the types of dementia present or the diagnostic criteria used. The dementia diagnosis is clearly associated with substantial service use.
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Affiliation(s)
- Laura L Krishnan
- Houston Center for Quality of Care and Utilization Studies, Health Services Research and Development Service, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe, Houston, TX 77030, USA
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Abstract
Stigmatization in research sustains the spread of the silent epidemic of Alzheimer's disease (AD) in African American populations. Researchers use stereotypes and inappropriate assumptions to select a paradigm to examine the symptoms of AD. This paradigm fails to encompass the symptoms as manifested by African American elders. Yet, stigmatization can be minimized by recognizing the genetic heterogeneity of the symptoms within the general population, especially those manifested by African American elders. Thus, researchers can utilize pioneering genetic analyses to identify other paradigms critical in the assessment and proactive treatment of the symptoms of AD needed for this vulnerable population.
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Clark PC, Kutner NG, Goldstein FC, Peterson-Hazen S, Garner V, Zhang R, Bowles T. Impediments to timely diagnosis of Alzheimer's disease in African Americans. J Am Geriatr Soc 2005; 53:2012-7. [PMID: 16274388 DOI: 10.1111/j.1532-5415.2005.53569.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to identify early patterns of care for Alzheimer's disease (AD) in a cohort of African-American patients and their caregivers presenting at an inner city clinic and a suburban memory assessment clinic. Caregivers (N=79) of patients diagnosed with probable AD were interviewed. Data were collected about the delay from noticing first AD signs until recognition that a problem existed and delay from problem recognition until first physician consultation. Patients and caregivers had lower educational status, and patients had been diagnosed more recently at the inner city clinic than at the suburban clinic, although MMSE scores of patients at the two clinics did not differ; median delays in caregivers' recognizing a problem and in consulting a physician were also similar across clinics. Delay was as long as 7 years between noticing symptoms and problem recognition and between problem recognition and physician consultation. Although patients attending the suburban clinic were more likely to have previously seen a physician than those attending the inner city clinic, they were no more likely to have received a prior diagnosis of AD. Lack of physician contact is likely to be widespread in families caring for African Americans with AD. Physician consultation is more characteristic of more highly educated families but may not yield a correct diagnosis for the patient. Intensive efforts are needed to connect African-American families with physicians and to achieve more timely diagnosis of AD to enable families to understand the illness, plan for patient safety, and make long-term plans.
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Affiliation(s)
- Patricia C Clark
- Department of Adult and Elder Health, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia 30322, USA.
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31
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Schrimsher GW, O'Bryant SE, Parker JD, Burke RS. The relation between ethnicity and cognistat performance in males seeking substance use disorder treatment. J Clin Exp Neuropsychol 2005; 27:873-85. [PMID: 16183620 DOI: 10.1080/13803390490919173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study examined the relation between ethnicity and results obtained during standard administration of the Cognistat, a screening measure of cognitive functioning, in a sample of male veterans seeking substance use disorder treatment (n = 312). Results indicated that screening items for the Naming, Calculation, and Similarities subtests were missed significantly more frequently by African American compared to Caucasian veterans, although the frequency of identification as impaired on the full metric portion of this scales did not differ based on ethnicity. The mean scores on the metric items for these three scales were very similar between groups. Additionally, African American veterans diverted to the Constructional Ability metric items had significantly lower scores on items from that subtest. Logistic regression analyses of impairment identification on the various subtests indicated that ethnicity was a significant (p < .005) predictor beyond the covariates of age and years of education for the Calculation subtest, but only accounted for 4.8% of the variance. Based on the results of the current study, it is recommended that 1) the entire Cognistat be administered regardless of screening item performance to minimize the risk of potential ethnic or cultural based performance bias and 2) a prospective study of potential demographic bias based on comparing Cognistat screening results to a battery of specific neuropsychological assessments of the same constructs be performed to maximize the potential specificity and sensitivity of this assessment for all demographic groups.
