bluuebunny/crossref_metadata_2025 huggingface dataset:
Heart rate variability is associated with global cognition and cognitive impairment: Results from the einstein aging study
Authors: Derby Carol A. , Qin Jiyue , Liu Grace , Koorathota Sharath , Wang Cuiling , Sloan Richard P.
Published: June 2023

Background

The role of autonomic function in cognitive impairment is unclear. Heart rate variability (HRV) provides a feasible, non‐invasive measure of cardiac autonomic control. We examined whether HRV is associated with global cognition and cognitive impairment using 7‐day ambulatory ECG assessments in the Einstein Aging Study.

Method

Analyses included 84 participants free of dementia (mean age 78.1 (± 5.2) years; 82% female; 39% non‐Hispanic White, 44% non‐Hispanic Black, mean education 14.7 (± 3.3 years)). Participants wore a small, single lead ECG device continuously over 7 days. Power spectral analyses were applied to determine HRV over 5‐minute epochs in the high (0.15‐0.40 Hz, hfHRV) and low (0.04‐0.15 Hz, lfHRV) frequency bands, and values were log transformed. Demographics, comorbidities, and cognition were assessed during clinic visits. Two tests per domain evaluated memory, executive function, language, visuo‐spatial and attention with impairment defined as performance ≥ 1.5 SD below the age, sex, education standardized norm on at least one test. Global cognition was assessed using the MoCA, and Mild Cognitive Impairment (MCI) was defined using Jak‐Bondi criteria. Associations of HRV with cognition were examined using logistic (MCI, domain specific impairment) and linear (MoCA) regression adjusting for age, sex, race/ethnicity and education, diabetes, and hypertension.

Result

Mean MoCA score was 24 (SD 3.5), 21 (25%) had MCI and impairment was identified in 25% (memory), 28.6% (executive function), 21.4% (attention), 17.9% (language) and 27.4% (visuospatial). Both hfHRV and lfHRV were inversely associated with MCI (OR per 1 SD increase in log HRV: 0.47, p = 0.02 for hfHRV and 0.42, p = 0.01 for lfHRV) and with memory impairment (OR per 1 SD increase in log HRV: 0.52, p = 0.03 for hfHRV and 0.43, p = 0.01 for lfHRV). Higher hfHRV and lfHRV were each associated with better MoCA score (β for 1 SD increase in log HRV: 0.65, p = 0.046 for hfHRV; 0.80, p = 0.02).

Conclusion

Whether HRV is associated with cognitive impairment remains unclear, particularly the role of hfHRV, indicative of parasympathetic control. Findings suggest that hfHRV is related to cognitive performance and impairment. Results for lfHRV also suggest joint effects of the sympathetic and parasympathetic systems.
Dyadic associations between cognitive functioning and depressive symptoms among older adult spouses over time in the Mexican Health and Aging Study
Authors: Monin Joan , McAvay Gail , Samper‐Ternent Rafael
Published: June 2023

Background

Marriage has important influences on cognitive and mental health. Although studies are increasingly showing interpersonal effects of cognition and depression in couples in the United States, there is a need to replicate these findings in other countries. The present study examined the bidirectional associations between older adult spouses’ cognitive functioning and depressive symptoms over time in the Mexican Health and Aging Study (MHAS) using an actor partner interdependence model.

Method

Data was from the MHAS, a national study of adults aged 50 and older residing in Mexico. The current study focuses on three interviews conducted in 2012, 2015 and 2018. We identified, 1,800 individuals (age 65 and over), consisting of 905 couples who had direct interviews in 2012 and at least one follow‐up direct interview in 2015 or 2018. Of these, 1,774 (98.6%:) had a direct interview in 2015, and 1389 (77.2%) completed the 2018 assessment. Cognitive functioning was measured with the MHAS Cognitive Battery. Depressive symptoms were measured with a 9‐item, modified Center for Epidemiologic Studies Depression Scale for the Mexican population. Covariates included socio‐demographics, physical functioning, comorbidities, and smoking status.

Result

Structural equation models testing longitudinal actor partner interdependence effects revealed a person’s own cognitive functioning and depressive symptoms predicted their own follow‐up cognitive functioning and depressive symptoms, respectively (see Table 1). Second, one’s own depressive symptoms was associated with more depressive symptoms in the spouse. Third, a person’s own cognitive functioning predicted their own depressive symptoms, and one’s own depressive symptoms predicted their own cognitive functioning across time. There were no significant interpersonal effects for cognitive functioning.

Conclusion

These findings partially replicate previous research in older adult couples in the United States and highlight dyadic influences on mental health. However, in contrast to our prior research the current study found no association between spouses’ cognitive functioning. This difference highlights the importance of replicating studies of predictors of cognitive functioning across cultures. Future research is also needed to elucidate cultural mechanisms for interpersonal associations.
MRI free water as a biomarker for cognitive performance: Validation in the markvcid consortium
Authors: Maillard Pauline , Hillmer Laura J. , Lu Hanzhang , Arfanakis Konstantinos , Gold Brian T. , Bauer Christopher E. , Kramer Joel H. , Staffaroni Adam M. , Stables Lara , Wang Danny J.J. , Seshadri Sudha , Satizabal Claudia L. , Beiser Alexa S. , Habes Mohamad , Fornage Myriam , Mosley Thomas H. , Rosenberg Gary A. , Singh Baljeet , Singh Herpreet , Schwab Kristin , Corriveau Roderick A , Helmer Karl G. , Greenberg Steven M. , Decarli Charles , Arvind Caprihan
Published: June 2023

Background

Free Water (FW), a Diffusion Tensor Imaging‐based biomarker kit has been demonstrated by the MarkVCID consortium to have excellent instrumental validity1. We sought to determine its clinical relevance by investigating association of FW with clinically meaningful aspects of vascular contributions to cognitive impairment and dementia (VCID) in the MarkVCID consortium cohort as well as 5 independent settings.

