bluuebunny/crossref_metadata_2025 huggingface dataset:
The Digital Divide Amongst High-Need High-Risk Veterans
Authors: Li Shirley , Muralidhar Kiranmayee , Tang Fei , Valencia Willy Marcos , Dang Stuti
Published: December 2021

High-need high-risk (HNHR) veterans are medically complex and at the highest risk of hospitalization and long-term institutionalization. Technology can mitigate challenges these veterans have in accessing healthcare. Willingness to use technology as well as access and ability to use technology were assessed in this study. At the time of the survey, 2543 Miami VAHS veterans were listed as HNHR. 634 veterans ultimately completed the questionnaire, and 602 answered the “willingness to use video-visits” question. Of the 602 respondents, 327 (54.3%) reported they were willing for video-visits with the VA, while 275 (45.6%) were not. Those who were willing were significantly younger (P<0.001), with higher educational qualifications (P=0.002), and more health literate than those not willing (P<0.001). They were more also capable of using the Internet, more likely to use email and be enrolled in the VA’s patient portal, My HealtheVet (P<0.001). However, of the veterans who were willing, 248 (75.8%) had a device with video-capable technology. Those with video-capable technology were younger (P=0.004), more health literate (P=0.01), and less likely to be Black or African American (P=0.007). They were more capable of using the Internet, more likely to use email, and be enrolled in My HealtheVet than those without (P<0.001). Half of the respondents were willing for video-visits but a quarter of those willing lacked requisite technology, thereby making only about 41.2% of the respondents willing and video-capable. To minimize the digital divide, especially during the ongoing COVID-19 pandemic, targeted measures need to address these disparities in this vulnerable population.
Using Artificial Intelligence to Improve Pain Assessment and Pain Management: A Scoping Review
Authors: Zhang Meina , Zhu Linzee , Lin Shih-Yin , Herr Keela , Chi Nai-Ching
Published: December 2021

Approximate 50 million U.S. adults experience chronic pain. It is a widely held view that pain has been linked to sleep disturbance, mental problems, and reduced quality of life. Uncontrolled pain has led to increased healthcare utilization, hospitalization, emergency visits, and financial burden. Recognizing, assessing, understanding, and treating pain can improve outcomes of patients and healthcare use. A comprehensive synthesis of the current use of AI-based interventions in pain management and pain assessment and their outcomes will guide the development of future clinical trials. This review aims to investigate the state of the science of AI-based interventions designed to improve pain management and pain assessment for adult patients. The electronic databases Web of Science, CINAHL, PsycINFO, Cochrane CENTRAL, Scopus, IEEE Xplore, and ACM Digital Library were searched. The search identified 2131 studies, and 18 studies met the inclusion criteria. The Critical Appraisals Skills Programme was used to assess the quality. This review provides evidence that machine learning, deep learning, data mining, and natural language processing were used to improve efficient pain recognition and pain assessment (44%), analyze self-reporting pain data (6%), predict pain (6%), and help physicians and patients to more effectively manage with chronic pain (44%). Findings from this review suggest that using AI-based interventions to improve pain recognition, pain prediction, and pain self-management is effective; however, most studies are pilot study which raises concerns about the generalizability of findings. Future research should focus on examining AI-based approaches on a larger cohort and over a longer period of time.
Effect of Dance Movement Therapy on Depression and Anxiety for Persons with Dementia: A Systematic Review
Authors: Wang Ying , Liu Mandong , Dong Zhixiao , wu Jing , Cui Huan , Shen Dianjun , Tan Youyou
Published: December 2021

Dance movement therapy（DMT）is a physical and psychological intervention, but there was no meta-analysis of RCTs in the systematic review of DMT for dementia, and the results of RCTs were inconsistent. The study aimed to assess the effectiveness of dance movement therapy on depression and anxiety of persons with dementia in comparison to no treatment, standard care. Six electronic databases (Cochrane, PsycINFO, Web of Science, PubMed, EBSCO, CNKI) were searched through January 2021. Randomized controlled trials (RCTs) in Chinese and English language were considered, including: (1) population is women and men of all age with dementia and MCI; (2) intervention is dance movement intervention; (3) comparison is no treatment or standard care; (4) outcome is depression or anxiety. The four review authors independently reviewed studies on an abstract/title level and again after reading the full paper, and we independently evaluated methodological quality. Six randomized controlled trials were identified on depression and anxiety symptoms in persons with dementia. The target sample size was 29-842 older adults. Meta-analysis showed there were significant differences in favor of dance in depression (SMD = 1.17, 95% CI: 0.39 to 1.95, P = 0.003), but not in outcomes of anxiety. Trials of high methodological quality, large sample sizes, and clarity in the way the intervention is put together and delivered are needed to assess whether dance movement therapy is an effective intervention on depression and anxiety for persons with dementia.
Alzheimer’s Disease Risk Reduction: An Evidence-Based, Multi-Component Lifestyle Program, Pre- & Intra-Covid-19
Authors: Touch Gina , Bendheim Paul
Published: December 2021

