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Adkins-Jackson PB, Kim B, Higgins Tejera C, Ford TN, Gobaud AN, Sherman-Wilkins KJ, Turney IC, Avila-Rieger JF, Sims KD, Okoye SM, Belsky DW, Hill-Jarrett TG, Samuel L, Solomon G, Cleeve JH, Gee G, Thorpe RJ, Crews DC, Hardeman RR, Bailey ZD, Szanton SL, Manly JJ. "Hang Ups, Let Downs, Bad Breaks, Setbacks": Impact of Structural Socioeconomic Racism and Resilience on Cognitive Change Over Time for Persons Racialized as Black. Health Equity 2024; 8:254-268. [PMID: 38665381 PMCID: PMC11043623 DOI: 10.1089/heq.2023.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 04/28/2024] Open
Abstract
Introduction Older adults racialized as Black experience higher rates of dementia than those racialized as White. Structural racism produces socioeconomic challenges, described by artist Marvin Gaye as "hang ups, let downs, bad breaks, setbacks" that likely contribute to dementia disparities. Robust dementia literature suggests socioeconomic factors may also be key resiliencies. Methods We linked state-level data reflecting the racialized landscape of economic opportunity across the 20th Century from the U.S. Census (1930-2010) with individual-level data on cognitive outcomes from the U.S. Health and Retirement Study participants racialized as Black. A purposive sample of participants born after the Brown v. Board ruling (born 1954-59) were selected who completed the modified Telephone Interview for Cognitive Status between 2010 and 2020 (N=1381). We tested associations of exposure to structural racism and resilience before birth, and during childhood, young-adulthood, and midlife with cognitive trajectories in mid-late life using mixed-effects regression models. Results Older adults born in places with higher state-level structural socioeconomic racism experienced a more rapid cognitive decline in later life compared to those with lower levels of exposure. In addition, participants born in places with higher levels of state-level structural socioeconomic resilience experienced slower cognitive change over time than their counterparts. Discussion These findings reveal the impact of racist U.S. policies enacted in the past that influence cognitive health over time and dementia risk later in life.
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Affiliation(s)
- Paris B. Adkins-Jackson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Boeun Kim
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - César Higgins Tejera
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Tiffany N. Ford
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
- The Brookings Institution, Washington, District of Columbia, USA
| | - Ariana N. Gobaud
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | | | - Indira C. Turney
- Department of Neurology, Vagelos College of Physicians & Surgeons, Taub Institute for Research on Alzheimer's Disease & The Aging Brain, Columbia University, New York, New York, USA
| | - Justina F. Avila-Rieger
- Department of Neurology, Vagelos College of Physicians & Surgeons, Taub Institute for Research on Alzheimer's Disease & The Aging Brain, Columbia University, New York, New York, USA
| | - Kendra D. Sims
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Safiyyah M. Okoye
- Department of Graduate Nursing, College of Nursing and Health Professions and Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
- Department of Health Management and Policy, College of Nursing and Health Professions and Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Daniel W. Belsky
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
- Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Tanisha G. Hill-Jarrett
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, California, USA
| | - Laura Samuel
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gabriella Solomon
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Jack H. Cleeve
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Gilbert Gee
- Department of Community Health Sciences, University of California at Los Angeles, Los Angeles, California, USA
| | - Roland J. Thorpe
- Alzheimer's Disease Resource Center for Minority Aging Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Deidra C. Crews
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rachel R. Hardeman
- Center for Antiracism Research for Health Equity, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Zinzi D. Bailey
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sarah L. Szanton
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer J. Manly
- Department of Neurology, Vagelos College of Physicians & Surgeons, Taub Institute for Research on Alzheimer's Disease & The Aging Brain, Columbia University, New York, New York, USA
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Alam MT, Vásquez E, Etnier JL, Echeverria S. Dietary Adherence and Cognitive Performance in Older Adults by Nativity Status: Results from the National Health and Nutrition Examination Survey (NHANES), 2011-2014. Geriatrics (Basel) 2024; 9:25. [PMID: 38525742 PMCID: PMC10961773 DOI: 10.3390/geriatrics9020025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/19/2024] [Accepted: 02/23/2024] [Indexed: 03/26/2024] Open
Abstract
Although adherence to dietary guidelines is associated with better cognitive performance, there may be differences by nativity status. This study aimed to investigate the association between adherence to the healthy eating index (HEI) and cognitive performance (CP) among United States (US)-born and foreign-born older adults (60+ years). Data were obtained from the 2011-2014 NHANES (n = 3065). Dietary adherence was assessed with HEI quintiles. CP (adequate vs. low) was examined using word listing (CERAD), animal naming (AFT), and the digit symbol substitution test (DSST). Weighted multivariable logistic regressions were used to examine associations. The US-born participants in higher dietary quintiles had adequate CP when compared to foreign-born participants. In adjusted models, the US-born participants in the highest HEI quintile had increased odds of adequate DSST scores (odds ratio: 1.95, 95% confidence interval: 1.15-3.28) compared with those in the lowest quintile. Patterns of association were generally reversed for foreign-born participants and were non-statistically significant. Future research should consider the influence of diets in delaying or preventing decline in cognition and evaluate nutritional factors that contribute to cognitive outcomes for the foreign-born population.
