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Tian W, Cao K, Kwan MP, Chiu MYL, Chen H. How does urbanization affect the cognitive function among older adults: A geospatial analysis in China. Health Place 2024; 88:103259. [PMID: 38776750 DOI: 10.1016/j.healthplace.2024.103259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/03/2024] [Accepted: 04/27/2024] [Indexed: 05/25/2024]
Abstract
There has been a plethora of studies on urbanization and older adults, and more recent ones on how older adults adapt to this process with their cognitive competence. Yet it has been unclear about the relationship between them, like how the level and rate of urbanization affect the cognitive function among older adults. This study sourced, formed, and analyzed a set of geospatial big datasets from different sources, such as the Chinese Longitudinal Healthy Longevity Survey (CLHLS) data, and the NPP/VIIRS nighttime light (NTL) data. Results showed a generally negative linear association between the rate of urbanization and cognitive performance among older adults in China. The "U" shaped non-linear relationship between urbanization level and cognitive function, as well as the tipping point, were identified. At the same time, it should be noted that mediators such as education, physical activity, social activity, and community elderly service might be able to mitigate these negative associations. Furthermore, older adults living in eastern regions or urban areas appeared to have better cognitive function than those living in mid-western regions or rural areas in China. The findings also pointed to the importance of focusing on older adults with poor cognitive health status in rapidly urbanizing areas.
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Affiliation(s)
- Wenxin Tian
- School of Geographic Sciences, East China Normal University, Shanghai, China; Key Lab of Geographic Information Science (Ministry of Education), East China Normal University, Shanghai, China
| | - Kai Cao
- School of Geographic Sciences, East China Normal University, Shanghai, China; Key Lab of Geographic Information Science (Ministry of Education), East China Normal University, Shanghai, China.
| | - Mei-Po Kwan
- Department of Geography and Resource Management, The Chinese University of Hong Kong, Hong Kong, China; Institute of Space and Earth Information Science, The Chinese University of Hong Kong, Hong Kong, China; Institute of Future Cities, The Chinese University of Hong Kong, Hong Kong, China
| | - Marcus Yu Lung Chiu
- School of Health and Wellbeing, Bolton University, Bolton, UK; Centre of Mental Health and Society, Bangor University, Bangor, UK; Felizberta Lo Padilla Tong School of Social Sciences, Saint Francis University, Hong Kong, China
| | - Huashuai Chen
- Business School, Xiangtan University, Xiangtan, China.
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2
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Wiese LK, Williams IC, Holt JK, Williams CL, Lingler J, Galvin JE, Schoenberg NE. Testing the 'Faith Moves Mountains model' to increase Alzheimer's disease awareness, detection, and diagnosis among rural, racially, and ethnically diverse older adults. Aging Ment Health 2024; 28:943-956. [PMID: 38127408 PMCID: PMC11144567 DOI: 10.1080/13607863.2023.2294062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Racially and ethnically diverse populations have recently contributed to the majority of rural and small-town growth. Consequently, the disproportionately high risk and prevalence of Alzheimer's disease and related dementias (ADRD) among rural and minoritized older residents will likely increase. To address this threat, we tested the hypotheses that (1) a faith-based, resident-led approach would increase basic ADRD knowledge and diagnosis, and (2) older age, female gender, lower educational levels, and more years lived rural would predict number of referrals, new dementia diagnoses, and treatment. METHODS An adaptation of Schoenberg's Faith Moves Mountains model, previously successful in detection and management of other chronic illnesses in rural settings, guided this community-based participatory research. Local faith community members were trained as research assistants to recruit, administer surveys, conduct brief memory assessments, teach brain health strategies, and follow-up with residents. Outreaches were offered virtually during the pandemic, then in-person monthly at rotating church sites, and repeated ∼1 year later. RESULTS This rural sample was racially and ethnically diverse (74.5% non-White), with 28% reporting eight or less years of formal education. Findings included that referrals and years lived rural were significant and positive predictors of new ADRD treatments [(b = 3.74, χ2(1, n = 235) = 13.01, p < 0.001); (b = 0.02, χ2(1, n = 235 = 3.93, p = 0.048)], respectively, regardless of participant characteristics. CONCLUSION Resident-led action research in rural, diverse, faith communities is a successful approach to increasing ADRD disease knowledge, detection, diagnosis, and treatment.
