bluuebunny/crossref_metadata_2025 huggingface dataset:
Virtual reality‐based cognitive‐motor training in middle‐aged adults at high Alzheimer’s disease risk improve cerebral blood flow in the frontal cortex: A randomized controlled trial
Authors: Plotnik Meir , Livny Abigail , Harel Maayan , Doniger Glen M , Bahar‐Fuchs Alex , Bahat Yotam , Gottlieb Amihai , Ravona‐Springer Ramit , Zeilig Gabi , Beeri Michal S
Published: January 2025

Background

Increasing prevalence of Alzheimer’s Disease (AD) and limited pharmacological intervention benefits to decelerate early neurodegeneration have prompted exploration of non‐pharmacological options. Recent studies indicate that combining cognitive‐motor training enhances outcomes.

Methods

In a single‐blind, parallel‐group, randomized controlled trial of middle‐aged adults with a parental history of AD, the experimental group (N = 22) underwent training with newly developed “real‐world” intensive, progressive, virtual reality (VR) tasks, while walking on a treadmill. Tasks included challenges to sustained attention, selective attention, working memory, covert rule deduction, and planning, all in daily living contexts. An active control group without treadmill (N = 17) and another group walking on a treadmill while watching scientific documentaries (N = 16) were included. A passive control group received no training (N = 11). Training sessions were 45 minutes, twice a week, for twelve weeks. The primary neurobiological outcome, cerebral blood flow (CBF), in the superior (SFG), middle (MFG) and inferior (IFG) frontal gyri and middle temporal gyrus (MTG), was assessed using MRI arterial spin labeling at 12 weeks (i.e., post training) and at 6 months (3 months follow up). Linear mixed regression models, adjusting for age, sex, education and baseline cognition, assessed group differences.

Results

Participants averaged 56.2 (SD = 5.78), were primarily female (70%) and had undergraduate education (mean = 16.4; SD = 3.12). The groups did not differ in any baseline characteristics. The interaction of group X time on CBF of the MFG was significant (p = 0.04), such that the experimental group had an increase in CBF at 3 months which then plateaued, there were no changes in CBF in the active control groups, and the passive control group had a decline in CBF (see Figure). Similar trends were found for the SFG and IFG (p for interaction 0.07 and 0.08, respectively). No differences were found between the groups in the MTG.

Conclusion

The sustained increase in CBF, a major contributor to cognitive functioning, observed in the frontal cortex of the experimental group over three months, implies that our innovative VR intervention may beneficially affect cerebrovascular function, even in midlife. This trend underscores the potential effectiveness of our intervention in preserving healthy cognition among asymptomatic individuals at high AD risk.
Assessment of Weekly Fluctuations in Zarit Burden Interview Scores in Caregivers of Individuals with Cognitive Impairment
Authors: Thomas Neil W. , Chimehi Bahareh , Lariviere‐Chartier Julien , Ault Laura , Wallace Bruce , Beattie Zachary T , Sheehy Lisa , Steele Joel S. , Miller Lyndsey M.
Published: January 2025

Background

Current tools to assess caregiver burden in individuals caring for people living with dementia commonly involve the use of questionnaires administered at infrequent intervals. Caregiver burden can vary significantly between individuals and at different time points throughout the progression of the disease. There has been research investigating the determinants of caregiver burden, but less is known about what represents a clinically‐meaningful amount of intra‐individual change in caregiver burden. The objective of this preliminary analysis is to present data showing change in caregiver burden over time in a cohort with frequent collection of burden level.

Method

Data were derived from longitudinal studies involving the ORCATECH technology platform, consisting of ambient, wearable and other sensors deployed in participants’ homes collecting continuous data on daily activities. Participants were individuals with mild cognitive impairment (MCI) or dementia living with a caregiver (one dyad per home). Caregivers completed the Zarit Burden Interview Short Version (ZBI‐12, range 0‐48) weekly through the duration of their participation. ZBI‐12 scores and their distribution were analyzed.

Result

Data are presented from 47 dyads. Caregivers completed a total of 2949 weekly ZBI‐12 questionnaires (range 2‐118). Caregivers had a mean age of 71.3 and 68% were female. The mean ZBI‐12 score was 15.5 (SD 9.5, range 0‐44). The modal distribution of ZBI‐12 scores demonstrated peaks at 2‐4, 11‐12, and 22‐24, at low, moderate and high levels of burden. The variability in ZBI‐12 scores (standard deviation) increased with the total mean ZBI‐12 score (r2 = 0.23) per participant.

Conclusion

Caregiver burden ranged from very low to high and fluctuated week‐to‐week in the majority of caregivers of individuals with MCI and dementia. Caregivers who had a higher average level of burden also had more variability in their ZBI‐12 scores. More frequent assessments of caregiver burden could help to provide a more complete picture of the dementia care situation. Novel approaches, such as continuous monitoring using home sensors, may provide a method to assess variability in burden level. Future work will evaluate changes in ZBI‐12 scores that represent clinically meaningful differences in caregiver burden and sensor outcome measures that predict higher levels of burden.
Association of cholesterol, triglycerides, and triglyceride to HDL cholesterol ratio with cognitive decline
Authors: Vidal‐Ferreira Naomi , Bittencourt Marcio S , Bensenor Isabela M , Lotufo Paulo A , Suemoto Claudia Kimie
Published: January 2025

Background

The association of serum cholesterol with cognitive performance is controversial. Besides, little is known about the association of triglycerides to HDL cholesterol ratio (TG/HDL‐c) with cognitive performance. We aimed to verify the association of baseline cholesterol, triglyceride, and TG/HDL‐c levels with cognitive decline in the Brazilian Longitudinal Study of Adult Health (ELSA‐Brasil) during eight years of follow‐up.

