1
|
Polsinelli AJ, Johnson S, Crouch A, Lane KA, Pena-Garcia A, Hammers DB, Wang S, Gao S, Apostolova LG. Neuropsychiatric symptom burden in early-onset and late-onset Alzheimer's disease as a function of age. Alzheimers Dement 2024. [PMID: 38958543 DOI: 10.1002/alz.14042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/29/2024] [Accepted: 05/12/2024] [Indexed: 07/04/2024]
Abstract
INTRODUCTION We examined the burden of neuropsychiatric symptoms (NPSs) in early-onset (EO) and late-onset (LO) Alzheimer's disease (AD) and adjusted for age effects via the inclusion of cognitively unimpaired (CU) individuals. METHODS Cross-sectional data from 2940 EOAD, 8665 LOAD, and 8775 age-stratified CU individuals (early-CU, n = 2433; late-CU, n = 6342) from the National Alzheimer's Coordinating Center database were included. Fisher's exact tests compared EOAD and LOAD on the presence and severity of NPSs. Multiple logistic regression models included an age*diagnosis interaction to examine age effects. RESULTS Presence (ps < 0.0001) and severity (ps < 0.05) of NPS were greater in EOAD than in LOAD. However, after adjusting for base rates in NPS in CU individuals (age effects), only elation and eating behaviors were more frequent in EOAD (ps < 0.05) and nighttime behaviors more frequent and severe in LOAD (ps < 0.05). DISCUSSION Few NPSs were specific to the EOAD versus LOAD. Previous findings of greater NPS burden in EOAD may partially reflect age effects. HIGHLIGHTS Adjusting for age effect, elation and eating problems are more frequent in EOAD. Adjusting for age effect, sleep disturbances are more frequent and severe in LOAD. Age effects underlie higher neuropsychiatric symptom presentation in EOAD than in LOAD.
Collapse
Affiliation(s)
- Angelina J Polsinelli
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Indiana Alzheimer's Disease Research Center, Indianapolis, Indiana, USA
| | - Sierah Johnson
- Department of Psychological Sciences, University of Indianapolis, Indianapolis, Indiana, USA
| | - Adele Crouch
- Science of Nursing Care Department, Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Kathleen A Lane
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alex Pena-Garcia
- College of Osteopathic Medicine, Marian University, Indianapolis, Indiana, USA
| | - Dustin B Hammers
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Indiana Alzheimer's Disease Research Center, Indianapolis, Indiana, USA
| | - Sophia Wang
- Indiana Alzheimer's Disease Research Center, Indianapolis, Indiana, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sujuan Gao
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Liana G Apostolova
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Indiana Alzheimer's Disease Research Center, Indianapolis, Indiana, USA
| |
Collapse
|
2
|
Ferreira DA, Macedo LBC, Foss MP. Neuropsychiatric symptoms as a prodromal factor in Alzheimer's type neurodegenerative disease: A scoping review. Clin Neuropsychol 2024; 38:1031-1059. [PMID: 37881945 DOI: 10.1080/13854046.2023.2273574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023]
Abstract
Objective: Identifying neuropsychiatric symptoms (NPS) can aid in the early detection of Alzheimer's disease (AD); however, there is still a need for a greater consensus. This review aims to delineate the predominant NPS, compile a comprehensive list of the most commonly employed NPS assessment tools, and corroborate the principal findings regarding the link between NPS and neuropsychological assessment and neurobiological substrates. Methods: To conduct this scoping review, we followed the Preferred Reporting Items for Systematic Reviews guidelines and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We searched for relevant articles published between 2017 and 2023 in MEDLINE, PsycINFO, PubMed, Web of Science, and Cochrane Library. Results: Of the 61 eligible articles, depression, anxiety, and apathy were the main NPSs. The Neuropsychiatric Inventory Questionnaire and Neuropsychiatric Inventory were the primary assessment tools used to evaluate NPS. Correlations between NPS severity and neurobiological markers were considered clinically significant. Furthermore, clinical procedures prioritized the use of global cognitive screening tools, assessments of executive functions, and functionality evaluations. Conclusion: Standardization of procedures is necessary because of the diversity of methods. The data show that NPS can predict the etiology, severity, form, and type of disease progression, serving as a precursor sign of AD. The results of the most common cognitive screening tools and NPS instruments provided an interesting overview of future clinical approaches.
Collapse
Affiliation(s)
- Diego Alves Ferreira
- Department of Neuroscience and Behavior Science, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Lorena Barbosa Cunha Macedo
- Faculty of Philosophy, Sciences, and Letters of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Maria Paula Foss
- Department of Neuroscience and Behavior Science, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
- Faculty of Philosophy, Sciences, and Letters of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| |
Collapse
|
3
|
Lassell RKF, Tamayo V, Pena TA, Kishi M, Zwerling J, Gitlin LN, Brody AA. "When she goes out, she feels better:" co-designing a Green Activity Program with Hispanic/Latino people living with memory challenges and care partners. Front Aging Neurosci 2024; 16:1401255. [PMID: 38957542 PMCID: PMC11217360 DOI: 10.3389/fnagi.2024.1401255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/28/2024] [Indexed: 07/04/2024] Open
Abstract
Purpose Utilizing a participatory approach, we sought to co-design a 12-week Green Activity Program (GAP) with Hispanic/Latino individuals living with memory challenges and their care partners, local outdoor professionals, and healthcare providers. Methods Participants were recruited via convenience and snowball sampling in the Bronx, New York with Hispanic/Latino persons living with memory challenges and care partners, outdoor activity professionals, and interdisciplinary healthcare providers/dementia experts. Co-design occurred iteratively with 5 focus groups and 4 individual interviews lasting 30-90 min and focused on program and research design. Sessions were recorded and transcribed. Utilizing directed content analysis data was coded using a priori codes program design and research design. Results 21 participants completed co-design activities: (n = 8 outdoor activity professionals, n = 6 Hispanic/Latino persons living with memory challenges and care partners, and n = 7 interdisciplinary healthcare providers/dementia experts). Participant preferences for program design were captured by subcodes session duration (30-90 min), frequency (4-8 sessions), and delivery modes (in-person and phone). Participants' preferred nature activities included group exercise and outdoor crafts [crocheting], outcomes of social participation, connectedness to nature, decreased loneliness, and stewardship were identified. Preferred language for recruiting and describing the program were "memory challenges," "Hispanic/Latino," and "wellbeing." Referral pathways were identified including community-based organizations and primary care. Conclusion Co-design was a successful form of engagement for people living with memory challenges that enabled participants to help design key elements of the GAP and research design. Our processes, findings, and recommendations for tailoring co-design to engage Hispanic/Latino people living with memory challenges can inform the development of other programs for this population.
Collapse
Affiliation(s)
- Rebecca K. F. Lassell
- Department of Health and Wellness Design, School of Public Health, Indiana University, Bloomington, IN, United States
- Regenstrief Institute, Indiana University Center for Aging Research, Indianapolis, IN, United States
- Hartford Institute for Geriatric Nursing (HIGN), NYU Rory Meyers College of Nursing, New York, NY, United States
| | - Valeria Tamayo
- Department of Health and Wellness Design, School of Public Health, Indiana University, Bloomington, IN, United States
- Department of Art and Art Professions, NYU Steinhardt, New York, NY, United States
| | - Triana A. Pena
- Hartford Institute for Geriatric Nursing (HIGN), NYU Rory Meyers College of Nursing, New York, NY, United States
| | - Misa Kishi
- Arthur S. Abramson Department of Rehabilitation Medicine, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Jessica Zwerling
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Laura N. Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, United States
| | - Abraham A. Brody
- Hartford Institute for Geriatric Nursing (HIGN), NYU Rory Meyers College of Nursing, New York, NY, United States
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| |
Collapse
|
4
|
Chen AP, Ismail Z, Mann FD, Bromet EJ, Clouston SAP, Luft BJ. Behavioral Impairments and Increased Risk of Cortical Atrophy Risk Scores Among World Trade Center Responders. J Geriatr Psychiatry Neurol 2024; 37:114-124. [PMID: 37542409 PMCID: PMC10839111 DOI: 10.1177/08919887231195234] [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] [Indexed: 08/06/2023]
Abstract
Objective: World Trade Center (WTC) responders are susceptible to both cognitive and neuropsychiatric impairments, particularly chronic posttraumatic stress disorder. The present study examined self-reported behavioral impairments in a sample of 732 WTC responders, 199 of whom were determined to have high risk of WTC-related cortical atrophy by an artificial neural network. Results: We found that responders at increased risk of cortical atrophy showed behavioral impairment across five domains: motivation, mood, disinhibition, empathy, and psychosis (14.6% vs 3.9% in the low-risk group; P = 3.90 × 10-7). Factor analysis models revealed that responders at high risk of cortical atrophy tended to have deficits generalized across all aspects of behavioral impairment with focal dysfunction in sensory psychosis. We additionally describe how relationships are modulated by exposure severity and pharmacological treatments. Discussion: Our findings suggest a potential link between sensory deficits and the development of cortical atrophy in WTC responders and may indicate symptoms consistent with a clinical portrait of parietal dominant Alzheimer's disease or a related dementia (ADRD). Results underscore the importance of investigating neuropsychiatric symptomatology in clinical evaluations of possible ADRD.
