bluuebunny/crossref_metadata_2025 huggingface dataset:
Imagining the preventive city: How can urban environments support dementia prevention? A qualitative study
Authors: Roehr Susanne , Rodriguez Francisca S , Siemensmeyer Rosa , Mueller Felix , Romero‐Ortuno Roman , Riedel‐Heller Steffi G
Published: December 2021

Background

Interventions for the risk reduction of cognitive decline and dementia are currently largely focused on individual‐level strategies. To maximize risk reduction, it is useful to consider how the environment we live in can support dementia prevention, i.e. promote healthy lifestyle behaviors known to attenuate dementia risk. As the majority of the ageing population will be living in cities in the future, we specifically explored how dementia prevention could be addressed in urban environments with the aim of generating transformative ideas for public health policy.

Method

In our trans‐ and multidisciplinary qualitative study, we conducted in‐depth problem‐centered, semi‐structured interviews with 10 community‐dwelling individuals at least 65 years of age and 10 experts (fields covered: architecture, cultural/arts education, environmental sciences, geriatrics, health policy, IT, philosophy, psychology, public health, and urban sociology), all living in the city of Leipzig, Germany. Interview guides were informed by the framework on modifiable risk factors for dementia of the Lancet Commission on Dementia Prevention, Intervention, and Care. Interviews were audio‐recorded and verbatim transcribed. Data were categorized and coded using computer‐assisted content analysis.

Result

Community‐dwelling individuals were M = 73.7 (SD = 6.0) years old, 50% were women. Experts were aged 39 to 72 years, 70% were women. Across interviews, both older individuals and experts stressed three urban environmental aspects to promote dementia prevention in the city: social participation and inclusion (emphasizing intergenerationality, digital literacy, co‐creating, cultural/arts/community events and lifelong learning), proximity and accessibility (emphasizing neighborhoods, social housing, mobility, access to health care services, public toilets) and local recreation (emphasizing urban greenery, environmental protection, public gardening, outdoor physical activity, cleanliness and security, especially after dark).

Conclusion

Urban environments play a crucial, but yet too little recognized role for promoting comprehensive healthy lifestyle behaviors that attenuate dementia risk. Public policy should more involve older community members in defining and creating such environments. Moreover, urban environments that promote healthy lifestyle behaviors may be particularly beneficial for marginalized and deprived community groups, which are usually hard to reach by individual‐level interventions.
Evaluating changes in gait and activity associated with cognitive impairment using a home‐based technology platform
Authors: Thomas Neil W. , Agarwal Ashi , Ault Laura , Lariviere‐Chartier Julien , Kingstone Lysa Legault , Wallace Bruce , Knoefel Frank , Goubran Rafik , Beattie Zachary , Kaye Jeffrey A
Published: December 2021

Background

Changes in mobility are associated with cognitive decline in older adults. Mobility is frequently assessed in the clinic setting at episodic intervals. Passive sensors within a home‐based technology platform allow for unobtrusive collection of mobility and gait information over an extended time period. This method of high‐frequency data collection could be sensitive to early changes in mobility associated with cognitive decline.

Method

We present data for a cohort of 32 participants living alone and enrolled in the Collaborative Aging Research Using Technology (CART) Initiative aging study with a pervasive sensing and computing system deployed in their homes. Sixteen individuals with a Clinical Dementia Rating (CDR) scale score of 0.5 were matched by age, sex and education to 16 participants with a CDR of 0; 80% lived in low‐income senior apartments; 6% were non‐white. Mobility and gait data is derived from a gait line, consisting of four ceiling mounted, field‐of‐view restricted passive infrared motion sensors placed 61 cm apart in a line, in each home. The number of walking events, defined as all four sensors being triggered, was analyzed between the two groups.

Result

Participants with a CDR score of 0 had a mean age of 72.1 years and a mean MoCA score of 26.1 (range 21 – 30). Participants with a CDR score of 0.5 had a mean age of 72.2 and a mean MoCA score of 22.1 (range 15 – 27). Fifty‐six percent of participants in each group were female. Preliminary data from the gait line from a combined 1400 days for CDR 0 participants and a combined 1250 days for CDR 0.5 participants is presented here. The mean number of daily walking events detected by the gait line was significantly greater for CDR 0 participants (101.4) compared to CDR 0.5 participants (92.8, p=0.03).

Conclusion

Ambient sensors are able to collect longitudinal data on gait and activity levels in individuals with a technology platform deployed within their home. This unobtrusive remote mobility assessment methodology identifies individuals experiencing cognitive impairment. Further evaluation of other gait metrics and home‐based activity patterns is ongoing to explore their association with changes in cognition.
Multi‐site neuroimaging analysis across ethnicities: Pilot study from the UNITED consortium
Authors: Evans Tavia E , Adams Hieab H.H.
Published: December 2021

Background

Non‐Europeans are severely unrepresented in neuroimaging research of neurodegenerative disorders. The uncovering neurodegenerative insights through ethnic diversity (UNITED) consortium was set up to tackle this, aiming to gain insight into the neurodegenerating brain in diverse populations. Large multi‐centre efforts are needed to adequately investigate this, however there are potential hurdles due to multiple sources of heterogeneity in neuroimaging data.