Alzheimer’s disease (AD) is the 5th leading cause of death in the USA. With nearly 300 failed therapeutic trials to date, lifestyle modifications have been shown to reduce AD risk by as much as 50%. Preceding the FINGER Study by nearly a decade, the BrainSavers Brain+Body Total Fitness program was developed by an interdisciplinary team to reduce the risk of AD / all-cause dementia and promote healthy aging via education, exercise, and engagement. This evidence-based program utilizes the principles of neuroplasticity and cognitive reserve. Pre-Covid, BrainSavers was delivered live, led by certified instructors. Two years of curriculum were developed, comprised of six lifestyle components: cognitive exercise, physical exercise, healthful nutrition, socialization, stress reduction, and sleep hygiene. Results of a six month beta trial documented self-rated improvements in memory and general cognitive performance, quality of life, socialization, nutritional status, and physical fitness. Quantitative results showed statistically significant differences in physical fitness measures including cardio-respiratory endurance, lower body strength, balance, speed, and agility. Trends were seen in six of nine cognitive skills. During Covid the program was transformed into an online format as BrainSavers Synapse: Staying Connected, which has been enthusiastically received. Future research will compare longer-term outcomes of both formats. Based on results to date and extensive peer-reviewed literature on lifestyle as a modifier of dementia risk, we predict this program will contribute to better individual and societal outcomes, including substantial improvements in cognitive and overall health, and a significant reduction in healthcare costs.
Trajectories of cognitive function and associated factors in community-dwelling older adults: a prospective study
Authors: Wu Zimu , Woods Robyn , Storey Elsdon , Chong Trevor , Shah Raj , Orchard Suzanne , Murray Anne , Ryan Joanne
Published: December 2021

There is variability in cognitive aging between individuals. This study aimed to investigate cognitive aging trajectories, the associated modifiable factors, and the association of these trajectories with dementia. Community-dwelling older adults (n=19,114) without dementia or major cognitive impairment at inclusion were followed for up to 7 years, with regular standardized cognitive assessments. Group-based (multi-) trajectory modeling identified distinct cognitive trajectories. Structural equation modeling (n=16,018) was used to analyze the associated predictors. Four to seven trajectories were identified per cognitive domain, with generally stable trajectories. Improvement in verbal fluency and minor psychomotor slowing were common. Substantial decline in global cognition and episodic memory were observed in a small proportion of individuals. The highest proportions of dementia cases were in trajectories with major decline in global cognition (56.9%) and memory (33.2%). A number of sociodemographic characteristics, health behaviors and chronic conditions were either directly or indirectly associated with cognitive change in older adults. This study found that some individuals appear resilient to cognitive decline even with advancing age, and that factors that promote healthy cognitive aging are not simply the absence of factors which confer risk for decline.
Eating Difficulties among Older Adults with Dementia in South Korean Long-Term Care Facilities: A Scoping Review
Authors: Choi Eunju , Jung Dukyoo , Lee Kyuri
Published: December 2021

This study aims to synthesize existing literature concerning eating difficulties among older adults with dementia in long-term care facilities. A scoping review, using the framework proposed by Arksey & O'Malley (2005) and improved and supplemented by Levac et al. (2010), was conducted. Literature was searched from five bibliographic databases—Research Information Sharing Service (RISS), Korean studies Information Service System (KISS), National Digital Science Library (NDSJ), Korean Medical Database (KMBASE), DataBase Periodical Information Academic(DBPia), Google Scholar, and gray literature. Literature selection and characteristics were approved by two independent reviewers, using pre-tested forms to determine final inclusion. Eventually, 111 articles from 2012–2020 were identified, and the 11 articles were used for the final analysis. We found that primarily utilized Eating behavior scale (EBS) and Edinburgh feeding evaluation in dementia scale (EdFED) had utilized as measurement tools for evaluating eating behavior. The most common factors related to eating behavior of older adults with dementia included cognitive and physical functions in the individual domain, the caregiver's attitude toward eating in the inter-individual domain, and types of meal in the environmental domain. Therefore, it is essential to develop measurement tools that reflect the eating behavior of older adults with dementia, a comprehensive understanding of the eating behavior of old adults with dementia, and create effective interventions that can be implemented in the specificity of long-term care facilities in Korea. The results of this analysis are intended to be used as basis to develop a meal support programs for older adults with dementia.
Which Cognitive Behavioral Therapy Formats Work for Depression in Dementia Family Caregivers ?
Authors: Sun Yue , Wang Zhi-wen
Published: December 2021