Method

We collected baseline fasting total cholesterol (TC), LDL‐cholesterol (LDL‐c), HDL‐cholesterol (HDL‐c), triglycerides (TG), and computed non‐HDL (TC minus HDL‐c) and TG/HDL‐c (triglycerides divided by HDL‐c). Cognition was assessed in three waves four years apart using the CERAD word list, semantic and phonemic verbal fluency, Trail Making Test B (TMT‐B), and a global composite score. We used inverse probability weighting to account for attrition bias and linear mixed models to investigate the association between lipids and cognition.

Result

In 12,803 participants at baseline, mean age was 51.4±8.87, 55% were women, and 43% were black. After a median follow‐up of 8.2 (7.9‐8.5) years, compared to the second quintile, lower (first quintile) and higher HDL‐c levels were associated with faster memory decline, while higher HDL‐c levels were related to faster global cognitive decline (Table 1). Compared to the second quintile, higher levels of TG were associated with faster memory and global cognitive decline (Table 2). Compared to the second quintile, higher levels of TG/HDL‐c were associated with faster memory decline, while lower (first quintile) and higher levels of TG/HDL‐c were related to faster verbal fluency and global cognitive decline (Table 3). TC, LDL‐c, and non‐HDL were not associated with cognitive decline.

Conclusion

After eight years of follow‐up, HDL‐c, triglycerides, and TG/HDL‐c levels were associated with global and domain‐specific cognitive decline.
Digital Elder Abuse Intervention for Early Detection of Abuse in Older Adults Living with Dementia
Authors: Abujarad Fuad , Edwards Chelsea , Neugroschl Judith A. , Hwang Ula , Marottoli Richard
Published: January 2025

Background

Elder abuse (EA) is a major public health problem and older people living with dementia (PLWD) are not likely to self‐report EA. As a result, identification of EA remains low, and providers often miss the opportunity to identify EA during Emergency Department (ED) visits. We present a pilot study on adapting an evidence‐informed intervention to motivate PLWD to self‐report abuse despite existing cognitive challenges.

Method

Our tablet‐based digital health intervention, VOICES, was developed to increase self‐reporting of EA among PLWD. VOICES uses educational content, screening, multimedia elements, and brief psychoeducational interviewing with a digital coach to motivate PLWD to report abuse on their own. VOICES’ success was previously demonstrated with at least 1,000 cognitively intact participants (ages 60+) in the ED and primary care setting and piloted with PLWD at a geriatric memory clinic (N = 30). This study evaluated using VOICES among PLWD (ages 60+ years) in the ED setting (N = 101). Participants were recruited, consented, and enrolled at Yale New Haven Health System in New Haven, Connecticut, USA. We used the Montreal Cognitive Assessment (MoCA) to assess cognitive ability of participants, excluding those with severe cognitive impairments.

Result

Ninety‐nine older adults with MoCA scores between 14 and 25 used VOICES independently and completed post‐survey questions. Satisfaction was high across all participants. Of all participants, eight self‐reported EA. 75% of participants who self‐reported (6/8) were offered additional services following a social worker evaluation, and 12.5% of participants who self‐reported (1/8) were reported to Adult Protective Services for EA.

Conclusion

Our findings suggest that not only is VOICES feasible (i.e., acceptable, practical, and satisfactory) for detecting EA in PLWD (MoCA scores 14‐25), but can provide additional services to those who would have otherwise gone discharged without intervention. VOICES may be able to be used for early detection and prevention of severe abuse for this high‐risk population. More research is needed to determine efficacy and long‐term outcomes of the benefits and harms.
Contrast in beliefs and knowledge about dementia risk reduction in Southern Latin American Indigenous and non‐Indigenous older adults: A qualitative analysis
Authors: Aravena Jose M , Muñoz Habana , Vargas Daniela , Albala Cecilia , Levy Becca R
Published: January 2025

Background

Although ethnic and cultural aspects can influence health behaviors, no studies have compared views about dementia and brain health between Indigenous and non‐Indigenous people living in the same territory. Therefore, we contrasted beliefs and knowledge about dementia risk reduction between Indigenous (Mapuche) and non‐Indigenous older adults in Chile.

Method

An exploratory qualitative study was conducted with people 60 years and older, self‐identified as Mapuche (‘people of the land’) or non‐Mapuche, with no dementia. We recruited people living in urban and rural settings of Santiago and the Araucania region of Chile using a convenience and snowball strategy. Interviews covered topics such as cognitive changes of aging and dementia, dementia risk factors, and practices for brain health. Thematic analysis following grounded theory and inductive analysis were used to generate main topics.