Method

This study included individuals from the MarkVCID UH3 phase cohort2 (N = 523) and 5 independent legacy cohorts: University of California Davis Alzheimer Disease Research Center3 (ADRC UCD, N = 173), MarkVCID UH2‐ phase data from University of California San Francisco4 (UH2 UCSF, N = 182) and RUSH Alzheimer Disease Center5 (N = 302), Framingham Heart Study6,7 (FHS, N = 2902) and Atherosclerosis Risk in Communities8 (ARIC, N = 1837). Table 1 summarizes participants’ characteristics. Our goal was to evaluate whether mean FW (mFW) computed within the white matter tissue as provided by the kit1 is cross‐sectionally associated with a composite measure of executive functions (EFC) derived from item‐response theory (IRT) generated score9,10, which incorporates scores from NACC Uniform Data Set Version 3 neuropsychological tests11. To test this hypothesis, a linear regression was used with EFC score as the dependent variable and mFW as the independent variable, adjusting for age, sex and education. In a second model, this model was additionally adjusted for presence of diabetes, smoking and hypertension to estimate the added contribution of mFW above vascular risk factors.

Result

Higher mFW was associated with lower EFC scores (see Figure 1) in all the subject groups studied. In the MarkVCID cohort (ß = ‐3.54, p<0.0001), as well as in the five legacy cohorts (UH2 UCSF: ß = ‐3.54, p<0.0001, RUSH: ß = ‐1.905, p = 0.00597, ADRC: ß = ‐6.18, p<0.0001, FHS: ß = ‐4.06, p<0.0001, ARIC: ß = ‐1.24, p<0.0001). Adjusting for vascular risk factors did not significantly change these associations (p values< 0.01).

Conclusion

Findings from this study indicated that mean FW is a sensitive biomarker of cognitive performances, providing strong evidence of the clinical rational of FW as a sensitive biomarker of WM injury in association with cognition for future observational studies and clinical trials in the context of VCID.
Using telepresence robots as a tool for virtual research during the COVID‐19 pandemic
Authors: Lake Charlie , Hung Lillian , Wong Joey , Hussein Ali , Mann Jim , Gregorio Mario
Published: June 2023

Background

Long‐term care (LTC) settings have been disproportionately affected by the COVID‐19 pandemic. It is necessary to investigate unmet needs and explore practical strategies for supporting LTC residents and staff. However, visitation restrictions and staff shortages have created barriers to conducting research in healthcare settings. Innovative methods and tools are needed for conducting research to support the research process. Telepresence robots enable virtual connections via videoconferencing and give a feeling of the person’s presence from a remote location. This study focuses on exploring the researchers’ experiences of using a telepresence robot as an interview tool.

Method

We interviewed a team of 10 researchers who used a telepresence robot to virtually conduct research during the COVID‐19 pandemic in British Columbia, Canada. The team includes academic researchers, graduate students and people living with dementia. Semi‐structured one‐to‐one interviews were conducted by Zoom virtual meetings. Thematic analysis was performed to identify themes.

Result

Analysis of the data produced five themes on benefits and challenges with respect to using a telepresence robot to conduct interviews with residents in LTC. Themes of benefits: (1) Use as a Research Enabler, (2) More accessible and engaged research process, and (3) Increased Environmental Inclusion and Engagement. Themes of challenges: (4) Lack of Infrastructure and Resources, and (5) Training and Technical Obstacles. Based on the results, we offer “ROBOT” – an acronym created for actionable recommendations that inspire and support others to use telepresence robots for research. These recommendations include Realign to adapt, Organize with champions, Blend strategies, Offer timely technical assistance, and Tailor training to individual needs.

Conclusion

This study offers unique and practical insights into using telepresence robots as a safe and innovative tool for conducting research remotely. Our results demonstrate that people living with dementia can be engaged meaningfully in research during the pandemic. Future research should apply more creativity and flexibility in adopting technology to expand possibilities for involving people with dementia in research.
Segmental bioimpedance variables in association with mild cognitive impairment due to Alzheimer disease
Authors: Doan Dieu Ni Thi , Ku Boncho Uk , Jun Min‐Ho , Lee Kun Ho , Kim Gahey Uk , Kim Jaeuk U
Published: June 2023

Background

Recognizing and monitoring changes in body composition can reveal early signs of body vital status, thereby applying appropriate therapies or lifestyle changes which may help to reverse the risk of MCI. This study aims to examine the association between body composition and bioimpedance variables with mild cognitive impairment (MCI) due to Alzheimer’s disease (AD).

Method

We obtained four water‐related and six impedance‐related variables for upper and lower extremities as well as several whole body composition variables such as fat (%), body cell mass (%), water volume (TBW_FFM), and metabolic rate (BMR) from segmental multi‐frequency bioelectrical impedance analysis (MF‐BIA) for 938 elderly participants, including 672 cognitively normal individuals (CN) and 266 MCI subjects. Participants’ characteristics, anthropometric information, and the selected BIA variables were described and statistically compared between CN and MCI subjects. The correlations between the selected BIA and neuropsychological tests such as the Korean version of Mini‐Mental State Examination (K‐MMSE) and Seoul Neuropsychological Screening Battery – second edition (SNSB‐II) before and after controlling for age and sex were also examined. Univariate and multivariate logistic regression analyses with the estimated odds ratios were conducted to investigate the associations between these BIA variables and MCI prevalence and for different gender groups.

