1
|
Gutiérrez Á, López-Anuarbe M, Webster NJ, Mahmoudi E. Rural-Urban Health Care Cost Differences Among Latinx Adults With and Without Dementia in the United States. J Aging Health 2024; 36:559-569. [PMID: 37899581 DOI: 10.1177/08982643231207517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
OBJECTIVES To compare rural-urban health care costs among Latinx adults ages 51+ and examine variations by dementia status. METHODS Data are from the Health and Retirement Study (2006-2018 waves; n = 15,567). We inflation-adjusted all health care costs using the 2021 consumer price index. Geographic context and dementia status were the main exposure variables. We applied multivariate two-part generalized linear models and adjusted for sociodemographic and health characteristics. RESULTS Rural residents had higher total health care costs, regardless of dementia status. Total health care costs were $850 higher in rural ($2,640) compared to urban ($1,789) areas (p < .001). Out-of-pocket costs were $870 higher in rural ($2,677) compared to urban ($1,806) areas (p < .001). Dementia status was not an effect modifier. DISCUSSION Health care costs are disproportionately higher among Latinx rural, relative to urban, residents. Addressing health care costs among Latinx rural residents is a public health priority.
Collapse
Affiliation(s)
- Ángela Gutiérrez
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA
| | | | - Noah J Webster
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Elham Mahmoudi
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
2
|
Keller MS, Guevara N, Guerrero JA, Mays AM, McCleskey SG, Reyes CE, Sarkisian CA. Experiences managing behavioral symptoms among Latino caregivers of Latino older adults with dementia and memory problems: a qualitative study. BMC Geriatr 2024; 24:725. [PMID: 39217285 PMCID: PMC11365257 DOI: 10.1186/s12877-024-05323-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Latinos are more likely than non-Latino Whites to develop dementia and be prescribed antipsychotics for dementia-related behavioral symptoms. Antipsychotics have significant risks yet are often overprescribed. Our understanding of how Latino caregivers of Latino older adults living with dementia perceive and address behavioral issues is limited, impeding our ability to address the root causes of antipsychotic overprescribing. METHODS We interviewed Latino older adults' caregivers and community-based organization workers serving older adults with cognitive impairment (key informants), focusing on the management of behavioral symptoms and experiences with health services. RESULTS We interviewed 8 caregivers and 2 key informants. Caregivers were the spouses, children, or grandchildren of the older adult living with cognitive impairment; their ages ranged from 30 to 95. We identified three categories of how caregivers learned about, managed, and coped with behavioral symptoms: caregivers often faced shortcomings with dementia care in the medical system, receiving limited guidance and support; caregivers found community organizations and senior day centers to be lifelines, as they received relevant, timely advice and support, caregivers often devised their own creative strategies to manage behavioral symptoms. CONCLUSION In-depth interviews suggest that the healthcare system is failing to provide support for behavioral symptoms from dementia; caregivers of Latino older adults rely on community organizations instead.
Collapse
Affiliation(s)
- Michelle S Keller
- USC Leonard Davis School of Gerontology, 3715 McClintock Avenue , Los Angeles, CA, 90089, USA.
- Department of Health Policy and Management, Fielding School of Public Health, University of California-Los Angeles, Los Angeles, CA, USA.
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Nathalie Guevara
- Section of Geriatric Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Allison M Mays
- Section of Geriatric Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Carmen E Reyes
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Catherine A Sarkisian
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Geriatric Research Education Clinical Center (GRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| |
Collapse
|
3
|
Salazar R, Dwivedi AK, Alvarado LA, Escamilla M. An 11-Fold Higher Risk of Incident Mild Cognitive Impairment With Hispanic Ethnicity and Baseline Neuropsychiatric Symptoms. J Neuropsychiatry Clin Neurosci 2024:appineuropsych20230180. [PMID: 39169739 DOI: 10.1176/appi.neuropsych.20230180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
OBJECTIVE Neuropsychiatric symptoms (NPSs) have been linked to cognitive decline. This study explored ethnic differences and the effects of baseline NPSs on incident mild cognitive impairment (MCI) among 386 Hispanic and non-Hispanic participants from the Texas Harris Alzheimer's Research Study. METHODS Data on NPSs from the Neuropsychiatric Inventory Questionnaire were available for all participants. Cox proportional hazards regression models were used to estimate the effect of ≥1 NPS at baseline and Hispanic ethnicity on incident MCI over a 7-year follow-up period. RESULTS NPSs at baseline were associated with incident MCI for Hispanic participants but not non-Hispanic participants. Being Hispanic with at least one NPS at baseline had an 11-times higher risk of incident MCI. CONCLUSIONS The Hispanic participants converted to MCI to a greater extent than the non-Hispanic participants. Only depressive symptoms increased the risk of MCI among non-Hispanics. Being of Hispanic ethnicity and having NPSs appeared to jointly increase the risk of progressing to MCI. To better understand the Alzheimer's disease continuum, further studies should explore other cultural, genetic, and medical risk factors influencing disease progression. Our findings strongly suggest the need to incorporate NPSs as outcomes of disease progression in future clinical trials involving Hispanic participants.
Collapse
Affiliation(s)
- Ricardo Salazar
- Department of Psychiatry, Division of Geriatric Psychiatry and Behavioral Neurosciences (Salazar), and Department of Molecular and Translational Medicine, Division of Biostatistics and Epidemiology (Dwivedi, Alvarado), Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso; Department of Psychiatry, School of Medicine, University of Texas Rio Grande Valley, Edinburg, Texas (Escamilla)
| | - Alok K Dwivedi
- Department of Psychiatry, Division of Geriatric Psychiatry and Behavioral Neurosciences (Salazar), and Department of Molecular and Translational Medicine, Division of Biostatistics and Epidemiology (Dwivedi, Alvarado), Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso; Department of Psychiatry, School of Medicine, University of Texas Rio Grande Valley, Edinburg, Texas (Escamilla)
| | - Luis A Alvarado
- Department of Psychiatry, Division of Geriatric Psychiatry and Behavioral Neurosciences (Salazar), and Department of Molecular and Translational Medicine, Division of Biostatistics and Epidemiology (Dwivedi, Alvarado), Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso; Department of Psychiatry, School of Medicine, University of Texas Rio Grande Valley, Edinburg, Texas (Escamilla)
| | - Michael Escamilla
- Department of Psychiatry, Division of Geriatric Psychiatry and Behavioral Neurosciences (Salazar), and Department of Molecular and Translational Medicine, Division of Biostatistics and Epidemiology (Dwivedi, Alvarado), Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso; Department of Psychiatry, School of Medicine, University of Texas Rio Grande Valley, Edinburg, Texas (Escamilla)
| |
Collapse
|
4
|
Llibre‐Guerra JJ, Jiang M, Acosta I, Sosa AL, Acosta D, Jimenez‐Velasquez IZ, Guerra M, Salas A, Rodriguez Salgado AM, Llibre‐Guerra JC, Sánchez ND, Prina M, Renton A, Albanese E, Yokoyama JS, Llibre Rodriguez JJ. Social determinants of health but not global genetic ancestry predict dementia prevalence in Latin America. Alzheimers Dement 2024; 20:4828-4840. [PMID: 38837526 PMCID: PMC11247688 DOI: 10.1002/alz.14041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION Leveraging the nonmonolithic structure of Latin America, which represents a large variability in social determinants of health (SDoH) and high levels of genetic admixture, we aim to evaluate the relative contributions of SDoH and genetic ancestry in predicting dementia prevalence in Latin American populations. METHODS Community-dwelling participants aged 65 and older (N = 3808) from Cuba, Dominican Republic, Mexico, and Peru completed the 10/66 protocol assessments. Dementia was diagnosed using the cross-culturally validated 10/66 algorithm. Multivariate linear regression models adjusted for SDoH were used in the main analysis. This study used cross-sectional data from the 1066 population-based study. RESULTS Individuals with higher proportions of Native American (>70%) and African American (>70%) ancestry were more likely to exhibit factors contributing to worse SDoH, such as lower educational levels (p < 0.001), lower socioeconomic status (p < 0.001), and higher frequency of vascular risk factors (p < 0.001). After adjusting for measures of SDoH, there was no association between ancestry proportion and dementia probability, and ancestry proportions no longer significantly accounted for the variance in cognitive performance (African predominant p = 0.31 [-0.19, 0.59] and Native predominant p = 0.74 [-0.24, 0.33]). DISCUSSION The findings suggest that social and environmental factors play a more crucial role than genetic ancestry in predicting dementia prevalence in Latin American populations. This underscores the need for public health strategies and policies that address these social determinants to effectively reduce dementia risk in these communities. HIGHLIGHTS Countries in Latin America express a large variability in social determinants of health and levels of admixture. After adjustment for downstream societal factors linked to SDoH, genetic ancestry shows no link to dementia. Population ancestry profiles alone do not influence cognitive performance. SDoH are key drivers of racial disparities in dementia and cognitive performance.
Collapse
Affiliation(s)
- Jorge J. Llibre‐Guerra
- Department of NeurologyWashington University School of Medicine in St. LouisSt LouisMissouriUSA
| | - Miao Jiang
- Institute of Public HealthFaculty of Biomedical SciencesUniversità della Svizzera italianaLuganoSwitzerland
| | - Isaac Acosta
- Laboratory of the DementiasNational Institute of Neurology and NeurosurgeryMexico CityMexico
- National Autonomous University of MexicoMexico CityMexico
| | - Ana Luisa Sosa
- Laboratory of the DementiasNational Institute of Neurology and NeurosurgeryMexico CityMexico
- National Autonomous University of MexicoMexico CityMexico
| | - Daisy Acosta
- Internal Medicine DepartmentUniversidad Nacional Pedro Henriquez Ureña (UNPHU), Geriatric SectionSanto DomingoDominican Republic
| | - Ivonne Z. Jimenez‐Velasquez
- Internal Medicine DepartmentGeriatrics Program, School of MedicineMedical Sciences CampusUniversity of Puerto RicoSan JuanPuerto RicoUSA
| | - Mariella Guerra
- Instituto de la Memoria Depresion y Enfermedades de Riesgo IMEDERLimaPerú
| | - Aquiles Salas
- Medicine DepartmentCaracas University Hospital, Faculty of Medicine, Universidad Central de VenezuelaCaracasVenezuela
| | | | | | - Nedelys Díaz Sánchez
- Dementia Research Unit, Facultad de Medicina Finlay‐AlbarranMedical University of HavanaHavanaCuba
| | - Matthew Prina
- Population Health Sciences InstituteFaculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
| | - Alan Renton
- Department of NeuroscienceIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Emiliano Albanese
- Institute of Public HealthFaculty of Biomedical SciencesUniversità della Svizzera italianaLuganoSwitzerland
| | - Jennifer S. Yokoyama
- Department of NeurologyUCSF Weill Institute for Neurosciences, University of California, San FranciscoSan FranciscoCaliforniaUSA
- Department of Radiology and Biomedical ImagingUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Juan J. Llibre Rodriguez
- Dementia Research Unit, Facultad de Medicina Finlay‐AlbarranMedical University of HavanaHavanaCuba
| |
Collapse
|
5
|
Silva-Rudberg JA, Carrión CI, Pérez-Palmer N, Li J, Mehta SK, Diab NS, Mecca AP, O'Dell RS. Assessment of disparities in timely diagnosis and comprehensive workup of cognitive impairment between English and Spanish speakers. Am J Geriatr Psychiatry 2024; 32:773-786. [PMID: 38336573 PMCID: PMC11162952 DOI: 10.1016/j.jagp.2024.01.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 01/13/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Previous studies have examined disparities in dementia care that affect the U.S. Hispanic/Latino population, including clinician bias, lack of cultural responsiveness, and less access to health care. However, there is limited research that specifically investigates the impact of language barriers to health disparities in dementia diagnosis. METHODS In this retrospective cross-sectional study, 12,080 English- or Spanish- speaking patients who received an initial diagnosis of mild cognitive impairment (MCI) or dementia between July 2017 and June 2019 were identified in the Yale New Haven Health (YNHH) electronic medical record. To evaluate the timeliness of diagnosis, an initial diagnosis of MCI was classified as "timely", while an initial diagnosis of dementia was considered "delayed." Comprehensiveness of diagnosis was assessed by measuring the presence of laboratory studies, neuroimaging, specialist evaluation, and advanced diagnostics six months before or after diagnosis. Binomial logistic regressions were calculated with and without adjustment for age, legal sex, ethnicity, neighborhood disadvantage, and medical comorbidities. RESULTS Spanish speakers were less likely to receive a timely diagnosis when compared with English speakers both before (unadjusted OR, 0.65; 95% CI, 0.53-0.80, p <0.0001) and after adjusting for covariates (adjusted OR, 0.55; 95% CI, 0.40-0.75, p = 0.0001). Diagnostic services were provided equally between groups, except for referrals to geriatrics, which were more frequent among Spanish-speaking patients. A subgroup analysis revealed that Spanish-speaking Hispanic/Latino patients were less likely to receive a timely diagnosis compared to English-speaking Hispanic/Latino patients (adjusted OR, 0.53; 95% CI, 0.38-0.73, p = 0.0001). CONCLUSIONS Non-English language preference is likely to be a contributing factor to timely diagnosis of cognitive impairment. In this study, Spanish language preference rather than Hispanic/Latino ethnicity was a significant predictor of a less timely diagnosis of cognitive impairment. Policy changes are needed to reduce barriers in cognitive disorders care for Spanish-speaking patients.
