bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk and vulnerabilities of Filipinos in the identification and management of dementia through knowledge, attitudes and practices about dementia in adults aged 18‐65 years old who consult at the outpatient department of a tertiary hospital in Quezon City
Authors: Pura Maria Angela Bobiles , Cano Jemellee , Pabellano‐Tiongson Ma Luisa Gwenn 
Published: December 2020

AbstractBackgroundDementia is an overwhelming disease that pose a burden in the society. Health information and education about dementia in the Philippines is still limited. Lack of awareness entails low identification and diagnosis rate, limited health care options and under‐utilization of existing programs and interventions. The paper aims to describe the risks and vulnerabilities of Filipinos in the identification and management of Dementia among adults through assessment of their knowledge, attitudes and practices.MethodA descriptive, cross‐sectional study was performed in a government tertiary hospital in Quezon City, Philippines. The primary investigator facilitated interviews guided by an experts reviewed‐interview schedule. A sample of 170 individuals aged 18‐65 years old who seek consult or is accompanying a patient were selected using a random sampling method.ResultThe study showed only 27.65% were knowledgeable of Dementia. Seventy percent of the participants considered it as a normal part of aging. Majority of the respondents (95.29%) showed accepting attitudes towards people with dementia. At least 33% showed a possibility of gearing towards negative practices towards those having the condition. One hundred fifteen out of 170 (67.75%) recognizes that patience is needed in taking care of people with dementia. No significant relationship identified between level of knowledge and attitude (95% CI, Fisher’s p = 0.115). Practices towards people with dementia showed significant relationship with level of knowledge (95% CI, Fisher’s p = <0.001). However, in terms of health seeking behavior, those who showed poor health seeking behavior were not knowledgeable of dementia (72.73%) showing significant correlation (95% CI, Fisher’s p = <0.001).ConclusionDespite the increasing prevalence of dementia in the Philippines, awareness and understanding of the condition remain limited. Though only a few was considered knowledgeable, majority showed accepting attitudes and positive practices. However, the health seeking behavior is influenced by their knowledge on dementia. Limited awareness and understanding, and the fear associated with dementia substantiates the urgency to come up with programs on public education and stigma reduction. These strategies could prevent neglect and social isolation of people living with dementia, help them achieve quality of life by maintaining self‐esteem and improve health‐seeking behaviors.
Greater apathy is associated with faster rate of cognitive decline in older adults with type 2 diabetes
Authors: Soleimani Laili , Ravona‐Springer Ramit , Lin HungMo , Liu Xiaoyu , Sano Mary , Heymann Anthony , Beeri Michal Schnaider 
Published: December 2020

AbstractBackgroundAlthough depression is known to be highly associated with cognitive impairment and dementia, it is unclear how its different dimensions affect cognition. Here, we examined the relationships between baseline dimensions of depression with cognitive decline in a sample of initially non‐demented older adults with type 2 diabetes (T2D) participating in the Israel Diabetes and Cognitive Decline (IDCD) study.MethodsSubjects [n=1023; mean age= 71.6 (SD= 4.6); 41.1% female] completed the 15‐item geriatric depression scale (GDS) at baseline and a neuropsychological battery approximately every 18 months. Cognitive domains included episodic memory, attention/working memory, executive functions, and language/semantic categorization. Global cognition was the average of the four domains z‐scores. The GDS dimensions were defined as Dysphoric Mood, Withdrawal–Apathy–Vigor (WAV), Anxiety, Hopelessness and Memory Complaint, based on previous studies. Mixed regression models adjusting for age, sex, and education assessed associations of baseline depression dimensions with cognitive decline.ResultsCross‐sectionally, there were numerous associations between depression dimensions and cognitive outcomes (Table 1). Overtime, WAV was significantly associated with greater decline in global cognition (p=0.004), executive function (p=0.002) and episodic memory (p=0.039). Dysphoric mood was associated with a faster rate of episodic memory decline (p=0.022). Anxiety was not associated with neither cross sectional nor longitudinal cognitive outcomes. Adjusting for cardiovascular risk factors did not alter substantively the results.ConclusionSimilar to non‐diabetic populations, different dimensions of depression in T2D elderly were associated with variable cognitive outcomes. Longitudinally, among the aspects of depression, apathy was consistently associated with greater rate of cognitive decline. This highlights the possibility of shared mechanisms between depression and dementia, an example of which could be cerebral microvascular disease, which is highly prevalent in T2D patients.
Multivariate prediction of rate of decline in memory functioning over six years using imaging biomarkers
Authors: Woodard John L. , Bellaali Youssef , Dricot Laurence , Lhommel Renaud , Malotaux Vincent , Quenon Lisa , Hanseeuw Bernard , Ivanoiu Adrian 
Published: December 2020

