bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

AbstractBackgroundRepetitive 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.MethodTwenty‐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).ResultThere 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).ConclusionThis 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

AbstractBackgroundPopulation 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).MethodThis 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.ResultIn 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.ConclusionThis 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

AbstractThe 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

AbstractBackgroundThe 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.MethodThe 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.ResultAll 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.ConclusionGeriatricians 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

AbstractBackgroundAmong 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.MethodIn 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).ResultFour 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.ConclusionThese 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

AbstractBackgroundThe 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.MethodThis 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).ResultChatGPT‐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).ConclusionChatGPT‐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

AbstractBackgroundThe 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.MethodAdopting 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.ResultThe 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.ConclusionThis 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

AbstractBackgroundCaregiving, 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.MethodData 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.ResultPreliminary 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.ConclusionTraditionally 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

AbstractBackgroundSubjective 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.MethodWe 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.ResultThere 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).ConclusionOur 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

AbstractBackgroundGut 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.MethodA 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).ResultAt 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.ConclusionThese findings provide evidence for dietary intervention to alter gut microbiota that may modulate cognitive status.