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Bay AA, Tian T, Hackney ME, Silverstein HA, Hart AR, Lazris D, Perkins MM. Interpretive Qualitative Evaluation Informs Research Participation and Advocacy Training Program for Seniors: A Pilot Study. Healthcare (Basel) 2023; 11:2679. [PMID: 37830715 PMCID: PMC10572667 DOI: 10.3390/healthcare11192679] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 09/29/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023] Open
Abstract
Background: An 8-week educational intervention co-taught by medical students and faculty was designed to foster communication between clinical researchers and populations of interest to ultimately increase participation in clinical research by older adults, including underrepresented groups. Weekly topics focused on age-related changes and health conditions, socio-contextual factors impacting aging populations, and wellness strategies. Objectives: To evaluate the successes and weaknesses of an educational intervention aimed at increasing the participation of older adults in clinical research. Design: A focus group was assembled after an 8-week educational intervention, titled DREAMS, to obtain participants' feedback on the program, following a pre-formulated interview guide. Settings: Participants were interviewed in a health center office environment in the United States of America in April of 2016. Participants: A post-intervention focus group was conducted with a group of eight older adults (mean age = 75.8 ± 11.4 years) from 51 total participants who completed the intervention. Methods: The focus group was interviewed loosely following a pre-formed question guide. Participants were encouraged to give honest feedback. The conversation was recorded, transcribed verbatim, and analyzed using thematic analyses. Results: While participants viewed most aspects of the study as a success and stated that it was a productive learning experience, most participants had suggestions for improvements in the program content and implementation. Specifically, the composition of and direction to small breakout groups should be carefully considered and planned in this population, and attention should be paid to the delivery of sensitive topic such as death and dementia. A clear main benefit of this programmatic approach is the development of a rapport amongst participants and between participants and clinical researchers. Conclusions: The results provide useful insights regarding improving participation among hard-to-reach and historically underrepresented groups of older adults in clinical research. Future iterations of this program and similar educational interventions can use these findings to better achieve the programmatic objectives.
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Affiliation(s)
- Allison A. Bay
- Department of Medicine, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA
| | - Tina Tian
- Department of Medicine, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA
| | - Madeleine E. Hackney
- Department of Medicine, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Healthcare System, 1670 Clairmont Rd., Decatur, GA 30033, USA
- Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center (GRECC), Decatur VA Research Building, 3101 Clairmont Rd., Mail Stop Code 11-B, Brookhaven, GA 30329, USA
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd., Atlanta, GA 30322, USA
- Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Rd., Atlanta, GA 30322, USA
| | - Hayley A. Silverstein
- Department of Medicine, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA
| | - Ariel R. Hart
- Department of Medicine, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA
| | - David Lazris
- Department of Medicine, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA
| | - Molly M. Perkins
- Department of Medicine, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA
- Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center (GRECC), Decatur VA Research Building, 3101 Clairmont Rd., Mail Stop Code 11-B, Brookhaven, GA 30329, USA
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd., Atlanta, GA 30322, USA
- Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Rd., Atlanta, GA 30322, USA
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Ramos ME, Pothineni S, Ni L, Bay AA, Prusin T, Hackney ME. Qualitative Analysis of Attitudes, Knowledge, and Interest in Research of People with Parkinson's Disease and Their Care Partners Receiving Accessible Research Education. Parkinsons Dis 2023; 2023:5519646. [PMID: 37727499 PMCID: PMC10506878 DOI: 10.1155/2023/5519646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/16/2023] [Accepted: 08/10/2023] [Indexed: 09/21/2023]
Abstract
Background People with Parkinson's disease (PWP) and their care partners (CP) are underrepresented in research. Methods As an eight-week research advocacy training program, TeleDREAMS was designed to increase understanding of, and participation in, clinical research by older adults through topics on the research process. Qualitative analysis was conducted to explore themes from 365 thirty-minute semistructured phone interviews with 32 PWP and 17 CP TeleDREAMS participants. Interviews gauged progress, motivation, and information retention after each weekly module. Results Eight salient themes were identified from the interviews, including Understanding the Importance of Advocacy and Becoming Cognizant of Past Advocacy Experiences. Conclusions While some findings aligned with weekly module topics, others, such as stated learning preferences and knowledge acquisition of older adults in an educational program, were unexpected. TeleDREAMS may increase interest in community engagement, research participation, and advocacy roles in marginalized and underrepresented participants.
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Affiliation(s)
- Maria E. Ramos
- Emory University College of Arts and Sciences, Atlanta, Georgia
| | - Suraj Pothineni
- Emory University School of Medicine, Department of Medicine, Division of Geriatrics and Gerontology, Atlanta, Georgia
| | - Liang Ni
- Emory University School of Medicine, Department of Medicine, Division of Geriatrics and Gerontology, Atlanta, Georgia
| | - Allison A. Bay
- Emory University School of Medicine, Department of Medicine, Division of Geriatrics and Gerontology, Atlanta, Georgia
| | - Todd Prusin
- Emory University School of Medicine, Department of Medicine, Division of Geriatrics and Gerontology, Atlanta, Georgia
| | - Madeleine E. Hackney
- Emory University School of Medicine, Department of Medicine, Division of Geriatrics and Gerontology, Atlanta, Georgia
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Atlanta, Georgia
- Emory University School of Medicine, Department of Rehabilitation Medicine, Atlanta, Georgia
- Emory University School of Nursing, Atlanta, Georgia
- Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Atlanta, Georgia
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Wells MD, Morse A, Barter J, Mammino K, Bay AA, Prusin T, Hackney ME. Walk with Me Hybrid Virtual/In-Person Walking for Older Adults with Neurodegenerative Disease. J Vis Exp 2023. [PMID: 37395568 DOI: 10.3791/62869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023] Open
Abstract
This study presents a protocol for virtual and in-person walking groups for older adults with neurodegenerative diseases and addresses the decline in physical activity and social connectivity during the pandemic. Physical activity, specifically moderate-intensity walking, has been shown to have multiple health benefits for older adults. This methodology was created during the COVID-19 pandemic, contributing to lower physical activity levels and social isolation in older adults. Both the in-person and virtual classes utilize technology such as fitness tracking apps and video platforms. Data are presented from two groups of older adults with neurodegenerative disease: people with prodromal Alzheimer's disease and people with Parkinson's disease. Participants in the virtual classes were screened for balance impairments before the walk, and any person deemed at risk for falls was not eligible to participate virtually. As COVID vaccines became available and restrictions were lifted, in-person walking groups became feasible. Staff and caregivers were trained in balance management, roles/responsibilities, and delivering walking cues. Both walks, virtual and in-person, consisted of a warm up, a walk, and a cool down, and posture, gait, and safety cues were given throughout. Measures of the rate of perceived exertion (RPE) and heart rate (HR) were taken pre-warm up, post-warm up, and at 15 min, 30 min, and 45 min time points. Participants also used a walking application (app) on their phones to record the distance walked and the number of steps taken. The study showed a positive correlation between HR and RPE in both groups. The participants in the virtual group rated the walking group favorably in terms of improving their quality of life during a period of social isolation and contributing to physical, mental, and emotional well-being. The methodology shows a safe and feasible way to implement virtual and in-person walking groups for older adults with neurological diseases.