Collapse
Affiliation(s)
- Allen P.F. Chen
- Department of Neurobiology and Behavior, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Zahinoor Ismail
- Hotchkiss Brain Institute and O’Brien Institute for Public Health, University of Calgary
| | - Frank D. Mann
- Program in Public Health, Renaissance School of Medicine, Stony Brook, NY, USA
- Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Evelyn J. Bromet
- Department of Psychiatry, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Sean A. P. Clouston
- Program in Public Health, Renaissance School of Medicine, Stony Brook, NY, USA
- Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Benjamin J. Luft
- Department of Medicine, Renaissance School of Medicine, Stony Brook, NY, USA
| |
Collapse
|
5
|
Thunell JA, Joyce GF, Ferido PM, Chen Y, Guadamuz JS, Qato DM, Zissimopoulos JM. Diagnoses and Treatment of Behavioral and Psychological Symptoms of Dementia Among Racially and Ethnically Diverse Persons Living with Dementia. J Alzheimers Dis 2024; 99:513-523. [PMID: 38669535 DOI: 10.3233/jad-231266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Background Behavioral and psychological symptoms of dementia (BPSD) and prescribed central nervous system (CNS) active drugs to treat them are prevalent among persons living with Alzheimer's disease and related dementias (PLWD) and lead to negative outcomes for PLWD and their caregivers. Yet, little is known about racial/ethnic disparities in diagnosis and use of drugs to treat BPSD. Objective Quantify racial/ethnic disparities in BPSD diagnoses and CNS-active drug use among community-dwelling PLWD. Methods We used a retrospective cohort of community-dwelling Medicare Fee-for-Service beneficiaries with dementia, continuously enrolled in Parts A, B and D, 2017-2019. Multivariate logistic models estimated rates of BPSD diagnosis and, conditional on diagnosis, CNS-active drug use. Results Among PLWD, 67.1% had diagnoses of an affective, psychosis or hyperactivity symptom. White (68.3%) and Hispanic (63.9%) PLWD were most likely, Blacks (56.6%) and Asians (52.7%) least likely, to have diagnoses. Among PLWD with BPSD diagnoses, 78.6% took a CNS-active drug. Use was highest among whites (79.3%) and Hispanics (76.2%) and lowest among Blacks (70.8%) and Asians (69.3%). Racial/ethnic differences in affective disorders were pronounced, 56.8% of white PLWD diagnosed; Asians had the lowest rates (37.8%). Similar differences were found in use of antidepressants. Conclusions BPSD diagnoses and CNS-active drug use were common in our study. Lower rates of BPSD diagnoses in non-white compared to white populations may indicate underdiagnosis in clinical settings of treatable conditions. Clinicians' review of prescriptions in this population to reduce poor outcomes is important as is informing care partners on the risks/benefits of using CNS-active drugs.
Collapse
Affiliation(s)
- Johanna A Thunell
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
- USC Sol Price School of Public Policy, Los Angeles, CA, USA
| | - Geoffrey F Joyce
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
- USC School of Pharmacy, Los Angeles, CA, USA
| | - Patricia M Ferido
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
| | - Yi Chen
- Rush Alzheimer's Disease Center, Chicago, IL, USA
| | - Jenny S Guadamuz
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
- USC School of Pharmacy, Los Angeles, CA, USA
| | - Dima M Qato
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
- USC School of Pharmacy, Los Angeles, CA, USA
| | - Julie M Zissimopoulos
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
- USC Sol Price School of Public Policy, Los Angeles, CA, USA
| |
Collapse
|
6
|
Chejor P, Atee M, Cain P, Whiting D, Morris T, Porock D. Comparing clinico-demographics and neuropsychiatric symptoms for immigrant and non-immigrant aged care residents living with dementia: a retrospective cross-sectional study from an Australian dementia-specific support service. BMC Geriatr 2023; 23:729. [PMID: 37950203 PMCID: PMC10636936 DOI: 10.1186/s12877-023-04447-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Neuropsychiatric symptoms of dementia such as agitation and aggression are common in people living with dementia. The presentation of neuropsychiatric symptoms is influenced by the cultural background of people living with dementia. Further, identifying factors contributing to neuropsychiatric symptoms may be complicated if people living with dementia are immigrants or from non-English-speaking backgrounds. Most of what is known about differences in neuropsychiatric symptoms between racial and ethnic groups living with dementia come from community-based samples. This study investigated differences in clinico-demographics and neuropsychiatric symptoms between immigrants and non-immigrants living with dementia in residential aged care homes who were referred to two Dementia Support Australia programs. METHODS This was a retrospective observational cross-sectional study from 2018 to 2022 using data extracted from the Dementia Support Australia database. Immigrant status was identified by documented country of birth. We conducted exploratory subgroup analyses for English-speaking or non-English-speaking immigrants in comparison to non-immigrants. Neuropsychiatric Inventory and PainChek® were used to assess neuropsychiatric symptoms of dementia and pain, respectively. RESULTS Of the 23,889 referrals, 36% were immigrants living with dementia. Immigrants were 0.8 years older than non-immigrants on average. Immigrants had a slightly higher prevalence of mixed dementia (9.5%) than non-immigrants (8.2%). Overall, the groups had no difference in the severity of neuropsychiatric symptoms and associated caregiver distress. However, there was a significant difference in the total number of neuropsychiatric inventory domains (Cohen's d = -0.06 [-0.09, - 0.02], p <.001) between non-English-speaking immigrants and non-immigrants. Immigrants were more likely to present with agitation/aggression, while non-immigrants were more likely to present with hallucinations. Factors contributing to neuropsychiatric symptoms were common between the groups, with language barriers and cultural considerations frequently endorsed for immigrants. CONCLUSION This study reveals a mixed picture of neuropsychiatric symptoms between immigrants and non-immigrants. However, due to the exploratory nature of the hypotheses, our findings need to be replicated in future studies to confirm any conclusions. There is a need for increased awareness on the impact of culture and language on neuropsychiatric symptoms for people receiving residential care. Future studies investigating neuropsychiatric symptoms in different immigrant groups will help increase our understanding of neuropsychiatric symptoms for all people.
Collapse
Affiliation(s)
- Pelden Chejor
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia, 6027, Australia.
| | - Mustafa Atee
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia, 6027, Australia
- The Dementia Centre, HammondCare, Osborne Park, Western Australia, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Patricia Cain
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia, 6027, Australia
| | - Daniel Whiting
- The Dementia Centre, HammondCare, St Leonards, New South Wales, Australia
| | - Thomas Morris
- The Dementia Centre, HammondCare, St Leonards, New South Wales, Australia
| | - Davina Porock
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia, 6027, Australia
| |
Collapse
|
7
|
Gutiérrez Á, López-Anuarbe M, Webster NJ, Mahmoudi E. Rural-Urban Health Care Cost Differences Among Latinx Adults With and Without Dementia in the United States. J Aging Health 2023:8982643231207517. [PMID: 37899581 DOI: 10.1177/08982643231207517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
OBJECTIVES To compare rural-urban health care costs among Latinx adults ages 51+ and examine variations by dementia status. METHODS Data are from the Health and Retirement Study (2006-2018 waves; n = 15,567). We inflation-adjusted all health care costs using the 2021 consumer price index. Geographic context and dementia status were the main exposure variables. We applied multivariate two-part generalized linear models and adjusted for sociodemographic and health characteristics. RESULTS Rural residents had higher total health care costs, regardless of dementia status. Total health care costs were $850 higher in rural ($2,640) compared to urban ($1,789) areas (p < .001). Out-of-pocket costs were $870 higher in rural ($2,677) compared to urban ($1,806) areas (p < .001). Dementia status was not an effect modifier. DISCUSSION Health care costs are disproportionately higher among Latinx rural, relative to urban, residents. Addressing health care costs among Latinx rural residents is a public health priority.
Collapse
Affiliation(s)
- Ángela Gutiérrez
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA
| | | | - Noah J Webster
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Elham Mahmoudi
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
8
|
Gutiérrez Á, Cronin CE, Franz B, Muniz-Terrera G. Alzheimer's Centers in US Hospitals: Enough to Adequately Address Dementia Care Nationwide? J Aging Health 2023:8982643231200691. [PMID: 37699204 DOI: 10.1177/08982643231200691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
OBJECTIVES To investigate the availability of Alzheimer's Centers (ACs) in US hospitals. METHODS Utilizing the American Hospital Association Annual Survey, Area Health Resource File, and US Census (n = 3251), we employed multivariable logistic regression to examine hospital, county, and regional predictors of AC availability. RESULTS Large hospitals (>399 beds) had approximately 14 times higher odds of having an AC than small hospitals (<50 beds; OR = 14.0; 95% CI = 6.44 - 30.46). Counties with a higher proportion of Latino residents, relative to non-Latino Whites, had lower odds of having an AC (OR = .05; 95% CI = .01 - .41). Northeastern (OR = 1.92; 95% CI = 1.15 - 3.22) and Midwestern (OR = 2.12; 95% CI = 1.34 - 3.37) hospitals had higher odds of having an AC than Southern hospitals. DISCUSSION To address dementia needs and disparities, investment in a national infrastructure is critical.
