bluuebunny/crossref_metadata_2025 huggingface dataset:
The relationship between submaximal measures of cardiorespiratory fitness, brain structure, and cognition in older adults
Authors: Key Mickeal N , White Sydney , Zweydoff Rebekah , Hawes Tara , Billinger Sandra A , Szabo‐Reed Amanda , Vidoni Eric D
Published: January 2025

Background

Cardiorespiratory fitness (CRF) has been repeatedly linked to healthy brain and cognitive outcomes in aging. Treadmill‐based graded maximal exercise testing (GXT) is a common technique for measuring CRF in exercise studies. Because it is often challenging for older adults to reach the commonly accepted criterion measure of oxygen consumption, alternate, submaximal measures have been explored. The relationship between submaximal assessments of CRF, cognition, and brain health has not been extensively studied. One that tracks well with peak oxygen consumption (VO2 peak) is the oxygen uptake efficiency slope (OUES), the regression slope between maximum oxygen consumption and the log of minute ventilation. We hypothesize that OUES will be associated with 1) medial temporal, parietal, and occipital structural brain regions and 2) attentional control, processing speed, and visuospatial function.

Method

In an ongoing exercise trial,163 older adults (age = 71.06 (4.18), 73.1% female, 19.2% from historically under‐represented populations) underwent baseline testing. As part of a broader physical function assessment, peak VO2peak was measured during a treadmill‐based GXT, and OUES was calculated based on 100% of exercise time. Structural MRI scans and scores from a comprehensive neuropsychological battery were also collected.

Result

VO2peak and OUES were positively associated with several hippocampal, medial temporal, and occipital volumetric measures, with VO2peak only tracking with gray matter segments and OUES tracking with both gray and white matter segments of these regions. Overall, the associations with brain volume were stronger for OUES than for VO2peak. Both VO2peak and OUES were positively associated with visuospatial function.

Conclusion

Our study is one of few to examine the relationship between OUES, brain volume, and cognition. Though both OUES and peak VO2peak were associated with visuospatial function, OUES was associated with more brain regions and brain tissue types. One possible interpretation is that OUES may account for more variance in CRF, making it less likely to be skewed by individual differences across participants and creating a more robust association with related brain and psychological testing measures. This could potentially make OUES a valuable measure for exercise interventions for improving brain health and cognition in clinical populations.
Association of High Density Lipoprotein Cholesterol with Incident Dementia in Patients with Cardiovascular Disease: Insights from a Heart‐Brain Registry
Authors: Saeed Anum , Zhu Jianhui , Thoma Floyd , Lopez Oscar L. , Pascoal Tharick Ali , Mulukutla Suresh , Cohen Ann D , Reis Steven E.
Published: January 2025

Background

Low levels of high density lipoprotein cholesterol (HDL‐c) are a risk factors for atherosclerotic cardiovascular disease (ASCVD). ASCVD can increase the risk for dementia. However, the link between HDL‐C and incidence of dementia remain less clear specifically in women. We investigated the association of HDL‐C and dementia incidence in a contemporary healthcare network electronic health record (EHR) based registry of patients with known ASCVD, stratified by sex.

Methods

Data were abstracted from EHR (2010‐20) in patients ≥50y) with known ASCVD (coronary revascularization or coronary artery bypass grafting) and followed for dementia incidence (based on ICD9/10 codes). Baseline HDL‐C levels risk (for dementia incidence was assessed using Cox proportional hazard ratios across follow up period, adjusted for traditional ASCVD risk factors and statin use. Chi‐square test was used for sex‐stratified analysis.

Results

Among 47,210 patients (70% men vs 30% women; p <0.001) with established ASCVD, 1,725 (3.7%) new dementia cases were documented over a median follow up of ∼5 yr. Women had a higher risk of dementia incidence (HR 1.26, 95% CI [1.13‐1.39] p<0.001) [Figure] and a higher mean HDL‐C (47.7 ± 13.4 vs 41.8 ± 12.5 mg/dL, p<0.001) compared to men.

In categorical analysis, lower HDL‐C was associated with an elevated risk of dementia incidence [HRHDL‐c <40vs ≥60: 0.81; (95% CI: 0.67‐0.98); p‐value 0.03]. However, when stratified by sex, lower HDL‐C was associated with increased risk of dementia incidence for men (p for interaction <0.05) [Table].

Conclusion

The relationship of high density lipoprotein cholesterol levels with dementia incidence was sex dependent in this contemporary patient cohort of known ASCVD. More research is needed to evaluate the lipoprotein profiles of patients with ASCVD who are at higher risk for dementia.
Respiratory volume changes and CSF circulation during human NREM sleep
Authors: Lee Jeyeon , Lim Seokbeen , Kandimalla Mahathi , Ghatamaneni Sujala , Thakkar Jay , Dewan Sannidhi , Cogswell Petrice M , Gunter Jeffrey L. , Botha Hugo , Graff‐Radford Jonathan , Yook Soonhyun , Kim Hosung , McCarter Stuart J , Park John G , St. Louis Erik K , Mantilla Carlos , Huston John , Lowe Val J. , Min Hoon‐Ki
Published: January 2025

Background

Sleep’s crucial role in maintaining brain health is increasingly recognized, particularly due to the rising prevalence of neurodegenerative diseases. It not only supports cognitive function but also aids in clearing brain metabolic waste through cerebrospinal fluid (CSF) dynamics. During sleep, especially in the non‐rapid eye movement (NREM) phase, CSF flow increases, essential for removing neurotoxic substances like amyloid‐beta proteins. This study explores the link between sleep respiratory patterns and CSF flow promotion.