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Affiliation(s)
- Md Towfiqul Alam
- Department of Health Sciences, James Madison University, Harrisonburg, VA 22807, USA
| | - Elizabeth Vásquez
- Department of Epidemiology & Biostatistics, University at Albany, Albany, NY 12144, USA
| | - Jennifer L Etnier
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC 27412, USA
| | - Sandra Echeverria
- Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, NC 27412, USA
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Henriques A, Ruano L, Fraga S, Soares S, Barros H, Talih M. Life-course socio-economic status and its impact on functional health of Portuguese older adults. J Biosoc Sci 2024; 56:36-49. [PMID: 37309019 DOI: 10.1017/s0021932023000093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Functional health is arguably one of the most important health indicators for older adults, because it assesses physical, cognitive and social functions in combination. However, life-course circumstances may impact this multidimensional construct. The aim of the present study was to assess the relationship between life-course socio-economic status (SES) and different dimensions of functional health in older adults. Data on 821 Portuguese adults aged 50 years and over in 2013-2015 were analysed. Life-course SES was computed using participants' paternal occupation (non-manual (nm); manual (m)) and own occupation (nm; m), resulting in four patterns: stable high (nm + nm), upward (m + nm), downward (nm + m) and stable low (m + m). Functional health included physical and mental functioning, cognitive function, handgrip strength, and walking speed. Linear (beta coefficients) and logistic regressions (odds ratios) were used to estimate the association between life-course SES and functional health.Overall, those who accumulated social disadvantage during life-course presented worse functional health than those with stable high SES (stable low - SF-36 physical functioning: β = -9.75; 95% CI: -14.34; -5.15; SF-36 mental health: β = -7.33; 95% CI: -11.55; -3.11; handgrip strength: β = -1.60; 95% CI: -2.86; -0.35; walking time, highest tertile: OR = 5.28; 95% CI: 3.07; 9.09). Those with an upward SES were not statistically different from those in the stable high SES for most of the health outcomes; however, those with an upward SES trajectory tended to have higher odds of cognitive impairment (OR = 1.75; 95% CI: 0.96; 3.19). A downward SES trajectory increased the odds of slower walking speed (OR = 4.62; 95% CI: 1.78; 11.95). A disadvantaged life-course SES impacts older adults' physical and mental functioning. For some outcomes, this was attenuated by a favourable adulthood SES but those with a stable low SES consistently presented worse functional health.