Cognitive behavioral therapy (CBT) has been shown to be effective to delay cognitive decline for family dementia caregivers (DCs). However, whether cognitive intervention could effectively reduce depression through internet, group, telephone, individual, unguided self-help and combined formats remains unclear. Pubmed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Central Register of Controlled Trials, Web of science, China National Knowledge Infrastructure database, Chinese Biomedical Literature database and Wan Fang database were systematically searched. A total of 34 studies were included in our analysis based on a series of rigorous screenings, which comprised 3577 DCs. We conducted a network meta-analysis (NMA) to evaluate the relative effects and rank probability of different CBT delivery formats. A series of analyses and assessments, such as the pairwise meta-analysis and the risk of bias, were performed concurrently. Compared with controls, internet, telephone, and individual showed the largest improvement on depressive symptoms, whereas the unguided self-help delivery format was less effective. Internet delivery formats had the highest probability among the five CBT delivery formats. Our study indicated that the internet might be the best delivery formats for reducing the depression of family DCs. The findings from our study may be useful for policy makers and service commissioners when they make choices among different CBT delivery formats.
Apolipoprotein E impairs aged bone fracture healing
Authors: Balu Abhinav , Huang Rong , Molitoris Kristin , Baht Gurpreet
Published: December 2021

Bone fracture healing and osteoblast differentiation are impaired with advanced age. Using a combination of parabiosis and proteomic models, we identified apolipoprotein E (ApoE) to be an aging factor in bone regeneration. Circulating levels of ApoE increased with age in patients and in mice. ApoE impaired bone fracture healing by decreasing bone deposition in the fracture callus which subsequently decreased the mechanical strength of healed tissue. Osteoblasts serve as the sole bone forming cells within the body. In tissue culture models, ApoE treatment decreased osteoblast differentiation and activity which led to decreased matrix formation and mineralization. This inhibition of osteoblast differentiation relied on down-regulation of the Wnt/β-catenin pathway. In mouse models, aged bone repair was rejuvenated when we lowered circulating ApoE levels using a hepatotropic AAV-siRNA model – serving as a proof of concept that ApoE can be targeted to improve bone repair in an older population. While promising, knockdown of circulating ApoE in such a fashion is likely not translatable to patient care. Thus, current work in our laboratory is focused on developing treatment strategies that temporally decrease circulating ApoE levels and consequently improve bone healing after acute injury and/or surgical orthopedic procedure in the geriatric population.
Effects of FOXO3 on Markers of Aging in Blood : An Okinawan Longevity Cohort Study
Authors: Allsopp Richard , Willcox D Craig , Torigoe Trevor , Gerschenson Mariana , Shimabukuro Michi , Chen Randi , Donlon Tim , Willcox Bradley
Published: December 2021

FOXO3 is among only a few genes that demonstrate a consistently reproducible genetic association with human longevity. We previously demonstrated, in a cross-sectional study of Okinawan Japanese, that the principal longevity variant of FOXO3 (rs 2802292 “G allele”) protects against age-associated attrition of telomere length. We now expand upon this initial observation in a more detailed cross-sectional analysis of the effect of FOXO3 on telomerase activity, FOXO3 expression and inflammatory cytokine levels in both men and women. In agreement with our initial study, we found the FOXO3 longevity variant conferred significant protection against telomere shortening to roughly the same degree in elderly (ages 55 and older) men and women. Carriers of the G - allele also had slightly higher levels of blood telomerase activity in young (ages 20 – 54) and elderly participants (P≤0.1). The expression (mRNA) of FOXO3 increased steadily with age in young and old G – allele carriers (borderline P≤0.08), in contrast to a lack of association with age in non-carriers. The FOXO3 G - allele was also observed to significantly impact levels of both interleukin 6 (IL 6) and IL10, but in a sex dependent manner (P<0.05). These sex-specific effects may point to different mechanisms by which FOXO3 exerts its effect on longevity in men and women.
Loneliness and marijuana use among Older Adults: An examination of the 2018 Health and Retirement Study
Authors: Yang Jie , Yockey Andrew
Published: December 2021

Introduction: There is substantial literature to suggest that loneliness is a risk factor for marijuana initiation, use, and continued use into adulthood. However, these relationships have yet to be investigated among older adults. Given that recent research suggests marijuana use is increasing among older adults, the purpose of the present study was to examine loneliness and other risk factors among a national sample of older adults ages 50 years or older. Methods: A secondary data analysis was conducted on the 2018 Health and Retirement Study (HRS) was conducted (n = 1,431). The HRS is a national, biannual survey conducted in the United States to assess health, psychosocial, and demographic questions among adults ages 50 years or older. We created a loneliness scale from the available questions and assessed differences based on demographics, lifetime use, and past-year use of marijuana. Weighted analyses with cyclical tree-based hot-deck imputation were conducted. Results: A sizeable percentage (23.5%) of older adults have ever used marijuana and a considerable amount (14.8%) of adults have used marijuana in the past year. Differences were found based on sex (p <.0001), age (p <.0001), race (p <.0001), and income (p <.0001). Loneliness significantly predicted marijuana usage, with adults who reported loneliness nearly 5 times more likely to use marijuana (aOR: 4.87, 95% CI 3.89, 6.10). Discussion: The present study investigated loneliness and marijuana usage among a national sample of adults. Findings from the present study may inform behavioral health interventions, harm reduction, and gerontological health.
Diet and Stress Impair Ovarian Function in Mid-life, Increasing Risk of Chronic Diseases of Aging in Primates
Authors: Frye Brett , Craft Suzanne , Register Thomas , Appt Susan , Vitolins Mara , Uberseder Beth , Silverstein-Metzler Marnie , Shively Carol
Published: December 2021