Result

A total of 24 in‐depth interviews (Mapuche: 14, non‐Mapuche: 10) were analyzed. For Mapuche people engaged in cultural religious practices, dementia was described as a ‘transition to their ancestors’ spiritual plane’. Regarding potential risk factors of dementia, Mapuche people were more prone to refer to trauma and grief, low‐quality food, social problems, and alcoholism as major risk factors. Non‐Mapuche people were more likely to mention loneliness and depression, as major risk factors. Regarding positive elements for brain health, non‐Mapuche people highlighted participating in more activities, an ‘active attitude’, social activities engagement, and cognitive activities. In contrast, Mapuche people prioritized ‘being in balance’ (referred to as avoiding any kind of ‘excess’, or mind‐body and person‐environment connections), natural nutrition, good sleep, pride in being Mapuche, and engaging in traditional Mapuche activities like agriculture and handcrafts as ways to promote brain health.

Conclusion

Even though groups share some common views about memory problems, there are differences in conceptions about the causes and prevention of dementia between Mapuche and non‐Mapuche older adults. Cultural and ethnic determinants may influence views and practices toward brain health and should be considered for designing dementia risk reduction interventions.
Wearable Internet‐of‐Thing Technology to Measure Sleep of Diverse Caregivers: Preliminary Results from a Randomized Controlled Trial
Authors: Lee Jung‐Ah , Zhang Jiuchen , Rahmani Amir , Qu Annie
Published: January 2025

Background

Family caregivers of persons with dementia (PWD) suffer from constant caregiving burden resulting in poor sleep quality. Understanding sleep parameters (e.g., total sleep, light, deep, REM sleep, awakening, latency) of the caregivers are important to improve sleep and self‐care behaviors. Wearable Internet‐Of‐Things (WIOT) technology (i.e., smartring‐smartphone‐cloud) would help monitor real‐time sleep quality of caregivers. WIOT is an objective tool to measure sleep parameters of caregivers with diverse ethnic background who might have limited English proficiency that could affect self‐report on survey sleep scales. The purpose of the study was to examine the effect of caregiver support intervention on sleep and to identify which characteristics of caregivers would get benefit from the intervention in relation to sleep.

Methods

The study is a randomized controlled trial (RCT) including (1) a 3‐month culturally and language specific home‐based caregiver support intervention group (IG) and (2) attention control group (CG) without the intervention. All caregivers of PWD recruited from community outreach in California were asked to wear smartrings for 3 months to monitor their sleep in real‐time. Linear mixed models were performed using Python for data analyses including sleep and demographic variables.

Results

103 caregivers participated in the RCT: mean age = 65 years (SD = 13), 78% females, 58% spouses, 53% with college education, race/ethnicity including 27% non‐Hispanic white, 16% Hispanic, 33% Korean, 24% Vietnamese. On daily average, REM sleep duration was significantly increased by 0.06 minute in IG and decreased 0.12 minute in CG (P<.001). In sub‐group analysis, average onset latency time were significantly improved in adult‐child caregivers compared to spousal caregivers (P = 0.016). The improvement of adult‐child caregivers’ sleep latency duration was in the reference range of 10‐20 minutes. Participants showed favorable interest in real‐time monitoring of their sleep through WIOT technology and better understanding of their sleep. Currently, the study participant recruitment is on‐going.

Conclusion

The preliminary results showed that WIOT measures on sleep were feasible among ethnically diverse caregivers of PWD. The intervention effect on sleep was found among adult‐child caregivers. Intervention may focus more on support for spousal caregivers in using WIOT technology to better understand their sleep quality.
A Non‐Pharmacological Perspective to Memory Improvement in Dementia
Authors: Dadoo Niharika , Prakash Ajay , Medhi Bikash
Published: January 2025

Background

Dementia is a progressive clinical syndrome which is marked by pervasive cognitive impairment and deterioration. With the ever‐increasing number of people living with dementia, it has become a global concern. Current medications focus on slowing the progression of dementia and managing the comorbidities and not on directly enhancing memory. Cholinesterase inhibitor drugs like donepezil are prescribed to enhance neurotransmitter function and regulate brain cell activity, thus reducing cognitive decline but they leave memory unaddressed.

A combination of psychology and pharmacology can lead to a more holistic approach to addressing dementia. Newer methods like art therapy can be used in adjunct to pharmacotherapy. Art therapy is a nonverbal creative approach to work around cognitive, memory, motor, emotional and social concerns in dementia. Cultural arts interventions (dance, visual arts, storytelling/theatre, music, and art) can expand the personhood and quality of life of those experiencing dementia. According to Kinney & Rentz (2005), participation in creative arts enhances the social and psychological well‐being of people with a diagnosis of dementia and their caregivers. Drawing, painting collaging and colouring can enhance memory and create an overall sense of wellbeing. Making visual art improves neuroplasticity and the connections between different brain regions. Creative arts programs in the community set‐up can prove to be a non‐stigmatising environment to engage the individuals, their caregivers and the community.

Conclusion

Community‐driven art programs can empower social bonds and people with the tools to contribute to supporting those living with dementia. More research is required on how art and psychotherapy can work in adjunct with pharmacotherapy in reducing the symptoms of dementia.
A prospective association between sensory impairment and cognitive performance among older community‐dwelling adults: The role of depressive symptoms
Authors: Khalaila Rabia , Grebe Lauren A , Allen Isabel Elaine
Published: January 2025

Background

There is a link between visual and hearing impairments and poor cognition in older people, although it is not clear how depressive symptoms contribute to this association. Specifically, this study examines how sensory impairment (vision and hearing) affects cognitive performance and how depression mediates that effect.

