bluuebunny/crossref_metadata_2025_split huggingface dataset:
ESTIMATED ARTERIAL STIFFNESS, COGNITIVE DECLINE, AND DEMENTIA AMONG MIDDLE-AGED AND OLDER ADULTS
Authors: Heffernan Kevin , Wilmoth Janet , London Andrew 
Published: December 2023

Abstract
Prior research suggests arterial stiffness may be a useful vascular biomarker that predicts age-related cognitive decline. In this paper, we use the Health and Retirement Study (HRS) to examine the relationship between estimated pulse wave velocity (ePWV), which is an under-analyzed but readily available estimate of arterial stiffness, and cognitive decline. The HRS assesses cognitive function with the Telephone Interview for Cognitive Status (TICS). In this 27-point TICS measure, scores between 7 and 11 indicate cognitively impaired but no dementia (CIND) and scores between 0 and 6 indicate dementia. We modeled the relationship between ePVW and cognitive status change from 2006/2008 through 2018. The findings indicate ePWV increases the odds of having CIND and dementia relative to having no CIND or dementia. In addition, ePWV increases the odds of transitioning into CIND and dementia from a higher cognitive functioning state. The results are robust to controlling for: age, age squared, age cubed, systolic and diastolic blood pressure along with sociodemographic characteristics (gender, race, ethnicity, wealth, income, education), health status (history of cardiovascular disease (CVD,) diabetes, and stroke and related medication use), health behaviors (smoking, physical activity, body mass index), and CVD-related biomarkers (C-reactive protein, cystatin-C, hemoglobin A1c, total cholesterol, high-density lipoprotein (HDL) cholesterol). These findings suggest that ePWV is a simple screening tool and novel biomarker that can be used to monitor vascular cognitive aging and CIND progression in middle-aged and older adults.
RACIAL/ETHNIC DIFFERENCES IN NEUROCOGNITIVE PROFILES OF OLDER ADULTS WITH 6-YEAR INCIDENT DEMENTIA
Authors: Jacobs Moyosoreoluwa , Chek Carmen , Tarraf Wassim 
Published: December 2023

Abstract
Hispanic and non-Hispanic Black (NHB) older adults have higher dementia rates than non-Hispanic Whites (NHWs). Estimates of dementia prevalence and incidence in community-based cohorts are mostly based on threshold value performance on cognitive assessment batteries. We used longitudinal data from the HRS Harmonized Cognitive Assessment Protocol (HCAP) to (1) generate and compare, across race/ethnicity, neurocognitive profiles for older adults (&gt;65 years) not meeting research criteria for dementia in 2010 and developing dementia by 2016 (using Langa-Weir’s dementia classification), (2) assess racial/ethnic differences in these profiles, and (3) test socio-demographic effects on dementia-specific differences in neurocognitive performance. Performance on all HCAP measures was highly sensitive to 6-year incident dementia classification. However, we found notable domain-specific differences in test sensitivity, whereby performance on general screeners (e.g., MMSE) and memory-based tests (e.g., CERAD word list recognition) were significantly lower (≤2 SDs from normed population means). Hispanics and NHBs generally performed lower than NHWs, with more pronounced group differences in general screeners and executive function tests. Sociodemographic characteristics significantly attenuated Hispanic differences, but less so for NHBs, relative to NHWs. Despite these group differences, NHWs with incident dementia had worse neurocognitive profiles than their NHB and Hispanic counterparts. Dementia classification algorithms (e.g., Langa-Weir) sensitively detect cognitive impairment. However, these algorithms more accurately identify higher severity cognitive impairment in NHWs compared to NHBs and Hispanics. Such methods can yield dementia estimates biased by sociocultural factors. Further research is needed to identify culturally appropriate neurocognitive tests that enhance precise dementia diagnosis, using population-level epidemiological data.
EXAMINING THE IMPACT OF BURNOUT ON RESEARCH PARTICIPATION IN CLINICIANS TREATING DEMENTIA
Authors: Rawoof Anam , Summerhayes Emily , Talwar Sonia , Hodgson Nancy 
Published: December 2023