Method

The UNITED consortium currently includes over 95,000 individuals from 64 partners spanning 30 countries on 6 continents [Figure 1]. MRI images were processed through multiple methods extracting millions of imaging markers to characterise the brains morphological architecture at a vertex and voxel level. We performed a pilot analysis using four studies including 25,000 individuals from the consortium to investigate the feasibility of meta‐analysing heterogenous data across multiple processing methods. MRI markers were investigated in relation to Alzheimer’s disease, MCI and apoe4 load. All analyses were stratified by ethnicity and subsequently meta‐analysed.

Result

Associations between clinical markers and MRI were similar across study designs [case‐control vs population‐based]. However, some associations differed significantly across image processing pipelines [FSL vs FreeSurfer], these differences were more pronounced within case‐control samples [Figure 2]. Fine grained imaging markers showed both positive and negative associations within the same brain structure, which was missed with traditional volumetric analysis [Figure 3]. We found subtle differences between ethnic groups [Figure 4].

Conclusion

Multi‐site analysis can capture a clearer more detailed picture of the neurodegenerating brain. The current pilot highlights the necessity of harmonizing neuroimage processing within meta‐analysis. Our results are promising for wider application to the full consortium and displays the additional insights that can be gained from fine grained imaging markers beyond traditional approaches. While we cannot draw definitive conclusions on the ethnic differences from the current pilot it paves the way for future studies to gain insight into ethnic disparities.
Anomia across the atypical AD phenotypic spectrum
Authors: Eustace Ana , Wong Bonnie , Quimby Megan , Dickerson Brad C. , Putcha Deepti
Published: December 2021

Background

Visual naming is impaired in AD, most prominently in the typical late‐onset amnestic and logopenic variant Primary Progressive Aphasia (lvPPA) syndromes. However, little is known about how patients with these or other AD syndromes (Posterior Cortical Atrophy; PCA, and early‐onset amnestic dysexecutive) perform on auditory confrontation naming tests that do not rely on visual perception of stimuli. Performance on such tests may be of particular relevance to measuring anomia in PCA, who present with visual cognitive deficits. The present study analyzes Auditory Naming Test (ANT) performance across the atypical AD phenotypic spectrum.

Method

Fifty‐three patients (19 PCA, 13 lvPPA, 21 amnestic dysexecutive) were administered the ANT. Total uncued correct responses and total correct responses with phonemic cues were analyzed. Performance differences between groups were evaluated using one‐way ANOVA. Independent samples t‐tests were performed to verify between‐group differences.

Result

Uncued auditory naming was impaired across all atypical AD groups, with group differences observed (F(2,50)=10.31, p<0.001) such that the lvPPA group (60% correct) performed most poorly followed by the amnestic dysexecutive group (77% correct; t=2.09, p=0.04). PCA patients performed best (91% correct; lvPPA < PCA, t=5.5, p<0.001; amnestic dysexecutive < PCA, t=2.5, p=0.02). Auditory naming after phonemic cuing also differed across groups (F(2,50)=6.15, p=0.004): lvPPA (76% correct), amnestic dysexecutive (81% correct), and PCA (97% correct). Performance was still impaired in lvPPA and amnestic dysexecutive groups after cuing, but were comparable to each other (p > 0.6), while PCA patients performed better than lvPPA (t=4.5, p=0.001) and amnestic dysexecutive (t=2.7, p=0.03) groups, falling within normal limits.

Conclusion

Auditory naming was most impaired in lvPPA but improved with phonemic cues. In contrast, cues did not greatly improve performance in the amnestic dysexecutive group, suggesting either a goal‐directed retrieval deficit or semantic knowledge loss. PCA patients demonstrated mild word retrieval deficits in the absence of visual stimuli, potentially reflecting auditory‐verbal working memory deficits previously identified in the literature. However, the PCA group improved with phonemic cuing, suggesting intact semantic knowledge. We plan to build on these results by next examining the cognitive contributors to and regional atrophy correlates of ANT performance in each group.
Affective factors may play a less important role in subjective cognitive decline symptoms of women than men
Authors: Smith Samantha , Splonskowski Moriah , Jacova Claudia
Published: December 2021

Background

The association between subjective cognitive decline (SCD) symptom burden and affective symptoms (i.e., depression and anxiety) is well established, but its interpretation remains elusive: are affective symptoms causally related to SCD or do they reflect independent neurobiological processes? We sought to further the understanding of the SCD/affective symptom association by examining the moderating effects of risk factors for AD/dementia (female gender, older age, and positive family history).

Method

A nation‐wide sample of community‐dwelling 483 adults between ages 50 and 79 (66.5% female; 14.5% age > 70; 27% with positive family history) completed an online survey via the crowdsourcing website Amazon Mechanical Turk. Respondents answered demographic questions, completed the Subjective Cognitive Decline Questionnaire (SCD‐Q MyCog) (0‐25, M=4.71, SD=5.77), and the PROMIS anxiety (7‐35, M=13.04, SD=5.68), and depression (8‐40, M=13.18, SD=6.32) measures. Linear regression was conducted to evaluate the interaction of each risk factor with SCD total in the prediction of depression and anxiety (separate models).