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Affiliation(s)
- Meredith D Wells
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine
| | - Amy Morse
- Department of Rehabilitation Medicine, Emory University School of Medicine
| | - Jolie Barter
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine
| | - Kevin Mammino
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation
| | - Allison A Bay
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine
| | - Todd Prusin
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine
| | - Madeleine E Hackney
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine; Department of Rehabilitation Medicine, Emory University School of Medicine; Atlanta VA Center for Visual and Neurocognitive Rehabilitation; Emory University School of Nursing; Birmingham/Atlanta VA Geriatric Research Education and Clinical Center;
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Barter JD, Thomas D, Ni L, Bay AA, Johnson TM, Prusin T, Hackney ME. Parkinson's Disease and Diabetes Mellitus: Individual and Combined Effects on Motor, Cognitive, and Psychosocial Functions. Healthcare (Basel) 2023; 11:healthcare11091316. [PMID: 37174858 PMCID: PMC10178005 DOI: 10.3390/healthcare11091316] [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: 12/22/2022] [Revised: 03/02/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND/OBJECTIVE Understanding the effects of multimorbidity on motor and cognitive function is important for tailoring therapies. Individuals with diabetes mellitus (DM) have a greater risk of developing Parkinson's disease (PD). This study investigated if individuals with comorbid PD and DM experienced poorer functional ability compared to individuals with only PD or DM. METHODS A cross-sectional analysis of 424 individuals: healthy older adults (HOA), n = 170; PD without DM (PD-only), n = 162; DM without PD (DM-only), n = 56; and comorbid PD and DM (PD+DM), n = 36. Motor, motor-cognitive, cognitive, and psychosocial functions and PD motor symptoms were compared among groups using a two-way analyses of covariance with PD and DM as factors. RESULTS The PD-only and DM-only participants exhibited slower gait, worse balance, reduced strength, and less endurance. Motor-cognitive function was impaired in individuals with PD but not DM. DM-only participants exhibited impaired inhibition. Individuals with comorbid PD+DM had worse PD motor symptoms and exhibited impaired attention compared to the PD-only group. CONCLUSIONS Having PD or DM was independently associated with poorer physical and mental quality of life, depression, and greater risk for loss of function. Both PD and DM have independent adverse effects on motor function. Comorbid PD+DM further impairs attention compared to the effect of PD-only, suggesting the importance of therapies focusing on attention. Understanding the functional ability levels for motor and cognitive domains will enhance the clinical care for PD, DM, and PD+DM.
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Affiliation(s)
- Jolie D Barter
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Dwaina Thomas
- School of Arts and Sciences, Clark Atlanta University, Atlanta, GA 30314, USA
| | - Liang Ni
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Allison A Bay
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Theodore M Johnson
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA
- Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Brookhaven, GA 30319, USA
| | - Todd Prusin
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Madeleine E Hackney
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA
- Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Brookhaven, GA 30319, USA
- School of Nursing, Emory University, Atlanta, GA 30322, USA
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Decatur, GA 30033, USA
- Department of Rehabilitation Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA
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Bay AA, Ramachandran S, Ni L, Prusin T, Hackney ME. Differences in Balance Confidence, Fear of Falling, and Fall Risk Factors Among White and Black Community-Dwelling Older Adults. J Geriatr Phys Ther 2023; 46:122-131. [PMID: 35981334 PMCID: PMC10189616 DOI: 10.1519/jpt.0000000000000364] [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] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Falling among older adults is common and can cause chronic health complications. Fear of falling, a lasting concern about falling that can lead an individual to avoid activities he or she can perform, is strongly associated with falling and fall risk. Although White older adults fall more often, Black older adults have more fall risk factors. The purpose of this study was to investigate factors that explain fear of falling and differences between White and Black community-dwelling older adults in fear of falling, balance confidence, and fall risk factors. METHODS Using a cross-sectional, retrospective design, 84 community-dwelling older adults (mean age [SD] = 69.0 [5.2], range: 55-80; White, n = 37, 44%; Black, n = 47, 56%, M/F = 20/64) were assessed. Assessments were conducted in a laboratory for human studies. Fall history and risk factors, and subjective fear of falling, were collected. The Montreal Cognitive Assessment (MoCA), Activities-Specific Balance Confidence (ABC) score, preferred, backward, and fast Gait Speed, Short Form-12 Physical and Mental Component Scores, fear of falling rating scale, and demographics questionnaires were administered. Analyses included a proportional odds logistic regression model to examine which factors predicted ABC score and which factors were associated with subjective fear of falling, 1-way analysis of variance for continuous variables, the Fisher exact test for categorical variables, and the Mann-Whitney-Wilcoxon test for ordinal variables. RESULTS Black participants had significantly fewer years of education ( P = .007), lower MoCA scores ( P = .002), and slower fast gait speed ( P = .032) than White participants. Black participants reported less subjective fear of falling ( P = .043). In the final ABC model (Akaike information criterion 208.26), lower ABC scores were predicted by White race, slower preferred and fast gait speeds, and worse Short Form-12 Mental Composite Scores. DISCUSSION Despite Black participants demonstrating typical characteristics of higher fall risk including lower cognitive scores, slower gait speed, and lower ABC scores, Black participants reported fewer falls. Understanding racial differences is an important factor in fear of falling and balance confidence. CONCLUSION Reasons for racial differences should be examined further in fear of falling and balance confidence to facilitate the development of patient-centered falls prevention physical therapy programs.
