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Frndak S, Cudjoe T, Thorpe RJ, Deng Z, Ward-Caviness CK, Clarke KA, Dickerson AS. Social cohesion as a modifier of joint air pollution exposure and incident dementia. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 949:175149. [PMID: 39084376 DOI: 10.1016/j.scitotenv.2024.175149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 06/19/2024] [Accepted: 07/28/2024] [Indexed: 08/02/2024]
Abstract
Social cohesion can reduce stress, increase social interaction, and improve cognitive reserve. These social mechanisms may modify the effects of air pollution on dementia risk. This cohort study examines the potential moderating effect of social cohesion on associations between joint air pollution exposure and incident dementia leveraging data from 5112 community-dwelling adults ≥65 years of age enrolled in the National Health and Aging Trends Study (NHATS). Study participants were enrolled in 2011 and followed through 2018. We assigned 2010 residential census tract-level exposures to five air pollutants, particulate matter (PM) ≤ 10 μm in diameter, PM ≤ 2.5 μm in diameter, carbon monoxide, nitric oxide, and nitrogen dioxide, using the US Environmental Protection Agency's Community Multiscale Air Quality Modeling System. Dementia status was determined based on self- or proxy-reported dementia diagnosis or "probable dementia" according to NHATS cognitive screening tools. Participants' self-rated neighborhood social cohesion was evaluated based on three questions: neighbors knowing each other, being helpful, and being trustworthy. Social cohesion was dichotomized at the median into high vs low social cohesion. Associations between air pollutants and incident dementia were assessed using quantile g-computation Cox proportional hazard models and stratified by high vs low social cohesion, adjusting for age, sex, education, partner status, urbanicity, annual income, race and ethnicity, years lived at current residence, neighborhood disadvantage index, and tract segregation. High social cohesion (HR = 1.20, 95 % CI = 0.98, 1.47) and air pollution (HR = 1.08, 95 % CI = 0.92, 1.28) were not associated with incident dementia alone. However, when stratified, greater joint air pollution exposure increased dementia risk among participants at low (HR = 1.34, 95 % CI = 1.04, 1.72), but not high (HR = 1.00, 95 % CI = 0.93, 1.06) social cohesion. Air pollution was a risk factor for dementia only when reported social cohesion was low, suggesting that social interaction may play a protective role, mitigating dementia risk via air pollution exposure.
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Affiliation(s)
- Seth Frndak
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States of America
| | - Thomas Cudjoe
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, United States of America
| | - Roland J Thorpe
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, United States of America; Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, United States of America; Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, United States of America
| | - Zhengyi Deng
- Department of Urology, Stanford School of Medicine, United States of America
| | - Cavin K Ward-Caviness
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, United States of America
| | - Kayan A Clarke
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States of America
| | - Aisha S Dickerson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States of America; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, United States of America; Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, United States of America; Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, United States of America.
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Agung Y, Hladkowicz E, Boland L, Moloo H, Lavallée LT, Lalu MM, McIsaac DI. Frailty and decisional regret after elective noncardiac surgery: a multicentre prospective cohort study. Br J Anaesth 2024:S0007-0912(24)00464-1. [PMID: 39232909 DOI: 10.1016/j.bja.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Frailty is associated with morbidity and mortality after surgery. The association of frailty with decisional regret is poorly defined. Our objective was to estimate the association of preoperative frailty with decisional regret status in the year after surgery. METHODS We conducted a secondary analysis of a prospective, multicentre cohort study of patients aged ≥65 years who underwent elective noncardiac surgery. Decisional regret about having undergone surgery was ascertained at 30, 90, and 365 (primary time point) days after surgery using a 3-point ordinal scale. Bayesian ordinal logistic regression was used to estimate the association of frailty with decisional regret, adjusted for surgery type, age, sex, and mental health conditions. Subgroup and sensitivity analyses were conducted. RESULTS We identified 669 patients; 293 (43.8%) lived with frailty. At 365 days after surgery, the unadjusted odds ratio (OR) associating frailty with greater decisional regret was 2.21 (95% credible interval [CrI] 0.98-5.09; P(OR>1)=0.97), which was attenuated after confounder adjustment (adjusted OR 1.68, 95% CrI 0.84-3.36; P(OR>1)=0.93). Similar results were estimated at 30 and 90 days. Additional adjustment for baseline comorbidities and disability score substantially altered the OR at 365 days (0.89, 95% CrI 0.37-2.12; P(OR>1)=0.39). There was a high probability that surgery type was an effect modifier (non-orthopaedic: OR 1.90, 95% CrI 1.00-3.59; P(OR>1)=0.98); orthopaedic: OR 0.87, 95% CrI 0.41-1.91; P(OR>1)=0.36). CONCLUSIONS Among older surgical patients, there appears to be a complex association with frailty and decisional regret, with substantial heterogeneity based on assumed causal pathways and surgery type. Future studies are required to untangle the complex interplay between these factors.
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Affiliation(s)
- Yonathan Agung
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Laura Boland
- Centre for Surveillance and Applied Research (CSAR), Public Health Agency of Canada, Ottawa, ON, Canada
| | - Husein Moloo
- Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Surgery, Division of General Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Luke T Lavallée
- Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Surgery, Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | - Manoj M Lalu
- Ottawa Hospital Research Institute, Ottawa, ON, Canada; Departments of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Daniel I McIsaac
- Ottawa Hospital Research Institute, Ottawa, ON, Canada; Departments of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
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Lu YR, Chang SF, Liou HH. Combining the AD8 and MMSE for community-based dementia screening. Exp Gerontol 2024; 194:112482. [PMID: 38852655 DOI: 10.1016/j.exger.2024.112482] [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: 01/25/2024] [Revised: 05/28/2024] [Accepted: 06/06/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND This study aimed to determine whether a cognitive test the Mini-Mental State Examination (MMSE) and the Ascertain Dementia 8 (AD8) instrument applied in combination could improve the accuracy of dementia detection in a community setting. METHODS Study participants were recruited from a community-based integrated screening program in Tainan, Taiwan. Participants completed the AD8 and were administered the Chinese version of the MMSE by psychologists. In addition, the presence of dementia was determined by neurologists based on the 2011 National Institute on Aging-Alzheimer's Association guidelines. Logistic regression analysis determined whether the combination of these two tests provided any additional information for dementia detection than either test alone. Receiver operating characteristic (ROC) curve analyses were conducted to explore the performances of different screening modalities in detecting dementia. RESULT In total, 282 participants with an average age of 69.31 ± 10.27 years were enrolled. The prevalence of dementia among participants aged ≥65 years was 9.29 %. The sensitivity and specificity of the AD8 applied alone for detecting dementia were 64.71 % and 87.89 %, respectively, and of the MMSE applied alone, after adjusting for education level, were 41.18 % and 84.50 %, respectively. Using a cutoff score of 21 for the MMSE resulted in sensitivity of 77.78 % and specificity of 73.58 %. The AD8 and MMSE when combined in parallel yielded 88.89 % sensitivity and 70.16 % specificity. The serial use of the AD8 followed by the MMSE yielded 50 % sensitivity and 93.02 % specificity. Except for when an MMSE cutoff value of 26 was applied, the sensitivity of all examined modalities was poor and specificity was moderate for detecting mild cognitive impairment. ROC curve analysis revealed that the parallel application of the MMSE and AD8 (area under the ROC curve [AUC]: 82.3 % [75.1 %-89.4 %]) resulted in better dementia detection accuracy than the AD8 alone (AUC: 73.3 % [60.7 %-85.9 %]), the MMSE alone (AUC: 77.4 % [67.6 %-87.3 %]), or serial test administration (AUC: 67.6 % [53.4 %-81.8 %]). CONCLUSION This study successfully demonstrated that the MMSE and AD8 combination for dementia screening could improve detection accuracy in a community setting.
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Affiliation(s)
- Yun-Ru Lu
- Department of Neurology, China Medical University Hospital Taipei Branch, Taiwan
| | - Shin-Fang Chang
- Department of Neurology and Pharmacology, College of Medicine, National Taiwan University Hospital, Taiwan
| | - Horng-Huei Liou
- Department of Neurology and Pharmacology, College of Medicine, National Taiwan University Hospital, Taiwan; Graduate Institute of Biomedical and Pharmaceutical Science, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan; Department of Neurology, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei, Taiwan.
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Terry C, Lecci L. Anosognosia in Alzheimer's Pathology: Validation of a New Measure. Arch Clin Neuropsychol 2024; 39:669-682. [PMID: 38469927 DOI: 10.1093/arclin/acae020] [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: 09/16/2023] [Revised: 01/18/2024] [Accepted: 02/15/2024] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVE Two studies were performed to validate a brief measure of cognitive insight and compare it to an empirical model - the Cognitive Awareness Model (CAM). METHOD A pilot study included 31 (52% male; Mage = 69.42) patients from an outpatient neuropsychological assessment clinic. Seven patients were diagnosed with likely Alzheimer's dementia (AD), 15 mild cognitive impairment (MCI), and 9 no diagnosis (i.e., cognitively normal; CN). The Cognitive Coding Form (CCF) and several other measures were administered. Study 2 entailed archival data extraction of 240 patients (80 CN, 80 MCI, and 80 AD; 53.3% female; Mage = 72.8) to examine whether the CCF predicts memory (Wechsler Memory Scale - IV) and executive functioning (Trail-Making Test B). RESULTS The pilot study found preliminary evidence of convergent and discriminant validity for the 8-item CCF. Study 2 confirmed that both patient-reported cognitive concerns (F(2,237) = 10.40, p < .001, ω2 = .07, power = .99) and, more strongly, CCF informant-patient discrepancy scores (F(2,237) = 24.52, p < .001, ω2 = .16, power = .99) can distinguish CNs from those with MCI and AD. A regression indicated that depression (5.5%; β = -.38, p < .001) and TMT-B (13%; β = -.43, p < .001), together accounted for 18.5% of the variance in insight (R2 = .19, F(2,219) = 26.10, p < .001), supporting the CAM. CONCLUSIONS These studies establish an efficient measure of insight with high clinical utility and inform the literature on the role of insight in predicting performance in those with Alzheimer's pathology.
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Affiliation(s)
- Christian Terry
- Department of Psychology, University of North Carolina Wilmington, Wilmington, NC, USA
| | - Len Lecci
- Department of Psychology, University of North Carolina Wilmington, Wilmington, NC, USA
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Wei YC, Kung YC, Lin C, Yeh CH, Chen PY, Huang WY, Shyu YC, Lin CP, Chen CK. Differential neuropsychiatric associations of plasma biomarkers in older adults with major depression and subjective cognitive decline. Transl Psychiatry 2024; 14:333. [PMID: 39152102 PMCID: PMC11329686 DOI: 10.1038/s41398-024-03049-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 06/23/2024] [Accepted: 08/05/2024] [Indexed: 08/19/2024] Open
Abstract
Older adults with major depressive disorder (MDD) or early cognitive decline during the subjective cognitive decline (SCD) stage may exhibit neuropsychiatric symptoms such as anxiety, depression, and subtle cognitive impairment. The clinicopathological features and biological mechanisms of MDD differ from those of SCD among older adults; these conditions thus require different treatment strategies. This study enrolled 82 participants above 50 years old with normal cognitive levels from the communities to examine biomarker-behavior correlations between MDD (n = 23) and SCD (n = 23) relative to a normal control (NC) group (n = 36). Multidomain assessments were performed for all participants, including immunomagnetic reduction tests to detect plasma beta-amyloid (Aβ), total tau (Tau), phosphorylated tau-181 (p-Tau181), neurofilament light chain, and glial fibrillary acidic protein (GFAP). This study observed that depressive symptoms in MDD were associated with amyloid pathology (plasma Aβ40 vs. HADS-D: R = 0.45, p = 0.031; Aβ42/Aβ40 vs. HADS-D: R = -0.47, p = 0.024), which was not observed in the NC (group difference p < 0.05). Moreover, cognitive decline in MDD was distinguished by a mixed neurodegenerative process involving amyloid (plasma Aβ42 vs. facial memory test: R = 0.48, p = 0.025), tau (Tau/Aβ42 vs. digit symbol substitution test (DSST): R = -0.53, p = 0.01), and astrocytic injury (plasma GFAP vs. Montreal cognitive assessment score: R = -0.44, p = 0.038; plasma GFAP vs. DSST: R = -0.52, p = 0.014), findings that did not apply to the NC (group difference p < 0.05). Moreover, this study revealed different biomarker-behavior correlations between individuals with SCD and the NC. Compared with the NC, cognitive decline in the SCD group might be unrelated to amyloid pathology and instead might be early manifestations of tau pathology. This study underscores the difference in clinicopathological features between MDD and SCD among older adults, which differ from those of the NC. These findings enhance our understanding of the mechanisms underlying MDD and SCD in older individuals.
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Affiliation(s)
- Yi-Chia Wei
- Department of Neurology, Chang Gung Memorial Hospital, Keelung, 204, Taiwan
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, 204, Taiwan
- Institute of Neuroscience, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Yi-Chia Kung
- Department of Radiology, Tri-Service General Hospital, Taipei, 114, Taiwan
| | - Chemin Lin
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, 204, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, 204, Taiwan
| | - Chun-Hung Yeh
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, 333, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, 333, Taiwan
| | - Pin-Yuan Chen
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, 204, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
- Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung, 204, Taiwan
| | - Wen-Yi Huang
- Department of Neurology, Chang Gung Memorial Hospital, Keelung, 204, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Yu-Chiau Shyu
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, 204, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, 333, Taiwan
| | - Ching-Po Lin
- Institute of Neuroscience, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan.
- Department of Education and Research, Taipei City Hospital, Taipei, 103, Taiwan.
| | - Chih-Ken Chen
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, 204, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.
- Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, 204, Taiwan.
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Roh S, Lee YS, Moon H, Steele JS, Warne DK, Lee JA. Cognitive Impairment and Social Determinants of Health Among Indigenous Women. THE GERONTOLOGIST 2024; 64:gnae072. [PMID: 38860660 PMCID: PMC11234291 DOI: 10.1093/geront/gnae072] [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: 11/16/2023] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Cognitive impairment and Alzheimer's disease and related dementias (ADRD) pose significant challenges for Indigenous populations, necessitating urgent research. Limited evidence suggests that high rates of ADRD among Indigenous peoples are associated with social determinants of health (SDOH), such as education, income, health literacy, religion, and social engagement. RESEARCH DESIGN AND METHODS Collaborating with a Northern Plains tribe, participants were recruited 123 self-identified Indigenous women aged 40-70 through a comprehensive recruitment strategy. Employing the SDOH framework, the research assessed cognitive impairment and Alzheimer's disease knowledge (ADK), utilizing the Ascertain Dementia 8 and Alzheimer's disease knowledge scales (ADK-30). The investigation examined the relationships between selected SDOH variables and cognitive impairment status. RESULTS More than half of the participants showed signs of cognitive impairment, which correlated with lower income and education levels. Increased knowledge about Alzheimer's disease, particularly in terms of treatment management and its life impact subscales, was associated with lower odds of cognitive impairment. Conversely, higher levels of depressive symptoms and participation in religious activities were linked to increased odds of cognitive impairment. DISCUSSION AND IMPLICATIONS The findings underscore the importance of culturally grounded tools and SDOH frameworks tailored to Indigenous contexts in addressing ADRD disparities. Future research should integrate historical and cultural factors to advance health equity within Indigenous communities, ultimately mitigating the impact of ADRD and promoting overall well-being.