Method

Electroencephalography (EEG), and functional magnetic resonance imaging (fMRI) were simultaneously acquired during sleep from Gu, et al. (n = 29) (Gu et al. 2022). Respiration, measured via a respiratory belt, calculated respiratory volume (RV) as the standard deviation within a 5 second sliding window. EEG data processed delta band power (1‐4Hz) averaged across channels. Parcellated fMRI data using the brain template followed by the calculation of the averaged gray matter (GM) blood‐oxygen‐level‐dependent (BOLD) signal using the GM mask. CSF inflow was manually extracted from the fMRI’s bottom slice at the foramen magnum level. Subsequently, all signals were temporally aligned to the peak of the CSF inflow signal.

Result

At the time of CSF inflow (time = 0 sec. in the Figure 1A‐D), we observed an earlier increase in RV and EEG delta power, followed by changes in the GM BOLD signal (Figure 1). EEG and RV changes preceded the BOLD signal changes, which, in turn, preceded changes in CSF flow. Sensitivity to detect RV involvement during MRI varied with the placement of the respiratory belt, being least sensitive on the chest and more on the abdomen.

Conclusion

These findings raise an interesting question on the role respiratory patterns during sleep, particularly in the NREM phase. Speculatively, RV change may influence CSF circulation during NREM sleep (Figure 1E). This enhancement in CSF flow is crucial for the clearance of metabolic waste from the brain, potentially reducing the risk of neurodegenerative diseases. Our findings indicate that respiratory volume may serve as a significant marker for CSF circulation during sleep.
Household Crowding and Neurocognitive Performance in a Cohort of Middle‐Aged Latina Women: The CHAMACOS Maternal Cognition Study
Authors: Torres Jacqueline M , Calderon Lucia , Kogut Katherine , Rodriguez Maria Teresa , Romero Monica , Garcia Lizari , Rocha Yesli Perez , Rojas Nadia , Rojas‐Saunero Liliana Paloma , Eskenazi Brenda , González Hector M
Published: January 2025

Background

Household crowding is a longstanding focus of public health research; there is growing interest in its impact on dementia risk. In the US, household crowding is prevalent among low‐income immigrant communities that have historically been excluded from dementia research. We evaluated the relationship between household crowding and neurocognitive performance among a novel cohort of middle‐aged and primarily immigrant Latinas living in an underserved agricultural community and whether mental health or sleep duration might serve as potential mechanisms.

Method

We used data from the 2022‐2023 CHAMACOS Maternal Cognition Study (n = 513). Household crowding (yes/no) was measured as with binary indicators of > 1 person per habitable room (ppr) and > 2 people per bedroom (ppb); we also considered continuous versions of these measures and the number of household residents < 18 years. Global and domain‐specific cognitive performance z‐scores were measured using the SOL‐INCA cognitive performance battery. Respondents also completed the 10‐item Centers for Epidemiologic Studies ‐ Depression and the 7‐item Generalized Anxiety Disorder scales. Self‐reported hours of nightly sleep were calculated from typical sleep and wake times. We estimated linear regression models controlling for socio‐demographic characteristics.

Result

Participants had a mean age of 48.8 years (SD: 5.2); 22.4%‐20.9% experienced household crowding depending on the metric (> 1 ppr; > 2 ppb). Household crowding (> 1 ppr) was associated with poorer memory (Coef: ‐0.20, 95% CI: ‐0.39, ‐0.02), executive function (Coef: ‐0.21, 95% CI: ‐0.32, ‐0.09), verbal fluency (Coef: ‐0.18, 95% CI: ‐0.33, 0.01) and global cognitive performance (Coef: ‐0.19, 95% CI: ‐0.31, ‐0.07) z‐scores. Associations were consistent when using alternative household crowding measures. Household crowding was also associated with fewer hours of sleep (Coef: ‐0.45, 95% CI: ‐0.80, ‐0.11), although associations with depressive and anxiety symptoms were null.

Conclusion

We observed meaningful associations between household crowding and neurocognitive performance scores among middle‐aged Latina women, with sleep duration as a potential underlying mechanism. Household crowding may be a predictor of future dementia risk and dementia inequities. Reduction of household crowding may be an amenable to population and community‐level intervention (e.g. housing and economic policies) to improve adult cognitive functioning.
Baduanjin Qigong exercise intervention improves subjective and objective cognitive functioning: the moderation and mediation effects of sleep
Authors: Yang Yi , Shi Haoer , Liu Jianghong
Published: January 2025

Background

Baduanjin exercise showed beneficial effects on cognition among older adults, yet the underlying mechanisms are not well understood. We aimed to further examine potential mediation or moderation roles of sleep improvements on the intervention effects in cognition.

Method

In our 10‐week intervention trial with control group, a total of 78 (intervention: n = 47, control: n = 31) older Chinese American adults in a senior daycare center were included. Objective cognition was measured by the computerized memory test. Subjective cognition was assessed by the cognitive function subscale of the Sub‐health Measurement Scale (SHMS). Sleep was measured by Pittsburgh Sleep Quality Index (PSQI). The SPSS PROCESS macro was used for moderation and mediation analyses, with the post‐pre differences in sleep and cognition used as moderator or mediator and outcome, respectively.

