bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of an intergenerational training program in the use of information and communication technologies for older adults who receive cognitive intervention in the context of a Covid‐19 pandemic: Preliminary results
Authors: Feldberg Carolina , Crivelli Lucia , Tartaglini María Florencia , Martin Maria Eugenia , Garcia Lydia Moya , Hermida Paula Daniela , Natalia Irrazabal , Somale Maria Veronica , Sevlever Gustavo , Allegri Ricardo Francisco
Published: February 2022

Background

Worldwide, the Covid‐19 pandemic impacted on professionals and patients receiving cognitive rehabilitation (CR) forcing them to instrument assistance programs through tele‐neuropsychology. Many of those who receive CR are older adults who lack the necessary technological knowledge to carry out CR through teleneuropsychology. The present study aims to evaluate the impact of a training program on technological tools, carried out by high school students, for older adults who received CR through teleneuropsychology.

Method

Design: Pre‐post, longitudinal intervention study. Participants: Older adults (n=13) (73.34 +/‐ 5.07 years old) and Students (n=20) (16.14 +/‐1.33 years old). The intervention consisted of a 4 week program for technological training. Participants were assessed at the beginning and the end of the program which consists in two training sessions of 45 minutes each. Instruments: Older adults were assessed with: Questionnaire of Social Demographic Data and Use of Technology (built ad. Hoc.), Functional Assessment Questionnaire, MOS Scale of Social Support, Try Your Memory Test (TYM). Students were assessed with: Basic data questionnaire and Negative stereotypes questionnaire towards old age (CENVE).

Result

When comparing pre and post‐tests, statistically significant differences were found in the assessed variables. In the older adult group, a significant difference was found in the use of zoom platform (z= ‐2.97, p= .003). In the student group, a statistically significant difference was found regarding the beliefs about aging (z=‐2,53 p= .01).

Conclusion

These results add evidence regarding the importance of applying technology training programs for older adults. Intergenerational programs are a promising alternative where both parts can benefit: older adults through the incorporation of meaningful technological tools for their daily lives, and young participants taking the opportunity to provide community service and to deconstruct negative prejudices and beliefs towards old age and its consequences.
Simulation of microvascular MRI signal changes in the presence of amyloid‐beta plaques or microbleeds
Authors: Jahng Geon‐Ho , Yoo Chang Hyun , Jin Seokha , Lee DongKyu , Cho HyungJoon
Published: February 2022

Background

There is currently no study in the literature that has evaluated microvascular (MV) alterations with accumulation of amyloid‐beta plaque proteins or the presence of microbleeds in the AD brain. Therefore, in this study, we simulated MRI signal changes by assuming three different environmental conditions in the imaging voxel: only the normal MV structures, normal MV structures in the presence of amyloid‐beta plaques, and normal MV structures in the presence of microbleeds. Alterations in MV imaging indices such as mean vessel diameter, vessel size index, mean vessel density, blood volume fraction, and microvessel‐weighted imaging were calculated by using the differences in relaxation rates, ΔR2* and ΔR2, through Monte Carlo simulations with application of FPM for the three conditions.

Method

The following MV indices were calculated using the simulation results of the differences in the transverse relaxation rates, ΔR2* and ΔR2: mean vessel diameter (mVD), vessel size index (VSI), mean vessel density (Q), blood volume fraction (BVf), and microvessel‐weighted imaging (MvWI).The simulations were repeated with three different main magnetic field strengths (1.5 T, 3 T, and 7 T) and two different contrast agents, Gadolinium (Gd)–chelated and Superparamagnetic Iron Oxide Nanoparticles (SPION) in three different voxel environmental conditions of only the MV structures, MV structures with amyloid‐beta plaques, and MV structures with microbleeds.

Result

In the amyloid‐plaque model, mVD and VSI decreased with increasing plaque loads, but BVf, Q, and MvWI increased with increasing plaque loads. In the microbleed model, the MV indices of mVD and VSI increased with increasing vessel size. The MV indices of mVD, BVF, VSI and MvWI increased with increasing microbleed loads, but Q did not.

Conclusion

All MV indices were sensitive enough to map accumulations of amyloid plaques, but did not vary with increasing vessel size. The MV indices, except Q, were sensitive to changes in microbleed loads and microvessel size. Therefore, we recommend evaluating MV structure changes in the AD human brain using 3T MRI with a Gadolinium (Gd) contrast agent.
COMPAs—An app designed to support communication between persons living with dementia in long‐term care and their caregivers
Authors: Dube Catherine , Delacourt Barbara , Masson‐Trottier Michele , Ansaldo Ana‐Inès
Published: February 2022

Background

People with dementia experience autonomy loss, and require caregiver support on a daily basis. Dementia is also characterized by progressive communication disorders, leading to isolation in both persons with dementia and caregivers. Caregivers also experience stress and increasing burden which makes them particularly susceptible to burnout. As a whole, these factors hamper quality of life in both members of the dyad. The present study examines the efficacy of COMPAs, an App designed on principles of person‐centered and emotional communication, with the purpose of improving well‐being in persons with dementia and their caregivers, including the extreme isolation conditions imposed by COVID‐19.