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Affiliation(s)
- Lisa Kirk Wiese
- C. E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Ishan C Williams
- University of Virginia School of Nursing, Charlottesville, VA, USA
| | - Janet K Holt
- C. E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
- Southern Illinois University, Edwardsville, IL, USA
| | | | - Jennifer Lingler
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - James E Galvin
- Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Boca Raton, FL, USA
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Steinberg N, Parisi JM, Feger DM, Clay OJ, Willis SL, Ball KK, Marsiske M, Harrell ER, Sisco SM, Rebok GW. Rural-Urban Differences in Cognition: Findings From the Advanced Cognitive Training for Independent and Vital Elderly Trial. J Aging Health 2023; 35:107S-118S. [PMID: 35604034 DOI: 10.1177/08982643221102718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
ObjectivesWe examined associations between three geographic areas (urban, suburban, rural) and cognition (memory, reasoning, processing speed) over a 10-year period. Methods: Data were obtained from 2539 participants in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial. Multilevel, mixed-effects linear regression was used to estimate cognitive trajectories by geographical areas over 10 years, after adjusting for social determinants of health. Results: Compared to urban and suburban participants, rural participants fared worse on all cognitive measures-memory (B = -1.17 (0.17)), reasoning (B = -1.55 (0.19)), and processing speed (B = 0.76 (0.19)) across the 10-year trajectory. Across geographic areas, greater economic stability, health care access and quality, and neighborhood resources were associated with better cognition over time. Discussion: Findings highlight the importance of geographical location when examining cognition later in life. More research examining place-based life experiences is needed to make the greatest impact on geographically diverse communities.
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Affiliation(s)
- Nessa Steinberg
- Marcus Institute for Aging, Hebrew SeniorLife, Boston, MA, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jeanine M Parisi
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Baltimore, MD, USA
| | - Danielle M Feger
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center on Aging and Health, Baltimore, MD, USA
| | - Olivio J Clay
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
- Deep South Resource Center for Minority Aging Research, Birmingham, AL, USA
- University of Alabama Alzheimer's Disease Research Center, Birmingham, AL, USA
| | - Sherry L Willis
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Karlene K Ball
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
- Deep South Resource Center for Minority Aging Research, Birmingham, AL, USA
| | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Erin R Harrell
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | | | - George W Rebok
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Baltimore, MD, USA
- Johns Hopkins Center on Aging and Health, Baltimore, MD, USA
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4
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Peritogiannis V, Roganaki A, Siarava E, Samakouri M. Mild Cognitive Impairment in Rural Areas: Research Advances and Implications for Clinical Practice and Healthcare Policy. Healthcare (Basel) 2022; 10:healthcare10071340. [PMID: 35885866 PMCID: PMC9323373 DOI: 10.3390/healthcare10071340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/09/2022] [Accepted: 07/15/2022] [Indexed: 11/18/2022] Open
Abstract
Mild cognitive or neurocognitive impairment (MCI) may be more prevalent in rural areas. Differences between rural and urban MCI patients in terms of risk factors, course and prognosis are rarely reported. The present review aims to summarize the latest research on MCI in rural areas. A literature search was performed in the databases of PubMed, Scopus and ScienceDirect for articles published over the last decade. Eleven articles were included in this review, reporting on the differences between rural and urban MCI patients. Several risk factors, such as older age, lack of activities and food insecurity have been associated with MCI in both rural and urban areas, whereas others, such as obesity, adverse childhood experiences and plasma chemokine C-C motif ligand 11 (considered as a potential negative regulator of neurogenesis), differed according to the place of residence. No specific protective factor for rural women has been reported. There is some evidence that MCI may present earlier in rural residents, but that progression to dementia may be more rapid in urban residents. It seems that there may be clinically relevant differences in the onset, course and prognosis of MCI with regards to the place of residence (urban vs rural). Those differences should be taken into account for the design of health policies and service delivery across different settings.
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Affiliation(s)
- Vaios Peritogiannis
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, 54 Pashidi Str., 44445 Ioannina, Greece
- Department of Psychiatry, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (A.R.); (M.S.)
- Correspondence: ; Tel.: +30-265-102-1227
| | - Aglaia Roganaki
- Department of Psychiatry, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (A.R.); (M.S.)
- Mouzaki Health Center, 43060 Mouzaki, Greece
| | - Eleftheria Siarava
- Department of Neurology, University of Ioannina, 45500 Ioannina, Greece;
| | - Maria Samakouri
- Department of Psychiatry, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (A.R.); (M.S.)