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Affiliation(s)
- A Henriques
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - L Ruano
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Serviço de Neurologia, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - S Fraga
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - S Soares
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - H Barros
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - M Talih
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
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Yuan Y, Peng C, Burr JA, Lapane KL. Frailty, cognitive impairment, and depressive symptoms in Chinese older adults: an eight-year multi-trajectory analysis. BMC Geriatr 2023; 23:843. [PMID: 38087208 PMCID: PMC10717397 DOI: 10.1186/s12877-023-04554-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Frailty, cognitive impairment, and depressive symptoms are closely interrelated conditions in the aging population. However, limited research has longitudinally analyzed the concurrent trajectories of these three prominent conditions in older adults in China. This study aimed to explore the eight-year trajectories of frailty, cognitive impairment, and depressive symptoms, and to identify individual-level and structural-level factors associated with the trajectories. METHODS Four waves of data from the China Health and Retirement Longitudinal Study (2011-2018) were used to identify 6,106 eligible older adults. The main measures included frailty by the frailty index constructed using 30 indicators, cognitive impairment by the summary score of immediate and delayed word recall, figure drawing, serial subtraction, and orientation, and depressive symptoms by the Center for Epidemiologic Studies Depression Scale. Multi-trajectory models identified the trajectories of frailty, cognitive impairment, and depressive symptoms over time. Multinomial logistic regression was employed to estimate the associations between individual-level capital factors and one structural factor (hukou and geographic residency) with the identified trajectories, adjusting for demographic characteristics. RESULTS Four trajectories emerged: (1) worsening frailty, worsening cognitive impairment, depression (14.0%); (2) declining pre-frailty, declining cognition, borderline depression (20.0%); (3) pre-frailty, worsening cognitive impairment, no depression (29.3%); and (4) physically robust, declining cognition, no depression (36.7%). Using the "physically robust, declining cognition, no depression" as the reference, not working, no social activity participant, worse childhood family financial situation, and poorer adult health were most strongly associated with the "worsening frailty, worsening cognitive impairment, depression" trajectory; worse health during childhood had the highest association with the "declining pre-frailty, declining cognition, borderline depression" trajectory; less education, lower household consumption, and rural hukou had the greatest association with the increased likelihood of the "pre-frailty, worsening cognitive impairment, no depression" trajectory. CONCLUSIONS Findings could inform the understanding of the interrelationship of frailty, cognitive impairment, and depressive symptoms in older adults in China and may help practitioners detect adults at risk for adverse trajectories to implement strategies for proper care.
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Affiliation(s)
- Yiyang Yuan
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, 01605, Worcester, MA, USA.
| | - Changmin Peng
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA
| | - Jeffrey A Burr
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA
| | - Kate L Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, 01605, Worcester, MA, USA
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Meyer OL, Harrati A, Gavett BE, Farias ST, Whitmer RA, Widaman K, Hoang V, Tobias M, Mungas D. Effects of early-life environment and adulthood SES on cognitive change in a multiethnic cohort. J Int Neuropsychol Soc 2023; 29:742-750. [PMID: 36880230 PMCID: PMC10483016 DOI: 10.1017/s135561772200087x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
OBJECTIVES Early-life socioeconomic status (SES) and adversity are associated with late-life cognition and risk of dementia. We examined the association between early-life SES and adversity and late-life cross-sectional cognitive outcomes as well as global cognitive decline, hypothesizing that adulthood SES would mediate these associations. METHODS Our sample (N = 837) was a racially and ethnically diverse cohort of non-Hispanic/Latino White (48%), Black (27%), and Hispanic/Latino (19%) participants from Northern California. Participant addresses were geocoded to the level of the census tract, and US Census Tract 2010 variables (e.g., percent with high school diploma) were extracted and combined to create a neighborhood SES composite. We used multilevel latent variable models to estimate early-life (e.g., parental education, whether participant ever went hungry) and adult (participant's education, main occupation) SES factors and their associations with cross-sectional and longitudinal cognitive outcomes of episodic memory, semantic memory, executive function, and spatial ability. RESULTS Child and adult factors were strongly related to domain-specific cognitive intercepts (0.20-0.48 SD per SD of SES factor); in contrast, SES factors were not related to global cognitive change (0.001-0.01 SD per year per SD of SES factor). Adulthood SES mediated a large percentage (68-75%) of the total early-life effect on cognition. CONCLUSIONS Early-life sociocontextual factors are more strongly associated with cross-sectional late-life cognitive performance compared to cognitive change; this effect is largely mediated through associations with adulthood SES.