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Affiliation(s)
- Allison A. Bay
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, Georgia
| | | | - Liang Ni
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, Georgia
| | - Todd Prusin
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, Georgia
| | - Madeleine E. Hackney
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, Georgia
- Atlanta Veterans Affairs Medical Center, Center for Visual and Neurocognitive Rehabilitation, Decatur, Georgia
- Geriatric Research, Education, and Clinical Center (GRECC), Birmingham/Atlanta Veterans Affairs Medical Centers, Birmingham, Alabama
- Emory University Department of Rehabilitation Medicine, Atlanta, Georgia
- Emory University School of Nursing, Atlanta, Georgia
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Schindler N, Bay AA, Perkins MM, Jackson J, Ni L, Pothineni S, Wincek R, Hackney ME. Remote and in-person research education for people with Parkinson's disease and their care partners. Fam Syst Health 2023; 41:26-43. [PMID: 35737554 PMCID: PMC9826735 DOI: 10.1037/fsh0000684] [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] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
OBJECTIVE TeleDREAMS, a distance learning version of the Developing a Research Participation Enhancement and Advocacy Training Program for Diverse Seniors (DREAMS) program, provides remote clinical research process and advocacy education to older adults with Parkinson's disease (PD) and their care partners. METHOD Participants engaged in remote learning, reading eight weekly clinical research process and advocacy education modules. They also had weekly half hour phone discussions with staff about each module. Participants (PD: n = 28, care partner: n = 15) were tested on health literacy, quality of life, depression, research involvement, and advocacy measures. RESULTS People with PD improved on health literacy postintervention. PD participants who participated with care partners improved more on health literacy than those without care partners. PD participants' attrition rates were lower for PD participants in TeleDREAMS than those of the similar, in-person program DREAMS program studied before TeleDREAMS. Most participants reported research involvement and patient advocacy for older adults with PD 6 to 9 months postprogram. CONCLUSIONS TeleDREAMS may improve health literacy in participants with Parkinson's and their care partners. If increased advocacy and health and research literacy translates to increased research involvement, then TeleDREAMS could be an important strategy for researchers interested in increasing participation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - Allison A. Bay
- Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine
| | - Molly M. Perkins
- Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine
| | | | - Liang Ni
- Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine
| | - Suraj Pothineni
- Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine
| | - Ron Wincek
- Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine
| | - Madeleine E. Hackney
- Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Decatur, Georgia, United States
- School of Nursing, Emory University
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Cao K, Bay AA, Hajjar I, Wharton W, Goldstein F, Qiu D, Prusin T, McKay JL, Perkins MM, Hackney ME. Rationale and Design of the PARTNER Trial: Partnered Rhythmic Rehabilitation for Enhanced Motor-Cognition in Prodromal Alzheimer's Disease. J Alzheimers Dis 2023; 91:1019-1033. [PMID: 36530084 PMCID: PMC10105523 DOI: 10.3233/jad-220783] [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] [Indexed: 12/23/2022]
Abstract
BACKGROUND Functional decline in Alzheimer's disease (AD) is impacted by impaired ability to integrate and modulate complex cognitive and motor abilities, commonly known as motor-cognitive integration. Impaired motor-cognitive integration occurs in the early stages of AD, prodromal AD (pAD), and may precede other symptoms. Combined motor and cognitive training have been recommended for people with pAD and need to be better researched. Our data suggest that partnered rhythmic rehabilitation (PRR) improves motor-cognitive integration in older adults with cognitive impairment. PRR is an ideal intervention to simultaneously target cardiovascular, social, and motor-cognitive domains important to AD. OBJECTIVE/METHODS We propose to conduct a 1-year Phase II, single-blind randomized controlled trial using PRR in 66 patients with pAD. Participants will be assigned to three months of biweekly sessions, followed by nine months of weekly sessions of PRR or group walking (WALK) with 1 : 1 allocation. Group walking in the control group will allow us to compare physical exercise alone versus the added benefit of the cognitively engaging elements of PRR. RESULTS/CONCLUSION Using an intent-to-treat approach, this innovative pilot study will 1) Determine acceptability, safety, tolerability, and satisfaction with PRR; 2) Compare efficacy of PRR versus WALK for improving motor-cognitive integration and identify the most sensitive endpoint for a Phase III trial from a set of motor-cognitive, volumetric MRI, and cognitive measures. The study will additionally explore potential neural, vascular, and inflammatory mechanisms by which PRR affects pAD to derive effect size of these intermediary measures and aid us in estimating sample size for a future trial.
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Affiliation(s)
- Ke Cao
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Allison A Bay
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Ihab Hajjar
- Department of Neurology, University of Texas Southwestern, Dallas, TX, USA
| | | | - Felicia Goldstein
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Deqiang Qiu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Todd Prusin
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - J Lucas McKay
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Bioinformatics, Emory University School of Medicine, Atlanta, GA, USA
| | - Molly M Perkins
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center (GRECC), Atlanta, GA, USA
| | - Madeleine E Hackney
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Emory University School of Nursing, Atlanta, GA, USA.,Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Decatur, GA, USA.,Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center (GRECC), Atlanta, GA, USA
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Shah AR, Ni L, Bay AA, Hart AR, Perkins MM, Hackney ME. Psychosocial Effects of Remote Reading with Telephone Support versus In-Person Health Education for Diverse, Older Adults. J Appl Gerontol 2023; 42:59-66. [PMID: 36112820 PMCID: PMC9475377 DOI: 10.1177/07334648221127014] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
This study evaluated initial information about psychosocial differences of 130 diverse, older adults (M age: 70.8 ± 9.2 years) who received a "low-tech" remote (independent reading with telephone support) or in-person education through DREAMS (Developing a Research Participation Enhancement and Advocacy Training Program for Diverse Seniors) health seminar series. Outcomes on measures of depression, quality of life, and spatial extent of lifestyle of 115 completers were analyzed at baseline, immediately post-intervention, and 8-week follow-up. Adjusted at baseline, psychosocial outcomes were compared between groups at post-test and 8-week follow-up using adjusted mean differences. Post-participation, compared to remote participants, in-person participants had significantly lower depression on Beck Depression Inventory-II, Geriatric Depression Scale, and significantly higher mental quality of life on Short Form-12. This study links knowledge acquisition via in-person learning with decreased stress, depression, and increased quality of life among seniors. Identifying effective educational delivery methods may increase clinical research involvement for aging communities.
