The Contributions of Active Spanish-English Bilingualism to Cognitive Reserve among Older Hispanic Adults Living in California

Objective

Bilinguals may be able to retain similar levels of cognitive functioning given age and/or Alzheimer’s Disease-related neurodegeneration, compared to monolinguals. Many studies have yielded equivocal findings that may be explained by within-group differences among bilinguals, such as frequency of language use. The current study aimed to clarify the role of frequency of bilingual language use (i.e., active versus passive) in the association of brain structure and memory. We hypothesized that active bilinguals would demonstrate better memory performance compared to passive bilinguals and monolinguals, and that active bilingualism would buffer the effects of temporal lobe integrity on memory.

Participants and Method

In a longitudinal aging study, 217 older Hispanic adults (Age M = 74 years, SD = 6; 70% women) underwent neuropsychological evaluation and 1.5T MR imaging. Bilingualism was determined by self-reported use of English and Spanish. Active bilinguals reported using both languages daily. Multiple regression tested main effects and interactions of bilingualism and entorhinal cortical thickness on semantic and episodic memory, adjusted for age, sex/gender, and education.

Results

Bilingualism was associated with better semantic memory(F[2,209] = 6.25, p = .002) but not with episodic memory(F[2,209)] = 0.34, p = .71). There was a significant bilingualism X entorhinal cortical thickness interaction on semantic memory (β = -.26, p = .02), indicating that active bilinguals were better able to maintain cognitive functioning with lower cortical thickness, compared to passive bilinguals and monolinguals.

Conclusions

Active bilingualism may protect semantic memory against cortical thinning of the entorhinal cortex. Future studies will explore whether this relationship remains after accounting for additional environmental and sociocultural factors (e.g., immigrant status) that influence the ability or opportunity to become bilingual, and whether active bilingualism affects cognitive trajectory in late life.

A randomized controlled trial of mindfulness-based stress reduction to prevent flare-up in patients with inactive ulcerative colitis

BACKGROUND/AIMS

The primary therapeutic goals in ulcerative colitis (UC) are to maintain excellent quality of life (QOL) by treating flare-ups when they occur, and preventing flare-ups. Since stress can trigger UC flare-ups, we investigated the efficacy of mindfulness-based stress reduction (MBSR) to reduce flare-ups and improve QOL.

METHODS

Patients with moderately severe UC, in remission, were randomized to MBSR or time/attention control. Primary outcome was disease status. Secondary outcomes were changes in markers of inflammation and disease activity, markers of stress and psychological assessments.

RESULTS

55 subjects were randomized. Absence of flares, time to flare and severity of flare over 1 year were similar between the two groups. However, post hoc analysis showed that MBSR decreased the proportion of participants with at least one flare-up among those with top tertile urinary cortisol and baseline perceived stress (30 vs. 70%; p < 0.001). MBSR patients who flared demonstrated significantly lower stress at the last visit compared to flared patients in the control group (p = 0.04). Furthermore, MBSR prevented a drop in the Inflammatory Bowel Disease Quality of Life Questionnaire during flare (p < 0.01).

CONCLUSION

MBSR did not affect the rate or severity of flare-ups in UC patients in remission. However, MBSR might be effective for those with high stress reactivity (high perceived stress and urinary cortisol) during remission. MBSR appears to improve QOL in UC patients by minimizing the negative impact of flare-ups on QOL. Further studies are needed to identify a subset of patients for whom MBSR could alter disease course.

The influence of synovial inflammation and hyperplasia on symptomatic outcomes up to 2 years post-operatively in patients undergoing partial meniscectomy

OBJECTIVE

Synovitis is associated with pain and other symptoms in patients with knee osteoarthritis (OA), and in patients with meniscal tears even in the absence of radiographic OA. Patients undergoing arthroscopic partial meniscectomy were followed for 2 years to determine whether synovitis predicts post-operative symptoms.

DESIGN

Thirty-three patients scheduled for arthroscopy were recruited for this pilot study. Symptoms were assessed using a knee pain scale, the Lysholm score, and the short form-12 (SF-12(®)) pre-operatively and at 16 weeks, 1 year and 2 years post-operatively. Synovial inflammation and hyperplasia were graded on surgical biopsies. Linear mixed effects models were tested to determine whether inflammation or hyperplasia is associated with outcome scores over time.

RESULTS

Lysholm scores and SF-12(®) physical component sub-scores were worse pre-operatively in patients with inflammation (Lysholm: 52.42 [95% confidence interval (CI) 42.37, 62.47] vs 72.38 [66.03, 78.72], P < 0.001; SF-12: 36.81 [28.26, 45.37] vs 46.23 [40.14, 52.32], P < 0.05). Up to 2-years post-operatively, patients with inflammation achieved mean scores similar to those without inflammation. As a result, the mean improvement in Lysholm scores was 13.01 [1.48-24.53] points higher than patients without inflammation, P = 0.03. 33% (4/12) of patients with inflammation still had fair to poor Lysholm scores 2 years after surgery compared to 7% (1/15, P=0.14) without inflammation. No association between hyperplasia and symptoms was noted.

CONCLUSIONS

In this pilot study of patients undergoing partial meniscectomy, synovial inflammation was associated with worse pre-operative symptoms, but not with poorer outcomes in the first 2 years post-arthroscopy. Larger cohorts and longer follow-up should be pursued to confirm this relationship, and determine if the initial response is sustained.

Temporal course of depressive symptoms during the development of Alzheimer disease

OBJECTIVE

To characterize change in depressive symptoms before and after the onset of dementia in Alzheimer disease (AD).

METHOD

We used data from the Chicago Health and Aging Project, a longitudinal cohort study of risk factors for AD in a geographically defined population of old people. Two subsets were analyzed. In 357 individuals who developed incident AD during the study, self-report of depressive symptoms (Center for Epidemiologic Studies Depression Scale) was obtained at 3-year intervals for a mean of 8 to 9 years. In 340 individuals who agreed to annual data collection, informant report of depressive symptoms (Hamilton Depression Rating Scale) was obtained for a mean of 3 years after a diagnosis of AD (n = 107), mild cognitive impairment (n = 81), or no cognitive impairment (n = 152).

RESULTS

The incident AD group reported a barely perceptible increase in depressive symptoms during 6 to 7 years of observation before the diagnosis (0.04 symptoms per year) and no change during 2 to 3 years of observation after the diagnosis except for a slight decrease in positive affect. In those with annual follow-up, neither AD nor its precursor, mild cognitive impairment, was associated with change in informant report of depressive symptoms during a mean of 3 years of observation.

CONCLUSION

Depressive symptoms show little change during the development and progression of AD to a moderate level of dementia severity.