Result

Our MCI samples were shown to be slightly older, more depressive, and have significantly poorer cognitive abilities compared to CN subjects. The partial correlations upon controlling for age and sex between the selected BIA variables and neuropsychological tests were not magnificent. However, after accounting for age, sex, GDS score, and the significant comorbidities, resistance and reactance in lower extremities survived to be associated with MCI with ORs (95%CI) of 0.81 (0.68‐0.96) and 0.79 (0.67‐0.94), respectively. After stratify by gender, these variables remained significant in only female group.

Conclusion

The reductions in segmental body resistance and reactance increase the incidence of MCI, these patterns are more pronounced in the lower extremities and especially in female subjects. These two variables can be considered as early bioimpedance changes in MCI due to AD.
Functionality according to frailty and cognitive status: Differences between scoring procedures for the Lawton‐Brody IADL scale
Authors: Facal David , Soage Sandra , Nieto‐Vieites Ana , Campos‐Magdaleno Maria , Pérez‐Blanco Lucía , Felpete Alba , Navarro‐Pardo Esparanza , Pereiro Arturo X
Published: June 2023

Background

Frailty is the state of physiological vulnerability that hindered age‐related decline that precedes disability. However, some functional decline in IADLs is expected, particularly when co‐occurring with Mild Cognitive Impairment (MCI). Our aim was to analyze differences in IADLs between prefrailty and frailty participants with or without MCI. Three scoring procedures for the Lawton & Brody Scale administered to informants were used to analyze IADL differences: 1) Raw scoring: percentage calculation of the raw scores considering all the items; 2) Gender‐corrected scoring: percentage calculation of the IADLs that continue to be carried out but excluding in men the 3 elements traditionally associated with the female gender role (i.e., housekeeping, food preparation, and laundry); 3) Past‐performance corrected scoring: percentage calculation of the IADL activities that the person could perform in the past but now performs with greater difficulty or no longer performs.

Method

The sample comprised 285 Spanish community‐dwelling older adults, without diagnosis of dementia nor disability. MoCA test was used to objectively measure cognitive functioning. Participants were classified using the frailty phenotype: No‐frailty (i.e., met no criteria), pre‐frailty (i.e., met one‐two criteria), and frailty (i.e., met three or more criteria). Presence of MCI were considered to further classify the participants considering cognitive status.

Results

Differences between No‐frailty (N = 80), (Pre)frailty without MCI (N = 123), and (Pre)frailty with MCI (N = 62) groups were tested using non‐parametric tests (see Figure 1). Group differences (Kruskal‐Wallis tests) were found using Raw (H = 11.30, p<0.01) and Past‐performance corrected scores (H = 10.57, p<0.01). For both, lower IADL scores were found in the (Pre)frailty with MCI compared with the No‐frailty group (Raw scoring: Z = ‐3,37, p<0.01; Past‐performance corrected scoring: Z = ‐1,97, p<0.05) and compared with (Pre)frailty without MCI group (Raw scoring: Z = ‐2,86, p<0.01; Past‐performance corrected scoring: Z = ‐2,65, p<0.01).

Conclusion

Differences in IADLs were found between groups with and without MCI using raw and proportional scores considering past performance skills. Between‐group differences in participants without cognitive impairment did not reach significance regardless of their frailty status. Results using the gender‐corrected score suggest a lower sensitivity for detecting functional impairment in men when this procedure is used.
The Korean brain aging study for the early diagnosis and prediction of Alzheimer’s disease (KBASE): Cognitive data harmonization
Authors: Yi Dahyun , Byun Min Soo , Risacher Shannon L. , Craft Hannah , Crane Paul K , Trittschuh Emily H. , Mez Jesse B. , Choi Seo‐Eun , Hohman Timothy J. , Cuccaro Michael L. , Lee Michael L. , Scollard Phoebe , Gibbons Laura E , Mukherjee Shubhabrata , Nho Kwangsik , Saykin Andrew J. , Lee Dong Young
Published: June 2023

Background

KBASE is a prospective cohort study launched at Seoul National University (SNU), South Korea, in 2014 using similar design and methods as the North American Alzheimer’s Disease Neuroimaging Initiative (ADNI). The KBASE cohort consists of well‐characterized participants (420 cognitively normal, 140 mild cognitive impairment, and 90 AD dementia) (Figure 1). It includes systematic longitudinal collection of comprehensive clinical, cognitive and lifestyle data, multimodal neuroimaging, and bio‐specimens for the first six years (“KBASE1”) at a single center. “KBASE2: Korean Brain Aging Study, Longitudinal Endophenotypes and Systems Biology” (NIH Grant U01AG072177) is the second phase of KBASE, launched in collaboration with Indiana University and other institutions. KBASE2 began in 2021, and has similar assessment protocols to the KBASE1. The NIA AD Sequencing Project (ADSP) will perform GWAS and whole genome sequencing (WGS).