Result

Compared to the control group, the Baduanjin Qigong intervention significantly predicted improvements in subjective and objective cognition for poor sleepers, while having no effect on good sleepers. Improvements in sleep quality significantly mediated the intervention effects on subjective cognition among populations with higher education (indirect effect: β = ‐.320, CI: [‐.717, ‐.041]) and less exercise (indirect effect: β = ‐.133, CI: [‐.573, .259]), while the direct effect of intervention remained significant.

Conclusion

In conclusion, Baduanjin exercise improved cognitive functioning in older Chinese American immigrants, particularly among those with poor sleep. Sleep quality played a mediating role, especially among individuals with higher education and less exercise. Our results shed light on future interventions in helping identify targeted mediating/moderating factors of Baduanjin interventions.
Multidisciplinary patient‐centered program implemented in a psychogeriatric unit in Brazil:Caregiver Burden Outcomes
Authors: Buchain Patricia Cardoso , Bassitt Debora Pastore , Alves Tania Correa de Toledo Ferraz
Published: January 2025

Background

Caregiver burden is the result of dealing with the dependency of the subject who needs attention and care. Caregivers of people with neuropsychiatric disease could experience emotional, physical and financial stress. The literature shows that the caregiver burden can negatively impact both, the caregiver and the patient. According to evidence, psychosocial interventions may decrease BPSD, depressive symptoms and caregiver burden. At Institute of Psychiatry USP Medical School, Brazil we offer psychosocial interventions by a multidisciplinary team in a transitional care service (day‐hospital unit). In this report we will analyse the impact of this intervention in caregiver burden.

Method

The program involves interventions at day‐hospital offering management of psychoactive drug treatment, prevention and care of geriatric neuropsychiatric syndromes, and support to family caregivers, for approximately two months. There are groups and individual interventions lead by a multidisciplinary team: medical team, nurse, psychologist, speech therapist, physiotherapist, occupational therapist, nutritionist and social worker. After an initial assessment an individualised care plan is established and also the caregivers are involved in the focus of intervention. The care related to caregivers involves psychoeducation, organising routine, strategies to manage BPSD and emotional support. To assess caregiver burden we use the Zarit scale. The intervention to caregivers involves psychoeducation groups (60‐90 min), and individual sessions.

Result

There were 30 consecutive admissions between march and december 2023, the main diagnosis at admission were depression and dementia. The mean age of the patients 71,24, gender 19 female, 11 male. Admission mean Zarit was 36,23 and discharged 28,84.

Conclusion

The therapeutic program demonstrates efficiently to caregivers in order to adapt to behaviour changes and develop a successful daily routine care at home and decreased caregiver burden. Our findings demonstrated that this patient‐centered program results in reducing burden from /moderate to severe/ to /mild to moderate/. The present intervention is an important strategy to assist caregivers.
Advanced Cognitive Impairment Outpatient Clinic and the importance of multidisciplinary care in the care of patients with advanced dementia
Authors: Hassem Carolina Saad , Souza Ana Carolina Borges de Miranda , Athias Rafael Tobias , Gonçalves Natália Mira , dos Reis João Otavio Sá , Jacob‐Filho Wilson , Morillo Lilian Schafirovits
Published: January 2025

Background

Dementia is characterized by a chronic and progressive loss of cognitive function in the absence of a fluctuating level of consciousness. Alzheimer’s disease is the main etiology of dementia, presenting insidiously and causing progressive cognitive impairment with increasing severity over the years. Given the immense complexity of managing patients with advanced dementia, the Advanced Cognitive Impairment Outpatient Clinic (ACIOC) of the Geriatric Service of the Internal Medicine Division of the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (HCFMUSP) was created in April 2008, which aimes to monitor elderly patients referred from other outpatient clinics, with moderate to advanced dementia, for multidisciplinary follow‐up: doctor, speech therapist, occupational therapist and dentist. Given the complexity of patients with advanced dementia, each patient is assessed, in person, on average, 4 times a year.

Method

To describe the functioning and sample of patients that make up the ACIOC, according to data collected via electronic medical records between August 2018 and January 2024.

Result

Electronic medical records were implemented in August 2018. Data taken from records indicate that 246 patients were assisted between August 2018 and January 2024, with an average age of 79.10 years. The majority of patients were white (60%), female (65%) and had 5 years of schooling, on average. The main comorbidities were: hypertension (40%), coronary artery disease (40%) and diabetes mellitus (17%). Regarding the etiology of dementia, Alzheimer’s was the most prevalent (28%), followed by Vascular (15%), Mixed (12%), Frontotemporal (5%), LBD (4,8%) and 23% of patients did not have diagnosis. Regarding the treatment carried out, 61% were treated with anticholinesterases, 59% with antidepressants, 53% with antipsychotics and 46% with memantine.