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Affiliation(s)
- Oanh L. Meyer
- Department of Neurology, University of California, Davis School of Medicine, Sacramento, CA 95817, USA
| | - Amal Harrati
- Mathematica, 505 14th Street, Suite 800, Oakland, CA 94645, USA
| | - Brandon E. Gavett
- School of Psychological Science, University of Western Australia, 35 Stirling Highway (M304), Crawley WA 6009, Australia
| | - Sarah T. Farias
- Department of Neurology, University of California, Davis School of Medicine, Sacramento, CA 95817, USA
| | - Rachel A. Whitmer
- Department of Public Health Sciences, University of California, Davis, Davis, CA 95616 USA
| | - Keith Widaman
- School of Education, University of California, Riverside, Riverside, CA 92521, USA
| | - Victoria Hoang
- Department of Neurology, University of California, Davis School of Medicine, Sacramento, CA 95817, USA
| | - Michele Tobias
- UC Davis DataLab, University of California, Davis, Davis, CA 95616 USA
| | - Dan Mungas
- Department of Neurology, University of California, Davis School of Medicine, Sacramento, CA 95817, USA
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Tan CH, Tan JJX. Low neighborhood deprivation buffers against hippocampal neurodegeneration, white matter hyperintensities, and poorer cognition. GeroScience 2023:10.1007/s11357-023-00780-y. [PMID: 37004594 PMCID: PMC10400521 DOI: 10.1007/s11357-023-00780-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/20/2023] [Indexed: 04/04/2023] Open
Abstract
There is increasing recognition that socioeconomic inequalities contribute to disparities in brain and cognitive health in older adults. However, whether neighborhood socioeconomic status (SES) buffers individuals with low individual SES against neurodegeneration, cerebrovascular disease, and poorer cognitive function is not well understood. Here, we evaluated whether neighborhood deprivation (Townsend deprivation index) interacted with individual SES (composite household income and education levels) on hippocampus volume, regional cortical thickness, white matter hyperintensities, and cognition in 19,638 individuals (mean age = 54.8) from the UK Biobank. We found that individuals with low individual SES had the smallest hippocampal volumes, greatest white matter hyperintensity burden, and poorest cognition if they were living in high deprivation neighborhoods but that these deleterious effects on brain and cognitive function were attenuated if they were living in low deprivation neighborhoods (p for interactions < .05). While neighborhood deprivation did not interact with individual SES to influence regional cortical thickness, higher neighborhood deprivation was independently associated with lower cortical thickness in 16 regions (false discovery rate q < .05). Across multiple brain indices and cognitive function analyses, we found converging evidence suggesting that low neighborhood deprivation may have a neuroprotective effect against neurodegeneration, cerebrovascular pathology, and cognitive impairment, particularly in vulnerable individuals with low household income and education levels.
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Affiliation(s)
- Chin Hong Tan
- Department of Psychology, Nanyang Technological University, 48 Nanyang Avenue, Singapore, S639818, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, 48 Nanyang Avenue, Singapore, S639818, Singapore.
| | - Jacinth J X Tan
- School of Social Sciences, Singapore Management University, Singapore, Singapore
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Migeot J, Calivar M, Granchetti H, Ibáñez A, Fittipaldi S. Socioeconomic status impacts cognitive and socioemotional processes in healthy ageing. Sci Rep 2022; 12:6048. [PMID: 35410333 PMCID: PMC9001669 DOI: 10.1038/s41598-022-09580-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/25/2022] [Indexed: 11/16/2022] Open
Abstract
Socioeconomic status (SES) negatively impacts cognitive and executive functioning in older adults, yet its effects on socioemotional abilities have not been studied in this population. Also, evidence on neurocognitive processes associated with ageing primarily comes from Western, educated, industrialized, rich, and democratic (WEIRD) populations, hindering the generalization of findings to persons from upper-middle- and low-middle-income countries, such as those of Latin America. Here, we compared the performance of low- and high-SES older adults from Argentina in cognitive state, executive functions, social cognition (emotion recognition and theory of mind), and counter-empathic social emotions (envy and Schadenfreude; displeasure at others' fortune and pleasure at others' misfortune, respectively). Subsequently, we developed a path analysis to test the relationship among those variables in a theoretically plausible model and tested the main paths via multiple regression analyses. Relative to the high-SES group, low-SES older adults showed poorer performance on all assessed domains. Convergent evidence from covariance analysis, path analysis, and linear regressions suggested that low-SES impact on socioemotional processes was not primary but mediated by cognitive and executive impairment. These findings offer the first characterization of SES impacts on cognitive and socioemotional processes in a non-WEIRD population and have relevant equity-related implications for brain health.
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Affiliation(s)
- Joaquín Migeot
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago de Chile, Chile
- Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago de Chile, Chile
| | - Mariela Calivar
- Centro de Atención Primaria de la salud Zonda, Ministerio de Salud Pública de La Provincia de San Juan, San Juan, Argentina
| | - Hugo Granchetti
- Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Agustín Ibáñez
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago de Chile, Chile
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Victoria, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Global Brain Health Institute, University of California San Francisco (UCSF), San Francisco, USA
- Trinity College Dublin (TCD), Dublin, Ireland
| | - Sol Fittipaldi
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago de Chile, Chile.
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Victoria, Buenos Aires, Argentina.
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.
- Facultad de Psicología, Universidad Nacional de Córdoba, Córdoba, Argentina.
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