bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acculturation in context: The relationship between acculturation and socioenvironmental factors with level of and change in cognition in older Latinos
Authors: Lamar Melissa , Barnes Lisa L. , Leurgans Sue E. , Fleischman Debra A , Farfel José Marcelo , Bennett David A. , Marquez David X. 
Published: December 2021

AbstractBackgroundLatinos are 1.5 times as likely to develop Alzheimer’s dementia as non‐Latino Whites. This health disparity may arise from multiple influences with culturally‐relevant factors receiving increasing attention. Models of acculturation stress the importance of considering acculturation‐related factors within the context of socioenvironmental factors to better capture the Latino experience in the US.MethodWe measured 10 acculturation and contextually‐related variables in 199 Latinos (age∼69.7yrs) without dementia participating in Rush Alzheimer’s Disease Center studies. We subjected these variables to Principal Component Analysis (PCA) to study their interrelationships; then investigated how the resulting components associated with level of and longitudinal change in domain‐specific cognition using separate linear mixed effects models adjusted for relevant confounders and their interactions with time.ResultThe PCA revealed a 3‐factor unrotated solution (variance explained ∼70%). Factor 1, representing acculturation‐related aspects of nativity, language‐ and social‐based acculturation, was positively associated with level, but not change, in semantic memory and perceptual speed. Factor 2, representing contextually‐related socioenvironmental experiences of discrimination, social isolation, and social networks, was associated with lower levels of episodic memory and working memory and faster longitudinal decline in visuospatial ability (Figure 1). Factor 3 (familism only) did not associate with level or change in any cognitive outcome. We are actively investigating the role of cardiovascular health on these associations.ConclusionAcculturation‐ and contextually‐related factors differentiated from each other and differentially contributed to cognition and cognitive decline in older Latinos. Providers should query multiple social determinants of health when evaluating older Latinos including acculturation‐ and contextually‐related lived experiences.
Vaccination beliefs in older African Americans in Detroit during the Covid‐19 pandemic
Authors: Bass Dwana , Hanna Sophie , Shair Sarah , DiCerbo Loraine M , Giordani Bruno , Kavcic Voyko 
Published: December 2021

AbstractBackgroundThe COVID‐19 pandemic has devastated multiple Countries targeting vulnerable populations. In Michigan there have been over 550,000 confirmed cases and over 14,000 deaths that forced health officials to rapidly develop and distribute COVID‐19 vaccines (MDHHS, 2021). As researchers study the COVID‐19 virus and vaccines, it is important to understand the educational needs of the public in deciding intent to accept the vaccine.MethodWe analyzed factors correlated with generalized anxiety rates in 150 African Americans age 65 and older, recruited from Wayne State Institute of Gerontology Healthier Black Elders Center and surrounding communities. Participants completed telephone questionnaires measuring demographics, stressors associated with COVID‐19 pandemic, and emotions. A scale was designed using the Health Belief Model assessing beliefs, susceptibility, severity, conspiracy beliefs of Covid‐19 (man‐made), and intent to be vaccinated. Applying factor analysis, questions were divided into: fear of COVID‐19 (I am worried about the likelihood of getting COVID‐19, My chances of getting COVID‐19 in next few months is great, I will be very sick if I get COVID‐19, Vaccinations decrease chances of infections or complications, I will get the vaccine if I receive adequate information), vaccination safety (I am concerned the vaccine will not work, I am concerned the vaccine will not be safe, Side effects from the vaccine interfere with activities and, Vaccinations make me less worried). Participants responded to these questions on 5‐point Likert scale (from “Strongly Disagree” to “Strongly Agree”).ResultOf 150 participants, 67% expressed intention to get vaccinated while only 15% were reluctant to vaccinate. Stepwise regression analysis showed that fear of COVID‐19 and vaccination safety explained 49% variance of intent to vaccinate. Vaccination safety was predicted by age, loneliness, vulnerability, and positive emotions (R2 = 20%). Fear of COVID‐19 was predicted by anxiety and positive emotions (R2 = 8%).ConclusionThis study provides a snapshot of urban African American older adults who are generally eager to get vaccinated for COVID‐19, and predictors of intent to get vaccinated. More research is needed to understand the scope of educational needs to increase the likelihood of older African Americans to get vaccinated.
Accuracy in estimating prevalence and incidence of dementia using longitudinal electronic health record data from the Indian Health Service
Authors: Jiang Luohua , Niu Xiaoyi , Grau Laura , Corrada Maria M , Manson Spero , O'Connell Joan 
Published: December 2021