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Caldichoury N, Soto-Añari M, Camargo L, Porto MF, Herrera-Pino J, Shelach S, Rivera-Fernández C, Ramos-Henderson M, Gargiulo PA, López N. Clinical utility of Phototest via teleneuropsychology in Chilean rural older adults. Dement Neuropsychol 2022; 16:316-323. [PMID: 36619838 PMCID: PMC9762386 DOI: 10.1590/1980-5764-dn-2021-0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 01/11/2023] Open
Abstract
The COVID-19 pandemic has shown the need for neuropsychological care for older adults with memory complaints in different contexts, including rural areas or areas with difficult access. Objective This study aimed to analyze the clinical utility of the Phototest, through telemedicine, to identify mild cognitive impairment in rural older adults with memory complaints, during the COVID-19 pandemic. Methods We performed a cross-sectional, case-control, and clinical utility comparison of brief cognitive tests (BCTs). The sample included 111 rural elderly people with mild cognitive impairment (MCI) and 130 healthy controls from the Los Lagos region, Chile. The instruments adopted were modified Mini-Mental State Examination (MMSEm) and adapted version of the Phototest (PT) for Chile. Results To identify mild cognitive impairment, using a cutoff score of 27-28 points, the Phototest showed a sensitivity of 96.6% and a specificity of 81.8%; indicators superior to those of the MMSEm. Conclusions The Phototest is more accurate than the MMSEm in identifying cognitive alterations in rural older adults with cognitive memory complaints through telemedicine. Therefore, its use in primary care is recommended in order to perform early detection of preclinical cognitive alterations in mild cognitive impairment or neurodegenerative diseases.
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Affiliation(s)
- Nicole Caldichoury
- Universidad de Los Lagos, Departamento de Ciencias Sociales, Osorno,
Chile
| | - Marcio Soto-Añari
- Universidad Católica San Pablo, Laboratorio de Neurociencia,
Arequipa, Perú
| | - Loida Camargo
- Universidad del Sinú, Facultad de Medicina, Cartagena de Indias,
Colombia
| | - María Fernanda Porto
- Universidad de la Costa, Departamento de Ciencias Sociales,
Barranquilla, Colombia
| | | | - Salomón Shelach
- Universidad Católica San Pablo, Laboratorio de Neurociencia,
Arequipa, Perú
| | | | - Miguel Ramos-Henderson
- Universidad Santo Tomás, Facultad De Salud, Centro de Investigación
e Innovación en Gerontología Aplicada, Antofagasta, Chile
| | - Pascual Angel Gargiulo
- Universidad Nacional de Cuyo, Facultad de Ciencias Médicas,
Departamento de Patología, Laboratorio de Neurociencias y Psicología Experimental,
Mendoza, Argentina
| | - Norman López
- Universidad de la Costa, Departamento de Ciencias Sociales,
Barranquilla, Colombia
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Pulsifer MB, Grieco JA, Burstein SM, Parsons MW, Gardner MM, Sherman JC. The development and implementation of teleneuropsychology in an academic lifespan neuropsychology center: Lessons learned from the COVID-19 pandemic. J Clin Exp Neuropsychol 2021; 43:774-785. [PMID: 34384335 DOI: 10.1080/13803395.2021.1963683] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Teleneuropsychology (TNP) became a critical means for providing care during the COVID-19 pandemic and may continue as an option for delivery of neuropsychological services. To understand how patient characteristics impact clinician decisions and service models, this study examines practice patterns within a lifespan outpatient neuropsychology center before, during and post-pandemic. METHODS Patient volume, demographics, and characteristics were compared across four, 3-month time intervals in 2019-2020. Two baseline intervals when the center was physically open (PO) were compared to one interval when the center was physically closed (PC) (all evaluations were conducted via direct-to-home TNP) and a fourth interval when the center was physically reopened (RO) and evaluations were conducted in one of the three modalities: in-person, virtual only or hybrid (both virtual/in-person). RESULTS A total of 1,459 total neuropsychological evaluations were conducted with a 64.6% reduction during PC. At RO, the number of evaluations returned to pre-COVID baseline during which in-person (72.4%) evaluations were conducted at a higher rate than hybrid (7.1%) or virtual only (20.4%). Across the lifespan, mean number of appointments to complete evaluations was significantly greater during PC (p< .001) than at other time intervals, and during RO, hybrid evaluations required significantly more appointments (p < .001) than in-person and virtual. The majority of evaluations were conducted with adult patients (71.4%). For adult patients, neurodegenerative/memory disorders received TNP evaluations at a higher rate during PC and RO. Pediatric patients were significantly older during PC (p < .001); neurodevelopmental referrals received more hybrid and virtual evaluations. CONCLUSIONS Results indicate that patient characteristics, especially age and referral categories, impact the feasibility of TNP. Data from the RO period suggest that in-person evaluations not surprisingly remain the mainstay; however, for adult patients, and especially older adults with neurodegenerative/memory disorders, TNP may provide an important option for delivery of neuropsychological evaluations.