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Affiliation(s)
- Anjali R. Shah
- Rollins School of Public Health, Emory University, Atlanta, GA, USA,College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Liang Ni
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Allison A. Bay
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Ariel R. Hart
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Molly M. Perkins
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA,Emory University School of Nursing, Atlanta, GA, USA,Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Birmingham, AL, USA,Deparment of Sociology, Emory University, Atlanta, GA, USA
| | - Madeleine E. Hackney
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA,Emory University School of Nursing, Atlanta, GA, USA,Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Birmingham, AL, USA,Atlanta VA Center for Visual & Neurocognitive Rehabilitation, Decatur, GA, USA,Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA,Madeleine E. Hackney, Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta VA Health Care System, 1841 Clifton Road NE, #553, Atlanta, GA 30324, USA. ,
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Abraham A, Bay AA, Ni L, Schindler N, Singh E, Leeth E, Bozorg A, Hart AR, Hackney ME. Gender differences in motor and non-motor symptoms in individuals with mild-moderate Parkinson's disease. PLoS One 2023; 18:e0272952. [PMID: 36630320 PMCID: PMC9833587 DOI: 10.1371/journal.pone.0272952] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 07/28/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) affects both men and women with documented gender differences across functional domains, with findings varying among reports. Knowledge regarding gender differences in PD for different geographic locations is important for further understanding of the disease and for developing personalized gender-specific PD assessment tools and therapies. OBJECTIVE This study aimed to examine gender differences in PD-related motor, motor-cognitive, cognitive, and psychosocial function in people with PD from the southern United States (US). METHODS 199 (127 men and 72 women; M age: 69.08±8.94) individuals with mild-moderate idiopathic PD (Hoehn &Yahr (H&Y) Median = 2, stages I-III) from a large metro area in the southeastern US were included in this retrospective, cross-sectional study. Motor, motor-cognitive, cognitive, and psychosocial data were obtained using standardized and validated clinical tests. Univariate analyses were performed, adjusting for age and housing type. RESULTS After adjustment for age, housing, PD duration and fall rate, men exhibited statistically significantly greater motor (Movement Disorders Society (MDS)-Unified Parkinson Disease Rating Scale (UPDRS)-II) and non-motor (MDS-UPDRS-I) impact of PD, and more severe motor signs (MDS-UPDRS-III). Men exhibited worse PD-specific health-related quality of life related to mobility, activities of daily living, emotional well-being, cognitive impairment, communication, and more depressive symptoms. Men performed worse on a subtraction working memory task. Women had slower fast gait speed. CONCLUSIONS In the southeastern United States, men may experience worse PD-related quality of life and more depression than women. Many non-motor and motor variables that are not PD specific show no differences between genders in this cohort. These findings can contribute to the development of gender-sensitive assessment and rehabilitation policies and protocols for people with PD.
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Affiliation(s)
- Amit Abraham
- Department of Physical Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel
- Navigation and Accessibility Research Center of Ariel University (NARCA), Ariel University, Ariel, Israel
| | - Allison A. Bay
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Liang Ni
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Nicole Schindler
- College of Arts and Sciences, Emory University, Atlanta, GA, United States of America
| | - Eeshani Singh
- College of Arts and Sciences, Emory University, Atlanta, GA, United States of America
| | - Ella Leeth
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Ariyana Bozorg
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
- Rehabilitation R&D Center Atlanta Veterans Affairs Health Care System, Decatur, Georgia, United States of America
| | - Ariel R. Hart
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Madeleine E. Hackney
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
- Rehabilitation R&D Center Atlanta Veterans Affairs Health Care System, Decatur, Georgia, United States of America
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
- Emory School of Nursing, Atlanta, GA, United States of America
- Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Decatur, Georgia, United States of America
- * E-mail: ,
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Shah AR, Ni L, Bay AA, Hart AR, Perkins MM, Hackney ME. Remote versus In-Person Health Education: Feasibility, Satisfaction, and Health Literacy for Diverse Older Adults. Health Educ Behav 2022; 50:369-381. [PMID: 36124443 DOI: 10.1177/10901981221121258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Health education may improve health in geriatric patients. To evaluate differences between remote and in-person education, the DREAMS (Developing a Research Participation Enhancement and Advocacy Training Program for Diverse Seniors) health seminar series compared in-person and remote learning groups to assess feasibility, satisfaction, adherence, health literacy, and cognitive outcomes. RESEARCH DESIGN Nonrandomized two-arm interventions occurred remotely or in-person. About 130 diverse, older adults (M age: 70.8 ± 9.2 years; in-person n = 95; remote, n = 35) enrolled. Data from 115 completers (In-person n = 80; Remote n = 35) were analyzed for performance outcomes. Feasibility, adherence, and satisfaction benchmarks were evaluated at baseline, immediately post intervention, and 8 weeks post intervention. Adjusting for baseline performances, outcomes on health literacy and cognitive measures were compared between groups after intervention (at posttest and at 8-week follow-up) using adjusted mean differences (β coefficients). RESULTS Eighty in-person and all remote participants completed at least six modules. Both programs had high satisfaction, feasibility, and strong adherence. After adjusting for demographic covariates and baseline values, cognitive and motor cognitive measures between groups were domain specific (e.g., global cognition, executive function, spatial memory, mental tracking capacity, and cognitive integration). DISCUSSION AND IMPLICATIONS This work explores feasible measures of knowledge acquisition and its link to health literacy and cognitive outcomes. Identifying effective delivery methods may increase involvement in clinical research. Future studies may encourage remote learning for increased accessibility.
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Affiliation(s)
- Anjali R Shah
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Liang Ni
- Emory University School of Medicine, Atlanta, GA, USA
| | - Allison A Bay
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Molly M Perkins
- Emory University School of Medicine, Atlanta, GA, USA.,Emory University School of Nursing, Atlanta, GA, USA.,Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Atlanta, GA, USA.,Department of Sociology, Emory University, Atlanta, GA, USA
| | - Madeleine E Hackney
- Emory University School of Medicine, Atlanta, GA, USA.,Emory University School of Nursing, Atlanta, GA, USA.,Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Atlanta, GA, USA.,Center for Visual and Neurocognitive Rehabilitation, Atlanta, GA, USA.,Atlanta VA Health Care System, Atlanta, GA, USA
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Wharton W, Jeong L, Ni L, Bay AA, Shin R, McCullough L, Silverstein H, Hart AR, Swieboda D, Hu WT, Hackney ME. Adapted Tango to improve blood inflammatory markers in middle‐aged African‐American female caregivers of persons with Alzheimer's disease: A clinical trial. Alzheimers Dement 2021. [DOI: 10.1002/alz.049626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lazris D, Perkins MM, Bay AA, Hackney ME. Qualitative Evaluation Informs Understanding of Motor Cognition and Therapies in Older Adults with Mild Cognitive Impairment. J Alzheimers Dis 2021; 84:691-703. [PMID: 34569954 PMCID: PMC10105980 DOI: 10.3233/jad-210617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND 10%to 20%of Americans aged 65 and older have mild cognitive impairment (MCI) with 10%progressing to Alzheimer's disease (AD) each year. Underserved groups, including African Americans (AAs), are among the most vulnerable to MCI and AD. Although evidence continues to amass, the benefits of exercise and movement for AD is still understudied in AD. OBJECTIVE Understanding the attitudes, perceptions, and beliefs about motor-cognitive integration and examining the physical activity of a sample of predominantly Black women community members with self-reported memory problems will allow improved recruitment and refinement of multimodal interventions designed to improve motor-cognitive and cognitive function. METHODS We conducted focus groups with older adults who reported subjective memory complaints (n = 15; Black: n = 12, White: n = 3, mean age 71.7±5.8). RESULTS Findings from thematic analysis showed most participants knew of benefits of exercise. However, most participants reported not getting adequate exercise due to factors such as pain, increased responsibilities, and fear of injury. Despite barriers, participants expressed enthusiasm for multimodal interventions designed to target body and brain health and provided several suggestions to improve or enhance the proposed interventions. CONCLUSION Results provide useful insights regarding improving participation among historically under-represented groups in clinical movement-based research. Participants' discussion focused primarily on the way motor-cognitive integration prevents falls, maintains memory, and provides a social benefit. The reported perceived benefits and limitations of exercise, as this population understands it, can help researchers and physicians better engage the community for lifestyle changes that will support greater motor-cognitive health.