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Affiliation(s)
- Gregory W Schrimsher
- G. V. (Sonny) Montgomery Veteran Affairs Medical Center, Jackson, Mississippi 39216, USA
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32
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Hinton L, Franz C, Friend J. Pathways to dementia diagnosis: evidence for cross-ethnic differences. Alzheimer Dis Assoc Disord 2004; 18:134-44. [PMID: 15494619 DOI: 10.1097/01.wad.0000127444.23312.ff] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED The diagnosis of dementia often occurs well after the onset of the disease. Studies of help-seeking behavior may help illuminate why delays occur. SPECIFIC AIMS (1) To describe pathways to diagnosis from the perspective of family caregivers and (2) to compare help-seeking patterns and experiences across three ethnic groups. METHODS Semi-structured qualitative interviews were conducted with 39 ethnically diverse family dementia caregivers. Interviews were coded for help-seeking events (initial help-seeking, referrals to secondary helpers, and site of final diagnosis), pathway types, and adverse experiences within the healthcare system along pathways to diagnosis. RESULTS Help-seeking was most often initiated by family members or formal care providers (ie, healthcare providers or social workers), usually in outpatient primary care settings but also elsewhere (eg, social service agencies, hospitals). "Secondary" formal helpers were often involved, usually through self-referral by families rather than by healthcare providers. While most families reported receiving a "final" diagnosis, a small minority of predominantly Chinese-American families did not. Four distinct pathways to diagnosis were identified and found to vary significantly (p < 0.03) across the three ethnic groups, which we label as smooth pathways, crisis events pathways, fragmented pathways, and dead-end pathways. Adverse experiences in the healthcare system were common and included unsatisfactory diagnosis disclosure and explanation, inadequate workup, uncaring or insensitive attitude, language barriers, and discrimination. CONCLUSIONS Cross-ethnic differences were found in both pathway types and in adverse experiences.
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Affiliation(s)
- Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA, USA.
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33
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Sink KM, Covinsky KE, Newcomer R, Yaffe K. Ethnic differences in the prevalence and pattern of dementia-related behaviors. J Am Geriatr Soc 2004; 52:1277-83. [PMID: 15271114 DOI: 10.1111/j.1532-5415.2004.52356.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the prevalence of dementia-related behaviors in a large, multiethnic sample of community-dwelling patients with moderate to severe dementia and to determine whether differences in patient or caregiver characteristics could explain any differences in prevalence of these behaviors between white and nonwhite patients. DESIGN Cross-sectional study. SETTING Community-based. PARTICIPANTS A total of 5,776 Medicare patients (5,090 white, 469 black, 217 Latino; mean age 78.9) enrolled in the Medicare Alzheimer's Disease Demonstration and Evaluation study at eight sites across the United States between 1989 and 1991. MEASUREMENTS Trained interviewers collected information on patient demographic characteristics, cognitive and functional status, and caregiver characteristics such as relationship to patient, functional status, depression, and burden. Ethnicity was obtained by self-report. Caregivers were asked if the patient typically demonstrated any of eight dementia-related behaviors. To determine the independent association between ethnicity and dementia-related behaviors, logistic regression models were developed for each of the behaviors, adjusting for patient and caregiver characteristics. RESULTS Overall, 92% of patients had one or more dementia-related behaviors. Sixty-one percent of black and 57% of Latino patients were reported to have four or more behaviors, compared with 46% of white patients (P<.001). The prevalence of specific behaviors ranged from 24% for combativeness to 67% for wandering. After multivariate adjustment, black patients were significantly more likely than whites to be constantly talkative (odds ratio (OR)=1.41, 95% confidence interval (CI)=1.11-1.80), to have hallucinations (OR=1.89, 95% CI=1.49-2.40) and episodes of unreasonable anger (OR=1.70, 95% CI=1.34-2.15), to wander (OR=1.40, 95% CI=1.08-1.81), and to wake their caregiver (OR=1.33, 95% CI=1.04-1.69). Latinos had a significantly higher likelihood than whites of having hallucinations (OR=1.49, 95% CI=1.10-2.01), episodes of unreasonable anger (OR=1.59, 95% CI=1.18-2.16), combativeness (OR=1.59, 95% CI=1.17-2.17), and wandering (OR=1.59, 95% CI=1.21-2.26). For most behaviors, these adjusted ORs are similar in magnitude of effect and statistical significance to the unadjusted estimates. CONCLUSION Black and Latino community-dwelling patients with moderate to severe dementia have a higher prevalence of dementia-related behaviors than whites. Therefore, as the aging minority population grows, it will be especially important to target caregiver education, in-home support, and resources to minority communities.