AbstractBackgroundA number of biomarkers have shown utility for predicting cognitive decline and conversion from mild cognitive impairment (MCI) to dementia. However, few studies have investigated the effectiveness of biomarkers combinations and their individual contributions for predicting rate of memory decline. This study evaluated the utility of several imaging biomarkers for predicting annual rate of decline in memory performance, as indexed by the Buschke Free and Cued Selective Reminding Test (FCSRT) Free Recall (FR), Cued Recall (CR), and Delayed Recall (DR).MethodAt baseline, 153 individuals (31 controls, 87 persons with MCI, and 35 persons with subjective cognitive impairment (SCI)) underwent neuropsychological evaluation (including the FCSRT), fluorodeoxyglucose (FDG) positron emission tomography (PET), amyloid PET and MRI measurement of bilateral hippocampal volume (HV) and bilateral entorhinal cortical thickness (EC). Follow‐up neuropsychological evaluations were performed after a mean of 2.05, 4.1, and 6.4 years. Individual intercepts and slopes (annualized rates of decline) for FCSRT indexes were computed for each participant using latent growth curve modeling. Bayesian linear regression identified the optimal models for predicting annual rate of change for each memory index. After adjusting for age, sex, and sociocultural level, baseline amyloid and FDG PET, bilateral HV, and bilateral EC were entered as predictors. Bayes Factors (BF10) grade the intensity of support in favor of the alternate hypothesis over the null hypothesis.ResultUsing Bayesian ANOVA, all groups differed significantly in rate of decline for each of the three memory indexes (Figure 1). Amyloid PET, FDG PET, and EC were the best predictors of FR decline (BF10=3.26e+12, R2=0.45), Amyloid PET and EC were the best predictors of CR decline (BF10=3.31e+13, R2=0.39), and the combination of all four biomarkers was the best set of predictors of DR decline (BF10=1.95e+12, R2=0.43).ConclusionDifferent combinations of baseline imaging biomarkers were highly sensitive to rate of decline in specific aspects of memory functioning. Amyloid PET and entorhinal cortex thickness were among the significant predictors for all three memory indexes, implicating their particular sensitivity to all FCSRT memory indexes. The predictive power of entorhinal cortex thickness may be due to early accumulation of tau in this region.
Sleep disturbance is associated with longitudinal Aβ accumulation in healthy older adults
Authors: Winer Joseph R. , Mander Bryce A. , Jagust William J. , Walker Matthew P. 
Published: December 2020

AbstractBackgroundWork in rodent models of Alzheimer’s disease has demonstrated that sleep disturbance leads to increased β‐amyloid (Aβ) production and decreased clearance. Impaired sleep quality has been shown to predict Aβ burden in healthy older populations cross‐sectionally. It remains untested whether objective measures of sleep quality predict the rate of Aβ accumulation over time.Method32 healthy older adults (age 75.5 ± 4.3 at baseline, 23 female) received overnight sleep EEG recording to assess sleep architecture and slow wave activity (SWA). All subjects additionally received multiple 11C‐PIB PET scans to assess longitudinal change in Aβ burden (Figure 1, 2.5 ± 0.8 scans over 3.6 ± 2.3 years). A global cortical 11C‐PIB DVR (0‐90 min, cerebellar gray reference) was calculated for every PET image, and a linear mixed‐effects model was used to derive slopes of 11C‐PIB DVR change over time for every subject. All analyses were adjusted for age at baseline and gender, and longitudinal analyses were additionally adjusted for number of PET scans per subject.ResultLower <1Hz SWA at baseline predicted not only higher cross‐sectional 11C‐PIB DVR, but further predicted an accelerated rate of 11C‐PIB DVR increase over time (Figure 2A, 3A&B). This was similarly true for the measure of poor sleep efficiency, predicting both baseline and rate of 11C‐PIB DVR increase (Figures 2B, 3C&D). The significance of these associations were attenuated when baseline 11C‐PIB DVR was included in the models, due to the strong correlation between 11C‐PIB DVR baseline and longitudinal change (Figure 3E).ConclusionThese findings demonstrate that impaired electrophysiological sleep quality (<1Hz SWA) and objective poor sleep quality are not only sensitive to an individual’s Aβ burden at the time of measurement, but also predictive of subsequent accelerated Aβ aggregation. Sleep may therefore serve as an informative, non‐invasive and scalable biomarker for assessing pathological progression of Alzheimer’s disease. If replicated in larger cohorts with high sensitivity, specificity, and accuracy, these objective sleep metrics may also provide a practical and cost‐effective measure for tracking treatment intervention efficacy.
Evidence of hot flash–induced awakenings in menopausal women
Authors: Van Doorn Jacob , Paget‐Blanc Alexandra , Drogos Lauren L. , Rubin Leah H. , Maki Pauline M. 
Published: December 2020