Ovarian dysfunction increases risk for chronic diseases of aging including cardiovascular disease, depression, cognitive impairment, and bone and muscle loss which promote frailty. Psychosocial stress disrupts ovarian function and recent observations suggest that Western diet may also. Determination of causal relationships among diet, psychosocial stress, and ovarian physiology is difficult in humans. Nonhuman primates provide relevant opportunities to investigate diet and psychosocial effects on ovarian physiology and aging because, like humans, they have monthly menstrual cycles and recapitulate many aging-related processes similar to humans. We examined ovarian function in 38 socially housed, middle-aged females fed either a Western or Mediterranean diet for 26 months (~ an 8-year period for humans). During the last 12 months, we examined cycle length, peak progesterone per cycle, and frequency of anovulatory cycles using blood sampling (3/week) and vaginal swabbing (6/week). Repeated measures analysis revealed that like middle-aged women, cycle length increased, and progesterone levels fell over time, suggesting that ovarian dysfunction generally increased in our sample with time. In addition, both Western diet and the stress of low social status reduced progesterone levels, disrupting ovarian function, and increasing risk of chronic diseases of aging. This study demonstrates the additive negative effects of poor diet and psychosocial stress on ovarian physiology in mid-life and lays the groundwork for future investigations to uncover associated metabolic signatures of accelerated aging. The results also suggest that a Mediterranean diet may exert a protective influence against ovarian dysfunction and its pathologic sequelae.
Loss of ischemic tolerance with age: can we protect an old kidney
Authors: Plotnikov Egor
Published: December 2021

The most abundant and vulnerable cohort of patients with acute kidney injury (AKI) is represented by the older people. It is well-known, the kidney tissue undergoes some changes with age, both at the morphological and molecular level. Therefore, when treating AKI in older patients, it is necessary to take into account the morphofunctional features of aging kidney tissue and metabolic alterations. We have shown that the kidney of old rats does not perceive signals from the most well-known protective approaches such as ischemic preconditioning (IPC) and caloric restriction (CR). Although the old kidney did not develop more severe AKI after ischemia, we found no pronounced effect on attempts to increase its resistance by IPC and CR. Analysis of the mechanisms underlying this loss of tolerance has shown that the most affected pathways are the mechanism of mitochondrial quality control, the effectiveness of autophagy, and the proliferative potential of kidney cells. However, several protective pathways activated in the young kidney were also active in the old one in response to the CR. In particular, an increase in SIRT1 deacetylase, antiapoptotic Bcl-xL, and a decrease in oxidative stress were observed. Our results show that some defense systems demonstrating their effectiveness in young organisms lose their beneficial effect in old organisms, while others still can be activated by protective approaches. Thus, it is necessary to carefully analyze the possibilities of increasing ischemic tolerance for old organisms. This work was supported by the Russian science foundation (grant #21-75-30009).
Metformin Preserves Mitochondrial Integrity at Old Age in Male Rats.
Authors: Wanagat Jonathan , Herbst Allen , Hoang Austin , Kim Chiye , Aiken Judd , McKenzie Debbie , Goldwater Deena
Published: December 2021

Metformin is being deployed in clinical trials to ameliorate aging in older humans who do not have diabetes. In C. elegans, metformin treatment at old ages exacerbated mitochondrial dysfunction, led to respiratory failure, and shortened lifespan. Metformin is a commonly used, well-tolerated treatment for diabetes in older adults. Mitochondrial effects of metformin treatment in aged mammals has not been sufficiently investigated. We hypothesized that metformin treatment would not be toxic to older mammals. To define a therapeutic dose in aged hybrid rats, we evaluated two doses of metformin (0.1%, 0.75% of the diet) at 30-months of age. Body mass decreased at the 0.75% dose. Neither dose affected mortality between 30- and 34-months of age. We assessed mitochondrial quality, quantity, and function in aged rats treated with metformin at the 0.75% dose by measuring mitochondrial DNA copy number, deletion mutation frequency, and respirometry in skeletal muscle and heart. In skeletal muscle, we observed no effect of metformin on quadriceps mass, mtDNA copy number or deletion frequency. In the heart, metformin treated rats had higher mtDNA copy number, lower cardiac mass and no effect on deletion frequency. Metformin treatment resulted in lower mitochondrial complex I activity in both heart and quadriceps. Metformin did not compromise mitochondrial integrity, was well tolerated, and may have cardiac benefits to rats at old ages.
Exploring Spirituality, Loneliness and HRQoL In Hispanic Cancer Caregivers
Authors: King Jennifer , Badger Terry , Segrin Chris , Thomson Cynthia
Published: December 2021