Result

The interaction term was statistically significant for gender, both in relation to depression (b=‐0.28, t[479]=‐3.42, p <.001), and anxiety (b=‐0.21, t[479]=‐2.27, p=.02). In both cases, the SCD/affective symptom correlation was lower for females than for males: SCD/depression: female, r=.239; male, r=.543 and SCD/anxiety: females, r=.260; males, r=.445), respectively. There were no significant interactions with age or family history.

Conclusion

Our finding of gender differences in the association between SCD and depression/anxiety symptoms suggest that affective factors play a less important role in the SCD symptoms of women than men, and raise the possibility that SCD is somewhat different in women than men. We speculate that gender‐specific cognition and affect characteristics rather than differences in AD/dementia risk may be responsible for our findings.
Napping characteristics and cognitive function in older adults
Authors: Leng Yue , Hagen Erika W , Ravelo Laurel A , Peppard Paul E , Yaffe Kristine
Published: December 2021

Background

Brief naps are considered beneficial for cognition in younger adults, whereas emerging evidence suggests excessive napping may be associated with dementia in older adults. The effects of napping parameters on different cognitive domains remain controversial, and the role of reasons for napping is poorly understood.

Method

We used cross‐sectional data from the Wisconsin Sleep Cohort Study. Participants reported on naps that lasted more than 5 minutes over the past month, nap frequency and length, and reasons for napping. Participants reported nighttime sleep duration and quality, and completed overnight polysomnography to assess sleep apnea. Six neurocognitive tests measured attention, memory, learning and executive function.

Result

Of the 686 participants (mean (SD), [range] age 65.0 (7.1), [50‐85] years; 44% women), 500 (73%) reported a nap >5 minutes during the past month and 184 (27%) napped at least four times per week. The average nap length was 41.4 minutes. 187 (27%) napped due to not getting enough sleep at night, 52 (7.6%) napped due to illness or medical reasons, 256 (37%) napped to feel refreshed, 27 (3.9%) napped because they felt unhappy or unwell, and 139 (20%) napped for other reasons. After adjustment for age, sex, body mass index, alcohol intake, smoking, depression, and history of diabetes and cardiovascular diseases, those with more frequent naps performed worse on three neurocognitive tests (P<0.02): Symbol‐Digit Modalities (SDMT) (b=‐1.9, standard error (SE)=0.7), Oral Word Fluency (b=‐2.3, SE=0.9) and Auditory Verbal Learning Test (b=‐1.9, SE=0.8). Those with longer naps performed worse on Grooved Pegboard (b=11.0, SE=2.8), Trails B (b=8.1, SE=2.3), SDMT (b=‐1.9, SE=0.4) and Digit Cancellation (b=14.4, SE=5.6). Further adjustment for sleep duration, quality and sleep apnea did not appreciably alter results. There were no associations between specific reasons for napping and cognition.

Conclusion

Among middle‐ to older‐aged adults, more frequent naps were associated with worse attention and memory and learning; longer naps were associated with worse attention and executive function. Longitudinal studies are needed to examine how napping characteristics predict cognition as individuals age and to further explore reasons for napping during this transition.
Transcriptomics, metabolomics, lipidomics, metabolic flux and mGWAS analyses of sphingolipid pathway highlights novel drugs for Alzheimer’s disease
Authors: Baloni Priyanka , Arnold Matthias , Moreno Herman , Nho Kwangsik , Kastenmüller Gabi , Suhre Karsten , Buitrago Luna , Louie Gregory , Kueider‐Paisley Alexandra , Saykin Andrew J. , Ekroos Kim , Meikle Peter J. , Huynh Kevin , Funk Cory C. , Hood Leroy , Price Nathan D. , Baillie Rebecca , Han Xianlin , Kaddurah‐Daouk Rima F.
Published: December 2021

Background

Alzheimer’s disease (AD) related neurodegeneration has been correlated with metabolic dysfunction. Sphingomyelins (SM), a class of lipids found in the cell membranes especially myelin sheath, have been shown to be disrupted in AD and in other neurodegenerative diseases. Ceramides, the simplest of the sphingolipids, are known to be associated with Aβ production and inflammation. In order to characterize the SM pathway for its molecular links to AD pathogenesis we used complementary multi‐omics approach and identified targets that can be used for intervention.

Method

In this study we used post‐mortem brain transcriptome data of 1000 AD and cognitively normal individuals from ROS/MAP, Mayo clinic and Mount Sinai Brain bank cohort and identified differentially expressed genes in SM pathway. We also used the information derived from metabolic networks of brain and carried out metabolic flux analysis to identify reactions and genes that are altered in SM pathway. We performed multimodal neuroimaging analysis and identified genetic variants linked to genes in SM pathway and associated with AD pathogenesis. Lipidomic analyses and genetic association studies were also carried out to study the SM pathway dysregulation in AD.

Result

The multi‐omics analysis suggested increase in ceramide and depletion of sphingosine‐1‐phosphate that alters sphingolipid homeostasis in AD. To test our hypothesis, we used APP/PS1 mice and modulated S1P activity by targeting the receptor using Fingolimod, an FDA‐approved drug for multiple sclerosis. Our study showed that altering S1P signaling rescues cognitive deficits in the treated mice and Fingolimod and other modulators of S1P metabolism might be potent drug repositioning candidates for AD.

