bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preventing Loss of Independence through Exercise (PLIÉ): Evaluation of implementation at a VA community living center
Authors: Akram Alirameen , Martin Lynn , Lee Maria , Nicosia Francesca M , Martinez Steven , Woo Michele , Ordonez Cherry , Lee Jennifer Ann , Barnes Deborah E 
Published: December 2020

AbstractBackgroundPreventing Loss of Independence through Exercise (PLIÉ) is an integrative group movement program developed to improve quality of life and daily function in people with mild‐to‐moderate dementia. We implemented PLIÉ at a VA Community Living Center (CLC) and conducted a formative evaluation.MethodsWe provided 12 weeks of experiential training to two local clinical champions. Approximately 9 months later, we evaluated implementation based on the following outcomes: 1) reach (number of post‐training classes offered and attendance) and 2) effectiveness (anonymous surveys administered to residents, staff, and family who attended >1 class; clinical progress notes for program participants). Surveys included satisfaction ratings (5‐point Likert scale) and open‐ended questions (changes in themselves and others due to PLIÉ, what they liked most and least, and other comments). Four independent coders performed a qualitative content analysis to identify key domains of change associated with PLIÉ participation.ResultsA total of 45 1‐hour PLIÉ classes were offered over 9 months. Residents attended an average of 13 +/‐ 12 classes with an average of 14 residents, 4 staff members and 2 family members per class. Anonymous survey respondents (15 residents, 14 staff, and 8 family members) were highly satisfied with the PLIÉ program (mean: 4.8, 4.4, and 4.9 on 5‐point Likert scale, respectively). Respondents reported improvements in themselves and/or others in four domains: 1) psychological, 2) physical, 3) cognitive, and 4) social. Psychological improvements included feelings of happiness/well‐being, enjoyment, and self‐empowerment. Physical improvements included mobility, strength, and energy. Cognitive improvements included engagement, communication ability, and focus/attention. Social improvements included connection, social skills, and social support. Domains identified were similar for residents, staff, family members, and clinical progress notes (Table). Negative comments were primarily related to logistics and suggesting that the class occur more frequently.ConclusionPLIÉ was successfully implemented in a VA nursing home with high satisfaction among residents, staff and family members. Residents experienced clinically meaningful psychological, physical, cognitive, and social benefits. We are currently developing and testing an implementation training program for other CLCs and nursing homes.
Investigating the relationship between neuropsychiatric symptoms and cognition in mild cognitive impairment and Alzheimer’s disease patients undergoing an exercise‐primed transcranial direct current stimulation clinical trial (The EXPRESS Study)
Authors: Lanctot Krista L. , Gallagher Damien , Rapoport Mark J. , Oh Paul I. , Marzolini Susan , Charles Jocelyn , Papneja Purti , Rajji Tarek K. , Andreazza Ana C. , Kiss Alex , Liu Celina , Vieira Danielle , Herrmann Nathan 
Published: December 2020