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Affiliation(s)
- Margaret B Pulsifer
- Department of Psychiatry/Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Julie A Grieco
- Department of Psychiatry/Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarah M Burstein
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael W Parsons
- Department of Psychiatry/Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.,Stephen E. & Catherine Pappas Center for Neuro-Oncology, Boston, Massachusetts, USA
| | - Melissa M Gardner
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Janet C Sherman
- Department of Psychiatry/Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
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Khalid S, Sambamoorthi U, Umer A, Lilly CL, Gross DK, Innes KE. Increased Odds of Incident Alzheimer's Disease and Related Dementias in Presence of Common Non-Cancer Chronic Pain Conditions in Appalachian Older Adults. J Aging Health 2021; 34:158-172. [PMID: 34351824 DOI: 10.1177/08982643211036219] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is a growing concern regarding the increasing prevalence of common non-cancer chronic pain conditions (NCPCs) and their possible association with Alzheimer's disease and related dementias (ADRD). However, large population-based studies are limited, especially in Appalachian and other predominantly rural, underserved populations who suffer elevated prevalence of both NCPCs and known ADRD risk factors. OBJECTIVES We investigated the relation of NCPC to risk of incident ADRD in older Appalachian Medicare beneficiaries and explored the potential mediating effects of mood and sleep disorders. METHODS Using a retrospective cohort design, we assessed the overall and cumulative association of common diagnosed NCPCs at baseline to incident ADRD in 161,573 elders ≥65 years, Medicare fee-for-service enrollees, 2013-2015. NCPCs and ADRD were ascertained using claims data. Additional competing risk for death analyses accounted for potential survival bias. MAIN FINDINGS Presence of any NCPC at baseline was associated with significantly increased odds for incident ADRD after adjustment for covariates [adjusted odds ratio (AOR) = 1.26 (1.20, 1.32), p < .0001]. The magnitude and strength of this association increased significantly with rising burden of NCPCs at baseline [AOR for ≥4 vs. no NCPC = 1.65 (1.34, 2.03), p-trend = .01]. The addition of depression and anxiety, but not sleep disorders, modestly attenuated these associations [AORs for any NCPC and ≥4 NCPCs, respectively = 1.16 (1.10, 1.22) and 1.39 (1.13, 1.71)], suggesting a partial mediating role of mood impairment. Sensitivity analyses, multinomial logistic regressions accounting for risk of death, yielded comparable findings. CONCLUSION In this large cohort of older Appalachian Medicare beneficiaries, baseline NCPCs showed a strong, positive, dose-response relationship to odds for incident ADRD; this association appeared partially mediated by depression and anxiety. Further longitudinal research in this and other high-risk, rural populations are needed to evaluate the causal relation between NCPC and ADRD.
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Affiliation(s)
- Sumaira Khalid
- Department of Epidemiology, 5631West Virginia University, School of Public Health, Morgantown, WV, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, 5631West Virginia University, School of Pharmacy, Morgantown, WV, USA
| | - Amna Umer
- Department of Pediatrics, 5631West Virginia University, School of Medicine, Morgantown, WV, USA
| | - Christa L Lilly
- Department of Biostatistics, 5631West Virginia University, School of Public Health, Morgantown, WV, USA
| | - Diane K Gross
- Department of Epidemiology, 5631West Virginia University, School of Public Health, Morgantown, WV, USA
| | - Kim E Innes
- Department of Epidemiology, 5631West Virginia University, School of Public Health, Morgantown, WV, USA
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Gardner MM, Aslanzadeh FJ, Zarrella GV, Braun SE, Loughan AR, Parsons MW. Cancer, cognition, and COVID: delivering direct-to-home teleneuropsychology services to neuro-oncology patients. Neurooncol Pract 2021; 8:485-496. [PMID: 34267923 PMCID: PMC8083492 DOI: 10.1093/nop/npab021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic induced rapid adoption of telemedicine services for neuro-oncology patients at an increased risk of infection. Neuropsychological assessment is important to neuro-oncology care yet challenging to complete outside of a structured testing environment. Teleneuropsychology (TNP) has been explored in limited populations and proven feasible and reliable. Conducting TNP visits directly to patients' home (DTH) had minimal prior study. METHODS We used two voluntary surveys to examine acceptance (patients) and feasibility (providers) of DTH-TNP at two regionally diverse medical institutions providing neuropsychological services to neuro-oncology patients from April to September 2020. RESULTS A total of 119 patients were scheduled during the study period, 79 of whom completed neuropsychological testing via DTH-TNP. Neuropsychology providers completed surveys on 68 of these encounters (86%). In 98% of cases, neuropsychologists were able to achieve or partially achieve the individually defined goals of their assessment. Common problems reported included patient dysregulation (16%) and slow/unreliable internet (15%). Of the 52 patients who responded, 98% were satisfied with the DTH-TNP experience, and 92% would recommend the virtual visit to others. All respondents felt understood by the examiner (100%) and the majority denied technical difficulties (90%), communication challenges (94%), or privacy concerns (98%). Patients reported reduced risk of infection and saved travel time as favorable aspects of DTH-TNP. CONCLUSIONS These preliminary results suggest neuro-oncology patients find DTH-TNP acceptable and neuropsychologists find it a feasible practice, while also recognizing its limitations. Results suggest that further study of DTH-TNP (eg, reliability, validity) for neuro-oncology patients is warranted.