Collapse
Affiliation(s)
- Ángela Gutiérrez
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Athens OH, USA
| | - Cory E Cronin
- College of Health Sciences and Professions, Ohio University, Athens OH, USA
| | - Berkeley Franz
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Athens OH, USA
| | - Graciela Muniz-Terrera
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Athens OH, USA
| |
Collapse
|
9
|
Celis K, Zaman A, Adams LD, Gardner O, Farid R, Starks TD, Lacroix FC, Hamilton-Nelson K, Mena P, Tejada S, Laux R, Song YE, Caban-Holt A, Feliciano-Astacio B, Vance JM, Haines JL, Byrd GS, Beecham GW, Pericak-Vance MA, Cuccaro ML. Neuropsychiatric features in a multi-ethnic population with Alzheimer disease and mild cognitive impairment. Int J Geriatr Psychiatry 2023; 38:e5992. [PMID: 37655494 PMCID: PMC10518518 DOI: 10.1002/gps.5992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 08/12/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Alzheimer disease (AD) is more prevalent in African American (AA) and Hispanic White (HIW) compared to Non-Hispanic White (NHW) individuals. Similarly, neuropsychiatric symptoms (NPS) vary by population in AD. This is likely the result of both sociocultural and genetic ancestral differences. However, the impact of these NPS on AD in different groups is not well understood. METHODS Self-declared AA, HIW, and NHW individuals were ascertained as part of ongoing AD genetics studies. Participants who scored higher than 0.5 on the Clinical Dementia Rating (CDR) Scale (CDR) were included. Group similarities and differences on Neuropsychiatric Inventory Questionnaire (NPI-Q) outcomes (NPI-Q total score, NPI-Q items) were evaluated using univariate ANOVAs and post hoc comparisons after controlling for sex and CDR stage. RESULTS Our sample consisted of 498 participants (26% AA; 30% HIW; 44% NHW). Overall, NPI-Q total scores differed significantly between our groups, with HIW having the highest NPI-Q total scores, and by AD stage as measured by CDR. We found no significant difference in NPI-Q total score by sex. There were six NPI-Q items with comparable prevalence in all groups and six items that significantly differed between the groups (Anxiety, Apathy, Depression, Disinhibition, Elation, and Irritability). Further, within the HIW group, differences were found between Puerto Rican and Cuban American Hispanics across several NPI-Q items. Finally, Six NPI-Q items were more prevalent in the later stages of AD including Agitation, Appetite, Hallucinations, Irritability, Motor Disturbance, and Nighttime Behavior. CONCLUSIONS We identified differences in NPS among HIW, AA, and NHW individuals. Most striking was the high burden of NPS in HIW, particularly for mood and anxiety symptoms. We suggest that NPS differences may represent the impact of sociocultural influences on symptom presentation as well as potential genetic factors rooted in ancestral background. Given the complex relationship between AD and NPS it is crucial to discern the presence of NPS to ensure appropriate interventions.
Collapse
Affiliation(s)
- Katrina Celis
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Andrew Zaman
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Larry Deon Adams
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Olivia Gardner
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rajabli Farid
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Takiyah D Starks
- Maya Angelou Center for Health Equity, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Faina C Lacroix
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Kara Hamilton-Nelson
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Pedro Mena
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sergio Tejada
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Renee Laux
- Department of Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Yeunjoo E Song
- Department of Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Allison Caban-Holt
- Maya Angelou Center for Health Equity, Wake Forest University, Winston-Salem, North Carolina, USA
| | | | - Jeffery M Vance
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
- Dr. John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jonathan L Haines
- Department of Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
- Cleveland Institute for Computational Biology, Cleveland, Ohio, USA
| | - Goldie S Byrd
- Maya Angelou Center for Health Equity, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Gary W Beecham
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
- Dr. John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Margaret A Pericak-Vance
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
- Dr. John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael L Cuccaro
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
- Dr. John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
10
|
Babulal GM, Zhu Y, Trani JF. Racial and ethnic differences in neuropsychiatric symptoms and progression to incident cognitive impairment among community-dwelling participants. Alzheimers Dement 2023; 19:3635-3643. [PMID: 36840665 PMCID: PMC10440214 DOI: 10.1002/alz.12988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 02/26/2023]
Abstract
INTRODUCTION Neuropsychiatric symptoms (NPS) are a risk factor for dementia; however, their prevalence and severity among ethnoracial groups are poorly understood. METHODS We used data from the National Alzheimer's Coordinating Center (NACC) (n = 6958; ≥50 years old). Cognitively normal participants at baseline, without any NPS or dementia diagnosis, had at least one follow-up. Survival analyses assessed the hazard ratio for 12 NPS models and progression to cognitive impairment. Propensity score weighting (PSW) matched participants on age, sex, education, and race/ethnicity. RESULTS All 12 NPS were significantly associated with progression to cognitive impairment. In the PSW models, compared to whites, Black/African Americans were more likely to progress to cognitive impairment across all 12 NPS models, followed by Hispanic, and then Asian participants. DISCUSSION PSW minimized selection bias to provide robust risk estimates. There is a higher risk of progressing to cognitive impairment for ethnoracial groups with NPS. Tailored screening of NPS and cognitive impairment should incorporate patient and caregiver reports.
Collapse
Affiliation(s)
- Ganesh M. Babulal
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Psychology, Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Institute of Public Health, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Yiqi Zhu
- School of Social Work, Adelphi University, New York, USA
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jean-Francois Trani
- Department of Psychology, Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
- Institute of Public Health, Washington University in St. Louis, St. Louis, Missouri, USA
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
- National Center for Arts and Crafts, Paris, France
| |
Collapse
|
11
|
Xu C, Padilla V, Lozano S, Gamez D, Su BB, Wang X, Maestre G, Wang K. APOE Gene Associated with Dementia-Related Traits, Depression, and Anxiety in the Hispanic Population. Genes (Basel) 2023; 14:1405. [PMID: 37510309 PMCID: PMC10379967 DOI: 10.3390/genes14071405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
Alzheimer's disease (AD), a main cause of dementia, is commonly seen in aging populations with a strong genetic component. AD is one of the most common neurodegenerative disorders; it is a genetically and clinically heterogeneous disease. Specific demographic factors and genetic variants have been identified in non-Hispanic populations; however, limited studies have observed the Hispanic population. Therefore, we focused on investigating a known gene, APOE, associated with AD-related phenotypes and two psychiatric diseases (depression and anxiety) within the U.S. Hispanic population in our current study. A total of 1382 subjects were studied based on data collected from the Texas Alzheimer's Research and Care Consortium (TARCC, N = 1320) and the Initial Study of Longevity and Dementia from the Rio Grande Valley (ISLD-RGV, N = 62). Questionnaires regarding demographics, medical history, and blood/saliva samples were collected. We genotyped the APOE gene. The current findings indicated that APOE-ε4 was associated with not only AD (p < 0.0001) but also with anxiety (p < 0.0001) and depression (p = 0.0004). However, APOE-ε3 was associated with depression (p = 0.002) in the Hispanic population. We provide additional evidence in which APOE-ε4 increased the risk for AD in Hispanics. For the first time, APOE alleles show increased risks for anxiety and depression in Hispanics. Further research is warranted to confirm the current findings.
Collapse
Affiliation(s)
- Chun Xu
- Department of Health and Biomedical Science, College of Health Affairs, University of Texas Rio Grande Valley, Edinburg, TX 78539, USA; (V.P.); (D.G.)
| | - Victoria Padilla
- Department of Health and Biomedical Science, College of Health Affairs, University of Texas Rio Grande Valley, Edinburg, TX 78539, USA; (V.P.); (D.G.)
| | - Stephanie Lozano
- Department of Science, Graduate College of Biochemistry and Molecular Biology, University of Texas Rio Grande Valley, Edinburg, TX 78539, USA;
| | - Daniela Gamez
- Department of Health and Biomedical Science, College of Health Affairs, University of Texas Rio Grande Valley, Edinburg, TX 78539, USA; (V.P.); (D.G.)
| | - Brenda Bin Su
- Department of Pediatrics, Division of Immunology, Allergy, and Retrovirology, Allergy and Immunology Baylor College of Medicine, William T. Shearer Center for Human Immunobiology, Texas Children Hospital, Houston, TX 77030, USA;
| | - Xuan Wang
- Department of Information Systems, Robert C. Vackar College of Business and Entrepreneurship, University of Texas Rio Grande Valley, Edinburg, TX 78539, USA;
| | - Gladys Maestre
- Neuroscience and School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX 78539, USA;
| | - Kesheng Wang
- Department of Family and Community Health, School of Nursing, Health Sciences Center, West Virginia University, Morgantown, WV 26506, USA
| |
Collapse
|
12
|
The influence of culture and cognitive reserve on the clinical presentation of behavioural-variant frontotemporal dementia. J Neurol 2023; 270:3192-3203. [PMID: 36914787 DOI: 10.1007/s00415-023-11638-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/25/2023] [Accepted: 02/19/2023] [Indexed: 03/16/2023]
Abstract
Characterisation of the clinical profile of behavioural-variant frontotemporal dementia (bvFTD) has predominantly been based on Western samples. Some small studies have suggested that the clinical profile may differ in culturally and linguistically diverse populations. Additionally, there is evidence that patients from non-English speaking backgrounds may have more cognitive reserve, allowing them to tolerate more disease pathology before clinical symptoms emerge. This study aims to characterise the clinical profiles of patients with bvFTD from culturally diverse backgrounds. BvFTD patients were classified as Australian-born (Australian) or Culturally and Linguistically Diverse-English-speaking (CALD-English) and Culturally and Linguistically Diverse-Language Other Than English (CALD-LOTE). Clinical features, cognitive test performance and cognitive reserve were compared between groups. Voxel-based morphometry was used to examine the neural correlates of cognitive reserve. 107 patients with bvFTD (53 Australian, 36 CALD-English, 18 CALD-LOTE) and 51 controls were included. Analysis of neuropsychiatric features revealed more elation in Australian patients compared to CALD-English patients, with trends for CALD-LOTE patients to report more irritability. CALD-LOTE patients also had higher cognitive reserve and showed relatively greater verbal than non-verbal cognitive impairment. Neuroimaging analyses revealed that higher cognitive reserve was associated with lower integrity in the frontal-temporal regions associated with typical disease pathology in bvFTD. Our findings support the hypothesis that cognitive reserve may delay early cognitive decline in culturally and linguistically diverse patients, although these patients may still show poor verbal performance due to cultural testing biases. Clinically, these results highlight the need to consider cultural and linguistic background to inform the assessment of dementia.