Collapse
Affiliation(s)
- Jason A Silva-Rudberg
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Medicine (JAS-R,), University of California, San Francisco, San Francisco, CA
| | - Carmen I Carrión
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Neurology (CIC), Yale University School of Medicine, New Haven, CT
| | - Nicolás Pérez-Palmer
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (NP-P), Veteran's Affairs Connecticut Healthcare System, West Haven, CT
| | - Judy Li
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT
| | - Sumarth K Mehta
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT
| | - Nicholas S Diab
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT
| | - Adam P Mecca
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT
| | - Ryan S O'Dell
- Alzheimer's Disease Research Center (JAS-R, CIC, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT; Department of Psychiatry (JAS-R, NP-P, JL, SKM, NSD, APM, RSO), Yale University School of Medicine, New Haven, CT.
| |
Collapse
|
6
|
Mildrum Chana S, Álvarez L, Poe A, Bibriescas N, Wang DH, DiFiglia S, Azuero A, Crowe M, Puga F. The Daily Experiences of Hispanic and Latinx Dementia Caregivers Study: Protocol for a Fully Remote Daily Diary Observational Cohort Study. JMIR Res Protoc 2024; 13:e55216. [PMID: 38869929 PMCID: PMC11211706 DOI: 10.2196/55216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/13/2024] [Accepted: 03/23/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND The Hispanic and Latinx community is disproportionately affected by Alzheimer disease and related dementias (ADRDs). In the United States, approximately 8.5 million caregivers of individuals with ADRDs identify as Hispanic and Latinx people, and caregiving-related stress and burden place caregivers at elevated risk for poor mental health outcomes, as well as loneliness and social isolation. To date, there is limited knowledge about the daily stress experiences of Hispanic and Latinx caregivers. Given this knowledge gap, it is critical to examine how personal, cultural, and contextual factors influence daily stress, mental health, and resilience over time among Hispanic and Latinx ADRD caregivers. OBJECTIVE The goal of this protocol report is to present the rationale, methodology, planned analytical strategy, progress completed to date, and implications of future findings for "Nuestros Días" (Spanish for "our days"), a fully remote daily diary (DD), observational cohort study examining the day-to-day experiences of Hispanic and Latinx ADRD caregivers. METHODS The study will recruit a cohort of up to 500 Hispanic and Latinx caregivers of individuals living with ADRD. Participants will complete measures assessing contextual, individual-level, and cultural factors at 3 intervals (enrollment, 6 months, and 12 months). Each of the timepoints will be followed by 21 days of DD surveys to report on daily stress, stress moderators, and mental health variables. RESULTS Data collection began in March 2023 and is projected to end in December 2026. As of March 2024, we have enrolled 60 caregivers in the Nuestros Días study, 78.9% (n=15) of whom are Spanish speakers. The current completion rate for DD surveys is 79.4%, averaging approximately 18 surveys out of 21 completed. We expect to enroll 10 to 15 participants per month moving forward to achieve our enrollment goal. CONCLUSIONS Results from this study will identify which Hispanic and Latinx ADRD caregivers, and under what circumstances, appear to be at the greatest risk of experiencing poor mental health outcomes over time. This study represents a critical step forward in providing key guidance to develop effective, culturally sensitive interventions to support the health and well-being of Hispanic and Latinx ADRD caregivers, a historically underrepresented and underserved population in aging and caregiving research. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/55216.
Collapse
Affiliation(s)
- Sofía Mildrum Chana
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Lorelí Álvarez
- Department of Acute, Chronic and Continuing Care, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Abigail Poe
- Department of Acute, Chronic and Continuing Care, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Natashia Bibriescas
- Department of Educational Psychology, University of Texas at Austin, Austin, TX, United States
| | - Danny Hai Wang
- Department of Biobehavioral Health, College of Health and Human Development, The Pennsylvania State University, University Park, PA, United States
| | - Stephanie DiFiglia
- MJHS Institute for Innovation in Palliative Care, New York, NY, United States
| | - Andrés Azuero
- Department of Nursing Family, Community & Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Michael Crowe
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Frank Puga
- Department of Acute, Chronic and Continuing Care, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| |
Collapse
|
7
|
Marquine MJ, Parks A, Perales-Puchalt J, González DA, Rosado-Bruno M, North R, Pieper C, Werry AE, Kiselica A, Chapman S, Dodge H, Gauthreaux K, Kukull WA, Rascovsky K. Demographically-adjusted normative data among Latinos for the version 3 of the Alzheimer's Disease Centers' Neuropsychological Test Battery in the Uniform Data Set. Alzheimers Dement 2023; 19:4174-4186. [PMID: 37356069 PMCID: PMC10622863 DOI: 10.1002/alz.13313] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 06/27/2023]
Abstract
INTRODUCTION We developed demographically-adjusted normative data for Spanish- and English-speaking Latinos on the Version 3.0 of the National Alzheimer's Coordinating Center Uniform Data Set Neuropsychological Battery (UDS3-NB). METHODS Healthy Latino adults (N = 437) age 50-94 (191 Spanish- and 246 English-speaking) enrolled in Alzheimer's Disease Research Centers completed the UDS3-NB in their preferred language. Normative data were developed via multiple linear regression models on UDS3-NB raw scores stratified by language group with terms for demographic characteristics (age, years of formal education, and sex). RESULTS Younger age and more years of education were associated with better performance on most tests in both language groups, with education being particularly influential on raw scores among Spanish-speakers. Sex effects varied across tests and language groups. DISCUSSION These normative data are a crucial step toward improving diagnostic accuracy of the UDS3-NB for neurocognitive disorders among Latinos in the United States and addressing disparities in Alzheimer's disease and related dementias. HIGHLIGHTS We developed normative data on the UDS3-NB for Latinos in the US ages 50-94. Younger age and more years of education were linked to better raw scores in several cognitive tests. Education was particularly influential on raw scores among Spanish-speakers. Sex effects varied across tests and between English- and Spanish-speaking Latinos. These normative data might improve diagnostic accuracy of the UDS3-NB among Latinos.
Collapse
Affiliation(s)
- María J Marquine
- Department of Medicine (Geriatrics Division) and Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina, USA
| | - Adam Parks
- Department of Neurology, University of Kansas Medical Center, Fairway, Kansas, USA
| | | | - David A González
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Mónica Rosado-Bruno
- Department of Health Psychology, University of Missouri, Columbia, Missouri, USA
| | - Rebecca North
- Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina, USA
| | - Carl Pieper
- Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina, USA
| | - Amy E Werry
- Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Andrew Kiselica
- Department of Health Psychology, University of Missouri, Columbia, Missouri, USA
| | - Silvia Chapman
- Cognitive Neuroscience Division, Taub Institute for Research on Alzheimer's Disease and Gertrude H. Sergievsky Center, Columbia University, New York, New York, USA
| | - Hiroko Dodge
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kathryn Gauthreaux
- Department of Epidemiology, National Alzheimer's Coordinating Center, University of Washington, Seattle, Washington, USA
| | - Walter A Kukull
- Department of Epidemiology, National Alzheimer's Coordinating Center, University of Washington, Seattle, Washington, USA
| | - Katya Rascovsky
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, Pennsylvania, USA
| |
Collapse
|
8
|
Duarte Folle A, Flores M, Kusters C, Paul K, Del Rosario I, Zhang K, Ruiz C, Castro E, Bronstein J, Ritz B, Keener A. Ethnicity and Parkinson's Disease: Motor and Nonmotor Features and Disease Progression in Latino Patients Living in Rural California. J Gerontol A Biol Sci Med Sci 2023; 78:1258-1268. [PMID: 36645401 PMCID: PMC10329232 DOI: 10.1093/gerona/glad016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) is the second most common neurodegenerative disorder among older adults worldwide. Currently, studies of PD progression rely primarily on White non-Latino (WNL) patients. Here, we compare clinical profiles and PD progression in Latino and WNL patients enrolled in a community-based study in rural Central California. METHOD PD patients within 5 years of diagnosis were identified from 3 counties between 2001 and 2015. During up to 3 visits, participants were examined by movement disorders specialists and interviewed. We analyzed cross-sectional differences in PD clinical features severity at each study visit and used linear mixed models and Cox proportional hazards models to compare motor, nonmotor, and disability progression longitudinally and to assess time to death in Latinos compared to WNL patients. RESULTS Of 775 patients included, 138 (18%) self-identified as Latino and presented with earlier age at diagnosis (63.6 vs 68.9) and death (78.6 vs 81.5) than WNL. Motor (hazard ratio [HR] = 1.17 [0.71, 1.94]) and nonmotor symptoms did not progress faster in Latino versus WNL patients after accounting for differences in baseline symptom severity. However, Latino patients progressed to disability stages according to Hoehn and Yahr faster than WNL (HR = 1.81 [1.11, 2.96]). Motor and nonmotor symptoms in Latino patients were also medically managed less well than in WNL. CONCLUSIONS Our PD study with a large proportion of Latino enrollees and progression data reveals disparities in clinical features and progression by ethnicity that may reflect healthcare access and structural socioeconomic disadvantages in Latino patients with PD.
Collapse
Affiliation(s)
- Aline Duarte Folle
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Marie E S Flores
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
- Altamed, Pico Rivera, California, USA
| | - Cynthia Kusters
- Department of Human Genetics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kimberly C Paul
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Irish Del Rosario
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Keren Zhang
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Cristina Ruiz
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Emily Castro
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Jeff Bronstein
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Beate Ritz
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Adrienne M Keener
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Department of Neurology, Veterans Administration Greater Los Angeles Health Care System, Los Angeles, California, USA
| |
Collapse
|
9
|
Aguiñaga S, Guzman J, Soto Y, Marquez DX. Self-rated health as a predictor of cognition among middle-aged and older Latinos. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2023; 30:388-401. [PMID: 35174775 PMCID: PMC9381643 DOI: 10.1080/13825585.2022.2038070] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 01/31/2022] [Indexed: 10/19/2022]
Abstract
Self-rated health (SRH) has been used to predict cognitive decline in various populations; however, this relationship has not been examined in Latinos. This study examines the relationship between SRH and cognition among middle-aged and older Latinos. A cross-sectional analysis was conducted among Latinos (n = 425, Mage = 64.13 ± 7.65, 82% female). Participants rated their health as poor/fair, good, and excellent and completed cognitive performance tests. Analyses of covariance (ANCOVA) examined differences in cognition between SRH categories. ANCOVAs showed significant differences in SRH categories for working memory (F [2, 357] = 3.63, p = .028) and global cognition (F [2, 348] = 3.074, p = .047), such that those who self-rated their health as good had better scores compared to participants in the poor/fair category. Findings show that SRH is associated with cognition among middle-aged and older Latinos. SRH may serve as an indicator of early signs of cognitive decline.
Collapse
Affiliation(s)
- Susan Aguiñaga
- University of Illinois at Urbana-Champaign, Department of Kinesiology and Community Health, 906 S. Goodwin Ave., Urbana, IL 61801, United States
| | - Jacqueline Guzman
- University of Illinois at Urbana-Champaign, Department of Kinesiology and Community Health, 906 S. Goodwin Ave., Urbana, IL 61801, United States
| | - Yuliana Soto
- University of Illinois at Urbana-Champaign, Department of Kinesiology and Community Health, 906 S. Goodwin Ave., Urbana, IL 61801, United States
| | - David X. Marquez
- University of Illinois at Chicago, Department of Kinesiology and Nutrition, 1919 W. Taylor Street, Chicago, IL 60612, United States
| |
Collapse
|
10
|
Bukhbinder AS, Hinojosa M, Harris K, Li X, Farrell CM, Shyer M, Goodwin N, Anjum S, Hasan O, Cooper S, Sciba L, Vargas A, Hunter DH, Ortiz GJ, Chung K, Cui L, Zhang GQ, Fisher-Hoch SP, McCormick JB, Schulz PE. Population-Based Mini-Mental State Examination Norms in Adults of Mexican Heritage in the Cameron County Hispanic Cohort. J Alzheimers Dis 2023; 92:1323-1339. [PMID: 36872776 DOI: 10.3233/jad-220934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
BACKGROUND Accurately identifying cognitive changes in Mexican American (MA) adults using the Mini-Mental State Examination (MMSE) requires knowledge of population-based norms for the MMSE, a scale which has widespread use in research settings. OBJECTIVE To describe the distribution of MMSE scores in a large cohort of MA adults, assess the impact of MMSE requirements on their clinical trial eligibility, and explore which factors are most strongly associated with their MMSE scores. METHODS Visits between 2004-2021 in the Cameron County Hispanic Cohort were analyzed. Eligible participants were ≥18 years old and of Mexican descent. MMSE distributions before and after stratification by age and years of education (YOE) were assessed, as was the proportion of trial-aged (50-85- year-old) participants with MMSE <24, a minimum MMSE cutoff most frequently used in Alzheimer's disease (AD) clinical trials. As a secondary analysis, random forest models were constructed to estimate the relative association of the MMSE with potentially relevant variables. RESULTS The mean age of the sample set (n = 3,404) was 44.4 (SD, 16.0) years old and 64.5% female. Median MMSE was 28 (IQR, 28-29). The percentage of trial-aged participants (n = 1,267) with MMSE <24 was 18.6%; 54.3% among the subset with 0-4 YOE (n = 230). The five variables most associated with the MMSE in the study sample were education, age, exercise, C-reactive protein, and anxiety. CONCLUSION The minimum MMSE cutoffs in most phase III prodromal-to-mild AD trials would exclude a significant proportion of trial-aged participants in this MA cohort, including over half of those with 0-4 YOE.
Collapse
Affiliation(s)
- Avram S Bukhbinder
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.,Division of Pediatric Neurology, Massachusetts General Hospital, Boston, MA
| | - Miriam Hinojosa
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kristofer Harris
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Xiaojin Li
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Christine M Farrell
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Madison Shyer
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Nathan Goodwin
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sahar Anjum
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Omar Hasan
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Susan Cooper
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Lois Sciba
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Amanda Vargas
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - David H Hunter
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Guadalupe J Ortiz
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Karen Chung
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Licong Cui
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Guo-Qiang Zhang
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.,School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Susan P Fisher-Hoch
- Department of Epidemiology, Human Genetics & Environmental Sciences, UTHealth School of Public Health, Brownsville, TX, USA
| | - Joseph B McCormick
- Department of Epidemiology, Human Genetics & Environmental Sciences, UTHealth School of Public Health, Brownsville, TX, USA
| | - Paul E Schulz
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| |
Collapse
|
11
|
Huie EZ, Escudero A, Saito N, Harvey D, Nguyen ML, Lucot KL, LaGrande J, Mungas D, DeCarli C, Lamar M, Schneider JA, Kapasi A, Rissman RA, Teich AF, Dugger BN. TDP-43 Pathology in the Setting of Intermediate and High Alzheimer's Disease Neuropathologic Changes: A Preliminary Evaluation Across Ethnoracial Groups. J Alzheimers Dis 2023; 91:1291-1301. [PMID: 36617779 PMCID: PMC9974776 DOI: 10.3233/jad-220558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Transactive Response DNA Binding Protein 43 kDa (TDP-43) pathology is frequently found in cases with Alzheimer's disease (AD). TDP-43 pathology is associated with hippocampal atrophy and greater AD severity denoted by cognition and clinical representation. Current TDP-43 pathology studies are predominantly based on non-Hispanic White cohorts. OBJECTIVE We sought to evaluate the presence of TDP-43 pathology across ethnoracial groups utilizing the National Alzheimer's Coordinating Center; a database containing data from over 29 institutions across the United States. Cases (N = 1135: Hispanics/Latinos = 29, African Americans/Black Americans = 51, Asians/Asian Americans = 10, American Indians/Alaskan Natives = 2, non-Hispanic White = 1043) with intermediate/high AD having data on TDP-43 pathology in the amygdala, hippocampus, entorhinal cortex, and neocortex were included. METHODS TDP-43 pathology frequency in each neuroanatomic region among ethnoracial groups were compared using generalized linear mixed effects models with center as a random effect adjusting for age at death, education, and gender. RESULTS Although groups were imbalanced, there was no significant difference across ethnoracial groups based on TDP-43 pathology (p = 0.84). With respect to neuroanatomical regions evaluated, there were no significant differences across ethnoracial groups (p-values > 0.06). There were also no significant differences for age at death and gender ratios across ethnoracial groups based on TDP-43 pathology. Although not statistically significant, TDP-43 pathology was present less often in Hispanic/Latinos (34%) when compared to non-Hispanic Whites (46%). CONCLUSION While this is a preliminary evaluation, it highlights the need for diverse cohorts and on TDP-43 pathology research across ethnoracial groups. This is the first study to our knowledge having a focus on the neuroanatomical distribution of TDP-43 deposits in Hispanic/Latino decedents with AD.