Method

In this implementation study on COMPAs, caregivers in two long‐term care facilities were trained to use COMPAs and taught strategies to improve communication with persons with dementia. Measures were taken before and after 8 weeks of interventions with COMPAs. Qualitative analyses on semi‐structured interviews and quantitative analysis on questionnaires were completed.

Results

Interventions with COMPAs improved the quality of communication and quality of life within the dyad. They also reduced caregiver burden and increased their feeling of personal accomplishment.

Conclusion

COMPAs contributes to the well‐being of persons with dementia and their caregivers, thanks to its focus on emotional communication. It represents a valid tool to improve person‐centered communication in long‐term care facilities, including extreme isolation contexts.
Neuroimaging research on dementia in Brazil between 2010‐2020
Authors: Rizzi Liara , Aventurato Ítalo Karmann , Balthazar Marcio Luiz Figueredo
Published: February 2022

Background

In low‐ and middle‐income countries, studies involving structural and functional neuroimaging are challenging due to low investments and heterogeneous populations. Outstanding the importance of an accurate diagnosis of dementia, and the contribution that neuroimaging can provide in this field, we aimed to offer an overview of neuroimaging dementia researches developed in Brazil in the last ten years.

Method

Pubmed was queried to select research papers that (a) had a Brazilian author, (b) presented some kind of neuroimaging result, (c) concerned a neurodegenerative disease presenting a dementia syndrome, and (d) were published from 2010 to 2020.

Result

65 original papers were included. Referred pathologies were mainly Alzheimer’s disease (54%, n=35) and MCI (48%, n=31), followed by vascular dementia (4.6%, n=3). Besides, the most utilized methods were morphometrics (58%, n=38), fMRI (23%, n=15), and DTI (18%, n= 12). There was no trend toward increasing or decreasing the number of publications per year between 2010‐2020 (Spearman ρ=0.13, p=0.70). The median of the citations for each paper was 5 (IQR 2‐18). Journal impact factor was available for 55/65 papers, with a median of 2.94 (IQR 1.90‐4.35). The vast majority of studies were set in the state of São Paulo (65%), with others from Rio de Janeiro (20%), Minas Gerais (7.6%), Rio Grande do Sul (4.5%), Pernambuco, and Goiás (each with 1.5%).

Conclusion

Dementia neuroimaging research in Brazil is highly focused on AD. Surprisingly, only 4.6% of the studies are about vascular dementia, although Brazilians may have more cerebrovascular damage than other populations. Despite difficulties, Brazilians are studying and refining new neuroimaging methods, such as functional and structural connectivity, DTI, and surface‐based morphometry. However, neuroimaging research in Brazil is far from being developed and widespread across the country. The trend towards a highly concentrated scientific production in the Southeast region along with average‐to‐low research impact reflects the national tendency. Researches in Brazil are also particularly affected by spatial restriction in the national territory, as the cultural, ethnic, and socioeconomic diversity. Therefore, neuroimaging researches with the Brazilian population in this field are an urgent matter to better improve the diagnosis of dementia in Brazil.
Adaptation of an in‐person dyadic care planning intervention for virtual delivery: Challenges and opportunities
Authors: Orsulic‐Jeras Silvia , Whitlatch Carol J. , Powers Sara
Published: February 2022

Background

Many psychosocial interventions targeting both persons living with dementia (PWD) and their family care partners (the care dyad) have been developed and have demonstrated significant positive effects for either, or both, care partners. One such intervention, SHARE for Dementia, is an evidence‐based, 6‐session program led by a trained SHARE Counselor typically in‐person within care dyads’ homes. In an effort to reach families in need of support during the Covid‐19 pandemic when home and office visits were not possible, necessary adaptations to SHARE protocols and materials were identified and piloted as a first step toward the creation of a remotely delivered version of SHARE.

Method

SHARE Counselors (n = 5) from various community‐based organizations licensed to deliver the in‐person SHARE for Dementia program participated in a series of virtual adaptation meetings under the guidance of the SHARE Research Team.

Result

The following areas of need for adaptation of SHARE were identified: 1) Mode of delivery (smart phones/tablets, Zoom/Skype); 2) Dissemination of intervention materials (email, use of the SHARE app for iPad); 3) Administration of Care Values and Preferences assessments; 4) Building and maintaining rapport and trust with care dyads; and 5) Remote presentation of SHARE intervention tools.