Collapse
|
13
|
Goudsmit M, van de Vorst I, van Campen J, Parlevliet J, Schmand B. Clinical characteristics and presenting symptoms of dementia - a case-control study of older ethnic minority patients in a Dutch urban memory clinic. Aging Ment Health 2022; 26:2277-2284. [PMID: 34459695 DOI: 10.1080/13607863.2021.1963416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Despite the suspected higher prevalence of dementia in first generation ethnic minority populations, little is known about their pathway to geriatric diagnostic facilities. This study describes presenting symptoms, demographic and clinical characteristics of a large cohort of patients from ethnic minority populations at their first visit to a geriatric day clinic and compares them with those of native majority (Dutch) patients. METHOD Retrospective case control study in an urban geriatric day clinic setting. Participants were 415 minority patients (cases) from 47 different countries and 428 native Dutch control patients. Measurements were demographic characteristics, cognitive screening results, informant questionnaires, neuropsychiatric and depressive symptoms and somatic comorbidity. RESULTS Ethnic minority patients presented with a different profile of psychiatric and somatic comorbidity. They were younger, had longer duration of symptoms and possibly presented somewhat later in the course of the dementia than the controls. Minority patients had more neuropsychiatric and depressive symptoms than native Dutch patients. They also had more often somatic comorbidities than controls, especially diabetes mellitus. CONCLUSIONS Clinicians in geriatric diagnostic facilities should be aware of the younger age at presentation and the high prevalence of some specific risk factors for dementia in ethnic minority patients.
Collapse
Affiliation(s)
- Miriam Goudsmit
- Department of Psychiatry and Medical Psychology, OLVG Hospital, Amsterdam, the Netherlands
| | | | - Jos van Campen
- Department of Geriatrics, OLVG Hospital, Amsterdam, the Netherlands
| | - Juliette Parlevliet
- Department of Geriatrics, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
| | - Ben Schmand
- Department of Medical Psychology, Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
14
|
Greig Custo MT, Lang MK, Barker WW, Gonzalez J, Vélez-Uribe I, Arruda F, Conniff J, Rodriguez MJ, Loewenstein DA, Duara R, Adjouadi M, Curiel RE, Rosselli M. The association of depression and apathy with Alzheimer's disease biomarkers in a cross-cultural sample. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-17. [PMID: 35764422 PMCID: PMC9930412 DOI: 10.1080/23279095.2022.2079414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Cross-cultural differences in the association between neuropsychiatric symptoms and Alzheimer's disease (AD) biomarkers are not well understood. This study aimed to (1) compare depressive symptoms and frequency of reported apathy across diagnostic groups of participants with normal cognition (CN), mild cognitive impairment (MCI), and dementia, as well as ethnic groups of Hispanic Americans (HA) and European Americans (EA); (2) evaluate the relationship between depression and apathy with Aβ deposition and brain atrophy. Statistical analyses included ANCOVAs, chi-squared, nonparametric tests, correlations, and logistic regressions. Higher scores on the Geriatric Depression Scale (GDS-15) were reported in the MCI and dementia cohorts, while older age corresponded with lower GDS-15 scores. The frequency of apathy differed across diagnoses within each ethnicity, but not when comparing ethnic groups. Reduced volume in the rostral anterior cingulate cortex (ACC) significantly correlated with and predicted apathy for the total sample after applying false discovery rate corrections (FDR), controlling for covariates. The EA group separately demonstrated a significant negative relationship between apathy and superior frontal volume, while for HA, there was a relationship between rostral ACC volume and apathy. Apathy corresponded with higher Aβ levels for the total sample and for the CN and HA groups.
Collapse
Affiliation(s)
- María T. Greig Custo
- Wien Center for Alzheimer’s Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA
- Florida Alzheimer’s Disease Research Center, Miami Beach, FL, USA
| | - Merike K. Lang
- Department of Psychology, Charles E Schmidt College of Science, Florida Atlantic University, Davie, FL, USA
| | - Warren W. Barker
- Wien Center for Alzheimer’s Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA
- Florida Alzheimer’s Disease Research Center, Miami Beach, FL, USA
| | - Joanna Gonzalez
- Wien Center for Alzheimer’s Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Idaly Vélez-Uribe
- Wien Center for Alzheimer’s Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA
- Department of Psychology, Charles E Schmidt College of Science, Florida Atlantic University, Davie, FL, USA
| | - Fernanda Arruda
- Department of Psychology, Charles E Schmidt College of Science, Florida Atlantic University, Davie, FL, USA
| | - Joshua Conniff
- Department of Psychology, Charles E Schmidt College of Science, Florida Atlantic University, Davie, FL, USA
| | | | - David A. Loewenstein
- Florida Alzheimer’s Disease Research Center, Miami Beach, FL, USA
- Department of Psychiatry and Behavioral Sciences and Center for Cognitive Neuroscience and Aging, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Ranjan Duara
- Wien Center for Alzheimer’s Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA
- Florida Alzheimer’s Disease Research Center, Miami Beach, FL, USA
| | - Malek Adjouadi
- Florida Alzheimer’s Disease Research Center, Miami Beach, FL, USA
- Center for Advanced Technology and Education, College of Engineering, Florida International University, Miami, FL, USA
| | - Rosie E. Curiel
- Florida Alzheimer’s Disease Research Center, Miami Beach, FL, USA
- Department of Psychiatry and Behavioral Sciences and Center for Cognitive Neuroscience and Aging, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Mónica Rosselli
- Florida Alzheimer’s Disease Research Center, Miami Beach, FL, USA
- Department of Psychology, Charles E Schmidt College of Science, Florida Atlantic University, Davie, FL, USA
| |
Collapse
|
15
|
Cantu PA, Aranda MP. Neuropsychiatric symptoms and caregiver relationship quality for older Mexican Americans. Aging Ment Health 2022; 27:896-903. [PMID: 35266850 PMCID: PMC9463394 DOI: 10.1080/13607863.2022.2048358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Caregivers play a key role in supporting older Mexican Americans, who are less likely to enter nursing facilities than other racial/ethnic groups in the US. However, there is little research on how Neuropsychiatric symptoms (NPS) affect relationship quality between caregivers and care recipients. METHOD Using data from the 2015 wave of the Hispanic Established Populations for Epidemiologic Studies of the Elderly (H-EPESE) (n = 416) study of older (age 85+) Mexican Americans, we examined relationship quality and NPS with ordered logistic regression. Relationship quality was measured using positive (enjoyment, appreciation) and negative (nerves, argue) assessments. NPS were categorized into hyperactivity, affective, and psychosis symptoms. RESULTS Hyperactivity symptoms were associated with appreciation, arguing, and nerves. Psychosis symptoms were associated with arguing and nerves. Spousal caregivers were more likely to report arguing and nerves and less likely to report feeling appreciated. Enjoyment assessments were not associated with NPS. CONCLUSION Relationship quality is related to behavioral changes in late life. Mexican American caregivers negatively evaluate their relationships, not in response to care tasks per se, but when the older person exhibits behavioral problems. The relationship between NPS and negative relationship assessments may be due to unanticipated behavior changes in late life and stigma around psychiatric symptomatology.
Collapse
Affiliation(s)
- Phillip A. Cantu
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
| | - María P. Aranda
- Suzanne Dworak-Peck School of Social Work, Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
16
|
Gutiérrez Á, Cain R, Nadine Diaz, Aranda MP. The Digital Divide Exacerbates Disparities in Latinx Recruitment for Alzheimer’s Disease and Related Dementias Online Education During COVID-19. Gerontol Geriatr Med 2022; 8:23337214221081372. [PMID: 35252476 PMCID: PMC8891594 DOI: 10.1177/23337214221081372] [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: 12/07/2021] [Revised: 01/14/2022] [Accepted: 02/01/2022] [Indexed: 12/24/2022] Open
Abstract
Latinx adults experience a high burden of dementia. Given that modifiable factors
drive dementia disparities, engaging Latinxs in Alzheimer’s disease and related
dementias (ADRD) education is critical to address dementia burden among this
aging population. Yet, no studies have documented the role of the COVID-19
pandemic on dementia education among Latinxs. This study: (1) elucidates the
recruitment and retention processes targeting Latinxs for online educational
events during the pandemic; (2) describes facilitators/barriers to
participation; and (3) offers lessons learned. We developed online
dementia-focused workshops (English and Spanish) and employed a cold-calling
approach to invite Latinx participants enrolled in clinical studies
(N = 209). Bivariate tests assessed demographic and
cognitive differences between those who recruiters did (n = 60)
and did not (n = 149) successfully engage. Frequency counts
assessed participants’ technological access. Only 8/209 attended the online
events; all held university degrees, most reported English as their primary
language, and none experienced cognitive impairment. Results underscore how
educational attainment, cognitive impairment, language preference, and age
intersect to shape recruitment in dementia-focused online education. To promote
healthy aging and to ameliorate dementia disparities, barriers to online
engagement among older Spanish-speaking Latinxs with cognitive impairment and
low educational attainment must be addressed.