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Affiliation(s)
- Soonhee Roh
- Department of Social Work, University of South Dakota-Sioux Falls, Sioux Falls, South Dakota, USA
| | - Yeon-Shim Lee
- School of Social Work, San Francisco State University, San Francisco, California, USA
| | - Heehyul Moon
- Raymond A. Kent School of Social Work, University of Louisville, Louisville, Kentucky, USA
| | - Joel S Steele
- School of Medicine & Health Sciences, University of North Dakota, Grand Forks, North Dakota, USA
| | - Donald K Warne
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jung-Ah Lee
- Sue and Bill Gross School of Nursing, University of California, Irvine, California, USA
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Berish D, Kuzmik A, Boltz M. Behavioral and psychological symptoms of dementia and adverse patient outcomes post-hospitalization. Aging Ment Health 2024; 28:1100-1109. [PMID: 38247272 PMCID: PMC11250546 DOI: 10.1080/13607863.2024.2304551] [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: 10/10/2023] [Accepted: 01/01/2024] [Indexed: 01/23/2024]
Abstract
OBJECTIVES The occurrence of behavioral and psychological symptoms of dementia (BPSD) are associated with adverse outcomes but have largely been studied in populations outside of acute care. The current study examines (1) the prevalence of BPSD during acute hospitalization and (2) if BPSD are predictive of adverse patient outcomes. METHODS A secondary analysis of Family-centered Function-focused Care (Fam-FFC) data including 461 patients with dementia/care partner dyads assessed at hospital admission, discharge, 2 months, and 6 months post-discharge, was conducted. Prevalence of BPSD (Neuropsychiatric Inventory-Questionnaire total and Frontal, Hyperactivity, Mood, and Psychosis sub-categories), associations with patient and care partner characteristics, and prediction of adverse events (falls, emergency room [ER] visits, hospitalizations, injury) were examined. RESULTS BPSD were highly prevalent (93.9% admission, 86.7% discharge). The most common symptom cluster at admission was Hyperactivity (76.7%) followed by Mood (72.3%) and Psychosis (71.9%), and Frontal (25.9%). Higher admission Hyperactivity was associated with ER admissions at 2 months, higher discharge Hyperactivity was associated with ER admissions and hospitalizations at 2 months, and change in Psychosis was associated with ER admissions at 2 months. CONCLUSIONS These findings highlight BPSD during hospitalization as potentially modifiable risk factors of adverse outcomes.
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Affiliation(s)
- Diane Berish
- The Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, United States of America
| | - Ashley Kuzmik
- The Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, United States of America
| | - Marie Boltz
- The Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, United States of America
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Yan E, Butris N, Alhamdah Y, Kapoor P, Lovblom LE, Islam S, Saripella A, Wong J, Tang-Wai DF, Mah L, Alibhai SMH, Tartaglia MC, He D, Chung F. The utility of remote cognitive screening tools in identifying cognitive impairment in older surgical patients: An observational cohort study. J Clin Anesth 2024; 97:111557. [PMID: 39047531 DOI: 10.1016/j.jclinane.2024.111557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/13/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
STUDY OBJECTIVES To determine the prevalence of suspected cognitive impairment using the Centers for Disease Control and Prevention (CDC) cognitive question, Ascertain Dementia Eight-item Questionnaire (AD8), Modified Telephone Interview for Cognitive Status (TICS-M), and Telephone Montreal Cognitive Assessment (T-MoCA), the agreement between each tool beyond chance, and the risk factors associated with a positive screen. DESIGN Multicenter prospective study. SETTING Remote preoperative assessments. PATIENTS 307 non-cardiac surgical patients aged ≥65 years. MEASUREMENTS Prevalence, Cohen's kappa (κ). MAIN RESULTS The T-MoCA detected the highest prevalence of suspected cognitive impairment (28%), followed by the AD8 (17%), CDC cognitive question (9%), and TICS-M (6%). The four screening tools showed poor agreement beyond chance with one another, with the CDC cognitive question and AD8 approaching the threshold for weak agreement (κ = 0.39). Depression was associated with screening positive on the CDC cognitive question (OR: 2.81; 95% CI: 1.04, 7.68). Obstructive sleep apnea (OSA) (OR: 3.10; 95% CI: 1.26, 7.71) and functional disability (OR: 3.74; 95% CI: 1.34, 11.11) were associated with a positive AD8 screen. Older age (OR: 1.56; 95% CI: 1.01, 2.41), male sex (OR: 3.08; 95% CI: 1.09, 9.40), and higher pain level (OR: 1.21; 95% CI: 1.01, 1.47) were associated with a positive TICS-M screen. Similarly, older age (OR: 1.33; 95% CI: 1.03, 1.73), male sex (OR: 2.02; 95% CI: 1.09, 3.83), and higher pain level (OR: 1.15; 95% CI: 1.02, 1.30) were associated with a positive T-MoCA screen. CONCLUSIONS The CDC cognitive question, AD8, TICS-M, and T-MoCA were easily implemented during preoperative assessment among older surgical patients. OSA, functional disability, and depression were associated with complaints on the CDC cognitive question and AD8. Older age, male sex, and higher pain level were associated with screening positive on the TICS-M and T-MoCA. Early remote cognitive screening may enhance risk stratification of vulnerable patients.
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Affiliation(s)
- Ellene Yan
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Nina Butris
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Yasmin Alhamdah
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Paras Kapoor
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Leif Erik Lovblom
- Biostatistics Department, University Health Network, Toronto, ON, Canada
| | - Sazzadul Islam
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Aparna Saripella
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Jean Wong
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada
| | - David F Tang-Wai
- Temerty Faculty of Medicine, University of Toronto, ON, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Linda Mah
- Temerty Faculty of Medicine, University of Toronto, ON, Canada; Division of Geriatric Psychiatry, Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Rotman Research Institute, Baycrest Health Sciences Centre, Toronto, ON, Canada
| | - Shabbir M H Alibhai
- Temerty Faculty of Medicine, University of Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Maria Carmela Tartaglia
- Temerty Faculty of Medicine, University of Toronto, ON, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - David He
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Frances Chung
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, ON, Canada.
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Su FC, Wei YC, Sun CY, Hsu HJ, Lee CC, Chen YT, Pan HC, Hsu CK, Liu YA, Chen CY. Endocrine-Disrupting Chemicals Exposure and Neurocognitive Function in the General Population: A Community-Based Study. TOXICS 2024; 12:514. [PMID: 39058166 PMCID: PMC11281080 DOI: 10.3390/toxics12070514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Endocrine-disrupting chemicals (EDCs) are pervasive in everyday environments. The impacts of these chemicals, along with EDC-related lifestyle and dietary habits on neurocognitive function, are not well understood. METHODS The Chang Gung Community Medicine Research Center conducted a cross-sectional study involving 887 participants. From this initial cohort, 120 individuals were selected based on their EDC exposure scores for detailed analysis. Among these, 67 participants aged 55 years or older were further chosen to undergo cognitive impairment assessments using the Ascertain Dementia-8 (AD-8) questionnaire. RESULTS These 67 older participants did not significantly differ in age, albuminuria, or estimated glomerular filtration rate compared to those with lower impairment scores. This study revealed that mono-(2-ethylhexyl) phthalate (MEHP) levels (8.511 vs. 6.432 µg/g creatinine, p = 0.038) were associated with greater risk of cognitive impairment (AD-8 ≥ 2). Statistical models adjusting for age, gender, and diabetes indicated that MEHP levels positively correlated with AD-8 scores, achieving statistical significance in more comprehensive models (β ± SE: 0.160 ± 0.076, p = 0.042). Logistic regression analysis underscored a significant positive association between high MEHP levels and higher AD-8 scores (odds ratio: 1.217, p = 0.006). Receiver operating characteristic curves highlighted the association of high MEHP levels and EDC exposure scores for significant cognitive impairment, with areas under the curve of 66.3% and 66.6%, respectively. CONCLUSION Exposure to EDCs, specifically di-(2-ethylhexyl) phthalate, the precursor to MEHP, may be associated with neurocognitive impairment in middle-aged and older adults.
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Affiliation(s)
- Feng-Chieh Su
- Department of Neurology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (F.-C.S.); (Y.-C.W.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.-Y.S.); (H.-J.H.); (C.-C.L.); (Y.-T.C.); (H.-C.P.); (C.-K.H.); (Y.-A.L.)
| | - Yi-Chia Wei
- Department of Neurology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (F.-C.S.); (Y.-C.W.)
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Chiao-Yin Sun
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.-Y.S.); (H.-J.H.); (C.-C.L.); (Y.-T.C.); (H.-C.P.); (C.-K.H.); (Y.-A.L.)
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung 204, Taiwan
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Heng-Jung Hsu
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.-Y.S.); (H.-J.H.); (C.-C.L.); (Y.-T.C.); (H.-C.P.); (C.-K.H.); (Y.-A.L.)
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung 204, Taiwan
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Chin-Chan Lee
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.-Y.S.); (H.-J.H.); (C.-C.L.); (Y.-T.C.); (H.-C.P.); (C.-K.H.); (Y.-A.L.)
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung 204, Taiwan
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Yih-Ting Chen
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.-Y.S.); (H.-J.H.); (C.-C.L.); (Y.-T.C.); (H.-C.P.); (C.-K.H.); (Y.-A.L.)
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung 204, Taiwan
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Heng-Chih Pan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.-Y.S.); (H.-J.H.); (C.-C.L.); (Y.-T.C.); (H.-C.P.); (C.-K.H.); (Y.-A.L.)
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung 204, Taiwan
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Cheng-Kai Hsu
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.-Y.S.); (H.-J.H.); (C.-C.L.); (Y.-T.C.); (H.-C.P.); (C.-K.H.); (Y.-A.L.)
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Yun-An Liu
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.-Y.S.); (H.-J.H.); (C.-C.L.); (Y.-T.C.); (H.-C.P.); (C.-K.H.); (Y.-A.L.)
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung 204, Taiwan
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Chun-Yu Chen
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.-Y.S.); (H.-J.H.); (C.-C.L.); (Y.-T.C.); (H.-C.P.); (C.-K.H.); (Y.-A.L.)
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung 204, Taiwan
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
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10
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Holmes SD, Scherr S, O'Brien E, Levy S, Gurlu M, Zhu S, Galik E, Resnick B. Testing the feasibility and preliminary efficacy of Meaningful Activity for Managing Behavioral Symptoms of Distress (MAC-4-BSD) intervention for residents with dementia in assisted living: Protocol description. Res Nurs Health 2024. [PMID: 38994689 DOI: 10.1002/nur.22415] [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: 11/07/2023] [Revised: 06/14/2024] [Accepted: 06/28/2024] [Indexed: 07/13/2024]
Abstract
The purpose of this manuscript is to describe the protocol for an Alzheimer's Association-funded cluster randomized trial that focuses on engaging assisted living residents with dementia in meaningful activity to help address their behavioral symptoms of distress using a theoretically based approach, Meaningful Activity for Managing Behavioral Symptoms of Distress (MAC-4-BSD). The development of MAC-4-BSD was based on the Social Ecological Model and Social Cognitive Theory. The MAC-4-BSD intervention includes the following four steps: (1) Assessment of the assisted living physical environment and policies to facilitate meaningful activity; (2) Education of staff about implementation of meaningful activity; (3) Assessment of resident preferences and goals for meaningful activity; (4) Mentoring and motivating staff and residents to facilitate engagement in meaningful activity. The overall aim of this study will be to determine the feasibility and preliminary efficacy of implementing the MAC-4-BSD intervention and test whether it will improve residents' engagement in meaningful activity, behavioral symptoms of distress, and quality of life as well as the environment and policies to promote meaningful activity in assisted living.
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Affiliation(s)
- Sarah D Holmes
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Susan Scherr
- Berman School of Nursing and Health Professions, Stevenson University, Owings Mills, Maryland, USA
| | - Erin O'Brien
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Sorah Levy
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Merve Gurlu
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Shijun Zhu
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Elizabeth Galik
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Barbara Resnick
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland, USA
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11
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Galske J, Chera T, Hwang U, Monin JK, Venkatesh A, Lam K, Leggett AN, Gettel C. Daily care hours among caregivers of older emergency department patients with dementia and undiagnosed cognitive impairment. J Am Geriatr Soc 2024. [PMID: 38970304 DOI: 10.1111/jgs.19062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/25/2024] [Accepted: 06/13/2024] [Indexed: 07/08/2024]
Affiliation(s)
- James Galske
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Tonya Chera
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ula Hwang
- Departments of Emergency Medicine and Population Health, New York University, New York City, New York, USA
- Geriatric Research, Education and Clinical Center, James J. Peters VAMC, Bronx, New York, USA
| | - Joan K Monin
- Yale School of Public Health, New Haven, Connecticut, USA
| | - Arjun Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kenneth Lam
- Division of Geriatrics, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Amanda N Leggett
- Institute of Gerontology & Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Cameron Gettel
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut, USA
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12
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Zhou DN, Yang X, Wang W, Jin WQ, Tang YL, Zheng Z, Ren Y. Exploring the interplay of psychiatric symptoms, antipsychotic medications, side effects, employment status, and quality of life in Chronic Schizophrenia. BMC Psychiatry 2024; 24:484. [PMID: 38956530 PMCID: PMC11220993 DOI: 10.1186/s12888-024-05929-3] [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: 03/12/2024] [Accepted: 06/24/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Many factors contribute to quality of life (QoL) in patients with schizophrenia, yet limited research examined these factors in patients in China. This cross-sectional study explores subjective QoL and its associated factors in patients. METHODS The QoL was assessed using the Schizophrenia Quality of Life Scale (SQLS). Clinical symptoms were evaluated using the Brief Psychiatric Rating Scale (BPRS) and seven factors were extracted. Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder Scale (GAD-7) were used to assess depression and anxiety. Cognitive impairment was assessed using the Ascertain Dementia 8 (AD8). The Treatment Emergent Symptom Scale (TESS) and Rating Scale for Extrapyramidal Side Effects (RSESE) were used to evaluate the side effects of medications. RESULTS We recruited 270 patients (male:142,52.6%, mean age:41.9 ± 9.4 years). Positive correlations were observed between SQLS and its subdomains with the total score of BPRS, PHQ-9, GAD-7, AD8, TESS, and RSESE (all P < 0.005). Patients who were taking activating second-generation antipsychotics (SGAs) had lower scores on total SQLS, Motivation/ Energy domain of SQLS (SQLS-ME) as well as Symptoms/ Side effects domain of SQLS (SQLS-SS) compared to those taking non-activating SGAs (all P < 0.005). Multiple regression analysis showed that depressive/ anxiety symptoms and cognitive impairment had significant negative effects on QoL (P ≤ 0.001), while activating SGAs had a positive effect (P < 0.005). Blunted affect and unemployment were inversely associated with the motivation/energy domain (P < 0.001). CONCLUSION Our findings emphasize the important role of depression/anxiety symptoms and cognitive impairment in the QoL of patients with chronic schizophrenia. Activating SGAs and employment may improve the QoL of these individuals. TRIAL REGISTRATION This protocol was registered at chictr.org.cn (Identifier: ChiCTR2100043537).
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Affiliation(s)
- Dan-Na Zhou
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xue Yang
- The First Psychiatric Hospital of Harbin, Harbin, Heilongjiang Province, China
| | - Wen Wang
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Wen-Qing Jin
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yi-Lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30329, USA
- Mental Health Service Line, Atlanta VA Medical Center, Decatur, GA, 30033, USA
| | - Zhi Zheng
- Huai'an No. 3 People's Hospital, Huaian, Jiangsu Province, China.
| | - Yanping Ren
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Capital Medical University, Beijing, China.