Conclusion

This study demonstrates the power of using diverse types of data to inform about underlying mechanisms of AD pathogenesis. It also raises the possibility of employing powerful new approaches to the repurposing of existing drugs used for treatment of other diseases.
Penetrance estimation of SORL1 loss‐of‐function variants adjusted on APOE genotypes suggest a non‐monogenic inheritance
Authors: Schramm Catherine , Charbonnier Camille , Zarea Aline , Wallon David , Lacour Morgane , Alarcon Flora , Génin Emmanuelle , Campion Dominique , Nuel Grégory , Nicolas Gaël ,   CNRMAJ Collaborators
Published: December 2021

Background

SORL1 rare loss‐of‐function (LoF) variants are a strong risk factor for Alzheimer disease (AD) with odds ratios above 30 for protein‐truncating variants (PTVs). Accordingly, some pedigrees suggest a high penetrance with individuals developing AD before 65 years. However, the age‐dependent penetrance of these variants is unknown, precluding an accurate use for genetic counselling or inclusion in preventive trials. Importantly, both rarity of these variants and co‐occurrence with other risk factors, including the common APOE4 allele, make penetrance estimations difficult based on classical strategies.

Method

We selected LoF SORL1 rare variants (PTVs and missense variants with a LoF effect following in vitro analyses) from exome sequencing data of >1,300 EOAD cases from France (Rouen‐CNRMAJ). To evaluate the age‐related penetrance of AD associated with SORL1 LoF variants, we first built a model based on family information. To ensure an accurate adjustment for APOE genotypes, our model combines a literature‐based baseline for SORL1 non carriers to an additive effect of SORL1 LoF variants computed from our pedigrees. Since pedigrees include relatives with missing genotypes, we applied an Expectation‐Maximization (EM) algorithm to take full advantage of the available information. Probands’ phenotype information was excluded to avoid ascertainment biases. We applied this first method to 34 pedigrees (69 affected relatives, 270 unaffected relatives, 45 relatives with available genotype information). Additionally, we used sequencing data from 7306 cases and 5852 controls to compute a population‐based estimate of the age‐dependent lifetime risk associated with both APOE4 allele and SORL1 rare PTVs or predicted damaging missense variants.

Result

In both models, 100% penetrance was reached before 75 years for carriers of SORL1 LoF variants who were also homozygous for APOE4. Penetrance remained incomplete for heterozygous E4 carriers, even at age 75, and was lower for non‐E4 carriers. We are providing penetrance estimation curves and 95%IC for the first time for SORL1 rare variants and at the digenic level.

Conclusion

Our results suggest that SORL1 rare LoF variants should be considered in a non‐monogenic model, different from APP and PSEN1/2 mutations. Such curves appear critical before these variants are used for genetic counseling and preventive clinical trials.
The Women’s Healthy Ageing Project: A pattern of cognitive decline after brain injury
Authors: Bird Stefanie , Faux Noel G , Szoeke Cassandra
Published: December 2021

Background

It is well recognised that damage sustained by traumatic brain injury (TBI) initiate injury mechanisms that continue to develop long after insult. Increasing evidence suggests TBI may lead to chronic cognitive decline and the development of dementia later in life. However, due to the low rate of TBI in the general community, there is a paucity of data on the impact of cognitive decline in community TBI. We examined longitudinal cognitive changes over a 12‐year period to determine if there was any relationship with community reported TBI.

Method

The Women’s Healthy Aging Project is an ongoing longitudinal cohort study of community‐dwelling Australian women. Assessments included an extensive range of measures, including neuropsychological testing of multiple cognitive domains and questions relating to head injury. In total, 110 women had complete neuropsychological testing at all three time points; from 2002, 2012 and 2014. Of these women, nine (aged 56‐65 in 2002) had a history of moderate to severe TBI. Composite cognitive scores were compared to 18 healthy controls randomly selected from the complete dataset individually matched for age, education, and APO4‐genotype. Analyses were conducted in five datasets drawn from the complete dataset and results were averaged.

Result

Median scores for executive function were similar for both the TBI group and healthy controls in 2002, lower in the TBI group by 2012 and this difference increased further in 2014. Median scores for verbal episodic memory were slightly lower in the TBI group than controls in 2002 and 2012, and this difference increased in 2014. Although this initial pilot study with small samples in mid‐aged healthy women did not show statistically significant results, the observed relationships were constant over the five datasets, warranting further exploration.

Conclusion

In our small pilot study, we observed greater rate of decline of both executive function and verbal episodic memory in women with a history of TBI. Findings warrant a need for larger studies to explore this relationship as it indicates that community‐based reported TBI may impact cognitive performance even in early ageing. Further work will continue to explore cognitive trajectories in women with a mean age 80 at next follow‐up.
Misappraisal of sleep quality is associated with lower cognitive functioning
Authors: Baril Andree‐Ann , Mysliwiec Vincent , Beiser Alexa S , Redline Susan , Seshadri Sudha , Himali Jayandra J , Pase Matthew P
Published: December 2021

Background

Self‐reported sleep quality often does not strongly correlate with objective measurements of sleep, and thus, other factors such as cognitive ability might contribute in the self‐awareness of one’s own sleep. Although sleep disturbances are increasingly recognized as risk factor for dementia, individuals with lower cognitive performance might present with an impaired ability to appropriately report their sleep, reducing the importance of self‐reported data. The purpose of this study was to evaluate whether misappraisal of sleep consolidation and quality was associated with poorer cognitive performance.

