Modifiable Risk Factors for Dementia Among Migrants, Refugees and Asylum Seekers in Australia: A Systematic Review

The design and implementation of culturally-safe dementia risk reduction strategies for immigrant women: a theoretical review

BACKGROUND

Raising awareness about dementia risk reduction is particularly important for ethno-culturally diverse or immigrant women, who have greater risk of dementia compared with men due to multiple interacting factors. We aimed to synthesize prior research on culturally-safe strategies to raise diverse women's awareness of dementia risk reduction.

METHODS

We conducted a theoretical review. We searched for studies published up to April 2023 included in a prior review and multiple databases. We screened studies and extracted data in triplicate, informed by existing and compiled theoretical frameworks (WIDER, RE-AIM, cultural safety approaches) and used summary statistics, tables and text to report study characteristics, and strategy design, cultural tailoring, implementation and impact.

RESULTS

We included 17 studies published from 2006 to 2021. Most were conducted in the United States (15, 88%), before-after cohorts (7, 41%), and included African, Caribbean or Latin Americans (82%). No studies focused solely on women (median women 72%, range 50% to 95%). All strategies consisted of in-person didactic lectures, supplemented with interactive discussion, role-playing, videos and/or reinforcing material. Strategies varied widely in terms of format, delivery, personnel, and length, frequency and duration. Details about tailoring for cultural safety were brief and varied across studies. Ten approaches were used to tailor strategies, most often, use of target participants' first language. Assessment of implementation was limited to reach and effectiveness, offering little insight on how to promote adoption, fidelity of implementation and longer-term maintenance of strategies. Strategies increased knowledge of dementia and decreased misconceptions, but did not prompt participants to seek dementia screening in the single study that assessed behaviour.

CONCLUSIONS

While this review revealed a paucity of research, it offers insight on how to design culturally-safe dementia risk reduction strategies that may be suitable for ethno-culturally diverse or immigrant women. Healthcare professionals can use these findings to inform policy, clinical guidelines and public health programs. Future research is needed to establish the ideal number, length and duration of sessions, and confirm strategy effectiveness for diverse women.

Objectively measured physical activity and mental health among asylum seekers residing in a camp

Physical activity has been linked to better mental health in the general population but also migrants and displaced populations. Studies on the latter populations have been almost exclusively based on self-reported physical activity, thus providing a limited perspective. The purpose of this study was to explore the associations between objectively measured physical activity and mental health indices, in asylum seekers residing in a camp. Participants were asked to wear the accelerometers for a period of seven days, after which they were administered questionnaires assessing depression, anxiety, and well-being in their spoken language. Out of a total of 116 participants, 79 (49 women) accomplished the criteria for valid accelerometer wear days and wear hours and completed the questionnaires. The results showed that participants accumulated adequate, according to the recommendations of the World Health Organization, levels of moderate-to-vigorous physical activity, reported mild to moderate anxiety and depression symptoms, and were marginally above the threshold of poor well-being. Physical activity and sedentary time predicted depression (adjusted R2 = .11) and anxiety (adjusted R2 = .08) symptoms, and levels of well-being (adjusted R2 = .15). In particular, moderate-to-vigorous physical activity was linked to lower depression and anxiety, and better well-being, while sedentary time was linked with poorer well-being. The findings provide valuable evidence regarding the links between physical activity and mental health in displaced populations and highlight the need for a multimethod examination of physical activity in such populations.

Insights for dementia risk reduction among lower SES adults in OECD countries: scoping review of interventions targeting multiple common health risk factors

The number of people living with dementia is expected to rise to 153 million cases globally by 2050. This will come at a high economic and human cost to societies with disproportionate effects on socioeconomically disadvantaged groups who experience greater exposures to- and fewer protections from- the environmental, social and behavioural drivers of dementia risk. Almost half (45%) of dementia incidence could theoretically be prevented or delayed by addressing 14 modifiable risk factors. While several studies have demonstrated the feasibility of multidomain dementia risk reduction interventions in relatively older, educated and wealthy populations, we are not aware of any studies to date explicitly targeting younger adults (< 50 years) with lower socioeconomic status. To inform future strategies, we conducted a scoping review of intervention studies targeting multiple 'dementia-related' risk factors among adults with lower socioeconomic status in developed country contexts. We identified 1003 unique records; 34 met our criteria for inclusion - involving more than 17,500 participants from 13 countries. While none of the studies explicitly targeted dementia risk reduction, they reported on 30 relevant multidomain interventions targeting common risk factors associated with dementia including; diet (28), physical inactivity (27), obesity (22), diabetes (9), hypertension (8), smoking (6), alcohol use (6), depression (3) and social isolation (1). While most studies recorded positive effects on one or more health behaviours, there was a diversity in the design, approach and outcomes of interventions, with significant intervention effects being associated with the use of a wider range of behaviour change techniques. We suggest that designing interventions to reduce dementia risk and disparities requires a high degree of contextual specificity and propose a structured and participatory approach.

Molecular insights into trauma: A framework of epigenetic pathways to resilience through intervention

Experiences of complex trauma and adversity, especially for children, are ongoing global crises necessitating adaptation. Bioadaptability to adversity and its health consequences emphasizes the dynamism of adaptation to trauma and the potential for research to inform intervention strategies. Epigenetic variability, particularly DNA methylation, associates with chronic adversity while allowing for resilience and adaptability. Epigenetics, including age- and site-specific changes in DNA methylation, gene-environment interactions, pharmacological responses, and biomarker characterization and evaluation, may aid in understanding trauma responses and promoting well-being by facilitating psychological and biological adaptation. Understanding these molecular processes provides a foundation for a biologically adaptive framework to shift public health strategies from restorative to long-term adaptation and resilience. Psychological, cultural, and biological trauma must be addressed in innovative interventions for vulnerable populations, particularly children and adolescents. Understanding molecular changes may provide a biopsychosocial perspective for culturally sensitive, evidence-based interventions that promote resilience and thriving in new settings.