Abstract
Clinicians treating people living with dementia (PLWD) are likely to face burnout due to 1) the significant emotional burden of the job and 2) the increasing number of patients requiring dementia care. While much research has been conducted on the impact of clinician burnout on patient care and outcomes, more research is needed on its effects on clinician participation in research studies. This study will analyze qualitative data to examine the effect of clinician burnout on participation and intervention uptake in a dementia care research study.
A MIXED METHODS APPROACH TO UNDERSTANDING SPOUSE AND CHILD CAREGIVERS’ EXPERIENCES OF LUCID EPISODES IN DEMENTIA
Authors: Kim Kyungmin , Bangerter Lauren , Finnie Dawne , Gaugler Joseph , Maria Lapid , Frangiosa Theresa , Griffin Joan 
Published: December 2023

Abstract
Lucid episodes (LE) in people living with late-stages of dementia (PLWD) have been reported anecdotally, but less is known about how this seemingly unexpected phenomenon is experienced by family members. This study aims to examine variability in family caregivers’ experiences with LE, focusing on the two most common groups of informal caregivers, spouses and children—whether they may exhibit differential appraisals of and responses to LEs. Using a sample of former and current family caregivers from UsAgainstAlzheimer’s A-LIST, we conducted an online survey to spouse and child caregivers (N = 387). Qualitative semi-structured interviews were also conducted with a subset of these caregivers who have witnessed an LE (n = 22). Survey results indicate that child caregivers were more likely to witness a LE. Among “former” caregivers who have witnessed a LE (n = 140), spouses were likely to appraise LEs more negatively and make changes in care decisions (i.e., end-of-life planning and financial decisions) after LE, compared to child caregivers. Among “current” caregivers who have witnessed a LE (n = 80), spouses were more likely to indicate no special circumstances prior to LE, whereas children were more likely to indicate LEs associated with visits from friends and family; there was no difference in positive and negative appraisals of LE between current spouse and child caregivers. Content analysis of qualitative interviews revealed that observed differences between spouses and children were related to their different caregiving contexts, such as relationship history, living arrangement, expectations/motivation, and care resources.
A SCOPING REVIEW OF PHYSICAL ACTIVITY IN ADULTS OVER 50 WITH AUTISM: MANY BARRIERS AND SPARSE DATA
Authors: Kartoz Connie , Jefferson Rebeca , Antonakakis Antigone , Eisenberg Chase 
Published: December 2023

Abstract
The population of older adults with autism is growing, yet the literature for this group is still relatively sparse (Mason et al., 2022). Adults with autism are reported to have multiple co-morbidities and a reduced life span (Hand et al., 2020). While physical activity (PA) is known to reduce chronic disease burden, extant research indicates young adults with autism do not engage in physical activity (PA) with the same frequency as neurotypical peers. Little is known about PA for older adults with autism. This scoping review aimed to explore research about PA for older adults with autism. Following the PRISMA-ScR guidelines, 5 databases were searched (2018 and later) with keywords ‘autism’, ‘older adults’, ‘PA’ and age group delimiters. Initially, no articles were found, and the search was expanded to include all adults. After eliminating duplicates, 121 studies were reviewed, with 31 meeting the criteria (PA, autism and no participants less than 18) and 9 having any participants over 50; in each of these 9 studies, the number of participants over 50 was less than 100. Only 2 studies focused on adults over 50. Level of evidence was low. The limited data suggests those aging with autism do not engage in recommended levels of PA, experience barriers to the same, but that interventions improve PA and possibly quality of life. Based on this review, there is a dire need to design interventional research regarding increasing PA in older adults with autism to improve equitable health outcomes for this at-risk group.
ACCULTURATION, ALCOHOL USE, AND SLEEP AMONG LATINX ADULTS AT RISK FOR ALZHEIMER’S DISEASE AND RELATED DEMENTIAS
Authors: Jimenez Daniel , Burke Shanna , Hayes Timothy , Grudzien Adrienne , Russell Accacia , Soto Gianinna Munoz , Peralta Eriana , Padden Eleni 
Published: December 2023

Abstract

Background
Excessive alcohol use can negatively impact sleep. In the U.S., Latinx people are most likely to engage in problematic drinking when compared to other racial/ethnic groups. Acculturation in U.S. society has been suggested as a contributing factor to problematic drinking. Excessive alcohol use and poor sleep are known risk factors for developing Alzheimer’s disease and related dementias (ADRD). Little is known about the interaction between acculturation and alcohol use on sleep outcomes in Latinx adults, especially among those at risk of ADRD. The current study explored whether acculturation to the U.S. moderated the relationship between alcohol use and sleep.