Collapse
Affiliation(s)
| | - Rosalba Cain
- University of Southern California, Los Angeles, CA, USA
- USC Alzheimer’s Disease Research Center, Los Angeles, CA, USA
| | - Nadine Diaz
- University of Southern California, Los Angeles, CA, USA
- USC Alzheimer’s Disease Research Center, Los Angeles, CA, USA
| | - María P. Aranda
- University of Southern California, Los Angeles, CA, USA
- USC Alzheimer’s Disease Research Center, Los Angeles, CA, USA
| |
Collapse
|
17
|
Thakur B, Alvarado L, Dodoo C, Salazar R, Espay AJ, Dwivedi AK. Ethnic Differences Between Hispanics and Non-Hispanic Whites in Neuropsychiatric Symptoms Predict Conversion to Mild Cognitive Impairment. J Geriatr Psychiatry Neurol 2021; 34:622-631. [PMID: 32909879 DOI: 10.1177/0891988720957087] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The aim of the study is to ascertain the neuropsychiatric symptoms (NPS) subtypes significantly influencing progression to mild cognitive impairment (MCI) by ethnicity. In this retrospective cohort study, we included 386 cognitively normal individuals participating in the longitudinal Texas Alzheimer's Research and Care Consortium between February 2007 and August 2014. The primary outcome was time to incident MCI. Data driven NPS subtypes at baseline were identified and the effects of these subtypes on the outcome were obtained for Hispanic and non-Hispanic ethnic cohorts and summarized with a hazard ratio (HR). Three NPS subtypes were identified and internally validated: psychomotor apathy factor (including agitation, irritability, apathy), affective mood factor (including depression, anxiety), and physical behavior factor (including nighttime behavior, eating/appetite disturbances). In adjusted analysis, a psychomotor apathy score of NPS was the best predictor for MCI (HR = 2.19, p = 0.037) among non-Hispanics whereas physical behavior score was the most predictive of MCI (HR = 2.55, p = 0.029) among Hispanics. A high score of affective mood factor also tended to increase the risk of MCI (HR = 2.09, p = 0.06) in Hispanics. Progression from normal cognition to MCI was differentially predicted by NPS subtypes in Hispanics and non-Hispanic whites. These data may inform the allocation of efforts for monitoring individuals at-risk of MCI.
Collapse
Affiliation(s)
- Bhaskar Thakur
- Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, 158161Texas Tech University Health Sciences Center El Paso, TX, USA
| | - Luis Alvarado
- Biostatistics and Epidemiological Consulting Lab, Paul L. Foster School of Medicine, 158161Texas Tech University Health Sciences Center El Paso, TX, USA
| | - Christopher Dodoo
- Biostatistics and Epidemiological Consulting Lab, Paul L. Foster School of Medicine, 158161Texas Tech University Health Sciences Center El Paso, TX, USA
| | - Ricardo Salazar
- Division of Geriatric Psychiatry, Memory Disorder & Geriatric Neuropsychiatry Clinic, Department of Psychiatry, Paul L. Foster School of Medicine, 158161Texas Tech University Health Sciences Center El Paso, TX, USA
| | - Alberto J Espay
- Department of Neurology and Rehabilitation Medicine, James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, 2514University of Cincinnati, OH, USA
| | - Alok Kumar Dwivedi
- Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, 158161Texas Tech University Health Sciences Center El Paso, TX, USA.,Biostatistics and Epidemiological Consulting Lab, Paul L. Foster School of Medicine, 158161Texas Tech University Health Sciences Center El Paso, TX, USA
| |
Collapse
|
18
|
Wilson RS, Capuano AW, Sampaio C, Leurgans SE, Barnes LL, Farfel JM, Bennett DA. Neuropsychiatric symptoms in Brazilians with mild cognitive impairment and dementia. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12219. [PMID: 34692976 PMCID: PMC8515552 DOI: 10.1002/dad2.12219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/08/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Knowledge is limited about behavioral and psychological symptoms of mild cognitive impairment (MCI) and dementia in racial and ethnic minorities. METHODS As part of the Pathology, Alzheimer's and Related Dementias Study (PARDoS), we interviewed knowledgeable informants of 2319 older Brazilian decedents (67% white, 11% black, 22% mixed) using the informant portion of the Clinical Dementia Rating Scale to classify MCI and dementia and the Neuropsychiatric Inventory to assess behavioral and psychological symptoms. RESULTS We identified four clusters of neuropsychiatric symptoms: agitation, affect/apathy, psychosis, and behavioral problems. On the Clinical Dementia Rating Scale, 1407 had no cognitive impairment, 180 had MCI, and 732 had dementia. Both MCI and dementia were associated with symptoms in each behavioral/psychological cluster (all P's < .001). There was little evidence of racial differences in the association of MCI and dementia with these neuropsychiatric symptoms. CONCLUSION MCI and dementia are associated with elevated behavioral and psychological symptoms in older black and white Brazilians.
Collapse
Affiliation(s)
- Robert S. Wilson
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
- Department of Psychiatry and Behavioral SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Ana W Capuano
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
- Instituto de Assistencia Medica ao Servidor Publico do Estado (IAMSPE)Sao PauloBrazil
| | - Carolina Sampaio
- Instituto de Assistencia Medica ao Servidor Publico do Estado (IAMSPE)Sao PauloBrazil
| | - Sue E. Leurgans
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Lisa L. Barnes
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
- Department of Psychiatry and Behavioral SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Jose M. Farfel
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Instituto de Assistencia Medica ao Servidor Publico do Estado (IAMSPE)Sao PauloBrazil
| | - David A. Bennett
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
- Instituto de Assistencia Medica ao Servidor Publico do Estado (IAMSPE)Sao PauloBrazil
| |
Collapse
|
19
|
Brown MJ, Patterson R. Gendered racial differences and similarities in subjective cognitive decline and life satisfaction: results from a population-based sample. Aging Ment Health 2021; 25:1636-1641. [PMID: 32338058 PMCID: PMC7593990 DOI: 10.1080/13607863.2020.1758910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The objectives of this study were to: 1) Determine the association between subjective cognitive decline (SCD) and life satisfaction; and 2) Assess the gendered racial/ethnic disparities in the association between SCD and life satisfaction. METHOD Data were obtained from 3,795 participants from the Behavioral Risk Factor Surveillance System survey. SCD was operationalized by "During the past 12 months, have you experienced confusion or memory loss that is happening more often or is getting worse?" Life satisfaction was operationalized by the question "In general how satisfied are you with your life?" Interaction terms of SCD*sex, SCD*race/ethnicity, and SCD*sex*race/ethnicity were used to determine potential effect measure modification. Crude and adjusted linear regression models, controlling for age, education, income and employment, were used to assess the association between SCD and life satisfaction by sex, race, and by gendered racial/ethnic groups: Black women, White women, Hispanic women, Other women; and Black men, White men, Hispanic men and Other men. RESULTS SCD was negatively associated with life satisfaction in the overall sample (β: -0.55; 95% CI: -0.66, -0.43). However, the negative associations seen across gender, race/ethnicity, and gendered racial/ethnic groups were statistically similar (p for interaction terms > 0.05). The highest effect estimate was seen for Other men (β: -1.22; 95% CI: -1.37, -1.09). CONCLUSION Interventions geared towards improving cognition may improve life satisfaction for all groups, irrespective of gender and/or race/ethnicity. Future research may include longitudinal studies to determine the temporal sequence between SCD and life satisfaction.
Collapse
Affiliation(s)
- Monique J. Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC,South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC,Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC,Office of the Study on Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Robert Patterson
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| |
Collapse
|
20
|
Aranda MP, Kremer IN, Hinton L, Zissimopoulos J, Whitmer RA, Hummel CH, Trejo L, Fabius C. Impact of dementia: Health disparities, population trends, care interventions, and economic costs. J Am Geriatr Soc 2021; 69:1774-1783. [PMID: 34245588 PMCID: PMC8608182 DOI: 10.1111/jgs.17345] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/07/2021] [Accepted: 05/16/2021] [Indexed: 01/14/2023]
Abstract
INTRODUCTION The dementia experience is not a monolithic phenomenon-and while core elements of dementia are considered universal-people living with dementia experience the disorder differently. Understanding the patterning of Alzheimer's disease and related dementias (ADRD) in the population with regards to incidence, risk factors, impacts on dementia care, and economic costs associated with ADRD can provide clues to target risk and protective factors for all populations as well as addressing health disparities. METHODS We discuss information presented at the 2020 National Research Summit on Care, Services, and Supports for Persons with Dementia and Their Caregivers, Theme 1: Impact of Dementia. In this article, we describe select population trends, care interventions, and economic impacts, health disparities and implications for future research from the perspective of our diverse panel comprised of academic stakeholders, and persons living with dementia, and care partners. RESULTS Dementia incidence is decreasing yet the advances in population health are uneven. Studies examining the educational, geographic and race/ethnic distribution of ADRD have identified clear disparities. Disparities in health and healthcare may be amplified by significant gaps in the evidence base for pharmacological and non-pharmacological interventions. The economic costs for persons living with dementia and the value of family care partners' time are high, and may persist into future generations. CONCLUSIONS Significant research gaps remain. Ensuring that ADRD healthcare services and long-term care services and supports are accessible, affordable, and effective for all segments of our population is essential for health equity. Policy-level interventions are in short supply to redress broad unmet needs and systemic sources of disparities. Whole of society challenges demand research producing whole of society solutions. The urgency, complexity, and scale merit a "whole of government" approach involving collaboration across numerous federal agencies.