Collapse
Affiliation(s)
- Emily Z. Huie
- Department of Pathology and Laboratory Medicine, University of California Davis, School of Medicine, Sacramento, California
| | - Anthony Escudero
- Department of Pathology and Laboratory Medicine, University of California Davis, School of Medicine, Sacramento, California
- Alzheimer’s Disease Research Center, Department of Neurology, University of California Davis, School of Medicine, Sacramento, California
| | - Naomi Saito
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, California
| | - Danielle Harvey
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, California
- Alzheimer’s Disease Research Center, Department of Neurology, University of California Davis, School of Medicine, Sacramento, California
| | - My-Le Nguyen
- Department of Pathology and Laboratory Medicine, University of California Davis, School of Medicine, Sacramento, California
| | - Katherine L. Lucot
- Department of Pathology and Laboratory Medicine, University of California Davis, School of Medicine, Sacramento, California
| | - Jayne LaGrande
- Alzheimer’s Disease Research Center, Department of Neurology, University of California Davis, School of Medicine, Sacramento, California
| | - Dan Mungas
- Alzheimer’s Disease Research Center, Department of Neurology, University of California Davis, School of Medicine, Sacramento, California
| | - Charles DeCarli
- Alzheimer’s Disease Research Center, Department of Neurology, University of California Davis, School of Medicine, Sacramento, California
| | - Melissa Lamar
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, Illinois
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Julie A. Schneider
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois
- Department of Pathology, Rush University Medical Center, Chicago, Illinois
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - Alifiya Kapasi
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois
- Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Robert A. Rissman
- Department of Neurosciences, University of California San Diego, San Diego, La Jolla, California
| | - Andrew F. Teich
- Taub Institute for Research on Alzheimer’s Disease and Aging Brain, Department of Neurology, Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
| | - Brittany N. Dugger
- Department of Pathology and Laboratory Medicine, University of California Davis, School of Medicine, Sacramento, California
- Alzheimer’s Disease Research Center, Department of Neurology, University of California Davis, School of Medicine, Sacramento, California
| |
Collapse
|
12
|
Wilkins CH, Windon CC, Dilworth-Anderson P, Romanoff J, Gatsonis C, Hanna L, Apgar C, Gareen IF, Hill CV, Hillner BE, March A, Siegel BA, Whitmer RA, Carrillo MC, Rabinovici GD. Racial and Ethnic Differences in Amyloid PET Positivity in Individuals With Mild Cognitive Impairment or Dementia: A Secondary Analysis of the Imaging Dementia-Evidence for Amyloid Scanning (IDEAS) Cohort Study. JAMA Neurol 2022; 79:2796653. [PMID: 36190710 PMCID: PMC9531087 DOI: 10.1001/jamaneurol.2022.3157] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/29/2022] [Indexed: 02/06/2023]
Abstract
Importance Racial and ethnic groups with higher rates of clinical Alzheimer disease (AD) are underrepresented in studies of AD biomarkers, including amyloid positron emission tomography (PET). Objective To compare amyloid PET positivity among a diverse cohort of individuals with mild cognitive impairment (MCI) or dementia. Design, Setting, and Participants Secondary analysis of the Imaging Dementia-Evidence for Amyloid Scanning (IDEAS), a single-arm multisite cohort study of Medicare beneficiaries who met appropriate-use criteria for amyloid PET imaging between February 2016 and September 2017 with follow-up through January 2018. Data were analyzed between April 2020 and January 2022. This study used 2 approaches: the McNemar test to compare amyloid PET positivity proportions between matched racial and ethnic groups and multivariable logistic regression to assess the odds of having a positive amyloid PET scan. IDEAS enrolled participants at 595 US dementia specialist practices. A total of 21 949 were enrolled and 4842 (22%) were excluded from the present analysis due to protocol violations, not receiving an amyloid PET scan, not having a positive or negative scan, or because of small numbers in some subgroups. Exposures In the IDEAS study, participants underwent a single amyloid PET scan. Main Outcomes and Measures The main outcomes were amyloid PET positivity proportions and odds. Results Data from 17 107 individuals (321 Asian, 635 Black, 829 Hispanic, and 15 322 White) with MCI or dementia and amyloid PET were analyzed between April 2020 and January 2022. The median (range) age of participants was 75 (65-105) years; 8769 participants (51.3%) were female and 8338 (48.7%) were male. In the optimal 1:1 matching analysis (n = 3154), White participants had a greater proportion of positive amyloid PET scans compared with Asian participants (181 of 313; 57.8%; 95% CI, 52.3-63.2 vs 142 of 313; 45.4%; 95% CI, 39.9-50.9, respectively; P = .001) and Hispanic participants (482 of 780; 61.8%; 95% CI, 58.3-65.1 vs 425 of 780; 54.5%; 95% CI, 51.0-58.0, respectively; P = .003) but not Black participants (359 of 615; 58.4%; 95% CI, 54.4-62.2 vs 333 of 615; 54.1%; 95% CI, 50.2-58.0, respectively; P = .13). In the adjusted model, the odds of having a positive amyloid PET scan were lower for Asian participants (odds ratio [OR], 0.47; 95% CI, 0.37-0.59; P < .001), Black participants (OR, 0.71; 95% CI, 0.60-0.84; P < .001), and Hispanic participants (OR, 0.68; 95% CI, 0.59-0.79; P < .001) compared with White participants. Conclusions and Relevance Racial and ethnic differences found in amyloid PET positivity among individuals with MCI and dementia in this study may indicate differences in underlying etiology of cognitive impairment and guide future treatment and prevention approaches.
Collapse
Affiliation(s)
- Consuelo H. Wilkins
- Department of Medicine, Division of Geriatric Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Charles C. Windon
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Peggye Dilworth-Anderson
- Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
| | - Justin Romanoff
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Constantine Gatsonis
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Lucy Hanna
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Charles Apgar
- Center for Research and Innovation, American College of Radiology, Reston, Virginia
| | - Ilana F. Gareen
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | | | - Bruce E. Hillner
- Department of Medicine, Virginia Commonwealth University, Richmond
| | - Andrew March
- Center for Research and Innovation, American College of Radiology, Philadelphia, Pennsylvania
| | - Barry A. Siegel
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Rachel A. Whitmer
- Division of Research, Kaiser Permanente, Oakland, California
- Department of Public Health Sciences, University of California, Davis
| | | | - Gil D. Rabinovici
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
- Associate Editor, JAMA Neurology
- Department of Radiology & Biomedical Imaging, University of California, San Francisco
| |
Collapse
|
13
|
Nguyen ML, Huie EZ, Whitmer RA, George KM, Dugger BN. Neuropathology Studies of Dementia in US Persons other than Non-Hispanic Whites. FREE NEUROPATHOLOGY 2022; 3. [PMID: 35425946 PMCID: PMC9007571 DOI: 10.17879/freeneuropathology-2022-3795] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Alzheimer's disease (AD) and vascular dementia are two of the most prevalent dementias that afflict the aging population in the United States (US). Studies have made great strides in understanding the neuropathology of these diseases; however, many studies are conducted in the context of non-Hispanic whites (NHWs), and few include the rapidly growing underrepresented populations that reside in the US. We sought to characterize current knowledge of the neuropathologic landscape of AD and vascular dementia of the largest growing US minority groups, namely Latinos/Hispanics, Black Americans, and Asian Americans, compared with NHWs being the majority group. It is vital to note these historic categories are social constructs and cultural and social associations may underlie differences. We conducted a literature search utilizing specific criteria to yield neuropathology papers that addressed the demographics and neuropathologies of relevance, then collated the findings into this review. We reveal that while there has been much progress in neuropathological research involving Latinos/Hispanics and Black Americans in the past decade, no cohesive conclusions could be extrapolated from the existing data due to the dearth of minority participants and even smaller amount of information related to the heterogeneity within each minority group, especially Latinos/Hispanics. Furthermore, we reveal an even greater scarcity in neuropathological studies involving Asian Americans, also a very heterogeneous group. We hope the presented findings will illuminate the paucity of minority representation in not just neuropathological research but the field of clinical research overall and serve to inspire clinicians and researchers to help reduce the health disparities underrepresented groups in the US face.
Collapse
Affiliation(s)
- My-le Nguyen
- Department of Pathology and Laboratory Medicine, University of California, Davis
| | - Emily Z Huie
- Department of Pathology and Laboratory Medicine, University of California, Davis
| | - Rachel A Whitmer
- Department of Public Health Sciences, University of California, Davis
| | - Kristen M George
- Department of Public Health Sciences, University of California, Davis
| | - Brittany N Dugger
- Department of Pathology and Laboratory Medicine, University of California, Davis
| |
Collapse
|
14
|
Liu MM, Crowe M, Telles EE, Jiménez-Velázquez IZ, Dow WH. Color disparities in cognitive aging among Puerto Ricans on the archipelago. SSM Popul Health 2022; 17:100998. [PMID: 35967472 PMCID: PMC9366965 DOI: 10.1016/j.ssmph.2021.100998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/24/2021] [Accepted: 12/08/2021] [Indexed: 01/19/2023] Open
Abstract
This research seeks to contribute new understanding of color disparities and gender in cognitive aging among older adults residing in Puerto Rico. We use the island-representative Puerto Rican Elderly Health Conditions (PREHCO) longitudinal study that measures cognitive health at baseline and cognitive decline between waves. In pooled models, we discern little or no color disparities in cognition at baseline. Sex-stratified models of baseline cognition indicate that Trigueño men slightly outperform white men. In contrast, color disparities in cognitive decline are apparent. In just four years between the two waves of PREHCO, on a 20-point cognitive test scale, Black men experienced 0.78 more points of cognitive decline, while Trigueño men experienced 0.44 more points of cognitive decline than white men in Puerto Rico. Mestiza women experience 0.80 less points of cognitive decline relative to white women. Nearly all of the color/race association with cognitive decline appears to be independent from health behaviors and conditions, individual human capital attainment, and family background. While lower-status color groups more frequently report discrimination, discrimination does not mediate the impact of color/skin tone and cognitive performance, suggesting the importance of further research on the role of broader dimensions of life course structural racism.
Collapse
Affiliation(s)
- Mao-Mei Liu
- Department of Demography, University of California Berkeley, 2232 Piedmont Avenue, Berkeley, CA, 94720, USA
| | - Michael Crowe
- Department of Psychology, University of Alabama, Birmingham, Campbell Hall, Rm 334, 1300 University Blvd., Birmingham, AL, 35233, USA
| | - Edward E. Telles
- Department of Sociology, University of California Irvine, 4171 Social Science Plaza A, Irvine, CA, 92697-5100, USA
| | - Ivonne Z. Jiménez-Velázquez
- School of Medicine & Department of Medicine, University of Puerto Rico, Medical Sciences Campus PO Box 365067, San Juan, PR, 00936-5067, USA
| | - William H. Dow
- Department of Demography, University of California Berkeley, 2232 Piedmont Avenue, Berkeley, CA, 94720, USA
- School of Public Health, University of California Berkeley, 2121 Berkeley Way #5324, Berkeley, CA, 94720, USA
| |
Collapse
|
15
|
Gutiérrez Á, Cain R, Nadine Diaz, Aranda MP. The Digital Divide Exacerbates Disparities in Latinx Recruitment for Alzheimer’s Disease and Related Dementias Online Education During COVID-19. Gerontol Geriatr Med 2022; 8:23337214221081372. [PMID: 35252476 PMCID: PMC8891594 DOI: 10.1177/23337214221081372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/14/2022] [Accepted: 02/01/2022] [Indexed: 12/24/2022] Open
Abstract
Latinx adults experience a high burden of dementia. Given that modifiable factors
drive dementia disparities, engaging Latinxs in Alzheimer’s disease and related
dementias (ADRD) education is critical to address dementia burden among this
aging population. Yet, no studies have documented the role of the COVID-19
pandemic on dementia education among Latinxs. This study: (1) elucidates the
recruitment and retention processes targeting Latinxs for online educational
events during the pandemic; (2) describes facilitators/barriers to
participation; and (3) offers lessons learned. We developed online
dementia-focused workshops (English and Spanish) and employed a cold-calling
approach to invite Latinx participants enrolled in clinical studies
(N = 209). Bivariate tests assessed demographic and
cognitive differences between those who recruiters did (n = 60)
and did not (n = 149) successfully engage. Frequency counts
assessed participants’ technological access. Only 8/209 attended the online
events; all held university degrees, most reported English as their primary
language, and none experienced cognitive impairment. Results underscore how
educational attainment, cognitive impairment, language preference, and age
intersect to shape recruitment in dementia-focused online education. To promote
healthy aging and to ameliorate dementia disparities, barriers to online
engagement among older Spanish-speaking Latinxs with cognitive impairment and
low educational attainment must be addressed.