Methods
A secondary analysis of a community-based sample of 113 Latinx adults, ages 40-60, was conducted. Participants had a parent diagnosed with ADRD. Measures included surveys gauging alcohol use (WHO ASSIST V.30), acculturation (Bicultural Involvement Questionnaire), subjective sleep (Pittsburgh Sleep Quality Index), and objective sleep measures using actigraphy (ActiGraph). A multiple regression analysis was performed to evaluate whether acculturation moderated the relationship between alcohol use and sleep outcomes

Results
The sample was predominantly female (92%), people born outside the US (74%), with approximately 83% of participants reported lifetime alcohol use. Americanism acculturation (b= 0.30, SE= 0.21, p=0.007) and biculturalism (-b= 0.30, SE= 0.13, p=0.003) significantly moderated the relationship between alcohol use and sleep duration. Implications: Expanded, targeted research and intervention focused on sociocultural factors impacting alcohol use for Latinx people at risk of ADRD must be further explored to identify and intervene in sleep disparities occurring among this population.
ACTIVATING THE NEXT GENERATION OF GERONTOLOGY ENTHUSIASTS... ONE SEMESTER AT A TIME
Authors: Culligan Joanna , Schepisi Ila 
Published: December 2023

Abstract
At the Engagement Center for Creative Aging at Virginia Tech, we are activating the next generation of gerontology enthusiasts while breaking down stigmas associated with aging and cognitive change. Each semester, we have an opportunity to engage with the undergraduate and graduate student population here on campus through field work, volunteerism and student employment. Here, students engage with adults in our community through a wide range of programs to support aging from community clubs, caregiver wellness and our adult day services program. This paper focuses on Reframing Aging with students who engage in field work at our adult day services program through the Department of Human Development and Family Science at Virginia Tech through strategic application of active learning pedagogical techniques including lecture, class discussion, experiential activities and application exercises. In addition to classroom components, students participate in service delivery at our center. At the beginning of each semester, students are asked (using an anonymous online polling tool), “What words do you associate with older adults” and “… older adults with dementia.” The most common words that have appeared, semester after semester, are: stubborn, inflexible, angry, sad, decline, struggling, forgetful and confused. At the end of the semester, sixteen-weeks later, students are asked the same questions. The most common words associated with older adults and those experiencing dementia at the end of the semester are: interesting, unique, wise, lovely, welcoming, insightful, experienced, helpful, normal, honest and human. In one semester, we are helping to Reframe Aging with this approach.
ADVANCED CARE PLANNING SERVICES BILLING ENCOUNTERS AMONG MEDICARE BENEFICIARIES WHO DIED IN 2019
Authors: Kobylarz Fred , Kim Hyosin , Zafar Anum , Lin Haiqun , Lopez Maria , Jarrín Olga 
Published: December 2023

Abstract
In 2016, the Centers for Medicare & Medicaid Services (CMS) introduced advanced care planning (ACP) services Current Procedural Terminology [CPT] codes 99497 (first 30 minutes) and 99498 (additional 30 minutes). This enabled healthcare providers to seek reimbursement for discussing future medical care preferences when patients are unable to make decisions. In this study, we linked administrative, claims, and encounter files for the 2,238,611 Medicare beneficiaries who died in 2019. Of these, 17.7% (395,258) had a billing code for ACP services in 2018 or 2019. Among fee-for-service (FFS) beneficiaries, 18.8% had ACP services billed compared to 15.7% of Medicare Advantage (MA) beneficiaries. Most ACP encounters were for the first 30 minutes of services (91% FFS, 90% MA). Among FFS beneficiaries, most ACP encounters were attributed to internal medicine (30.8%), family medicine (12.6%), and nurse practitioners (29.9%); and took place in hospitals (47.6%), skilled nursing facilities (18.4%), and office (14.2%) settings. Location of ACP services was available for only 8% of MA encounters: hospitals (40.3%), skilled nursing facilities (18.2%), and office (20.1%). Additional findings will be presented regarding variation in ACP encounters by race/ethnicity and geographic region (state, rural/urban community, area deprivation index) that enhance our understanding of ACP service use at the end-of-life for Medicare fee-for-service and Medicare Advantage beneficiaries.
BETTER DIET QUALITY IS ASSOCIATED WITH REMAINING NON-FRAIL OVER TIME IN A DIVERSE COHORT
Authors: Kuczmarski Marie , Beydoun May , Georgescu Michael , Hooten Nicole Noren , Mode Nicolle , Evans Michele , Zonderman Alan B 
Published: December 2023