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Affiliation(s)
- Melissa M Gardner
- Department of Psychiatry, Psychology Assessment Center, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
- William James College, Newton, Massachusetts, USA
| | - Farah J Aslanzadeh
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Giuliana V Zarrella
- Department of Psychiatry, Psychology Assessment Center, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah E Braun
- School of Medicine, Department of Neurology, Division of Neuro-Oncology, Virginia Commonwealth University, Richmond, Virginia, USA
- Massey Cancer Center, Richmond, Virginia, USA
| | - Ashlee R Loughan
- School of Medicine, Department of Neurology, Division of Neuro-Oncology, Virginia Commonwealth University, Richmond, Virginia, USA
- Massey Cancer Center, Richmond, Virginia, USA
| | - Michael W Parsons
- Department of Psychiatry, Psychology Assessment Center, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
- Stephen and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
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9
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Wiese LK, Williams I, Williams CL, Galvin JE. Discerning rural Appalachian stakeholder attitudes toward memory screening. Aging Ment Health 2021; 25:797-806. [PMID: 32081028 PMCID: PMC8456570 DOI: 10.1080/13607863.2020.1725739] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 01/18/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The aim of this descriptive study was to examine Appalachian stakeholder attitudes toward routine memory screening, and to compare and contrast results from a similar study conducted in an ethnically diverse rural Florida cohort. Determining perceptions about memory screening is essential prior to developing culturally relevant programs for increasing early dementia detection and management among rural underserved older adults at risk of cognitive impairment. Benefits of early detection include ruling out other causes of illness and treating accordingly, delaying onset of dementia symptoms through behavior management and medications, and improving long-term care planning (Dubois, Padovani, Scheltens, Rossi, & Dell'Agnello, 2016). These interventions can potentially help to maintain independence, decrease dementia care costs, and reduce family burdens (Frisoni, et al., 2017). METHOD Researchers applied a parallel mixed method design (Tashakkori & Newman, 2010) of semi-structured interviews, measurements of health literacy (REALM-SF) (Arozullah, et al., 2007), sociodemographics, and cognitive screening perceptions (PRISM-PC) (Boustani, et al., 2008), to examine beliefs and attitudes about memory screening among 22 FL and 21 WV rural stakeholders (residents, health providers, and administrators). RESULTS Findings included that > 90% participants across both cohorts were highly supportive of earlier dementia detection through routine screening regardless of sample characteristics. However, half of those interviewed were doubtful that provider care or assistance would be adequate for this terminal illness. Despite previous concerns of stigma associated with an Alzheimer's disease diagnosis, rural providers are encouraged to educate patients and community members regarding Alzheimer's disease and offer routine cognitive screening and follow-through.
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Affiliation(s)
- Lisa Kirk Wiese
- C. E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Ishan Williams
- Family, Community, and Mental Health Systems, University of Virginia, Charlottesville, VA, USA
| | | | - James. E. Galvin
- Charles E Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
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10
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Wiese LK, Williams CL, Hain D, Newman D, Houston CP, Kaack C, Galvin JE. Detecting dementia among older, ethnically diverse residents of rural subsidized housing. Geriatr Nurs 2021; 42:524-532. [PMID: 33039199 PMCID: PMC8024416 DOI: 10.1016/j.gerinurse.2020.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 02/07/2023]
Abstract
Rural, ethnically diverse residents face at least twice the risk of Alzheimer's disease than urban residents. Chronic diseases such as diabetes and hypertension which increase dementia risk are more prevalent in rural areas with less access to specialty providers. A home-based approach for increasing dementia detection and treatment rates was tested among rural residents of government-assisted independent living facilities (N = 139; 78% non-White, and 70% with health literacy below 5th grade). Of 28 residents identified at risk during cognitive screening, 25 agreed to further in-depth assessment by adult gerontological nurse practitioners (AGNP). Fifteen of 25 (60%) completing consequent primary provider referrals were diagnosed with dementia and receiving new care (statistically significant; [χ2(1) = 76.67, p < .001, Phi = 0.743]). Home-based dementia management through a community engagement approach can help to meet the Healthy People 2030 goals of earlier detection and treatment and reduce the length of costly institutionalizations.
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Affiliation(s)
- Lisa Kirk Wiese
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Mail Code #84, Boca Raton, FL 33431, United States.
| | - Christine L Williams
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Boca Raton, FL 33431, United States.
| | - Debra Hain
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Mail Code #84, Boca Raton, FL 33431, United States.
| | - David Newman
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Mail Code #84, Boca Raton, FL 33431, United States.
| | - Christina P Houston
- C. E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Mail Code #84, Boca Raton, FL 33431, United States.
| | - Carolina Kaack
- Louis and Anne Green Memory & Wellness Center, 777 Glades Road, Bldg AZ-79, Boca Raton, FL 33431, United States
| | - James E Galvin
- Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, 5250 University Drive, Coral Gables, FL, United States.