Collapse
Affiliation(s)
| | - Rosalba Cain
- University of Southern California, Los Angeles, CA, USA
- USC Alzheimer’s Disease Research Center, Los Angeles, CA, USA
| | - Nadine Diaz
- University of Southern California, Los Angeles, CA, USA
- USC Alzheimer’s Disease Research Center, Los Angeles, CA, USA
| | - María P. Aranda
- University of Southern California, Los Angeles, CA, USA
- USC Alzheimer’s Disease Research Center, Los Angeles, CA, USA
| |
Collapse
|
16
|
Breton J, Stickel AM, Tarraf W, Gonzalez KA, Keamy AJ, Schneiderman N, Marquine MJ, Zlatar ZZ, Salmon DP, Lamar M, Daviglus ML, Lipton RB, Gallo LC, Goodman ZT, González HM. Normative data for the Brief Spanish-English Verbal Learning Test for representative and diverse Hispanics/Latinos: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12260. [PMID: 34934802 PMCID: PMC8650755 DOI: 10.1002/dad2.12260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/21/2021] [Accepted: 06/28/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Episodic learning and memory performance are crucial components of cognitive assessment. To meet the needs of a diverse Hispanic/Latino population, we aimed to provide normative data on the Brief Spanish-English Verbal Learning Test (B-SEVLT). METHODS The target population for the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) included individuals 45+ years old from Central American, Cuban, Dominican, Mexican, Puerto Rican, and South American backgrounds. Average age was 56.5 years ± 9.92, 54.5% were female, and mean education was 11.0 years ± 5.6 (unweighted n = 9309). Participants were administered the B-SEVLT in their preferred language (Spanish or English). Hispanic/Latino background adjusted B-SEVLT scores and percentile cut-points were created using survey-adjusted regression models. RESULTS Higher educational attainment, younger age, and being female were associated with higher learning and memory performance. Hispanic/Latino background groups differed in B-SEVLT performance. DISCUSSION Representative learning and memory norms for Hispanic/Latinos of diverse backgrounds will improve cognitive assessment and accuracy of neurocognitive disorder diagnosis.
Collapse
Affiliation(s)
- Jordana Breton
- Department of PsychiatryUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Ariana M. Stickel
- Department of Neurosciences and Shiley‐Marcos Alzheimer's Disease Research CenterUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Wassim Tarraf
- Institute of Gerontology & Department of Healthcare SciencesWayne State UniversityDetroitMichiganUSA
| | - Kevin A. Gonzalez
- Department of Neurosciences and Shiley‐Marcos Alzheimer's Disease Research CenterUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Alexandra J. Keamy
- Department of Neurosciences and Shiley‐Marcos Alzheimer's Disease Research CenterUniversity of California San DiegoLa JollaCaliforniaUSA
| | | | - María J. Marquine
- Department of PsychiatryUniversity of California San DiegoLa JollaCaliforniaUSA
- Department of MedicineUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Zvinka Z. Zlatar
- Department of PsychiatryUniversity of California San DiegoLa JollaCaliforniaUSA
| | - David P. Salmon
- Department of Neurosciences and Shiley‐Marcos Alzheimer's Disease Research CenterUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Melissa Lamar
- Institute for Minority Health ResearchUniversity of Illinois at ChicagoCollege of MedicineChicagoIllinoisUSA
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
| | - Martha L. Daviglus
- Institute for Minority Health ResearchUniversity of Illinois at ChicagoCollege of MedicineChicagoIllinoisUSA
| | - Richard B. Lipton
- Departments of NeurologyEpidemiology & Population HealthAlbert Einstein College of MedicineNew YorkNew YorkUSA
| | - Linda C. Gallo
- Department of PsychologySan Diego State UniversitySan DiegoCaliforniaUSA
| | | | - Hector M. González
- Department of Neurosciences and Shiley‐Marcos Alzheimer's Disease Research CenterUniversity of California San DiegoLa JollaCaliforniaUSA
| |
Collapse
|
17
|
Gonyea JG, O'Donnell AE. Religious coping and psychological well-being in Latino Alzheimer's caregivers. Int J Geriatr Psychiatry 2021; 36:1922-1930. [PMID: 34378229 DOI: 10.1002/gps.5606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/05/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Prior research has demonstrated the benefits of religion on caregiver well-being; however, less research exists on the processes underlying this relationship, particularly in Latino Alzheimer's disease (AD) families. This study's aim was therefore to explore the direct and indirect influences of positive religious coping (RC-P) and negative religious coping (RC-N) on caregivers' experiences of depression and anxiety. METHODS The data are from the Circulo de Cuidado Study baseline interviews; participant eligibility criteria were that the person identifies as being Latino, providing at least 5 h of care weekly, and their relative has an AD diagnosis and neuropsychiatric symptoms. In person at-home interviews were conducted in Spanish with 67 caregivers. Religious coping was assessed with the Brief RCOPE; depression and anxiety were measured with the Center for Epidemiological Studies Depression Scale-Spanish version and State Anxiety Inventory. Multivariate regression analyses, controlling for caregiving stressors, were used to test our core hypotheses. RESULTS As hypothesized, RC-N had significant direct effect on depression (p < 0.001) and anxiety (p < 0.001) as well as partially mediated the relationship between caregiver subjective stressor and depression (p < 0.01) and anxiety (p < 0.01). However, contrary to our hypothesis, RC-P did not have a direct or indirect effects on psychological well-being. CONCLUSIONS Our findings are consistent with other studies linking RC-N to poorer caregiver outcomes. Caregivers who questioned God's power, perceived God punishing them, or felt abandoned by God reported greater levels of depression and anxiety. The results suggest that caregivers experiencing religious distress may feel overwhelmed and view a more hopeless future.
Collapse
Affiliation(s)
- Judith G Gonyea
- Human Behavior, Policy and Research Department, School of Social Work, Boston University, Boston University Institute for Health Systems Innovation & Policy, Boston, Massachusetts, USA
| | - Arden E O'Donnell
- Human Behavior, Policy and Research Department, School of Social Work, Boston University, Boston, Massachusetts, USA
| |
Collapse
|
18
|
Thakur B, Alvarado L, Dodoo C, Salazar R, Espay AJ, Dwivedi AK. Ethnic Differences Between Hispanics and Non-Hispanic Whites in Neuropsychiatric Symptoms Predict Conversion to Mild Cognitive Impairment. J Geriatr Psychiatry Neurol 2021; 34:622-631. [PMID: 32909879 DOI: 10.1177/0891988720957087] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The aim of the study is to ascertain the neuropsychiatric symptoms (NPS) subtypes significantly influencing progression to mild cognitive impairment (MCI) by ethnicity. In this retrospective cohort study, we included 386 cognitively normal individuals participating in the longitudinal Texas Alzheimer's Research and Care Consortium between February 2007 and August 2014. The primary outcome was time to incident MCI. Data driven NPS subtypes at baseline were identified and the effects of these subtypes on the outcome were obtained for Hispanic and non-Hispanic ethnic cohorts and summarized with a hazard ratio (HR). Three NPS subtypes were identified and internally validated: psychomotor apathy factor (including agitation, irritability, apathy), affective mood factor (including depression, anxiety), and physical behavior factor (including nighttime behavior, eating/appetite disturbances). In adjusted analysis, a psychomotor apathy score of NPS was the best predictor for MCI (HR = 2.19, p = 0.037) among non-Hispanics whereas physical behavior score was the most predictive of MCI (HR = 2.55, p = 0.029) among Hispanics. A high score of affective mood factor also tended to increase the risk of MCI (HR = 2.09, p = 0.06) in Hispanics. Progression from normal cognition to MCI was differentially predicted by NPS subtypes in Hispanics and non-Hispanic whites. These data may inform the allocation of efforts for monitoring individuals at-risk of MCI.
Collapse
Affiliation(s)
- Bhaskar Thakur
- Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, 158161Texas Tech University Health Sciences Center El Paso, TX, USA
| | - Luis Alvarado
- Biostatistics and Epidemiological Consulting Lab, Paul L. Foster School of Medicine, 158161Texas Tech University Health Sciences Center El Paso, TX, USA
| | - Christopher Dodoo
- Biostatistics and Epidemiological Consulting Lab, Paul L. Foster School of Medicine, 158161Texas Tech University Health Sciences Center El Paso, TX, USA
| | - Ricardo Salazar
- Division of Geriatric Psychiatry, Memory Disorder & Geriatric Neuropsychiatry Clinic, Department of Psychiatry, Paul L. Foster School of Medicine, 158161Texas Tech University Health Sciences Center El Paso, TX, USA
| | - Alberto J Espay
- Department of Neurology and Rehabilitation Medicine, James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, 2514University of Cincinnati, OH, USA
| | - Alok Kumar Dwivedi
- Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, 158161Texas Tech University Health Sciences Center El Paso, TX, USA.,Biostatistics and Epidemiological Consulting Lab, Paul L. Foster School of Medicine, 158161Texas Tech University Health Sciences Center El Paso, TX, USA
| |
Collapse
|
19
|
Flores DV, Rote S, Angel J, Chen NW, Downer B, Markides K. Depressive symptoms in child caregivers of very old Mexican Americans. Aging Ment Health 2021; 25:61-67. [PMID: 32883095 PMCID: PMC7785680 DOI: 10.1080/13607863.2017.1423024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To study the effects of disability, cognitive impairment, and neuropsychiatric disturbance among older Mexican Americans on depressive symptoms in their children caregivers. METHODS This study utilizes data from Wave 7 (2010-2011) of the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE). The final sample included 200 adult children caregivers that provided direct personal care with activities of daily living (ADL) (e.g. bathing, toileting, dressing, etc.) to their older parents (average age = 87). We analyzed the influence of ADL disability, cognition (MMSE), and neuropsychiatric symptoms (NPI) of the care recipient on depressive symptoms of the adult child caregiver. A cross-sectional multivariable linear regression analysis was conducted to examine the effect of neuropsychiatric disturbance on caregiver depressive symptoms. RESULTS Presence of care recipient NPI symptoms was associated with higher depressive symptoms for caregivers. Additional characteristics associated with caregiver depressive symptoms were not being married, and higher perceived social stress. ADL disability of the care recipient, cognitive functioning of the care recipient, or caregiver health status alone did not have a significant effect on depressive symptoms of the caregiver. CONCLUSIONS In a Mexican American familistic culture, disability and cognitive impairment might be better tolerated by families but neuropsychiatric behavioral symptoms related to dementia may take an increased toll on family member caregivers. The need to provide respite services, mental health resources and community services for caregivers of care recipients with neuropsychiatric symptoms is of paramount importance to alleviate depressive symptoms and burden among caregivers.
Collapse
Affiliation(s)
- David V. Flores
- Department of Preventive Medicine and Population Health,
The University of Texas Medical Branch, Galveston, TX, USA
| | - Sunshine Rote
- Kent School of Social Work, The University of Louisville,
Louisville, KY, USA
| | - Jacqueline Angel
- LBJ School of Public Affairs, The University of Texas,
Austin, TX, USA
| | - Nai-Wei Chen
- Department of Preventive Medicine and Population Health,
The University of Texas Medical Branch, Galveston, TX, USA
| | - Brian Downer
- Division of Rehabilitation Sciences, The University of
Texas Medical Branch, Galveston, TX, USA
| | - Kyriakos Markides
- Department of Preventive Medicine and Population Health,
The University of Texas Medical Branch, Galveston, TX, USA
| |
Collapse
|
20
|
Gil M, Alliey-Rodriguez N, Lopez-Alvarenga JC, Diego V, Gaona CA, Mata L, Pirela RV, Chavez CA, de Erausquin GA, Melgarejo JD, Maestre GE. Neuropsychiatric Symptoms Among Hispanics: Results of the Maracaibo Aging Study. J Alzheimers Dis 2021; 82:S251-S261. [PMID: 33612541 PMCID: PMC8354010 DOI: 10.3233/jad-201144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neuropsychiatric symptoms play an important role in diagnosing and clinical follow-up of cognitive impairment and dementia. OBJECTIVE We investigated the relationship between neuropsychiatric symptoms, cognitive impairment, and dementia in Hispanics. METHODS We included 529 participants (age ≥40 years) from the Maracaibo Aging Study with standardized neuropsychiatric assessments, including the Neuropsychiatric Inventory (NPI). Based on the Clinical Dementia Rating and the Mini-Mental State Examination scores, participants' cognitive status was categorized into normal cognition, mild/moderate, and severe cognitive impairment. Diagnosis of dementia was established in a consensus conference. Statistical analyses included multivariable logistic regression models and area under the curve (AUC). RESULTS The mean age of participants was 59.3 years, and 71.8%were women. The proportion of dementia was 6.8%. Disturbed sleep, anxiety, and depression were the most common neuropsychiatric symptoms in the study sample. In crude analyses, the proportions of hallucinations, aberrant motor behavior, agitation/aggression, apathy, delusions, irritability, eating disturbance, depression, and euphoria were differently distributed among cognitive status groups (p < 0.05). After accounting for confounders, aberrant motor behavior and agitation/aggression remained significantly associated with cognitive impairment and dementia (p < 0.05). The inclusion of the NPI domains significantly improved the AUC to discriminate severe cognitive impairment and dementia compared to a basic model that included sex, age, education, alcohol, obesity, serum glucose, total cholesterol, hypertension, and stroke. CONCLUSION Neuropsychiatric symptoms are associated with severe cognitive impairment and dementia. The addition of NPI items to the global cognitive assessment might help early detection of dementia in primary care settings.