AbstractBackgroundWomen are disproportionately afflicted with dementias, though the exact risk factors explaining why are yet to be determined. Additionally, perimenopausal women experience deficits in verbal memory during menopause compared to their pre‐ and postmenopausal state. Because sleep debt also leads to verbal memory deficits, we explored whether one of the hallmark symptoms of menopause, hot flushes, cause an increase of sleep disturbances.Methods
N = 63 perimenopausal and postmenopausal women (mean age of 53.1 ± 1.1 years old) with hot flushes were recorded using actigraphy for sleep/wake activity and skin conductance for objective hot flushes over one night. The two time series were compared to each other using Granger causality to establish statistical causality. The number of objective hot flushes, determined by skin conductance, and amount of time spent awake were compared with linear regression.ResultsOf the 63 women, 76.2% were found to have skin conductance which granger‐caused more awake activity at night. Additionally, we have reinforced that a greater number of nightly objective hot flushes is associated with greater time spent awake (b = 28 minutes/hot flush, p < .001).ConclusionThose women who have hot flush granger‐caused awakenings may be at a higher risk of sleep disturbances during and following menopause. The relationship between hot flushes and lower sleep quality has previously been shown, but here we show that there may be a causal link of hot flushes causing night‐time awakenings. These hot flush granger‐caused awakenings may represent a female‐specific risk factor for cognitive impairment.
Investigating neuroimaging differences by cognitive and metabolic status in a community‐dwelling cohort
Authors: Lockhart Samuel N. , Okonmah‐Obazee Stephanie , Bateman James R. , Williams Benjamin J. , Cleveland Maryjo , Yang Mia , Haq Ihtsham , Rogers Samantha D. , Sachs Bonnie C. , Espeland Mark A. , Hughes Timothy M. , Fischer Eric , Sai Kiran Solingapuram , Williamson Jeff D. , Jung Youngkyoo , Whitlow Christopher T. , Craft Suzanne 
Published: December 2020

AbstractBackgroundLittle is know about how metabolic function relates to late‐life physical and cognitive health. In a community‐dwelling cohort of older adults with normal cognition (CN) and mild cognitive impairment (MCI), we investigated whether cognitive and metabolic status predicted neuroimaging biomarkers, and cognitive and physical function.MethodParticipants enrolled in the Wake Forest Alzheimer’s Disease Research Center (ADRC) Clinical Core cohort received neuropsychological assessment, MR imaging (T1, FLAIR, DTI, NODDI, pcASL), and PiB PET imaging on a subset. Participants were adjudicated as CN or MCI using NIA‐AA criteria. T1 MRI were processed (FreeSurfer v5.3) to calculate “AD‐signature” meta‐ROI cortical thickness. A set of AD‐sensitive cortical ROIs was used to extract mean PET SUVR signal. White matter hyperintensity (WMH) volume was calculated on FLAIR with LST in SPM12. DTI were processed using FSL, and NODDI using AMICO, to generate mean white matter (WM) Fractional Anisotropy (FA) and Free Water (FW), to assess WM microstructure. PcASL were processed to yield mean GM and WM cerebral blood flow (CBF). Cognitive measures included Montreal Cognitive Assessment (MoCA) and Free and Cued Selective Reminding Test (total free recall; FCSRT). Mobility function was assessed using the expanded Short Physical Performance Battery (eSPPB). Oral Glucose Tolerance Testing (OGTT) assessed blood glucose 120 minutes post‐challenge; OGTT was thresholded (>=140 mg/dl) to classify participants with impaired glucose tolerance (IGT) or normoglycemic (NG). We assessed group differences using t‐tests and multivariable linear regression (covariates: age, sex, race).ResultAmong 391 participants with both MRI and cognitive testing, MCI participants were older, less educated and had fewer females relative to CN (Table 1). IGT participants were older and less educated than NG participants. MCI participants had lower cortical thickness, higher WMH volume and FW, and higher PiB than CN (Table 2). MCI participants had lower MOCA and FCSRT (as expected) and eSPPB scores than CN, which remained significant in fully adjusted models. GM CBF differences did not survive adjustment. IGT was only associated with lower eSPPB score (p=.00004; adjusted p=.0051).ConclusionCognitive impairment is associated with reduced brain health and physical function, while IGT relates more specifically with reduced physical function.
A mixed‐methods approach to establish clinically meaningful categories of impairment in instrumental activities of daily living
Authors: Dubbelman Mark A. , Verrijp Merike , Visser Leonie N.C. , Terwee Caroline B. , van Der Flier Wiesje , Scheltens Philip , Sikkes Sietske A.M. 
Published: December 2020