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Wiese LK, Williams CL, Tappen RM, Newman D. An updated measure for investigating basic knowledge of Alzheimer's disease in underserved rural settings. Aging Ment Health 2020; 24:1348-1355. [PMID: 30869990 PMCID: PMC8474126 DOI: 10.1080/13607863.2019.1584880] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 02/16/2019] [Indexed: 10/27/2022]
Abstract
Objective: Older rural adults face a higher burden of Alzheimer's disease (AD) and delayed detection. This risk is heightened in rural populations that are ethnically diverse. Patients and providers are often hesitant to participate in screening, partially due to gaps in knowledge of the current science. The purpose of this paper is to describe the results of administering the revised version of the Basic Knowledge of Alzheimer's Disease (BKAD) measure in small rural communities in five different states.Methods: The BKAD measure was revised after first being tested in rural Appalachia. Revisions including eliminating non-discriminating items and adding questions regarding early detection, sleep, head injury, and vision changes. Reliability and validity testing included Cronbach's alpha and Rasch item analysis, test-retest, and predictive validity. Descriptive measures and independent sample t-tests were used to analyze knowledge gaps and sociodemographics.Results: Tests for reliability and validity were highly favorable, including Cronbach's alpha = .85 and overall Rasch item analysis of .94. Three-fourths of participants knew that annual cognitive screening was recommended for older adults, but only one-fourth had been previously screened. Sociodemographic findings revealed that a majority of participants (86%) would participate in annual memory screening if offered, regardless of education or health literacy level.Conclusion: The BKAD measure is a good fit for use in rural and underserved populations. BKAD results can inform the design of culturally relevant programs for raising awareness of the importance of early AD detection and treatment.
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Affiliation(s)
- Lisa Kirk Wiese
- C. E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | | | - Ruth M Tappen
- C. E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - David Newman
- C. E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
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Orimaye SO, Southerland JL, Oke AO, Ajibade A. Increased Prevalence in Alzheimer Disease in the Northeast Tennessee Region of the United States. South Med J 2020; 113:351-355. [PMID: 32617597 DOI: 10.14423/smj.0000000000001116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study describes the changes in prevalence odds ratios (PORs) for Alzheimer disease (AD) in the northeast Tennessee region (NTR) during a 3-year period, describes the statistical assessment process, and critically assesses the database from which the statistical association was derived. The article also examines several beliefs pertinent to the clinical management of AD in the NTR from the perspective of professionals delivering services. METHODS We extracted prevalence data for NTR counties for 2013, 2014, and 2015 from the Centers for Medicare & Medicaid Services Geographic Variation Public Use File. We used the crude prevalence and the 2010 US Census Data fixed population for each county to compute the POR. The 2013 Economic Research Service Rural-Urban Continuum Codes were used to identify rural and urban counties in the NTR. We collected primary data on the perceived observation of the increasing prevalence in the NTR during the last 3 years and barriers to early diagnosis through an online survey from 44 experts and professionals working in AD-related fields within the NTR. RESULTS The PORs of AD in rural counties in NTR increased by 18.3%, 4.7%, and 19% compared with urban counties for 2013, 2014, and 2015, respectively. The POR of AD for the entire NTR region increased by 22.7%, 22.5%, and 21.2% compared with other regions in Tennessee for 2013, 2014, and 2015, respectively. Compared with 2012, 68.4% of respondents currently work with more individuals with AD; 71.8% reported that the NTR has a higher number of late-stage diagnoses of AD. A total of 92.3% strongly agreed that early detection of AD is important, and 95% agreed that early diagnosis could prolong the lives of patients with AD; 51.2% were unaware of existing AD screening services. Reported barriers were denial, lack of patient awareness, inefficient screening methods, communication, and lack of community resources. CONCLUSIONS Increased prevalence of AD among inhabitants in the NTR and identified barriers to early screening or diagnosis in the management of AD were identified. Access to early screening techniques must be prioritized in deprived areas within the NTR. Healthcare providers and medical professionals in the NTR must be well equipped with the required training and resources to respond adequately to the increasing prevalence of AD.