Providing care to an aging society in the new normal requires increased attention to the informal caregivers who support the health and well-being of older adults with chronic conditions. Hispanic caregivers carry a high caregiver-associated burden. Health disparities experienced by Hispanics, coupled with the emotional, social and physical demands of caregiving, may set an unprecedented risk for lower health-related quality of life (HRQoL). In a quantitative analysis, we investigated the relationship between spirituality, loneliness and HRQoL in Hispanic cancer caregivers using baseline data from the Support for Latinas with Breast Cancer study (N= 234 Hispanic caregivers). Findings suggested an indirect effect of spirituality on HRQoL through reduced loneliness among more spiritual caregivers, effects that were independent of age. The second study was conducted using qualitative semi-structured interviews (N= 10) with Hispanic caregivers. Interviews evaluated spirituality and HRQoL in Hispanic cancer caregivers who reported variable levels of loneliness. Five themes emerged: caregiver experience, coping strategies, loneliness, religion to gain strength or support, and spirituality to gain strength or support. Results supported the role of spirituality in promoting higher HRQoL in Hispanic cancer caregivers and elucidated pathways to intervene on HRQoL through spirituality. With Hispanics often underutilizing formal services, having an improved understanding of caregiving experiences, particularly related to spirituality, will support the development of culturally-relevant strategies and programming to promote HRQoL for Hispanic caregivers.
The Science Behind Multidomain Interventions to Slow Cognitive Decline
Authors: Mangialasche Francesca
Published: December 2021

The spotlight on interventions to protect brain health and prevent Alzheimer’s disease (AD) has recently widened to include risk modification. In the last 20 years, evidence continues to build to support cognition-enhancing effects of individual lifestyle components, which include, among others, physical exercise, diet, cognitive training, and cardiovascular risk management. A recent evolution of lifestyle trials is to combine these components as part of intervention delivery. The potential benefit of this approach on cognition in older adults, first showcased in the FINGER trial, is now under investigation by multiple groups across the nation and the globe. The multidomain approach offers important opportunities to boost lifestyle intervention ‘dose’, to examine inter-component synergistic effects, and for intervention tailoring to meet specific needs and limitations. Harmonization and data-sharing will be essential to meaningfully address the question of whether multidomain lifestyle modification can indeed be ‘medicine’ to protect brain health and reduce AD risk.
Risk perception and communal coping in families affected by type 2 diabetes
Authors: Lin Jielu , Zajdel Melissa , Myers Melanie , Koehly Laura
Published: December 2021

Despite a recent decline, rates of type 2 diabetes remain high among older adults. Preventing and delaying the onset of the condition with lifestyle changes is key to reducing disease burden in the population. Type 2 diabetes is a complex disease, likely a result from the joint effect of genetic, socio-environmental and lifestyle risk factors that are clustered in families. As such, the prevention of type 2 diabetes is a communal coping process, where individuals communicate about risk and establish routines to facilitate one another’s health habits and compliance with therapeutics. This poster investigates how such a process is affected by one’s perception of risk based on his/her knowledge about family health history (FHH). We collected family network data from families of different racial backgrounds in the greater Cincinnati area (28 white and 17 black/ African American households; 127 participants). The analysis focuses on how the density of diabetes diagnosis in one’s FHH affects communication about shared risk for type 2 diabetes and encouragement to maintain or adopt a healthy lifestyle. Results suggest a higher concentration of diabetes diagnosis in one’s FHH is associated with a higher number of risk communication ties in all families. With regards to encouragement ties, high rates of diabetes diagnosis in FHH are associated with an increased number of encouragement ties only in families of black/African heritage. The findings highlight the need and promise of using FHH to motivate co-encouragement to maintain/adopt a healthier lifestyle in families of black/African heritage.
Daily alcohol use covaries with daily concentration problems across the lifespan: Findings from the MIDUS Refresher
Authors: Mogle Jacqueline , Linden-Carmichael Ashley , Miller Sara , Almeida David
Published: December 2021

Alcohol use is typically associated with impaired cognitive functioning on tasks related to attention and concentration. However, it remains unclear whether these impairments persist across days in ways that are noticeable to the individual. We examined this using the daily diary project of the Midlife in the United States Refresher cohort. Participants (n=710; Mage=50.5; range 25-75) completed 8 nights of telephone-based diaries (Mdiaries=6.87) that included questions about daily alcohol use (“how many drinks did you have today?”) and five items assessing concentration (e.g., “today, did you have difficulty concentrating?”) rated on a scale (1=none of the time to 5=all of the time). Using autoregressive multilevel models, we examined how same and previous day alcohol use related to perceived difficulties with concentration. Greater total alcohol use over the diary period was related to reports of concentration problems (b=.31, SE=.10, p=.002) though current day (b=-.03, SE=.04, p=.49) and previous day alcohol use (b=.05, SE=.04, p=.23) were not. The association between previous day use and concentration problems was qualified by an interaction with total alcohol use (b=-.07, SE=.03, p=.002). Individuals who drank less alcohol in general, experienced greater perceived concentration problems following the days on which they did drink (b=.14, SE=.07, p=.03) relative to those who drank more alcohol across the diary period (b=-.04, SE=.04, p=.36). This relationship did not vary based on age, sex, or education. These results suggest that daily alcohol use could impair concentration across days, particularly for those adults who tend to consume less alcohol.
Grassroots Approaches To Community-Based Representative Recruitment In Multidomain Trials
Authors: Hill Marcus
Published: December 2021