AbstractBackgroundNeuropsychiatric symptoms (NPS) are common features of Mild Cognitive Impairment (MCI) and Alzheimer’s disease (AD), and are associated with poorer cognition. Transcranial direct current stimulation (tDCS), a non‐invasive type of brain stimulation, has been investigated for the treatment of some NPS in a few small AD studies, but with negative results for apathy and depression. Priming the brain with an excitatory intervention, such as exercise, may elicit greater changes if applied prior to tDCS. Using data from an ongoing blinded study, we aimed to evaluate the relationship between NPS and cognition in MCI and mild AD.MethodMCI or mild AD participants were enrolled in a two‐week, randomized, blinded clinical trial investigating the effects of exercise‐primed tDCS for cognition using the Montreal Cognitive Assessment (MoCA). NPS were measured using the Neuropsychiatric Inventory (NPI) subscales. A Pearson’s correlation determined the relationship between NPI scores and the MoCA at baseline in patients who received exercise‐primed tDCS or tDCS alone. A repeated measures analysis of variance compared changes in NPI scores between the two treatment groups over time. As the study is ongoing, the treatment groups have been randomly coded as Group 1 and Group 2 to avoid unblinding.ResultAt baseline, participants (N=13) were 76.5±7.2 years of age, MoCA score= 20.9±3.6, 53% female, and 53% MCI. Nine (69.2%) participants reported having at least one NPS (NPI Score ≥ 1). Apathy (46.2%), sleep disturbances (38.5%), agitation (30.8%), and anxiety (30.8%) were the most prevalent NPS. At baseline, only anxiety was negatively correlated with MoCA scores (r=‐0.57, p=0.041; Figure 1). There were no significant differences between treatment groups on anxiety scores over time (F(1,10)= 2.4, p=0.16). However, after controlling for baseline MoCA scores, there was a significantly greater reduction on anxiety scores in Group 1 (‐0.83±1.3) compared to Group 2 over time (0±0; F(1,9)= 5.3, p=0.047).ConclusionRecruitment is ongoing (total N=30). Only anxiety was associated with poorer cognition at baseline. There were differences between treatment groups on anxiety scores over time, after controlling for baseline MoCA scores. It remains to be seen, after unblinding, whether the group with reduction in anxiety was receiving the primed intervention.
Carotid artery stenosis as a risk factor for Alzheimer’s disease
Authors: Vitali Francesca , Beach Thomas G. , Alexander Gene , Reiman Eric M. , Arias Juan Aristizabal , Brinton Roberta Diaz , Altbach Maria , Weinkauf Craig 
Published: December 2020

AbstractBackgroundThe role of extra‐cranial carotid artery disease (ECAD) in Alzheimer’s disease (AD) is not clear but of significance because treatments including carotid endarterectomy (CEA) are available yet not offered for the indication of dementia prevention. Here, we conducted a preliminary study to elucidate if ECAD can be considered a risk factor for Alzheimer’s disease (AD) and if CEA can improve cognitive impairment and dementia opening new views on possible treatment intervention options.MethodUsing Banner Alzheimer’s Brain Bank, post‐mortem pathological analyses were conducted on 48 patients with ECAD treated with CEA and 92 subjects with ECAD without CEA. Neurofibrillary tangles and white matter lesion burden were quantified by post‐mortem histology and scored at autopsy by pathologists. Student’s t‐test was performed to compare patients with ECAD with and without carotid endarterectomy (CEA).ResultPreliminary results indicate that patients with CEA had significantly lower burden of white matter lesions (P = .05) and neurofibrillary tangles (P = .04). Additional analyses will evaluate whether CEA improves cognition in a cohort of patients with ECAD.ConclusionOutcomes of these analyses provide proof of concept indicating impact of ECAD on changes in brain structure associated with dementia. These outcomes provide a foundation on which to test hypotheses regarding the mechanisms contributing to ECAD associated AD.
The state of the science on synchronous video‐conferencing interventions for care partners of persons with dementia
Authors: Tarter Robin R , Tran Leslie , Lindauer Allison 
Published: December 2020

AbstractBackgroundThe need for effective clinical interventions to prevent the potentially deleterious health impact of providing unpaid care to friends and family members with Alzheimer’s disease and related dementias (ADRDs) has become increasingly urgent. Synchronous video‐conferencing in which ADRD care partners interact in real time with trained healthcare professionals has emerged as an especially promising method for telehealth interventional research. Here we report on the designs and outcomes of such interventions for care partners of persons with ADRDs.MethodA scoping review was undertaken following Arksey and O’Malley’s systematic methodological framework. Articles were identified through a comprehensive search of PubMed, PsychINFO, and CINAHL. Inclusion criteria were peer reviewed, data‐based research articles published between 2015 and 2020 reporting results of synchronous video‐conferencing interventions specifically designed to address the needs of care partners of persons with ADRDs. Reviews, scale development, protocols, and case studies were excluded.ResultFull text screening of 159 articles resulted in the identification of seven articles reporting the results of six independent interventions. Included studies fell into two categories, psychoeducational behavior modification interventions delivered by nursing professionals and facilitated peer support interventions delivered by psychologists and social workers. Interventions varied based on technological mode of delivery, level of interaction among participants and between participants and interventionists, duration and frequency of sessions, and outcomes measured or described. Articles reported evidence of efficacy for decreasing care partner loneliness, depression, burden, and increasing care competence. Feasibility and acceptability of the technological interface varied between interventions, but was high overall.ConclusionBy comparing and contrasting these 6 synchronous video‐conferencing interventions, we are able support the viability of synchronous video‐conferencing as an effective mode of intervention for care partners of persons with ADRDs, and generate information to inform future research. Despite evidence that care partners need stage‐specific interventions, none of the reviewed studies were tailored to specific dementia stages, and there was a glaring lack of diversity in most study samples. Our results suggest that future research with care partners should not be limited to earth‐bound, face‐to‐face interventions, and that synchronous video‐conferencing has benefits above and beyond other approaches.
Diffusion MRI‐derived free water fraction may be a sensitive imaging biomarker that could improve identification of mild cognitive impairment participants progressing to Alzheimer’s disease dementia
Authors: Mishra Virendra R , Caldwell Jessica ZK , Cordes Dietmar , Shan Guogen , Ritter Aaron 
Published: December 2020