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Affiliation(s)
- Sylvester O Orimaye
- From the Departments of Health Services Management and Policy and Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, and Adventist Health System, Roseville, California
| | - Jodi L Southerland
- From the Departments of Health Services Management and Policy and Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, and Adventist Health System, Roseville, California
| | - Adekunle O Oke
- From the Departments of Health Services Management and Policy and Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, and Adventist Health System, Roseville, California
| | - Aderonke Ajibade
- From the Departments of Health Services Management and Policy and Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, and Adventist Health System, Roseville, California
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Wing JJ, Levine DA, Ramamurthy A, Reider C. Alzheimer's Disease and Related Disorders Prevalence Differs by Appalachian Residence in Ohio. J Alzheimers Dis 2020; 76:1309-1316. [PMID: 32597814 DOI: 10.3233/jad-200491] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Areas within the Appalachian region may have a greater burden of under diagnosed Alzheimer's disease and related disorders (ADRD). OBJECTIVE To estimate the prevalence of ADRD in the Appalachian counties of Ohio, and to determine if differences exist by geographic location (Appalachian/non-Appalachian and rural/urban) and across time among Medicare beneficiaries. METHODS Centers for Medicare and Medicaid Services Public Use Files from 2007-2017 were used to estimate county-level ADRD prevalence among all fee-for-service beneficiaries in Ohio. Negative binomial regression was used to estimate prevalence overall, by Appalachian Regional Commission's Appalachian/non-Appalachian designation, and by rural/urban (Rural-Urban Continuum Codes) classification. Models were repeated, adjusting for county-level demographics and comorbidities. RESULTS The prevalence of ADRD varied by both Appalachian residence and rural status (p = 0.008). Before adjustment by county-level demographics and comorbidities, the prevalence of ADRD in urban Appalachian counties was 1-3% lower than in urban non-Appalachian counties, while rural Appalachian counties had 2-3% higher prevalence compared to rural non-Appalachian counties. After adjustment, the differences between prevalence ratios were accentuated; the prevalence ratio was consistently higher for rural Appalachian counties, yet varied across the study period for urban counties (1.03 in 2007 to 0.97 in 2017). CONCLUSION The results suggest a disparate burden of ADRD in Ohio with higher prevalence in rural Appalachian counties. This potential difference by Appalachian region is important to consider for availability of services and subsequent delivery of care. In order to better understand the disparity, further epidemiologic studies are necessary to better estimate the burden of ADRD.
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Affiliation(s)
- Jeffrey J Wing
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Deborah A Levine
- Department of Internal Medicine, Cognitive Health Services Research Program, University of Michigan, Ann Arbor, MI, USA.,Department of Neurology, Stroke Program, University of Michigan, Ann Arbor, MI, USA.,Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Arun Ramamurthy
- Department of Neurology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Carson Reider
- Neurological Institute, College of Medicine, The Ohio State University, Columbus, OH, USA
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Wiese LK, Galvin JE, Williams CL. Rural stakeholder perceptions about cognitive screening. Aging Ment Health 2019; 23:1616-1628. [PMID: 30588841 PMCID: PMC8330816 DOI: 10.1080/13607863.2018.1525607] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/23/2018] [Accepted: 07/31/2018] [Indexed: 12/24/2022]
Abstract
Objectives: The study aims were to explore stakeholder perceptions about cognitive screening in a rural, ethnically diverse, underserved setting, and to examine whether perceptions varied by years lived in a rural area, career, health literacy, willingness to be screened, ethnicity, education, or age. Methods: Twenty-one rural, ethnically diverse stakeholders completed an open-ended interview of five questions and a measure regarding perceptions about cognitive screening (PRISM-PC, Boustani, et al., 2008 ). Open coding using the in vivo process (Saldaña, 2015 ) to "derive codes from the actual participant language" (p. 77) was used to analyze the qualitative data. We used Pearson correlation to examine relationships between the PRISM-PC and sociodemographics including age, years of education, health literacy, years lived in rural areas, and willingness to participate in cognitive screening. Results: Eight codes and two themes were identified from the in vivo analysis. The eight codes were "a sentence being pronounced over the lives", "keep everybody at home", "Education is big", the trust issues is everything here", "identify support systems", "access to care", and "there is a cost to do that". The two themes were "Trust is the essential component of connecting with Community", and (2) "The Community recognizes the importance of knowledge in improving care. PRISM-PC results added new information in that persons were concerned about the emotional and financial burden on their families. Overall, regardless of age, careers, care involvement, health literacy, or education, 81% of stakeholders indicated they would seek annual cognitive screening. Discussion: It is important for rural health professionals to consider that contrary to previous stigma concerns, stakeholders may support earlier dementia detection.
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Affiliation(s)
- Lisa Kirk Wiese
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | | | - Christine L. Williams
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
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Abstract
PURPOSE OF REVIEW Cognitive disorders remain a major global burden with an estimated 47 million people living with dementia worldwide. Rates of cognitive disorders are expected to grow, especially as the global population ages. Global trends also indicate that about half of the global population lives in urban settings. To help guide future research, as well as the development of targeted and tailored interventions to prevent and care for people living with cognitive disorders, we present an up-to-date review and summary of the literature examining cognitive disorders and urbanization. RECENT FINDINGS We reviewed the literature between January 2017 and September 2018 on cognitive disorders and urbanization. We found that rates of dementia among urban dwellers tends to be lower than those of rural dwellers. Leading theories explaining this difference tend to focus on better access to higher quality education, as well as public and health services among urban dwellers. We also found that greater exposure to air and noise pollutants may negatively impact cognition. SUMMARY The reasons why older adults living in urban settings appear to have lower rates of dementia and better performance on cognitive measures are not well understood. Furthermore, the definitions of urban and rural and cognitive disorder, as well as how they are measured vary greatly between studies, making comparisons difficult.