Conclusion

This presentation will highlight a series of best practices and recommendations for a full‐scale adaptation of SHARE for Dementia for remote delivery. Insights from SHARE Counselors will highlight support for the use of a remote version of SHARE in non‐pandemic times to reach underserved and rural populations in need of support or for PWDs that live alone and have a long‐distance care partner. Case examples will be used to illustrate remote delivery successes and challenges as well as highlight ways SHARE can be delivered using a hybrid model to accommodate the unique needs of families that may benefit.
Dialogical perspective on the use of digital communication tools in interaction involving people with dementia
Authors: Samuelsson Christina , Ekström Anna , Ingebrand Elias
Published: February 2022

Background

While dementia is predominantly associated with cognitive impairments, communication and participation in social activities have been reported as areas where people with dementia experience immense challenges. The extent to which a person with dementia is able to participate in communicative activities does not only depend on the severity of the individual condition, but also on the interactional environment, the actions of co‐interlocutors and the organization of the material surrounding. In this presentation, focus is on aggregated results from several projects where two digital communication supporting tools for people living with dementia have been developed. The tools are both built around conversation stimulation materials (video clips, photos and music) with the difference that one (CIRCA) includes generic material (i.e., photos of famous people and top list music) and the other (CIRCUS) uses personalized materials (i.e., photos of family members and favourite songs).

Method

The study comprises four different datasets with in total 18 participants with dementia engaged in either dyadic or group communication activities, both with and without digital communication support. All sessions were video recorded and analyzed by means of multimodal interactional analysis.

Results

The results showed that digital communication support has the potential to facilitate participation in conversational activities for people with dementia. Conversations involving digital support were longer and the participants with dementia took more initiatives compared to conversations without digital support.The results also showed that in group activities, the participants with dementia were able to initiate and maintain conversations without support from a group leader. The participants with dementia further orient towards each other as competent and knowing.

Conclusion

There is a need for communication activities within dementia care, and activities focusing on communication are much appreciated by people with dementia. Digital communication support applications have the potential of enhancing and facilitate such activities. This in turn, may contribute to increased participation and social inclusion for people with dementia.
Cultural perceptions of medication management during hospital‐to‐home transitions of older Latino adults living with dementia
Authors: Arbaje Alicia I , Greyson Sylvan , Keita Maningbe , Sharma Rhea , Keller Sara , Gurses Ayse , Samus Quincy M
Published: February 2022

Background

In a country with a growing Latin American and Spanish‐speaking population, the health care system is tasked with providing care across changing landscapes of culture and language. Specifically, the hospital‐to‐home transition is a high‐risk period for medication errors and adverse events for older adults with Alzheimer’s Disease and Related Dementias (ADRD), and the older Latino population is widely understudied. Family caregiver perspectives are especially important in Latino populations. The field of human factors engineering, which studies the interactions among people and systems, can be useful to understand complex phenomena. Our objective was to elicit and categorize family caregivers’ cultural perceptions of ADRD and views on medication use during the hospital‐to‐home transition of Latino older adults with ADRD.

Method

Qualitative study using semi‐structured interviews and participant solicited diaries with family caregivers of older Latino adults with ADRD after hospital discharge. We used the human factors engineering‐informed Systems Ambiguity Framework to guide data analysis. At least two researchers independently coded each transcript using a content analysis approach. We identified recurring cultural perceptions of medication use and resource accessibility. We used Atlas.ti software to facilitate data analysis.

Result

We interviewed 11 caregivers of older Latino adults with moderate‐to‐severe ADRD. We elicited caregivers’ cultural perceptions of medication management, medication purpose, and available resources. Recurring themes expressed by caregivers indicate 1) Concern about over‐medication, 2) Resignation over limited medication effectiveness for treating ADRD, 3) Scarcity of culturally specific and appropriately translated resources, and 4) Wariness to trust providers and medical institutions based on negative experience. Multiple caregivers experienced initially incorrect diagnoses or contradictory information from multiple providers, contributing to a sense of resignation regarding treatment options and a lack of trust in providers and institutional resources.

Conclusion

We identified four cultural perceptions of medication use and resource accessibility. The elicited themes point to a need for culturally tailored care instructions for family caregivers, appropriate language services across the care continuum, and a concerted outreach effort to form trusted relationships among Latino communities and health care providers.
Only baseline amyloid burdens and their incremental change could not predict AD progression in mild cognitive impairment
Authors: Choo Il Han , Chong Ari , Chung Ji Yeon , Ha Jung‐Min , Choi Yu Yong , Kim Hoowon
Published: February 2022

Background

Mild cognitive impairment (MCI) is the intermediate stage between cognitively normal and dementia. Cerebral amyloid burden by amyloid PET is the pathological biomarker of Alzheimer’s disease (AD). The goal of this study was to evaluate the prognostic ability of baseline amyloid burdens and their incremental change in the MCI participants.

Method

Seventy‐two MCI participants were selected in this study by inclusion and exclusion criteria. They underwent baseline and annual follow‐up evaluation including comprehensive neuropsychological assessment, consensus clinical diagnosis for 2 years. The [18F]Florbetaben PET and MRI scans were also performed. T1‐weighted MR 3D volumes were acquired for co‐registration with PET. Dichotomous categorization was performed for baseline β‐amyloid (Aβ) positivity by mean cortical amyloid burden cut‐off score. And annual amyloid burden changes were also acquired.