Collapse
Affiliation(s)
- Mario Gil
- Department of Psychological Science, University of Texas Rio Grande Valley, Brownsville, TX, USA
- Department of Neuroscience, School of Medicine, University of Texas Rio Grande Valley, Harlingen, TX, USA
- Rio Grande Valley Alzheimer’s Disease Resource Center for Minority Aging Research (RGV AD-RCMAR), University of Texas Rio Grande Valley, Brownsville, TX, USA
- Institute for Neuroscience, School of Medicine, University of Texas Rio Grande Valley, Harlingen, TX, USA
| | - Ney Alliey-Rodriguez
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Laboratory of Neurosciences, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Juan Carlos Lopez-Alvarenga
- Rio Grande Valley Alzheimer’s Disease Resource Center for Minority Aging Research (RGV AD-RCMAR), University of Texas Rio Grande Valley, Brownsville, TX, USA
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, USA
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Vincent Diego
- Rio Grande Valley Alzheimer’s Disease Resource Center for Minority Aging Research (RGV AD-RCMAR), University of Texas Rio Grande Valley, Brownsville, TX, USA
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, USA
- SOM South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Ciro A. Gaona
- Laboratory of Neurosciences, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Ledys Mata
- Laboratory of Neurosciences, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Rosa V. Pirela
- Rio Grande Valley Alzheimer’s Disease Resource Center for Minority Aging Research (RGV AD-RCMAR), University of Texas Rio Grande Valley, Brownsville, TX, USA
- Laboratory of Neurosciences, School of Medicine, University of Zulia, Maracaibo, Venezuela
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Carlos A. Chavez
- Laboratory of Neurosciences, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Gabriel A. de Erausquin
- Department of Neurology, Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Jesus D. Melgarejo
- Laboratory of Neurosciences, School of Medicine, University of Zulia, Maracaibo, Venezuela
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Gladys E. Maestre
- Department of Neuroscience, School of Medicine, University of Texas Rio Grande Valley, Harlingen, TX, USA
- Rio Grande Valley Alzheimer’s Disease Resource Center for Minority Aging Research (RGV AD-RCMAR), University of Texas Rio Grande Valley, Brownsville, TX, USA
- Institute for Neuroscience, School of Medicine, University of Texas Rio Grande Valley, Harlingen, TX, USA
- Laboratory of Neurosciences, School of Medicine, University of Zulia, Maracaibo, Venezuela
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, USA
| |
Collapse
|
21
|
Garza N, Uscamayta-Ayvar M, Maestre GE. Addressing Neurocognitive Disorders, Dementias, and Alzheimer's Disease in Colonias of the Lower Rio Grande Valley: Establishing a Research Foundation Using Promotores. Ethn Dis 2020; 30:775-780. [PMID: 33250624 PMCID: PMC7683034 DOI: 10.18865/ed.30.s2.775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Several Texas communities along the Mexican border, including the Lower Rio Grande Valley (LRGV), are home to low-income Hispanic populations, many of whom live in underserved communities known as colonias. These areas have high incidences of neurocognitive disorders, dementia, and Alzheimer's disease (AD); health care strategies that are culturally and linguistically appropriate for the area are needed. We aim to build capacity to reduce risk, facilitate treatment, and provide caregiver support for affected individuals. However, gaining trust of communities and presenting information about research studies in a way that is culturally appropriate is critical for engagement of underserved communities. This brief report examines our work with local community health workers.(CHWs), promotores in Spanish, to establish contact with, engage, mobilize, and educate the Hispanic communities of the LGRV. Lessons from the succesful experience of training promotores in autism spectrum disorder in the LRGV highlight the importance of specifically addressing outreach in health fairs, clinic vists and referral as well as adequate selection, training, management, and support of the promotores as critical aspects. To initiate and sustain recruitment of older adults and care partners in research studies of AD and other dementias in the RGV, we have incorporated these aspects as components of the promotores training and engagement model, which has been developed and implemented by researchers and their colleagues at the School of Medicine at the University of Texas Rio Grande Valley.
Collapse
Affiliation(s)
- Noé Garza
- Department of Neuroscience, University of Texas Rio Grande Valley School of Medicine Harlingen, TX
- Community Health Worker (Promotor) Training Program, Institute for Neuroscience, University of Texas Rio Grande Valley School of Medicine, Harlingen TX
- Rio Grande Valley Alzheimer’s Disease-Resource Center for Minority Aging Research (AD-RCMAR), University of Texas Rio Grande Valley, Brownsville, TX
| | - Marucela Uscamayta-Ayvar
- Department of Neuroscience, University of Texas Rio Grande Valley School of Medicine Harlingen, TX
- Institute for Neuroscience, School of Medicine, University of Texas Rio Grande Valley, Harlingen, TX
| | - Gladys E. Maestre
- Department of Neuroscience, University of Texas Rio Grande Valley School of Medicine Harlingen, TX
- Rio Grande Valley Alzheimer’s Disease-Resource Center for Minority Aging Research (AD-RCMAR), University of Texas Rio Grande Valley, Brownsville, TX
- Institute for Neuroscience, School of Medicine, University of Texas Rio Grande Valley, Harlingen, TX
- Department of Human Genetics, School of Medicine University of Texas Rio Grande Valley, Brownsville, TX
| |
Collapse
|
22
|
Mendez SEA, Mendez-Luck CA, Nylund-Gibson K, Ng B. Mental Health Attribution for Mexican-Origin Latinx and Non-Latinx Older Adults: A Latent Class Analysis. Innov Aging 2020; 4:igaa028. [PMID: 34136663 PMCID: PMC8202504 DOI: 10.1093/geroni/igaa028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives Providing appropriate and culturally sensitive care to the rapidly growing number of
U.S. Latinx older adults with psychiatric conditions presents a major public health
challenge. We know little about older Latinx adults’ perceived causes of mental health
problems, offering clinicians limited insight to guide successful and culturally
congruent treatment. Moreover, there is a paucity of mental health research examining
heterogeneity in how Latinx individuals may attribute mental health symptoms. The
present study sought to identify how Latinx and non-Latinx older adults attributed the
sources of their mental health problems and how these types of attributions differ by
ethnicity. Research Design and Methods This study analyzed data collected from a retrospective chart review and survey of 673
adults aged 55–95 years (430 Mexican origin and 244 non-Latinx) from a rural psychiatric
outpatient clinic near the California–Mexico border. We conducted stratified latent
class analysis (LCA) by race/ethnicity to explore the mental health attribution beliefs
of Mexican-origin and non-Latinx clinic patients. Results Different LCA patterns for Mexican-origin Latinx versus non-Latinx groups were found.
For non-Latinx adults, there was a class of individuals who attributed their mental
health issues to social and financial problems. For Mexican-origin adults, there was a
class of individuals who attributed their mental health issues to spiritual and/or
supernatural factors, unaffected by acculturation level, depressive symptom severity,
and time spent in the United States, but differing by gender. We found within-group
heterogeneity: Not all Mexican-origin or non-Latinx older adults were alike in how they
conceptualized their mental health. Discussion and Implications Mexican-origin Latinx and non-Latinx older adults attributed their mental health issues
to different causes. More Mexican-origin older adults attributed their symptoms to
spiritual causes, even after controlling for contextual factors. Further research is
needed to determine whether attribution beliefs are affected by specific mental health
diagnoses and other cultural factors not measured in this study.
Collapse
Affiliation(s)
- Stephanie E A Mendez
- University of Southern California, University Center for Excellence in Developmental Disabilities, Children's Hospital Los Angeles
| | | | | | - Bernardo Ng
- Sun Valley Behavioral Research Center, Imperial, California
| |
Collapse
|
23
|
Barnes-Marrero I, Horter L, Hayden JD, Patel NC, Mendoza L, Castillo L. Diagnostic accuracy of the repeatable battery of the assessment of neuropsychological status update, Spanish version, in predicting Alzheimer's disease among Hispanic older adults in the United States reporting memory problems. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:509-519. [PMID: 32584154 DOI: 10.1080/23279095.2020.1777554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: There are few standardized, Spanish-language diagnostic tools to help identify Hispanic persons at early stages of Alzheimer's disease (AD). This study evaluated the accuracy of the Spanish version of the Repeatable Battery for the Assessment of Neuropsychological Status-Update (RBANS) in predicting AD in older Hispanic adults in the United States reporting memory problems.Methods: We analyzed data from age, sex, and education level propensity score-matched Hispanic memory clinic patients with (n = 38) and without (n = 38) a clinical diagnosis of AD. Estimates of diagnostic accuracy included sensitivity, specificity, predictive value, and receiver operating characteristic analysis.Results: After controlling for sex and matched pairs, the Total Scale score [area under curve (AUC) = 0.7417] and the Immediate (AUC = 0.7258) and Delayed (AUC = 0.7735) Memory index scores provided better estimates of diagnostic accuracy than Language, Attention, and Visuospatial/Constructional index scores. A minus 2-standard deviation (SD) cut point enhanced the predictive probability of the Delayed Memory index score. A cut point of -1.5 SD optimized the predictive probability of the Total Scale score.Conclusions: These results suggest that optimal cutoff values for the RBANS Delayed Memory index and Total Scale scores that may help identify Hispanic patients with AD as part of a comprehensive diagnostic AD assessment.
Collapse
Affiliation(s)
| | - Libby Horter
- Humana Healthcare Research, Inc, Louisville, KY, USA
| | | | - Nick C Patel
- Humana Healthcare Research, Inc, Louisville, KY, USA
| | - Lisandra Mendoza
- Department of Clinical Psychology, Albizu University, Miami, FL, USA
| | | |
Collapse
|
24
|
Vásquez PM, Tarraf W, Doza A, Marquine MJ, Perreira KM, Schneiderman N, Zeng D, Cai J, Isasi CR, Daviglus ML, González HM. The cross-sectional association of cognitive stimulation factors and cognitive function among Latino adults in Hispanic Community Health Study/Study of Latinos (HCHS/SOL). ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2019; 5:533-541. [PMID: 31650010 PMCID: PMC6804586 DOI: 10.1016/j.trci.2019.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Higher cognitive stimulation (CS) is associated with improved cognition. Sources of CS among Hispanics/Latinos are understudied. METHODS In the Hispanic Community Health Study/Study of Latinos 2008 to 2011 (n = 9438), we used finite mixture models to generate latent CS profiles, and multivariate linear regressions to examine associations with cognition in Hispanic/Latino adults (45-74 years). CS included education, occupation, social network, and acculturation. Cognitive measures included the Six-Item Screener, Brief-Spanish English Verbal Learning Test Sum and Recall, Controlled Oral Word Association Test, Digit Symbol Substitution, and Global Cognition. RESULTS Two CS profiles emerged, and were labeled "typical" and "enhanced." The enhanced CS profile (22%) had more family connections, bicultural engagements, skilled/professional occupations, education, and higher cognitive scores. DISCUSSION An enhanced CS profile emerged from contextual and culturally relevant factors, and was associated with higher cognitive scores across all measures. This provides initial evidence on how factors coalesce to shape cognitive protection in Hispanics/Latinos.
Collapse
Affiliation(s)
- Priscilla M. Vásquez
- Department of Neuroscience, University of California San Diego, La Jolla, CA, USA
| | - Wassim Tarraf
- Department of Healthcare Sciences & Institute of Gerontology, Wayne State University, Detroit, MI, USA
| | - Adit Doza
- Department of Healthcare Sciences & Institute of Gerontology, Wayne State University, Detroit, MI, USA
| | - Maria J. Marquine
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Krista M. Perreira
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Neil Schneiderman
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Donglin Zeng
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Carmen R. Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Martha L. Daviglus
- College of Medicine, Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Hector M. González
- Department of Neuroscience, University of California San Diego, La Jolla, CA, USA
| |
Collapse
|
25
|
Lamar M, Durazo-Arvizu RA, Sachdeva S, Pirzada A, Perreira KM, Rundek T, Gallo LC, Grober E, DeCarli C, Lipton RB, Tarraf W, González HM, Daviglus ML. Cardiovascular disease risk factor burden and cognition: Implications of ethnic diversity within the Hispanic Community Health Study/Study of Latinos. PLoS One 2019; 14:e0215378. [PMID: 31009492 PMCID: PMC6476505 DOI: 10.1371/journal.pone.0215378] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 04/01/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Hispanics/Latinos have some of the highest prevalence rates for cardiovascular disease risk factors, but stark differences exist by self-reported background. Cardiovascular disease risk factors negatively impact cognition in Hispanics/Latinos; less is known about these relationships by Hispanic/Latino backgrounds. We investigated cognitive associations with cardiovascular disease risk factor burden in a diverse cohort, the Hispanic Community Health Study/Study of Latinos. METHODS Baseline data from this observational study of cardiovascular disease and its antecedents was collected from 2008-2011. We included 7,121 participants 45-74 years old from Central American, Cuban, Dominican, Mexican, Puerto Rican, or South American backgrounds. Dichotomous indicators for hypertension, diabetes, hypercholesterolemia, obesity, and smoking were evaluated and totaled, with participants grouped by lowest (0-2), middle (3) or highest (4-5) burden. Cognitive testing included the Brief Spanish English Verbal Learning Test, letter fluency, and digit symbol substitution. RESULTS In separate fully-adjusted linear regression models, lower fluency and digit symbol substitution performance were restricted to the highest compared to the lowest burden group; whereas the middle burden group displayed impaired memory performance compared to the lowest burden group (p-values≤0.05). Background interacted with burden for learning and memory performance. That is, the association of burden level (i.e., lowest, middle, or highest) with cognitive performance was modified by background (e.g., Mexicans vs Cuban). CONCLUSIONS Hispanics/Latinos with higher levels of cardiovascular disease risk factor burden displayed lower levels of cognitive performance, with learning and memory performance modified by background.
Collapse
Affiliation(s)
- Melissa Lamar
- Rush Alzheimer’s Disease Center and the Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Ramon A. Durazo-Arvizu
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Department of Public Health Sciences, Loyola University, Chicago, Illinois, United States of America
| | - Shruti Sachdeva
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Amber Pirzada
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Krista M. Perreira
- Department of Public Policy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Tatjana Rundek
- Department of Neurology, University of Miami Health System, Miami, Florida, United States of America
| | - Linda C. Gallo
- Department of Psychology, San Diego State University, San Diego, California, United States of America
| | - Ellen Grober
- Department of Neurology, Albert Einstein College of Medicine, New York, New York, United States of America
| | - Charles DeCarli
- Department of Neurology, University of California Davis Health System, Sacramento, California, United States of America
| | - Richard B. Lipton
- Department of Neurology, Albert Einstein College of Medicine, New York, New York, United States of America
| | - Wassim Tarraf
- Institute of Gerontology, Wayne State University, Detroit, Michigan, United States of America
| | - Hector M. González
- Department of Neurosciences and Shiley-Marcos Alzheimer’s Disease Research Center, University of California San Diego, San Diego, California, United States of America
| | - Martha L. Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
| |
Collapse
|
26
|
Canevelli M, Bruno G, Grande G, Quarata F, Raganato R, Remiddi F, Valletta M, Zaccaria V, Vanacore N, Cesari M. Race reporting and disparities in clinical trials on Alzheimer's disease: A systematic review. Neurosci Biobehav Rev 2019; 101:122-128. [PMID: 30946856 DOI: 10.1016/j.neubiorev.2019.03.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 02/24/2019] [Accepted: 03/24/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Race is an important health determinant and should adequately be considered in research and drug development protocols targeting Alzheimer's disease (AD). METHODS A systematic review of available randomized controlled trials (RCTs) on the currently marketed treatments for AD was conducted with the aim of 1) documenting the reporting of race, and 2) exploring the impact of race on the efficacy and safety/tolerability of the considered medications. RESULTS Overall, 59.2% of the 49 retained RCTs reported information concerning the race of participants. Only a striking minority of enrolled patients was constituted of blacks and Hispanics. None on the retained studies reported results on the efficacy and safety/tolerability of the tested treatment separately for racial groups nor performed sensitivity analyses accounting for the race of participants. DISCUSSION Race has insufficiently been reported in previous interventional studies on AD. Its potential association with the effectiveness and safety/tolerability of the tested medications has completely been neglected.