Conclusion

The data obtained highlights the importance of ACIOC in dementia care, especially for those residing in São Paulo / Brazil. This study seeks not only to contribute to the understanding of dementia in the Brazilian context, but also emphasizes the need to share these findings to improve services offered in other institutions dedicated to the care of these patients.
Technology Use Amongst Older Adults with and without Cognitive Impairment: Results from the ‘Validation of Video Administration of a Modified UDSv3 Cognitive Battery (VCog)’ Study
Authors: Sachs Bonnie C. , Latham Lauren , Craft Suzanne , Gaussoin Sarah A. , Clark Lindsay R. , Duff Kevin , Farias Sarah Tomaszewski , Goldstein Felicia , Hampstead Benjamin M. , Jayadev Suman , Jicha Gregory A , Kukull Walter A. , Mechanic‐Hamilton Dawn , Neugroschl Judith A. , Papp Kathryn V , Saykin Andrew J. , Sewell Margaret , Rapp Stephen R.
Published: January 2025

Background

Video interfacing is increasingly being used in research and health care. The ‘VCog’ Study seeks to determine whether remote research cognitive assessments are reliable and valid by directly comparing results from in‐person administration of a standardized cognitive battery to the same battery administered remotely by video. The study also assesses technology use and comfort amongst participants of varying levels of cognitive impairment.

Methods

Participants (Table 1) were recruited from 12 Alzheimer’s Disease Research Centers (ADRCs). 313 ADRC enrollees who were previously classified as having normal cognition (CN), Mild Cognitive Impairment (MCI), or mild dementia were administered the Uniform Data Set v3 (UDSv3) cognitive battery remotely by video 4‐8 weeks before or after their annual in‐person UDSv3 cognitive assessments, in counterbalanced order. Participants also completed questionnaires assessing their typical use and confidence using various forms of technology.

Results

More than 50% of participants reported daily‐to‐monthly use of technology, with 74‐92% of participants reporting daily smartphone use (Table 2). All participants reported moderate‐to‐high confidence when using technology (Range: 5.57‐8.10 on a 0‐10 scale, with 0 being ‘not confident at all’ and 10 being ‘extremely confident’). As expected, both frequency and confidence using technology varied with cognitive status; poorer cognitive status was typically associated with less usage and lower confidence (Table 3). Despite this, ‘dislike of video interfacing’ was not endorsed more frequently by those with cognitive impairment as the reason for study refusal (dementia = 8%; MCI = 13%; CN = 18% of total refusals).

Conclusion

Technology is rapidly becoming a routine part of our lives though little is known about the relationship older adults have with it, especially those with cognitive impairment. This research indicates that among older adults of varied cognitive status, including dementia, both utilization and confidence in use are relatively high. Some group differences exist, with worse cognition being associated with less use and confidence. Despite this, persons with dementia were not likely to refuse participation because of dislike of videoconferencing. Future reports from the VCog study will report the validity and reliability of remote assessments.

Funded by R01 AG075959
Increased Functional Connectivity Relates to Cognitive Improvement Following Non‐Invasive Brain Stimulation in MCI
Authors: Aghamoosa Stephanie , Nolin Sara , Chen Andrew A , Caulfield Kevin A , Lopez James , Rbeiz Katrina , Fleischmann Holly H , Horn Olivia , Madden Katrina , Antonucci Michael U , Revuelta Gonzalo , McTeague Lisa M , Benitez Andreana
Published: January 2025

Background

Repetitive transcranial magnetic stimulation enhances cognition in people with mild cognitive impairment (MCI). Whereas conventional treatment requires daily sessions for 4‐6 weeks, accelerated intermittent theta burst stimulation (iTBS) shortens the treatment course to just 3 days, substantially improving feasibility of use in people with MCI. We conducted a Phase I safety and feasibility trial of iTBS in MCI, finding preliminary evidence of cognitive improvement. Here, we explore the neural mechanism of this effect by evaluating iTBS‐related changes in functional connectivity in relation to the observed cognitive change.

Method

Twenty‐two patients with amnestic MCI received iTBS to left dorsolateral prefrontal cortex (l‐dlPFC) over 3 treatment days (with 8 stimulation sessions of 600 pulses per day) within 1 week. Nineteen had complete MRI and cognitive testing data. The primary cognitive outcome was the fluid cognition composite score from the NIH Toolbox Cognition Battery. We computed functional connectivity from resting‐state fMRI and calculated participation coefficient for three regions of interest. Lower participation coefficient values indicate that a region is more selectively connected to its own network and higher values indicate that it is more widely connected across networks (i.e., a “hub”). We calculated change in participation coefficient from pre‐ to post‐treatment for two regions belonging to the frontoparietal network (the l‐dlPFC iTBS target and the contralateral right dlPFC) and a negative control (primary visual; V1).

Result

There was a significant, large effect‐size (d = 0.98) improvement in fluid cognition from pre‐ to post‐iTBS treatment. Improvements in cognition were significantly associated with increased participation coefficient of l‐dlPFC (r = .52, p = .022), with a marginal effect in r‐dlPFC (r = .41, p = .084) and a near zero effect in the negative control V1 (r = .03, p = .898).