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
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13
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Turner TH, Scott EP, Barlis K, Rodriguez-Porcel F, Sartori AC, Joseph J. The Rapid Access Memory Program for Addressing Concerns of Incipient Dementia in Academic Primary Care Settings. J Geriatr Psychiatry Neurol 2024; 37:255-262. [PMID: 38156442 DOI: 10.1177/08919887231225482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
BACKGROUND Expedient diagnosis of incipient dementia is often hindered by time constraints in primary care visits, shortage of dementia specialists, and extended waitlists for comprehensive neuropsychological evaluations. METHODS We developed the Rapid Access Memory Program (RAMP) to improve access of neuropsychological services for older adults presenting to our institutional primary care clinics with concerns of cognitive decline. RAMP provides abbreviated neurocognitive assessment, same-day patient feedback, expedited reporting to referring providers, and is financially self-supported. Here, we describe development of RAMP and clinical outcomes from the first 3 years. RESULTS Of 160 patients seen, dementia was diagnosed in 30% and Mild Cognitive Impairment in 50%; Alzheimer's disease was the most common suspected etiology. New psychiatric diagnosis was made in about one-third (n = 54). Most frequent recommendations involved medication adjustments (initiating cholinesterase inhibitors, deprescribing anticholinergics), safety (driving, decision-making), and specialist referrals. Additionally, 27 (17%) subsequently enrolled in local research. CONCLUSIONS Results support feasibility and utility of RAMP for connecting older adults in primary care with neuropsychological services.
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Affiliation(s)
- Travis H Turner
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
- WCG Clinical Endpoint Solutions, Princeton, NJ, USA
| | - Emmi P Scott
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Katherine Barlis
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | | | - Andrea C Sartori
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Jane Joseph
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
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14
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Hill PL, Pfund GN, Cruitt PJ, Spears I, Norton SA, Bogdan R, Oltmanns TF. Personality traits moderate associations between word recall and subjective memory. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2024; 31:705-722. [PMID: 37665355 PMCID: PMC11139457 DOI: 10.1080/13825585.2023.2249195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/09/2023] [Indexed: 09/05/2023]
Abstract
Cognitive gerontology research requires consideration of performance as well as perceptions of performance. While subjective memory is positively associated with memory performance, these correlations typically are modest in magnitude, leading to the need to consider whether certain people may show weaker or stronger linkages between performance and perceptions. The current study leveraged personality (NEO Big Five), memory performance (i.e., word recall), and perceptions of memory ability (i.e., metamemory in adulthood and memory decline) data from the St. Louis Personality and Aging Network (SPAN) study (n = 774, mean age: 71.52 years). Extraversion and conscientiousness held the most consistent associations with the cognitive variables of interest, as both traits were positively associated with metamemory and word recall, but negatively associated with subjective decline. Moreover, extraversion moderated associations between word recall and both memory capacity and complaints, insofar that objective-subjective associations were weaker for those adults higher in extraversion. These findings highlight the need to understand how personality influences the sources of information employed for subjective cognitive beliefs.
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Affiliation(s)
- Patrick L Hill
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Gabrielle N Pfund
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
- Department of Medical Social Sciences, Northwestern University, Evanston, IL, USA
| | | | - Isaiah Spears
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Sara A Norton
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Ryan Bogdan
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Thomas F Oltmanns
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
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Drazich BF, Kim N, Gurlu M, Boltz M, Kuzmik A, Galik E, Resnick B. Examining the association of physical activity and mortality among recently hospitalized older adults with dementia. Geriatr Nurs 2024; 58:506-511. [PMID: 38996477 PMCID: PMC11323226 DOI: 10.1016/j.gerinurse.2024.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/11/2024] [Accepted: 06/21/2024] [Indexed: 07/14/2024]
Abstract
INTRODUCTION This study aimed to examine the association between physical activity one month post discharge and mortality over the first-year post discharge among recently hospitalized older adults with dementia. METHODS For this descriptive sub-study, among 42 participants, we obtained physical activity data via accelerometry at one month post discharge and death status via phone call at 6 months and 1 year post discharge. We performed logistic regression. RESULTS We found that participants' amount of time spent in physical activity one month post hospital discharge was not statistically significantly associated with mortality within the first-year post hospital discharge (OR=.996, CI=.992,1.000; p=.053). However, we did observe a strong trend. CONCLUSIONS Given the small sample of participants, this trend is salient and should be examined in a larger sample. The results highlight a specific patient profile, recently hospitalized older adults with dementia, that would greatly benefit from physical activity interventions.
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Affiliation(s)
| | - Nayeon Kim
- School of Nursing, University of Maryland Baltimore, USA
| | - Merve Gurlu
- School of Nursing, University of Maryland Baltimore, USA
| | - Marie Boltz
- School of Nursing, Penn State University, USA
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O’Caoimh R, Foley MJ, Timmons S, Molloy DW. Screening for Cognitive Impairment in Movement Disorders: Comparison of the Montreal Cognitive Assessment and Quick Mild Cognitive Impairment Screen in Parkinson's Disease and Lewy Body Dementia. J Alzheimers Dis Rep 2024; 8:971-980. [PMID: 39114555 PMCID: PMC11305847 DOI: 10.3233/adr-230207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 05/04/2024] [Indexed: 08/10/2024] Open
Abstract
Background The Montreal Cognitive Assessment (MoCA) is recommended by the Movement Disorder Society for cognitive testing in movement disorders including Parkinson's disease (PD) and lewy body dementia. Few studies have compared cognitive screening instruments in these diseases, which overlap clinically. Objective To compare the MoCA and Quick Mild Cognitive Impairment (Qmci) screen in this population. Methods Patients attending memory and movement disorder clinics associated with a university hospital had the MoCA and Qmci screen performed and diagnostic accuracy compared with the area under the receiver operating characteristic curve (AUC). Duration and severity of movement disorders was assessed using the Unified PD Rating Scale (UPDRS). Results In total, 133 assessments were available, median age 74±5. Median education was 11±4 years and 65% were male. Median total UPDRS score was 37±26. Median Qmci screen was 51±27, median MoCA was 19±10. There were statistically significant differences in test scores between those with subjective symptoms but normal cognition, mild cognitive impairment (MCI) and dementia (p < 0.001). The Qmci screen had significantly greater accuracy differentiating normal cognition from MCI versus the MoCA (AUC 0.90 versus 0.72, p = 0.01). Both instruments had similar accuracy in identifying cognitive impairment and separating MCI from dementia. The median administration time for the Qmci screen and MoCA were 5.19 and 9.24 minutes (p < 0.001), respectively. Conclusions Both the MoCA and Qmci screen have good to excellent accuracy in a population with movement disorders experiencing cognitive symptoms. The Qmci screen was significantly more accurate for those with early symptoms and had a shorter administration time.
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Affiliation(s)
- Rónán O’Caoimh
- Department of Geriatric and Stroke Medicine, Mercy University Hospital, Grenville Place, Cork, Ireland
- Health Research Board Clinical Research Facility, University College Cork, Mercy University Hospital, Cork, Ireland
| | - Mary J. Foley
- Centre for Gerontology and Rehabilitation, St Finbarr’s Hospital, Cork, Ireland
| | - Suzanne Timmons
- Department of Geriatric and Stroke Medicine, Mercy University Hospital, Grenville Place, Cork, Ireland
- Centre for Gerontology and Rehabilitation, St Finbarr’s Hospital, Cork, Ireland
| | - D. William Molloy
- Department of Geriatric and Stroke Medicine, Mercy University Hospital, Grenville Place, Cork, Ireland
- Centre for Gerontology and Rehabilitation, St Finbarr’s Hospital, Cork, Ireland
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Klein CB, Klinger LG. Aging Well and Autism: A Narrative Review and Recommendations for Future Research. Healthcare (Basel) 2024; 12:1207. [PMID: 38921321 PMCID: PMC11203987 DOI: 10.3390/healthcare12121207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 06/05/2024] [Accepted: 06/08/2024] [Indexed: 06/27/2024] Open
Abstract
With autism first recognized in the 1940s, the early cohorts of autistic children are beginning to enter older adulthood. Little is known about the experiences and outcomes of autistic older adults. In the general population, "successful aging" is a dominant model among gerontologists and is used to evaluate outcomes in older adulthood. This narrative review aims to provide a framework for understanding and supporting successful aging in older autistic adults. Using Fernández-Ballesteros' four-domain model of "aging well" we review knowledge on aging and autism by examining outcomes in health and functioning, cognitive and physical functioning, positive affect and control, and social participation and engagement. Findings indicate that outcomes in autistic older adults are generally poor, marked by increased medical conditions, low adaptive skills, elevated risk of cognitive decline, limited physical activity, high rates of mental health conditions, low quality of life, and reduced social or community participation. Patterns of challenges are similar across cognitive abilities and profiles of autistic traits. Challenges and next steps in aging and autism research are identified, and future directions for the field are discussed.
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Affiliation(s)
- Claire B. Klein
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
- UNC TEACCH Autism Program, Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Laura G. Klinger
- UNC TEACCH Autism Program, Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Frndak S, Deng Z, Ward-Caviness CK, Gorski-Steiner I, Thorpe RJ, Dickerson AS. Risk of dementia due to Co-exposure to air pollution and neighborhood disadvantage. ENVIRONMENTAL RESEARCH 2024; 251:118709. [PMID: 38493859 DOI: 10.1016/j.envres.2024.118709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 03/06/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Co-exposure to air pollution and neighborhood disadvantage may influence cognition decline. We tested these associations in the context of dementia risk. METHODS We leveraged a cohort of adults ≥65 years (n = 5397) enrolled from 2011 to 2018 in the National Health and Aging Trends Study (NHATS). Particulate matter (PM) ≤ 10 μm in diameter, PM ≤ 2.5 μm in diameter, carbon monoxide, nitric oxide, and nitrogen dioxide - and neighborhood disadvantage were tested for joint associations with dementia risk. Pollutant concentrations at the 2010 census tract level were assigned using the US Environmental Protection Agency's Community Multiscale Air Quality Modeling System. Neighborhood disadvantage was defined using the tract Social Deprivation Index (SDI). Dementia was determined through self- or proxy-report or scores indicative of "probable dementia" according to NHATS screening tools. Joint effects of air pollutants and SDI were tested using quantile g-computation Cox proportional hazards models. We also stratified joint air pollution effects across SDI tertiles. Analyses adjusted for age at enrollment, sex, education, partner status, urbanicity, income, race and ethnicity, years at residence, census segregation, and census region. RESULTS SDI score (aHR = 1.08; 95% CI 0.96, 1.22), joint air pollution (aHR = 1.03, 95% CI 0.92, 1.16) and joint SDI with air pollution (aHR = 1.04, 95% CI 0.89, 1.22) were not associated with dementia risk. After accounting for competing risk of death, joint SDI with air pollution was not associated with dementia risk (aHR = 1.06; 95% CI 0.87, 1.29). In stratified models, joint air pollution was associated with greater risk of dementia at high (aHR = 1.19; 95% CI 0.87, 1.63), but not at medium or low SDI. CONCLUSION Air pollution was associated with greater dementia risk in disadvantaged areas after accounting for competing risks. Air pollution associations with dementia incidence may be attenuated when other risk factors are more prominent in disadvantaged neighborhoods.
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Affiliation(s)
- Seth Frndak
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA.
| | - Zhengyi Deng
- Department of Urology, Stanford School of Medicine, USA
| | - Cavin K Ward-Caviness
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, USA
| | - Irena Gorski-Steiner
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, USA
| | - Roland J Thorpe
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA; Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, USA; Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, USA
| | - Aisha S Dickerson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA; Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, USA
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Mildrum Chana S, Álvarez L, Poe A, Bibriescas N, Wang DH, DiFiglia S, Azuero A, Crowe M, Puga F. The Daily Experiences of Hispanic and Latinx Dementia Caregivers Study: Protocol for a Fully Remote Daily Diary Observational Cohort Study. JMIR Res Protoc 2024; 13:e55216. [PMID: 38869929 PMCID: PMC11211706 DOI: 10.2196/55216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/13/2024] [Accepted: 03/23/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND The Hispanic and Latinx community is disproportionately affected by Alzheimer disease and related dementias (ADRDs). In the United States, approximately 8.5 million caregivers of individuals with ADRDs identify as Hispanic and Latinx people, and caregiving-related stress and burden place caregivers at elevated risk for poor mental health outcomes, as well as loneliness and social isolation. To date, there is limited knowledge about the daily stress experiences of Hispanic and Latinx caregivers. Given this knowledge gap, it is critical to examine how personal, cultural, and contextual factors influence daily stress, mental health, and resilience over time among Hispanic and Latinx ADRD caregivers. OBJECTIVE The goal of this protocol report is to present the rationale, methodology, planned analytical strategy, progress completed to date, and implications of future findings for "Nuestros Días" (Spanish for "our days"), a fully remote daily diary (DD), observational cohort study examining the day-to-day experiences of Hispanic and Latinx ADRD caregivers. METHODS The study will recruit a cohort of up to 500 Hispanic and Latinx caregivers of individuals living with ADRD. Participants will complete measures assessing contextual, individual-level, and cultural factors at 3 intervals (enrollment, 6 months, and 12 months). Each of the timepoints will be followed by 21 days of DD surveys to report on daily stress, stress moderators, and mental health variables. RESULTS Data collection began in March 2023 and is projected to end in December 2026. As of March 2024, we have enrolled 60 caregivers in the Nuestros Días study, 78.9% (n=15) of whom are Spanish speakers. The current completion rate for DD surveys is 79.4%, averaging approximately 18 surveys out of 21 completed. We expect to enroll 10 to 15 participants per month moving forward to achieve our enrollment goal. CONCLUSIONS Results from this study will identify which Hispanic and Latinx ADRD caregivers, and under what circumstances, appear to be at the greatest risk of experiencing poor mental health outcomes over time. This study represents a critical step forward in providing key guidance to develop effective, culturally sensitive interventions to support the health and well-being of Hispanic and Latinx ADRD caregivers, a historically underrepresented and underserved population in aging and caregiving research. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/55216.
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Affiliation(s)
- Sofía Mildrum Chana
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Lorelí Álvarez
- Department of Acute, Chronic and Continuing Care, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Abigail Poe
- Department of Acute, Chronic and Continuing Care, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Natashia Bibriescas
- Department of Educational Psychology, University of Texas at Austin, Austin, TX, United States
| | - Danny Hai Wang
- Department of Biobehavioral Health, College of Health and Human Development, The Pennsylvania State University, University Park, PA, United States
| | - Stephanie DiFiglia
- MJHS Institute for Innovation in Palliative Care, New York, NY, United States
| | - Andrés Azuero
- Department of Nursing Family, Community & Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Michael Crowe
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Frank Puga
- Department of Acute, Chronic and Continuing Care, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
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Alzola P, Carnero C, Bermejo-Pareja F, Sánchez-Benavides G, Peña-Casanova J, Puertas-Martín V, Fernández-Calvo B, Contador I. Neuropsychological Assessment for Early Detection and Diagnosis of Dementia: Current Knowledge and New Insights. J Clin Med 2024; 13:3442. [PMID: 38929971 PMCID: PMC11204334 DOI: 10.3390/jcm13123442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/06/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
Dementia remains an underdiagnosed syndrome, and there is a need to improve the early detection of cognitive decline. This narrative review examines the role of neuropsychological assessment in the characterization of cognitive changes associated with dementia syndrome at different states. The first section describes the early indicators of cognitive decline and the major barriers to their identification. Further, the optimal cognitive screening conditions and the most widely accepted tests are described. The second section analyzes the main differences in cognitive performance between Alzheimer's disease and other subtypes of dementia. Finally, the current challenges of neuropsychological assessment in aging/dementia and future approaches are discussed. Essentially, we find that current research is beginning to uncover early cognitive changes that precede dementia, while continuing to improve and refine the differential diagnosis of neurodegenerative disorders that cause dementia. However, neuropsychology faces several barriers, including the cultural diversity of the populations, a limited implementation in public health systems, and the adaptation to technological advances. Nowadays, neuropsychological assessment plays a fundamental role in characterizing cognitive decline in the different stages of dementia, but more efforts are needed to develop harmonized procedures that facilitate its use in different clinical contexts and research protocols.