Collapse
Affiliation(s)
| | - Ian N. Kremer
- LEAD Coalition (Leaders Engaged on Alzheimer’s Disease)
| | | | | | | | | | | | | |
Collapse
|
21
|
Rote SM, Angel JL, Kim J, Markides KS. Dual Trajectories of Dementia and Social Support in the Mexican-Origin Population. THE GERONTOLOGIST 2021; 61:374-382. [PMID: 32756950 DOI: 10.1093/geront/gnaa100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In the next few decades, the number of Mexican American older adults with Alzheimer's disease and related disorders will increase dramatically. Given that this population underutilizes formal care services, the degree of care responsibilities in Mexican American families is likely to increase at the same time. However, little is known about the changing need for assistance with instrumental day-to-day activities and emotional support by long-term patterns of cognitive impairment. RESEARCH DESIGN AND METHODS We use 7 waves of the Hispanic Established Populations for the Epidemiologic Studies of the Elderly (1992/1993-2010/2011) and trajectory modeling to describe long-term patterns of perceived emotional and instrumental support, and dementia. RESULTS Results revealed 2 latent classes of both emotional and instrumental support trajectories: low and high support. Specifically, those living alone were more likely to belong to the group with low support than to that with high support. Three latent classes for likely dementia were also revealed: likely dementia, increasing impairment, and no impairment. Those living alone were more likely to belong to the increasing impairment and likely dementia groups. The dual trajectory of emotional and instrumental support with likely dementia revealed that the probability of belonging to the low-support group was highest for those with increasing impairment. DISCUSSION AND IMPLICATIONS These findings highlight the risk and vulnerability of those who live alone concerning perceived social support and dementia. Implications of the findings for the potential dependency burden on Latino caregivers are discussed.
Collapse
Affiliation(s)
- Sunshine M Rote
- Kent School of Social Work, University of Louisville, Kentucky
| | - Jacqueline L Angel
- LBJ School of Public Affairs and Department of Sociology, The University of Texas at Austin
| | - Jiwon Kim
- Department of Educational Psychology-Quantitative Methods, The University of Texas at Austin
| | - Kyriakos S Markides
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston
| |
Collapse
|
22
|
Flores DV, Rote S, Angel J, Chen NW, Downer B, Markides K. Depressive symptoms in child caregivers of very old Mexican Americans. Aging Ment Health 2021; 25:61-67. [PMID: 32883095 PMCID: PMC7785680 DOI: 10.1080/13607863.2017.1423024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To study the effects of disability, cognitive impairment, and neuropsychiatric disturbance among older Mexican Americans on depressive symptoms in their children caregivers. METHODS This study utilizes data from Wave 7 (2010-2011) of the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE). The final sample included 200 adult children caregivers that provided direct personal care with activities of daily living (ADL) (e.g. bathing, toileting, dressing, etc.) to their older parents (average age = 87). We analyzed the influence of ADL disability, cognition (MMSE), and neuropsychiatric symptoms (NPI) of the care recipient on depressive symptoms of the adult child caregiver. A cross-sectional multivariable linear regression analysis was conducted to examine the effect of neuropsychiatric disturbance on caregiver depressive symptoms. RESULTS Presence of care recipient NPI symptoms was associated with higher depressive symptoms for caregivers. Additional characteristics associated with caregiver depressive symptoms were not being married, and higher perceived social stress. ADL disability of the care recipient, cognitive functioning of the care recipient, or caregiver health status alone did not have a significant effect on depressive symptoms of the caregiver. CONCLUSIONS In a Mexican American familistic culture, disability and cognitive impairment might be better tolerated by families but neuropsychiatric behavioral symptoms related to dementia may take an increased toll on family member caregivers. The need to provide respite services, mental health resources and community services for caregivers of care recipients with neuropsychiatric symptoms is of paramount importance to alleviate depressive symptoms and burden among caregivers.
Collapse
Affiliation(s)
- David V. Flores
- Department of Preventive Medicine and Population Health,
The University of Texas Medical Branch, Galveston, TX, USA
| | - Sunshine Rote
- Kent School of Social Work, The University of Louisville,
Louisville, KY, USA
| | - Jacqueline Angel
- LBJ School of Public Affairs, The University of Texas,
Austin, TX, USA
| | - Nai-Wei Chen
- Department of Preventive Medicine and Population Health,
The University of Texas Medical Branch, Galveston, TX, USA
| | - Brian Downer
- Division of Rehabilitation Sciences, The University of
Texas Medical Branch, Galveston, TX, USA
| | - Kyriakos Markides
- Department of Preventive Medicine and Population Health,
The University of Texas Medical Branch, Galveston, TX, USA
| |
Collapse
|
23
|
Gil M, Alliey-Rodriguez N, Lopez-Alvarenga JC, Diego V, Gaona CA, Mata L, Pirela RV, Chavez CA, de Erausquin GA, Melgarejo JD, Maestre GE. Neuropsychiatric Symptoms Among Hispanics: Results of the Maracaibo Aging Study. J Alzheimers Dis 2021; 82:S251-S261. [PMID: 33612541 PMCID: PMC8354010 DOI: 10.3233/jad-201144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neuropsychiatric symptoms play an important role in diagnosing and clinical follow-up of cognitive impairment and dementia. OBJECTIVE We investigated the relationship between neuropsychiatric symptoms, cognitive impairment, and dementia in Hispanics. METHODS We included 529 participants (age ≥40 years) from the Maracaibo Aging Study with standardized neuropsychiatric assessments, including the Neuropsychiatric Inventory (NPI). Based on the Clinical Dementia Rating and the Mini-Mental State Examination scores, participants' cognitive status was categorized into normal cognition, mild/moderate, and severe cognitive impairment. Diagnosis of dementia was established in a consensus conference. Statistical analyses included multivariable logistic regression models and area under the curve (AUC). RESULTS The mean age of participants was 59.3 years, and 71.8%were women. The proportion of dementia was 6.8%. Disturbed sleep, anxiety, and depression were the most common neuropsychiatric symptoms in the study sample. In crude analyses, the proportions of hallucinations, aberrant motor behavior, agitation/aggression, apathy, delusions, irritability, eating disturbance, depression, and euphoria were differently distributed among cognitive status groups (p < 0.05). After accounting for confounders, aberrant motor behavior and agitation/aggression remained significantly associated with cognitive impairment and dementia (p < 0.05). The inclusion of the NPI domains significantly improved the AUC to discriminate severe cognitive impairment and dementia compared to a basic model that included sex, age, education, alcohol, obesity, serum glucose, total cholesterol, hypertension, and stroke. CONCLUSION Neuropsychiatric symptoms are associated with severe cognitive impairment and dementia. The addition of NPI items to the global cognitive assessment might help early detection of dementia in primary care settings.
Collapse
Affiliation(s)
- Mario Gil
- Department of Psychological Science, University of Texas Rio Grande Valley, Brownsville, TX, USA
- Department of Neuroscience, School of Medicine, University of Texas Rio Grande Valley, Harlingen, TX, USA
- Rio Grande Valley Alzheimer’s Disease Resource Center for Minority Aging Research (RGV AD-RCMAR), University of Texas Rio Grande Valley, Brownsville, TX, USA
- Institute for Neuroscience, School of Medicine, University of Texas Rio Grande Valley, Harlingen, TX, USA
| | - Ney Alliey-Rodriguez
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Laboratory of Neurosciences, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Juan Carlos Lopez-Alvarenga
- Rio Grande Valley Alzheimer’s Disease Resource Center for Minority Aging Research (RGV AD-RCMAR), University of Texas Rio Grande Valley, Brownsville, TX, USA
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, USA
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Vincent Diego
- Rio Grande Valley Alzheimer’s Disease Resource Center for Minority Aging Research (RGV AD-RCMAR), University of Texas Rio Grande Valley, Brownsville, TX, USA
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, USA
- SOM South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Ciro A. Gaona
- Laboratory of Neurosciences, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Ledys Mata
- Laboratory of Neurosciences, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Rosa V. Pirela
- Rio Grande Valley Alzheimer’s Disease Resource Center for Minority Aging Research (RGV AD-RCMAR), University of Texas Rio Grande Valley, Brownsville, TX, USA
- Laboratory of Neurosciences, School of Medicine, University of Zulia, Maracaibo, Venezuela
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Carlos A. Chavez
- Laboratory of Neurosciences, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Gabriel A. de Erausquin
- Department of Neurology, Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Jesus D. Melgarejo
- Laboratory of Neurosciences, School of Medicine, University of Zulia, Maracaibo, Venezuela
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Gladys E. Maestre
- Department of Neuroscience, School of Medicine, University of Texas Rio Grande Valley, Harlingen, TX, USA
- Rio Grande Valley Alzheimer’s Disease Resource Center for Minority Aging Research (RGV AD-RCMAR), University of Texas Rio Grande Valley, Brownsville, TX, USA
- Institute for Neuroscience, School of Medicine, University of Texas Rio Grande Valley, Harlingen, TX, USA
- Laboratory of Neurosciences, School of Medicine, University of Zulia, Maracaibo, Venezuela
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, USA
| |
Collapse
|
24
|
Johnston K, Preston R, Strivens E, Qaloewai S, Larkins S. Understandings of dementia in low and middle income countries and amongst indigenous peoples: a systematic review and qualitative meta-synthesis. Aging Ment Health 2020; 24:1183-1195. [PMID: 31074290 DOI: 10.1080/13607863.2019.1606891] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Dementia is a growing health priority, particularly in less resourced countries and amongst indigenous populations. Understanding cultural meanings ascribed to dementia is an important aspect of policy development and the provision of culturally congruent care and support for people with dementia, their families and the caring professions. This review investigates conceptualizations of dementia amongst indigenous peoples and populations living in low and middle income countries (LMIC), who experience limited diagnosis and formal care for dementia, and how these shape responses to dementia.Methods: A systematic search was conducted for qualitative studies, reported in English, that investigated the perceptions, attitudes or understandings of dementia in LMIC and amongst indigenous populations. A qualitative analysis and meta-synthesis was carried out.Findings: Nineteen articles were included in the review following quality assessment. Dementia was rarely conceptualized as a defined, pathological condition characterized by progressive cognitive decline. Rather, notions of dementia existed within conceptualizations of aging, mental illness, traditional cultural beliefs and the trauma of colonization. Responses to dementia were influenced and perpetuated by community and health providers, and cultural norms for caregiving.Conclusions: There is a need to understand conceptualizations of dementia from the perspective of all stakeholders within a setting, and the dynamic responses that exist between key stakeholders. Community knowledge systems could facilitate understanding about appropriate and acceptable health and community care responses to dementia, and approaches to stigma reduction. Inclusive discussions about dementia are essential if awareness campaigns are to improve the wellbeing of people with dementia and caregivers.