Conclusion

This preliminary investigation suggests that iTBS‐related cognitive improvement in MCI may be attributable to increased connectivity of the stimulated frontoparietal network. Specifically, a larger increase in “hubness” (i.e., connectivity across multiple networks) of the l‐dlPFC target region is associated with greater cognitive gains. However, as these analyses are based on a limited number of regions and small sample, future studies are needed to further evaluate the neural mechanisms of iTBS in MCI.
Mortality Rates in Individuals with Dementia: An Analysis of the Brazilian Longitudinal Study of Aging (ELSI‐Brazil)
Authors: Rabelo Wendell Lima , Barbosa Matheus Ghossain , Bertola Laiss , Lima‐Costa Maria Fernanda , Ferri Cleusa P
Published: January 2025

Background

Population aging is occuring faster in low‐ and middle‐income countries (LMICs) and contributes to the increasing prevalence of chronic conditions, including dementia. In Brazil, dementia‐mortality studies rely mainly on death certificate registrations, which are poorly completed, thereby compromising the results. This study examines mortality rates of older people, especially those living with dementia, in the Brazilian Longitudinal Study of Ageing (ELSI‐Brazil).

Method

This is a secondary analysis of the ELSI‐Brazil longitudinal data. We estimated the prevalence of dementia using data from 5249 participants aged 60 years and older for whom the vital status was determined. We employed Cox regression to estimate the association between dementia and mortality. Mortality rates per 1000 person‐years were calculated and stratified by, sex, age, and schooling groups.

Result

In the current analysis, 4971 individuals were considered after excluding those with missing data for any variable (table 1). They were primarily female (60%), with a mean age of 70.0 years (SD = 7.7), did not live alone (84.2%), and had 4.6 years of schooling (SD = 4.3). The sample comprised 4,652 individuals without dementia and 319 individuals with dementia.

In those with dementia, the mortality rate per 1000 person‐years was significantly higher in males 117.9 (95% CI: 188,3 – 157,4) compared to females 74,1 (95% CI: 158,8 – 93,3). In addition, individuals affected by dementia experienced higher mortality risks across various age groups and educational backgrounds.

The hazard ratio adjusted for multiple factors was 2.2 (95% CI: 1,8 – 2,7). Table two shows the mortality rates among people with dementia per gender, years of schooling and age‐groups.

Conclusion

This study shows how dementia affects mortality in Brazil’s aging population. We expect these findings to support and direct public health interventions to improve care and support for people with dementia and their families.
The Advanced Therapeutics for Alzheimer’s Disease Review Board: A Multidisciplinary Model to Facilitate Safe Access to Lecenemab across the Sutter Health System
Authors: Moughamian Armen , Kile Shawn , Urban Travis , Zhao Chen , Manifield Michelle , Minton Jean
Published: January 2025

The full approval by the FDA of the first disease‐modifying therapy for Alzheimer’s disease has significantly impacted the treatment paradigm of the disease. Safe administration of lecanemab requires a greater level of care and monitoring and increases the care‐burden on patients, their care‐team, and the health system. Prior to the approval of lecanemab, a significant shortage of cognitive specialists already existed. The Sutter Health system treats over 3 million patients across Northern California but has only 4 cognitive neurology specialists. In the face of a limited number of cognitive neurologists, we set out to develop a system‐wide approach to improve access to advances in the treatment of Alzheimer’s disease. The Advanced Therapeutics for Alzheimer’s Disease Review Board emerges as an innovative model to promote the safe, equitable, efficient and local access to these novel therapies. The board is comprised of a multidisciplinary team of specialists, including cognitive neurologists, a neuroradiologist, a pharmacist, and an RN navigator. General neurologists throughout the Sutter Health system submit cases to the board which meets weekly. The board plays a crucial role in reviewing and guiding the local practitioners in the appropriate use for patients considering treatment. The board enables local neurologists to safely prescribe lecanemab and improves access to these advanced therapeutics in diverse and underserved populations. The board further enhances safety by re‐reviewing cases in which local providers have concerns about the management of side‐effects, including as ARIA. Outcomes of our innovative model including access to and safety of treatment will be tracked. Lastly, as additional advanced treatment options for Alzheimer’s disease are approved, we anticipate that the Advanced Therapeutics of Alzheimer’s Disease Review Board will be able to assist general neurologists in the Sutter Health network with the appropriate selection of these novel agents. Sutter Health’s Advanced Therapeutics for Alzheimer’s Disease Review board is a novel system‐wide model to address the shortage of cognitive specialists while enhancing the safe and equitable access to advanced treatments for Alzheimer’s Disease across a health system.
Challenges to Dementia Care in El Salvador: Perspectives from Geriatricians of the Salvadoran Older Adults Study
Authors: Valdivieso‐Mora Esmeralda , Mancia‐Zuniga Ricardo E.
Published: January 2025

Background

The Salvadoran Older Adults Study is the first nation‐wide research project conducted at a university level in El Salvador (Central America). The study included semi‐structured qualitative interviews of seven geriatricians. There are only 12 geriatricians for over one million 200 thousand older adults in El Salvador. The present analysis examines their perspectives on dementia care in this country.

Method

The Salvadoran Older Adults Study consisted of an explanatory mixed‐methods Quan‐Qual design that included a national survey of Salvadoran older adults and qualitative interviews. Seven geriatricians were interviewed as part of the study. Questions inquired about their educational background, professional career, main reason for referrals in their clinical practices, challenges faced by older adults in the public and private health systems.

Result

All geriatricians indicated that dementia and neurocognitive disorders were the main reason for referrals in their private practice and public health institutions. They reported that lack of education about geriatric care among the population was the main challenge they face for providing services to older adults. Other challenges mentioned are categorized as expressions of ageism, even among their medical doctor colleagues.