AbstractBackgroundWe hypothesize that diffusion MRI (dMRI)‐derived free‐water‐fraction (fiso) of not only hippocampus but also of limbic and temporal cortex along with fiso of white matter (WM) of cingulate, corpus‐callosum, and frontotemporal tracts will show significant difference in participants progressing to Alzheimer’s disease (AD)‐dementia as compared to non‐progressors. Incorporating these measures may improve identification of mild cognitive impairment (MCI) participants progressing to AD‐dementia.Method7 MCI‐Stable (M2M) and 4 MCI‐Converters (M2A) over a period of one‐year, each with at least one ε4 allele, positive PET‐quantified amyloid‐beta, and matched demographics were recruited at our center. MCI and AD diagnoses were based on expert consensus, using results of a neuropsychological test battery and the Clinical Dementia Rating (CDR) interview. Isotropic 1mm3 T1‐weighted MPRAGE along with a 213 directions multi‐shell dMRI (b‐values=500s/mm2, 1000s/mm2, and 2500s/mm2) at an isotropic 1.5mm3 resolution was acquired on a 3T Siemens Skyra scanner. Average volumes and fiso within each FreeSurfer defined region‐of‐interest (ROI), and average fiso in twenty major WM fiber tracts was estimated for each participant at each timepoint. Only those ROIs and WM fiber tracts that showed at least 10% change in fiso longitudinally within each group were selected for further analysis.ResultBilateral hippocampus showed lower volume (Figure 1) and elevated fiso (Figure 2) within M2A group. However, volume of other ROIs (e.g.: Anterior corpus callosum, posterior cingulate cortex, tranverse‐temporal cortex etc.) did not show a lower volume longitudinally, even though there was a 10% increase in fiso longitudinally in those ROIs. Furthermore, a complex correlation between fiso and volume was observed at each timepoint (Figure 3). Interestingly, hippocampal tail was found to be driving the effect seen in right hippocampus, with an opposite slope at each timepoint between M2A and M2M group (Figure 4). Contrary to our hypothesis, right cingulate WM tract and genu of corpus‐callosum (FMinor) showed a decrease in fiso within M2A group (Figure 5).ConclusionOur pilot analysis, albeit with small sample size and potentially underpowered, revealed that fiso of tail of hippocampus, frontal and temporal cortex, and WM fibers of limbic cortex and FMinor may be included as potential predictive imaging biomarkers of AD‐dementia from MCI.
Recruiting African American males in Alzheimer's disease education and genetics research
Authors: Starks Takiyah D , Adams Larry D , Byfield Grace , Hamilton‐Nelson Kara L , Howard Jazmine , Edwards Christopher , Scott Aja M , Lacroix Faina C , Laux Renee A , Haines Johnathan L , Cuccaro Michael L , Vance Jeffery M , Mayeux Richard , Kunkle Brian W , Reitz Christiane , Beecham Gary W , Pericak‐Vance Margaret A , Byrd Goldie S 
Published: December 2020