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Affiliation(s)
- Patricia Alzola
- Department of Basic Psychology, Psychobiology and Methodology of Behavioral Sciences, University of Salamanca, 37005 Salamanca, Spain;
| | - Cristóbal Carnero
- Neurology Department, Granada University Hospital Complex, 18014 Granada, Spain
| | - Félix Bermejo-Pareja
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Institute of Health Carlos III, 28029 Madrid, Spain
- Institute of Research i+12, University Hospital “12 de Octubre”, 28041 Madrid, Spain
| | | | | | | | | | - Israel Contador
- Department of Basic Psychology, Psychobiology and Methodology of Behavioral Sciences, University of Salamanca, 37005 Salamanca, Spain;
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21
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Almidani L, Mihailovic A, Varadaraj V, Swenor BK, Ramulu PY. Longitudinal Changes in Visual Acuity and Contrast Sensitivity and Incident Dementia. Am J Ophthalmol 2024; 266:227-234. [PMID: 38866358 DOI: 10.1016/j.ajo.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE To evaluate the impact of baseline and change in vision on the risk of developing dementia. DESIGN Retrospective cohort study. METHODS This longitudinal analysis utilized data from the 2021 and 2022 National Health and Aging Trends Study. Binocular presenting vision was assessed, including distance (DVA) and near (NVA) visual acuity, and contrast sensitivity (CS). Dementia status was defined based on: (1) medical diagnosis of dementia, (2) dementia score, or (3) poor cognitive test performance. RESULTS Of the 2,159 adults included in this study, weighted mean (SD) age was 77.9 years (5.2), with the majority being female (weighted: 54%), and White (88%). The baseline median (interquartile range [IQR]) DVA was 0.08 (0-0.20) logMAR, NVA was 0.17 (0.09-0.26) logMAR, and CS was 1.80 (1.65-1.85) logCS. Over the 1-year follow up period, 192 (6.6%) adults developed dementia. In time-to-event analyses, baseline DVA (HR: 1.08 [95% CI: 1.02-1.14], per 0.1 logMAR), NVA (HR: 1.07 [95% CI: 1.01-1.13], per 0.1 logMAR), and CS (HR: 1.09 [95% CI: 1.03-1.15], per 0.1 logCS) were associated with greater likelihood of incident dementia. Further, change in CS (HR: 1.14 [95% CI: 1.04-1.25], per 0.1 logCS worse/year), but not VA, was associated with greater likelihood of incident dementia. CONCLUSIONS Worse baseline VA and CS are associated with greater likelihood of incident dementia. Further, worsening CS over time, but not VA, was associated with higher likelihood of incident dementia. Future work is needed to study interventions targeted at improving vision deficits and examine their impact on decreasing dementia risk.
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Affiliation(s)
- Louay Almidani
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine (L.A., A.M., P.Y.R.), Baltimore, Maryland, USA
| | - Aleksandra Mihailovic
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine (L.A., A.M., P.Y.R.), Baltimore, Maryland, USA
| | - Varshini Varadaraj
- Johns Hopkins Disability Health Research Center, Johns Hopkins School of Nursing (V.V., B.K.S.), Baltimore, Maryland, USA
| | - Bonnielin K Swenor
- Johns Hopkins Disability Health Research Center, Johns Hopkins School of Nursing (V.V., B.K.S.), Baltimore, Maryland, USA; Johns Hopkins University School of Nursing (B.K.S.), Baltimore, Maryland, USA
| | - Pradeep Y Ramulu
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine (L.A., A.M., P.Y.R.), Baltimore, Maryland, USA.
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22
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Lin C, Yeh FC, Glynn NW, Gmelin T, Wei YC, Chen YL, Huang CM, Shyu YC, Chen CK. Associations of depression and perceived physical fatigability with white matter integrity in older adults. Psychiatry Res Neuroimaging 2024; 340:111793. [PMID: 38373367 DOI: 10.1016/j.pscychresns.2024.111793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUNDS Fatigability is prevalent in older adults. However, it is often associated with depressed mood. We aim to investigate these two psychobehavioral constructs by examining their underpinning of white matter structures in the brain and their associations with different medical conditions. METHODS Twenty-seven older adults with late-life depression (LLD) and 34 cognitively normal controls (CN) underwent multi-shell diffusion MRI. Fatigability was measured with the Pittsburgh Fatigability Scale. We examined white matter integrity by measuring the quantitative anisotropy (QA), a fiber tracking parameter with better accuracy than the traditional imaging technique. RESULTS We found those with LLD had lower QA in the 2nd branch of the left superior longitudinal fasciculus (SLF-II), and those with more physical fatigability had lower QA in more widespread brain regions. In tracts associated with more physical fatigability, the lower QA in left acoustic radiation and left superior thalamic radiation correlated with higher blood glucose (r = - 0.46 and - 0.49). In tracts associated with depression, lower QA in left SLF-II correlated with higher bilirubin level (r = - 0.58). DISCUSSION Depression and fatigability were associated with various white matter integrity changes, which correlated with biochemistry biomarkers all related to inflammation.
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Affiliation(s)
- Chemin Lin
- Department of Psychiatry, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan; College of Medicine, Chang Gung University, Taoyuan County, Taiwan; Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Keelung, Taiwan
| | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nancy W Glynn
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Theresa Gmelin
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yi-Chia Wei
- College of Medicine, Chang Gung University, Taoyuan County, Taiwan; Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Keelung, Taiwan; Department of Neurology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan
| | - Yao-Liang Chen
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chih-Mao Huang
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Yu-Chiau Shyu
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Keelung, Taiwan
| | - Chih-Ken Chen
- Department of Psychiatry, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan; College of Medicine, Chang Gung University, Taoyuan County, Taiwan; Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Keelung, Taiwan.
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Onyemekwu CA, Prendergast NT, Potter KM, Toney NA, Nouraie MS, Shiva S, Girard TD. Platelet Bioenergetics and Associations With Delirium and Coma in Patients With Sepsis: A Prospective Cohort Study. CHEST CRITICAL CARE 2024; 2:100076. [PMID: 38938510 PMCID: PMC11210717 DOI: 10.1016/j.chstcc.2024.100076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
BACKGROUND Acute brain dysfunction during sepsis, which manifests as delirium or coma, is common and is associated with multiple adverse outcomes, including longer periods of mechanical ventilation, prolonged hospital stays, and increased mortality. Delirium and coma during sepsis may be manifestations of alteration in systemic metabolism. Because access to brain mitochondria is a limiting factor, measurement of peripheral platelet bioenergetics offers a potential opportunity to understand metabolic changes associated with acute brain dysfunction during sepsis. RESEARCH QUESTION Are altered platelet mitochondrial bioenergetics associated with acute brain dysfunction during sepsis? STUDY DESIGN AND METHODS We assessed participants with critical illness in the ICU for the presence of delirium or coma via validated assessment measures. Blood samples were collected and processed to isolate and measure platelet mitochondrial oxygen consumption. We used Seahorse extracellular flux to measure directly baseline, proton leak, maximal oxygen consumption rate, and extracellular acidification rate. We calculated adenosine triphosphate-linked, spare respiratory capacity, and nonmitochondrial oxygen consumption rate from the measured values. RESULTS Maximum oxygen consumption was highest in patients with coma, as was spare respiratory capacity and extracellular acidification rate in unadjusted analysis. After adjusting for age, sedation, modified Sequential Organ Failure Assessment score without the neurologic component, and preexisting cognitive function, increased spare respiratory capacity remained associated with coma. Delirium was not associated with any platelet mitochondrial bioenergetics. INTERPRETATION In this single-center exploratory prospective cohort study, we found that increased platelet mitochondrial spare respiratory capacity was associated with coma in patients with sepsis. Future studies powered to determine any relationship between delirium and mitochondrial respiration bioenergetics are needed.
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Affiliation(s)
- Chukwudi A Onyemekwu
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Niall T Prendergast
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Kelly M Potter
- Center for Research, Investigation, and Systems Modeling of Acute Illness, and Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Nicole A Toney
- Center for Research, Investigation, and Systems Modeling of Acute Illness, and Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Mehdi S Nouraie
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Sruti Shiva
- Vascular Medicine Institute, Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Timothy D Girard
- Center for Research, Investigation, and Systems Modeling of Acute Illness, and Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Lin YT, Lai YH. Phonological processing in Chinese word repetition: Dementia effect and age effect. CLINICAL LINGUISTICS & PHONETICS 2024:1-17. [PMID: 38818875 DOI: 10.1080/02699206.2023.2278421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 10/23/2023] [Indexed: 06/01/2024]
Abstract
This paper examined phonological processing as reflected in Mandarin word and non-word repetition. Issues related to dementia effects, age effects, and linguistic variables are discussed. Forty-five speakers of Mandarin Chinese in Taiwan took part in this study. Fourteen seniors with Alzheimer's disease (AD), 14 healthy adults, and 17 healthy seniors individually completed a task of word repetition. Scores of accurate repetition were calculated, and error types as well as error frequency were analysed. Linguistic variables, including lexicality, frequency, non-word, and syllable length, were discussed. Major findings were indicative of a significant dementia effect, in which participants with AD were significantly impaired in repeating words with more syllables, specifically 5-syllable non-words of low frequency. Numerous significant age effects were noted. Theoretical implications and directions for future study are discussed.
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Affiliation(s)
- Yu-Te Lin
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Yi-Hsiu Lai
- Department of Western Languages and Literature, National University of Kaohsiung, Taiwan
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25
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Miao W, Xiao Y, Lu Y, Sha J, Zheng C, Yang W, Qian X, Geng G. Correlation Between Lifestyle Patterns and Cognitive Function Among Community-Dwelling Older Chinese Adults in the Pre-Dementia Stages: A Latent Class Analysis. J Appl Gerontol 2024:7334648241255529. [PMID: 38806177 DOI: 10.1177/07334648241255529] [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: 05/30/2024] Open
Abstract
Lifestyle activity engagement is a modifiable factor for cognitive decline. We aimed to identify lifestyle patterns (LPs) among community-dwelling older adults in the pre-dementia stages and to explore the links between LPs, cognitive function, and individual characteristics. 702 older Chinese adults were recruited. Three LPs were identified by latent class analysis: active aging lifestyle pattern (AALP), leisure lifestyle pattern (LLP), and work-centered lifestyle pattern (WLP). AALP refers to participation in various activities that are meaningful to individuals and benefit their well-being. LLP is the pattern of activities aimed at recreation. WLP refers to the LP where individuals are most likely to engage in work-related activities. However, only AALP is protected against mild cognitive impairment (MCI). Multinomial logistic regression models revealed the differences in individual characteristics among participants with different LPs, indicating the importance of tailored intervention strategies. As a protective factor against MCI, AALP should be highlighted in community-based care.
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Affiliation(s)
- Weiwei Miao
- School of Nursing and Rehabilitation, Nantong University, Nantong, China
| | - Yuhua Xiao
- The Second People's Hospital of Nantong, Nantong, China
| | | | - Jinghua Sha
- The Second People's Hospital of Nantong, Nantong, China
| | - Chen Zheng
- School of Nursing and Rehabilitation, Nantong University, Nantong, China
| | - Wenwen Yang
- School of Nursing and Rehabilitation, Nantong University, Nantong, China
| | - Xiangyun Qian
- Nantong Third People's Hospital, Affiliated Nantong Hospital 3 of Nantong University, Nantong, China
| | - Guiling Geng
- School of Nursing and Rehabilitation, Nantong University, Nantong, China
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26
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Wei YC, Kung YC, Lin CP, Chen CK, Lin C, Tseng RY, Chen YL, Huang WY, Chen PY, Chong ST, Shyu YC, Chang WC, Yeh CH. White matter alterations and their associations with biomarkers and behavior in subjective cognitive decline individuals: a fixel-based analysis. BEHAVIORAL AND BRAIN FUNCTIONS : BBF 2024; 20:12. [PMID: 38778325 PMCID: PMC11110460 DOI: 10.1186/s12993-024-00238-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 05/04/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Subjective cognitive decline (SCD) is an early stage of dementia linked to Alzheimer's disease pathology. White matter changes were found in SCD using diffusion tensor imaging, but there are known limitations in voxel-wise tensor-based methods. Fixel-based analysis (FBA) can help understand changes in white matter fibers and how they relate to neurodegenerative proteins and multidomain behavior data in individuals with SCD. METHODS Healthy adults with normal cognition were recruited in the Northeastern Taiwan Community Medicine Research Cohort in 2018-2022 and divided into SCD and normal control (NC). Participants underwent evaluations to assess cognitive abilities, mental states, physical activity levels, and susceptibility to fatigue. Neurodegenerative proteins were measured using an immunomagnetic reduction technique. Multi-shell diffusion MRI data were collected and analyzed using whole-brain FBA, comparing results between groups and correlating them with multidomain assessments. RESULTS The final enrollment included 33 SCD and 46 NC participants, with no significant differences in age, sex, or education between the groups. SCD had a greater fiber-bundle cross-section than NC (pFWE < 0.05) at bilateral frontal superior longitudinal fasciculus II (SLFII). These white matter changes correlate negatively with plasma Aβ42 level (r = -0.38, p = 0.01) and positively with the AD8 score for subjective cognitive complaints (r = 0.42, p = 0.004) and the Hamilton Anxiety Rating Scale score for the degree of anxiety (Ham-A, r = 0.35, p = 0.019). The dimensional analysis of FBA metrics and blood biomarkers found positive correlations of plasma neurofilament light chain with fiber density at the splenium of corpus callosum (pFWE < 0.05) and with fiber-bundle cross-section at the right thalamus (pFWE < 0.05). Further examination of how SCD grouping interacts between the correlations of FBA metrics and multidomain assessments showed interactions between the fiber density at the corpus callosum with letter-number sequencing cognitive score (pFWE < 0.01) and with fatigue to leisure activities (pFWE < 0.05). CONCLUSION Based on FBA, our investigation suggests white matter structural alterations in SCD. The enlargement of SLFII's fiber cross-section is linked to plasma Aβ42 and neuropsychiatric symptoms, which suggests potential early axonal dystrophy associated with Alzheimer's pathology in SCD. The splenium of the corpus callosum is also a critical region of axonal degeneration and cognitive alteration for SCD.
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Affiliation(s)
- Yi-Chia Wei
- Department of Neurology, Chang Gung Memorial Hospital, Keelung, 204, Taiwan
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, 204, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
- Institute of Neuroscience, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan
| | - Yi-Chia Kung
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, 114, Taiwan
| | - Ching-Po Lin
- Institute of Neuroscience, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Chih-Ken Chen
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, 204, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, 204, Taiwan
| | - Chemin Lin
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, 204, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, 204, Taiwan
| | - Rung-Yu Tseng
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, 333, Taiwan
| | - Yao-Liang Chen
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, 333, Taiwan
- Department of Radiology, Chang Gung Memorial Hospital, Keelung, 204, Taiwan
| | - Wen-Yi Huang
- Department of Neurology, Chang Gung Memorial Hospital, Keelung, 204, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Pin-Yuan Chen
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, 204, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
- Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung, 204, Taiwan
| | - Shin-Tai Chong
- Institute of Neuroscience, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan
| | - Yu-Chiau Shyu
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, 204, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, 333, Taiwan
| | - Wei-Chou Chang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, 114, Taiwan
| | - Chun-Hung Yeh
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, 333, Taiwan.
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, 333, Taiwan.