Method

We studied 265 participants (58.0±8.9 years, 50.2 % men) in the Framingham Heart Study Offspring Cohort who had an overnight in‐home polysomnography and neuropsychological testing 3.5 years later on average. Self‐reported sleep quality regarding the night of the polysomnography was compared to objective sleep efficiency (cut‐off at 85%). Four groups were created representing those with consistent appraisal of good sleep (n=75, good self‐reported and objective sleep); consistent appraisal of poor sleep (n=72, poor self‐reported and objective sleep); misappraisal of poor sleep (n=41, good self‐reported sleep but poor objective sleep); misappraisal of good sleep (n=77, poor self‐reported sleep but good objective sleep). We evaluated global cognition (composite score), verbal memory (Logical Memory immediate and delayed recall), executive function (Trail Making Test B minus A) and visual organization (Hooper Visual Organization Test). Models were adjusted for age, sex, education, time between polysomnography and neuropsychology, APOE4 allele status, body mass index, sleeping pills, depression, and stroke risk.

Result

Participants that misappraised poor sleep, i.e., reported good sleep quality but had lower sleep efficiency, had lower global cognitive performance (β±SE=‐0.34±0.17; p=0.047), worse immediate verbal memory recall (‐1.39±0.67; p=0.039) and poorer executive functioning (‐0.16±0.05; p=0.003) compared to participants with consistent appraisal of good sleep. No other between‐group differences were observed.

Conclusion

Individuals with misappraisal of poor sleep had poorer cognitive performance than individuals with consistent appraisal of good sleep. This type of sleep misappraisal could be occurring when cognitive functions are declining and self‐awareness is impaired. Further studies comparing self‐report to objective measures of sleep are required in patients in preclinical stages of dementia and with cognitive impairment.
Acculturation in context: The relationship between acculturation and socioenvironmental factors with level of and change in cognition in older Latinos
Authors: Lamar Melissa , Barnes Lisa L. , Leurgans Sue E. , Fleischman Debra A , Farfel José Marcelo , Bennett David A. , Marquez David X.
Published: December 2021

Background

Latinos are 1.5 times as likely to develop Alzheimer’s dementia as non‐Latino Whites. This health disparity may arise from multiple influences with culturally‐relevant factors receiving increasing attention. Models of acculturation stress the importance of considering acculturation‐related factors within the context of socioenvironmental factors to better capture the Latino experience in the US.

Method

We measured 10 acculturation and contextually‐related variables in 199 Latinos (age∼69.7yrs) without dementia participating in Rush Alzheimer’s Disease Center studies. We subjected these variables to Principal Component Analysis (PCA) to study their interrelationships; then investigated how the resulting components associated with level of and longitudinal change in domain‐specific cognition using separate linear mixed effects models adjusted for relevant confounders and their interactions with time.

Result

The PCA revealed a 3‐factor unrotated solution (variance explained ∼70%). Factor 1, representing acculturation‐related aspects of nativity, language‐ and social‐based acculturation, was positively associated with level, but not change, in semantic memory and perceptual speed. Factor 2, representing contextually‐related socioenvironmental experiences of discrimination, social isolation, and social networks, was associated with lower levels of episodic memory and working memory and faster longitudinal decline in visuospatial ability (Figure 1). Factor 3 (familism only) did not associate with level or change in any cognitive outcome. We are actively investigating the role of cardiovascular health on these associations.

Conclusion

Acculturation‐ and contextually‐related factors differentiated from each other and differentially contributed to cognition and cognitive decline in older Latinos. Providers should query multiple social determinants of health when evaluating older Latinos including acculturation‐ and contextually‐related lived experiences.
Vaccination beliefs in older African Americans in Detroit during the Covid‐19 pandemic
Authors: Bass Dwana , Hanna Sophie , Shair Sarah , DiCerbo Loraine M , Giordani Bruno , Kavcic Voyko
Published: December 2021

Background

The COVID‐19 pandemic has devastated multiple Countries targeting vulnerable populations. In Michigan there have been over 550,000 confirmed cases and over 14,000 deaths that forced health officials to rapidly develop and distribute COVID‐19 vaccines (MDHHS, 2021). As researchers study the COVID‐19 virus and vaccines, it is important to understand the educational needs of the public in deciding intent to accept the vaccine.

Method

We analyzed factors correlated with generalized anxiety rates in 150 African Americans age 65 and older, recruited from Wayne State Institute of Gerontology Healthier Black Elders Center and surrounding communities. Participants completed telephone questionnaires measuring demographics, stressors associated with COVID‐19 pandemic, and emotions. A scale was designed using the Health Belief Model assessing beliefs, susceptibility, severity, conspiracy beliefs of Covid‐19 (man‐made), and intent to be vaccinated. Applying factor analysis, questions were divided into: fear of COVID‐19 (I am worried about the likelihood of getting COVID‐19, My chances of getting COVID‐19 in next few months is great, I will be very sick if I get COVID‐19, Vaccinations decrease chances of infections or complications, I will get the vaccine if I receive adequate information), vaccination safety (I am concerned the vaccine will not work, I am concerned the vaccine will not be safe, Side effects from the vaccine interfere with activities and, Vaccinations make me less worried). Participants responded to these questions on 5‐point Likert scale (from “Strongly Disagree” to “Strongly Agree”).