AbstractBackgroundAddressing the disparity Late Onset Alzheimer’s disease (LOAD) prevalence among African Americans (AA) requires deliberate inclusion of this population in Alzheimer’s disease (AD) studies. Recruiting AA for research studies remains a significant challenge for AD genetic studies. Recruiting and retaining AA males (AAMs) is an even greater challenge, even when study personnel is AA, many traditional recruitment barriers are removed, and community outreach in AA communities is available and culturally appropriate. In this project, we highlight engagement of African American males in outreach and recruitment in three AD studies, and point to the need for expanded and targeted engagement opportunities for this population. While AA males indicate a willingness to participate equal to women, their actual participation is significantly less and may diminish potential generalization of studies in African Americans.MethodWe used culturally relevant approaches to educate and build trust within AA communities and made significant contributions to AA participation in AD genomic studies. For this study, we tracked AAM participation in community engagement activities and enrollment in AD genomic research studies over time.ResultsOver the past 5 years, 22% of the participants surveyed at an annual AA AD conference were AAM. Participation of AAM’s in large genomic studies such as the Research in African American Alzheimer’s Disease Initiative (24%), African American Alzheimer’s Disease study (24%), the largest Genome Wide Association Study, with 5896 total participants (30%), consistently fell below their non‐Hispanic White counterparts. The average participation of NHW males was 41% over the same period.ConclusionWe have used culturally relevant strategies to engage AAMs in education and in genomic research studies. Their participation falls far below their representation in the general population and below their NHW counterparts. Implementing evidence‐based strategies that specifically address trust and gender‐specific needs of AAMs will be important in increasing their participation in genomic studies in AD, and thus generalizability of study results.
The regional and local relationships between amyloid and MRI‐visible perivascular spaces in white matter differ according to amyloid load: An ADNI study
Authors: Schwartz Daniel L , Boespflug Erin L , Lahna David , Dodge Hiroko H , Roese Natalie E , Baker Suzanne L , Woltjer Randall , Jagust William J , Kaye Jeffrey , Silbert Lisa C 
Published: December 2020

AbstractBackgroundThe relationship between amyloid (Aβ) production and clearance is disturbed in Alzheimer’s disease (AD). Evidence suggests that a decrease in clearance efficiency from cortical gray matter (GM) is relevant in late‐onset cases, a framework supported by findings of concomitant decreases in cerebrospinal fluid Aβ. A peri/paravascular bulk flow pathway for CSF and interstitial fluid in parenchyma, which transports solutes like Aβ, was identified in mammals more than 30 years ago; perivascular spaces (PVS) in white matter (WM) are part of this clearance system, and PVS dysfunction may be both a cause and effect of Aβ buildup in GM.MethodFlorbetapir PET, T1, and FLAIR MRI datasets of 95 ADNI subjects were used. Amyloid positive subjects (Aβ+) were defined by ADNI PET thresholds. MRI‐visible PVS were segmented using an automated algorithm and each was manually inspected, resulting in 8,392 PVS; GM was divided into 34 parcels per hemisphere and underlying WM was assigned to a parcel (Figure 1A). After Muller‐Gartner partial volume correction, amyloid SUVR in each GM parcel and PVS density in its associated WM, as well as the amyloid load in juxta‐WM GM (jGM) nearest each confirmed PVS (Figure 1B), were used as variables to describe the regional and local relationships between amyloid and PVS, respectively.ResultCohort‐wide amyloid load and PVS density varied widely across brain regions (Figure 2, middle row). Regional measurements of PVS and Aβ significantly correlated in Aβ+ subjects but not Aβ‐ (Figure 2, bottom). A pattern of decreasing amyloid load 1‐4mm away from the nearest jGM voxel was found in both Aβ+ and Aβ‐; amyloid burden in jGM near PVS was higher than non PVS‐associated jGM in Aβ+ but lower in Aβ‐ (Figure 3).ConclusionThe complicated relationship between WM PVS and amyloid in GM differs according to amyloid load. Regional results suggest that PVS density is higher in regions with higher amyloid load, but only in Aβ+ individuals. Locally, WM PVS can be conceptualized as the clogged drain of a catchment system in Aβ+ subjects but as a functioning clearance system in those with sub‐threshold amyloid burden.
Neuroimaging methods in the randomized pivotal study of Renew NCP‐5 for the treatment of mild cognitive impairment (MCI) due to Alzheimer's disease or mild dementia of the Alzheimer's type
Authors: Salat David H , Helfgott Jonathan S , Helmer Karl G , Juttukonda Meher , Loveley Allison , Stufflebeam Steven , Tchoukoua Fridien Nana , Greve Douglas N 
Published: December 2020