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Zhang Y, Xu J, Zhang C, Zhang X, Yuan X, Ni W, Zhang H, Zheng Y, Zhao Z. Community screening for dementia among older adults in China: a machine learning-based strategy. BMC Public Health 2024; 24:1206. [PMID: 38693495 PMCID: PMC11062005 DOI: 10.1186/s12889-024-18692-7] [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: 11/05/2023] [Accepted: 04/23/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Dementia is a leading cause of disability in people older than 65 years worldwide. However, diagnosing dementia in its earliest symptomatic stages remains challenging. This study combined specific questions from the AD8 scale with comprehensive health-related characteristics, and used machine learning (ML) to construct diagnostic models of cognitive impairment (CI). METHODS The study was based on the Shenzhen Healthy Ageing Research (SHARE) project, and we recruited 823 participants aged 65 years and older, who completed a comprehensive health assessment and cognitive function assessments. Permutation importance was used to select features. Five ML models using BalanceCascade were applied to predict CI: a support vector machine (SVM), multilayer perceptron (MLP), AdaBoost, gradient boosting decision tree (GBDT), and logistic regression (LR). An AD8 score ≥ 2 was used to define CI as a baseline. SHapley Additive exPlanations (SHAP) values were used to interpret the results of ML models. RESULTS The first and sixth items of AD8, platelets, waist circumference, body mass index, carcinoembryonic antigens, age, serum uric acid, white blood cells, abnormal electrocardiogram, heart rate, and sex were selected as predictive features. Compared to the baseline (AUC = 0.65), the MLP showed the highest performance (AUC: 0.83 ± 0.04), followed by AdaBoost (AUC: 0.80 ± 0.04), SVM (AUC: 0.78 ± 0.04), GBDT (0.76 ± 0.04). Furthermore, the accuracy, sensitivity and specificity of four ML models were higher than the baseline. SHAP summary plots based on MLP showed the most influential feature on model decision for positive CI prediction was female sex, followed by older age and lower waist circumference. CONCLUSIONS The diagnostic models of CI applying ML, especially the MLP, were substantially more effective than the traditional AD8 scale with a score of ≥ 2 points. Our findings may provide new ideas for community dementia screening and to promote such screening while minimizing medical and health resources.
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Affiliation(s)
- Yan Zhang
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, No.2021, Buxin Road, Shenzhen, Guangdong, 518020, China
| | - Jian Xu
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, No.2021, Buxin Road, Shenzhen, Guangdong, 518020, China
| | - Chi Zhang
- Shenzhen Yiwei Technology Company, Shenzhen, Guangdong, 518000, China
| | - Xu Zhang
- National Engineering Laboratory of Big Data System Computing Technology, Shenzhen University, Shenzhen, Guangdong, 518060, China
| | - Xueli Yuan
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, No.2021, Buxin Road, Shenzhen, Guangdong, 518020, China
| | - Wenqing Ni
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, No.2021, Buxin Road, Shenzhen, Guangdong, 518020, China
| | - Hongmin Zhang
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, No.2021, Buxin Road, Shenzhen, Guangdong, 518020, China
| | - Yijin Zheng
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, No.2021, Buxin Road, Shenzhen, Guangdong, 518020, China
| | - Zhiguang Zhao
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, No.2021, Buxin Road, Shenzhen, Guangdong, 518020, China.
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Sathyan S, Milman S, Ayers E, Gao T, Verghese J, Barzilai N. Plasma proteomic profile of abdominal obesity in older adults. Obesity (Silver Spring) 2024; 32:938-948. [PMID: 38439214 PMCID: PMC11039368 DOI: 10.1002/oby.24000] [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: 08/17/2023] [Revised: 12/30/2023] [Accepted: 01/07/2024] [Indexed: 03/06/2024]
Abstract
OBJECTIVE This study examines the plasma proteomic profile of abdominal obesity in older adults. METHODS The association of abdominal obesity (waist circumference [WC]) with 4265 plasma proteins identified using the SomaScan Assay was examined in 969 Ashkenazi Jewish participants (LonGenity cohort), aged 65 years and older (mean [SD] age 75.7 [6.7] years, 55.4% women), using regression models. Pathway analysis, as well as weighted correlation network analysis, was performed. WC was determined from the proteome using elastic net regression. RESULTS A total of 480 out of 4265 proteins were associated with WC in the linear regression model. Leptin (β [SE] = 12.363 [0.490]), inhibin β C chain (INHBC; β [SE] = 24.324 [1.448]), insulin-like growth factor-binding protein 2 (IGFBP-2; β [SE] = -12.782 [0.841]), heparan-sulfate 6-O-sulfotransferase 3 (H6ST3; β [SE] = -39.995 [2.729]), and matrix-remodeling-associated protein 8 (MXRA8; β [SE] = -27.101 [1.850]) were the top proteins associated with WC. Cell adhesion, extracellular matrix remodeling, and IGF transport pathways were the top enriched pathways associated with WC. WC signature determined from plasma proteins was highly correlated with measured WC (r = 0.80) and was associated with various metabolic and physical traits. CONCLUSIONS The study unveiled a multifaceted plasma proteomic profile of abdominal obesity in older adults, offering insights into its wide-ranging impact on the proteome. It also elucidated novel proteins, clusters of correlated proteins, and pathways that are intricately associated with abdominal obesity.
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Affiliation(s)
- Sanish Sathyan
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sofiya Milman
- Institute for Aging Research, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Emmeline Ayers
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Tina Gao
- Institute for Aging Research, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joe Verghese
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- Institute for Aging Research, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nir Barzilai
- Institute for Aging Research, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, USA
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Holmes SD, Resnick B, Galik E, Levy S, Scherr S, O'Brien E. Examining pain, function, behavioral symptoms and associations with engagement in meaningful activity for residents with dementia in assisted living. Aging Ment Health 2024:1-7. [PMID: 38651198 DOI: 10.1080/13607863.2024.2342963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVES The purpose of this study was to examine factors associated with engagement in meaningful activity among residents with dementia in assisted living. We hypothesized that greater functional independence, less pain, and lower behavioral and psychological symptom severity would be associated with higher engagement in meaningful activity after controlling for residents' age, gender, comorbidities, and cognition. Understanding factors associated with engagement in meaningful activity can help to inform strategies for optimizing engagement among residents with dementia in assisted living. METHOD This descriptive study used baseline data from a randomized controlled trial, Meaningful Activity for Managing Behavioral Symptoms of Distress (MAC-4-BSD). Linear regression was used to examine factors associated with engagement in meaningful activity. RESULTS A total of 71 residents from 5 assisted living settings were included in the sample. Most participants were female (n = 52, 73%), White (n = 62, 87%), and mean age was 85 years old (SD = 8.2). Controlling for age, gender, comorbidities, and cognition, pain was significantly associated with engagement in meaningful activity (b= -2.09, p < 0.05). There were no associations found between function and behavioral symptoms with engagement in meaningful activity. CONCLUSION Findings from this study show that pain is a significant factor that is negatively associated with residents' engagement in meaningful activity. Ongoing research is needed to help improve pain management for residents with dementia in assisted living and support their engagement in meaningful activity.
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Affiliation(s)
- Sarah D Holmes
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Barbara Resnick
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Elizabeth Galik
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Sorah Levy
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Susan Scherr
- Berman School of Nursing and Health Professions, Stevenson University, Owings Mills, MD, USA
| | - Erin O'Brien
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, MD, USA
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Groechel RC, Liu AC, Liu C, Knopman DS, Koton S, Kucharska‐Newton AM, Lutsey PL, Mosley TH, Palta P, Sharrett AR, Walker KA, Wong DF, Gottesman RF. Social relationships, amyloid burden, and dementia: The ARIC-PET study. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e12560. [PMID: 38571965 PMCID: PMC10988116 DOI: 10.1002/dad2.12560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/21/2023] [Accepted: 01/30/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION This study aimed to assess whether social relationships in mid-life reduce the risk of dementia related to amyloid burden. METHODS Participants in the Atherosclerosis Risk in Communities (ARIC) study were assessed for social support and isolation (visit 2; 1990-1992). A composite measure, "social relationships," was generated. Brain amyloid was evaluated with florbetapir positron emission tomography (PET); (visit 5; 2012-2014). Incident dementia cases were identified following visit 5 through 2019 using ongoing surveillance. Relative contributions of mid-life social relationships and elevated brain amyloid to incident dementia were evaluated with Cox regression models. RESULTS Among 310 participants without dementia, strong mid-life social relationships were associated independently with lower dementia risk. Elevated late-life brain amyloid was associated with greater dementia risk. DISCUSSION Although mid-life social relationships did not moderate the relationship between amyloid burden and dementia, these findings affirm the importance of strong social relationships as a potentially protective factor against dementia.
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Affiliation(s)
- Renée C. Groechel
- National Institute of Neurological Disorders & Stroke Intramural Research ProgramNational Institutes of HealthBethesdaMarylandUSA
| | - Albert C. Liu
- Department of EpidemiologyUniversity of North Carolina Gillings School of Global Public HealthChapel HillNorth CarolinaUSA
| | - Chelsea Liu
- Department of EpidemiologyGeorge Washington University‐Milken Institute School of Public HealthWashingtonDistrict of ColumbiaUSA
| | | | - Silvia Koton
- Department of NursingThe Stanley Steyer School of Health ProfessionsTel Aviv UniversityTel AvivIsrael
- Department of EpidemiologyJohns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Anna M. Kucharska‐Newton
- Department of EpidemiologyUniversity of North Carolina Gillings School of Global Public HealthChapel HillNorth CarolinaUSA
| | - Pamela L. Lutsey
- Division of Epidemiology and Community HealthUniversity of Minnesota School of Public HealthMinneapolisMinnesotaUSA
| | - Thomas H. Mosley
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMississippiUSA
| | - Priya Palta
- Department of NeurologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - A. Richey Sharrett
- Department of EpidemiologyJohns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Keenan A. Walker
- National Institute on Aging Intramural Research ProgramNational Institutes of HealthBethesdaMarylandUSA
| | - Dean F. Wong
- Mallinckrodt Institute of RadiologyWashington UniversitySt. LouisMissouriUSA
| | - Rebecca F. Gottesman
- National Institute of Neurological Disorders & Stroke Intramural Research ProgramNational Institutes of HealthBethesdaMarylandUSA
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Huh J, Arpawong TE, Gruenewald TL, Fisher GG, Prescott CA, Manly JJ, Seblova D, Walters EE, Gatz M. General cognitive ability in high school, attained education, occupational complexity, and dementia risk. Alzheimers Dement 2024; 20:2662-2669. [PMID: 38375960 PMCID: PMC11032536 DOI: 10.1002/alz.13739] [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: 05/17/2023] [Revised: 12/11/2023] [Accepted: 01/20/2024] [Indexed: 02/21/2024]
Abstract
INTRODUCTION We address the extent to which adolescent cognition predicts dementia risk in later life, mediated by educational attainment and occupational complexity. METHODS Using data from Project Talent Aging Study (PTAS), we fitted two structural equation models to test whether adolescent cognition predicts cognitive impairment (CI) and Ascertain Dementia 8 (AD8) status simultaneously (NCognitive Assessment = 2477) and AD8 alone (NQuestionnaire = 6491) 60 years later, mediated by education and occupational complexity. Co-twin control analysis examined 82 discordant pairs for CI/AD8. RESULTS Education partially mediated the effect of adolescent cognition on CI in the cognitive assessment aample and AD8 in the questionnaire sample (Ps < 0.001). Within twin pairs, differences in adolescent cognition were small, but intrapair differences in education predicted CI status. DISCUSSION Adolescent cognition predicted dementia risk 60 years later, partially mediated through education. Educational attainment, but not occupational complexity, contributes to CI risk beyond its role as a mediator of adolescent cognition, further supported by the co-twin analyses. HIGHLIGHTS Project Talent Aging Study follows enrollees from high school for nearly 60 years. General cognitive ability in high school predicts later-life cognitive impairment. Low education is a risk partially due to its association with cognitive ability.
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Affiliation(s)
- Jimi Huh
- Department of Population and Public Health SciencesUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Thalida Em Arpawong
- Leonard Davis School of GerontologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | | | - Gwenith G. Fisher
- Department of PsychologyColorado State UniversityColorado State UniversityFort CollinsColoradoUSA
| | - Carol A. Prescott
- Department of PsychologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | | | - Dominika Seblova
- Second Faculty of MedicineCharles University Prague, Second Faculty of Medicine (2. LF UK)PragueCzech Republic
| | - Ellen E. Walters
- Department of PsychologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Margaret Gatz
- Center for Economic and Social Research, University of Southern CaliforniaLos AngelesCaliforniaUSA
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Chyr LC, Wolff JL, Zissimopoulos JM, Drabo EF. Analysis of agreement between measures of subjective cognitive impairment and probable dementia in the National Health and Aging Trends Study. Alzheimers Dement 2024; 20:2817-2829. [PMID: 38426381 PMCID: PMC11032562 DOI: 10.1002/alz.13758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 01/03/2024] [Accepted: 01/29/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Subjective cognitive impairment (SCI) measures in population-based surveys offer potential for dementia surveillance, yet their validation against established dementia measures is lacking. METHODS We assessed agreement between SCI and a validated probable dementia algorithm in a random one-third sample (n = 1936) of participants in the 2012 National Health and Aging Trends Study (NHATS). RESULTS SCI was more prevalent than probable dementia (12.2% vs 8.4%). Agreement between measures was 90.0% and of substantial strength. Misclassification rates were higher among older and less-educated subgroups due to higher prevalence of false-positive misclassification but did not vary by sex or race and ethnicity. DISCUSSION SCI sensitivity (63.4%) and specificity (92.5%) against dementia were comparable with similar metrics for the NHATS probable dementia measure against the "gold-standard" Aging, Demographics, and Memory Study-based dementia criteria, implying that population-based surveys may afford cost-effective opportunities for dementia surveillance to assess risk and inform policy. HIGHLIGHTS The prevalence of subjective cognitive impairment (SCI) is generally higher than that of a validated measure of probable dementia, particularly within the youngest age group, females, Whites, and persons with a college or higher degree. Percent agreement between SCI and a validated measure of probable dementia was 90.0% and of substantial strength (prevalence- and bias-adjusted kappa, 0.80). Agreement rates were higher in older and less-educated subgroups, driven by the higher prevalence of false-positive disagreement, but did not vary significantly by sex or race and ethnicity. SCI's overall sensitivity and specificity were 63.4% and 92.5%, respectively, against a validated measure of probable dementia, suggesting utility as a low-cost option for dementia surveillance. Heterogeneity in agreement quality across subpopulations warrants caution in its use for subgroup analyses.
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Affiliation(s)
- Linda C. Chyr
- Enterprise Analytics Core, Elevance Health, Inc.WilmingtonDelawareUSA
| | - Jennifer L. Wolff
- Department of Health Policy and ManagementJohn Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Julie M. Zissimopoulos
- Sol Price School of Public PolicyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Leonard D. Schaeffer Center for Health PolicyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Emmanuel F. Drabo
- Department of Health Policy and ManagementJohn Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
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McQuaid GA, Duane SC, Ahmed N, Lee NR, Charlton R, Wallace GL. Increased anticholinergic medication use in middle-aged and older autistic adults and its associations with self-reported memory difficulties and cognitive decline. Autism Res 2024; 17:852-867. [PMID: 38108575 PMCID: PMC11332248 DOI: 10.1002/aur.3076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/18/2023] [Indexed: 12/19/2023]
Abstract
Many commonly used prescription and over-the-counter medicines have potent anticholinergic (AC) effects. Among older adults, AC medications are associated with cognitive impairment and risk for cognitive disorders, including Alzheimer's disease. Collectively, the impact of AC medications is known as anticholinergic cognitive burden (ACB). Because of the high rates of co-occurring medical and psychiatric conditions, autistic adults may have high AC exposure and, thus, may experience elevated ACB. However, no research has characterized AC exposure or examined its associations with cognitive outcomes in autistic adults. Autistic adults (40-83 years) recruited via Simons Powering Autism Research's (SPARK) Research Match service self-reported their medication use (N = 415) and memory complaints (N = 382) at Time (T)1. At T2, 2 years later, a subset of T1 participants (N = 197) self-reported on decline in cognition. Medications were coded using two scales of AC potency. A high proportion (48.2%-62.9%, depending upon the AC potency scale) of autistic adults reported taking at least one medication with AC effects, and 20.5% to 26.5% of autistic adults reported clinically-relevant levels of AC medication (potency ≥3). After controlling for birth-sex, and age, hierarchical linear regression models showed total ACB scores and AC potency values of ≥3 predicted greater memory complaints. Logistic regression models showed that AC medicines at T1 were associated with self-reported cognitive decline at follow-up 2 years later. Understanding AC medications-including potentially earlier AC polypharmacy-and their impacts on cognition (e.g., dementia risk) in autistic adults is warranted.