Method

Neuropsychological data will be harmonized by the study team and members of the ADSP Phenotype Harmonization Consortium. Comprehensive cognitive data were collected using a battery of standardized tests (Table 1). Harmonization and co‐calibration will enable comparative analyses with cognitive data from similar studies with largely non‐Hispanic white (NHW) cohorts, including the ADNI and AIBL, and ultimately the range of other aging and dementia cohorts including those with underrepresented multi‐ethnic populations. WGS and GWAS data will be harmonized and shared by the ADSP.

Result

Cognitive data harmonization processes are underway and have begun to address the challenges of language and cultural differences. Initial steps include mapping tests and items into an English template. Harmonization and co‐calibration efforts will include identifying appropriate anchor items and accounting for differences in test items that were made to be more culturally and linguistically appropriate. Additional challenges include the wide range of educational attainment as well as gender effects on educational opportunities. A bilingual neuropsychologist who is trained and licensed in the U.S. and a bilingual psychometrics expert are deeply involved in harmonization processes.

Conclusion

Harmonized KBASE cognitive data will be shared with the ADSP and other investigators for use in quantitative phenotype analyses, as well as other pooled, integrative, and comparative studies of other multiethnic, multilingual, U.S., and international cohorts.
Mayo‐PACC: Optimizing a parsimonious Preclinical Alzheimer’s disease cognitive composite comprised of public‐domain measures
Authors: Karstens Aimee J. , Twohy Erin L , Albertson Sabrina M. , Kremers Walter K. , Machulda Mary M. , Jack Clifford R. , Knopman David S. , Mielke Michelle M. , Petersen Ronald C. , Stricker Nikki H.
Published: June 2023

Background

Preclinical Alzheimer’s cognitive composites (PACC) are designed to detect subtle cognitive changes in clinical trials. PACCs often include measures of memory, attention, and semantic fluency, with variations based on available measures. We created a Mayo Clinic PACC (Mayo‐PACC) to address limitations of existing PACCs by prioritizing parsimony, non‐proprietary measures, clinical applicability, and psychometric properties. We developed a Mayo‐PACC and examined sensitivity to detecting longitudinal cognitive change in amyloid positive (A+) older adults relative to the Preclinical Alzheimer’s Cognitive Composite‐Revised (PACC‐R). Exploratory analyses included comparison to other composites.

Method

Participants included 614 individuals in the Mayo Clinic Study of Aging (428 A‐ and 186 A+) age 65‐85 who were cognitively unimpaired at baseline with 7 years mean follow‐up. A+ was defined as PiB‐PET meta‐ROI SUVR ≥ 1.48 (centiloid 22). The Mayo‐PACC included the AVLT sum of trials (trials 1‐5, short delay, long delay), Trails B and Animal fluency. Measures included in the PACC‐R and other comparison composites are listed in Table 1. We calculated study‐specific z‐scores and examined psychometric properties of component measures including test‐retest reliability, practice effects, and distributional properties (ceiling/floor effects, skew, kurtosis). We examined sensitivity to preclinical cognitive change using slope estimates (difference in annualized change across A+ and A‐ groups) from linear mixed models (LMMs) for each composite. A jackknife procedure was used to calculate the standard error and subsequent confidence intervals of differences in rates of change (A+>A‐ indicating more significant decline in A+). Significance was determined based on whether the 95% Confidence Interval (CI) contained 0 (alpha = .05).

Result

All composites showed sensitivity to amyloid‐related longitudinal cognitive decline (A+>A‐ annualized change p<.05; see Table 2). Jack‐knife comparisons revealed comparable utility of Mayo‐PACC and PACC‐R (CI contained 0, see Table 3). Exploratory analyses revealed Mayo‐PACC performed similarly to an adaptation of the ADCS‐PACC, Global‐z, Memory‐z and Attention‐z. The Mayo‐PACC performed better than a 2‐measure Mayo‐PACC‐remote and a single memory measure.

Conclusion

The Mayo‐PACC provides a parsimonious composite score that has comparable utility for detecting A+>A‐ cognitive decline compared to the PACC‐R and other composites and can be widely used in both research and clinical settings.
Comparison of word list recall and paragraph recall to distinguish dementia severity in the Uniform Data Set (UDS): Results from a diverse cohort
Authors: Loizos Maria , Zhu Carolyn W , Akrivos Jimmy , Sewell Margaret , Li Clara , Neugroschl Judith A. , Melnick Jonah , Grossman Hillel , Aloysi Amy , Schimming Corbett , Sano Mary
Published: June 2023

Background

Prior research reported word list is more sensitive to changes early in the Alzheimer’s disease process. However, there is limited investigation into ethnic level differences between memory tests. This project examines: ethnic level (Black/African American) and testing language differences (Spanish) between word list and paragraph recall to distinguish dementia severity, and added benefit of using both tests.

Method

Baseline UDS and site‐specific supplemental participant data collected at the Icahn School of Medicine at Mount Sinai’s Alzheimer’s Disease Research Center (ISMMS ADRC) were utilized to compare the efficacy of paragraph recall (Logical Memory and Craft Story) versus a word list test (CERAD) both together and alone in differentiating dementia severity as measured by the Clinical Dementia Rating (CDR) Scale. Composite scores for each memory test were established by calculating Z‐scores and taking the average. Logistic regression models were employed to distinguish between CDR 0 versus 0.5 and 0.5 versus 1. Receiver Operating Characteristic‐Area Under the Curves (ROC‐AUCs) were used as an indicator for overall performance in differentiating CDR. Subsample analyses were performed for White, Black/African American (AA), English, and Spanish language testing.