AbstractBackgroundVascular disease and even subclinical variation in vascular health are known contributors to cognitive impairment and hasten the progression of symptoms in individuals with Alzheimer’s disease. Recent trials have demonstrated the therapeutic benefit of pharmacological treatments for enhancing vascular health on the incidence of cognitive impairment and on the progression of vascular brain injury measured by magnetic resonance imaging (MRI). Thus, novel vascular therapeutics provide a promising approach to slowing or preventing impairment in older adults. RenewTM NCP‐5 is an FDA‐cleared, external counterpulsation (ECP) device used clinically to improve coronary and peripheral vascular hemodynamics by sequential compression and decompression of vascular beds in synchrony with the cardiac cycle. ECP is currently used to treat patients with chronic angina and congestive heart failure and has been demonstrated to alter cerebral hemodynamics.MethodNeuroimaging was coordinated across 12 sites (10 in the US and 2 outside of the US) for safety screening as well as for acquisition of exploratory neuroimaging markers of disease stage and treatment modification. Imaging protocols were in created based on a modified cross‐platform protocols developed for the Alzheimer’s Disease Neuroimaging Initiative (ADNI). Additional sequences were added for safety. Coded data are uploaded to the central imaging coordinating site (CICS) at Massachusetts General Hospital. Patient characterization and exploratory outcome measures include T1‐weighted hippocampal volume measures and arterial spin labeling (ASL)‐based measures of cerebral blood flow (CBF). Imaging protocols include phantom scanning and test‐retest at each scan session to evaluate platform specific data quality. Imaging is performed at baseline, 6 months, and 12 months after initial treatment.ResultImaging has been performed on 214 individuals to date with 76 6 month and 6 12‐month scans. The imaging protocol is tolerated with minimal motion. ASL imaging is variable quality across scanners due to differences in hardware, software, and imaging support. This study is ongoing and initial study analyses are expected by November 2020.ConclusionRenewTM NCP‐5 treatment in Alzheimer's disease may impact cerebral hemodynamics and the ongoing clinical trial will test the effect of this treatment on cognitive symptoms as well the impact on Alzheimer’s or vascular‐associated disease processes in the brain.
Global Alzheimer’s Platform Foundation® (GAP) characterizes successful free memory screening programs
Authors: Zisko Leigh , Trotter Jennifer , Reynolds Allison , Thurman Lisa , Hollingshead Sarah 
Published: December 2020

AbstractBackgroundIdentification of eligible trial participants is essential to successful Alzheimer’s disease (AD) research. Participants are needed for more than 250 actively recruiting clinical trials in the US. Over 5.8 million Americans are living with AD – many of whom have not been formally diagnosed. It is established that physicians are often unaware of cognitive impairment in a significant percentage of their cognitively impaired patients. Free memory screens (FMS) at research sites provide the ideal environment to identify potential trial participants. This study will characterize successful FMS programs that identify eligible AD trial participants.MethodThe Global Alzheimer’s Platform Foundation® (GAP) developed the GAP Participant Services (GPS) program to provide AD trial‐specific, concierge‐level support for sites in the GAP Network (GAP‐Net). Anecdotal results were collected from over 500 GPS Liaison in‐person visit reports since Jan 2018. These results informed the construct of a survey that will collect more details about FMS programs including the following: Promotion and scheduling, Venue, Education level of staff conducting FMS, Information gathered, tools used, procedures conducted, How research opportunities are presented, and Metrics (including outcomes). GAP will report trends and FMS methods that generate the most successful outcomes.ResultQuantitative survey results from up to 40 GAP‐Net sites are expected by the end of March 2020. Anecdotal results indicate the following: FMS advertised in the community and conducted both at the site and at community events are accessible and well attended; FMS conducted by master’s level staff or above result in better conversion rates; and Sites with an FMS program rapidly identify more eligible candidates for AD researchConclusionCharacterizing and replicating successful components of a site‐level FMS program may result in identifying qualified candidates and lead to more rapid trial enrollment.