Operationalizing Social Environments in Cognitive Aging and Dementia Research: A Scoping Review

BACKGROUND

Social environments are a contributing determinant of health and disparities. This scoping review details how social environments have been operationalized in observational studies of cognitive aging and dementia.

METHODS

A systematic search in PubMed and Web of Science identified studies of social environment exposures and late-life cognition/dementia outcomes. Data were extracted on (1) study design; (2) population; (3) social environment(s); (4) cognitive outcome(s); (5) analytic approach; and (6) theorized causal pathways. Studies were organized using a 3-tiered social ecological model at interpersonal, community, or policy levels.

RESULTS

Of 7802 non-duplicated articles, 123 studies met inclusion criteria. Eighty-four studies were longitudinal (range 1-28 years) and 16 examined time-varying social environments. When sorted into social ecological levels, 91 studies examined the interpersonal level; 37 examined the community/neighborhood level; 3 examined policy level social environments; and 7 studies examined more than one level.

CONCLUSIONS

Most studies of social environments and cognitive aging and dementia examined interpersonal factors measured at a single point in time. Few assessed time-varying social environmental factors or considered multiple social ecological levels. Future studies can help clarify opportunities for intervention by delineating if, when, and how social environments shape late-life cognitive aging and dementia outcomes.

P82 Pelvic neurophysiological and urodynamics findings in patients with sacral-level tarlov cysts

Objectives

Sacral Tarlov cysts (TC) are frequent incidental findings on spinal MRI. Controversy remains regarding their ability to cause nerve root compression. Pelvic neurophysiological and urodynamics testing provides information about sacral nerve root involvement.

Design

Case series

Subjects

Patients with MRI evidence of sacral (S1, 2 or 3) TC seen in the Uro-neurology Department between 2011 and 2018.

Methods

Clinical, neurophysiological and urodynamics data were reviewed.

Results

13 patients (9 females, mean age54/SD13.1) were included. Symptoms were urgency/incontinence (n=8), hesitancy/urinary retention (n=7), bowel complaints (n=4), sexual complaints (n=3), back pain (n=5), genital/pelvic pain (n=6), genital numbness (n=5), impaired sensation of bladder fullness (n=2), lower limb (LL) pain/hypoesthesia (n=6), LL weakness (n=2). The following neurophysiological abnormalities were seen: anal sphincter EMG (n=10) evidence for reinnervation (n=8), pudendal sensory evoked potentials (SEPs) (n=6) absent response (n=1), S2 and S3 dermatomal SEPs (n=6) absent response (n=2), sympathetic skin response (n=6) absent response (n=3). Findings in cystometry (n=5) were: detrusor underactivity (n=2), detrusor after-contraction (n=1), equivocal obstructed voiding (n=1) and reduced bladder compliance (n=1).

Conclusions

Abnormal results in urodynamics and pelvic neurophysiology suggest involvement of the somatic and autonomic sacral innervation. Further studies are required to explore any association between structural changes on MRI and functional changes in urodynamics and neurophysiology.

Gestational autoimmune disease in newborns with an indeterminate cause of death following a complete autopsy

Gestational alloimmune liver disease (GALD) is the result of neonatal complement-mediated severe liver injury mediated by maternal alloantibodies, which is detected by immunohistochemistry staining for the complement C5b-9 complex. GALD leads to the neonatal hemochromatosis (NH) phenotype, which also shows extrahepatic siderosis, and can result in neonatal death. At autopsy, the histologic damage of the liver in GALD may be subtle and misinterpreted as non-specific post-mortem changes, resulting in the cause of death classified as indeterminate. We reviewed the pathologic diagnoses from autopsy material from 1996 to 2011 of infants 0-90 days of age from our institution. Liver samples were stained with H&E, trichrome and for C5b-9. 13 cases originally diagnosed as indeterminate cause of death were identified and divided in 3 groups: (1) No clinical or autopsy-derived diagnoses (n = 7), (2) Defined clinical diagnoses but no cause of death determined at autopsy (n = 2), and (3) Liver disease, but no clinical or autopsy diagnoses to establish the cause of the liver injury (n = 4). On reexamination, all group 1 and 3 cases were reclassified as GALD, based on a positive C5b-9 stain. Group 2 cases were not GALD, retaining the original, clinically-based cause of death. We conclude that, in cases of indeterminate cause of neonatal death, very careful examination for hepatocyte injury/necrosis, extrahepatic siderosis, liver fibrosis and/or C5b-9 stain should be considered.