Result

Of 150 participants, 67% expressed intention to get vaccinated while only 15% were reluctant to vaccinate. Stepwise regression analysis showed that fear of COVID‐19 and vaccination safety explained 49% variance of intent to vaccinate. Vaccination safety was predicted by age, loneliness, vulnerability, and positive emotions (R2 = 20%). Fear of COVID‐19 was predicted by anxiety and positive emotions (R2 = 8%).

Conclusion

This study provides a snapshot of urban African American older adults who are generally eager to get vaccinated for COVID‐19, and predictors of intent to get vaccinated. More research is needed to understand the scope of educational needs to increase the likelihood of older African Americans to get vaccinated.
Accuracy in estimating prevalence and incidence of dementia using longitudinal electronic health record data from the Indian Health Service
Authors: Jiang Luohua , Niu Xiaoyi , Grau Laura , Corrada Maria M , Manson Spero , O'Connell Joan
Published: December 2021

Background

Our knowledge regarding dementia epidemiology for American Indians and Alaska Natives (AI/ANs) is very limited. Longitudinal electronic health record (EHR) data available in the Indian Health Service (IHS) provides an opportunity to estimate dementia prevalence and incidence among AI/ANs at the national level. However, as with other EHR‐based studies, identifying dementia patients via clinical diagnostic codes likely underestimates the prevalence of dementia. Furthermore, longitudinal studies of dementia using EHR could be challenging if some prevalent cases of dementia cannot be identified at baseline, which might be mistakenly considered as incident cases in subsequent years.

Methods

We extracted data from the IHS National Data Warehouse and related EHR databases between fiscal year (FY) 2007‐2013. Adults were identified as having dementia if they had at least one qualifying ICD‐9 diagnostic code for all‐cause dementia. A total of 1,117 AI/AN adults who were 45+ years old were identified as dementia patients in FY2007. Among these patients, we evaluated the number of years needed to correctly classify them as prevalent cases using data after FY2007. We also examined the impact of different dementia definitions on our ability to identify these prevalent cases using FY2008‐2013 data.

Results

Among the FY2007 dementia patients who used IHS services in FY2008, only 63.7% of them were identified as having dementia in FY2008. The remaining 36.3% prevalent cases might be classified as incident cases if they have a qualifying diagnostic code after FY2008. Even when we used a 5‐year window (FY2008‐FY2012), only 78.9% of the FY2007 dementia patients were identified as prevalent cases. Among dementia patients who were 65+ years old in FY2007, a 5‐year window correctly identified 87.7% of the FY2007 dementia patients as prevalent cases. Altering the definition of dementia by adding dementia medications or diagnostic codes for other types of cognitive disorders did not substantially change our ability in distinguishing prevalent vs. incident cases of dementia.

Conclusions

It is challenging to distinguish dementia prevalent and incident cases using EHR data from the IHS. The accuracy of estimating prevalence and incidence of dementia using this data source might be higher among older patients.
Cerebral amyloid accumulation–related rapid mental deterioration presented with status epilepticus
Authors: Hsin Yue Loong , Chen Kuan Wen
Published: December 2021

Background

Amyloids are characterized by a fibrillar β‐sheet secondary structure. Cerebral accumulation of β‐amyloid peptide is proposed to be one of the toxic pathogeneses of dementia, most commonly seen in Alzheimer’s disease (AD) and cerebral amyloid angiopathy (CAA). Here we reported patients who presented with status epilepticus and rapid mental deterioration. Their amyloid PET imaging displayed diffuse deposition.

Method

We retrospectively reviewed clinical presentation, EEGs, and brain MRI from a patient group with an amyloid‐PET imaging study.

Result

Four patients were admitted to the hospital with status epilepticus. Case 1, a 75‐year‐old woman, suffered an impairment of consciousness with focal jerks. Epileptic discharging from bilateral frontotemporal regions continued for days after jerking controlled. Noticeable decline in remembering and problem solving developed rapidly within two months. Case 2, a 79‐year‐old woman, had mild cognitive impairment before administered anti‐seizure medications for right leg weakness after repeated focal seizures. After that, she had a more severe decline of dementia. Case 3, an 81‐year‐old woman, got an unimprovable left hemiparesis for two weeks of a continuing left‐sided jerk. She had rapidly increasing forgetfulness. Case 4, a 61‐year‐old man, was treated as super‐refractory status epilepticus for periodical choreic movement and dystonic jerks. Medications suppressed generalized periodic epileptiform discharges temporally. After one month, the epileptic discharging turned to periodic sharp wave complexes. He expired one month later. MRIs of Case 1 and 3 showed cortical atrophy. On case 2’s MRI, corticosubcortical microhemorrahge was revealed. Case 4’s diffusion‐weighted MRI showed diffuse cortical ribbon. The amyloid PETs of Case 1, 2, and 3 demonstrated diffuse deposition with focal cortical maximum spatially responsible for generating focal ictal discharges. The nuclear imaging on Case 4 showed maximal amyloid deposition on basal ganglia.