Collapse
Affiliation(s)
- Marco Canevelli
- Department of Human Neuroscience, "Sapienza" University, Rome, Italy; National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy.
| | - Giuseppe Bruno
- Department of Human Neuroscience, "Sapienza" University, Rome, Italy
| | - Giulia Grande
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Federica Quarata
- Department of Human Neuroscience, "Sapienza" University, Rome, Italy
| | - Riccardo Raganato
- Department of Human Neuroscience, "Sapienza" University, Rome, Italy
| | - Francesca Remiddi
- Department of Human Neuroscience, "Sapienza" University, Rome, Italy
| | - Martina Valletta
- Department of Human Neuroscience, "Sapienza" University, Rome, Italy
| | - Valerio Zaccaria
- Department of Human Neuroscience, "Sapienza" University, Rome, Italy
| | - Nicola Vanacore
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Matteo Cesari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Geriatric Unit, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
| |
Collapse
|
27
|
Santos OA, Pedraza O, Lucas JA, Duara R, Greig-Custo MT, Hanna Al-Shaikh FS, Liesinger AM, Bieniek KF, Hinkle KM, Lesser ER, Crook JE, Carrasquillo MM, Ross OA, Ertekin-Taner N, Graff-Radford NR, Dickson DW, Murray ME. Ethnoracial differences in Alzheimer's disease from the FLorida Autopsied Multi-Ethnic (FLAME) cohort. Alzheimers Dement 2019; 15:635-643. [PMID: 30792090 PMCID: PMC6511501 DOI: 10.1016/j.jalz.2018.12.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/13/2018] [Accepted: 12/02/2018] [Indexed: 12/28/2022]
Abstract
Introduction: Our primary goal was to examine demographic and clinicopathologic differences across an ethnoracially diverse autopsy-confirmed cohort of Alzheimer’s disease cases. Methods: A retrospective study was conducted in the Florida Autopsied Multi-Ethnic cohort on 1625 Alzheimer’s disease cases, including decedents who self-reported as Hispanic/Latino (n = 67), black/African American (n = 19), and white/European American (n = 1539). Results: Hispanic decedents had a higher frequency of family history of cognitive impairment (58%), an earlier age at onset (median age of 70 years), longer disease duration (median of 12 years), and lower MMSE proximal to death (median of 4 points) compared with the other ethnoracial groups. Black decedents had a lower Braak tangle stage (stage V) and higher frequency of coexisting hippocampal sclerosis (21%); however, only hippocampal sclerosis differences survived adjustment for sex, age at onset, and disease duration. Neither Thal amyloid phase nor coexisting Lewy body disease differed across ethnoracial groups. Discussion: Despite a smaller sample size, Hispanics demonstrated longer disease duration with Alzheimer’s disease, but not greater lifespan. Neuropathologic differences across ethnoracial groups supported differences in tau pathology distribution and coexisting hippocampal sclerosis, which may impact biomarker studies.
Collapse
Affiliation(s)
- Octavio A Santos
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | - Otto Pedraza
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | - John A Lucas
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | - Ranjan Duara
- Department of Neurology, Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA; University of Florida College of Medicine, Gainesville, FL, USA
| | - Maria T Greig-Custo
- Department of Neurology, Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA
| | | | | | - Kevin F Bieniek
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Kelly M Hinkle
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | | | - Julia E Crook
- Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | | | - Owen A Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Nilüfer Ertekin-Taner
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA; Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | | | | | | |
Collapse
|
28
|
Tzuang M, Owusu JT, Spira AP, Albert MS, Rebok GW. Cognitive Training for Ethnic Minority Older Adults in the United States: A Review. THE GERONTOLOGIST 2019; 58:e311-e324. [PMID: 28575230 DOI: 10.1093/geront/gnw260] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Indexed: 11/14/2022] Open
Abstract
Purpose of the Study Interest in cognitive training for healthy older adults to reduce cognitive decline has grown considerably over the past few decades. Given the shift toward a more diverse society, the purpose of this review is to examine the extent of race/ethnic minority participation in cognitive training studies and characteristics of studies that included race/ethnic minority participants. Design and Methods This review considered peer-reviewed studies reporting cognitive training studies for cognitively healthy, community-dwelling older adults (age 55+) in the United States published in English before December 31, 2015. A total of 31 articles published between 1986 and 2015 meeting inclusion criteria were identified and included in the review. Results A total of 6,432 participants were recruited across all of the studies, and ranged in age from 55 to 99 years. Across all studies examined, 39% reported racial/ethnic background information. Only 3 of these studies included a substantial number of minorities (26.7% in the ACTIVE study; 28.4% in the SeniorWISE study; 22.7% in the TEAM study). Race/ethnic minority older adults were disproportionately underrepresented in cognitive training studies. Implications Further research should aim to enroll participants representative of various race/ethnic minority populations. Strategies for recruitment and retention of ethnic minority participants in cognitive training research are discussed, which could lead to the development of more culturally appropriate and perhaps more effective cognitive interventions.
Collapse
Affiliation(s)
- Marian Tzuang
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jocelynn T Owusu
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
| | - Marilyn S Albert
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - George W Rebok
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
29
|
Neuropsychological Evaluation of Culturally/Linguistically Diverse Older Adults. HANDBOOK ON THE NEUROPSYCHOLOGY OF AGING AND DEMENTIA 2019. [DOI: 10.1007/978-3-319-93497-6_3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
30
|
Kajiyama B, Fernandez G, Carter EA, Humber MB, Thompson LW. Helping Hispanic Dementia Caregivers Cope with Stress Using Technology-based Resources. Clin Gerontol 2018; 41:209-216. [PMID: 29236621 DOI: 10.1080/07317115.2017.1377797] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The objectives of this study were to develop and evaluate a culturally appropriate intervention for Hispanic/Latino caregivers of individuals with dementia, using a structured online program without professional involvement to improve well-being, decrease stress, and reduce depression. METHODS The Webnovela Mirela, an online Spanish-language telenovela, was designed specifically to teach caregivers how to cope with dementia caregiving. A prototype of Webnovela Mirela was tested in a pilot study with 25 Hispanic/Latino dementia caregivers, 19 of whom completed the study. RESULTS Data were analyzed using paired-samples t-tests. Results indicated a significant decrease from pre- to post-treatment in levels of stress and symptoms of depression (p = .045). CONCLUSIONS The pilot study indicated high potential of the Webnovela Mirela to help the target population and demonstrated that the telenovela format is acceptable and helpful for Hispanic dementia caregivers. CLINICAL IMPLICATIONS Study outcomes suggested that self-paced approaches with culturally relevant content in an appealing format for the target population have the potential to implement effective interventions. Furthermore, technology enables support programs to reach a broader audience in a cost-effective manner. Of note is the fact that minimal professional and/or personal assistance was required for caregivers to complete this intervention.
Collapse
Affiliation(s)
| | | | | | - Marika B Humber
- b Palo Alto University , Palo Alto , California , USA.,c Stanford Alzheimer's Disease Research Center, Stanford University School of Medicine , Stanford , California , USA
| | - Larry W Thompson
- d Department of Medicine , Stanford University School of Medicine , Stanford , California , USA
| |
Collapse
|
31
|
Aguiñaga S, Marquez DX. Feasibility of a Latin Dance Program for Older Latinos With Mild Cognitive Impairment. Am J Alzheimers Dis Other Demen 2017; 32:479-488. [PMID: 28683560 PMCID: PMC10852848 DOI: 10.1177/1533317517719500] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study investigates the feasibility of a Latin dance program in older Latinos with mild cognitive impairment (MCI) via a feasibility mixed methods randomized controlled design. Spanish-speaking older Latinos (N = 21, 75.4 [6.3] years old, 16 females/5 males, 22.4 [2.8] Mini-Mental State Examination [MMSE] score) were randomized into a 16-week dance intervention (BAILAMOS) or wait-list control; the control group crossed over at week 17 and received the dance intervention. Feasibility was determined by assessing reach, retention, attendance, dance logs, and postintervention focus groups. Reach was 91.3% of people who were screened and eligible. Program retention was 95.2%. The dropout rate was 42.8% (n = 9), and attendance for all participants was 55.76%. The focus group data revealed 4 themes: enthusiasm for dance, positive aspects of BAILAMOS, unfavorable aspects of BAILAMOS, and physical well-being after BAILAMOS. In conclusion, older Latinos with MCI find Latin dance as an enjoyable and safe mode of physical activity.
Collapse
Affiliation(s)
- Susan Aguiñaga
- Department of Kinesiology and Community Health, University of Illinois at Urbana–Champaign, Urbana, IL, USA
| | - David X. Marquez
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
32
|
Systematic review of dementia prevalence and incidence in United States race/ethnic populations. Alzheimers Dement 2016; 13:72-83. [PMID: 27599209 DOI: 10.1016/j.jalz.2016.06.2360] [Citation(s) in RCA: 263] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 05/27/2016] [Accepted: 06/13/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To identify incidence and prevalence of dementia in racial and ethnic populations in the United States. METHODS A systematic review of literature. RESULTS A total of 1215 studies were reviewed; 114 were included. Dementia prevalence rates reported for age 65+ years from a low of 6.3% in Japanese Americans, 12.9% in Caribbean Hispanic Americans, 12.2% in Guamanian Chamorro and ranged widely in African Americans from 7.2% to 20.9%. Dementia annual incidence for African American (mean = 2.6%; SD = 1%; range, 1.4%-5.5%) and Caribbean Hispanic populations were significantly higher (mean, 3.6%; SD, 1.2%; range, 2.3%-5.3%) than Mexican American and Japanese Americans and non-Latino white populations (0.8%-2.7%), P < .001. CONCLUSIONS Data are needed for American Indian, most Asian, and Pacific Islander populations. Disaggregation of large race/ethnic classifications is warranted due to within-population heterogeneity in incidence and prevalence. African American and Caribbean Hispanic studies showed higher incidence of dementia. A nationwide approach is needed to identify communities at high risk and to tailor culturally appropriate services accordingly.
Collapse
|
33
|
Díaz-Venegas C, Downer B, Langa KM, Wong R. Racial and ethnic differences in cognitive function among older adults in the USA. Int J Geriatr Psychiatry 2016; 31:1004-12. [PMID: 26766788 PMCID: PMC4945484 DOI: 10.1002/gps.4410] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 11/28/2015] [Accepted: 12/03/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Examine differences in cognition between Hispanic, non-Hispanic black (NHB), and non-Hispanic white (NHW) older adults in the United States. DATA/METHODS The final sample includes 18 982 participants aged 51 or older who received a modified version of the Telephone Interview for Cognitive Status during the 2010 Health and Retirement Study follow-up. Ordinary least squares will be used to examine differences in overall cognition according to race/ethnicity. RESULTS Hispanics and NHB had lower cognition than NHW for all age groups (51-59, 60-69, 70-79, 80+). Hispanics had higher cognition than NHB for all age groups but these differences were all within one point. The lower cognition among NHB compared to NHW remained significant after controlling for age, gender, and education, whereas the differences in cognition between Hispanics and NHW were no longer significant after controlling for these covariates. Cognitive scores increased with greater educational attainment for all race/ethnic groups, but Hispanics exhibited the least benefit. DISCUSSION Our results highlight the role of education in race/ethnic differences in cognitive function during old age. Education seems beneficial for cognition in old age for all race/ethnic groups, but Hispanics appear to receive a lower benefit compared to other race/ethnic groups. Further research is needed on the racial and ethnic differences in the pathways of the benefits of educational attainment for late-life cognitive function. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Carlos Díaz-Venegas
- Postdoctoral Fellow, Rehabilitation Sciences Academic Division and Research Center, The University of Texas Medical Branch, Galveston, TX, USA
| | - Brian Downer
- Postdoctoral Trainee, Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA
| | - Kenneth M. Langa
- Professor of Medicine, Division of General Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Rebeca Wong
- Senior Fellow, Sealy Center on Aging, Professor, Preventive Medicine & Community Health, Director, WHO/PAHO Collaborating Center on Aging and Health, The University of Texas Medical Branch, Galveston, TX, USA
| |
Collapse
|
34
|
Marquine MJ, Sakamoto M, Dufour C, Rooney A, Fazeli P, Umlauf A, Gouaux B, Franklin D, Ellis R, Letendre S, Cherner M, Heaton RK, Grant I, Moore DJ. The impact of ethnicity/race on the association between the Veterans Aging Cohort Study (VACS) Index and neurocognitive function among HIV-infected persons. J Neurovirol 2016; 22:442-54. [PMID: 26679535 PMCID: PMC4912471 DOI: 10.1007/s13365-015-0411-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 11/18/2015] [Accepted: 12/01/2015] [Indexed: 01/04/2023]
Abstract
The Veterans Aging Cohort Study (VACS) Index was developed as a risk index for health outcomes in HIV, and it has been consistently associated with mortality. It shows a significant, yet relatively weak, association with neurocognitive impairment, and little is known about its utility among ethnic/racial minority groups. We examined whether the association between the VACS Index and neurocognition differed by ethnic/racial group. Participants included 674 HIV-infected individuals (369 non-Hispanic whites, 111 non-Hispanic blacks, and 194 Hispanics). Neurocognitive function was assessed via a comprehensive battery. Scaled scores for each neurocognitive test were averaged to calculate domain and global neurocognitive scores. Models adjusting for demographics and HIV disease characteristics not included in the VACS Index showed that higher VACS Index scores (indicating poorer health) were significantly associated with worse global neurocognition among non-Hispanic whites. This association was comparable in non-Hispanic blacks, but nonsignificant among Hispanics (with similar results for English and Spanish speaking). We obtained comparable findings in analyses adjusting for other covariates (psychiatric and medical comorbidities and lifestyle factors). Analyses of individual neurocognitive domains showed similar results in learning and delayed recall. For other domains, there was an effect of the VACS Index and no significant interactions with race/ethnicity. Different components of the VACS Index were associated with global neurocognition by race/ethnicity. In conclusion, the association between the VACS Index and neurocognitive function differs by ethnic/racial group. Identifying key indicators of HIV-associated neurocognitive impairment by ethnic/racial group might play an important role in furthering our understanding of the biomarkers of neuroAIDS.