Result

Baseline Aβ positivity evaluation defined 36 Aβ positive (Aβ+ve) and 36 Aβ negative (Aβ‐ve) MCI individuals. Of 36 Aβ+ve MCI subjects, 9 MCI progressed to AD and of 36 Aβ‐ve MCI subjects, 7 MCI progressed to AD (p = 0.280). MCI subjects with amyloid burden increase were 4 of 16 AD converters and 22 of 56 non‐converters (stable MCI) (p = 0.294).

Conclusion

Our results suggest that only baseline MCI amyloid burdens and their incremental change could not predict AD progression.
Development and validation of cerebral white matter hyperintensity probability map of elderly Koreans
Authors: Kim Jun Sung , Lee Subin , Kim Grace Eun , Oh Dae Jong , Moon Woori , Bae Jong Bin , Han Ji Won , Byun Seonjeong , Suh Seung Wan , Choi Yu Yong , Choi Kyu Yeong , Lee Kun Ho , Kim Jae Hyoung , Kim Ki Woong
Published: February 2022

Background

Although previously constructed white matter hyperintensity (WMH) probability maps of healthy older adults exist, they have several limitations in representing the distribution of WMH in healthy older adults, especially Asian older adults. We developed and validated a WMH probability map (WPM) of healthy older Koreans and examined the age‐associated differences of WMH.

Method

We constructed WPM using development dataset that consisted of high‐resolution 3D fluid‐attenuated inversion recovery images of 5 age groups (60–64 years, 65–69 years, 70–74 years, 75–79 years, and 80+ years). Each age group included 30 age‐matched men and women each. We tested the validity of the WPM by comparing WMH ages estimated by the WPM and the chronological ages of 30 healthy controls, 30 hypertension patients, and 30 stroke patients.

Result

Older age groups showed a higher volume of WMH in both hemispheres (p < 0.001). About 90% of the WMH were located in periventricular space in all age groups. With advancing age, the peak of the distance histogram from the ventricular wall of the periventricular WMH shifted away from the ventricular wall, while that of deep WMH shifted toward the ventricular wall. The estimated WMH ages were comparable to the chronological ages in the healthy controls, while being higher than the chronological ages in hypertension and stroke patients.

Conclusion

The WPM may serve as a standard atlas in research on WMH of older adults, especially Asians.
Instituto Alzheimer Brasil: A Brazilian support group for Alzheimer's disease during the COVID‐19 pandemic
Authors: da Silva Novais Ticyana Moralez , de Santana Beatriz Raz Franco , Piovezan Mauro Roberto , Piovezan Elizabeth S , Silva e Moreira Raissa Carla Paulino , Reginatto Genita S , Stein Angelica Miki
Published: February 2022

Background

The Instituto Alzheimer Brasil (IAB) is a non‐governmental organization that promotes information about Alzheimer’s disease to community, offering support for people with dementia, caregivers and familiars. Before the pandemic period, two monthly presential meetings were organized by IAB, in two cities, São Paulo and Curitiba, with 80 participants estimated in each one. However, with social distancing regime, alternatives were required to maintain the activities. Thus, the present study aimed to describe the actions developed by IAB and the participants during the distancing regime of COVID‐19 in 2020.

Method

The mainly activities developed by IAB during the distancing regime included: 1) The virtual meetings by applicative; 2) Lives in the social media; 3) Message app group to support individualized cases. Parts of the meetings and the lives were recorded and posted after transmission. The number of participants was counted during the transmission and followed by the later access to the videos. The number of demands via message was counted, as well. As a part of apps, the geographic location of participants was showed and, in some cases, the location was asked directly to the caregiver via message.

Result

Nine virtual meetings and seven lives lectures had been broadcasted on social media open to the community, from March to November 2020. The total of 643 participants through the application meetings and 628 on live lectures. Being the most watched video with over 9000 views, and over 500 comments per video. The online actions reached more participants than São Paulo and Curitiba, in 14 Brazilian states and in other 6 countries: Portugal, Japan, Germany, Italy, Australia and the USA.

Conclusion

Considering virtual activities, the main result had been an increase in the number of people assisted who need a huge dealing support for Alzheimer`s disease. With virtual actions, people from other countries and regions of Brazil were able to participate in the support group. The feedbacks of caregivers had been extremely positive, showing that online model should last along with the presential model, even with the end of the social distance regime.
The impact of COVID‐19 related isolation on the mental health of Alzheimer’s disease caregivers: Where does communication technology fit in?
Authors: Faieta Julie , Routier Francois , Faieta Lily , Best Krista
Published: February 2022

Background

The COVID‐19 lockdown and social isolation protocols implemented to slow the spread of the virus created a unique environment of separation between individuals with Alzheimer’s disease and related dementias (ADRD) and their informal caregivers. The health and wellness of dementia caregivers has been shown to be affected by the challenges of their caregiving role. Yet the inability to fulfill these roles may exude equally detrimental health outcomes. Furthermore, the impact of communication technologies such as smart phone and tablet apps, is not yet fully understood. This study investigated the mental health outcomes of ADRD caregivers in the wake of widespread COVID‐19 related social isolation, and the influence of app use on these outcomes.