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Affiliation(s)
- Goldie A McQuaid
- Department of Psychology, George Mason University, Fairfax, Virginia, USA
| | - Sean C Duane
- Department of Speech, Language, and Hearing Sciences, The George Washington University, Washington, District of Columbia, USA
| | - Neha Ahmed
- Department of Speech, Language, and Hearing Sciences, The George Washington University, Washington, District of Columbia, USA
| | - Nancy Raitano Lee
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
| | - Rebecca Charlton
- Department of Psychology, Goldsmiths University of London, London, UK
| | - Gregory L Wallace
- Department of Speech, Language, and Hearing Sciences, The George Washington University, Washington, District of Columbia, USA
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Murawski A, Ramirez-Zohfeld V, Mell J, Tschoe M, Schierer A, Olvera C, Brett J, Gratch J, Lindquist LA. NegotiAge: Development and pilot testing of an artificial intelligence-based family caregiver negotiation program. J Am Geriatr Soc 2024; 72:1112-1121. [PMID: 38217356 PMCID: PMC11018462 DOI: 10.1111/jgs.18775] [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: 09/05/2023] [Revised: 12/02/2023] [Accepted: 12/23/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Family caregivers of people with Alzheimer's disease experience conflicts as they navigate health care but lack training to resolve these disputes. We sought to develop and pilot test an artificial-intelligence negotiation training program, NegotiAge, for family caregivers. METHODS We convened negotiation experts, a geriatrician, a social worker, and community-based family caregivers. Content matter experts created short videos to teach negotiation skills. Caregivers generated dialogue surrounding conflicts. Computer scientists utilized the dialogue with the Interactive Arbitration Guide Online (IAGO) platform to develop avatar-based agents (e.g., sibling, older adult, physician) for caregivers to practice negotiating. Pilot testing was conducted with family caregivers to assess usability (USE) and satisfaction (open-ended questions with thematic analysis). RESULTS Development: With NegotiAge, caregivers progress through didactic material, then receive scenarios to negotiate (e.g., physician recommends gastric tube, sibling disagrees with home support, older adult refusing support). Caregivers negotiate in real-time with avatars who are designed to act like humans, including emotional tactics and irrational behaviors. Caregivers send/receive offers, using tactics until either mutual agreement or time expires. Immediate feedback is generated for the user to improve skills training. Pilot testing: Family caregivers (n = 12) completed the program and survey. USE questionnaire (Likert scale 1-7) subset scores revealed: (1) Useful-Mean 5.69 (SD 0.76); (2) Ease-Mean 5.24 (SD 0.96); (3) Learn-Mean 5.69 (SD 0.74); (4) Satisfy-Mean 5.62 (SD 1.10). Items that received over 80% agreements were: It helps me be more effective; It helps me be more productive; It is useful; It gives me more control over the activities in my life; It makes the things I want to accomplish easier to get done. Participants were highly satisfied and found NegotiAge fun to use (91.7%), with 100% who would recommend it to a friend. CONCLUSION NegotiAge is an Artificial-Intelligent Caregiver Negotiation Program, that is usable and feasible for family caregivers to become familiar with negotiating conflicts commonly seen in health care.
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Affiliation(s)
- Alaine Murawski
- Division of Geriatrics; Northwestern University, Feinberg School of Medicine; Chicago, IL, USA
| | - Vanessa Ramirez-Zohfeld
- Division of Geriatrics; Northwestern University, Feinberg School of Medicine; Chicago, IL, USA
| | - Johnathan Mell
- University of Central Florida, Department of Computer Science; Orlando, FL, USA
| | - Marianne Tschoe
- Division of Geriatrics; Northwestern University, Feinberg School of Medicine; Chicago, IL, USA
| | - Allison Schierer
- Division of Geriatrics; Northwestern University, Feinberg School of Medicine; Chicago, IL, USA
| | - Charles Olvera
- Division of Geriatrics; Northwestern University, Feinberg School of Medicine; Chicago, IL, USA
| | - Jeanne Brett
- Northwestern University, Kellogg School of Management; Evanston, IL USA
| | - Jonathan Gratch
- University of Southern California, Viterbi School of Engineering; Los Angeles, CA, USA
| | - Lee A. Lindquist
- Division of Geriatrics; Northwestern University, Feinberg School of Medicine; Chicago, IL, USA
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Zhang H, Hu Z, Jiang S, Hao M, Li Y, Liu Y, Jiang X, Jin L, Wang X. Social frailty and the incidence of motoric cognitive risk syndrome in older adults. Alzheimers Dement 2024; 20:2329-2339. [PMID: 38284799 PMCID: PMC11032557 DOI: 10.1002/alz.13696] [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: 09/11/2023] [Revised: 12/18/2023] [Accepted: 12/21/2023] [Indexed: 01/30/2024]
Abstract
INTRODUCTION Various associations between social factors and motoric cognitive risk syndrome (MCR) have been reported. However, whether social frailty (integrated from multiple social factors) is associated with MCR is still unclear. METHODS We included 4657 individuals without MCR at Round 1 of the NHATS as the discovery sample, and 3075 newly recruited individuals from Round 5 of the NHATS as the independent validation sample. Social frailty was assessed by five social items. MCR was defined as the presence of both subjective cognitive complaints and slow gait speed in individuals without dementia or mobility disability. RESULTS Compared with normal individuals, those with social frailty had higher risk of incident MCR (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 1.34-1.84). Each additional unfavorable social item was associated with an increased risk of MCR (HR: 1.32, 95% CI: 1.22-1.43). DISCUSSION Social frailty was associated with an increased risk of incident MCR in older adults. HIGHLIGHTS Various associations between social factors and motoric cognitive risk syndrome (MCR) have been reported. Social frailty that integrated from multiple social factors was associated with an increased risk of incident MCR. Social frailty should be included in the early screening of individuals to identify those at higher risk of MCR.
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Affiliation(s)
- Hui Zhang
- Human Phenome InstituteZhangjiang Fudan International Innovation CentreFudan UniversityShanghaiChina
| | - Zixin Hu
- Artificial Intelligence Innovation and Incubation InstituteFudan UniversityShanghaiChina
| | - Shuai Jiang
- Department of Vascular SurgeryShanghai Key Laboratory of Vascular Lesion Regulation and RemodelingShanghai Pudong HospitalFudan University Pudong Medical CenterShanghaiChina
| | - Meng Hao
- Human Phenome InstituteZhangjiang Fudan International Innovation CentreFudan UniversityShanghaiChina
| | - Yi Li
- Human Phenome InstituteZhangjiang Fudan International Innovation CentreFudan UniversityShanghaiChina
| | - Yining Liu
- Human Phenome InstituteZhangjiang Fudan International Innovation CentreFudan UniversityShanghaiChina
| | - Xiao‐Yan Jiang
- State Key Laboratory of CardiologyDepartment of Pathology and PathophysiologySchool of MedicineTongji UniversityShanghaiChina
| | - Li Jin
- Human Phenome InstituteZhangjiang Fudan International Innovation CentreFudan UniversityShanghaiChina
| | - Xiaofeng Wang
- Human Phenome InstituteZhangjiang Fudan International Innovation CentreFudan UniversityShanghaiChina
- National Clinical Research Centre for Aging and MedicineHuashan HospitalFudan UniversityShanghaiChina
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Siette J, Guion J, Ijaz K, Strutt P, Porte M, Savage G, Richards D. Development of a new computer simulated environment to screen cognition: assessing the feasibility and acceptability of Leaf Café in younger and older adults. BMC Med Inform Decis Mak 2024; 24:79. [PMID: 38504250 PMCID: PMC10949698 DOI: 10.1186/s12911-024-02478-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 03/07/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Existing traditional cognitive screening tools for dementia have various limitations, including overreliance on tests assessing verbal memory and, to a lesser extent, on some aspects of executive functioning. Comprehensive neuropsychological assessment is sensitive to impairment but time-intensive and expensive. Virtual reality may provide a dynamic and unique understanding of cognitive performance and increase the ecological validity of cognitive assessment. The use of virtual reality in screening for cognitive function in older persons is promising, but evidence for its use remains sparse. OBJECTIVE Our primary aim was to examine the feasibility and acceptability of a newly developed, virtual reality assessment module, 'Leaf Café', a computer-based program that assesses cognition in an engaging, efficient, and ecologically relevant way. The secondary aim was to assess the ability of the module to discriminate between performances of younger and older adults. METHODS A cross-sectional study was carried out in Sydney, Australia, targeting adults aged 18 years and above. Participants completed a traditional cognitive screening tool (Telephone Interview for Cognitive Status-Modified, TICS-M) and Leaf Café, a low-immersive virtual reality module designed to evaluate learning and memory, perceptual-motor function, and executive functioning. The total performance score for each participant, ranging from 0 to 180, was correlated with their cognitive performance assessed by TICS-M, using Pearson's correlation coefficient. Following module completion, participants were presented with an open and closed-question survey to capture their perceptions, attitudes, and feedback on the module, encompassing practicality, acceptability, and enjoyment. Both descriptive and content analyses were employed to interpret the obtained data. RESULTS A sample of 131 participants (mean age 54.9 years, SD = 20.8, range 20-85) took part. The majority were female (71.8%) and born in an English-speaking country (75.8%). The mean amount of time spent in the module was 32.8 min (SD = 13.3) with a mean module score of 107.6 (SD = 38.7). Most participants completed the highest level (5; 80.5%). There was a significant correlation between Leaf Café total scores with TICS-M cognitive scores overall, and for both younger (aged 18-64 years) and older adult (aged 65 + years) groups. No significant difference was found on performance between age groups on TICS-M performance, however, younger adults had significantly better performance on the Leaf Café module than older adults (M = 124.1 vs 95.9; p < .001). Participants had similar response proportions regarding user experience with most agreeing that the module was easy to use (84%) and to navigate (85%). Compared with younger adults, older adults had lower rates of agreement on the module's design (36.8% vs 64.3%; p = .020) and support experienced (20.5% vs 53.6%; p = .007). Participants highlighted the significance of practicality and the cognitive challenges presented by the module, in terms of memory strain and user interface concerns. Feedback encompassed different opinions on the usefulness of music, with suggestions for improvements centred around clearer instructions, varied game dynamics, and considerations for diverse user needs. CONCLUSIONS Leaf Café is a feasible and acceptable tool to be used for screening for cognitive impairment in older adults and has real-world assessment value. Further verification on the game's utility in detecting cognitive impairment is required.
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Affiliation(s)
- Joyce Siette
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Westmead, NSW, 2145, Australia.
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2109, Australia.
| | - Jonathan Guion
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Westmead, NSW, 2145, Australia
| | - Kiran Ijaz
- Affective Interactions Lab, School of Architecture, Design and Planning, University of Sydney, Sydney, NSW, Australia
| | - Paul Strutt
- School of Psychology, Western Sydney University, Kingswood, NSW, 2747, Australia
| | - Meredith Porte
- School of Computing, Macquarie University, Macquarie Park, NSW, 2109, Australia
| | - Greg Savage
- School of Psychological Sciences, Macquarie University, Macquarie Park, NSW, 2109, Australia
| | - Deborah Richards
- School of Computing, Macquarie University, Macquarie Park, NSW, 2109, Australia
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Stimmel MB, Orkaby AR, Ayers E, Verghese J, Nsubayi CK, Weiss EF. Is the Montreal cognitive assessment culturally valid in a diverse geriatric primary care setting? Lessons from the Bronx. J Am Geriatr Soc 2024; 72:850-857. [PMID: 38196332 PMCID: PMC10947962 DOI: 10.1111/jgs.18705] [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: 08/11/2023] [Revised: 11/05/2023] [Accepted: 11/09/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Efficacy and validity of the MoCA for cognitive screening in ethnoculturally and linguistically diverse settings is unclear. We sought to examine the utility and discriminative validity of the Spanish and English MoCA versions to identify cognitive impairment among diverse community-dwelling older adults. METHODS Participants aged ≥65 with cognitive concerns attending outpatient primary care in Bronx, NY, were recruited. MoCA and neuropsychological measures were administered in Spanish or English, and a neuropsychologist determined cognitive status (normal with subjective cognitive concerns [SCC], mild cognitive impairment [MCI], and dementia). One-way ANOVA compared cognitive statuses. ROC analyses identified optimal MoCA cutpoints for discriminating possible cognitive impairment. RESULTS There were 231 participants, with mean age 73, 72% women, 43% Hispanic; 39% Black/African American; 113 (49%) completed testing in English and 118 (51%) in Spanish. Overall MoCA mean was 17.7 (SD = 4.3). Neuropsychological assessment identified 90 as cognitively normal/SCC, average MoCA 19.9 (SD = 4.1), 133 with MCI, average MoCA 16.6 (SD = 3.7), and 8 with dementia, average MoCA 10.6 (SD = 3.1). Mean English MoCA average was 18.6 (SD = 4.1) versus Spanish 16.7 (SD = 4.3). The published cutpoint ≤23 for MCI yielded a high false-positive rate (79%). ROC analyses identified ≤18.5 as the score to identify MCI or dementia using the English MoCA (65% sensitivity; 77% specificity) and ≤16.5 for the Spanish MoCA (64% sensitivity;73% specificity) in this sample of older adults with cognitive concerns. CONCLUSIONS Current MoCA cutpoints were inappropriately high in a culturally/linguistically diverse urban setting, leading to a high false-positive rate. Lower Spanish and English MoCA cutpoints may improve diagnostic accuracy for identifying cognitive impairment in this group, highlighting the need for the creation and validation of accurate cognitive screeners for ethnoculturally and linguistically diverse older adults.
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Affiliation(s)
- Marnina B Stimmel
- Departments of Neurology and Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ariela R Orkaby
- New England GRECC, VA Boston Healthcare System, Boston, Massachusetts, USA
- Division of Aging, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Emmeline Ayers
- Departments of Neurology and Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Joe Verghese
- Departments of Neurology and Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Celeste K Nsubayi
- Departments of Neurology and Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Erica F Weiss
- Departments of Neurology and Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
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Bayram S, Akkaş ÖA. Adaptation of the Australian National University Alzheimer's Disease Risk Index-Short Form (ANU-ADRI-SF) into Turkish. Int J Older People Nurs 2024; 19:e12608. [PMID: 38509777 DOI: 10.1111/opn.12608] [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: 02/07/2023] [Revised: 02/20/2024] [Accepted: 02/25/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND The 'Australian National University Alzheimer's Disease Risk Index' (ANU-ADRI) assesses the risk of developing Alzheimer's disease (AD) and is a potential tool for its prevention. OBJECTIVES The aim of this study is to adapt the ANU-ADRI-SF (the short version of ANU-ADRI) into the Turkish language and Turkish cultural context. METHODS The study was methodological and involved the translation and intercultural adaptation of the ANU-ADRI-SF into the Turkish language. The study included 384 community-based participants from a province in the Western Black Sea Region of Türkiye. Data was collected via an online form prepared using Google Forms. RESULTS The index was translated from its original language, English, into Turkish and then retranslated to English by bilingual translators. It was then reviewed and evaluated for possible issues related to translation and degrees of equivalence. When TR-ANU-ADRI-SF levels were compared according to sex, the mean risk scores were found to be 11.25 ± 7.02 for males and 11.69 ± 7.99 for females. After cross-cultural adaptation, the TR-ANU-ADRI-SF was conceptually intelligible to Turkish adults. CONCLUSIONS The TR-ANU-ADRI-SF is a valid and reliable AD risk assessment tool. IMPLICATIONS FOR PRACTICE Given the increase in AD and its impact on people's health, there is a great need for strategies to be implemented by health professionals to improve the lifestyle of the adult population. For use in conjunction with these strategies, a localised AD risk assessment tool that can be applied by clinicians or by individual patients has been adapted and introduced to the Turkish literature.