U.S. POINTER is a randomized, controlled, multi-domain clinical trial to slow the progression of cognitive decline within the American population via tailored and culturally-appropriate healthy lifestyle interventions. For findings to be broadly relevant across the American population, incorporating an inclusive and robust recruitment effort has been essential to form a diverse and properly representative participant cohort. As such, the trial’s inclusive enrollment goal is 30% from traditionally underrepresented communities that include those at elevated risk for Alzheimer’s disease and related disorders. To accomplish this goal, U.S. POINTER developed and deployed a grassroots recruitment strategy in partnership with outreach specialists at each site that includes a mix of evidence-based and innovative community engagement approaches. While the COVID-19 pandemic continues to present unique challenges for recruitment, our team has been able to strategize ways to continue working within the community to support trial recruitment. An overview of these methods will be presented.
Vitamin D, Insulin-Like Growth Factor, and Cognitive Performance: Age and Sex Variations
Authors: Tolea Magdalena , Chrisphonte Stephanie , Galvin James
Published: December 2021

Vitamin D has been consistently linked to better cognitive function in observational studies. This impact may be due in part through its influence on neurotrophins. Whether the relationships between vitamin D, neurotrophins, and cognition vary based on biological factors such as age and sex is unclear. Using data from a sample of 400 community-dwelling older (mean age=75.3±9.4; 47% female) participants in a cross-sectional study of cognitive aging, we assessed relationships between plasma 25-hydroxy-Vitamin D and performance on a neuropsychological battery modeled after the UDSv3.0. Moderation by age and sex and the impact of vitamin D on the relationship between Insulin-like Growth Factor-1 and cognitive performance were assessed by linear regression stratified by sex and age (median split at 76y). We found vitamin D to be positively linked to global cognition (MoCA: β=0.095±0.025SE, p<0.001), working memory (Number Span Forward: β=0.017±0.007SE, p=0.011; Number Span Backward: β=0.016±0.007SE, p=0.028), episodic memory (Immediate Recall : β=0.089±0.027SE, p=0.001; Delayed Recall: β=0.047±0.015SE, p=0.002), attention and processing speed (Trail Making A: β=-0.365±0.163SE, p=0.026), executive function (Trail Making B: β=-0.537±0.215SE, p=0.014; Number-Symbol Coding: β=0.139±0.057SE, p=0.016), and an overall measure of cognitive function (z score: β=0.049±0.018SE, p=0.007). Most of these relationships were observed in women and younger older individuals (<76y). In addition, vitamin D increased the effect of IGF-1 on global cognition and memory by 13% and 8%, respectively. Our findings suggest that vitamin D-focused dementia prevention efforts would benefit if targeted to women and younger segments of the senior population and/or as an adjuvant to cognitive enhancement interventions.
Evaluation of Episodic and Lexical Metamemory and Executive Function in Healthy Older Adults
Authors: Hayashi Atsuko
Published: December 2021

In older adults, it is important to maintain awareness of memory as well as memory performance. However, it is not clear whether the awareness of episodic and lexical memory changes with age and is related to self-evaluation of memory and executive function. Here age-related changes and the relationship between metamemory, executive function, and metamemory scale were investigated. Healthy old (n=40) and young (n=34) groups participated in this study. In the episodic memory task, participants were asked to memorize ten Kanji words and to estimate the number of words they could recall after ten minutes. In the lexical memory task, they rated the likelihood that they could write a target Kanji word written in hiragana and then wrote them down. They were also asked to complete the metamemory in adulthood(MIA) and the position stroop task. In the episodic and lexical memory and the position stroop task and MIA subscales, the performances of the younger group were significantly better than those of the older group. In the episodic memory task, there were correlations between the metamemory and MIA subscales in both groups, but in the lexical memory task, only in the old group. No correlation was found between the results of both memory tasks and the stroop test. These results suggest that older people overestimate memory performances in the episodic and lexical memory tasks and metamemory performances may be associated with self-evaluation of memory. In addition, metamemory might not be related to frontal lobe function as shown in executive function tasks.
Frailty and Processing Speed Performance at the Cusp of Midlife in CATSLife
Authors: Luna Maria , Pahlen Shandell , Corley Robin , Wadsworth Sally , Reynolds Chandra
Published: December 2021