Result

1,319 participants who self‐identified as White (n = 788, 60%), Black/AA (n = 225, 17%), or Hispanic (n = 306, 23%). Results reveal high discriminability and no statistically significant difference between word list and paragraph recall in distinguishing between CDR 0 vs 0.5 (range AUC = 0.79 to 0.84; p>.05) or 0.5 vs 1 (range AUC = 0.81 to 0.87; p>.05). Discriminability was greater when combining tests in the overall group (0 vs 0.5 range AUC = 0.82 to 0.87; p<.01, 0.5 vs 1 range AUC = 0.81 to 0.93; p<.05) but this not always the case for the Black/AA group (0 vs 0.5 range AUC = 0.80 to 0.91; p>.05, 0.5 vs 1 range AUC = 0.83 to 0.93; p>.05) or Spanish speakers (0 vs 0.5 range AUC = 0.74 to 0.86; p>.05, 0.5 vs 1 range AUC = 0.85 to 0.90; p>.05).

Conclusion

Our findings confirm that there is utility in employing multiple memory tests to differentiate between CDR levels. However, these findings do not extend to all ethnically diverse or Spanish speaking participants. Researchers may want to consider burden of extra testing time when assessing the cognition of diverse participants.
A stakeholder‐engaged process to design and implement a dementia diagnosis Toolkit in primary care settings
Authors: Sideman Alissa Bernstein , Alagappan Cecilia , Segal‐Gidan Freddi , Alving Loren , Rosen Howard J.
Published: June 2023

Background

Dementia is frequently underdiagnosed or misdiagnosed in primary care, where most patients are initially seen. In 2018, in response to California State Bill 833, the ten California Alzheimer’s Disease Centers (CADCs) developed an instrument, the Assessment of Cognitive Complaints Toolkit for AD (ACCT‐AD), to guide primary care providers (PCPs) through the dementia diagnostic process. We examine how a stakeholder‐informed process shaped the development of the ACCT‐AD toolkit.

Method

Our implementation study involved a two‐phase process. In Phase 1, experts from the CADCs provided consensus input to design the toolkit. We then conducted three focus groups with primary care providers to get feedback on toolkit design and workflow. Changes were made based on feedback. In Phase Two, we conducted 10 feedback sessions with providers who used or reviewed the toolkit and 124 surveys about experiences using the toolkit.

Result

The toolkit: The toolkit offers step‐by‐step instruction on how to collect information for a dementia diagnosis, including a series of questions, identified by CADC committee consensus. Each question is followed by examples of typical concerns. The toolkit interprets answers commonly encountered, indicating which are indicative of normal aging, Alzheimer’s disease (AD), or a non‐AD dementia. Focus groups: PCPs reported lack of systematic approach to diagnosing dementia and time constraints. They found the toolkit valuable as an educational tool but were concerned about length. They suggested modifications: a self‐administered questionnaire, streamline answer tracking, and electronic health record (EHR) integration. A major concern was how to identify patients who have Mild Cognitive Impairment (MCI). The team addressed all PCP concerns. Surveys, 66 providers found the toolkit extremely useful in identifying a probable diagnosis, 55 found it somewhat useful, 3 did not find it to be useful.

Conclusion

Engagement of stakeholders in the design and improvement of a dementia diagnosis toolkit is critical for improving its feasibility and usability for clinical practice. The ACCT‐AD toolkit is part of a larger vision to create a network of dementia‐proficient community practices connected to the CADC system. As potential treatments for AD and options for diagnostic testing evolve, this network can serve as a resource for disseminating knowledge.
Using electronic medical records to develop a predictive model of 30‐day hospital readmission for people with ADRD
Authors: Najarian Cyrus , Mahmoudi Elham , Wu Wenbo , Aikens James , Bynum Julie
Published: June 2023

Background

Hospitals are insufficiently equipped for Alzheimer’s disease and related dementia (ADRD) patients. Thus, readmission incidence is much higher and costlier among ADRD patients than the general population. Hospital discharges often occur without adequate preparation for the complex care management needs of ADRD patients and their caregivers. This study’s objective was to develop a risk‐assessment tool for hospitalized patients with ADRD. By supporting timely and better identification of who is at risk and why, already‐scarce resources can be allocated more efficiently to reduce readmissions.

Methods

We used 2016‐2019 EMR data from the University of Michigan health system (Michigan Medicine) and applied machine learning techniques (Random Forest, XGBoost, and Logistic LASSO) to develop a readmission risk‐assessment tool. We identified 2,899 individuals with ADRD who had at least one index hospital admission. All data features available in EMR – demographics, lab results, prior counts of healthcare use, and characteristics of index hospitalization – were included in our predictive models. Additionally, we geocoded the street address of place of residence using the National Neighborhood Data Archive (NaNDA) using the U.S. Census tract‐level information to include two composite measures of socioeconomic status: disadvantage and affluence.

Results

The readmission rate for ADRD patients was 22% versus 17% for the general population. The best predictive model was the Random Forest (area under the receiver operating characteristic curve = 0.66; sensitivity = 0.64; specificity = 0.61). The accuracy of our model (0.61) was 42% higher than the LACE score (0.43), which is currently used by the hospital for all patients. The top 5 predictors of 30‐day readmission among people with ADRD included length of hospital stay, frailty index, living in a disadvantaged neighborhood, and total prior‐year healthcare charges.