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Affiliation(s)
- David Lazris
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Molly M Perkins
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Birmingham/Atlanta VA Geriatric Research, Education and Clinical Center (GRECC), Atlanta, GA, USA.,Emory University School of Nursing, Atlanta, GA, USA.,Emory University, Department of Sociology, Atlanta, GA, USA
| | - Allison A Bay
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Madeleine E Hackney
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Birmingham/Atlanta VA Geriatric Research, Education and Clinical Center (GRECC), Atlanta, GA, USA.,Emory University School of Nursing, Atlanta, GA, USA.,Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Atlanta, GA, USA
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Shah A, Macauley C, Ni L, Bay AA, Hackney ME. The Relationship Between Attitudes about Research and Health Literacy among African American and White (Non-Hispanic) Community Dwelling Older Adults. J Racial Ethn Health Disparities 2021; 9:93-102. [PMID: 33415701 PMCID: PMC7790309 DOI: 10.1007/s40615-020-00932-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/07/2020] [Accepted: 11/23/2020] [Indexed: 12/29/2022]
Abstract
Background Ethnic minority representation lacks in research. Understanding factors that promote minorities in research helps address this participation gap. Minorities often face representation disparities, including health education, socioeconomic status, and race. Compared to other races in the USA, over 50% of African Americans (AA) over age 65 face obstacles towards achieving basic health literacy skills. This study aims to investigate differences in beliefs regarding research and health literacy between White and AA participants. Methods This cross-sectional study compared 46 AA vs. 60 White healthy older adults (n = 106; age = 73.97 ± 10.6 years). Participants were assessed once with the Participant Attitudes and Beliefs towards Research Questionnaire (PABRQ) and two validated health literacy measures, the Rapid Estimate of Adult Literacy in Medicine (REALM) and the Short Test of Functional Health Literacy for Adults (S-TOFHLA). Results Controlling for age, sex, and education, AA performed significantly worse on REALM. Compared to White participants, AA more likely believed that researchers were motivated to perform studies to increase their general knowledge. Participants with lower health literacy scores more likely believed that scientists were motivated to conduct research to minimize treatment expenses. About 83–85% of participants reported not being familiar with the informed consent process, 90–95% had positive attitudes towards research involvement, and 38–52% believed researchers performed to promote their own careers. Conclusion This work helps link older adults’ beliefs towards research, health literacy, and their participation in research. Future research is needed to remove barriers to participation in research for underserved, older adults.
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Affiliation(s)
- Anjali Shah
- Emory College of Arts and Sciences, Atlanta, GA, USA
| | | | - Liang Ni
- Department of Medicine, Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, GA, USA
| | - Allison A Bay
- Department of Medicine, Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, GA, USA
| | - Madeleine E Hackney
- Department of Medicine, Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, GA, USA. .,Atlanta VA Center for Visual & Neurocognitive Rehabilitation, Atlanta, GA, USA. .,Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA. .,Emory University School of Nursing, Atlanta, GA, USA. .,Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Atlanta, GA, USA.
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Wharton W, Jeong L, Ni L, Bay AA, Shin RJ, McCullough LE, Silverstein H, Hart AR, Swieboda D, Hu W, Hackney ME. A Pilot randomized clinical trial of adapted tango to improve cognition and psychosocial function in African American women with family history of Alzheimer's disease (ACT trial). Cerebral Circulation - Cognition and Behavior 2021; 2:100018. [PMID: 36324714 PMCID: PMC9616328 DOI: 10.1016/j.cccb.2021.100018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/30/2021] [Accepted: 06/17/2021] [Indexed: 11/24/2022]
Abstract
the adapted tango intervention was very well received as demonstrated by minimal participant attrition, satisfaction questionnaires that indicated high satisfaction, and anecdotal reports. Adapted tango intervention may be helpful in controlling or reducing markers of inflammation in AA women with a parental history of AD. Participants in tango demonstrated improvements in whole-body spatial cognition and short-term and working memory, and reduced deterioration of executive function. Although our tango group did not show large positive effect in cumulative caregiver burden post intervention, the large positive effect in role Captivity, caregiver confidence, and deprivation of intimate exchange displays some of the positive effects of this dance intervention for the caregivers.
Alzheimer's disease (AD) is a devastating, progressive neurodegenerative disease resulting in memory loss and a severe reduction in the ability to perform activities of daily living. Ethnicity-related genetic factors promoting the development of dementias among African Americans (AA) and increased risk among women for developing AD indicates that AA women with a parental history of AD are at great risk for developing AD. This phase I study assessed the impact of a 12 week, 20-lesson adapted Argentine Tango intervention (n = 24) to a no-contact control group (n = 10) on measures of plasma inflammatory markers, cognition, and motor and psychosocial performance in middle-aged AA woman at increased risk for AD by virtue of parental history. Some woman (n = 16) were also caregivers; thus, the impact of the intervention on caregiving burden was examined in this subset. Preliminary analysis of efficacy was conducted with significance tests on biomarkers and key measures of cognition, including visuospatial and executive function, balance, and strength. After 12 weeks, Tango participants had significantly decreased inflammatory cytokine, including reductions in IL-7 (p = 0.003), IFN-γ (p = 0.011), TNFα (p = 0.011), and MCP-1 (p = 0.042) compared to controls. Large effects were noted for the Tango group on tests of executive functioning (d = 0.89), and inhibition (p = 0.031). Participants in Tango improved in dynamic and static balance (p = 0.018) and functional lower body strength (p = 0.023). Secondary assessment revealed trends favoring the intervention group were noted in spatial cognition and executive function. Moderate effects were noted in caregiving burden measures among the subset of caregivers. These data demonstrate substantial reductions in inflammatory biomarkers along with cognitive and motor improvements through a non-pharmacologic, affordable intervention among a small, well-characterized cohort of AA women with a parental history of AD.