Conclusion

Geriatricians perceive their role in the public health system has been minimized. The referrals they receive are mostly of individuals with late stage dementia. They provide care mostly to patients that have been seen previously by a medical provider that “does not know what else to do with them”. Other challenges mentioned can be categorized as expressions of ageism present in the public health systems, their university‐level doctoral education and communities.
From the Voices of Black Dementia Caregivers: The Need for Culturally Responsive Education on Navigating Care
Authors: Epps Fayron , Gore Janelle , Cave Nkosi , Shoemake Jamiah , Alexander Karah L , Bennett Stephanie R
Published: January 2025

Background

Among Black caregivers of persons living with Alzheimer’s disease and related dementias (ADRD), the overlay of health disparities and systemic discrimination substantially contribute to heightened adverse health outcomes. Black dementia caregivers report experiencing challenges in providing care that may be exacerbated by them receiving fewer support services and having more unmet needs compared to their racial counterparts. Furthermore, historical systemic failures and disadvantages impacting Black dementia caregivers contribute to long‐established stressors and vulnerabilities. Currently, there is limited caregiver education and resources that are culturally responsive to the unique needs of Black caregivers.

Method

In hopes of developing an education course responding to the needs of Black dementia caregivers, focus groups were held to explore the demand and need for culturally responsive education on navigating the care of persons living with dementia. Thematic analysis was conducted on focus group sessions with current and former caregivers (N = 16).

Result

Four themes emerged: Limited accessible opportunities for education and resources, Black caregivers have their own cultural identity, culturally responsive education creates a space to feel seen, and a culturally responsive course will provide a sense of empowerment. Caregivers felt that there were minimal opportunities for education and resources. However, when they were about to access resources, they were not applicable to their caregiving needs and experiences. Additionally, Black dementia caregivers acknowledged there is a cultural identity including shared experiences amongst Black caregivers. If these experiences are acknowledged within caregiver educations and resources, it would provide Black dementia caregivers with a sense of belonging, empowerment, and encouragement by showing them that they are not in this caregiving journey alone.

Conclusion

These results support the development of a course that seeks to equip and empower Black dementia caregivers with the knowledge, skills, and sense of mastery they need to address and cope effectively within their role. Ultimately, a culturally responsive education course will address an urgent need to embrace the ontology of Blackness, underlying social “Blackness” and the experience of being Black in America and a dementia caregiver.
ChatGPT‐4 in Clinical Neurology: An Alzheimer’s Disease Information Quality Analysis
Authors: Yasin Ihsaan , Irfan Bilal , Reader Jonathan M , Fox‐Fuller Joshua T
Published: January 2025

Background

The integration of Large Language Models (LLMs) like ChatGPT‐4 in clinical settings offers potential enhancements in medical practice, particularly in neurology and dementia care. There is rising public usage of ChatGPT‐4 for preliminary information gathering. This study aims to evaluate the effectiveness of ChatGPT‐4 in responding to neurology‐focused queries, with an emphasis on Alzheimer’s Disease (AD). It addresses the challenges of accuracy and reliability in artificial intelligence (AI)‐generated medical information, which are crucial for practical clinical applications.

Method

This investigation utilized ChatGPT‐4 to respond to six diverse neurology‐related questions covering symptomatology and caregiver guidance for AD. The responses were assessed using a context‐adapted DISCERN and AGREE II scoring framework, which are rating systems for evaluating the clarity and appropriateness of healthcare information and advice. Two blinded neurologists independently reviewed and scored the AI’s responses. Statistical analyses, including correlation, variance, and linear regression, were conducted to quantify the relationship between the AI’s adherence to clinical guidelines (AGREE II scores) and the quality of information provided (DISCERN scores).

Result

ChatGPT‐4’s responses achieved a moderate level of alignment with clinical guidelines, indicated by a total AGREE average score of 2.27/7. The general quality rating average was 5.25/7, reflecting moderate accuracy and relevance. The combined AGREE and rating average score was 2.51/7, with a total DISCERN average of 2.14/5. Statistical analysis revealed a moderate positive correlation (Pearson coefficient: 0.58) between AGREE and DISCERN scores. Variance analysis showed low variability in AGREE scores (0.0499) and higher variability in DISCERN scores (0.2200). Regression analysis indicated that AGREE scores moderately predicted DISCERN scores (R² = 0.334), but the relationship was not statistically significant (p > 0.05).

Conclusion

ChatGPT‐4 demonstrates potential in providing neurology‐specific information, particularly for AD, with moderate effectiveness. Healthcare professionals should employ AI‐generated information cautiously, treating it as a supplement to established clinical guidelines and professional judgment. It is essential to ensure that the public is well informed about the limitations and appropriate uses of AI as a tool for health information.
Decoding the Mechanism of the Loss of Self in Spouse Caregivers of Alzheimer’s Patients: A Sociocultural and Communication Perspective
Authors: Sa Erting
Published: January 2025

Background

The experience of spouse caregivers of individuals with Alzheimer’s Disease (AD) is marked by witnessing the gradual cognitive decline of their loved ones. This journey transforms the nature of their marital relationship, evolving from mutual interdependence to a more unilateral caregiving role. Despite this significant shift, the specific phenomenon of self‐loss among these caregivers remains underexplored in academic research.