Abstract
Frailty is a major public health concern affecting the health and well-being of adults. Poor diet is among several modifiable risk factors for developing frailty. We examined associations of dietary quality assessed by the Healthy Eating Index with frailty status over mean 8.7y follow-up. The sample was comprised of African American (AA) and White participants enrolled in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study (44% male, 44% AA, mean baseline age of 48.5y). Only participants from the baseline study and first 2 follow-up visits with dietary data, 2 recall days per visit, and frailty data were included (n=2901). Frailty was prospectively determined by the modified FRAIL scale. Group-based trajectory modeling identified 3 diet quality groups (high: g3 [5.2% of sample, HEI(X±SD): 57.4±4.1], medium (g2: 48.2%, 46.1±3.7), low (g1: 46.5%, 38.2±2.9) and 2 frailty groups (remaining non-frail [20.2% sample] or being pre-frail or frail over time). Multiple logistic and Cox proportional hazards regressions found high and medium HEI trajectory groups, compared to the low HEI group, were associated with reduced risk of being pre-frail or frail, with a clear dose-response relationship (g2 vs. g1: HR=0.77, 95% CI: 0.64-0.92, p=0.004; g3 vs. g1: HR=0.29, 95% CI: 0.18-0.49, P&lt; 0.001), even after adjusting for sociodemographic factors, smoking, drug use, and allostatic load. These findings were corroborated with Kaplan-Meier curves and log-rank tests, providing longitudinal evidence of the link between better diet quality with lower frailty risk, and the importance of diet in successful aging during middle age.
BIOMARKERS IN CNS-ORIGINATING EXTRACELLULAR VESICLES: A DIAGNOSTIC META-ANALYSIS FOR PARKINSONIAN DISORDERS
Authors: Taha Hash Brown , Bogoniewski Aleks 
Published: December 2023

Abstract
Parkinsonian disorders, including Parkinson’s disease (PD), multiple system atrophy (MSA), dementia with Lewy bodies (DLB), progressive supranuclear palsy (PSP), and corticobasal syndrome (CBS), present overlapping early symptoms, complicating accurate diagnosis. Predicting the conversion of prodromal conditions like REM behavior disorder (RBD) to PD, MSA, or DLB is also complex. Extracellular vesicles (EVs), small structures released by cells, carry cell-state-specific biomarkers that can cross the blood-brain barrier, providing a window into the brain’s biochemistry. Blood-isolated CNS-originating EVs have become a popular diagnostic tool. Yet, challenges remain in replicating and validating these findings. We conducted a PRISMA-guided systematic review and meta-analysis of 15 studies involving 1,455 persons with PD, 206 with MSA, 21 with DLB, 172 with PSP, 152 with CBS, 189 with RBD, and 1,045 healthy controls (HCs). Diagnostic accuracy for distinguishing persons with PD from HCs was moderate but showed high heterogeneity and significant publication bias. This indicates that studies with non-significant or lower effect sizes were less likely to be published. Differentiating persons with PD from those with PSP or CBS is limited due to the small number of involved studies. Our analyses suggest that biomarkers from CNS-originating EVs may not reliably differentiate persons with MSA or RBD from HCs due to variable accuracy and high heterogeneity. Our findings highlight the moderate diagnostic accuracy of EV biomarkers in differentiating Parkinsonian disorders, emphasizing substantial heterogeneity and significant publication bias. The need for larger, more standardized, and unbiased studies is underscored to validate the utility of EV biomarkers as diagnostic tools.
CAREGIVERS & COLONOSCOPIES: A QUANTITATIVE COMPARATIVE STUDY OF CAREGIVERS’ PREVENTATIVE HEALTH BEHAVIORS
Authors: Quinlan Claire , Brady Samantha , Ashebir Sophia , Balmuth Alexa , D’Ambrosio Lisa , Coughlin Joseph 
Published: December 2023