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Affiliation(s)
| | - Leanne Jeong
- Emory University College of Arts and Sciences, 550 Asbury Circle, Atlanta, GA, 30322, USA
| | - Liang Ni
- Division of Geriatrics and Gerontology, Department of Medicine, Emory School of Medicine, 1841 Clifton Rd NE, Atlanta, GA, 30307, USA
| | - Allison A. Bay
- Division of Geriatrics and Gerontology, Department of Medicine, Emory School of Medicine, 1841 Clifton Rd NE, Atlanta, GA, 30307, USA
| | - Ryan J. Shin
- Emory University College of Arts and Sciences, 550 Asbury Circle, Atlanta, GA, 30322, USA
| | - Lauren E. McCullough
- Emory University Rollins School of Public Health, 1518 Clifton Rd., Atlanta, GA, 30329, USA
| | - Hayley Silverstein
- Division of Geriatrics and Gerontology, Department of Medicine, Emory School of Medicine, 1841 Clifton Rd NE, Atlanta, GA, 30307, USA
| | | | | | - William Hu
- Division of Cognitive Neurology, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ 08901, USA
| | - Madeleine E. Hackney
- Emory University School of Nursing, Atlanta, GA, 30307, USA
- Division of Geriatrics and Gerontology, Department of Medicine, Emory School of Medicine, 1841 Clifton Rd NE, Atlanta, GA, 30307, USA
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation, 1670 Clairmont Rd., Decatur, GA, 30033, USA
- Department of Rehabilitation Medicine, Emory School of Medicine, 1648 Pierce Dr. NE, Atlanta, GA, 30307, USA
- Birmingham/Atlanta VA Geriatric Research Clinical and Education Center
- Corresponding author at: Emory University School of Medicine, Department of Medicine, Division of Geriatrics and Gerontology, Research Health Scientist, Atlanta VA Rehabilitation R&D Center for Visual and Neurocognitive Rehabilitation, 1841 Clifton Rd. NE, #553, Atlanta, GA 30329, USA.
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Wharton W, Shin R, Hu WT, Jeong L, Bay AA, Hart AR, Ni L, Hackney ME. A pilot clinical trial of adapted tango to improve negative health impacts in middle aged African‐American women caregivers of persons with Alzheimer’s disease. Alzheimers Dement 2020. [DOI: 10.1002/alz.044865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Hackney ME, Bay AA, Jackson JM, Nocera JR, Krishnamurthy V, Crosson B, Evatt ML, Langley J, Cui X, McKay JL, Huddleston DE. Rationale and Design of the PAIRED Trial: Partnered Dance Aerobic Exercise as a Neuroprotective, Motor, and Cognitive Intervention in Parkinson's Disease. Front Neurol 2020; 11:943. [PMID: 33162925 PMCID: PMC7581698 DOI: 10.3389/fneur.2020.00943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/21/2020] [Indexed: 12/11/2022] Open
Abstract
Parkinson's disease (PD), an intractable condition impairing motor and cognitive function, is imperfectly treated by drugs and surgery. Two priority issues for many people with PD are OFF-time and cognitive impairment. Even under best medical management, three-fourths of people with PD experience “OFF-time” related to medication-related motor fluctuations, which severely impacts both quality of life and cognition. Cognitive deficits are found even in newly diagnosed people with PD and are often intractable. Our data suggest that partnered dance aerobic exercise (PDAE) reduces OFF-time on the Movement Disorders Society Unified Parkinson Disease Rating Scale-IV (MDS-UPDRS-IV) and ameliorates other disease features, which motivate the PAIRED trial. PDAE provides AE during an improvisational, cognitively engaging rehabilitative physical activity. Although exercise benefits motor and cognitive symptoms and may be neuroprotective for PD, studies using robust biomarkers of neuroprotection in humans are rare. We propose to perform a randomized, controlled trial in individuals with diagnosed mild–moderate PD to compare the efficacy of PDAE vs. walking aerobic exercise (WALK) for OFF-time, cognition, and neuroprotection. We will assess neuroprotection with neuromelanin-sensitive MRI (NM-MRI) and iron-sensitive (R2*) MRI sequences to quantify neuromelanin loss and iron accumulation in substantia nigra pars compacta (SNc). We will use these biomarkers, neuromelanin loss, and iron accumulation, as tools to chart the course of neurodegeneration in patients with PD who have undergone long-term (16 months) intervention. We will randomly assign 102 individuals with mild–moderate PD to 16 months of PDAE or WALK. The 16-month intervention period will consist of Training (3 months of biweekly sessions) and Maintenance (13 months of weekly sessions) phases. We will assess participants at baseline, 3 months (immediately post-Training), and 16 months (immediately post-Maintenance) for OFF-time and behaviorally and physiologically measured cognition. We will acquire NM-MRI and R2* imaging data at baseline and 16 months to assess neuroprotection. We will (1) examine effects of Training and Maintenance phases of PDAE vs. WALK on OFF-time, (2) compare PDAE vs. WALK at 3 and 16 months on behavioral and functional MRI (fMRI) measures of spatial cognition, and (3) compare PDAE vs. WALK for effects on rates of neurodegeneration.