Method

Adopting the symbolic interactionist perspectives, which argue the self is a symbolic and relational process, created and sustained through ongoing social interactions, this research conducts an extensive review of interdisciplinary literature, integrating influential theoretical models, including George Mead’s (1967) interacting self, Peter Berger and Hansfried Kellner’s (1964) theories on marriage and reality construction, Wegner, Giuliano, & Hertel’s (1985) work on cognitive interdependence in close relationships, and Timothy Stephen’s (1986) symbolic interdependence theory. These frameworks collectively inform a new theoretical concept to elucidate the nature of self‐loss experienced by AD spouse caregivers.

Result

The proposed theoretical perspective suggests that AD significantly transforms the intimate reality previously co‐constructed by marital partners. The deterioration of the AD‐affected spouse’s language and memory capacities erodes the symbolic coherence that once underpinned the marital relationship. This leads to a profound disruption in the couple’s shared reality, which is essential for affirming and supporting each partner’s self‐identity, beliefs, and values. As a consequence, spouse caregivers not only witness the gradual erosion of their partner’s self but also experience a profound disruption in their own sense of self, particularly in aspects deeply intertwined with their marital identity.

Conclusion

This theoretical exploration offers significant implications at societal, community, interpersonal, and intrapersonal levels. By enriching existing literature, it aids policymakers, researchers, healthcare organizations, and families affected by AD in comprehending the interpersonal impact of the disease on spouse caregivers. Furthermore, this perspective sheds light on the emotional, mental, and psychological challenges faced by caregivers, underscoring the critical need for robust social support systems. Consequently, this research could inform the development of targeted intervention programs and health policies, thereby supporting spouse caregivers who play a crucial role in the healthcare system and in the lives of their loved ones.
Cross‐sectional and longitudinal associations of caregiving and caregiving stress with caregiver cognitive functioning
Authors: Antonucci Toni C , Ajrouch Kristine J , Zahodne Laura B.
Published: January 2025

Background

Caregiving, both cross‐sectional and longitudinal, is often considered a stressful experience. Less is known about the effect of the caregiving experience or the associated stress on cognitive functioning of the care provider.

Method

Data are drawn from the Social Relations Study (SRS) and the Detroit Area Wellness Network (DAWN) Studies. SRS data are from two face‐to‐face panel data collections in 2005 and 2015, a Detroit area study, focused on social relations among a random representative sample for the Detroit metropolitan area. The DAWN study examined social relations, stress and cognitive performance via a telephone interview during the Covid pandemic, specifically in 2021. Respondents were asked if they were caregiving to a parent, spouse/partner, or (other adult). They were also asked how stressful caregiving has been for them (using a 4 point scale from (1) very stressful to (4) not at all stressful). Cognition was assessed via telephone with multiple measures including the CERAD, Animal Naming, Digit Span F, Digit Span B.

Result

Preliminary findings indicate that people who were caregiving at either time point actually scored higher on cognitive functioning than those who were not; this finding was also evident among people reporting that caregiving was stressful. The same association is evident among those who report feeling stressed by the caregiving experience either previously or contemporaneously. To be precise, they scored higher on all the separate cognitive measures as well as the latent cognitive functioning measure than those who were not stressed by the caregiving experience.

Conclusion

Traditionally caregiving and caregiving stress have been assumed to have a negative effect on the caregiver. These data suggest a more detailed examination of this issue is warranted, especially with respect to cognitive functioning of the caregiver. Additional analyses will examine these findings in greater detail to specify if there are age, education or race health disparities.
Examining the Effect of Work‐Life Imbalance on Cognitive Complaints
Authors: McCray Rachel , Oruru Daisha , Locklear Clarence , Bubu Omonigho M , Turner Arlener
Published: January 2025

Background

Subjective cognitive complaints (SCCs) are self‐reported cognitive concerns, often without objective impairment and are associated with higher risk of MCI and/or dementia. Moreover, the related subjective cognitive decline is suggested as a form of cognitive impairment, and precursor to Alzheimer’s disease and related dementias (ADRD). Sleep, stress, and anxiety have been shown to explain significant portions of variance in relationships between multi‐morbidity and SCCs. Leisure/social time can mediate stress and negative moods which may prevent worsening cardiovascular and cognitive decline. While there are many barriers to leisure, the most universal limitation is lack of time. Specifically the US has less vacation days and more expected work hours than other nations, leaving little time for rest, resulting in a work‐life imbalance (WLI) causing added stress and possible mood disorders. Though discussions are rising around federal minimum wage, and remote work, there’s little insight into WLI’s impact on long term health outcomes and cognition.

Method

We explored the effect of markers of WLI (ex: stress, sleep, life satisfaction) on the presence of SCCs in participants (N = 89,976, 51.6% Female, 16.0% Black, Mage = 35.64 years) from the 2010 National Health Interview Survey. WLI was defined via a composite score of the subjective measures work‐family responsibility compatibility, social satisfaction, and hours slept. SCC was defined via self‐report of difficulty remembering or concentrating, with reporting at least some difficulty representing the presence of a SCC.