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Affiliation(s)
- Reuben N. Robbins
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, NY, USA
| | - Travis Scott
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - John A. Joska
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Hetta Gouse
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Wiese LK, Williams CL. An Appalachian Perspective of Alzheimer's Disease: A Rural Health Nurse Opportunity. ONLINE JOURNAL OF RURAL NURSING AND HEALTH CARE 2018; 18:180-208. [PMID: 38239848 PMCID: PMC10795758 DOI: 10.14574/ojrnhc.v17i1.469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024] Open
Abstract
Predictions of the devastating impact of Alzheimer's disease (AD) are heightened in disadvantaged rural populations, yet studies investigating AD in this population are limited. Other researchers have shown that when rural Appalachian people are aware of their risk for a chronic illness, they are more willing to adopt healthy behaviors (Della, 2011; Schoenberg et al. 2011), suggesting that educational programs to increase knowledge and perception of risk are needed. The purpose of this article was to report findings from exploring knowledge of Alzheimer's disease in a southern rural West Virginia community of residents (N = 193) and a sample of caregivers (n = 20) using cognitive interview techniques of "Think-aloud" and "Laddering". The cultural fit and relevance of the "Knowledge of Alzheimer's Disease scale or KAD (Jang, Kim, Hansen, & Chiriboga, 2010) was also examined. Findings from the KAD included that an updated AD measure appropriate for use in rural settings is needed. Findings from the cognitive interview included that instead of fatalistic attitudes toward Alzheimer's disease, residents often viewed AD as something potentially preventable through healthier living, use of herbs as children, and eventual discovery of more effective treatment regimens. The themes that emerged were "preventing AD" and "personal knowing of AD". Considering cultural perceptions and determining knowledge gaps in the communities by rural providers is an important component of changing stigma regarding routine cognitive screening for rural older adults at increased risk for Alzheimer's disease.
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Affiliation(s)
- Lisa K Wiese
- Christine E. Lynn College of Nursing, Florida Atlantic University
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Weden MM, Shih RA, Kabeto MU, Langa KM. Secular Trends in Dementia and Cognitive Impairment of U.S. Rural and Urban Older Adults. Am J Prev Med 2018; 54:164-172. [PMID: 29246677 PMCID: PMC5783777 DOI: 10.1016/j.amepre.2017.10.021] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/19/2017] [Accepted: 10/20/2017] [Indexed: 01/25/2023]
Abstract
INTRODUCTION This is a nationally representative study of rural-urban disparities in the prevalence of probable dementia and cognitive impairment without dementia (CIND). METHODS Data on non-institutionalized U.S. adults from the 2000 (n=16,386) and 2010 (n=16,311) cross-sections of the Health and Retirement Study were linked to respective Census assessments of the urban composition of residential census tracts. Relative risk ratios (RRR) for rural-urban differentials in dementia and CIND respective to normal cognitive status were assessed using multinomial logistic regression. Analyses were conducted in 2016. RESULTS Unadjusted prevalence of dementia and CIND in rural and urban tracts converged so that rural disadvantages in the relative risk of dementia (RRR=1.42, 95% CI=1.10, 1.83) and CIND (RRR=1.35, 95% CI=1.13, 1.61) in 2000 no longer reached statistical significance in 2010. Adjustment for the strong protective role of educational attainment reduced rural disadvantages in 2000 to statistical nonsignificance, whereas adjustment for race/ethnicity resulted in a statistically significant increase in RRRs in 2010. Full adjustment for sociodemographic and health factors revealed persisting rural disadvantages for dementia and CIND in both periods with RRR in 2010 for dementia of 1.79 (95% CI=1.31, 2.43) and for CIND of 1.38 (95% CI=1.14, 1.68). CONCLUSIONS Larger gains in rural adults' cognitive functioning between 2000 and 2010 that are linked with increased educational attainment demonstrate long-term public health benefits of investment in secondary education. Persistent disadvantages in cognitive functioning among rural adults compared with sociodemographically similar urban peers highlight the importance of public health planning for more rapidly aging rural communities.
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Affiliation(s)
| | | | - Mohammed U Kabeto
- University of Michigan, Ann Arbor, Michigan; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Kenneth M Langa
- University of Michigan, Ann Arbor, Michigan; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
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