Method

Caregiver perceptions were gathered via a web‐based survey (available in both French and English). Inclusion criteria included: self‐reported status as a dementia caregiver, 18 years of age or older, and ability to read either English or French. Survey data was analyzed via descriptive statistics and specific variables of interested were investigated deeper via principal component analysis and ordinal regression model analysis.

Result

A total of 84 complete surveys (67 English, 17 French) were collected. Of these, 80% reported that their loved one was isolated due to some form of institutionalization or hospitalization. Furthermore, 87% of respondents reported that they experienced negative mental health outcomes related to either experiencing, or worrying about isolation from their loved one. Using no or only 1 smart device application was significantly associated with increased likelihood of negative mental health outcomes for the caregiver.

Conclusion

These findings highlight the need for methods of mitigating the negative effects of physical separation in periods of health and safety‐related lockdowns and isolation. Furthermore, the potential alleviating effect of increased technology use was indicated by the increased risk of health concerns with less app use as compared to more app use. Future studies should further investigate the extent to which various smart personal device applications can facilitate care provision at a distance.
“We’re Walking Around Blindfolded”: Diverse caregiver reflections on dementia diagnosis and care
Authors: Amjad Halima , Gundavarpu Sneha , Blinka Marcela D , Samus Quincy M
Published: February 2022

Background

Prevalence of dementia is highest in African Americans and Hispanics. Yet, many minorities experience missed or delayed dementia diagnoses and disparities in quality of dementia care. The objective of this study was to understand racial and ethnic minority experiences of dementia diagnosis and develop recommendations for clinicians and health systems to improve diagnosis and early care for diverse populations from the caregiver perspective.

Method

Minority dementia caregivers in the Baltimore, Maryland region were recruited from specialty clinics, prior studies, and the Alzheimer’s Association to participate in semi‐structured, in‐depth, qualitative interviews. Interviews topics included early dementia symptoms, diagnosis experiences, healthcare system interactions, and recommendations for clinicians. Interviews were coded and analyzed by three investigators using qualitative content analysis methods.

Result

Eighteen family caregivers (11 African American, 4 Asian and 3 Hispanic), mostly adult children (n=15) of the person with dementia, participated. Four themes emerged around recommendations for clinicians and health systems throughout the diagnosis process. 1) Involve family: Recommendations pertaining to family involvement included listening to family concerns, sharing patient information including diagnosis, recommending family counseling or meetings, and understanding family and culture specific care plans. 2) Knowledge is power: Information was felt to be essential. Caregivers desired clear or written diagnosis, guidance on what to expect (roadmap), and concrete resources. 3) Provide proactive care: Caregivers likened the need for cognitive screening to cancer screening. They felt clinicians should proactively detect early signs of dementia, educate caregivers on potential challenges (safety, finances), and offer support to both patient and caregivers. 4) Mind your (bedside) manners: Caregivers shared both positive and off‐putting interactions. They appreciated clinicians who were straightforward, demonstrated compassion rather than nihilism or negativity, and were readily available for questions.

Conclusion

Minority dementia caregivers shared recommendations for clinicians related to four themes, which included involving family, offering knowledge and information, providing proactive care, and being mindful of bedside manner and language in dementia detection, diagnosis, and early care processes. Caregiver perspectives and recommendations should be incorporated into clinical practice and dementia care interventions for diverse aging populations.
The impact of pandemic‐related measures on COVID‐negative dementia inpatients
Authors: Bukala Bernard R , Carpenter Kilda J , Fox Willow , Reyes Demi , Sanghvi Hazel , Vickers Philip
Published: February 2022

Background

During the COVID‐19 pandemic, infection control measures and changes to patient flow have drastically altered the care provided to inpatients with dementia. Some of these emergency steps mainly affected COVID‐19 positive patients, whereas others had an impact on all. This project aimed to examine the pandemic’s impact on the demographics, care and outcomes of inpatients with dementia who did not test positive for the virus.

Methods

This analysis formed a part of an overarching initiative at Stoke Mandeville Hospital, which leveraged the National Audit of Dementia (NAD) framework to assess care during the pandemic. A tailor‐made questionnaire was composed of the relevant NAD elements and additional items, including questions on capacity assessment. The full sample included 100 patients with dementia admitted between April and July 2020. In this project, data from patients who tested negative for COVID‐19 (n=75) were compared to the local results of the last available NAD (2018; n=50). A combination of student’s t, binomial, and Chi‐squared statistical tests was applied to numerical, two‐answer categorical, and multiple‐answer categorical data respectively (with FDR correction where appropriate).

Results

Demographics of dementia patients admitted during the pandemic were different, with fewer males (27% vs. 40% in 2018), fewer ethnic minorities (13% vs. 36%) and fewer patients admitted from their own home (45% vs 63%). During admission, fewer functional assessments were carried out and less patient‐specific information made available. Inpatient falls were less frequent (19% vs. 64%), presumably due to decreased opportunities for mobility. Admissions were shorter overall, but discharges appeared less well planned and coordinated. Rates of delirium and mortality were unaffected.