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Affiliation(s)
- Serap Bayram
- Elderly Care Program, Vocational School of Health Services, Düzce University, Düzce, Turkey
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Wei YC, Chen CK, Lin C, Shyu YC, Chen PY. Life After Traumatic Brain Injury: Effects on the Lifestyle and Quality of Life of Community-Dwelling Patients. Neurotrauma Rep 2024; 5:159-171. [PMID: 38463415 PMCID: PMC10924056 DOI: 10.1089/neur.2023.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Persons who have experienced traumatic brain injury (TBI) may encounter a range of changes in their physical, mental, and cognitive functions as well as high fatigue levels. To gain a comprehensive understanding of the challenges faced by persons after TBI, we conducted multi-domain assessments among community-dwelling persons with a history of TBI and compared them with age- and sex-matched controls from the Northeastern Taiwan Community Medicine Research Cohort between 2019 and 2021. A total of 168 persons with TBI and 672 non-TBI controls were not different in terms of demographics, comorbidities, and physiological features. However, compared with the non-TBI group, the TBI group had a distinct lifestyle that involved increased reliance on analgesics (6.9% vs. 15.0%, respectively; p = 0.001) and sleep aids (p = 0.008), which negatively affected their quality of life. Moreover, they consumed more coffee (p < 0.001), tea (p < 0.001), cigarettes (p = 0.002), and betel nuts (p = 0.032) than did the non-TBI group. Notably, the use of coffee had a positive effect on the quality of life of the TBI group (F = 4.034; p = 0.045). Further, compared with the non-TBI group, the TBI group had increased risks of sarcopenia (p = 0.003), malnutrition (p = 0.003), and anxiety (p = 0.029) and reduced blood levels of vitamin D (29.83 ± 10.39 vs. 24.20 ± 6.59 ng/mL, respectively; p < 0.001). Overall, the TBI group had a reduced health-related quality of life, with significant challenges related to physical health, mental well-being, social interactions, pain management, and fatigue levels. Moreover, the TBI group experienced poorer sleep quality and efficiency than did the non-TBI group. In conclusion, persons who have sustained brain injuries that require comprehensive and holistic care that includes lifestyle modification, mental and physical healthcare plans, and increased long-term support from their communities. ClinicalTrials.gov (identifier: NCT04839796).
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Affiliation(s)
- Yi-Chia Wei
- Department of Neurology, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
| | - Chih-Ken Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
| | - Chemin Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
| | - Yu-Chiau Shyu
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Pin-Yuan Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
- Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
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Liu Z, Jia C, Yue L, Zhou Y, Wang S, Yao N. Care stressors and perceived stress among family caregivers of Chinese older adults with disabilities: The mediation effect of resilience. Geriatr Nurs 2024; 56:252-258. [PMID: 38387149 DOI: 10.1016/j.gerinurse.2024.02.020] [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: 11/21/2023] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVES Guided by the Stress Process Model, this study examined the mediating effect of resilience on the relationship between care stressors and perceived caregiving stress. METHODS Data were based on 234 older adults with disabilities and their caregivers from 6 urban districts and 6 rural counties from Jinan, China. Descriptive analysis, analysis of variance, ordinary least squares regression, and mediation analysis were performed. RESULTS Perceived stress among family caregivers of Chinese older adults with disabilities was affected by the physical and mental health of both themselves and the care recipients, as well as care intensity and financial difficulties. Resilience played a partial mediating role in the associations among three stressors (i.e. older adults' disability levels, number of chronic diseases, and caregivers' self-reported mental) and perceived caregiving stress. CONCLUSIONS Enhanced resilience aids caregivers' adaptation to their roles, suggesting the need for societal, spiritual, emotional, and behavioral resilience training.
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Affiliation(s)
- Zeyu Liu
- The First Clinical College of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, 250012, China
| | - Congxi Jia
- Weifang Health Supervision Institute, Weifang, Shandong, 261000, China
| | - Lirong Yue
- Jinzhong Development and Reform Commission, Jin Zhong, Shanxi, 030600, China
| | - Yuanjin Zhou
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, 78705, USA
| | - Shuangshuang Wang
- School of Public Administration, Southwest Jiaotong University, No. 111, North Section I, Second Ring Road, Chengdu, 610031, China.
| | - Nengliang Yao
- Home Centered Care Institute, Schaumburg, IL, 60173, USA
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Hsu HC, Chang SC, Liang CY, Ting JR. Intervention to reduce loneliness among older adults in the community: Making friends with volunteers. Geriatr Gerontol Int 2024; 24 Suppl 1:240-245. [PMID: 38323733 DOI: 10.1111/ggi.14828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/08/2024]
Abstract
AIM This study aimed to examine the effects of providing a program that introduced volunteers to make friends with older adults to reduce loneliness and increase loneliness literacy. METHODS Eight community development associations in Taiwan participated in the study. In the first stage, older people living alone or with only a spouse, or those with a family, but without substantial interactions, were screened for loneliness. Older adults with a higher risk of loneliness were given priority to be invited to participate in this intervention. This 3-month intervention program was designed by each community development association and delivered at the older adults' homes. A total of 87 older persons completed both waves of the interviews. RESULTS Loneliness was reduced (UCLA-6 Loneliness Scale scores decreased from 13.5 to 11.6), and loneliness literacy improved (loneliness literacy scores increased from 38.9 to 42.0) compared with what it was before the program. In a generalized linear model, when controlling for covariates, loneliness was reduced, but not significantly (B = -0.934, P > 0.05), whereas loneliness literacy improved significantly for older participants (B = 2.088, P < 0.05). CONCLUSIONS Making friends with older adults who are lonely might improve their loneliness literacy. Geriatr Gerontol Int 2024; 24: 240-245.
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Affiliation(s)
- Hui-Chuan Hsu
- School of Public Health, Taipei Medical University, Taipei, Taiwan
| | | | - Chun-Yu Liang
- Federation for the Welfare of the Elderly, Taipei, Taiwan
| | - Jie-Rong Ting
- School of Public Health, Taipei Medical University, Taipei, Taiwan
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Tainta M, Ecay-Torres M, de Arriba M, Barandiaran M, Otaegui-Arrazola A, Iriondo A, Garcia-Sebastian M, Estanga A, Saldias J, Clerigue M, Gabilondo A, Ros N, Mugica J, Barandiaran A, Mangialasche F, Kivipelto M, Arrospide A, Mar J, Martinez-Lage P. GOIZ ZAINDU study: a FINGER-like multidomain lifestyle intervention feasibility randomized trial to prevent dementia in Southern Europe. Alzheimers Res Ther 2024; 16:44. [PMID: 38413990 PMCID: PMC10898038 DOI: 10.1186/s13195-024-01393-z] [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: 09/11/2023] [Accepted: 01/16/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND GOIZ ZAINDU ("caring early" in Basque) is a pilot study to adapt the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) methodology to the Basque population and evaluate the feasibility and adherence to a FINGER-like multidomain intervention program. Additional aims included the assessment of efficacy on cognition and data collection to design a large efficacy trial. METHOD GOIZ ZAINDU is a 1-year, randomized, controlled trial of a multidomain intervention in persons aged 60+ years, with Cardiovascular Risk Factors, Aging and Dementia (CAIDE) risk score ≥ 6, no diagnosis of dementia, and below-than-expected performance in at least one of three cognitive screening tests. Randomization to a multidomain intervention (MD-Int) or regular health advice (RHA) was stratified by sex, age (>/≤ 75), and cognitive status (mild cognitive impairment (MCI)/normal cognition). MD-Int included cardiovascular risk factor control, nutritional counseling, physical activity, and cognitive training. The primary outcomes were retention rate and adherence to the intervention program. Exploratory cognitive outcomes included changes in the Neuropsychological Test Battery z-scores. Analyses were performed according to the intention to treat. RESULTS One hundred twenty-five participants were recruited (mean age: 75.64 (± 6.46); 58% women). The MD-Int (n = 61) and RHA (n = 64) groups were balanced in terms of their demographics and cognition. Fifty-two (85%) participants from the RHA group and 56 (88%) from the MD-Int group completed the study. More than 70% of the participants had high overall adherence to the intervention activities. The risk of cognitive decline was higher in the RHA group than in the MD-Int group in terms of executive function (p =.019) and processing speed scores (p =.026). CONCLUSIONS The GOIZ-ZAINDU study proved that the FINGER methodology is adaptable and feasible in a different socio-cultural environment. The exploratory efficacy results showed a lower risk of decline in executive function and processing speed in the intervention group. These results support the design of a large-scale efficacy trial. TRIAL REGISTRATION GOIZ ZAINDU feasibility trial was approved and registered by the Euskadi Drug Research Ethics Committee (ID: PI2017134) on 23 January 2018. Retrospectively registered in ClinicalTrials.gov (NCT06163716) on 8 December 2023.
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Affiliation(s)
- Mikel Tainta
- CITA-alzheimer Foundation, Donostia-San Sebastián, País Vasco, Spain
- Osakidetza, Organización Sanitaria Integrada (OSI) Goierri-Urola Garaia, País Vasco, Spain
- Instituto de Investigación Sanitaria Biodonostia, Donostia-San Sebastián, Spain
| | | | - Maria de Arriba
- CITA-alzheimer Foundation, Donostia-San Sebastián, País Vasco, Spain
| | - Myriam Barandiaran
- CITA-alzheimer Foundation, Donostia-San Sebastián, País Vasco, Spain
- Osakidetza, Organización Sanitaria Integrada (OSI) Donostialdea, País Vasco, Spain
- Instituto de Investigación Sanitaria Biodonostia, Donostia-San Sebastián, Spain
| | | | - Ane Iriondo
- CITA-alzheimer Foundation, Donostia-San Sebastián, País Vasco, Spain
| | | | - Ainara Estanga
- CITA-alzheimer Foundation, Donostia-San Sebastián, País Vasco, Spain
| | - Jon Saldias
- CITA-alzheimer Foundation, Donostia-San Sebastián, País Vasco, Spain
| | | | - Alazne Gabilondo
- Osakidetza, Organización Sanitaria Integrada (OSI) Donostialdea, País Vasco, Spain
- Osakidetza, Organización Sanitaria Integrada (OSI) Bidasoa, País Vasco, Spain
- Instituto de Investigación Sanitaria Biodonostia, Donostia-San Sebastián, Spain
| | - Naia Ros
- University of the Basque Country UPV/EHU, Donostia-San Sebastian, Spain
| | - Justo Mugica
- Osakidetza, Organización Sanitaria Integrada (OSI) Goierri-Urola Garaia, País Vasco, Spain
| | - Aitziber Barandiaran
- Osakidetza, Organización Sanitaria Integrada (OSI) Goierri-Urola Garaia, País Vasco, Spain
| | - Francesca Mangialasche
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
- Medical Unit Aging, Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Aging, Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
- The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Arantzazu Arrospide
- Osakidetza, Organización Sanitaria Integrada (OSI) Debagoiena, País Vasco, Spain
- Instituto de Investigación Sanitaria Biodonostia, Donostia-San Sebastián, Spain
| | - Javier Mar
- Osakidetza, Organización Sanitaria Integrada (OSI) Debagoiena, País Vasco, Spain
- Instituto de Investigación Sanitaria Biodonostia, Donostia-San Sebastián, Spain
- Instituto de Investigación en Servicios Sanitarios Kronikgune, Barakaldo, Spain
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Ijaz N, Jamil Y, Brown CH, Krishnaswami A, Orkaby A, Stimmel MB, Gerstenblith G, Nanna MG, Damluji AA. Role of Cognitive Frailty in Older Adults With Cardiovascular Disease. J Am Heart Assoc 2024; 13:e033594. [PMID: 38353229 PMCID: PMC11010094 DOI: 10.1161/jaha.123.033594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 12/19/2023] [Indexed: 02/21/2024]
Abstract
As the older adult population expands, an increasing number of patients affected by geriatric syndromes are seen by cardiovascular clinicians. One such syndrome that has been associated with poor outcomes is cognitive frailty: the simultaneous presence of cognitive impairment, without evidence of dementia, and physical frailty, which results in decreased cognitive reserve. Driven by common pathophysiologic underpinnings (eg, inflammation and neurohormonal dysregulation), cardiovascular disease, cognitive impairment, and frailty also share the following risk factors: hypertension, diabetes, obesity, sedentary behavior, and tobacco use. Cardiovascular disease has been associated with the onset and progression of cognitive frailty, which may be reversible in early stages, making it essential for clinicians to diagnose the condition in a timely manner and prescribe appropriate interventions. Additional research is required to elucidate the mechanisms underlying the development of cognitive frailty, establish preventive and therapeutic strategies to address the needs of older patients with cardiovascular disease at risk for cognitive frailty, and ultimately facilitate targeted intervention studies.
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Affiliation(s)
- Naila Ijaz
- Thomas Jefferson University HospitalPhiladelphiaPAUSA
| | - Yasser Jamil
- Yale University School of MedicineNew HavenCTUSA
| | | | | | - Ariela Orkaby
- New England GRECC, VA Boston Healthcare SystemBostonMAUSA
- Division of AgingBrigham & Women’s Hospital, Harvard Medical SchoolBostonMAUSA
| | | | | | | | - Abdulla A. Damluji
- Johns Hopkins University School of MedicineBaltimoreMDUSA
- The Inova Center of Outcomes ResearchInova Heart and Vascular InstituteFalls ChurchVAUSA
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Yang CW, Li CI, Liu CS, Lin CH, Lin WY, Li TC, Lin CC. Mitochondrial DNA haplogroup D and brain microstructure regulate cognitive function among community-dwelling older adults. Arch Gerontol Geriatr 2024; 117:105197. [PMID: 37741134 DOI: 10.1016/j.archger.2023.105197] [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: 05/30/2023] [Revised: 09/12/2023] [Accepted: 09/12/2023] [Indexed: 09/25/2023]
Abstract
INTRODUCTION Maintaining physical and cognitive function among older adults is important. These functional states are affected by mitochondria through various mechanisms, such as cellular energy production and oxidative stress control. Owing to its involvement in the relations among the brain, cognition, and physical function, mitochondrial function may be affected by mitochondrial DNA (mtDNA) haplogroups. This study explored the effect of mtDNA haplogroups and brain microstructure on physical and cognitive functions among community-dwelling older adults. METHODS This study was a community-based cross-sectional research. A total of 128 subjects aged 65 years and older without dementia completed several assessments, including mtDNA sequencing, physical and cognitive function tests, and magnetic resonance imaging (MRI) scans. Cognitive function and impairment were assessed by the MMSE and AD8 questionnaires. mtDNA haplogroups were classified by HaploGrep 2 software, and white matter microstructural integrity was scanned by 3T MRI. RESULTS The mean age of the subjects was 77.3 years. After the adjustment for covariates, the mtDNA haplogroup D carriers showed significantly lower mini-mental state examination (MMSE) scores than other carriers (p = 0.047). Further considering the brain microstructure, the mtDNA haplogroup D (p = 0.002) and white matter volumes in the left precuneus corrected for total intracranial volumes (p = 0.014) were found to be independently influencing factors of the MMSE scores. CONCLUSIONS The mtDNA haplogroup D and white matter microstructure regulated the cognitive function among community-dwelling older adults. The findings provide new insights into the research gap. Scientists must further venture into this field.
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Affiliation(s)
- Chuan-Wei Yang
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Ing Li
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chiu-Shong Liu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Hsueh Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Yuan Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Tsai-Chung Li
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Medical and Health Sciences, Asia University, Taichung, Taiwan.
| | - Cheng-Chieh Lin
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.