Conclusion

Here we reported four patients with refractory status epilepticus before dementia. Two cases were diagnosed with AD. One patient was categorized into CAA. In Case 4, according to positive CSF‐14‐3‐3, MRI cortical ribboning, EEG features, and clinical course, probable Creutzfeldt‐Jakob disease was impressed. Amyloid deposition may contribute to the increase of cortical susceptibility to seizures. Moreover, medically refractory status epilepticus hastens mental deterioration.
Examining differences across sleep profiles in late middle‐aged adults: Results from the Wisconsin Registry for Alzheimer's Prevention (WRAP)
Authors: Du Lianlian , Koscik Rebecca L , Jonaitis Erin M , Betthauser Tobey J , Cody Karly Alex , Hermann Bruce P , Mueller Kimberly D , Zuelsdorff Megan , Chin Nathaniel A , Ennis Gilda E. , Bendlin Barbara B , Gleason Carey E. , Christian Bradley T , Plante David T , Chappell Richard J. , Johnson Sterling C.
Published: December 2021

Background

Previous studies suggest associations between self‐reported poor sleep and relevant health markers and AD‐related outcomes including cognition and AD pathology. It is important to understand how sleep, a modifiable risk factor, may be related to cognition and other measures of aging in late midlife when AD pathology may be accruing. The study objectives included examining whether sleep profiles were associated with concurrent health and cognition, and positron emission tomography (PET) measures of amyloid.

Methods

Dementia‐free participants from the Wisconsin Registry for Alzheimer’s Prevention (WRAP) who had completed sleep questionnaires were eligible (n=619); questionnaires included the Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Medical Outcomes Study Sleep Scale (MOS). K‐means clustering analysis identified three clusters. We compared concurrent health markers (e.g., depression and insulin resistance) and cognitive composite scores across the sleep profile clusters. In the subset with Pittsburgh Compound B (PiB; n=107) PET imaging, we also compared amyloid measures (estimated global PiB distribution volume ratio (DVR), PiB chronicity, and PiB(+) (DVR>=1.2) at sleep assessment. Significant omnibus tests (p<.05) were followed with pairwise comparisons.

Results

Mean(sd) sample baseline age was 62.6(6.7). Cluster analysis identified 3 groups: Healthy Sleepers (HS, n=262(42.3%)), Intermediate Sleepers (IS, n=229(37.0%)), and Poor Sleepers (PS, n=128(20.7%); Fig. 1, Fig. 2, Table 1). All omnibus tests comparing demographics and health measures across sleep groups were significant except age, gender, and APOE e4 carriers; the PS group was worse than HS and/or IS on all other measures, including self‐reported depression, health, and memory complaints (Table 2). PS performed worse than HS and/or IS on measured body mass index, waist‐hip ratio and insulin resistance (Fig. 3a); and after adjusting for covariates, PS performed worse on all cognitive outcomes except working memory (Fig. 4). There were no differences between sleep groups on measures of amyloid (Fig. 3b).

Conclusion

Sleep profiles were associated with differences in additional modifiable risk factors and concurrent cognition, but not amyloid. Further analysis was needed in the association between the sleep constructs and amyloid clearance/accumulation. Management of sleep and related factors may provide an opportunity for early intervention that could ultimately delay or prevent clinical impairment.
Beta test of a mobile health application for dementia caregivers
Authors: Maynard Taylor R , Chapman Kimberly R , Sadhu Shehjar , Frink Travis , Mankodiya Kunal , Davis Jennifer D , Uebelacker Lisa , Ott Brian R , Tremont Geoffrey
Published: December 2021

Background

Dementia caregivers are at risk for negative health outcomes. Caregiver interventions to address this risk are limited by time and personnel constraints. Mobile technology is one means of reaching many caregivers while mitigating these constraints. The aim of the current project was to obtain initial data from a month‐long beta test of a new mobile health tablet App for dementia caregivers.

Method

A purposive sample of community‐dwelling dementia caregivers was given access to the CARE‐Well (Caregiver Assessment, Resources, and Education) App for one month. The App consisted of 6 primary sections: (1) Self‐Assessment of Stress and Care Recipient Behavioral Problems; (2) Psychoeducation; (3) Goal Diary; (4) Managing Behavior Problems; (5) Online Message Forum; and (6) Video Library. Feedback was collected from caregivers in a qualitative interview following study completion. Data were analyzed via a mixed‐methods approach.

Result

Caregivers (n = 10) were White, in their mid‐60s (M = 66.2, SD = 12.12), and well educated (M = 16.00 years, SD = 1.63). Care recipients had either mild (80%) or moderate dementia (20%), and 90% had probable Alzheimer’s disease. The average total time spent on the App across all participants was 754.29 minutes (SD = 1584.12). The most heavily used (in minutes) sections of the App were: Managing Behavior Problems (M = 592.10, SD = 1595.75), Video Library (M = 54.33, SD = 88.18) and Psychoeducation (M = 53.18, SD = 54.50). Qualitative feedback was predominantly positive. Caregivers reported Managing Behavior Problems to be the most helpful section followed by Psychoeducation and Online Message Forum. Caregivers reported difficulty with or disinterest in the Goal Diary section. In general, caregivers reported that the App would have been more helpful earlier in their care recipient’s illness.