Conclusions

While major outcomes appear unchanged, the real impact may be masked by limited, selective admissions. The findings highlight the need to preserve assessment and discharge planning for COVID‐negative patients with dementia during future crisis response measures.
IDEAS and New IDEAS: Amyloid PET in diverse populations
Authors: Windon Charles , Dilworth‐Anderson Peggye , Carrillo Maria C. , Apgar Charles , Gatsonis Constantine , Gareen Ilana F. , Gutman Roee , Hanna Lucy , Hill Carl V. , Hillner Bruce E. , Hoover Stephanie , March Andrew , O'Bryant Sid , Rissman Robert A. , Rodriguez Mariela , Romanoff Justin , Siegel Barry A. , Smith Karen , Song Yunjie , Weber Christopher J. , Whitmer Rachel A. , Wilkins Consuelo H. , Rabinovici Gil D.
Published: February 2022

Background

Imaging biomarkers for neurodegenerative disease are understudied in diverse populations. The completed Imaging Dementia‐Evidence for Amyloid Scanning (IDEAS) and recently launched New IDEAS studies evaluate the clinical impact of amyloid PET in large samples of Medicare beneficiaries across the U.S. with MCI or dementia, enabling comparisons between patients from different racial and ethnic backgrounds.

Method

Amyloid PET was performed in 18,295 IDEAS Study participants recruited from 590 clinical sites between 2016‐2018. Dementia specialists completed pre‐ and post‐PET case report forms. Medicare claims were followed for 12 months. New IDEAS will enroll 7000 Medicare beneficiaries (minimum 2000 African Americans and 2000 Latinos) with MCI or dementia at ∼350 memory clinics across the US between 2020‐2023, following analogous procedures. Quantified social determinants of health (quality of education, midlife/current income, marital status and living arrangement) will be measured. A team involving Vanderbilt University, University of North Carolina and the Alzheimer’s Association will use community engaged research principles (community stakeholders as study champions, tailored recruitment strategies) to ensure cohort diversity.

Result

Recruitment in IDEAS included a low proportion of minority participants (83.9% White (N=15,568), 3.4% African American (N=639), 4.6% Hispanic (N=848), 1.8% Asian (N=328)). The proportion of positive amyloid scans was lower for African Americans (53.8%), Hispanics (54%) and Asians (45.1%) compared to Whites (62.7%). African Americans (52%), Hispanics (56%) and Asians (47%) presented more frequently with dementia (as opposed to MCI) than Whites (37%). There were disparities in vascular risk factors (hypertension/diabetes: 68%/28% African Americans, 55%/26% Hispanics, 48%/25% Asians, 50%/15% Whites) and lower educational attainment for African Americans and Hispanics. New IDEAS will examine the impact of amyloid PET on health outcomes and patient management in the total cohort and individual racial groups. A biorepository of banked plasma and DNA from 5000 participants will be established.

Conclusion

IDEAS demonstrated baseline differences in disease stage, risk factors and etiologies across racial and ethnic groups. New IDEAS will employ a multi‐pronged approach to improve participation of under‐represented populations and evaluate the clinical utility of amyloid PET and its relationship with social determinants of health in a diverse population of patients with cognitive impairment.
Differential atrophy along the longitudinal hippocampal axis in Alzheimer’s disease
Authors: Morais‐Ribeiro Rafaela , Coelho Ana , Oliveira Tiago Gil
Published: February 2022

Background

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder that primarily affects the hippocampus. Since hippocampal studies have highlighted a differential subregional regulation along its longitudinal axis, a more detailed analysis addressing subregional changes along the longitudinal hippocampal axis has the potential to provide new relevant biomarkers.

Method

This study analysed structural brain MRI data of 600 participants (aged 55‐92 years‐old) from the Alzheimer’s Disease Neuroimaging Initiative (ADNI). Hippocampi of cognitively normal (CN) subjects (n=200), mild cognitively impaired (MCI) subjects (n=200) and AD patients (n=200) were segmented with Freesurfer v6.0 and sub‐segmented along its longitudinal axis in anterior, intermediate and posterior sub‐divisions using an in‐house algorithm.

Result

Total hippocampal volume normalized to intracranial volume (ICV) negatively correlated with age in all groups. Standardized residuals from the linear regression of normalized hippocampal volume by age were then calculated, showing that the mean relative atrophy corrected for the aging effect was higher in CN (µ = 0.54) than in MCI (µ = 0.13), and lower in AD (µ = ‐0.67), with significant differences between all groups (p < .001 in all comparisons). Both anterior, intermediate and posterior hippocampus negatively correlate with age in all groups, with no significant differences between them. However, when normalizing to total hippocampus, only CN subjects show a significant positive correlation (r = 0.15, p = .03) between anterior sub‐division and age, and only CN (r = ‐0.27, p < .001) and MCI (r = ‐0.18, p = .01) posterior hippocampus negatively correlate with age. The longitudinal ratio of hippocampal atrophy (anterior sub‐division divided by the posterior one) shows a significant increase with age in CN (r = 0.25, p < .001) and MCI (r = 0.15, p = .04) but not in AD (r = ‐0.07, p = .35).