Method

We examined whether vision and hearing impairment affects cognitive performance and whether depression mediates that effect. Utilizing data from the Survey of Health, Ageing and Retirement in Europe which assessed 32,325 participants in 2011 (baseline, Time 1) and 2015 (follow up, Time 2), we analyzed sociodemographic and health factors, self‐reported vision and hearing impairment at baseline, depression, and cognitive performance at the 4‐year follow‐up. A multiple mediator model was tested by bootstrapping with resampling strategies.

Result

At baseline, 22.9% had impaired vision only, 10.2% impaired hearing only, and 10.4% impairment of both. We found significant negative association between vision impairment (b = ‐0.023, p = 0.001) and dual sensory impairment (b = ‐0.083, p = 0.001) and cognitive performance; both were also associated with depression, which in turn was linked with poor cognition.

Conclusion

Visual impairment or dual sensory impairment among older adults are associated with poor cognitive function directly and indirectly by increasing depression symptoms.
Challenges Involved in Caring for a Loved One Who is Living with Dementia and the Potential Appropriateness of an Innovative Gaming Activity for Social and Emotional Wellness: Exploring Focus Group Results from Caregivers of Clients Involved in a Group Digital Gaming Intervention
Authors: Hand Michelle D , Inoue Megumi , Koizumi Naoru , Booker Emma , Nosrat Sarah , Mehak Samreen , Shaikh Eyesha
Published: January 2025

Background

Slowing the progression of dementia and maintaining mental and social wellness are important for people living with dementia (PWD) and their caregivers. Social engagement can help with delaying the onset of dementia among people living with mild cognitive impairment. Maintaining meaningful social engagement through activities, such as gameplay, can promote a sense of belonging and identity while maintaining mental functioning. Physical activities can also improve strength and cognitive outcomes in PWD. Nursing homes, assisted living facilities, and adult day health centers provide various types of activities that encourage social, physical and mental wellness for PWD (e.g., through gameplay). A group gaming system, Obie Technology, was developed to promote these activities, to facilitate movement, cognitive exercises, and social interaction. This study explored the potential appropriateness of a group gaming intervention on cognitive function, mood, and behavior in PWD. The qualitative focus group results with caregivers will be presented.

Method

Included were caregivers of clients in an adult day health center who were selected to participate in a group digital gaming intervention. All clients that were cared for by the participants were living with mild‐ or moderate‐stage impairment. Three semi‐structured focus groups were conducted, to discuss what it is like to care for someone living with mild‐ or moderate‐stage dementia, client mood, and participant questions surrounding the gaming intervention.

Results

The three focus groups lasted approximately one hour each, and were conducted with a total of 21 participants, who were caring for PWD selected for the group gaming intervention. The results illuminate caregiver perceptions surrounding their challenges in providing care to PWD and the appropriateness of the gaming intervention for PWD.

Conclusion

Challenges were discussed surrounding changes in relationships with loved ones, who were primarily spouses or parents of the participants. Participants also discussed challenges surrounding anger and aggression expressed by clients toward them as caregivers. Concerns were expressed about the possibility of the digital gaming intervention resulting in falls among the clients as well, adding to these challenges. These results will be further discussed, along with implications for research, practice, and policy centered around PWD and their caregivers.
Blood biomarker profiles in autopsy‐diagnosed carriers of different PSEN1 mutations relative to sporadic Alzheimer’s disease and controls
Authors: Lafferty Tara K , Sehrawat Anuradha , Zeng Xuemei , Chen Yijun , Klunk William E , Pascoal Tharick A. , Cohen Ann D , Villemagne Victor L , Kamboh M. Ilyas , Lopez Oscar L. , Abrahamson Eric E , Berman Sarah , Kofler Julia , Ikonomovic Milos D , Karikari Thomas K
Published: January 2025

Background

Specific PSEN1 mutations cause early‐onset AD but their effects on blood biomarker levels are unknown. We evaluated autopsy‐confirmed individuals affected by six different PSEN1 mutations; two of known (L381V, C410Y) and three (A426P/E318G, M233L, and V261I) of unknown pathogenic status. The sixth patient had Autosomal Dominant AD (ADAD) not yet genotyped. Neuropathologically diagnosed sporadic AD (sAD; n=8) and unaffected controls (n=7) were included for comparison.

Method

The participants, except the controls, had brain autopsy performed under informed consent at the University of Pittsburgh Alzheimer’s Disease Research Center. Genetic testing was performed to confirm the presence of PSEN1 mutation(s). Blood was collected, processed, and stored during life. Plasma p‐tau217, p‐tau181, neurofilament light (NfL), glial fibrillary acidic protein (GFAP), amyloid beta (Ab) 40 and 42 were measured using commercial assays on Simoa HDX at the Biofluid Biomarker Laboratory, Department of Psychiatry, University of Pittsburgh.

Result

Plasma p‐tau217 and p‐tau181 were increased 5‐8‐fold and 3‐4‐fold in the PSEN1 and sAD groups respectively versus controls. GFAP had 4‐fold increase in both sAD and PSEN1 groups while NfL was highest in sAD. Ab42, Ab40 and Ab42/40 showed no between‐group differences. Individuals with the two pathogenic mutations recorded the highest levels of p‐tau217, p‐tau181, GFAP and NfL, with the A426P/E318G carrier also having a comparably high p‐tau181.