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Affiliation(s)
- Kaycee M Sink
- Division of Geriatrics, University of California at San Francisco, California 94121, USA.
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34
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Abstract
In conclusion, many researchers from multiple disciplines are addressing AD at many levels, ranging from prevention, to cellular alterations, to treatment modalities, and coping and care giving with the consequences of the ravages left by the disease. Although much has been learned in the last several decades of active research, much remains to be learned. In its current status, AD is a chronic disease without a cure, which provides ample opportunities for nursing management throughout the course progression.
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Affiliation(s)
- Elaine Souder
- College of Nursing, Department of Nursing Science, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 529, Little Rock, AR 72205, USA.
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35
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Zamrini E, Parrish JA, Parsons D, Harrell LE. Medical comorbidity in black and white patients with Alzheimer's disease. South Med J 2004; 97:2-6. [PMID: 14746413 DOI: 10.1097/01.smj.0000077061.01235.42] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Little is known about co-medical illnesses in black and white patients with probable Alzheimer's disease (AD). METHODS To address this question, we used two methods. In the first (Group I), black and white probable AD patients were matched on age at presentation to the clinic, age of onset of AD, duration of illness, and Mini-Mental State Examination scores; then, a variety of co-medical illnesses were compared between blacks and whites. In Group II, whites were randomly matched to blacks on the variables listed above. RESULTS In Group I, blacks were found to have a higher rate of hypertension than whites, whereas whites had a higher incidence of atrial fibrillation and cancer than blacks. In Group II, age at presentation to the clinic was found to be shorter for men than for women; duration of illness was shorter for black men than for white men, white women, and black women; and Mini-Mental State Examination scores were lower in blacks than whites. As in Group I, blacks were found to have a higher rate of hypertension, whereas whites had higher rates of atrial fibrillation, cancer, coronary artery disease, high cholesterol, and gastrointestinal disease. CONCLUSION In both groups, black patients with probable AD had a higher rate of hypertension than white patients with probable AD, and whites had higher rates of atrial fibrillation and cancer. This finding suggests that these comorbid illnesses in black and white patients with probable AD is not due to a statistical Type II error, but rather to differences in these groups.
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Affiliation(s)
- Edward Zamrini
- Veteran's Administration Hospital, Alzheimer's Disease Center, Birmingham, AL, USA.
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36
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Tan EJ, Lui LY, Eng C, Jha AK, Covinsky KE. Differences in mortality of black and white patients enrolled in the program of all-inclusive care for the elderly. J Am Geriatr Soc 2003; 51:246-51. [PMID: 12558723 DOI: 10.1046/j.1532-5415.2003.51065.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To examine the relationship between race and mortality in frail community-dwelling older people with access to a program providing comprehensive access and coordination of services. DESIGN A longitudinal cohort study. SETTING Twelve nationwide demonstration sites of the Program of All-Inclusive Care for the Elderly (PACE) from 1990 to 1996. PACE provides comprehensive medical and long-term care services for nursing home-eligible older people who live in the community. PARTICIPANTS Two thousand two white patients and 859 black patients. MEASUREMENTS Patients were followed after enrollment until death or the end of the follow-up period. Time from enrollment to death was measured with adjustment of the Cox proportional hazards model for comorbid conditions, functional status, site, and other demographic characteristics. RESULTS Black patients were younger than white patients (mean age 77 vs 80, P <.001) but had worse functional status (mean activity of daily living (ADL) score 6.5 vs 7.2, P <.001) on enrollment. Survival for black and white patients was 88% and 86% at 1 year, 67% and 61% at 3 years, and 51% and 42% at 5 years, respectively (unadjusted hazard ratio (HR) for black patients = 0.77; 95% confidence interval (CI) = 0.67-0.89). After adjustment for baseline comorbid conditions, functional status, site, and demographic characteristics, black patients still had a lower mortality rate (HR = 0.77; 95% CI =.65-0.93). The survival advantage for black patients did not emerge until about 1 year after PACE enrollment (HR for first year after enrollment = 0.97; 95% CI = 0.72-1.31; HR after first year = 0.67; 95% CI = 0.54-0.85, P-value for time interaction <.001). During the first year of enrollment, black patients were more likely to improve and less likely to decline in ADL function than white patients (P <.001). CONCLUSION In PACE, a system providing access to and coordination of comprehensive medical and long-term care services for frail older people, black patients have a lower mortality rate than white patients. This survival advantage, which emerges approximately 1 year after PACE enrollment, may be related to the comprehensive access and coordination of services provided by the PACE program.