AbstractBackgroundAlthough often used as outcome measure in treatment studies, the clinical meaningfulness of scores on instrumental activities of daily living (IADL) questionnaires is not yet well‐established. We aimed to establish cut‐offs for clinically meaningful categories of IADL functioning, as determined by caregivers of dementia patients using the Amsterdam IADL Questionnaire (A‐IADL‐Q). Secondly, we examined category change within a 1‐year follow‐up period in memory clinic patients.MethodFirst, we performed a qualitative study to determine four clinically meaningful categories on the A‐IADL‐Q: ‘no impairment’, ‘mild’, ‘moderate’, or ‘severe impairment’. T‐scores ranged from 20–70, with lower scores representing more severe impairment. In focus groups, caregivers (n=6) were invited to rate written scenarios representing various levels of IADL impairment (‘vignettes’). The vignettes were based on the most likely item responses at given total scores of the A‐IADL‐Q, to which caregivers were blinded. First, caregivers individually categorized the vignettes. Based on nominal group technique, they subsequently placed votes for a category on each vignette. Then, they engaged in group discussion to reach consensus about the categorization. From this, we derived cut‐offs on the A‐IADL‐Q T‐score. Second, in a quantitative study, we applied the cut‐offs in a longitudinal sample of 169 patients (Table 1) from the Amsterdam Dementia Cohort, diagnosed with either subjective cognitive decline, mild cognitive impairment, Alzheimer’s disease dementia, and other dementias. We assessed what proportion of patients changed to worse categories.ResultThere was some discussion about the categorization, in particular for deciding which vignettes represented ‘moderate’ and ‘severe impairment’. Consensus cut‐offs were established for mild (≥57.5), moderate (≥47.5), and severe impairment (≥42.5). Figure 1 shows the proportion of patients in each category for the different diagnoses, at baseline and after 1 year. Within one year, 45 patients (26.6%) progressed to a worse clinical category.ConclusionThis study provides cut‐off values for clinically meaningful categories, which seem to be in correspondence with disease severity. Over a relatively short follow‐up period of 1 year, approximately one quarter of patients declined to a worse category, providing support for the ability of the A‐IADL‐Q to measure clinically meaningful change.
Pilot study of remote monitoring technologies for frontotemporal lobar degeneration (REMOTE FTLD): Feasibility and compliance
Authors: Taylor Jack Carson , Heuer Hilary W , Vento Stephanie , Bajorek Lynn , Ong Elise , Wang Ping , You Michelle , Rosen Howard J , Staffaroni Adam M , Boxer Adam L 
Published: December 2020