Conclusion

Normal aging affects the hippocampus differently along its longitudinal axis: its posterior aspect shows more atrophy and the anterior one becomes relatively more prominent. In AD, this antero‐posterior gradient is disrupted early on, and hippocampal atrophy occurs in a similar manner along its longitudinal axis from late‐adulthood to older ages.
Learning climate in long‐term care facilities for people with dementia
Authors: Hartstra Egbert , Prins Marleen , Overbeek Anouk , van der Roest Henriëtte G
Published: February 2022

Background

To allow learning processes within an organization, the presence of a facilitating and safe "learning climate" is of utmost importance. We studied which preconditions contribute to a facilitating and safe learning climate in long‐term care facilities for people with dementia. Furthermore, we studied the effect of a facilitating and safe learning climate on job satisfaction, person‐centred care and emotional exhaustion experienced by care staff.

Method

Data were collected among long‐term care facilities which participated in the fifth round of the Dutch Living Arrangements for people with Dementia (LAD)‐study. Care staff, supervisors and practitioners completed an online questionnaire which included two subscales of the Learning Climate Scale (facilitation and safety) and four subscales of the Learning Potential of the Workplace Scale (learning through reflection; through experimentation; from colleagues; from supervisor). We performed hierarchical linear modelling.

Result

Participants from 58 long‐term care facilities completed the questionnaire. Preconditions that significantly contribute to a facilitating learning climate include development opportunities, successful leadership characteristics, and small care teams. Preconditions that significantly contribute to a safe learning climate include social support from colleagues and supervisors, a high degree of emotional support, and being part of a self‐steering team. Both a more facilitating learning climate and a safer learning climate contribute to more job satisfaction, person‐centred care, and less emotional exhaustion experienced by care staff. Studying different ways of learning, we found that learning through reflection and learning from colleagues and supervisors contribute to more job satisfaction and person‐centred care, while learning through experimentation and learning from colleagues is associated with less emotional exhaustion.

Conclusion

A facilitating and safe learning climate has several positive effects on care staff and person‐centred care. Therefore, long‐term care organizations should offer sufficient development opportunities and training. Furthermore, this study provides insight in how organizations can learn. Care staff should be given the opportunity to discuss their mistakes without being ashamed, in order to allow further development.
Only within resting state network connectivity of the frontoparietal control and Cingulo Opercular networks predict useful field of view performance
Authors: Hardcastle Cheshire , Kraft Jessica N. , Hausman Hanna K. , O'Shea Andrew , Albizu Alejandro , Evangelista Nicole D. , Boutzoukas Emanuel , Nissim Nicole R. , Van Etten Emily J. , Bharadwaj Pradyumna K. , Song Hyun , Smith Samantha G. , Porges Eric , DeKosky Steven T. , Hishaw Georg A. , Wu Samuel S. , Marsiske Michael , Cohen Ronald , Alexander Gene , Woods Adam J.
Published: February 2022

Background

The Useful Field of View (UFOV) test assesses divided attention/speed of processing and relates to independent activities of daily living. Cognitive training utilizing UFOV improves speed‐of‐processing and reduces dementia risk by 29%. Neural correlates of UFOV include key regions of “higher‐order” resting state networks (RSNs) involved in attention processing and dementia risk: Frontoparietal control network (FPCN), Cingulo Opercular network (CON), Default Mode network (DMN), and Dorsal Attention network (DAN). Reduced anti‐correlation between the DMN and task positive RSNs (FPCN, CON, and DAN) is reported in dementia progression. Assessing the relationship of UFOV performance with within‐ and between‐ RSN connectivity may suggest neural mechanisms of cognitive training and potential pathways for reduced dementia risk. We hypothesize that FPCN, CON, and DAN within network connectivity will predict UFOV performance, as these networks are involved in attention processing. We also predict that DMN‐CON anti‐correlation will predict UFOV performance, as this anti‐correlation is related to dementia progression.

Method

279 healthy older adults (M = 71.6, SD = 5.1) from a larger multi‐site clinical trial were recruited. UFOV performance was measured via Double Decision (DD) task from Posit Science Brain HQ. Participants correctly identified a central target, while simultaneously specifying location of a peripheral target among distractors. Average within‐network connectivity of FPCN, CON, DAN, and DMN, and between‐network connectivity of DMN‐CON, DMN‐FPCN, and DMN‐DAN were extracted from resting‐state functional magnetic resonance imaging through the CONN Toolbox v18b via SPM 12. Multiple linear regressions predicted DD performance from within‐ and between‐network values, controlling for age, sex, education, and scanner. All between‐network values were included in the same regression model.