Conclusion

Results indicated that caregivers regularly used the App and provided mostly positive responses to content. Findings highlighted the importance of user feedback and an iterative approach for developing digital health technology for dementia caregivers. Future interventions that are introduced earlier in the disease process may be well‐received and more beneficial to a wider range of dementia caregivers and their care recipients.
Temporal ordering of subjective cognitive decline and depressive symptoms in a multiracial community cohort
Authors: Chapman Silvia , Dworkin Jordan J , Rentería Miguel Arce , Manly Jennifer J , Joyce Jillian L , Vonk Jet MJ , Avila Justina F , Brickman Adam M. , Mayeux Richard , Cosentino Stephanie
Published: December 2021

Background

Subjective Cognitive Decline (SCD), a proposed marker of preclinical Alzheimer’s disease (AD), is commonly associated with depressive symptoms. However, the basis and directionality of this association is unclear. Divergent hypotheses propose that mood changes either cause SCD or represent a psychological reaction to perceived cognitive decline. Alternatively, mood and SCD may both be part of a dementia prodrome. Longitudinal evaluation is critical to understand the temporal ordering of SCD and depressive symptoms. Further, given known differences in the prevalence of depressive symptoms across sex‐ethnoracial groups, it is important to examine temporality across these groups.

Methods

3365 (68% women, 75 (SD=6) years old, 10 (SD=5) years educated) participants without dementia at baseline were included in this study. Of these, 1005 were non‐Hispanic Black, 1450 Hispanic and 910 non‐Hispanic White. Depressive symptoms were measured using the Center for Epidemiological Studies Depression scale (CES‐D). SCD was assessed with a 9‐item questionnaire assessing memory difficulties. Separate autoregressive generalized additive mixed effects models (GAMMs) were conducted. Each model included a lagged cross‐symptom variable, an autoregressive same‐symptom variable, and a within‐visit association between CES‐D and SCD. Models additionally included age, time in study, dementia status, education and objective memory performance. Primary coefficients of interest were lagged cross‐symptom effects, estimated across and within sex‐ethnoracial groups.

Results

Whole‐sample results showed similar coefficients for models of SCD predicting depressive symptoms (b=.021, p=.021) and models of depressive symptoms predicting SCD (b=.045, p=.001; Figure 1). Stratified analyses showed that within Black participants, depressive symptoms preceded SCD (b=.098, p<.001) whilst the opposite pattern was seen in Hispanic participants (b=.025, p=.027). With regard to sex, depressive symptoms preceded SCD in men, particularly white men (b=.141, p=.004). In contrast, SCD preceded depressive symptoms in women, primarily Hispanic women (b=.030, p=.019).

Conclusions

Results provide evidence for bidirectionality between depressive symptoms and SCD, underscoring the multiple pathways by which these two factors are linked in the course of cognitive aging. However, stratified results reveal nuanced patterns between depressive symptoms and SCD across sex‐ethnoracial groups that may offer clues to the relevance of SCD as a marker of pre‐clinical AD in different populations.
Quality measures in dementia care across a network of memory clinics: An implementation study
Authors: Pinzon Maria C Mora , Krainer Jody , Houston Stephanie , LeCaire Tamara , Green‐Harris Gina , Norris Nia , Walaszek Art , Johnson Sterling C. , Carlsson Cynthia M
Published: December 2021

Background

In 2015 the American Academy of Neurology and American Psychiatric Association updated the Dementia Management Measurement Set from 2009. Out of the nine measures proposed, four have been included by the Centers for Medicare and Medicaid Services (CMS) in their Merit‐Based Incentive Payment System, which is used to determine payment adjustments in pay‐for‐reporting program. In 2018, the Wisconsin Alzheimer’s Institute (WAI) developed a process to track the performance of these measures across the WAI Dementia Diagnostic Clinic Network, which consists of 44 statewide clinics across 24 healthcare systems.

Method

In September 2018, WAI launched the following implementation strategies to improve adoption of the quality measures: audit and feedback, new de‐identified forms, and development of a codebook with definitions and examples on how to fill the new forms. Clinics submit de‐identified forms containing demographics, diagnosis and process measures that are used to calculate performance on the quality measures. Descriptive analyses were performed, and performance was calculated according to criteria set by CMS.

Result

Over 24 months, 23 clinics have submitted information on 3,247 patients. Early adopters demonstrated a high performance on the measures, but as more clinics participate, the distribution has shown regression to the mean (Table 1). When comparing clinic performance between Oct 2019 – Oct 2020 with CMS benchmarks for 2020, the percentage of clinics performing above the CMS average were: 68% for measure #2; 91% for measure #3; 48% for measure #4; and 86% for measure #5 (Figure). Variations in performances have been attributed to unique characteristics of each clinic, for example, some do not follow‐up individuals and only provide recommendations to primary care providers; this lowers their metrics in measures that require management of behaviors or conditions.

Conclusion

Implementation of the quality measures across the WAI network has been facilitated by the use of clinical care models that promote interdisciplinary care. Further research is required to explore additional mechanisms that increase participation of clinics, and to develop new data collection methods that can explore the impact of these measures on health outcomes.