Collapse
Affiliation(s)
- Karen Johnston
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Queensland, Australia
| | - Robyn Preston
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Queensland, Australia
| | - Edward Strivens
- Sub-acute and Rehabilitation Services, Cairns and Hinterland Hospital Health Service, Cairns, Queensland, Australia
| | - Sefanaia Qaloewai
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Queensland, Australia
| |
Collapse
|
25
|
Barnes-Marrero I, Horter L, Hayden JD, Patel NC, Mendoza L, Castillo L. Diagnostic accuracy of the repeatable battery of the assessment of neuropsychological status update, Spanish version, in predicting Alzheimer's disease among Hispanic older adults in the United States reporting memory problems. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:509-519. [PMID: 32584154 DOI: 10.1080/23279095.2020.1777554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: There are few standardized, Spanish-language diagnostic tools to help identify Hispanic persons at early stages of Alzheimer's disease (AD). This study evaluated the accuracy of the Spanish version of the Repeatable Battery for the Assessment of Neuropsychological Status-Update (RBANS) in predicting AD in older Hispanic adults in the United States reporting memory problems.Methods: We analyzed data from age, sex, and education level propensity score-matched Hispanic memory clinic patients with (n = 38) and without (n = 38) a clinical diagnosis of AD. Estimates of diagnostic accuracy included sensitivity, specificity, predictive value, and receiver operating characteristic analysis.Results: After controlling for sex and matched pairs, the Total Scale score [area under curve (AUC) = 0.7417] and the Immediate (AUC = 0.7258) and Delayed (AUC = 0.7735) Memory index scores provided better estimates of diagnostic accuracy than Language, Attention, and Visuospatial/Constructional index scores. A minus 2-standard deviation (SD) cut point enhanced the predictive probability of the Delayed Memory index score. A cut point of -1.5 SD optimized the predictive probability of the Total Scale score.Conclusions: These results suggest that optimal cutoff values for the RBANS Delayed Memory index and Total Scale scores that may help identify Hispanic patients with AD as part of a comprehensive diagnostic AD assessment.
Collapse
Affiliation(s)
| | - Libby Horter
- Humana Healthcare Research, Inc, Louisville, KY, USA
| | | | - Nick C Patel
- Humana Healthcare Research, Inc, Louisville, KY, USA
| | - Lisandra Mendoza
- Department of Clinical Psychology, Albizu University, Miami, FL, USA
| | | |
Collapse
|
26
|
Cognitive and neuropsychological examination of the elderly. HANDBOOK OF CLINICAL NEUROLOGY 2020. [PMID: 31753159 DOI: 10.1016/b978-0-12-804766-8.00006-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
Neuropsychological assessment plays a prominent role in the evaluation and care of patients with neurodegenerative diseases throughout the dynamic course of disease. As a biomarker of disease, neuropsychological measurement can distinguish normal from pathologic aging processes. Further, neuropsychological data can help distinguish and classify underlying pathologies in dementing diseases, augmenting imaging and biofluid markers in this area. Neuropsychological data can predict increased or reduced risk for dementia conferred by multiple factors, and describe disease trajectory in affected individuals. Cognitive evaluation can also estimate and address functional outcomes that are most important to patients and their loved ones and that are clinically relevant to diagnostic staging. In informing intervention and patient care needs, areas of cognitive weakness highlight targets for support/intervention, while areas of cognitive strength can be capitalized upon to modify the clinical course of disease. These functions can be accomplished through the complementary use of brief screening tools and comprehensive test batteries. However, for neuropsychological data to serve these functions, it is critical to understand neuropsychological test properties and nondisease factors that can account for variance in test performance. This chapter concludes with directions for future research.
Collapse
|
27
|
Briceño EM, Mehdipanah R, Gonzales XF, Langa KM, Levine DA, Garcia NM, Longoria R, Giordani BJ, Heeringa SG, Morgenstern LB. Neuropsychological assessment of mild cognitive impairment in Latinx adults: A scoping review. Neuropsychology 2020; 34:493-510. [PMID: 32281811 DOI: 10.1037/neu0000628] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective: Latinx populations are rapidly growing and aging in the United States. There is a critical need to accurately and efficiently detect those at risk for dementia, particularly those with mild cognitive impairment (MCI). MCI diagnosis often relies on neuropsychological assessment, although cultural, demographic, and linguistic characteristics may impact test scores. This study provides a scoping review of neuropsychological studies on MCI in Hispanic/Latinx populations to evaluate how studies report and account for these factors in diagnosis of MCI. Method: Studies were identified using Web of Science, PubMed, and Scopus, using search terms (Hispanic* OR Latin* OR "Mexican American*" OR "Puerto Ric*" OR Caribbean) and ("Mild Cognitive Impairment" OR MCI). Studies using neuropsychological tests in diagnosis of MCI for Latinx individuals in the United States were identified. Sample characterization (e.g., country of origin, literacy, language preference and proficiency), neuropsychological testing methods (e.g., test selection and translation, normative data source), and method of MCI diagnosis were reviewed. Results: Forty-four articles met inclusion criteria. There was considerable variability in reporting of demographic, cultural and linguistic factors across studies of MCI in Latinx individuals. For example, only 5% of studies reported nativity status, 52% reported information on language preference and use, and 34% reported the method and/or source of test translation and adaptation. Conclusions: Future studies of diagnosis of MCI in Latinx individuals should report cultural details and use of appropriate neuropsychological assessment tools and normative data. This is important to accurately estimate the prevalence of MCI in Latinx individuals. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Collapse
Affiliation(s)
- Emily M Briceño
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School
| | | | | | - Kenneth M Langa
- Development Service (HSR&D), Center for Clinical Management Research (CCMR), University of Michigan
| | - Deborah A Levine
- Development Service (HSR&D), Center for Clinical Management Research (CCMR), University of Michigan
| | - Nelda M Garcia
- Department of Neurology, University of Michigan Medical School
| | - Ruth Longoria
- Department of Neurology, University of Michigan Medical School
| | - Bruno J Giordani
- Departments of Psychiatry, Neurology, and Psychology and School of Nursing, University of Michigan
| | | | | |
Collapse
|
28
|
Kurasz AM, Smith GE, McFarland MG, Armstrong MJ. Ethnoracial Differences in Lewy Body Diseases with Cognitive Impairment. J Alzheimers Dis 2020; 77:165-174. [PMID: 32804137 PMCID: PMC7553012 DOI: 10.3233/jad-200395] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Increasing research focuses on ethnic differences in Alzheimer's disease, but such efforts in other neurodegenerative dementias are lacking. Currently, data on the ethnic profile of cognitively impaired persons with Lewy body disease (LBD) is limited, despite Lewy body dementia being the second most common neurodegenerative dementia. OBJECTIVE The study aimed to investigate presenting characteristics among ethnoracially diverse individuals with cognitive impairment secondary to LBD using the National Alzheimer's Coordinating Center database. METHODS Participants self-identified as African American, Hispanic, or White. We used Kruskal-Wallis and Pearson χ2 analyses to investigate group differences in presenting characteristics and linear regression to compare neuropsychological test performance. RESULTS Presentation age was similar between groups (median 74-75 years). Compared to Whites (n = 1782), African Americans (n = 130) and Hispanics (n = 122) were more likely to be female and single, have less educational attainment, report more cardiovascular risk factors, describe less medication use, and perform worse on select cognitive tests. Hispanics reported more depressive symptoms. CONCLUSION Cohorts differences highlight the need for population-based LBD studies with racial-ethnic diversity. Culturally-sensitive neuropsychological tests are needed to determine whether observed differences relate to cultural, social, testing, or disease-related factors. More research is needed regarding how social and biological factors impact LBD care among diverse populations.
Collapse
Affiliation(s)
- Andrea M. Kurasz
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Glenn E. Smith
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | | | | |
Collapse
|
29
|
Babulal GM, Quiroz YT, Albensi BC, Arenaza-Urquijo E, Astell AJ, Babiloni C, Bahar-Fuchs A, Bell J, Bowman GL, Brickman AM, Chételat G, Ciro C, Cohen AD, Dilworth-Anderson P, Dodge HH, Dreux S, Edland S, Esbensen A, Evered L, Ewers M, Fargo KN, Fortea J, Gonzalez H, Gustafson DR, Head E, Hendrix JA, Hofer SM, Johnson LA, Jutten R, Kilborn K, Lanctôt KL, Manly JJ, Martins RN, Mielke MM, Morris MC, Murray ME, Oh ES, Parra MA, Rissman RA, Roe CM, Santos OA, Scarmeas N, Schneider LS, Schupf N, Sikkes S, Snyder HM, Sohrabi HR, Stern Y, Strydom A, Tang Y, Terrera GM, Teunissen C, Melo van Lent D, Weinborn M, Wesselman L, Wilcock DM, Zetterberg H, O'Bryant SE. Perspectives on ethnic and racial disparities in Alzheimer's disease and related dementias: Update and areas of immediate need. Alzheimers Dement 2019; 15:292-312. [PMID: 30555031 PMCID: PMC6368893 DOI: 10.1016/j.jalz.2018.09.009] [Citation(s) in RCA: 307] [Impact Index Per Article: 61.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 07/12/2018] [Accepted: 09/13/2018] [Indexed: 02/07/2023]
Abstract
Alzheimer's disease and related dementias (ADRDs) are a global crisis facing the aging population and society as a whole. With the numbers of people with ADRDs predicted to rise dramatically across the world, the scientific community can no longer neglect the need for research focusing on ADRDs among underrepresented ethnoracial diverse groups. The Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART; alz.org/ISTAART) comprises a number of professional interest areas (PIAs), each focusing on a major scientific area associated with ADRDs. We leverage the expertise of the existing international cadre of ISTAART scientists and experts to synthesize a cross-PIA white paper that provides both a concise "state-of-the-science" report of ethnoracial factors across PIA foci and updated recommendations to address immediate needs to advance ADRD science across ethnoracial populations.