Result

There was a significant association between WLI and greater reporting of SCCs; (X2
2, N = 379) = 7.145, p = 0.028. ANOVA analysis further demonstrated the significant influence of a greater presence of WLI on SCCs; F(2,376) = 10.29, p<.001. Those who experienced a higher frequency of SCCs (e.g. difficulty remembering things “all of the time”; [M = 2.4231]) scored highest on the WLI scale followed by the next highest “frequently” (M = 2.3456) and then “sometimes” (M = 2.0428).

Conclusion

Our results demonstrate potential harmful effects of WLI on the presence SCCs. These results confirm previous research connecting stress and other modifiable risk factors for AD like impaired sleep to SCCs, suggesting an avenue for intervention. Further research is needed to fully illuminate how this relation applies to cognitive decline and ADRD.
Understanding the gut‐brain axis to mitigate cognitive frailty
Authors: Majeed Abu Bakar Abdul , Ramasamy Kalavathy , Tan Maw Pin , LIm Siong Meng , Hui Khor Min , Tan Ai Huey , Fadzuli Nurul Izzati Ahmad
Published: January 2025

Background

Gut microbiota modulation of the brain function may present an opportunity to devise preventive or treatment strategies to manage impairments such as cognitive frailty (CF). This study aims to uncover the relationship between CF, gut microbiota, intestinal permeability and proteome.

Method

A total of 137 fecal samples of the elderly were collected, and subjected to DNA analysis, and enzyme‐linked immunosorbent assays (ELISA). Plasma samples were subjected to mass spectrometry proteomic analysis. The parameters of the subjects measured include functional reach test (FRT), handgrip strength (HGS), Visual Cognitive Assessment Test (VCAT), Montreal Cognitive Assessment (MoCA), timed up and go (TUG) and UCLA three‐item loneliness scale (UCLA‐3).

Result

At the genus level, Alistipes which are potential drivers of dysbiosis, are significantly increased in CF subjects. Proteobacteria are also negatively linked to FRT, HGS, VCAT, and MoCA, but positively correlated to TUG and UCLA‐3. Lactoferrin was upregulated in pre‐frail subjects. The plasma apolipoprotein AI (Apo‐AI) was upregulated 5 times in the CF subjects.

Conclusion

These findings provide evidence for dietary intervention to alter gut microbiota that may modulate cognitive status.
Early outcomes of a community‐based participatory research (CBPR) approach to investigating brain health and ADRD phenotypes following traumatic brain injury
Authors: Dams‐O'Connor Kristen
Published: January 2025

This session is proposed for consideration to be presented as part of the Partnering with Research Participants Professional Interest Area (PIA), for AAIC 2024 FRS titled Participant and Public Involvement Across Alzheimer’s Disease Research Studies: Conceptual and Empirical Strategies for Equitable Participation. This session will focus on areas of opportunity in the involvement of research volunteers to further and enhance research design and practices in different aspects of AD and ADRD research studies. This session is specifically focused on conceptual and applied approaches for the involvement of research volunteers across all study designs. We will use a use‐case example to illustrate the implementation of a DoD CDMRP‐funded Focused Program Award designed to investigate brain health and ADRD phenotypes following traumatic brain injury. The ENRICH brain health study is founded in a community‐based participatory research (CBPR) approach, with one of the five studies focused on the formation and implementation of a Community Advisory Group for Brain Health (CAGE‐BH). The CAGE‐BH consists of individuals with lived experience of brain injury, neurodegenerative disease, military service history, leadership of or participation in local or national brain injury or dementia care advocacy groups, and veteran service organizations. The CAGE‐BH is involved in the development and implementation at all stages of the four research studies comprising the ENRICH Focused Program Award. The proposed session will share early outcomes of a community‐based participatory research (CBPR) approach to investigating brain health and ADRD phenotypes following traumatic brain injury.
An Usability and Acceptability Study for Immersive Virtual Reality Application in People With Alzheimer’s Disease: A Case Series
Authors: Menengiç Kübra Nur , Çelikçi Cengiz , Süzme Zeynep , Yeldan İpek
Published: January 2025

Background

Virtual reality (VR), an emerging technology that is becoming increasingly widespread, shows promise as an effective rehabilitation strategy for various diseases. The aim of this study was investigating usability and acceptability of VR in people with Alzheimer’s Disease (AD).

Method

Nine people with early and middle stages of AD were included in the study. The immersive VR application was implemented via the BOBO® VR Z Headset. Selected YouTube VR films, such as relaxing animal and space videos, as well as museum tours, were watched. The VR experience of participants was assessed after a 15 minute application. The usability was evaluated with a survey prepared for this study, including questions evaluating aspects such as realism, comfort, enthusiasm, entertainment, and willingness to participate again. Participants' sickness symptoms were evaluated with the Simulator Sickness Questionnaire, and their moods were evaluated with the Brunel Mood Scale.

Results

All participants found the application realistic and exciting. 4 of participants found the goggles uncomfortable and 2 of them stated that they would not want to apply it again. 4 of the participants experienced symptoms of general discomfort, fatigue, eye discomfort, and difficulty in concentrating.

Conclusion

While the application was found to be feasible and acceptable for some participants, it was not for others. The discomfort, especially in the nose part of the headset, appears to be caused by the design factors of the device. Additionally, some participants experienced sickness symptoms. VR has the potential to serve as an alternative, offering a different and enjoyable approach within rehabilitation practices for certain individuals. However, we are of the opinion that the results of the application show individual differences and the immersive VR may not be suitable for all individuals with AD.