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Affiliation(s)
- Madeleine E Hackney
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA, Decatur, GA, United States.,Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States.,Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States.,Emory University School of Nursing, Atlanta, GA, United States.,Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Atlanta, GA, United States
| | - Allison A Bay
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Jordan M Jackson
- Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Joe R Nocera
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA, Decatur, GA, United States.,Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States.,Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Atlanta, GA, United States.,Emory University School of Medicine Department of Neurology, Atlanta, GA, United States
| | - Venkatagiri Krishnamurthy
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA, Decatur, GA, United States.,Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States.,Emory University School of Medicine Department of Neurology, Atlanta, GA, United States
| | - Bruce Crosson
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA, Decatur, GA, United States.,Emory University School of Medicine Department of Neurology, Atlanta, GA, United States.,Georgia State University Department of Psychology, Atlanta, GA, United States.,Health and Rehabilitation Science, University of Queensland, Brisbane, QLD, Australia
| | - Marian L Evatt
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA, Decatur, GA, United States.,Emory University School of Medicine Department of Neurology, Atlanta, GA, United States
| | - Jason Langley
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA, Decatur, GA, United States.,Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States.,Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Atlanta, GA, United States.,Emory University School of Medicine Department of Neurology, Atlanta, GA, United States.,Center for Advanced Neuroimaging, University of California, Riverside, Riverside, CA, United States
| | - Xiangqin Cui
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA, Decatur, GA, United States.,Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - J Lucas McKay
- Department of Biomedical Engineering, Emory University School of Medicine, Atlanta, GA, United States
| | - Daniel E Huddleston
- Emory University School of Medicine Department of Neurology, Atlanta, GA, United States
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Patel RA, Wharton W, Bay AA, Nid L, Barter JD, Hackney ME. Association between anti-inflammatory interleukin-10 and executive function in African American women at risk for Alzheimer's disease. J Clin Exp Neuropsychol 2020; 42:647-659. [PMID: 32781877 PMCID: PMC9747330 DOI: 10.1080/13803395.2020.1798879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION African-Americans (AAs) are 64% more likely to be diagnosed with AD than non-Hispanic Whites. AAs with elevated AD biomarkers exhibit greater neurodegeneration in AD signature regions compared to non-Hispanic Whites with elevated AD biomarkers. This pilot trial examined whether normal or elevated plasma levels of interleukin (IL)-10 are associated with changes in executive function and short-term memory in AA women at risk for developing AD due to parental history. METHOD Observational study comparing groups with elevated and normal plasma IL-10 levels. Study included 31 AA women (age=58.9±8 years) with parental history of AD. Measures included inflammatory blood biomarkers, executive function and visuospatial short-term memory tests. Multivariate linear regression with adjustment for comorbidities, and Bonferroni corrections for multiple comparisons were used to compare groups. Effect sizes (Cohen's d) were generated. Using endpoints with moderate-large effects between groups, Pearson correlations determined associations between biomarker levels and cognitive performance. RESULTS The elevated IL-10 group performed worse on the Trail-Making Test proportional score ((B-A)/A) (effect size (d =-0.87 (-1.6, -.1)). Moderate effects with large confident intervals were noted in inhibition, set-switching, and body position spatial memory. Significant differences between groups in levels of other inflammatory markers were noted, including IL-7 (p=0.002) and interferon γ (p=0.02). IL-7 remained significant after Bonferroni correction. Correlation matrices revealed moderate-large, significant correlations (yet with wide confidence intervals) between levels of IL-10 and IL-9 with BPST total correct trials, and between interferon γ and delayed recall. CONCLUSIONS Interleukins may incite inflammation, leading to impaired aspects of executive function and short-term memory in this sample of African American women at risk for developing AD. This research provides effect sizes that will be used to power future research that will further investigate the relationship between inflammation, AD biomarkers, and cognitive function in an understudied population.
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Affiliation(s)
- Ruhee A. Patel
- Emory University College of Arts and Sciences, Atlanta, USA
| | - Whitney Wharton
- Emory University School of Nursing, Atlanta, USA,Department of Neurology, Emory University School of Medicine, Atlanta, USA
| | - Allison A. Bay
- Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, USA
| | - Liang Nid
- Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, USA,Emory University Rollins School of Public Health, Atlanta, USA
| | - Jolie D. Barter
- Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, USA
| | - Madeleine E. Hackney
- Emory University School of Nursing, Atlanta, USA,Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, USA,Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, USA,Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Healthcare System, Decatur, GA, USA,Birmingham/Atlanta VA Geriatric Research Clinical and Education Center, Atlanta, USA
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Jackson JM, Bay AA, Barter JD, Ni L, Caudle WM, Serra MC, Wharton W, Hackney ME. The Role of Nutrition and Inflammation on Cognition in a High-Risk Group for Alzheimer's Disease. J Alzheimers Dis Rep 2020; 4:345-352. [PMID: 33024941 PMCID: PMC7504978 DOI: 10.3233/adr-200224] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Alzheimer’s disease (AD) is a prevalent neurodegenerative disease. Treatments are necessary to target people at high risk for AD. Inflammation, particularly tumor necrosis factor alpha (TNFα), appears to be an important marker associated with the development of AD pathophysiology. Consuming a high-fat diet induces tissue expression of TNFα. Objective: This study investigates the relationship between nutrition, circulating inflammation, and cognition in African American women (age: M = 59.5 (±8.20) [42–73] years) at risk for developing AD. Methods: Participants were split into high-fat and low-fat groups based on total dietary fat consumption self-reported on the Lower Mississippi Delta Nutrition Intervention Research Initiative Food Frequency Questionnaire (Delta NIRI FFQ). Results: A high-fat diet was associated with increased blood serum TNFα (p = 0.02) compared to the low-fat diet. In addition, global cognition scores were 9.0% better in those who consumed a higher fat diet (p = 0.04). No significant differences across groups were noted for executive function, dual-tasking, and visuospatial performance. Conclusion: These results indicate that there may be multiple biological pathways involved in AD development, suggesting the need for more holistic approaches to mitigate AD-development risk.
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Affiliation(s)
- Jordan M Jackson
- Emory University's Rollins School of Public Health, Gangarosa Department of Environmental Health, Atlanta, GA, USA
| | - Allison A Bay
- Emory University School of Medicine Department of Medicine, Division of General Medicine and Geriatrics, Atlanta, GA, USA
| | - Jolie Denise Barter
- Emory University School of Medicine Department of Medicine, Division of General Medicine and Geriatrics, Atlanta, GA, USA
| | - Liang Ni
- Emory University School of Medicine Department of Medicine, Division of General Medicine and Geriatrics, Atlanta, GA, USA
| | - William Michael Caudle
- Emory University's Rollins School of Public Health, Gangarosa Department of Environmental Health, Atlanta, GA, USA.,Emory Center for Neurodegenerative Disease, Atlanta, GA, USA
| | - Monica C Serra
- Division of Geriatrics, Gerontology & Palliative Medicine, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,San Antonio Geriatrics Research, Education & Clinical Center, South Texas Veterans Health Care System, San Antonio, TX, USA
| | | | - Madeleine E Hackney
- Emory University School of Medicine Department of Medicine, Division of General Medicine and Geriatrics, Atlanta, GA, USA.,Emory University School of Nursing, Atlanta, GA, USA.,Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Decatur, GA, USA.,Emory University School of Medicine, Department of Rehabilitation Medicine, Atlanta, GA, USA
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Hackney ME, McCullough LE, Bay AA, Silverstein HA, Hart AR, Shin RJ, Wharton W. Rationale and Design of a Clinical Trial of Adapted Tango to Improve Negative Health Impacts in Middle Aged African-American Female Caregivers of Persons with Alzheimer's Disease (ACT Trial). J Alzheimers Dis 2020; 68:767-775. [PMID: 30883357 DOI: 10.3233/jad-181130] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Alzheimer's disease (AD) is a devastating progressive neurodegenerative disease resulting in memory loss and a severe reduction in ability to perform activities of daily living. The role of caring for someone with AD frequently falls to female family members, often daughters. The burden of caregiving can increase stress and anxiety and cause health decline in the caregiver. The combination of ethnicity-related genetic factors promoting the development of dementias among African-Americans (AA) and the increased risk among women for developing AD means that AA women who are caregivers of a parent with AD are at great risk for developing dementias including AD. The proposed study would compare the cognitive, motor, and psychosocial benefits of a well-established 12 week, 20-lesson adapted Argentine Tango intervention (N = 30) to a no-contact control group (N = 10) in middle-aged (45-65 years) AA women who are caregivers of a parent with AD in the metro Atlanta area.