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Embling R, Neilson L, Mellor C, Durodola M, Rouse N, Haselgrove A, Shipley K, Tales A, Wilkinson L. Exploring consumer beliefs about novel fortified foods: A focus group study with UK-based older and younger adult consumers. Appetite 2024; 193:107139. [PMID: 38043697 DOI: 10.1016/j.appet.2023.107139] [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: 09/11/2023] [Revised: 11/09/2023] [Accepted: 11/22/2023] [Indexed: 12/05/2023]
Abstract
Consuming 'nutritionally-enhanced' food products (including those that are fortified or enriched to deliver nutritional and functional properties) may help to improve overall diet quality and combat risks associated with malnutrition. However, fortification can negatively impact consumer acceptance, particularly where expected sensory properties of 'delivery' foods are affected by target ingredients. Here, we explored factors influencing consumer acceptability for six novel food products that had been fortified, including both savoury and sweet meal components (e.g., high protein dumplings, probiotic yoghurt drink). In person focus groups (25 consumers aged between 22 and 76 years old) were conducted with two stages; firstly, participants completed a blind taste test of products without awareness of fortification. Secondly, participants discussed products with awareness of additional ingredients and food properties. Reflexive thematic analysis showed that liking of sensory properties differed between foods, but informing participants about the fortification of products highlighted potential trade-offs between taste, health, price, and familiarity. Though taste and texture were generally prioritised by participants, positive perceptions of health benefits increased consumer willingness to buy, whilst both cost and uncertainty about product use were potential barriers. Trust of information was a key concern for labelling and product claims. These results highlight product features that may be optimised to support the success of fortified foods. Greater transparency when building product brands and improving consumer knowledge of fortification may also be important for longer-term consumer acceptance.
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Affiliation(s)
- Rochelle Embling
- School of Psychology, Faculty of Medicine, Health, & Life Science, Swansea University, Swansea, SA2 8PP, UK
| | - Louise Neilson
- BIC Innovation Ltd, One Court Road, Bridgend, CF31 1BE, UK
| | - Chloe Mellor
- School of Psychology, Faculty of Medicine, Health, & Life Science, Swansea University, Swansea, SA2 8PP, UK; BIC Innovation Ltd, One Court Road, Bridgend, CF31 1BE, UK
| | - Mercy Durodola
- School of Psychology, Faculty of Medicine, Health, & Life Science, Swansea University, Swansea, SA2 8PP, UK
| | - Natalie Rouse
- BIC Innovation Ltd, One Court Road, Bridgend, CF31 1BE, UK
| | | | | | - Andrea Tales
- The Awen Institute, Talbot Building, Swansea University, Swansea, SA2 8PP, UK
| | - Laura Wilkinson
- School of Psychology, Faculty of Medicine, Health, & Life Science, Swansea University, Swansea, SA2 8PP, UK.
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Yoshikawa A, Bouldin ED, López-Anuarbe M, Kindratt TB, Sylvers DL, Webster NJ. Use of Caregiving Support Services Among Diverse Dementia Caregivers by Geographic Context. THE GERONTOLOGIST 2024; 64:gnad067. [PMID: 37318017 PMCID: PMC10825843 DOI: 10.1093/geront/gnad067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Little is known about how race/ethnicity and geographic context relate to support service use among dementia caregivers. Our objectives were to investigate (a) whether the use of at least one formal caregiving service-support groups, respite care, and training-differed by race/ethnicity and across metro and nonmetro areas; and (b) whether predisposing, enabling, and need characteristics influenced support service use by race/ethnicity. RESEARCH DESIGN AND METHODS Data were analyzed from a sample of primary caregivers of care recipients aged 65 years or older with probable dementia (n = 482) in the 2017 National Health and Aging Trends Study and National Study of Caregiving. We calculated weighted prevalence estimates and then used the Hosmer-Lemeshow goodness of fit statistic to find the best-fitting logistic regression models. RESULTS Among minority dementia caregivers, support service use was higher in metro than nonmetro areas (35% and 15%); the trend was reversed for non-Hispanic White caregivers (47% nonmetro and 29% metro). The best-fitting regression models included predisposing, enabling, and need factors for both minority and non-Hispanic White caregivers. Younger age and more disagreement within the family were consistently associated with more service use in both groups. Among minority caregivers, better caregiver and care recipient health were associated with using support services. Among non-Hispanic White caregivers, nonmetro geographic context and caregiving interfering with valued activities were associated with using support services. DISCUSSION AND IMPLICATIONS Geographic context differently affected support service use and the influence of predisposing, enabling, and need factors varied by race/ethnicity.
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Affiliation(s)
- Aya Yoshikawa
- School of Health Promotion and Kinesiology, Texas Woman’s University, Denton, Texas, USA
| | - Erin D Bouldin
- Health Services Research and Development, Department of Veterans Affairs Medical Center, Salt Lake City, Utah, USA
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | | | - Tiffany B Kindratt
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas, USA
| | - Dominique L Sylvers
- Population Studies Center, Institute for Social Research, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Noah J Webster
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
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Murray-Smith H, Barker S, Barkhof F, Barnes J, Brown TM, Captur G, R E Cartlidge M, Cash DM, Coath W, Davis D, Dickson JC, Groves J, Hughes AD, James SN, Keshavan A, Keuss SE, King-Robson J, Lu K, Malone IB, Nicholas JM, Rapala A, Scott CJ, Street R, Sudre CH, Thomas DL, Wong A, Wray S, Zetterberg H, Chaturvedi N, Fox NC, Crutch SJ, Richards M, Schott JM. Updating the study protocol: Insight 46 - a longitudinal neuroscience sub-study of the MRC National Survey of Health and Development - phases 2 and 3. BMC Neurol 2024; 24:40. [PMID: 38263061 PMCID: PMC10804658 DOI: 10.1186/s12883-023-03465-3] [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: 08/30/2023] [Accepted: 11/13/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Although age is the biggest known risk factor for dementia, there remains uncertainty about other factors over the life course that contribute to a person's risk for cognitive decline later in life. Furthermore, the pathological processes leading to dementia are not fully understood. The main goals of Insight 46-a multi-phase longitudinal observational study-are to collect detailed cognitive, neurological, physical, cardiovascular, and sensory data; to combine those data with genetic and life-course information collected from the MRC National Survey of Health and Development (NSHD; 1946 British birth cohort); and thereby contribute to a better understanding of healthy ageing and dementia. METHODS/DESIGN Phase 1 of Insight 46 (2015-2018) involved the recruitment of 502 members of the NSHD (median age = 70.7 years; 49% female) and has been described in detail by Lane and Parker et al. 2017. The present paper describes phase 2 (2018-2021) and phase 3 (2021-ongoing). Of the 502 phase 1 study members who were invited to a phase 2 research visit, 413 were willing to return for a clinic visit in London and 29 participated in a remote research assessment due to COVID-19 restrictions. Phase 3 aims to recruit 250 study members who previously participated in both phases 1 and 2 of Insight 46 (providing a third data time point) and 500 additional members of the NSHD who have not previously participated in Insight 46. DISCUSSION The NSHD is the oldest and longest continuously running British birth cohort. Members of the NSHD are now at a critical point in their lives for us to investigate successful ageing and key age-related brain morbidities. Data collected from Insight 46 have the potential to greatly contribute to and impact the field of healthy ageing and dementia by combining unique life course data with longitudinal multiparametric clinical, imaging, and biomarker measurements. Further protocol enhancements are planned, including in-home sleep measurements and the engagement of participants through remote online cognitive testing. Data collected are and will continue to be made available to the scientific community.
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Affiliation(s)
- Heidi Murray-Smith
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK.
| | - Suzie Barker
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Centre for Medical Image Computing, University College London, London, UK
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Josephine Barnes
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Thomas M Brown
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Gabriella Captur
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Molly R E Cartlidge
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - David M Cash
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
- Centre for Medical Image Computing, University College London, London, UK
| | - William Coath
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - John C Dickson
- Institute of Nuclear Medicine, University College London Hospitals, London, UK
| | - James Groves
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Sarah-Naomi James
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Ashvini Keshavan
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Sarah E Keuss
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Josh King-Robson
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Kirsty Lu
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Ian B Malone
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Jennifer M Nicholas
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Alicja Rapala
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Catherine J Scott
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
- Institute of Nuclear Medicine, University College London Hospitals, London, UK
| | - Rebecca Street
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Carole H Sudre
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
- Centre for Medical Image Computing, University College London, London, UK
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - David L Thomas
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Andrew Wong
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Selina Wray
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Henrik Zetterberg
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
- UK Dementia Research Institute, University College London, London, UK
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Hong, Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Nick C Fox
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Sebastian J Crutch
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Jonathan M Schott
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, 1St Floor, 8-11 Queen Square, London, UK
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Yuan J, Tan H, Cheng Y, Ma X, Jiang S, Hou X, Li S, Shi L, Li P, Xu H, Lv J, Han B. Air particulate pollution exposure associated with impaired cognition via microbiota gut-brain axis: an evidence from rural elderly female in northwest China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2024; 31:6398-6410. [PMID: 38151560 DOI: 10.1007/s11356-023-31504-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/08/2023] [Indexed: 12/29/2023]
Abstract
This study aimed to reveal harm of exposure to indoor air pollution to cognitive function through "gut-brain-axis" among rural elderly residents. There were 120 participants recruited in rural villages of northwest China from December 2021 to February 2022. The cognitive level was assessed by eight-item ascertain dementia (AD) questionnaire, and indoor air pollution exposure was measured by air quality sensor. Inflammatory cytokines and oxidative stress-related index were detected in blood serum. Fecal samples were collected for gut microbiota analysis. The 120 participants were divided into impaired cognition (AD8) (81/67.5%) and cognition normal (NG) (39/32.5%). And there had more female in AD8 (FAD) (55/67.9%) than NG (FNG) (18/46.2%) (P = 0.003). Exposure of air pollution in FAD was higher than FNG (PM1, PM2.5, PM10, P < 0.001; NO2, P < 0.001; CO, P = 0.014; O3, P = 0.002). The risk of cognitive impairment increases 6.8%, 3.6%, 2.6%, 11%, and 2.4% in female for every 1 μg/m3 increased in exposure of PM1, PM2.5, PM10, NO2, and O3, separately. And GSH-Px and T-SOD in FAD were significantly lower than the FNG group (P = 0.011, P = 0.019). Gut microbiota in FAD is disordered with lower richness and diversity. Relative abundance of core bacteria Faecalibacterium (top 1 genus) in FAD was reduced (13.65% vs 19.81%, P = 0.0235), while Escherichia_Shigella and Akkermansia was increased. Correlation analysis showed Faecalibacterium was negatively correlated with age, and exposure of O3, PM1, PM2.5, and PM10; Akkermansia and Monoglobus were positively correlated with exposure of PM1, PM2.5 and PM10; Escherichia_Shigella was significantly positively correlated with NO2. Indoor air pollution exposure impaired cognitive function in elderly people, especially female, which may cause systemic inflammation, dysbiosis of the gut microbiota, and ultimately leading to early cognitive impairment through the gut-brain axis.
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Affiliation(s)
- Jia Yuan
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Hui Tan
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yue Cheng
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, 710061, Shaanxi, China
| | - Xinxin Ma
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Sijin Jiang
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Xinyao Hou
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Shaoru Li
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, 710061, Shaanxi, China
| | - Lu Shi
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Pu Li
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Hongmei Xu
- School of Energy and Power Engineering, Xi'an Jiaotong University, Xi'an, 710049, Shaanxi, China
| | - Jia Lv
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, 710061, Shaanxi, China
| | - Bei Han
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, 710061, Shaanxi, China.
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, China.
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Getz SJ, Levin BE, Galvin JE. The Assessment of Situational Judgement Questionnaire: A Novel Instrument to Detect Susceptibility to Financial Scamming. J Alzheimers Dis 2024; 97:1365-1379. [PMID: 38250778 DOI: 10.3233/jad-231194] [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: 01/23/2024]
Abstract
BACKGROUND Existing measures of scam susceptibility lack ecological validity and situational variability. Evidence suggests that all adults may be susceptible to scams, though a comprehensive fraud victimization theory remains to be explored. OBJECTIVE To identify cognitive and sociodemographic variables that differentiate individuals with high scam susceptibility from those less susceptible. This article describes the development and feasibility of the Assessment of Situational Judgment questionnaire (ASJ), a brief tool designed to detect scam susceptibility. METHODS The 17-item ASJ was developed using a combination of existing scams reported by the Florida Division of Consumer Services and legitimate scenarios. Participants were presented with scam and legitimate scenarios and queried regarding their willingness to engage. Response options were offered with instructions on a 7-point Likert scale (extremely unlikely to extremely likely). Pilot data from a development sample provided the foundation for the final version of the ASJ. RESULTS The final version of the ASJ was administered to 183 online participants. The Scam factor (8 items) explained 50.6% of the variance. The Legit factor (9 items) reported on a 7-point Likert scale explaining 10.6% of the variance. A Scam to Legit ratio provides a proxy for overall scam susceptibility. Cut-off scores of 24 on the Scam factor, 47 on the Legit factor, and 0.62 on the ratio optimize measures of scam susceptibility. CONCLUSIONS The ASJ is a brief, ecologically valid measure of scam susceptibility. There is a need for a sensitive and specific tool to detect scam susceptibility in clinical, community, and financial settings.
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Affiliation(s)
- Sarah J Getz
- Comprehensive Center for Brain Health, University of Miami, Miller School of Medicine, Boca Raton, FL, USA
- Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Bonnie E Levin
- Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - James E Galvin
- Comprehensive Center for Brain Health, University of Miami, Miller School of Medicine, Boca Raton, FL, USA
- Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL, USA
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50
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Shang Y, Guo Y, Wei C, Zhou B, Xie H. A comparison of the diagnostic accuracy of the Mini-Cog and AD8 in identifying cognitive impairment in a geriatric health screening population in China. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:69-76. [PMID: 34672895 DOI: 10.1080/23279095.2021.1991930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The present study aimed to evaluate and compare the discriminative abilities of the Mini-Cog and AD8 tests in detecting cognitive impairment in a Chinese health screening population. 160 geriatric participants were enrolled at an academic medical center . The Mini-Cog, AD8, and Mini-Mental State Examination (MMSE) were used to assess the possibility of cognitive impairment. Logistic regression and receiver operator characteristic curve analyses were performed to evaluate the discriminative abilities of the tests. The prevalence of cognitive impairment was 41.25%. Logistic regression modeling showed that the Mini-Cog (odds ratio (OR) = 0.34, 95% confidence interval (CI): 0.25-0.46) and MMSE (OR = 0.58, 95%CI: 0.49-0.69) predicted cognitive impairment with 79.4% and 80.6% correct classification, respectively. While the AD8 (OR = 1.56, 95% CI: 1.32-1.85) predicted cognitive impairment with 72.5% correct classification. The areas under the receiver operating characteristic curves of the Mini-Cog, AD8 and MMSE for detecting cognitive impairment were 0.79 (95% CI: 0.72-0.85), 0.66 (95% CI: 0.58-0.73) and 0.80 (95% CI: 0.73-0.86). Both sensitivity and specificity of the Mini-Cog were superior to those of the AD8 (sensitivity 78.79% vs. 56.06%; specificity 79.79% vs. 75.53%). Cognitive screening is crucial to maintain the quality of life of older adults. Compared with the AD8, the Mini-Cog test is a more effective tool for screening cognitive impairment in older adults.
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Affiliation(s)
- Yanchang Shang
- Department of Geriatric Neurology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Yane Guo
- Department of Geriatric Neurology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Chao Wei
- Department of Geriatric Neurology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Bo Zhou
- Department of Geriatric Neurology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Hengge Xie
- Department of Geriatric Neurology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
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