Collapse
Affiliation(s)
- M J Marquine
- Department of Psychiatry, University of California, San Diego, CA, USA.
| | - M Sakamoto
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - C Dufour
- Department of Medicine, University of California, San Diego, CA, USA
| | - A Rooney
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - P Fazeli
- Psychology Department, University of Alabama, Birmingham, CA, USA
| | - A Umlauf
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - B Gouaux
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - D Franklin
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - R Ellis
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - S Letendre
- Department of Medicine, University of California, San Diego, CA, USA
| | - M Cherner
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - R K Heaton
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - I Grant
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - D J Moore
- Department of Psychiatry, University of California, San Diego, CA, USA
| |
Collapse
|
35
|
Effectiveness of a fotonovela for reducing depression and stress in Latino dementia family caregivers. Alzheimer Dis Assoc Disord 2016; 29:146-53. [PMID: 25590939 DOI: 10.1097/wad.0000000000000077] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The clinical need to address stress and depression in Latino dementia caregivers (CGs) combined with low health literacy and less accurate knowledge of dementia motivated the development of a pictorial tool [called a fotonovela (FN)] to teach (a) coping skills for caregiver (CG) stress; (b) self-assessment of depression; and (c) encourage improved utilization of available resources. To test the effectiveness of the FN, 110 of 147 Latino CGs, who were randomly assigned to the Fotonovela Condition (FNC) or the Usual Information Condition (UIC), were included in the final analyses. Self-report measures were given at baseline and post intervention. Results showed that FNC CGs demonstrated significantly greater reductions in level of depressive symptoms than UIC CGs. A significant decrease in level of stress due to memory and behavioral problems exhibited by their loved ones was similar in both groups. The FNC CGs reported that the FN was more helpful and that they referred to it more often than the UIC CGs did with regard to the informational materials they were provided about dementia. In conclusion, a culturally tailored FN can be an effective tool for Latino CGs given their high unmet needs for assistance and various barriers in accessing resources.
Collapse
|
36
|
McDougall GJ, Simpson G, Friend ML. Strategies for research recruitment and retention of older adults of racial and ethnic minorities. J Gerontol Nurs 2015; 41:14-23; quiz 24-5. [PMID: 25849063 PMCID: PMC6415923 DOI: 10.3928/00989134-20150325-01] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 02/20/2015] [Indexed: 11/20/2022]
Abstract
HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.4 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Strategies for Research Recruitment and Retention of Older Adults of Racial and Ethnic Minorities" found on pages 14-23, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until April 30, 2018. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVE 1. Identify strategies and barriers for the recruitment and retention of older adults of racial and ethnic minorities in cognitive aging research. DISCLOSURE STATEMENT Neither the planners nor the authors have any conflicts of interest to disclose. The numbers of Hispanic and African American older adults in the United States are expected to increase by 86% and more than 31%, respectively. African American and Hispanic American individuals are more likely than Caucasian individuals to have chronic health conditions, and researchers have argued that these health disparities may contribute to their higher rates of dementia-related illnesses. The current article explores strategies to improve participation in cognitive aging research by older adults, particularly minority older adults. The cultural aspects of cognitive aging are examined, especially the role of stigma and stereotype threat. The perceptions of cognitive aging of African American and Hispanic older adults are also described. Specific strategies are presented that have been successfully implemented to improve recruitment and retention in research targeting minority older adults. Strategies that yielded retention of minority older adults included advertising and marketing a randomized clinical trial, media relations, intervention tailoring, and adaptation of psychometric instruments.
Collapse
|
37
|
Pasha EP, Kaur SS, Gonzales MM, Machin DR, Kasischke K, Tanaka H, Haley AP. Vascular function, cerebral cortical thickness, and cognitive performance in middle-aged Hispanic and non-Hispanic Caucasian adults. J Clin Hypertens (Greenwich) 2015; 17:306-12. [PMID: 25720950 PMCID: PMC4390456 DOI: 10.1111/jch.12512] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 01/05/2015] [Accepted: 01/07/2015] [Indexed: 11/26/2022]
Abstract
Hispanics are at increased risk for acquiring cardiovascular risk factors that contribute to cognitive dysfunction. To compare indices of vascular health with measures of cerebral gray matter integrity, 60 middle-aged Hispanic and non-Hispanic Caucasian participants were matched across age, sex, years of education, and mental status. Arterial stiffness was characterized by β-stiffness index and carotid-femoral pulse wave velocity, and magnetic resonance imaging estimated cortical thickness in a priori regions of interest known to be susceptible to vascular risk factors. Measures of arterial stiffness were significantly higher in Hispanics than in non-Hispanic Caucasians. Hispanics exhibited thinner left inferior frontal gyrus (LIFG) cortical thickness (P=.04) with concurrently lower language (P=.02), memory (P=.03), and attention-executive functioning (P=.02). These results suggest that compromised vascular health may occur simultaneously with cortical thinning of the LIFG as an early neuropathological alteration in Hispanics.
Collapse
Affiliation(s)
- Evan P Pasha
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX
| | | | | | | | | | | | | |
Collapse
|
38
|
Salazar R, Royall DR, Palmer RF. Neuropsychiatric symptoms in community-dwelling Mexican-Americans: results from the Hispanic Established Population for Epidemiological Study of the Elderly (HEPESE) study. Int J Geriatr Psychiatry 2015; 30:300-7. [PMID: 24838594 PMCID: PMC4898196 DOI: 10.1002/gps.4141] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 04/08/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The Neuropsychiatric Inventory (NPI) is a well-established measure of psychopathology and frequently used in dementia studies. Little is known about its psychometric characteristics at a population level, particularly among Hispanics. We report the frequency of NPI symptoms in a community-dwelling older Mexican-American (MA) population cohort and the degree of symptom-related distress experienced by participant informants. METHODS Participants were 1079 MA age 80 years and over residing in five southwestern states who were administered the NPI as part of wave-7 of the Hispanic Established Population for Epidemiological Study of the Elderly (HEPESE) conducted from 2010 to 2011. RESULTS Nine hundred twenty-five informants rated NPI domains. Prevalence of neuropsychiatric symptoms (NPS) varied by symptom domain and ranged from agitation/aggression (32%) to euphoria/elation (5%). The overall rate of behavioral disturbances was 62.7%. On the other hand, 37.3% of informants reported no NPS. A significant fraction of the informants reported distress from the mood disorder cluster of the scale. CONCLUSIONS A large percentage (>60%) of community-dwelling older MA have one or more informant-reported NPS. These symptoms have diagnostic, prognostic, and therapeutic implications. Although neuropsychiatric disorders may be the initial clinical manifestation of dementia and often appear before cognitive alterations, the high frequency of these symptoms in the HEPESE cohort may reflect a high prevalence of these disorders among community-dwelling MA. The pattern we observed also suggests relatively advanced stages of dementia.
Collapse
Affiliation(s)
- Ricardo Salazar
- Department of Psychiatry and Behavioral Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | | |
Collapse
|
39
|
Chodosh J, Colaiaco BA, Connor KI, Cope DW, Liu H, Ganz DA, Richman MJ, Cherry DL, Blank JM, Carbone RDP, Wolf SM, Vickrey BG. Dementia Care Management in an Underserved Community: The Comparative Effectiveness of Two Different Approaches. J Aging Health 2015; 27:864-93. [PMID: 25656074 DOI: 10.1177/0898264315569454] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To compare the effectiveness and costs of telephone-only approach to in-person plus telephone for delivering an evidence-based, coordinated care management program for dementia. METHODS We randomized 151 patient-caregiver dyads from an underserved predominantly Latino community to two arms that shared a care management protocol but implemented in different formats: in-person visits at home and/or in the community plus telephone and mail, versus telephone and mail only. We compared between-arm caregiver burden and care-recipient problem behaviors (primary outcomes) and patient-caregiver dyad retention, care quality, health care utilization, and costs (secondary outcomes) at 6- and 12-months follow-up. RESULTS Care quality improved substantially over time in both arms. Caregiver burden, care-recipient problem behaviors, retention, and health care utilization did not differ across arms but the in-person program cost more to deliver. DISCUSSION Dementia care quality improved regardless of how care management was delivered; large differences in effectiveness or cost offsets were not detected.
Collapse
Affiliation(s)
- Joshua Chodosh
- University of California, Los Angeles, USA Veteran Affairs Greater Los Angeles Healthcare System, CA, USA RAND Corporation, Santa Monica, CA, USA
| | | | - Karen Ilene Connor
- University of California, Los Angeles, USA Veteran Affairs Greater Los Angeles Healthcare System, CA, USA
| | - Dennis Wesley Cope
- University of California, Los Angeles, USA Olive View-UCLA Medical Center, Los Angeles, USA
| | - Hangsheng Liu
- RAND Corporation, Santa Monica, CA, USA RAND Corporation, Boston, MA, USA
| | - David Avram Ganz
- University of California, Los Angeles, USA Veteran Affairs Greater Los Angeles Healthcare System, CA, USA RAND Corporation, Santa Monica, CA, USA
| | - Mark Jason Richman
- University of California, Los Angeles, USA Olive View-UCLA Medical Center, Los Angeles, USA
| | - Debra Lynn Cherry
- University of California, Los Angeles, USA Alzheimer's Association, Los Angeles, CA, USA University of Southern California, Los Angeles, USA
| | - Joseph Moshe Blank
- University of California, Los Angeles, USA Olive View-UCLA Medical Center, Los Angeles, USA
| | | | - Sheldon Mark Wolf
- University of California, Los Angeles, USA Olive View-UCLA Medical Center, Los Angeles, USA
| | - Barbara Grace Vickrey
- University of California, Los Angeles, USA Veteran Affairs Greater Los Angeles Healthcare System, CA, USA RAND Corporation, Santa Monica, CA, USA
| |
Collapse
|
40
|
Abstract
The purpose was to compare the Spanish language picture version of the Free and Cued Selective Reminding Test with Immediate Recall (pFCSRT+IR) and the Mini Mental State Exam (MMSE) in identifying very mild dementia among Spanish speaking Latino patients. The tests and an independent diagnostic assessment were administered to 112 Latino patients free of medically diagnosed dementia from an urban primary care clinic. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were used to examine differences in the operating characteristics of the pFCSRT+IR and the MMSE. Cut scores were manipulated to equate sensitivities (specificities) at clinically relevant values to compare differences in specificities (sensitivities) using the Pearson Chi Square test. Youden's index was used to select the optimal cut scores. Twenty-four of the 112 primary care patients (21%) received a research dementia diagnosis, indicating a substantial burden of unrecognized dementia. MMSE scores but not free recall scores were associated with years of education in patients free of dementia. AUC was significantly higher for free recall than for MMSE. Free recall performed significantly better than the MMSE in sensitivity and in specificity. Using optimal cut scores, patients with impaired free recall were 10 times more likely to have dementia than patients with intact recall, and patients with impaired MMSE scores were 4.5 times more likely to have dementia than patients with intact scores. These results suggest that the Spanish language pFCSRT+IR may be an effective tool for dementia screening in educationally diverse Latino primary care populations.
Collapse
|
41
|
C. Arévalo-Flechas L, Acton G, I. Escamilla M, N. Bonner P, L. Lewis S. Latino Alzheimer's caregivers: what is important to them? JOURNAL OF MANAGERIAL PSYCHOLOGY 2014. [DOI: 10.1108/jmp-11-2012-0357] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
42
|
Marquez DX, Wilbur J, Hughes SL, Berbaum ML, Wilson RS, Buchner DM, McAuley E. B.A.I.L.A. - a Latin dance randomized controlled trial for older Spanish-speaking Latinos: rationale, design, and methods. Contemp Clin Trials 2014; 38:397-408. [PMID: 24969395 DOI: 10.1016/j.cct.2014.06.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 06/13/2014] [Accepted: 06/15/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Physical activity (PA) has documented health benefits, but older Latinos are less likely to engage in leisure time PA than older non-Latino whites. Dance holds a promise as a culturally appropriate form of PA that challenges individuals physically and cognitively. This paper describes a randomized controlled trial that will test the efficacy of BAILAMOS, a 4-month Latin dance program followed by a 4-month maintenance program, for improving lifestyle PA and health outcomes. METHODS Older adults (n=332), aged 55+, Latino/Hispanic, Spanish speaking, with low PA levels, and at risk for disability will be randomized to one of two programs, a dance program or health education control group. BAILAMOS is a 4-month program that meets two times per week for one 1h per session. Dance sessions focus on instruction, including four styles of dance, and couples dancing. Bi-monthly Fiestas de Baile (dance parties) are also included, in which participants dance and practice what they have learned. Monthly 1-hour discussion sessions utilize a Social Cognitive framework and focus on knowledge, social support, and self-efficacy to increase lifestyle PA. The health education control group will meet one time per week for two 2h per session. OUTCOMES Primary outcomes including PA changes and secondary outcomes including self-efficacy, physical function, cognitive function, and disability will be assessed at baseline, 4, and 8 months. It is hypothesized that PA, self-efficacy, physical function, cognitive function, and functional limitations and disability scores will be significantly better in the BAILAMOS group at 4 and 8 months compared to the control group.