Result

Reduced CON (β=‐.134, p=.023) and FPCN (β=‐.126, p=.029) connectivity was associated with poorer DD performance. Less DMN‐CON anticorrelation demonstrated a trend for predicting better DD performance (β=‐.126, p=.060).

Conclusion

Consistent with previous research, faster DD performance is associated with RSNs involved in executive functioning, attention, and processing speed. Although only trending, reduced DMN‐CON anticorrelation may be related to DD performance. This suggests that within network connectivity may contribute more to DD performance than between‐network connectivity involved in dementia progression in healthy older adults.
Perfusion and free water show opposite trends across tissue layers surrounding white matter hyperintensities in participants with dementia and mild cognitive impairment
Authors: Donnay Corinne A. , Fan Audrey P. , DeCarli Charles S. , Maillard Pauline
Published: February 2022

Background

White matter hyperintensities (WMH) are associated with an increased risk of cognitive impairment and AD. While WMHs are thought to reflect vascular disease, the physiological basis of WMHs remain unclear. New imaging biomarkers are needed to understand the cascade of events leading to the development of WMH. The present MRI study aims to investigate changes in both Free Water (FW) and Cerebral Blood Flow (CBF) in WMH and its penumbra elderly cohort with and without cognitive impairment.

Method

Fluid‐attenuated inversion recovery, diffusion tensor imaging, and pulsed arterial spin labeling (ASL) perfusion images were acquired in participants with dementia (n=17), MCI (n=41), and normal cognition (n=130) with an 8‐channel coil on a 3 Tesla MRI (Siemens Tim Trio). ASL scan parameters included TR/TE: 4000/13ms, inversion time=1800, voxel size: 4x4x10mm3. CBF maps, calculated using the FMRIB software library, and FW maps were co‐registered into structural space. WMHs were segmented from fluid‐attenuated inversion recovery and T1‐weighted images using an automated protocol. For each subject, individual WMH lesions were identified and successively dilated by 1mm to create 4 WM layers surrounding the lesion core (Figure 1). For each biomarker (CBF and FW), linear mixed‐effect models were used to compare (1) normal WM to WMHs and their surrounding layers; and (2) WMHs to their surrounding layers (lme4 in R software). All models specified individual lesions per participant as a nested random effect as random effects, and age and cognitive diagnosis as fixed effects.

Result

CBF in WMHs and Layers 1‐4 were lower than the reference WM (p<0.001, Figure 2A). CBF reduced inlayer 1 (p=0.013) and increased toward normal values in layers 2‐4 (p<0.001) compared the WMH core (Figure 2B). In contrast, the mean FW content was higher in the WMHs and layers 1‐2 compared to the WM (p<0.001). The WMH core had higher FW content than the surrounding layers 1‐4 (p<0.001, Figure 3A, B).

Conclusion

Decreased CBF and increased FW was observed in tissue surrounding WMHs, suggestive of vascular and microstructural damage in a penumbra region beyond the WMH core. FW and CBF measures provide complementary information to understand the pathological mechanisms of WMH.
Developing a reminiscence therapy platform—LifeBio MemoryTM—with a novel machine‐learning‐based application that transfers speech to text and generates life stories for nursing home residents with dementia
Authors: Orsulic‐Jeras Silvia , Sanders Beth , Powers Sara , Ejaz Farida , Cordell Ashlee , Wilk Christa
Published: February 2022

Background

Nonpharmacologic interventions positively influence cognition, mood, and other behavioral and psychological symptoms of dementia. One such intervention, LifeBio, creates conversations through a series of questions to elicit memories in persons living with dementia. Gathering and processing life story data is often done manually, leading to challenges with feasibility. As a result, novel software, LifeBio MemoryTM, is being developed to streamline the process with the use of machine learning and artificial intelligence. LifeBio Memory will minimize the need to hand‐write or type individualized life story data with the use of speech‐to‐text technology and automatic processing.

Method

Seven focus groups (n=35) were conducted with persons living with dementia, family care partners, and residential care staff. Feasibility of use and other general reactions to interacting with the new LifeBio Memory prototypes were examined. Each focus group was audiotaped and transcribed, followed by a thematic analysis of the data that resulted in a list of recommended changes that were first prioritized and then discussed by the research team.

Result

Results from the work groups strongly suggest that the use of the LifeBio Memory application is the preferred method for obtaining life story information, showing less support for writing or typing responses as in previous versions of LifeBio. Staff participants report the app would create a more efficient workflow, allowing them to serve a larger number of residents. While a consensus was reached on the value of the concept of LifeBio as well as the LifeBio Memory prototypes, potential barriers to implementing the new platform in residential care settings with persons living with dementia were also identified.

Conclusion

The existing LifeBio program faces challenges to scalability due to the time‐and labor‐intensive nature of processing life story information. Results suggest the feasibility of using machine‐learning as an effective, efficient, and preferred method for collecting life story data in place of manualized techniques of the past. Findings from this focus group study will be used to develop a list of specific changes to existing LifeBio processes and materials as well as a plan for developing a full‐scale system to automatically record and process individuals' life stories.