Conclusion

Marked elevation of plasma p‐tau and GFAP suggest increased tau phosphorylation and astrogliosis in ADAD while neurodegeneration intensity (by NfL) may be comparable to sAD.
Spirituality and Cognition in Black Older Adults: Examining Changes in Church Activity
Authors: Britt Katherine Carroll , Dong Fanghong , Massimo Lauren M , Hamilton Jill B , Hodgson Nancy A , Stites Shana D. , Mechanic‐Hamilton Dawn
Published: January 2025

Background

Historically underrepresented populations experience a disproportionate burden of Alzheimer’s disease and Alzheimer’s disease related dementias (AD/ADRD) compared to White populations. As a salient resource for coping in Black communities, spiritual and religious practice may support better cognitive health, but it is unknown if changes in these practices are related to cognitive decline.

Methods

We analyzed secondary data of cognitively normal (via Consensus Conference at enrollment) older adults in the U.S. (N = 158) from The University of Pennsylvania Alzheimer’s Disease Research Center (ADRC) Aging Brain Cohort (ABC) in 2021‐2022 to examine associations between change in spiritual and religious practice (i.e., major change in church activity) with cognition, separately between racial groups (Black (n = 44), White (n = 114)). Self‐reported age, sex, education, and number of friends interacted with monthly were entered as control variables in multivariable regression analysis.

Results

Cognitively normal participants had a mean age of 74.4(6.54) years, were 64.6% female, and reported 16.7 (2.40) mean years of education. Significant associations were found for Black but not White older adults between major change in church activity (measured with one item: major change in church activity during the previous year (i.e. a lot more or less than usual)) with lower cognition (measured with Global Clinical Dementia Score) (β = 0.19, 95%CI [0.04, 0.34], p<0.05) controlling for age, social interaction, sex, and education.

Conclusion

A reported change in church activity over the last year was associated with a lower rating of cognitive and functional status among Black but not White older adults. As some individuals may progress, an early indicator of cognitive or functional change may be reported changes in church activity for older Black adults, for which spirituality is a cultural resource that may support cognitive health. Longitudinal studies are needed to further assess temporal associations between change in church activity and cognition in Black communities; maintaining church activity may be important in supporting cognitive and functional stability. The absence of significant findings in older White adults may be influenced by cultural differences that warrant further investigation and consideration in future research.
Frequency of modifiable risk factors in primary care compared with tertiary care in Brazil
Authors: de Freitas Núbia Alencar , Borelli Wyllians Vendramini , Rosa‐Neto Pedro , Castilhos Raphael Machado , Martins Sheila O , Vasques Vivian Silveira , Carello‐Collar Giovanna , Tello Brunna Jaeger , Zimmer Eduardo R. , Farina Jeanette Inglez‐de‐Souza , Araujo Mariana Dagnino , Maia Alberto Luiz Grigoli , Fuhr Anelise
Published: January 2025

Background

The Better at Home Program (BHP) is a Brazilian government initiative to provide dehospitalization through homecare health access in primary care. The profile of modifiable risk factors of dementia in this vulnerable population may provide targets for public health policies, as it represents the majority of the Brazilian population. In this study, we aimed at investigating the profile of modifiable risk factors in primary care compared with a tertiary care clinic in Brazil.

Method

Community‐dwelling patients attending the BHP and from tertiary memory clinics were invited to participate. We collected demographic variables, the profile of modifiable risk factors of dementia, neuropsychological battery and blood sampling of both primary and tertiary care settings. Frequency of risk factors were compared with chi‐squared tests and quantitative demographic variables were compared with parametric tests.

Results

A total of 59 patients were included in primary care (mean 72.3±7.9 years of age, 62.7% females) and 63 in tertiary care setting (mean 70±11 years, 66.6% females). Primary care patients were significantly less educated compared with tertiary centers (7.44±3.9 vs. 16±5.34), and more racially diverse (Table), with similar MMSE scores (22.76±5.31 vs. 22±6.97). The profile of frequency of modifiable risk factors of dementia was distinct according to the level of care (Figure). Specifically, individuals from primary care presented increased frequency of low education (23 vs. 3, p = 0.03), social isolation (37 vs. 22, p = 0.007), physical inactivity (31 vs 10, p = 0.0001) and smoking. Furthermore, people in homebound situations were identified only in the primary care group (11 vs. 0, p<0.001).

Conclusion

Patients from primary care services present a distinct profile of modifiable risk factors of dementia when compared with tertiary care. They presented increased frequency of low education, social isolation, physical inactivity, and smoking. Public policies targeting primary care populations in LMIC may address risk factors differently.
A Prognostic Model to Predict Risk of Dementia or Death in Older Veterans with Traumatic Brain Injury (TBI)
Authors: Barnes Deborah E , Li Yixia , Boscardin W John , Bahorik Amber L , Peltz Carrie B. , Yaffe Kristine
Published: January 2025

Background

Prior studies have found that traumatic brain injury (TBI) is associated with increased risk of both death and dementia in older adults including veterans. Clinically, it would be useful to be able to accurately predict the likelihood of these two outcomes for a given patient.