Abstract
That many caregivers experience some degree of burden is well-established, but little research has investigated the association of burden on caregiver preventative health behaviors. A lack of adherence to these behaviors, including to recommended colonoscopy and mammography screenings, routine vaccinations, annual clinic visits, and HIV testing, may portend worsening health outcomes for family caregivers if diseases are left undetected or untreated; such outcomes could also be caused by and contribute to the crisis of lack of care to meet demand. Survey questionnaires (N=326) were completed by 214 current caregivers and 112 former caregivers from the national MIT AgeLab Caregiver Panel. Respondents predominately identified as white (88%) and female (83%), with a median age of 40-49 years old. Questions assessed caregiving intensity, health status, reported caregiving burden, and adherence to preventative health screenings and vaccinations (per USPTF age- and gender-based recommendations). Among all caregivers, just 17% reported that they were up-to-date with appropriate preventative health screenings. Current caregivers were less likely than previous caregivers to be up-to-date. Controlling for age, income level, and health status, caregiving intensity (as measured by hours per week) was an independent predictor of adherence to preventative health screenings. These findings suggest that current caregivers who are providing high-intensity care are less likely to be engaging in preventative health behaviors for themselves. This finding is concerning for the future health of these caregivers as well as their care recipients and highlights the need for primary care preventative health initiatives specifically targeting family caregivers.
CAUSAL EFFECT OF ANTI-DEMENTIA DRUGS ON PATIENTS’ ECONOMIC BURDEN USING DOUBLE/DEBIASED MACHINE LEARNING APPROACH
Authors: Jiang Xiangxiang , Lv Gang , Li Minghui , Lu Kevin 
Published: December 2023

Abstract
Alzheimer’s disease and related dementia (ADRD) present a significant public health challenge and carry a substantial financial burden. Exploring avenues for treatment, the administration of anti-dementia drugs has emerged as a potential intervention for ADRD. However, prior research has been susceptible to omitted variable bias due to data limitations and struggled to establish causal relationships due to confounding by indication. Our study aims to uncover the causal impact of anti-dementia drug utilization on the economic burden among ADRD patients through Double/Debiased Machine Learning (DML) method. Leveraging data from the Medicare Current Beneficiary Survey (MCBS) spanning 2015 to 2017, we utilized a nationally representative survey linked to Medicare data, providing comprehensive insights. DML techniques, including Random Forest (RF) regression and Least Absolute Shrinkage and Selection Operator (LASSO) regression algorithms, were employed to investigate the causal effect. After exclusion and inclusion, a total of 218,237 ADRD patients used anti-dementia drugs, with an average total medical cost of $16,695.87; 95.51% (4,646,408 patients) of ADRD patients did not use anti-dementia drug, with an average total medical cost of $27,567.09. Results from generalized linear regression showed that anti-dementia drug use did not have a significant impact on total medial cost (β = -0.29, P = 0.10). However, results from DML demonstrated a significant true effect [RF regression (β = -0.85, P = 6.79×10-3), LASSO regression (β = -0.78, P = 9.95×10-3)]. To conclude, our analysis demonstrated the causal effect of anti-dementia drug utilization in reducing overall medical costs borne by ADRD patients.
CHOICE TO PROVIDE CARE AND KNOWLEDGE OF DEMENTIA SYMPTOMS: IMPACT ON CAREGIVERS’ EXPERIENCES
Authors: Zimami Sumiyyah , Darwish Hala , Marriott Deanna J 
Published: December 2023

Abstract
As the population ages, understanding the needs of people with dementia and their caregivers becomes increasingly crucial. Caregivers have various experiences related to the rewards and challenges of choosing to provide care. This project investigates how caregivers’ choice to provide care for someone with dementia and their knowledge of dementia symptoms influence their caregiving experiences. The study employed a secondary data analysis from the National Alliance for Caregiving and the American Association of Retired Persons. Caregiving experiences were gauged using a 5-point Likert scale ranging from ’completely negative’ to ’completely positive’. Statistical analyses were conducted using descriptive statistics, chi-square tests, and ordinal logistic regression adjusting for covariates such as dementia stage, caregiver relationship, mental health, and caregiving attitude. Relative risks and 95% confidence intervals were estimated for interpretation using Stata/SE 18.0 with an a-priori significance level of p&lt; 0.05. The study involves 927 caregivers, predominantly women (66.13%) aged 50 – 74. Caregivers who chose to provide care and recognized dementia symptoms were significantly more likely to report positive experiences (ARR= 1.38, p=&lt; 0.001; ARR= 2.27, p=0.03) respectively. Caregivers who felt fulfilled or optimistic had positive experiences (ARR= 1.92, p&lt; 0.001; ARR= 2.21, p&lt; 0.001). Contrastingly, caregivers dealing with emotional stress or caring for relatives with moderate dementia were more likely to have a negative experience (ARR= 2.80, p&lt; 0.001; ARR= 1.39, p=0.006). These findings highlight the importance of developing tailored nursing interventions to support caregivers’ conscious decision to provide care and increase caregivers’ knowledge, potentially enhancing the quality of life for caregivers.