AbstractBackgroundFamilial frontotemporal lobar degeneration (fFTLD) is a group of inherited neurodegenerative diseases that present with alterations in speech and language, motor abilities, cognition, and behavior. Because fFTLD is inherited in an autosomal dominant fashion, asymptomatic participants with mutations can be studied before symptom onset. To date, early detection strategies have focused on data collected in person, usually annually. Although more frequent monitoring would likely improve detection of the earliest clinical manifestations of fFTLD, repeated assessments over shorter intervals would place undue burden on patients and study staff. We evaluated the feasibility and compliance of frequent, remote assessment using a custom smartphone application in participants at risk for or diagnosed with fFTLD.MethodTen older adults, five functionally intact members of fFTLD kindreds (unknown mutation status), and five symptomatic FTLD participants completed the Revised Self Monitoring Scale and Corticobasal Functional Scale at baseline on their mobile device. They also completed five cognitive tests (e.g., flanker, Stroop, 2‐back) and several speech and language tasks (e.g., picture description) on their mobile phone, three times over the course of ten days. Cognitive pretesting was conducted during the first exposure to the application, and an interview was conducted with participants and study partners at completion. We present qualitative results related to compliance and feasibility.ResultQualitative analysis of cognitive pretesting interviews suggested that participants generally described their experience as positive. Feedback about specific concerns were used iteratively to improve the user experience. Compliance in the first 10 participants was 97.8%. Post‐study interviews with participants and their caregivers suggested that remote monitoring of cognition, language, and behavior is feasible in this cohort.ConclusionEarly results suggest that a mobile phone application is a feasible methodology for frequent remote data collection in fFTLD. The majority of participants showed high rates of compliance. Future analyses will inform whether this approach can improve early detection and monitoring of people at risk for fFTLD, and allow for symptom tracking in those who are have already developed a clinical syndrome.
Mid‐life blood pressure and microstructural white matter: Findings from the 1946 British birth cohort
Authors: Storey Mathew , James Sarah‐Naomi , Lane Christopher A , Barnes Jo , Sudre Carole H , Parker Thomas D , Lu Kirsty , Keshavan Ashvini , Buchanan Sarah M , Keuss Sarah E , Wagen Aaron , Cash David M , Malone Ian B , Coath William , Prosser Lloyd , Nicholas Jennifer M , Murray‐Smith Heidi , Wong Andrew , Hughes Alun , Chaturvedi Nishi , Fox Nick C , Richards Marcus , Schott Jonathan M 
Published: December 2020

AbstractBackgroundMid‐life hypertension is an established risk factor for late‐life cognitive impairment. Whilst previous studies demonstrate mid‐life hypertension is associated with larger white matter (WM) hyperintensity volumes, Differences in normal appearing white matter (NAWM) microstructure may provide an earlier indication of WM injury. In a population‐based life‐course study of cognitively healthy individuals, we explored the relationship between blood pressure (BP) over 30 years and NAWM microstructural metrics in later life.MethodParticipants from Insight 46, a sub‐study of the 1946 British birth cohort, underwent multi‐modal MR imaging including T1, T2, FLAIR and multi‐shell diffusion‐weighted sequences at age 69‐71. Diffusion‐weighted images were processed by automated pipelines, NAWM masks were derived by subtracting the BaMoS‐derived white matter hyperintensity mask from GIF pipeline generated WM mask (eroded by 1 voxel) using FSL. Mean values of microstructural integrity metrics (fractional anisotropy (FA), mean diffusivity (MD), neurite density index (NDI), orientation dispersion index (ODI)) were extracted from T1‐registered diffusion maps using FSL and NODDI toolbox. Individuals with a major brain or neurodegenerative disorder such as dementia, neuroinflammatory condition or stroke were excluded. Linear regression analyses examined relationships between systolic blood pressure (SBP) and diastolic blood pressure (DBP) at ages 36, 43, 53, 60‐64 and 69 and microstructural metrics at age 69‐71 adjusting for sex, age, socioeconomic class, educational attainment, childhood cognition and antihypertensive medication.Result379 participants were included (mean age at imaging 70.7 years, 50% female). Higher SBP at ages 53 and 69 was associated with lower FA and NDI; and higher MD, and SBP at 69 was associated with higher ODI. Similarly, higher DBP at ages 53, 60‐64 and 69 were associated with lower FA and NDI; and higher MD. There was no evidence of associations between BP at age 36 or 43 and NAWM diffusion metrics.ConclusionHigher systolic and diastolic blood pressure from age 53 onwards are shown to be associated with differences in diffusion‐based measures of white matter microstructural integrity later in life, suggesting that systolic or diastolic hypertension in over 50’s may contribute to cognitive impairment risk via alterations in NAWM microstructure differences in later life.