Collapse
Affiliation(s)
- Ganesh M Babulal
- Department of Neurology and Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Yakeel T Quiroz
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Benedict C Albensi
- Division of Neurodegenerative Disorders, St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada; Department of Pharmacology & Therapeutics, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Arlene J Astell
- Department of Occupational Sciences & Occupational Therapy, University of Toronto, CA; School of Psychology and Clinical Language Sciences, University of Reading, UK
| | - Claudio Babiloni
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome, Italy; Department of Neuroscience, IRCCS-Hospital San Raffaele Pisana of Rome and Cassino, Rome and Cassino, Italy
| | - Alex Bahar-Fuchs
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, the University of Melbourne, Australia
| | | | - Gene L Bowman
- Nutrition and Brain Health Laboratory, Nestlé Institute of Health Sciences, Lausanne, Switzerland; Department of Neurology, Layton Aging & Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA
| | - Adam M Brickman
- Taub Institute for Research in Alzheimer's Disease and the Aging Brain, The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY, USA
| | - Gaël Chételat
- Inserm, Inserm UMR-S U1237, Université de Caen-Normandie, GIP Cyceron, Caen, France
| | - Carrie Ciro
- Department of Occupational Therapy Education, University of Kansas Medical Center, Kansas City, KS, USA
| | - Ann D Cohen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Hiroko H Dodge
- Department of Neurology, Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA
| | - Simone Dreux
- Undergraduate Program of History and Science, Harvard College, Cambridge, MA, USA
| | - Steven Edland
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - Anna Esbensen
- Department of Pediatrics, University of Cincinnati College of Medicine & Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lisbeth Evered
- Melbourne Medical School, University of Melbourne, Australia
| | - Michael Ewers
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Munich, Germany
| | - Keith N Fargo
- Medical & Scientific Relations, Alzheimer's Association, Chicago, IL, USA
| | - Juan Fortea
- Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Barcelona Down Medical Center, Fundació Catalana de Síndrome de Down, Barcelona, Spain
| | - Hector Gonzalez
- Department of Neurosciences and Shiley-Marcos Alzheimer's Disease Research Center, University of San Diego, CA, USA
| | - Deborah R Gustafson
- Department of Neurology, Section for NeuroEpidemiology, State University of New York - Downstate Medical Center, Brooklyn, NY, USA
| | - Elizabeth Head
- Sanders Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - James A Hendrix
- Medical & Scientific Relations, Alzheimer's Association, Chicago, IL, USA
| | - Scott M Hofer
- Adult Development and Aging, University of Victoria, British Columbia, CA, USA
| | - Leigh A Johnson
- Department of Pharmacology & Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Roos Jutten
- VU University Medical Center, Department of Neurology, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Kerry Kilborn
- Department of Psychology, University of Glasgow, Glasgow, Scotland, UK
| | - Krista L Lanctôt
- Sunnybrook Research Institute of Psychiatry and Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Jennifer J Manly
- Taub Institute for Research in Alzheimer's Disease and the Aging Brain, The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY, USA
| | - Ralph N Martins
- Aging and Alzheimer's Disease, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Michelle M Mielke
- Department of Epidemiology, Mayo Clinic, Rochester, MN, USA; Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Esther S Oh
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mario A Parra
- School of Social Sciences, Department of Psychology, Heriot-Watt University, UK; Universidad Autónoma del Caribe, Barranquilla, Colombia; Neuroprogressive and Dementia Network, UK
| | - Robert A Rissman
- Department of Neurosciences, University of California San Diego School of Medicine, CA, USA
| | - Catherine M Roe
- Department of Neurology and Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Octavio A Santos
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | - Nikolaos Scarmeas
- Taub Institute for Research in Alzheimer's Disease and the Aging Brain, The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY, USA; Aiginition Hospital, 1st Neurology Clinic, Department of Social Medicine, Psychiatry and Neurology, National and Kapodistrian University of Athens, Athens, Greece
| | - Lon S Schneider
- Department of Psychiatry and The Behavioral Sciences, University of Southern California, CA, USA
| | - Nicole Schupf
- Department of Epidemiology, Mailman School of Public Health Columbia University, New York, NY, USA
| | - Sietske Sikkes
- Massachusetts General Hospital, Department of Neurology, Boston, MA, USA
| | - Heather M Snyder
- Medical & Scientific Relations, Alzheimer's Association, Chicago, IL, USA
| | - Hamid R Sohrabi
- Aging and Alzheimer's Disease, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Yaakov Stern
- Department of Neurology, Columbia University, New York, NY, USA; Department of Psychiatry, Columbia University, New York, NY, USA
| | - Andre Strydom
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Yi Tang
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Graciela Muniz Terrera
- Centers for Clinical Brain Sciences and Dementia Prevention, University in Edinburgh, Scotland, UK
| | - Charlotte Teunissen
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
| | - Debora Melo van Lent
- Department of Clinical Research, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Michael Weinborn
- Aging and Alzheimer's Disease, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | | | - Donna M Wilcock
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
| | - Henrik Zetterberg
- UK Dementia Research Institute at UCL, London, UK; Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, UK; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Sid E O'Bryant
- Department of Pharmacology & Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, USA.
| |
Collapse
|
30
|
Cummings JL, Atri A, Ballard C, Boneva N, Frölich L, Molinuevo JL, Raket LL, Tariot PN. Insights into globalization: comparison of patient characteristics and disease progression among geographic regions in a multinational Alzheimer's disease clinical program. Alzheimers Res Ther 2018; 10:116. [PMID: 30474567 PMCID: PMC6260857 DOI: 10.1186/s13195-018-0443-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/24/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Globalization of clinical trials has important consequences for trial planning and interpretation. This study investigated heterogeneity in patient characteristics and outcomes among world regions in the global idalopirdine Phase 3 clinical program. METHODS Data were pooled from three 24-week randomized controlled trials in patients aged ≥ 50 years with mild-to-moderate Alzheimer's disease (AD) (n = 2506). Patients received idalopirdine (10, 30, or 60 mg/day) or placebo, added to cholinesterase inhibitor treatment. Patients were categorized into the following regions: Eastern Europe/Turkey (n = 759), Western Europe/Israel (n = 709), USA/Canada (n = 444), South America/Mexico (n = 361), Asia (n = 134), and Australia/South Africa (n = 99). For each region, operational characteristics, baseline demographic and clinical characteristics, adverse events, and mean change from baseline to week 24 in clinical rating scale scores (placebo group only) were summarized using descriptive statistics. RESULTS Completion rates were 0.86-0.90 in all regions. Heterogeneity among global regions was evident. Protocol deviations were twice as common in South America/Mexico as in USA/Canada (2.64 vs 1.35 per patient screened). Educational level ranged from 9.2 years in South America/Mexico to 13.4 years in USA/Canada. APOE ε4 carriage was 80.6% in Australia/South Africa, 63.1% in Western Europe/Israel, and < 60% in other regions. Screening Mini-Mental State Examination scores were higher in Eastern Europe/Turkey (18.0) and USA/Canada (17.5) than in other regions (16.9-17.1). Baseline AD Assessment Scale-Cognitive subscale (ADAS-Cog) scores ranged from 24.3 in USA/Canada to 27.2 in South America/Mexico. Baseline AD Cooperative Study-Activities of Daily Living, 23-item version (ADCS-ADL23) scores ranged from 58.5 in USA/Canada to 53.5 in Eastern Europe/Turkey. In the placebo group, adverse events were 1.6-1.7 times more common in Western Europe/Israel, USA/Canada, and Australia/South Africa than in Eastern Europe/Turkey. On the ADAS-Cog, Australia/South Africa and Western Europe/Israel showed the most worsening among patients receiving placebo (1.56 and 1.40 points, respectively), whereas South America/Mexico showed an improvement (-0.71 points). All regions worsened on the ADCS-ADL23, from -3.21 points in Western Europe/Israel to -0.59 points in Eastern Europe/Turkey. CONCLUSIONS Regional heterogeneity-in terms of study conduct, patient characteristics, and outcomes-exists, and should be accounted for, when planning and conducting multinational AD clinical trials. TRIAL REGISTRATION ClinicalTrials.gov, NCT01955161 . Registered on 27 September 2013. ClinicalTrials.gov, NCT02006641 . Registered on 5 December 2013. ClinicalTrials.gov, NCT02006654 . Registered on 5 December 2013.
Collapse
Affiliation(s)
- Jeffrey L. Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W Bonneville Avenue, Las Vegas, NV 89106 USA
| | - Alireza Atri
- Banner Sun Health Research Institute, Sun City, AZ USA
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA USA
| | | | | | - Lutz Frölich
- Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - José Luis Molinuevo
- Alzheimer’s Disease and Other Cognitive Disorders Unit, IDIBAPS, Hospital Clinic i Universitari, Barcelona, Spain
- Barcelonaβeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
| | | | | |
Collapse
|