Method

Our study population included all individuals aged 55 years or older who received care from the Veterans Health Administration between 2002 and 2019, had a TBI diagnosis, had at least one post‐TBI healthcare visit, and did not have a dementia diagnosis or medication before or up to 1 month after the TBI (n = 113,779). We used multinomial logistic regression with Lasso to develop a prognostic model that simultaneously predicts risk of dementia or death. Potential predictors included demographics, medical and psychiatric comorbidities, and healthcare utilization variables. Model accuracy was assessed based on c‐statistics. We also calculated observed outcome rates over decile of predicted risk and performed stratified analyses to assess for differences in accuracy based on TBI severity and combat veteran status.

Result

Cohort members had a mean ± SD age of 68 ± 10 years; 6% were female; and 20% were non‐White or Hispanic. The final model included 22 variables. Key predictors included older age, being male, number of inpatient visits, and comorbidities including Parkinson’s disease, diabetes, weight loss, epilepsy, substance use disorder, and psychosis. The c‐statistics were 0.756 (95% confidence interval: 0.751, 0.761) for dementia and 0.783 (0.779, 0.786) for death. Model accuracy was slightly better for mild vs moderate/severe TBI (0.777 vs. 0.743 for dementia, 0.805 vs. 0.755 for death) and for combat vs. non‐combat veterans (0.776 vs. 0.751 for dementia, 0.806 vs. 0.776 for death). The observed proportion who developed dementia ranged from 3% to 43% over decile of predicted risk, while the observed proportion of deaths ranged from 4% to 64%.

Conclusion

A single prognostic model that includes demographics, comorbidities, and utilization variables can predict risk of dementia or death in older veterans who have experienced TBI with good accuracy. Additional studies are needed to determine how this information might best be utilized to support better care.
The mediating effect of BMI on the association between gender and domain specific cognition in a diverse cohort of individuals 80+
Authors: Meunier Claire C. , Roscoe Joseph , Gilsanz Paola , Corrada María M. M. , George Kristen M. , Glymour M. Maria , Mayeda Elizabeth Rose , Gavett Brandon E , Posis Alexander Ivan B. , Whitmer Rachel A.
Published: January 2025

Background

Gender differences are often associated with specific cognitive domains. Additionally, gender may be associated with BMI through biological and social differences. We evaluated if mid‐life BMI mediated the effect of gender on domain specific cognition in an ethnoracially diverse population of individuals 80+.

Method

Data from three ongoing cohort studies, LifeAfter90, Kaiser Healthy Aging and Diverse Life Experiences, and Study of Healthy Aging in African Americans, was pooled to include participants aged 80+ (n = 671). Baseline verbal episodic memory (VEM), executive function (EF), and semantic memory (SM) were measured using the z‐standardized Spanish English Neuropsychological Assessment Scales. Mid‐life BMI was categorized as normal (18.5‐24.9 kg/m2), overweight (25‐29.9 kg/m2), and obese (30 kg/m2) using the first clinical measurement at ages 40‐60. Structural equation models were used to estimate the indirect effect (IDE) of mid‐life BMI category on the association between gender and cognition adjusting for age at baseline cognitive assessment, age at BMI measurement, racial/ethnic identity, and education.

Result

Participants were 37% male, 17% Asian, 35% Black, 12% Latino, 33% White, 3% other racial/ethnic group with a mean age of 88.5±5.3 at baseline cognitive assessment and a mean age at mid‐life BMI measure of 44.6±4.3 years (table 1). Midlife obesity (9%) and overweight (31%) were common. The total effect of gender (ref = women) on each cognitive domain was significant (VEM: ‐0.19, p < 0.001; EF: ‐0.12, p = 0.001; SM: 0.202, p < 0.001). Five percent (p‐value = 0.07) of the association between gender and VEM was explained by BMI category (IDE (β = ‐0.01; p‐value = 0.06) divided by total effect (β = ‐0.19; (p‐value<0.001); Figure 1). BMI did not mediate the association between gender and SM (β(IDE) = ‐0.003;p‐value = 0.29) or between gender and EF (β(IDE) = ‐0.005; p‐value = 0.19).

Conclusion

In this ethnoracially diverse population of individuals aged 80+, mid‐life BMI marginally mediated the association between gender and baseline VEM, while it did not mediate the associations with EF and SM. Additionally, men had lower EF and VEM but higher SM compared to women. The effect of mid‐life BMI on the association between gender and cognition may vary by cognitive domain, suggesting that mid‐life BMI may impact specific late‐life cognitive functions that are associated with VEM.
CREATE: Enhancing Cognitive Reserve through Assistive Technology in Elderly Care – Introduction to a Primary Prevention Program
Authors: Taurisano Paolo , Abbatantuono Chiara , Gasparre Daphne , Biasi Madia Marika , Paparella Giulia , Dentamaro Vincenzo , Veneto Davide , Impedovo Donato , De Caro Maria Fara
Published: January 2025

Background

In the international landscape, assistive technologies are often integrated into programs to support elderly individuals with dementia and/or multiple disabilities (Lancioni et al., 2021). However, there is a need to extend these interventions to primary/secondary prevention of such conditions in the elderly population at higher risk. In response to this need, the collaboration between the U.O.S. of Psychology and Clinical Neuropsychology in Bari and the Welfare Association in Levante offers a novel program for active aging based on the use of health tracking smartwatches in the prevention of neurocognitive disorders

Method

We enrolled 10 MCI subjects who were over 65 years old and had them wear a smartwatch for a period of 6 months. The program requires participants to wear smartwatches that track their health using different sensors. These watches monitor various health parameters and provide personalized prompts. The goal of the program is to improve cognitive reserve, promote independence, and increase participants' awareness of their lifestyle. This is all done through a structured intervention and training sessions as part of the C.R.E.A.T.E. program.