Risk factors for the neurodegenerative dementias in the Western Pacific region

The Western Pacific Region (WPR) is characterized by a group of socioeconomically, culturally, and geopolitically heterogenous countries and represents a microcosm of the global endemic of neurodegeneration. This review will chart the known risk factors for dementia across the WPR. We explore the intersection between the established risk factors for dementia including the biomedical and lifestyle (cardiovascular and metabolic disease, sleep, hearing loss, depression, alcohol, smoking, traumatic brain injury, genetics) and social determinants (social disadvantage, limited education, systemic racism) as well as incorporate neuroimaging data, where available, to predict disease progression in the WPR. In doing so, we highlight core risk factors for dementia in the WPR, as well as geographical epicentres at heightened risk for dementia, to orient future research towards addressing these disparities.

Self-Reported Physical Activity and Mental Health Among Asylum Seekers in a Refugee Camp

BACKGROUND

Global forced displacement has been rising steeply since 2015 as a result of wars and human rights abuses. Forcibly displaced people are often exposed to physical and mental strain, which can cause traumatic experiences and poor mental health. Physical activity has been linked with better mental health, although such evidence is scarce among those populations. The purpose of the study was to examine the relationships of self-reported physical activity and fitness with mental health indices among people residing in a refugee camp in Greece as asylum seekers.

METHODS

Participants were 151 individuals (76 women, 75 men; mean age 28.90 y) displaced from their homes for an average of 32.03 months. Among them, 67% were from Afghanistan and countries from southwest Asia, and 33% from sub-Saharan African countries. Participants completed self-report measures assessing physical activity, fitness, symptoms of post-traumatic stress disorder, depression, anxiety, and well-being.

RESULTS

High prevalence of mental health disorder symptoms and poor well-being were identified, with women and Asians showing poorer mental health. Symptoms of post-traumatic stress disorder, depression, and anxiety were related to perceived fitness, but not to self-reported physical activity. Regression analysis showed that perceived fitness (β: 0.34; 95% CI, 0.43 to 1.52) and low-intensity physical activity (β: 0.24; 95% CI, 0.001 to 0.009) significantly positively predicted well-being, showing small to medium effect.

CONCLUSIONS

The findings provide useful insights regarding the link between physical activity and well-being; nevertheless, further research examining objectively measured physical activity is warranted to complement these data and further explore the associations between physical activity and mental health.

Neurological Care of Refugees and Other Forcibly Displaced Persons

There are more than 100 million forcibly displaced persons (FDPs) in the world today, including a high number of people who experience neurologic symptoms and presentations. This review summarizes the conceptual frameworks for understanding neurological health risks and conditions across the migration journey (premigration, migration journey, and postmigration) and life span, including special attention to pediatric FDPs. The interaction with psychiatric illness is discussed, as well as the available published data on neurologic presentations in FDPs in the medical literature. A social determinant of health lens is used to provide ways in which forcible displacement can influence brain health and neurological outcomes. Priorities and future needs for the neurological care of refugees and other FDPs are suggested.

Gender differences in modifiable dementia risk factors in monolingual and bilingual Australian adults

ISSUE ADDRESSED

Gender and bilingualism are reported to influence the risk of dementia. This study examined the prevalence of self-reported modifiable dementia risk factors by gender in two samples: one that speaks at least one language other than English (LoE) and one that speaks only English.

METHODS

A descriptive cross-sectional study was conducted on a sample of Australian residents aged 50 years or over (n = 4339). Participant characteristics and dementia risk behaviours were inspected using descriptive statistics in data collected via online surveys between October 2020 and November 2021.

RESULTS

In both samples, men had a higher rate than women of being overweight and were classified more frequently as being at risk of dementia due to alcohol consumption, lower cognitive activity, and non-adherence to the Mediterranean-style diet. Men reported better management of their cardiometabolic health than women across both groups. Non-significant trends showed men were more often smokers but more physically active than women in the LoE group, and less often smokers but less physically active than women in the English-only group.

CONCLUSION

This study found men and women reported similar patterns of dementia risk behaviours regardless of LoE or English-only status. SO WHAT?: Gender differences in risk behaviours prevail regardless of language-speaking status. The results can be used to guide future research aiming to understand and reduce modifiable dementia risk in Australia and beyond.

Pangenomics: A new era in the field of neurodegenerative diseases

A pangenome is composed of all the genetic variability of a group of individuals, and its application to the study of neurodegenerative diseases may provide valuable insights into the underlying aspects of genetic heterogenetiy for these complex ailments, including gene expression, epigenetics, and translation mechanisms. Furthermore, a reference pangenome allows for the identification of previously undetected structural commonalities and differences among individuals, which may help in the diagnosis of a disease, support the prediction of what will happen over time (prognosis) and aid in developing novel treatments in the perspective of personalized medicine. Therefore, in the present review, the application of the pangenome concept to the study of neurodegenerative diseases will be discussed and analyzed for its potential to enable an improvement in diagnosis and prognosis for these illnesses, leading to the development of tailored treatments for individual patients from the knowledge of the genomic composition of a whole population.