Conclusion

ADRD patients are highly vulnerable and require many resources, with substantially greater readmission risk and elevated rates of other adverse health events. Leveraging EMR data in a readmission risk‐assessment tool can help inform appropriate and efficient coordination and transitions of care for ADRD patients. Our risk‐assessment tool can identify ADRD patients at high risk for readmission and why they are at higher risk. This can enable better decision‐making upon discharge.
Lower extremity kinematic comparisons between patients with mild cognitive impairment and healthy individuals during single and dual tasks
Authors: Kuan Yi‐Chun ,   Dementia
Published: June 2023

Background

Mild cognitive impairment (MCI) is one of the common health issues in modern societies, and it has a high rate of progression to dementia. Studies have shown that MCI has the potential to cause abnormal postural control and altered intersegmental coordination during functional activities, which may be one of the causes that lead to the increase of the risk of falls. The study aimed to compare the kinematics of the lower limb joints between patients with MCI and healthy controls during single‐task (gait) and cognitive or motor dual‐tasks (gait with arithmetic subtraction or tray handling).

Method

Seventeen patients with MCI (age: 67.6±3.9 yrs; BMI:23.5±3.7) and seventeen healthy individuals (age: 67.9±3.7 yrs; BMI:24.0±4.2) were recruited in the study. Each participant performed single‐task (gait), cognitive dual tasks (gait while conducting arithmetic subtraction), and motor dual tasks (gait while balancing a ball on a tray), and the movements were recorded by a standard motion capture system. Peak angular magnitudes of the hip, knee, and ankle in the sagittal plane were extracted. Differences between the MCI and control groups were defined by independent t‐tests with a significant level at 0.05.

Results

The significant differences between groups were found at the hip joint but not at the knee and ankle joint in all single‐ and dual‐tasks conditions. Compared to the healthy group, the MCI group demonstrated less maximum hip flexion and greater hip extension during the stance phase and less maximum hip flexion during the swing phase. The hip kinematics difference might be a change of the control of hip and pelvis muscles due to MCI thus altering the hip kinematic performance. This may also explain the increasing fall risks in patients with MCI due to this altered hip control strategy.

Conclusion

In summary, the patients with MCI may have an alternative hip kinematic adaptation that is different from the healthy individuals. However, the cause of this adaptation is not clear at this point, and further investigation is necessary to make sure whether this is an important biomechanical marker or not.
Evaluation of cognitive performance and daily life activities in dementia patients with online cognitive tracking and exercise application
Authors: Bülbül Nazlı Gamze , Çınar Nilgün , Özge Aynur , Saka Esen , Oktar Ayla Çulha , Er Didem , Küspeci Özge Yılmaz , Okluoğlu Tuğba , Doğan Hasan , Evlice Ahmet Turan , Demirel Esra Acıman , Mungan Behiye , Adapınar Demet Özbabalık , Gelişin Özlem , Kibaroğlu Seda , Can Ufuk , Kenangil Gülay , Kandemir Arzu Uluakay , Yılmaz Gülcan Göçmen , Kiraz Mümine Özdağ , Taşkıran Aslıhan , Çakmaklı Gül Yalçın , Özer Özge Gönül , Sakallı Nazan , İşeri Pervin Kutluay , İnci İpek , Susuz Çiğdem , Bölükbaşı Okan , Akkaya Ömer Faruk , Gürsoy Görkem Tutal , Bizpınar Özlem , Ülker Mustafa , Şirinocak Pınar , Öz Didem , Mehdiyev Duygu , Çelik Çiğdem , Genç Hamit , Kutlar Hamdiye Nihal , Sarı Tacim , Menengiç Kübra Nur , KARALI Fenise Selin , Ateş Miruna Florentina , Şahiner Türker AH
Published: June 2023

Background

BEYNEX (version 2.0) is an online application for tracking cognitive abilities using gamified follow‐up tests designed in eight different cognitive categories by Neurologists and psychologists. In this study, we aimed to determine and monitor the cognitive level of the person using this application by establishing an early alarm system, and to evaluate their relationship with daily living activities.

Method

Our study was designed as multicenter and prospective. Free codes were given to the patients to enter the BEYNEX 2.0 application. The initial cognitive evaluations of the patients who entered the application using the codes were recorded by measuring with the online SLUMS (The Saint Louis Mental Status Examination Test), and a questionnaire was presented to evaluate the activity of their life at least once every seven days.

Result

265 patients aged between 58 and 75 years participated in the study. There was an increase especially in attention, language and memory scores, as the SLUMS score increased in patients with a SLUMS score above 17 (p = 0.001). No significant change was observed in speed and flexibility scores (p = 0.001). There was an increase in problem solving, memory and arithmetic scores of people with an SLUMS score below 17 as SLUMS increased (p = 0.001), but no change was observed in flexibility and language scores (p = 0.001). As the SLUMS score increases, the sleep quality of the patients, the time they spend on hobbies and social media increase in direct proportion.

Conclusion

Online tracking and exercise applications may act as an early warning system in terms of providing feedback to caregivers in terms of monitoring cognitive functions and allowing patients to follow themselves at an early stage, and also monitoring the ADLs of dementia patients and observing their changes over time is as important as the medical treatment given to the patient.
Neural mass framework for decoding amyloid and Tau impact on neuronal activity under Alzheimer’s Disease
Authors: Sanchez‐Rodriguez Lazaro M , Medina Yasser Iturria
Published: June 2023

Background

We introduce a computational brain network model to understand the effect of abnormal microscopical processes into non‐invasive macroscopic neuronal activity observations and cognitive impairment across the Alzheimer’s disease (AD) spectrum. Amyloid‐beta (Aβ) plaques and tau protein aggregates (τ) modulate neuronal firing with the former likely increasing firing (hyperactivity) and the latter inhibiting activity (hypoactivity), especially in the abundant pyramidal populations ‐see (Maestu et al., 2021) for more details. We assume that such interactions scale up to macroscopic regions in humans, specifically influencing resting‐state fMRI signals.