Result

The use of affordable and easily accessible everyday technology, such as wristwatches connected to smartphones or PCs, has been proven to create a physical and psychological environment that participants perceive as “protected” and “safe.” This technology provides practical support for daily activities from the beginning of the intervention and helps maintain learned habits over time. Furthermore, the effectiveness of the technology is confirmed by the adoption of systematic indicators and criteria, which verify the observed behavioral changes in participants.

Conclusion

The future integration of wearable technologies, such as smartwatches, with artificial intelligence is becoming increasingly important. This integration allows for interventions to be tailored specifically to each patient, which further enhances the effectiveness of preventive and supportive strategies in promoting active aging.
Neuroimaging Correlates of Alzheimer’s Disease biomarkers in a mid‐life, racially diverse high‐risk cohort
Authors: Misiura Maria , Munkombwe Chinkuli , Igwe Kay C. , Verble Danielle D , Likos Kelly D. S. , Zetterberg Henrik , Dotson Vonetta M , Brickman Adam M. , Wharton Whitney
Published: January 2025

Background

Clinicians and researchers utilize neuroimaging (NI) biomarkers of Alzheimer’s disease (AD) at an increasing rate. It is crucial that we determine whether these biomarkers generalize to underrepresented populations, particularly Black Americans (BAs), as they are 64% more likely as white individuals to develop AD. BAs may exhibit unique AD biomarker profiles across disease states, including NI biomarkers. Investigating biomarkers in at‐risk individuals may allow for early identification and intervention. Here we analyze comprehensive NI biomarkers including resting state fMRI, white matter lesions, and hippocampal volumes in conjunction with cerebrospinal fluid (CSF) markers in a midlife, racially diverse, cognitively normal cohort with a parental history of AD.

Method

Data included 57 cognitively normal, middle‐aged individuals, 14 BAs and 43 white. CSF was acquired via lumbar puncture to determine CSF t‐tau and Aβ1–42 concentrations. Using resting state fMRI data, we analyzed default mode network connectivity between the posterior cingulate & precuneus, parrahippocampal gyrus (PHG), temporal pole, hippocampus, and lateral temporal cortex. We obtained regional WMH data from FLAIR images using an in‐house algorithm, and hippocampal volumes from Freesurfer. In our multivariate model, outcome variables were connectivity values, regional WMH and hippocampal volumes, with race and CSF t‐tau and Aβ1–42 as our independent variables with a race X CSF interaction term.

Result

We identified a significant race X t‐tau and race X Aβ1–42 interaction term for temporal and parietal WMH volumes and connectivity between PHG and temporal pole. Higher AD CSF biomarkers negatively correlated with brain connectivity (p=0.01), and positively with WMH volume (p<0.001) in BAs.

Conclusion

We extend our previous work to a middle‐aged cohort to show that DMN connectivity may be a predictor of AD risk in middle‐age, particularly for BAs, and that BAs may exhibit earlier vulnerability to vascular lesions. We support previous work that the temporal lobe is the first region to experience AD‐related connectivity changes, and that WMHs may predispose this region to AD vulnerability. This study emphasizes the need for recruitment of diverse cohorts in NI studies of AD.
Midlife hypertension status does not mediate associations between childhood community advantage and MRI‐derived markers of late‐life brain health
Authors: Peterson Rachel , Gilsanz Paola , George Kristen M. , Maillard Pauline , Jimenez Marcia Pescador , Barnes Lisa L. , Decarli Charles , Whitmer Rachel A.
Published: January 2025

Background

Prior research suggests living in an advantaged community in childhood is protective for late‐life cognition and MRI‐derived markers of brain health, independent of individual socioeconomic status. We examined the extent to which this effect is mediated by midlife hypertension status.

Method

KHANDLE and STAR are racially/ethnically diverse cohorts of older adults residing in northern California. A random subset of participants underwent 3T MRI; regional brain volumes and white matter integrity were derived. Participants’ self‐reported birth address was geocoded and linked to historical county‐level Area Deprivation Indices (ADI) for the Census decade of residence (1920‐1970). Childhood community advantage was defined as ADI<20, (i.e., most advantaged quintile nationally). Midlife hypertension was derived from prospectively collected blood pressure (bp) at ages 30‐45 and defined as systolic/diastolic bp ≥130/80 or prior hypertension diagnosis. Generalized linear models estimated the direct (c’) and total effects (ab+c’) of ADI on imaging measures among participants age 65+, adjusting for age, sex, race/ethnicity, and education. Indirect effects (ab) via midlife hypertension were calculated by subtracting direct from total effects. Standard errors were bootstrapped with 500 replications.