Collapse
Affiliation(s)
- David X Marquez
- University of Illinois at Chicago, Department of Kinesiology and Nutrition, 1919 W. Taylor Street, Chicago, IL 60612, United States; University of Illinois at Chicago, Institute for Health Research and Policy, Center for Research on Health and Aging, 1747 West Roosevelt Road, Chicago, IL 60608, United States.
| | - JoEllen Wilbur
- Rush University, College of Nursing, 600 S. Paulina, 1062B, Chicago, IL 60612, United States
| | - Susan L Hughes
- University of Illinois at Chicago, Institute for Health Research and Policy, Center for Research on Health and Aging, 1747 West Roosevelt Road, Chicago, IL 60608, United States
| | - Michael L Berbaum
- University of Illinois at Chicago, Institute for Health Research and Policy, Methodology Research Core, 1747 West Roosevelt Road, Chicago, IL 60608, United States
| | - Robert S Wilson
- Rush University Medical Center, Departments of Neurological Sciences and Behavioral Sciences, Rush Alzheimer's Disease Center, 600 South Paulina Street, Suite 1038, Chicago, IL 60612, United States
| | - David M Buchner
- University of Illinois at Urbana-Champaign, Department of Kinesiology and Community Health, 906 S. Goodwin Ave., Urbana, IL 61801, United States
| | - Edward McAuley
- University of Illinois at Urbana-Champaign, Department of Kinesiology and Community Health, 906 S. Goodwin Ave., Urbana, IL 61801, United States
| |
Collapse
|
43
|
Fitten LJ, Ortiz F, Fairbanks L, Bartzokis G, Lu P, Klein E, Coppola G, Ringman J. Younger age of dementia diagnosis in a Hispanic population in southern California. Int J Geriatr Psychiatry 2014; 29:586-93. [PMID: 24478258 PMCID: PMC4013239 DOI: 10.1002/gps.4040] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 09/23/2013] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Prior studies of US Hispanics, largely performed on the East Coast, have found a younger age of dementia onset than in White non-Hispanics. We performed a cross-sectional study to examine clinical and sociodemographic variables associated with age of dementia diagnosis in older Hispanics and White, non-Hispanics in southern California. METHODS Two hundred ninety (110 Hispanic and 180 White non-Hispanic) community dwelling, cognitively symptomatic subjects, aged 50 years and older, were assessed and diagnosed with probable Alzheimer's disease or probable vascular dementia. Apolipoprotein E (APOE) genotype was assessed in a subset of cases. Analysis of variance and multiple stepwise linear regression were used to assess main effects and interactions of ethnicity with dementia severity (indexed by mini mental state examination scores) and other sociodemographic and clinical variables on age of dementia diagnosis. RESULTS Hispanics were younger by an average of 4 years at the time of diagnosis, regardless of dementia subtype, despite a similar prevalence of the APOE ε4 genotype. The earlier age at diagnosis for Hispanics was not explained by gender, dementia severity, years of education, history of hypercholesterolemia, hypertension, or diabetes. Only ethnicity was significantly associated with age of onset. CONCLUSIONS These findings confirm that US Hispanics living in the southwestern USA tend to be younger at the time of dementia diagnosis than their White non-Hispanic counterparts. As this is not explained by the presence of the APOE ε4 genotype, further studies should explore other cultural, medical, or genetic risk factors influencing the age of dementia onset in this population.
Collapse
Affiliation(s)
- L. Jaime Fitten
- Easton Center for Alzheimer Disease Research, David Geffen School of Medicine at UCLA,Greater Los Angeles Veterans Affairs Healthcare System, Sepulveda Campus,Department of Psychiatry Olive View-UCLA Medical Center,Department of Psychiatry and Biobehavioral Sciences, School of Medicine at UCLA
| | - Freddy Ortiz
- Easton Center for Alzheimer Disease Research, David Geffen School of Medicine at UCLA,Greater Los Angeles Veterans Affairs Healthcare System, Sepulveda Campus,Department of Psychiatry Olive View-UCLA Medical Center,Department of Neurology, David Geffen School of Medicine at UCLA,Corresponding Author: L. Jaime Fitten, MD, Greater Los Angeles VA Healthcare System, Sepulveda Campus, 16111 Plummer St. (116A-9), Los Angeles, CA. 91343, Telephone: (818) 895-9541, Fax:(818) 895-9515,
| | - Lynn Fairbanks
- Easton Center for Alzheimer Disease Research, David Geffen School of Medicine at UCLA,Department of Psychiatry and Biobehavioral Sciences, School of Medicine at UCLA
| | - George Bartzokis
- Easton Center for Alzheimer Disease Research, David Geffen School of Medicine at UCLA,Department of Psychiatry and Biobehavioral Sciences, School of Medicine at UCLA
| | - Po Lu
- Easton Center for Alzheimer Disease Research, David Geffen School of Medicine at UCLA,Department of Psychiatry and Biobehavioral Sciences, School of Medicine at UCLA,Department of Neurology, David Geffen School of Medicine at UCLA
| | - Eric Klein
- Department of Psychiatry and Biobehavioral Sciences, School of Medicine at UCLA
| | - Giovanni Coppola
- Easton Center for Alzheimer Disease Research, David Geffen School of Medicine at UCLA,Department of Psychiatry and Biobehavioral Sciences, School of Medicine at UCLA
| | - John Ringman
- Easton Center for Alzheimer Disease Research, David Geffen School of Medicine at UCLA,Department of Neurology, David Geffen School of Medicine at UCLA
| |
Collapse
|
44
|
Gonyea JG, López LM, Velásquez EH. The Effectiveness of a Culturally Sensitive Cognitive Behavioral Group Intervention for Latino Alzheimer's Caregivers. THE GERONTOLOGIST 2014; 56:292-302. [PMID: 24855313 DOI: 10.1093/geront/gnu045] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 04/09/2014] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY Demographic projections suggest that the older Latino population will experience the fastest growth among all racial/ethnic groups; and by 2050 will constitute 20% of the nation's seniors. Yet, Latino Alzheimer's elders and their families remain underrepresented in the health care system and caregiver intervention studies. To address this gap, this study tested the effectiveness of Circulo de Cuidado, a culturally-sensitive, cognitive behavioral (CBT) group intervention, in supporting Latino families' ability to manage the disease's neuropsychiatric symptoms and improve caregiver well-being. DESIGN AND METHODS Using a randomized controlled trial design, 67 caregivers were assigned to the CBT experimental condition or the psychoeducational (PED) control condition and interviewed at baseline, post-group, and 3 months follow-up. The 2 manualized interventions had the same structure: 5 weekly 90-minute group sessions, followed by telephone coaching at 3, 6, 9 and 12 weeks post-group. RESULTS Repeated measures analysis of covariance revealed significant group by time interaction effects. Compared with the PED participants, CBT participants reported lower neuropsychiatric symptoms in their relative, less caregiver distress about neuropsychiatric symptoms, a greater sense of caregiver self-efficacy, and less depressive symptoms over time. IMPLICATIONS Our findings offer preliminary evidence that a culturally tailored, CBT group intervention targeted toward neuropsychiatric symptom management has positive psychological benefits for Latino caregivers.
Collapse
Affiliation(s)
| | - Luz M López
- School of Social Work, Boston University, Massachusetts
| | | |
Collapse
|
45
|
Garrett MD, Valle R. A methodological critique of the National Institute of Aging and Alzheimer's Association Guidelines for Alzheimer's disease, dementia, and mild cognitive impairments. DEMENTIA 2014; 15:239-54. [PMID: 24662500 DOI: 10.1177/1471301214525166] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In 2011, the U.S. National Institute on Aging published guidelines for clinical diagnostics for Alzheimer's disease dementia. These guidelines define a continuum with three stages-an early, pre-clinical stage with no symptoms, followed by mild cognitive impairment, and a final stage of Alzheimer's disease dementia. This methodological critique examines the validity of this continuum. No studies exist showing the progression of these biomarkers to Alzheimer's disease. There is also a lack of empirical evidence showing how biomarkers determine mild cognitive impairment, which has multiple etiologies. The guidelines fail to explain anomalies where there are biomarkers but no expression of Alzheimer's disease.
Collapse
Affiliation(s)
| | - Ramón Valle
- Alzheimer's Cross-Cultural Research and Development [ACCORD]. San Diego, CA, USA
| |
Collapse
|
46
|
Arnold SE, Vega IE, Karlawish JH, Wolk DA, Nunez J, Negron M, Xie SX, Wang LS, Dubroff JG, McCarty-Wood E, Trojanowski JQ, Van Deerlin V. Frequency and clinicopathological characteristics of presenilin 1 Gly206Ala mutation in Puerto Rican Hispanics with dementia. J Alzheimers Dis 2013; 33:1089-95. [PMID: 23114514 DOI: 10.3233/jad-2012-121570] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The frequency and clinical and pathological characteristics associated with the Gly206Ala presenilin 1 (PSEN1) mutation in Puerto Rican and non-Puerto Rican Hispanics were evaluated at the University of Pennsylvania's Alzheimer's Disease Center. DNAs from all cohort subjects were genotyped for the Gly206Ala PSEN1 mutation. Carriers and non-carriers with neurodegenerative disease dementias were compared for demographic, clinical, psychometric, and biomarker variables. Nineteen (12.6%) of 151 unrelated subjects with dementia were discovered to carry the PSEN1 Gly206Ala mutation. Microsatellite marker genotyping determined a common ancestral haplotype for all carriers. Carriers were all of Puerto Rican heritage with significantly younger age of onset, but otherwise were clinically and neuropsychologically comparable to those of non-carriers with AD. Three subjects had extensive topographic and biochemical biomarker assessments that were also typical of non-carriers with AD. Neuropathological examination in one subject revealed severe, widespread plaque and tangle pathology without other meaningful disease lesions. The PSEN1 Gly206Ala mutation is notably frequent in unrelated Puerto Rican immigrants with dementia in Philadelphia. Considered together with the increased prevalence and mortality of AD reported in Puerto Rico, these high rates may reflect hereditary risk concentrated in the island which warrants further study.
Collapse
Affiliation(s)
- Steven E Arnold
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Weissberger GH, Salmon DP, Bondi MW, Gollan TH. Which neuropsychological tests predict progression to Alzheimer's disease in Hispanics? Neuropsychology 2013; 27:343-355. [PMID: 23688216 PMCID: PMC3740167 DOI: 10.1037/a0032399] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To investigate which neuropsychological tests predict eventual progression to Alzheimer's disease (AD) in both Hispanic and non-Hispanic individuals. Although our approach was exploratory, we predicted that tests that underestimate cognitive ability in healthy aging Hispanics might not be sensitive to future cognitive decline in this cultural group. METHOD We compared first-year data of 22 older adults (11 Hispanic) who were diagnosed as cognitively normal but eventually developed AD (decliners), to 60 age- and education-matched controls (27 Hispanic) who remained cognitively normal. To identify tests that may be culturally biased in our sample, we compared Hispanic with non-Hispanic controls on all tests and asked which tests were sensitive to future decline in each cultural group. RESULTS Compared to age-, education-, and gender-matched non-Hispanic controls, Hispanic controls obtained lower scores on tests of language, executive function, and some measures of global cognition. Consistent with our predictions, some tests identified non-Hispanic, but not Hispanic, decliners (vocabulary, semantic fluency). Contrary to our predictions, a number of tests on which Hispanics obtained lower scores than non-Hispanics nevertheless predicted eventual progression to AD in both cultural groups (e.g., Boston Naming Test [BNT], Trails A and B). CONCLUSIONS Cross-cultural variation in test sensitivity to decline may reflect greater resistance of medium difficulty items to decline and bilingual advantages that initially protect Hispanics against some aspects of cognitive decline commonly observed in non-Hispanics with preclinical AD. These findings highlight a need for further consideration of cross-cultural differences in neuropsychological test performance and development of culturally unbiased measures.
Collapse
Affiliation(s)
| | - David P Salmon
- Department of Neurosciences, University of California, San Diego
| | | | - Tamar H Gollan
- Department of Psychiatry, University of California, San Diego
| |
Collapse
|
48
|
Developing Dementia Prevalence Rates Among Latinos: A Locally-Attuned, Data-Based, Service Planning Tool. JOURNAL OF POPULATION AGEING 2013. [DOI: 10.1007/s12062-013-9084-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
49
|
Schrauf RW, Iris M. Very long pathways to diagnosis among African Americans and Hispanics with memory and behavioral problems associated with dementia. DEMENTIA 2011. [DOI: 10.1177/1471301211416615] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Research shows that African Americans and Hispanics experience longer delays in dementia diagnosis than do whites. This study focuses on the duration and direction of help-seeking pathways among individuals who had either very short (median: 1 year, 9 months) or very long (median: 9 years, 2 months) times-to-diagnosis. Participants reported the frequencies of events, actions, outcomes, and results around four key time points in the pathway: First Notice of a Problem, Recognition of a Pattern, First Doctor Visit, and Final Diagnosis. Using reported frequencies of events, actions, and outcomes around these events, we constructed the modal pathway or ‘canonical narrative’ and then used correspondence analysis of the data to model short and long pathways. Short pathways were dominated by stepwise movement toward diagnosis (84.5% of inertia or variance) and some ambivalence around symptom recognition (10%). Long pathways were marked by a shift away from movement toward diagnosis (44.5%) but toward the family's taking over key quotidian tasks (55.5%). We suggest that Hispanic and African American caregivers effectively provide a kind of ‘scaffolding’ for the patient, which may in fact be adaptive rather than dysfunctional. Thus, delayed diagnoses and non-diagnosis may reflect ‘active’ choices for dealing with the disease rather than avoidance of the problem.
Collapse
|
50
|
Akter K, Lanza EA, Martin SA, Myronyuk N, Rua M, Raffa RB. Diabetes mellitus and Alzheimer's disease: shared pathology and treatment? Br J Clin Pharmacol 2011; 71:365-76. [PMID: 21284695 DOI: 10.1111/j.1365-2125.2010.03830.x] [Citation(s) in RCA: 237] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Epidemiological and basic science evidence suggest a possible shared pathophysiology between type 2 diabetes mellitus (T2DM) and Alzheimer's disease (AD). It has even been hypothesized that AD might be 'type 3 diabetes'. The present review summarizes some of the evidence for the possible link, putative biochemical pathways and ongoing clinical trials of antidiabetic drugs in AD patients. The primary and review literature were searched for articles published in peer-reviewed sources that were related to a putative connection between T2DM and AD. In addition, public sources of clinical trials were searched for the relevant information regarding the testing of antidiabetic drugs in AD patients. The evidence for a connection between T2DM and AD is based upon a variety of diverse studies, but definitive biochemical mechanisms remain unknown. Additional study is needed to prove the existence or the extent of a link between T2DM and AD, but sufficient evidence exists to warrant further study. Presently, AD patients might benefit from treatment with pharmacotherapy currently used to treat T2DM and clinical trials of such therapy are currently underway.
Collapse
Affiliation(s)
- Kawser Akter
- Temple University School of Pharmacy, Philadelphia, PA19140, USA
| | | | | | | | | | | |
Collapse
|