Method

Multimodal data, including amyloid ([18F]Florbetapir) and tau ([18F]flortaucipir) PET, baseline resting‐state fMRI, structural and diffusion MRI, and clinical/cognitive indicators were obtained from the Alzheimer’s Disease Neuroimaging Initiative. The imaging modalities were processed to produce values for a parcellation consisting of 66 brain regions. We considered four neural masses interacting within a region. The regional excitatory and inhibitory activities then transform into BOLD signals (Valdes‐Sosa et al., 2009) ‐see Fig. 1A. Pyramidal excitabilities (v0E,k) contain the Aβ‐ and τ‐ parameters of interest, and their combined effect (Fig. 1B), which we estimated by minimizing the spectral distance between simulated signals and observations.

Result

The synergy between disease factors seems to change with disease states and subjects (Fig. 1C). Most of the considered healthy controls (HC) presented relatively low excitability change by Aβ and by τ, albeit having a greater, generally positive or ‘towards hypoactivity’ combined action. Mild cognitive impairment subjects appeared in two sub‐groups, one significantly close to the HC and another with stronger individual effects and smaller joined action. All AD patients presented positive synergistic effects and relatively high independent contributions to pyramidal population firing, as estimated from the data.

Conclusion

The obtained significant, subject‐specific influences of pathological factors on neural activity verify the interactions reported by (Busche et al., 2020) in animal models experiments at the mesoscopic scale. There exist causal relationships between the amyloid and tau influence parameters and clinical variables. Further research must be performed to clarify characteristic disease trajectories as effective sub‐typing in early stages could improve therapeutic interventions.
Impact of the COVID‐19 pandemic on early career dementia researchers: a global online survey
Authors: Shaaban C. Elizabeth , Bartels Sara , Brum Wagner S. , Welikovitch Lindsay A. , Folarin Royhaan , Smith Adam ,   ISTAART PEERs PIA
Published: June 2023

Background

The COVID‐19 pandemic has strained research around the world and has presented an unprecedented challenge to early career researchers (ECRs). The ISTAART Professional Interest Area (PIA) to Elevate Early Career Researchers (PEERs) works with worldwide dementia ECRs to attract, support, and retain them in dementia research. A key aim is to understand, bring attention to, and develop solutions for career challenges faced by ECRs. Our study objective was to understand the impacts of the pandemic on dementia ECRs.

Methods

We queried ECRs’ pandemic experiences in a global online survey conducted from September 1, 2021, through October 31, 2021. The survey was shared through ISTAART membership emails and newsletters, social media, podcasts, discussion boards, and emailing lists. Participation was open to individuals who self‐identified as ECRs (students through early career/pre‐tenure faculty) presently working in any dementia‐related research discipline or who left dementia research within the prior two years. Data were analyzed using descriptive statistics.

Results

ECRs from 34 countries responded to the survey (n = 321; 68% women; 79% working in academia). Overall, 78% indicated experiencing research delays; 54% had to make project adjustments; 41% reported a negative impact on their career progression due to lack of funding or job opportunities; and 38% required additional or extended funding. Furthermore, 43% thought institutions/employers could have supported them better, and 20% felt their institutions/employers did not support them at all. We also noted 31% of respondents reported increased conference attendance during the pandemic.

Conclusion

We recommend: 1) funders and institutions provide additional sources of funding, both specific to ECRs and on which ECRs may be co‐applicants; 2) principal investigators/supervisors and institutions support opportunities for ECRs to have enhanced research community participation online, such as networking, presenting their work in webinars, and online or hybrid conference attendance; 3) professional organizations maintain hybrid conference options in the future, given the expanded and more affordable access they give ECRs, especially those from low‐ and middle‐income countries; and 4) institutions and supervisors adjust promotion and tenure review requirements to accommodate inabilities to work in the same way during the pandemic. We also highlight resources specific to dementia ECRs.
A new synthesis of aberrant reward processing in frontotemporal dementias
Authors: Chokesuwattanaskul Anthipa , Jiang Harmony , Bond Rebecca L , van Leeuwen Janneke EP , Sivasathiaseelan Harri , Hardy Chris , Rohrer Jonathan D. , Warren Jason D
Published: June 2023

Background

Aberrant reward processing is a cardinal feature of frontotemporal dementias (FTD), driving abnormal socio‐emotional behaviours that define these diseases clinically. However, the hedonic architecture of FTD remains poorly characterised. Here we addressed this issue for a multimodal spectrum of hedonic behaviours in a large patient cohort representing all major syndromes of FTD.

Method

Twenty‐seven patients with behavioural variant (bv)FTD and 58 with primary progressive aphasia (PPA) (24 non‐fluent variant (nfvPPA), 22 semantic (svPPA), 12 logopenic (lvPPA)) were studied in relation to 34 patients with typical Alzheimer’s disease (AD) and 42 healthy controls. Patients’ caregivers completed a questionnaire recording changes in liking and/or interest in stimuli or activities with primary (appetite/sweet tooth, sex) or non‐primary (music, religion, art, colour) reward value. We applied multiple correspondence analysis (MCA) to map the relationships between hedonic domains and extract core factors defining aberrant hedonic phenotypes. Voxel‐based morphometry (VBM) was used to define neuroanatomical substrates across the patient cohort.