Result

Imaging participants (n = 392) from advantaged childhood communities were younger (mean age = 72.6 vs. 76.4), had more education (15.3 vs. 14.3 years) and were less likely to have midlife hypertension (49% vs. 58%; Table 1). The total effect of childhood community advantage was associated with better MRI‐derived measures of brain health (e.g., total gray β = 0.26, 95%CI = 0.04, 0.48; lateral ventricle β = ‐0.22, 95%CI = ‐0.44, ‐0.003; log white matter hyperintensity volumeβ = ‐0.35, 95%CI = ‐0.56, ‐0.13; Table 2, column A). The direct effect of not having midlife hypertension was associated with better MRI‐derived measures of late‐life brain health (e.g., total gray β = 0.31; 95%CI = ‐0.10, 0.53); Table 2, column D). Null indirect effects (Table 2, column C) indicate the effects of childhood community advantage on MRI‐derived measures are not mediated by midlife hypertension status.

Conclusion

Late‐life brain health benefits among participants from an advantaged childhood community were not explained by the absence of midlife hypertension. Future work will investigate additional modifiable risk/protective factors as alternative mechanistic pathways by which community advantage may affect late‐life brain health.
The process of creating culturally and linguistically appropriate materials on dementia for Hmong and Cambodian elders
Authors: Yang Kao Lee , Thor Yer , Bendlin Barbara B. , Chin Nathaniel A.
Published: January 2025

Hmong and Cambodian Americans, minoritized Asian American subgroups, are underrepresented in research, and prevalence of Alzheimer’s disease (AD) in these communities is unknown. However, our community partners in the Madison, Wisconsin area, who have served Hmong and Cambodian elders in the community for over 20 years, informed us in the fall of 2021 that they have encountered cases of dementia among elders they serve. They expressed a need for educational materials on dementia that could aid their community work. Following this meeting, we spent the year 2022‐2023 developing culturally and linguistically appropriate informational brochures on dementia.

Brochures were developed with funding from the UW‐Madison Morgridge Center for Public Service. The project involved a diverse team of dementia researchers, community partners with expertise in providing wraparound services to the Hmong and Cambodian communities, a geriatrician, professional Hmong and Cambodian translators, and a professional graphic designer. The brochure development process was iterative. We started by researching existing educational materials on dementia for individuals with various health literacies. A draft of a 3‐panel brochure was drawn up by the first author in English and discussed with the team. Verbiage for each panel was carefully chosen based on feedback from our community partners. Specifically, the brochure would minimize verbosity and technical terms so elders could more easily grasp concepts. The graphic designer skillfully enhanced our preliminary brochure design. The translators worked in consultation with the first author to ensure the brochure’s overall concepts were accurately translated. The final product was a single brochure on dementia available in Hmong, Khmer (the Cambodian language), or English (Figure). Brochures were then disseminated to our community partners and during community events in the spring and fall of 2023.

Our project demonstrates the feasibility of creating brochures that are culturally and linguistically tailored for the Hmong and Cambodian communities. We found the collaborative efforts of experts across various fields and vital insights from community partners familiar with target audiences to be imperative in our success. Similar initiatives should prioritize assembling diverse teams and engaging with community specialists at the beginning of the project to best reach underrepresented groups.
Obstructive Sleep Apnea and Alzheimer’s Disease in Down Syndrome
Authors: Yoon Dasoo Milton , Schworer Emily K , Fleming Victoria L , Handen Benjamin L , Peven Jamie C , Plante David T , Hartley Sigan L
Published: January 2025

Background

The present study examined OSA using an objective home sleep test in 81 adults with DS (aged 25 ∼ 61 years) and evaluated associations between sleep‐disordered breathing problems and biomarkers of AD pathology (PET Aβ and tau) and symptomology (cognitive performance and depressed mood).

Method

As part of the ABC‐DS study, participants completed a 2.5‐hour battery of cognitive measures and underwent MRI and PET imaging scans and a blood draw. Study partners completed informant measures to report on the participant’s sociodemographics, dementia symptoms, and mood. As part of the lifestyle auxiliary study, the adult with DS wore the WatchPAT 300 device for one night to assess sleep‐disordered breathing and caregivers reported on sleep habits and any sleep‐related conditions or treatments. The adults with DS and study partners earned up to $200 for completion of ABC‐DS study activities and $50 for completion of WatchPAT study activities.

Result

Of the 81 participants with valid sleep data, 67 (83%) screened positive for OSA based on the WatchPAT data. When considering pAHI, 25 (31%) had mild OSA, 19 (24%) had moderate OSA, and 22 (27%) had severe OSA. In total, 25 of the 39 (64%) participants without a medical diagnosis of OSA screened positive for OSA based on the WatchPAT. A chi‐square test indicated no significant difference in OSA severity level (none, mild, moderate, severe) between participants who did versus did not have a medical diagnosis of OSA (𝝌2 = 1.648, p = .648). Main findings between sleep and biomarker variables included PET Aβ being significantly associated with mean of desaturations, wake state, and total sleep time, while tau being significantly associated with % of REM Sleep, minimum oxygen level, wake state, and number of wakes.

Conclusion

Findings indicate there is a high prevalence of sleep problems and OSA in adults with DS. There were also significant correlations between the presence and severity of OSA‐related sleep problems with higher PET Aβ and tau levels, as well as more AD‐related cognitive impairments and worse mood.