AbstractBackgroundOur knowledge regarding dementia epidemiology for American Indians and Alaska Natives (AI/ANs) is very limited. Longitudinal electronic health record (EHR) data available in the Indian Health Service (IHS) provides an opportunity to estimate dementia prevalence and incidence among AI/ANs at the national level. However, as with other EHR‐based studies, identifying dementia patients via clinical diagnostic codes likely underestimates the prevalence of dementia. Furthermore, longitudinal studies of dementia using EHR could be challenging if some prevalent cases of dementia cannot be identified at baseline, which might be mistakenly considered as incident cases in subsequent years.MethodsWe extracted data from the IHS National Data Warehouse and related EHR databases between fiscal year (FY) 2007‐2013. Adults were identified as having dementia if they had at least one qualifying ICD‐9 diagnostic code for all‐cause dementia. A total of 1,117 AI/AN adults who were 45+ years old were identified as dementia patients in FY2007. Among these patients, we evaluated the number of years needed to correctly classify them as prevalent cases using data after FY2007. We also examined the impact of different dementia definitions on our ability to identify these prevalent cases using FY2008‐2013 data.ResultsAmong the FY2007 dementia patients who used IHS services in FY2008, only 63.7% of them were identified as having dementia in FY2008. The remaining 36.3% prevalent cases might be classified as incident cases if they have a qualifying diagnostic code after FY2008. Even when we used a 5‐year window (FY2008‐FY2012), only 78.9% of the FY2007 dementia patients were identified as prevalent cases. Among dementia patients who were 65+ years old in FY2007, a 5‐year window correctly identified 87.7% of the FY2007 dementia patients as prevalent cases. Altering the definition of dementia by adding dementia medications or diagnostic codes for other types of cognitive disorders did not substantially change our ability in distinguishing prevalent vs. incident cases of dementia.ConclusionsIt is challenging to distinguish dementia prevalent and incident cases using EHR data from the IHS. The accuracy of estimating prevalence and incidence of dementia using this data source might be higher among older patients.
Cerebral amyloid accumulation–related rapid mental deterioration presented with status epilepticus
Authors: Hsin Yue Loong , Chen Kuan Wen 
Published: December 2021

AbstractBackgroundAmyloids are characterized by a fibrillar β‐sheet secondary structure. Cerebral accumulation of β‐amyloid peptide is proposed to be one of the toxic pathogeneses of dementia, most commonly seen in Alzheimer’s disease (AD) and cerebral amyloid angiopathy (CAA). Here we reported patients who presented with status epilepticus and rapid mental deterioration. Their amyloid PET imaging displayed diffuse deposition.MethodWe retrospectively reviewed clinical presentation, EEGs, and brain MRI from a patient group with an amyloid‐PET imaging study.ResultFour patients were admitted to the hospital with status epilepticus. Case 1, a 75‐year‐old woman, suffered an impairment of consciousness with focal jerks. Epileptic discharging from bilateral frontotemporal regions continued for days after jerking controlled. Noticeable decline in remembering and problem solving developed rapidly within two months. Case 2, a 79‐year‐old woman, had mild cognitive impairment before administered anti‐seizure medications for right leg weakness after repeated focal seizures. After that, she had a more severe decline of dementia. Case 3, an 81‐year‐old woman, got an unimprovable left hemiparesis for two weeks of a continuing left‐sided jerk. She had rapidly increasing forgetfulness. Case 4, a 61‐year‐old man, was treated as super‐refractory status epilepticus for periodical choreic movement and dystonic jerks. Medications suppressed generalized periodic epileptiform discharges temporally. After one month, the epileptic discharging turned to periodic sharp wave complexes. He expired one month later. MRIs of Case 1 and 3 showed cortical atrophy. On case 2’s MRI, corticosubcortical microhemorrahge was revealed. Case 4’s diffusion‐weighted MRI showed diffuse cortical ribbon. The amyloid PETs of Case 1, 2, and 3 demonstrated diffuse deposition with focal cortical maximum spatially responsible for generating focal ictal discharges. The nuclear imaging on Case 4 showed maximal amyloid deposition on basal ganglia.ConclusionHere we reported four patients with refractory status epilepticus before dementia. Two cases were diagnosed with AD. One patient was categorized into CAA. In Case 4, according to positive CSF‐14‐3‐3, MRI cortical ribboning, EEG features, and clinical course, probable Creutzfeldt‐Jakob disease was impressed. Amyloid deposition may contribute to the increase of cortical susceptibility to seizures. Moreover, medically refractory status epilepticus hastens mental deterioration.
Examining differences across sleep profiles in late middle‐aged adults: Results from the Wisconsin Registry for Alzheimer's Prevention (WRAP)
Authors: Du Lianlian , Koscik Rebecca L , Jonaitis Erin M , Betthauser Tobey J , Cody Karly Alex , Hermann Bruce P , Mueller Kimberly D , Zuelsdorff Megan , Chin Nathaniel A , Ennis Gilda E. , Bendlin Barbara B , Gleason Carey E. , Christian Bradley T , Plante David T , Chappell Richard J. , Johnson Sterling C. 
Published: December 2021