Frailty is an important multi-domain measure of health status and aging. Processing speed (PS) performance may be predictive of later frailty among older adults, but the interrelation between frailty and PS at the cusp of mid-adulthood is unclear. Using data from the ongoing Colorado Adoption/Twin Study of Lifespan Behavioral Development and Cognitive Aging (CATSLife; N = 1213; Mean age = 33.22 years; SD = 5.0), we constructed a 24-item frailty sum score across anthropomorphic, objective health, and perceived health and engagement measures based on the Accumulation of Deficits model. PS was measured using the Colorado Perceptual Speed (CPS) and WAIS-III Digit Symbol (DS) tests. All mixed-effects regression models accounted for clustering among siblings, and covariates included sex, age, race, ethnicity, and educational attainment. Intraclass correlations (ICCs) [95% CI] for frailty among siblings, adjusted for sex and age, ranged from near zero for siblings in adoptive families, .13 [.08-.30] for nonadoptive siblings/fraternal (DZ) twins, and .44 [.40-.48] for identical (MZ) twins, suggesting possible heritable influences. Poorer PS performance was associated with higher frailty, but was significant for DS only (B: DS = -0.43, p =.005). Furthermore, the DS-frailty association was magnified by age (B: DSxAge = -0.06, p =.025), suggesting that the associations between processing speed and frailty may increase with age. These findings help elucidate the interrelationship between indicators of frailty and cognitive performance for adults approaching midlife, a salient and understudied period within lifespan development.
Intergenerational Socioeconomic Mobility and Cognitive Impairment in Chinese Older Adults: Does Gender Matter?
Authors: Fu Rong , Liu Yujun
Published: December 2021

The prevalence of dementia among older adults in mainland China is projected to increase rapidly in the next few decades. This study aimed to examine the impact of intergenerational socioeconomic mobility on the risk of cognitive impairment in a cohort of Chinese older adults, with a focus on potential gender differences. Data were derived from the 2011 wave of the Chinese Longitudinal Healthy Longevity Survey. Socioeconomic mobility in this study includes three dimensions: occupational mobility, educational mobility, and residential mobility. Cognitive impairment was assessed using the Chinese version of Mini-Mental State Examination. The final sample included 6,233 older adults aged 80 years and above. Logistic regression models were performed to assess the impact of the three dimensions of socioeconomic mobility on the risk of cognitive impairment in older men and women. For men, those with stable high occupational status across generations had the lowest risk of cognitive impairment. For women, those who received no education and lived in rural areas across generations had the highest risk of cognitive impairment. These findings lend support to the cumulative risk theory, which highlights the accumulation of risk factors that places individuals in jeopardy for negative health consequences in later life. The findings have implications for advancing supportive policies and practices related to maximizing the benefits of education and occupation for cognition in later life, especially for women in rural China.
Vascular Illness, Cognition, and Subjective Aging: Examining the Vascular Hypothesis of Aging
Authors: Dunsmore Victoria , Neupert Shevaun
Published: December 2021

Cognition relates longitudinally and cross-sectionally to physical and psychological health among older adults. The Vascular Hypothesis of Aging (Drewelies & Gerstorf, 2020) suggests that illnesses of a vascular nature (e.g., stroke, hypertension, severe varicose veins) negatively affect cognitive abilities. Awareness of age-related change (AARC) is also related to cognition. What is not known is whether the presence of a vascular illness and daily cognitive abilities interact to predict daily awareness of age-related changes. The purpose of this study is to examine the daily fluctuations of cognition, (i.e., memory failures) and their interaction with vascular illness to predict daily awareness of age-related changes. Data were analyzed from 104 participants (M age = 64.67, 60-90 years) who completed online self-report questionnaires. On Day 1, participants answered baseline questionnaires regarding presence of vascular illness, and on Days 2-9 completed measures regarding AARC losses and memory failures. Multilevel models revealed main effects of daily memory failures on awareness of age-related losses, such that on days with more memory failures, older adults reported more age-related losses. We also found a main effect for vascular illness, such that those with a vascular illness reported higher levels of daily age-related losses. We did not find a significant interaction between vascular illness and daily memory failures on daily reported age-related losses. Our results provide preliminary evidence that the vascular hypothesis of aging may also extend to perceptions of age-related changes. Future research could consider examining daily symptoms of vascular illness as they unfold over time.
Intergeneration Bonding: An Acceptability and Feasibility Study
Authors: Saidi Ladan Ghazi , Rezac Lauren , McKelvey Miechelle
Published: December 2021