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Affiliation(s)
- Madeleine E Hackney
- Department of Medicine, Division of General Medicine and Geriatrics, Emory School of Medicine, Atlanta, GA, USA.,Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Decatur, GA, USA.,Department of Rehabilitation Medicine, Emory School of Medicine, Atlanta, GA, USA
| | | | - Allison A Bay
- Department of Medicine, Division of General Medicine and Geriatrics, Emory School of Medicine, Atlanta, GA, USA
| | - Hayley A Silverstein
- Department of Medicine, Division of General Medicine and Geriatrics, Emory School of Medicine, Atlanta, GA, USA
| | - Ariel R Hart
- Department of Medicine, Division of General Medicine and Geriatrics, Emory School of Medicine, Atlanta, GA, USA
| | - Ryan J Shin
- Emory University College of Arts and Sciences, Atlanta, GA, USA
| | - Whitney Wharton
- Department of Neurology, Atlanta, Emory University School of Medicine, GA, USA
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Bay AA, Prizer L, Orusa A, Hart AR, Perkins MM, Hackney ME. Effects of a Health Education and Research Participation Enhancement Program on Participation and Autonomy in Diverse Older Adults. Gerontol Geriatr Med 2020; 6:2333721420924952. [PMID: 32587881 PMCID: PMC7294373 DOI: 10.1177/2333721420924952] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/28/2020] [Accepted: 03/06/2020] [Indexed: 11/16/2022] Open
Abstract
Social engagement and autonomy are vital for life satisfaction among older adults. We measured multiple domains of social participation and autonomy in 120 adults over age 55 years that were part of an educational program at pretest, posttest, and follow-up. Quantitative and qualitative data were analyzed for differences between Black and White participants. White participants reported worse engagement in the family role domain and a lower Total Participation Score at posttest than pretest; however, scores returned to baseline levels by follow-up. Black participants reported better levels of participation in the social relationship domain at follow-up than at pretest. We found no evidence of qualitative differences between racial groups. Barriers to social participation and autonomy included challenges related to health, ageism, transportation, and mobility. Adequate housing, social support, socialization, and perception of individual utility contributed to feeling independent. Educational programs for older adults may provide an opportunity for increased social participation.
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Affiliation(s)
- Allison A Bay
- Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Lindsay Prizer
- Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Ahauve Orusa
- Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Ariel R Hart
- Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Molly M Perkins
- Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Emory University School of Nursing, Atlanta, GA, USA.,Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Decatur, GA, USA
| | - Madeleine E Hackney
- Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Emory University School of Nursing, Atlanta, GA, USA.,Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Decatur, GA, USA.,Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Decatur, GA, USA.,Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Bay AA, Hart AR, Michael Caudle W, Corcos DM, Hackney ME. The association between Parkinson's disease symptom side-of-onset and performance on the MDS-UPDRS scale part IV: Motor complications. J Neurol Sci 2018; 396:262-265. [PMID: 30537631 DOI: 10.1016/j.jns.2018.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 07/19/2018] [Revised: 10/18/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Parkinson's disease (PD) is a neurodegenerative condition associated with aging characterized by loss of dopamine-producing neurons in the substantia nigra pars compacta and a reduction in dopamine levels in the striatum. PD is commonly treated using dopamine-replacement medication called levodopa. Levodopa has decreasing efficacy over time. Periods when levodopa is not effective at controlling symptoms of PD are called "OFF-time" or "medication-related motor fluctuations," (MRMF). One characteristic of PD is unilateral side of symptom onset. Previous studies have found that side of onset was associated with differential motor and cognitive PD-related symptoms. The main study objective was to examine differences in left and right onset PD patients and OFF-time as measured by the Movement Disorders Society Unified Parkinson Disease Rating Scale (MDS-UPDRS) Part IV Sum Score and Part IV item scores. METHODS 64 individuals with mild-moderate PD (age: M(SD) = 68.72 (8.88)), years with PD: M(SD) = 6.61 (5.05); Hoehn and Yahr stage Med (1st, 3rd quartile) = 2.0 (2.0, 3.0) were assessed with the MDS-UPDRS parts I-IV. We conducted two-tailed independent sample t-tests to examine the differences between PD patients with left versus right onset. RESULTS Right onset PD was significantly associated with more overall MRMF (p = 0.01), more OFF-time (p = 0.04), greater impact of motor fluctuations on daily life (p = 0.02) and more complex (unpredictable) MRMF (p = 0.01). CONCLUSION People with right onset PD have more complications with levodopa treatment. Alternative and/or adjuvant treatments to levodopa may be particularly beneficial for those with right onset PD.
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Affiliation(s)
- Allison A Bay
- Division of General Medicine and Geriatrics, Department of Medicine, Emory School of Medicine, 1648 Pierce Dr. NE, Atlanta, GA 30307, USA
| | - Ariel R Hart
- Division of General Medicine and Geriatrics, Department of Medicine, Emory School of Medicine, 1648 Pierce Dr. NE, Atlanta, GA 30307, USA
| | - W Michael Caudle
- Department of Environmental Health, Emory University Rollins School of Public Health, 1518 Clifton Rd., Atlanta, GA 30322, USA
| | - Daniel M Corcos
- Physical Therapy and Human Movement Science, Northwestern University, 633 Clark St., Evanston, IL 60208, USA
| | - Madeleine E Hackney
- Division of General Medicine and Geriatrics, Department of Medicine, Emory School of Medicine, 1648 Pierce Dr. NE, Atlanta, GA 30307, USA; Atlanta VA Center for Visual and Neurocognitive Rehabilitation, 1670 Clairmont Rd., Decatur, GA 30033, USA; Department of Rehabilitation Medicine, Emory School of Medicine, 1648 Pierce Dr. NE, Atlanta, GA 30307, USA.
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