AbstractBackgroundPrevious studies suggest associations between self‐reported poor sleep and relevant health markers and AD‐related outcomes including cognition and AD pathology. It is important to understand how sleep, a modifiable risk factor, may be related to cognition and other measures of aging in late midlife when AD pathology may be accruing. The study objectives included examining whether sleep profiles were associated with concurrent health and cognition, and positron emission tomography (PET) measures of amyloid.MethodsDementia‐free participants from the Wisconsin Registry for Alzheimer’s Prevention (WRAP) who had completed sleep questionnaires were eligible (n=619); questionnaires included the Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Medical Outcomes Study Sleep Scale (MOS). K‐means clustering analysis identified three clusters. We compared concurrent health markers (e.g., depression and insulin resistance) and cognitive composite scores across the sleep profile clusters. In the subset with Pittsburgh Compound B (PiB; n=107) PET imaging, we also compared amyloid measures (estimated global PiB distribution volume ratio (DVR), PiB chronicity, and PiB(+) (DVR>=1.2) at sleep assessment. Significant omnibus tests (p<.05) were followed with pairwise comparisons.ResultsMean(sd) sample baseline age was 62.6(6.7). Cluster analysis identified 3 groups: Healthy Sleepers (HS, n=262(42.3%)), Intermediate Sleepers (IS, n=229(37.0%)), and Poor Sleepers (PS, n=128(20.7%); Fig. 1, Fig. 2, Table 1). All omnibus tests comparing demographics and health measures across sleep groups were significant except age, gender, and APOE e4 carriers; the PS group was worse than HS and/or IS on all other measures, including self‐reported depression, health, and memory complaints (Table 2). PS performed worse than HS and/or IS on measured body mass index, waist‐hip ratio and insulin resistance (Fig. 3a); and after adjusting for covariates, PS performed worse on all cognitive outcomes except working memory (Fig. 4). There were no differences between sleep groups on measures of amyloid (Fig. 3b).ConclusionSleep profiles were associated with differences in additional modifiable risk factors and concurrent cognition, but not amyloid. Further analysis was needed in the association between the sleep constructs and amyloid clearance/accumulation. Management of sleep and related factors may provide an opportunity for early intervention that could ultimately delay or prevent clinical impairment.
Beta test of a mobile health application for dementia caregivers
Authors: Maynard Taylor R , Chapman Kimberly R , Sadhu Shehjar , Frink Travis , Mankodiya Kunal , Davis Jennifer D , Uebelacker Lisa , Ott Brian R , Tremont Geoffrey 
Published: December 2021