Social isolation and loneliness are detrimental risk factors to older adult’s physical and psychological well-being and quality of life. Given the current situation of the COVID-19 pandemic, social isolation has risen. Social isolation affects younger adults as well and may increase the chances of depression and anxiety. In this study, we tested the acceptability and feasibility of an Intergenerational Bonding (IGB) Program with older and younger adults. Participants include students aged 19-29 at the University of Nebraska at Kearney and older adults above the age of 60 residing in the community. First, we surveyed younger and older adults to determine their interest level in participating in an IGB Program. Both groups of participants rated their interest in different activities. The most popular activities among both groups included engaging in conversations, board games, and an exchange of skills. Neither of the groups was in favor of participating in free housing opportunities or sports-related activities. Response rates were high in young adults but low in older adults, due to lack of trust. Then, in a pilot study, we measured the feasibility and acceptability of the IGB Program. Older adults residing in independent dwellings, assisted living environments, nursing homes and members of community groups were invited to participate in the intergenerational program. Response rates of older adults were low. Further, establishing collaboration with institutions such as nursing homes was not easy despite initial interest. Building trust and working with community activity group facilitators would be beneficial in recruiting older adults.
Musical experience relates to functional connectivity in older adults
Authors: Ai Meishan , Morris Timothy , Chaddock-Heyman Laura , Loui Psyche , Whitfield-Gabrieli Susan , Hillman Charles , McAuley Edward , Kramer Arthur
Published: December 2021

Previous studies have shown that engaging in musical activities throughout the lifespan may buffer age-related decline in auditory and motor function, as well as in general cognitive function. MRI studies have demonstrated that individuals with musical training and experience exhibited greater grey matter volume and functional connectivity in extensive brain regions, especially in auditory and motor systems, compared to matched controls with no particular musical training or experience. Therefore, musical activity is a potential protective factor for brain health across lifespan. However, how lifespan musical experience shapes functional connectivity in older adults is still unknown. The current analysis investigated whether general musical experience (Goldsmith Music Sophistication Index) is associated with functional connectivity in older adults (age=65.7±4.4, n=69), focusing on seed regions in primary motor areas (bilateral precentral gyrus) and primary auditory regions (bilateral anterior/posterior superior temporal gyrus) and their functional connectivity towards other areas throughout the whole brain. We found that older adults with more musical experience showed greater functional connectivity between anterior superior temporal gyrus and insula (R2=0.10, p=0.01), and between posterior superior temporal gyrus and cerebellum (R2=0.08, p=0.02). However, musical experience and music-related functional connectivity was not significantly correlated with general cognitive functions in our sample. Overall, our findings suggest that older adults with more musical experience might be more efficient in some aspects of auditory processing and auditory-motor skills, but this may not transfer towards domain-general cognitive tests. Our results support the notion that even non-professional engagement in musical experiences may afford benefits to the aging brain.
Physical Activity and Episodic Memory: An Analysis of Longitudinal Associations Over 12 Years
Authors: Tate Rio , Hueluer Gizem
Published: December 2021

With the increasing prevalence of Alzheimer’s and related dementias, it is becoming a growing public health concern to identify modifiable risk factors to prevent cognitive decline. Previous research suggest that physical exercise may promote cognitive function in aging. However, most of this research is based on experimental or cross-sectional studies and fewer studies have studied longitudinal associations over longer time frames. In the present study, we examined how physical activity is related to cognition in older adults. To do so, we applied multilevel models to data from 29,740 participants (age at baseline: M = 63 years, SD = 11 years, 50 to 102 years) from years 2004-2016, measured biennially (waves 7-13) of the Health and Retirement Study. Our findings showed that at the between-person level, those who practiced light, moderate, and vigorous- physical activity more frequently than others showed higher levels of episodic memory than others at the age of 70. At the within-person level, participants performed better than usual on a test of episodic memory on occasions when they reported more frequent physical activity of light, moderate and vigorous intensity. More frequent vigorous physical activity was related to less age-related decline in episodic memory, while the frequency of moderate physical exercise was unrelated to age-related change in memory. Contrary to our expectations, more frequent light physical exercise was related to more age-related decline in episodic memory. We discuss the implications of these findings for future research and practice.
Gender Difference in Unmet Needs Among People Aging With a Traumatic Brain Injury
Authors: Barton Kelli , Swinford Emma
Published: December 2021

Traumatic Brain Injury (TBI) can result in a myriad of short and long-term mental and physical changes and conditions. While fall-related brain injury prevention strategies and outcomes among older adults have been well-documented in previous literature, less is understood about the experiences and needs of those aging with a brain injury. The aim of this project is to explore gender differences in experiences and needs among people aging with a TBI. A Needs Assessment survey was conducted in early 2020 with adult TBI survivors and their family members in Missouri (n = 150). The mean age of respondents was 45.8 and 58% identified as male. Bivariate analyses reveal gender difference in unmet needs related to information and referral, recreation, and continuing education among TBI survivors. For example, more female respondents (43.1%) identified unmet needs associated with physical activity than their male counterparts (25.9%, p < .05). More females (61.3%) than males (43.4%) also identified unmet continuing education needs related to aging with brain injury (p < .05), whereas more males (10.8%) identified unmet continuing education needs on the topic of parenting (females: 1.6%, p < .05). Significantly more females (31.1%) than males (16.9%) identified lack of transportation as a barrier to accessing needed supports and resources (p < .05). Results will guide development of an Annual State Action Plan to maximize the independence, well-being, and health of Missourians aging with TBI and their families. A better understanding of needs and preferences can inform targeted policies, programs, and resources.