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Affiliation(s)
- Erwin J Tan
- Division of Geriatrics, University of California at San Francisco, San Francisco, California, USA.
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Shadlen MF, McCormick WC, Larson EB. Research agenda for understanding Alzheimer disease in diverse populations: work group on cultural diversity, Alzheimer's association. Alzheimer Dis Assoc Disord 2002; 16 Suppl 2:S96-S100. [PMID: 12351923 DOI: 10.1097/00002093-200200002-00012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The emerging evidence of ethnic variations in apolipoprotein polymorphism and Alzheimer disease risk shows that one cannot generalize findings based on a single cultural group too broadly ( Tang et al., 2001). Presence of one apolipoprotein E epsilon 4 allele is a stronger risk factor for Alzheimer disease in whites and Asians than in blacks ( Farrer et al., 1997). Environmental or genetic cofactors may modulate the effects of epsilon 4 on beta-amyloid metabolism differently in different subpopulations ( Shadlen, 1998). Recognizing this, the Alzheimer's Association has extended its goals to strengthen the scientific information base on the interactions of population diversity and Alzheimer disease heterogeneity ( NIA, 1998). This new focus is timely since minority elderly are the most rapidly increasing segment of the elderly population ( Lilienfeld and Perl, 1994, Brookmeyer et al., 1998). In this article, the authors highlight recent progress in research on Alzheimer disease among culturally diverse populations with a special emphasis on gaps in the knowledge base. The authors recommend four priorities for future Alzheimer disease research: (1) determine whether genetic causative factors interact differently in different populations; (2) reexamine the nature and role of cerebral ischemia and infarction and variations in symptom severity of Alzheimer disease; (3) explore the interaction of genes and environmental influences that are protective against Alzheimer disease; and (4) recruit and enroll ethnically diverse subjects in Alzheimer disease clinical trials.
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Wight RG, Aneshensel CS, Seeman TE. Educational attainment, continued learning experience, and cognitive function among older men. J Aging Health 2002; 14:211-36. [PMID: 11995741 DOI: 10.1177/089826430201400203] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This article assesses the effects of educational attainment, posteducational training experience, and occupational status on cognitive function among older men, controlling for demographic and health factors. Conditional relationships between educational attainment and factors that importantly influence cognitive function are also investigated. METHODS Data from a nationally representative sample of 1,839 older men are used to explore life-course effects of occupational and training experiences during the 1960s, 1970s, and 1980s. RESULTS A positive relationship is found between formal educational attainment and cognitive function, but this association is conditional on subsequent training experience, ethnicity, and symptoms of depression. Training experiences are also positively associated with cognitive function. DISCUSSION Continued pursuit of education and training may offer opportunities to promote cognitive function throughout the life course, especially among those with low educational attainment early in life.
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Affiliation(s)
- Richard G Wight
- Department of Community Health Sciences, UCLA School of Public Health, Los Angeles, CA.