AbstractBackgroundDementia caregivers are at risk for negative health outcomes. Caregiver interventions to address this risk are limited by time and personnel constraints. Mobile technology is one means of reaching many caregivers while mitigating these constraints. The aim of the current project was to obtain initial data from a month‐long beta test of a new mobile health tablet App for dementia caregivers.MethodA purposive sample of community‐dwelling dementia caregivers was given access to the CARE‐Well (Caregiver Assessment, Resources, and Education) App for one month. The App consisted of 6 primary sections: (1) Self‐Assessment of Stress and Care Recipient Behavioral Problems; (2) Psychoeducation; (3) Goal Diary; (4) Managing Behavior Problems; (5) Online Message Forum; and (6) Video Library. Feedback was collected from caregivers in a qualitative interview following study completion. Data were analyzed via a mixed‐methods approach.ResultCaregivers (n = 10) were White, in their mid‐60s (M = 66.2, SD = 12.12), and well educated (M = 16.00 years, SD = 1.63). Care recipients had either mild (80%) or moderate dementia (20%), and 90% had probable Alzheimer’s disease. The average total time spent on the App across all participants was 754.29 minutes (SD = 1584.12). The most heavily used (in minutes) sections of the App were: Managing Behavior Problems (M = 592.10, SD = 1595.75), Video Library (M = 54.33, SD = 88.18) and Psychoeducation (M = 53.18, SD = 54.50). Qualitative feedback was predominantly positive. Caregivers reported Managing Behavior Problems to be the most helpful section followed by Psychoeducation and Online Message Forum. Caregivers reported difficulty with or disinterest in the Goal Diary section. In general, caregivers reported that the App would have been more helpful earlier in their care recipient’s illness.ConclusionResults indicated that caregivers regularly used the App and provided mostly positive responses to content. Findings highlighted the importance of user feedback and an iterative approach for developing digital health technology for dementia caregivers. Future interventions that are introduced earlier in the disease process may be well‐received and more beneficial to a wider range of dementia caregivers and their care recipients.
Temporal ordering of subjective cognitive decline and depressive symptoms in a multiracial community cohort
Authors: Chapman Silvia , Dworkin Jordan J , Rentería Miguel Arce , Manly Jennifer J , Joyce Jillian L , Vonk Jet MJ , Avila Justina F , Brickman Adam M. , Mayeux Richard , Cosentino Stephanie 
Published: December 2021

AbstractBackgroundSubjective Cognitive Decline (SCD), a proposed marker of preclinical Alzheimer’s disease (AD), is commonly associated with depressive symptoms. However, the basis and directionality of this association is unclear. Divergent hypotheses propose that mood changes either cause SCD or represent a psychological reaction to perceived cognitive decline. Alternatively, mood and SCD may both be part of a dementia prodrome. Longitudinal evaluation is critical to understand the temporal ordering of SCD and depressive symptoms. Further, given known differences in the prevalence of depressive symptoms across sex‐ethnoracial groups, it is important to examine temporality across these groups.Methods3365 (68% women, 75 (SD=6) years old, 10 (SD=5) years educated) participants without dementia at baseline were included in this study. Of these, 1005 were non‐Hispanic Black, 1450 Hispanic and 910 non‐Hispanic White. Depressive symptoms were measured using the Center for Epidemiological Studies Depression scale (CES‐D). SCD was assessed with a 9‐item questionnaire assessing memory difficulties. Separate autoregressive generalized additive mixed effects models (GAMMs) were conducted. Each model included a lagged cross‐symptom variable, an autoregressive same‐symptom variable, and a within‐visit association between CES‐D and SCD. Models additionally included age, time in study, dementia status, education and objective memory performance. Primary coefficients of interest were lagged cross‐symptom effects, estimated across and within sex‐ethnoracial groups.ResultsWhole‐sample results showed similar coefficients for models of SCD predicting depressive symptoms (b=.021, p=.021) and models of depressive symptoms predicting SCD (b=.045, p=.001; Figure 1). Stratified analyses showed that within Black participants, depressive symptoms preceded SCD (b=.098, p<.001) whilst the opposite pattern was seen in Hispanic participants (b=.025, p=.027). With regard to sex, depressive symptoms preceded SCD in men, particularly white men (b=.141, p=.004). In contrast, SCD preceded depressive symptoms in women, primarily Hispanic women (b=.030, p=.019).ConclusionsResults provide evidence for bidirectionality between depressive symptoms and SCD, underscoring the multiple pathways by which these two factors are linked in the course of cognitive aging. However, stratified results reveal nuanced patterns between depressive symptoms and SCD across sex‐ethnoracial groups that may offer clues to the relevance of SCD as a marker of pre‐clinical AD in different populations.
Quality measures in dementia care across a network of memory clinics: An implementation study
Authors: Pinzon Maria C Mora , Krainer Jody , Houston Stephanie , LeCaire Tamara , Green‐Harris Gina , Norris Nia , Walaszek Art , Johnson Sterling C. , Carlsson Cynthia M 
Published: December 2021