Result

The most striking hedonic phenotypes defined bvFTD and svPPA: whereas both syndromes were characterised by altered hedonic valuation of food, they were polarised by their profiles in other hedonic domains (bvFTD ‐ decreased interest in sex and music, altered interest in art and colour; svPPA ‐ increased interest in sex, religion and music). Across the combined participant cohort, one MCA factor largely accounted for the presence of hedonic alterations: this factor was linked to a diverse repertoire of appetitive and socio‐emotional behaviours (apathy, disinhibition, inappropriate humour and affection) and underpinned by grey matter loss in a distributed frontotemporal and subcortical network anchored in right anterior temporal cortex. A second MCA factor largely determined the polarity of altered hedonic valuation (approach vs avoidance).

Conclusion

Our findings define new, multimodal hedonic phenotypes of bvFTD and svPPA and suggest a neurobiological synthesis in which involvement of right anterior temporal lobe and its connections drives the phenotypic expression of aberrant reward processing across the FTD and AD spectrum. This work has implications for the development of novel hedonic instruments and biomarkers in neurodegenerative diseases.
Correlations between APOE4 status and regional amyloid and tau burdens in cognitively normal older individuals
Authors: Hong Yun Jeong , Kim Chan‐Mi , Lee Jae‐Hong , Sepulcre Jorge
Published: June 2023

Background

The correlations between apolipoprotein epsilon 4 (APOE4) status and regional Alzheimer’s disease–related biomarkers in cognitively normal elderly are not fully understood. Our cross‐sectional study compared clinical characteristics, amyloid/tau burden, and cortical thickness according to APOE4 carrier status to assess correlations between APOE4 and regional biomarker burdens.

Method

We analyzed 185 cognitively normal participants from the ADNI 3 cohort study. Participants aged 55‐90 with normal cognitive function were eligible. We divided participants into Aß+ APOE4 carriers (group 1, n = 27), Aß+ APOE4 non‐carriers (group 2, n = 29), and Aß‐ normal controls regardless of APOE4 carrier status (group 0, n = 129). We compared clinical characteristics, cerebrospinal fluid (CSF) amyloid β42 & phosphorylated tau, florbetapir positron emission tomography (PET), flortaucipir PET, cortical thickness, and cognitive scores among the 3 groups. Quantitative imaging analyses were performed using the standardized uptake value ratio (SUVR). We additionally assessed correlations between APOE4 carrier status and imaging biomarkers.

Result

The baseline characteristics except age were similar among the groups. The participants in group 2 were oldest. The regional amyloid/tau SUVRs did not differ between groups 1 and 2, but the amyloid/tau SUVRs in most regions were numerically higher in group 1 than group 2 after adjusting for age difference. The regional amyloid and tau SUVRs in the younger (<70) group were higher in group 1 than group 2. APOE4 carrier status showed significant association with amyloid burden in diffuse cortical areas after adjustment for age and sex, but it was not associated with regional tau burden or cortical thickness.

Conclusion

We identified that cognitively normal APOE4 carriers showed similar but numerically greater amyloid and tau burdens than did APOE4 non‐carriers after adjusting for age. APOE4 carrier status might be more highly associated with amyloid deposition than with other AD‐related biomarkers such as tau or cortical thickness, especially in the younger group below 70.
Individual analysis of changes in a single reminiscence session from nostalgic music videos using text mining
Authors: Urabe Mie , Miyata Chiharu , Fukuda Hiroko , Yoneda Sho , Sakai Katsumi , Kato Yuka , Kitajima Kengo , Sawada Chikao
Published: June 2023

Background

This study conducts an intervention using nostalgic music videos and reminiscence, which provide stimulation to the emotions of a person with dementia. This study found the occurrence of positive emotions. In AAIC, we provided a presentation on this intervention and its analysis using text mining (Urabe et al., 2020, 2021).

As we proceeded with this intervention, we found that nostalgic music or words led the person with dementia to mention stories from memory even after only one session.

The purpose of this study is to clarify the individual changes and important music or words in the narrative of one reminiscence session of a person with Alzheimer’s disease using text mining.

Method

The participant with Alzheimer’s disease was a female aged over 80 years old (MMSE: eight points) and is in a psychiatric hospital in Japan due to behavioral and psychological symptoms of dementia. We intervened two times using nostalgic music videos that she liked and listened to her memories of youth. We recorded her narrative and analyzed the words of her stories using text mining. Moreover, we divided the time points where we noted changes in the narrative from a single session and compared these changes.

Result

After 10 min and 23 sec from the start of the first session, we noted a change in the content of the narrative (Point A).In the second session, the change appeared after 4 min and 53 sec. (Point B)

In the co‐occurrence network, the number of connected co‐occurrence words increased clearly after Point A and Point B.

In the first session, the number of sentences was 61 (before Point A) and 159 (after Point A), the number of paragraphs was 39 (before Point A) and 68 (after Point A).In the second session, the number of sentences was 33 (before Point B) and 269 (after Point B), the number of paragraphs was 22 (before Point B) and 164 (after Point B).

Conclusion

Nostalgic music and important words for persons with dementia hold the potential to increase memory and the number of utterances even after one session of intervention.