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Bassiony MM, Warren A, Rosenblatt A, Baker A, Steinberg M, Steele CD, Lyketsos CG. Isolated hallucinosis in Alzheimer's disease is associated with African-American race. Int J Geriatr Psychiatry 2002; 17:205-10. [PMID: 11921146 DOI: 10.1002/gps.519] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The aim of this investigation was to study the relationship between isolated hallucinosis and race in Alzheimer's disease. METHODS This was a cross-sectional, case control study carried out at the Neuropsychiatry Service, outpatient clinic at the Johns Hopkins School of Medicine, USA. The participants were 237 community-residing patients with probable Alzheimer's disease according to NINCDS/ADRDA criteria were included in the study. 9 patients with isolated hallucinosis were compared to a control group of 228 patients who had neither delusions nor hallucinations. Patients with only delusions or both delusions and hallucinations were excluded based on prior research. Patients were assessed clinically for the presence of hallucinations using the DSM-IV glossary definitions. They were also rated on standardized measures of cognitive impairment, depression, functional impairment, and general health. RESULTS There was a significant association between hallucinations and race in patients with Alzheimer's disease. Before adjustment for other variables, the African-American race conferred a 5.5-fold (95% CI = 1.4-21.6; p = 0.02) increased risk for isolated hallucinosis. After adjustment for multiple other variables, this risk increased further to 27.2-fold (95% CI = 1.6-457.3; p = 0.02). CONCLUSIONS African-American patients with Alzheimer's disease are more likely to have isolated hallucinations than Caucasian patients even after statistical adjustment for multiple confounding variables, which might distort this association. This finding has implications for our understanding of the etio-pathogenesis of hallucinations in Alzheimer's disease and for meeting health service needs of African-American patients.
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Affiliation(s)
- Medhat M Bassiony
- Neuropsychiatry Service, Department of Psychiatry and Behavioral Science, School of Medicine, The Johns Hopkins University, USA
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40
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Abstract
BACKGROUND The number of older adult drivers with dementia is expected to increase over the next few decades. This increase raises public and personal safety concerns given the higher crash rates of drivers with a dementing illness. However, the identification of drivers with a dementia who may be at risk for a crash is difficult, particularly for those in the early stages of dementia. REVIEW SUMMARY Studies examining the correlation of dementia with driving outcomes such as motor vehicle crashes are reviewed. The strengths and weaknesses of recent consensus statements, published to assist clinicians in evaluating drivers with a dementia, are discussed. The authors also review common practices currently in use by physicians to identify at-risk drivers, including mental status examinations, global dementia rating scales, specialist referral, medical evaluations, and the use of caregiver reports and other proxy measures. Legal issues, based on the role of the physician, are reviewed along with suggestions for driving cessation and education for the caregiver and family. CONCLUSIONS In patients with mild to moderate dementia, the literature indicates that physicians would have difficulty in identifying which individuals should not drive. Performance-based measures of driving skills, such as on-road driving tests, are recommended as a means of assessing driving competency.
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Affiliation(s)
- Bonnie M Dobbs
- Department of Psychology, University of Alberta, Edmonton, Alberta, Canada.
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42
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Shadlen MF, Larson EB, Yukawa M. The epidemiology of Alzheimer's disease and vascular dementia in Japanese and African-American populations: the search for etiological clues. Neurobiol Aging 2000; 21:171-81. [PMID: 10867202 DOI: 10.1016/s0197-4580(00)00115-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- M F Shadlen
- Department of Medicine, Harborview Medical Center, School of Pharmacy, University of Washington, 325 9th Avenue, Box 359755, Seattle, WA 98104-2499, USA.
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43
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Abstract
A large number of studies have examined both the epidemiology and neuropsychiatric manifestations of dementia among older adults. However, there is a relative dearth of studies focusing on ethnic minority elders in the United States. This article reviews the existing empiric literature in the area of ethnicity and dementia. For the purpose of this paper, the focus will be on Hispanics and black Americans, the two most prevalent ethnic minority populations in the United States. This review includes discussion of terminology issues, diagnosis, epidemiology, and clinical features, in addition to caregiver issues.
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Affiliation(s)
- D G Harwood
- UCLA Neuropsychiatric Institute and Hospital, Geriatric Psychiatry Service, 760 Westwood Plaza, Room 37-425 NPH, Los Angeles, CA 90024-1759, USA.
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