The role of the human Fc receptor Fc gamma RIIA in the immune clearance of platelets: a transgenic mouse model

In humans, the Fc receptor for IgG, FcgammaRIIA, is expressed on macrophages and platelets and may play an important role in the pathophysiology of immune-mediated thrombocytopenia. Mice lack the genetic equivalent of human FcgammaRIIA. To better understand the role of FcgammaRIIA in vivo, FcgammaRIIA transgenic mice were generated and characterized. One transgenic mouse line expressed FcgammaRIIA on platelets and macrophages at levels equivalent to human cells, and cross-linking FcgammaRIIA on these platelets induced platelet aggregation. Immune-mediated thrombocytopenia in this transgenic line was studied using i.v. and i.p. administration of anti-mouse platelet Ab. In comparison with matched wild-type littermates that are negative for the FcgammaRIIA transgene, Ab-mediated thrombocytopenia was significantly more severe in the FcgammaRIIA transgenic mice. In contrast, FcR gamma-chain knockout mice that lack functional expression of the Fc receptors FcgammaRI and FcgammaRIII on splenic macrophages did not demonstrate Ab-mediated thrombocytopenia. We generated FcgammaRIIA transgenic x FcR gamma-chain knockout mice to examine the role of FcgammaRIIA in immune clearance in the absence of functional FcgammaRI and FcgammaRIII. In FcgammaRIIA transgenic x FcR gamma-chain knockout mice, severe immune thrombocytopenia mediated by FcgammaRIIA was observed. These results demonstrate that FcgammaRIIA does not require the FcR gamma-chain for expression or function in vivo. Furthermore, taken together, the data suggest that the human Fc receptor FcgammaRIIA plays a significant role in the immune clearance of platelets in vivo.

A single-base change at position -175 in the 5'-flanking region of the G gamma-globin gene from a black with G gamma-beta+ HPFH

Hereditary persistence of fetal hemoglobin (HPFH) is a human hemoglobinopathy characterized by the continued expression of fetal globins during adult life. Both deletional and nondeletional forms have been described. A number of single-base changes in the immediate 5'-flanking region of the fetal G gamma and A gamma have been reported associated with nondeletional forms of HPFH. We now present the nucleotide sequence of a G gamma-globin gene from an American black with G gamma-beta + HPFH. The immediate 5'-flanking region of this G gamma gene has a T-to-C change at -175, C at -158, and a normal C at -202. Additional changes were found in IVS2 and in the immediate 3'-flanking region, some of which may represent gene-conversion events. The sequence change at -175 probably represents a second mutation associated with the G gamma-beta + HPFH phenotype in blacks. This base change alters an octamer sequence known to be of importance in the normal expression of several other genes.

Functional analysis of a beta-globin gene containing a TATA box mutation from a Kurdish Jew with beta thalassemia

We recently reported a TATA box mutation (ATAAAA to ATACAA) in a cloned beta-globin gene from a Kurdish Jew with homozygous beta thalassemia (Poncz, M., Ballantine, M., Solowiejczyk, D., Barak, I., Schwartz, E., and Surrey, S. (1982) J. Biol. Chem. 257, 5994-5996). We have now introduced this gene into HeLa cells after CaPO4 precipitation of the DNA and studied expression by analyzing globin-gene transcripts with a novel S1 nuclease mapping assay. Quantitative and qualitative comparison with the normal beta-globin gene revealed a promoter-down phenotype in the TATA box mutant, with normal RNA processing, and a normal start site for initiation of the primary transcript. Decreased transcriptional efficiency was confirmed directly by analysis of run-off transcripts using assays in vitro. The patient's phenotype of beta thalassemia major is probably the result of two different mutations since haplotype analysis of the beta-like globin gene clusters in genomic DNA from this patient shows heterozygosity for the Mediterranean-type haplotypes I and VII, with the TATA box mutation on a haplotype I chromosomal background.

The silent carrier allele: beta thalassemia without a mutation in the beta-globin gene or its immediate flanking regions

A molecular genetic analysis has been performed using as subjects an Albanian family in which the father is a silent carrier, the mother has high Hb A2-beta thalassemia trait, and both children have beta thalassemia. Nucleotide sequence analysis of the daughter's paternal beta-globin gene and its flanking regions failed to reveal any base changes of known functional significance. When introduced into HeLa cells the gene was expressed at normal levels with proper processing of RNA. Haplotype analysis revealed that the affected son and daughter inherited different epsilon gamma delta beta-globin gene clusters from the father. The silent carrier allele is not due to a mutation within the beta-globin structural gene or its flanking regions and as such represents a novel form of beta+ thalassemia.

Detection of a novel DNA polymorphism in the beta-globin gene cluster

Analysis of DNA from the beta-globin gene cluster in an Albanian family identified a novel RsaI site approximately 550 base pairs 5' to the beta-globin gene. In this family, two chromosomes carrying otherwise identical beta-globin haplotypes were found to differ at the RsaI site. Population screening demonstrated the presence and absence of the site in DNA from individuals of northern European, Mediterranean, Middle Eastern, Southeast Asian, African, and Asian Indian descent, indicating that this site is a DNA polymorphism common in many ethnic groups. The polymorphism is also present in DNA from individuals carrying different beta-globin alleles. Additional nucleotide sequence changes identified in an RsaI (+) genomic clone in the region immediately 3' to the RsaI site suggest a mechanism for the randomization of the site with respect to haplotype.