AbstractBackgroundIn 2015 the American Academy of Neurology and American Psychiatric Association updated the Dementia Management Measurement Set from 2009. Out of the nine measures proposed, four have been included by the Centers for Medicare and Medicaid Services (CMS) in their Merit‐Based Incentive Payment System, which is used to determine payment adjustments in pay‐for‐reporting program. In 2018, the Wisconsin Alzheimer’s Institute (WAI) developed a process to track the performance of these measures across the WAI Dementia Diagnostic Clinic Network, which consists of 44 statewide clinics across 24 healthcare systems.MethodIn September 2018, WAI launched the following implementation strategies to improve adoption of the quality measures: audit and feedback, new de‐identified forms, and development of a codebook with definitions and examples on how to fill the new forms. Clinics submit de‐identified forms containing demographics, diagnosis and process measures that are used to calculate performance on the quality measures. Descriptive analyses were performed, and performance was calculated according to criteria set by CMS.ResultOver 24 months, 23 clinics have submitted information on 3,247 patients. Early adopters demonstrated a high performance on the measures, but as more clinics participate, the distribution has shown regression to the mean (Table 1). When comparing clinic performance between Oct 2019 – Oct 2020 with CMS benchmarks for 2020, the percentage of clinics performing above the CMS average were: 68% for measure #2; 91% for measure #3; 48% for measure #4; and 86% for measure #5 (Figure). Variations in performances have been attributed to unique characteristics of each clinic, for example, some do not follow‐up individuals and only provide recommendations to primary care providers; this lowers their metrics in measures that require management of behaviors or conditions.ConclusionImplementation of the quality measures across the WAI network has been facilitated by the use of clinical care models that promote interdisciplinary care. Further research is required to explore additional mechanisms that increase participation of clinics, and to develop new data collection methods that can explore the impact of these measures on health outcomes.
Amyloid and tau deposition influences cognitive decline in Down syndrome
Authors: Grigorova Monika , Mak Elijah , Beresford‐Webb Jessica , Brown Stephanie S G , Jones Elizabeth , Clare Isabel , Holland Tony , Hong Young T , Fryer Tim D , Coles Jonathan P , Williams Guy B , Aigbirhio Franklin I , Ances Beau M. , Christian Bradley T , Handen Benjamin L , Klunk William E , Laymon Charles M , Tudorascu Dana L , Zaman Shahid ,   NiAD (Neurodegeneration in Aging Down Syndrome)
Published: December 2021

AbstractBackgroundAmyloid‐β accumulation in the brain has been associated with decline in cognitive functioning in adults with Down Syndrome (DS). Despite the significant relationship between in vivo Amyloid‐β and tau pathology, no studies have assessed whether tau potentiates the relationship between amyloid‐β and cognitive decline in DS. Here we investigate whether (i) tau has an independent effect on changes in cognition; (ii) tau has a synergistic relationship with amyloid in the exacerbation of cognitive decline.MethodA baseline cohort of 105 participants with DS underwent PET AV‐1451 and PiB scans to quantify tau and Amyloid‐β deposition. Neuropsychological assessment of participants included a test for episodic memory (Cued Recall), visuospatial ability (WISC‐IV Block Design and Haxby Extension) and global cognition (DSMSE). Cognition was re‐assessed at 16 (n = 105) and 32 months (n=26) after baseline. Amyloid‐β burden was quantified categorically as PiB+/‐ where PiB+ status was defined as PiB standard uptake value ratio (SUVR) above a defined threshold. Braak regions (2‐6) and the Striatum were used for generating the SUVR for AV‐1451. Linear Mixed Effects models were implemented to assess the independent effects of tau and PiB status on change in cognition. Additional models tested the 3‐way interactions between tau, PiB status and time for each ROI. P‐values were adjusted via the FDR method.ResultFor the memory outcome, the interactions between time and tau (with PiB status – time interactions also included in the model) were significant for all ROIs, except the Striatum, while Braak regions 3 to 5 were significantly associated with change in DSMSE scores. All ROIs’ tau showed a significant interaction with time for the Block Design task. The three‐way interaction between time, PiB status and striatal tau was significant in the models of memory change. Braak 5 and tau showed a significant interaction with time and PiB status for the visuospatial ability outcome (Fig 1‐4).ConclusionThere was evidence for a significant independent effect of baseline tau on cognitive change, over and above the effect of amyloid status. We also found evidence for a synergistic relationship between PiB status and tau as predictors of change in memory and visuospatial ability.