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Kim H, Senders A, Sergi C, Simeon E, Huang SS, Dodge HH, McConnell KJ, Roberts ET. Differences in healthcare utilization between enrollees of fully integrated dual eligible special needs plans versus non-fully integrated plans. J Am Geriatr Soc 2024. [PMID: 38581144 DOI: 10.1111/jgs.18916] [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: 11/28/2023] [Revised: 03/06/2024] [Accepted: 03/15/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Policymakers advocate care integration models to enhance Medicare and Medicaid service coordination for dually eligible individuals. One rapidly expanding model is the fully integrated dual eligible (FIDE) plan, a sub-type of the dual eligible special needs plan (D-SNP) in which a parent insurer manages Medicare and Medicaid spending for dually eligible individuals. We examined healthcare utilization differences among dually eligible individuals aged 65 years or older enrolled in D-SNPs by plan type (FIDE vs non-FIDE). METHODS Using 2018 Medicare Advantage encounters and Medicaid claims of FIDE and non-FIDE enrollees in six states (AZ, CA, FL, NY, TN, WI), we compared healthcare utilization between plan types, adjusting for enrollee characteristics and county indicators. We applied propensity score weighting to address differences between FIDE and non-FIDE plan enrollees. RESULTS In our main analysis, which included all dually eligible individuals in our sample, we observed no significant difference in healthcare utilization between FIDE and non-FIDE plan enrollees. However, we identified some differences in healthcare utilization between FIDE and non-FIDE plan enrollees in subgroup analyses. For example, among home and community-based service (HCBS) users, FIDE plan enrollees had 6.0 fewer hospitalizations per 1000 person-months (95% CI: -7.9, -4.0) and were 7.0 percentage points more likely to be discharged to home (95% CI: 2.6, 11.5) after hospitalization, compared to non-FIDE plan enrollees. CONCLUSION While we found no differences in healthcare utilization between FIDE and non-FIDE plan enrollees when considering all dually eligible individuals in our sample, some differences emerged when focusing on subgroups. For example, HCBS users with FIDE plans had fewer hospitalizations and were more likely to be discharged to their home following hospitalization, compared to HCBS users with non-FIDE plans. These findings suggest that FIDE plans may improve care coordination for specific subsets of dually eligible individuals.
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Affiliation(s)
- Hyunjee Kim
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon, USA
| | - Angela Senders
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon, USA
| | - Clint Sergi
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon, USA
| | - Erika Simeon
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon, USA
| | - Sean Shenghsiu Huang
- Department of Health Systems Administration, Georgetown University, Washington, DC, USA
| | - Hiroko H Dodge
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - K John McConnell
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon, USA
| | - Eric T Roberts
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Dodge HH, Yu K, Wu CY, Pruitt PJ, Asgari M, Kaye JA, Hampstead BM, Struble L, Potempa K, Lichtenberg P, Croff R, Albin RL, Silbert LC. Internet-Based Conversational Engagement Randomized Controlled Clinical Trial (I-CONECT) Among Socially Isolated Adults 75+ Years Old With Normal Cognition or Mild Cognitive Impairment: Topline Results. The Gerontologist 2024; 64:gnad147. [PMID: 37935416 PMCID: PMC10943511 DOI: 10.1093/geront/gnad147] [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] [Received: 04/28/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Social isolation is a risk factor for cognitive decline and dementia. We conducted a randomized controlled clinical trial (RCT) of enhanced social interactions, hypothesizing that conversational interactions can stimulate brain functions among socially isolated older adults without dementia. We report topline results of this multisite RCT (Internet-based conversational engagement clinical trial [I-CONECT]; NCT02871921). RESEARCH DESIGN AND METHODS The experimental group received cognitively stimulating semistructured conversations with trained interviewers via internet/webcam 4 times per week for 6 months (induction) and twice per week for an additional 6 months (maintenance). The experimental and control groups both received weekly 10 minutes telephone check-ins. Protocol modifications were required due to the coronavirus disease 2019 pandemic. RESULTS A total of 186 participants were randomized. After the induction period, the experimental group had higher global cognitive test scores (Montreal Cognitive Assessment [primary outcome]; 1.75 points [p = .03]) compared with the control group. After induction, experimental group participants with normal cognition had higher language-based executive function (semantic fluency test [secondary outcome]; 2.56 points [p = .03]). At the end of the maintenance period, the experimental group of mild cognitive impairment subjects had higher encoding function (Craft Story immediate recall test [secondary outcome]; 2.19 points [p = .04]). Measure of emotional well-being improved in both control and experimental groups. Resting-state functional magnetic resonance imaging showed that the experimental group had increased connectivity within the dorsal attention network relative to the control group (p = .02), but the sample size was limited. DISCUSSION AND IMPLICATIONS Providing frequent stimulating conversational interactions via the internet could be an effective home-based dementia risk-reduction strategy against social isolation and cognitive decline. CLINICAL TRIALS REGISTRATION NUMBER NCT02871921.
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Affiliation(s)
- Hiroko H Dodge
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Oregon Center for Aging and Technology (ORCATECH), Oregon Health & Science University, Portland, Oregon, USA
| | - Kexin Yu
- Oregon Center for Aging and Technology (ORCATECH), Oregon Health & Science University, Portland, Oregon, USA
- Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Chao-Yi Wu
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Oregon Center for Aging and Technology (ORCATECH), Oregon Health & Science University, Portland, Oregon, USA
| | - Patrick J Pruitt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Meysam Asgari
- Oregon Center for Aging and Technology (ORCATECH), Oregon Health & Science University, Portland, Oregon, USA
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - Jeffrey A Kaye
- Oregon Center for Aging and Technology (ORCATECH), Oregon Health & Science University, Portland, Oregon, USA
- Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Benjamin M Hampstead
- Michigan Alzheimer's Disease Center, Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
- Research Program on Cognition and Neuromodulation Based Interventions, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Laura Struble
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Kathleen Potempa
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Peter Lichtenberg
- Institute of Gerontology and Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Raina Croff
- Oregon Center for Aging and Technology (ORCATECH), Oregon Health & Science University, Portland, Oregon, USA
- Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Roger L Albin
- Michigan Alzheimer's Disease Center, Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
- GRECC & Neurology Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Lisa C Silbert
- Oregon Center for Aging and Technology (ORCATECH), Oregon Health & Science University, Portland, Oregon, USA
- VA Portland Healthcare System, Portland, Oregon, USA
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Hoang B, Pang Y, Dodge HH, Zhou J. Subject Harmonization of Digital Biomarkers: Improved Detection of Mild Cognitive Impairment from Language Markers. Pac Symp Biocomput 2024; 29:187-200. [PMID: 38160279 PMCID: PMC11017207] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Mild cognitive impairment (MCI) represents the early stage of dementia including Alzheimer's disease (AD) and is a crucial stage for therapeutic interventions and treatment. Early detection of MCI offers opportunities for early intervention and significantly benefits cohort enrichment for clinical trials. Imaging and in vivo markers in plasma and cerebrospinal fluid biomarkers have high detection performance, yet their prohibitive costs and intrusiveness demand more affordable and accessible alternatives. The recent advances in digital biomarkers, especially language markers, have shown great potential, where variables informative to MCI are derived from linguistic and/or speech and later used for predictive modeling. A major challenge in modeling language markers comes from the variability of how each person speaks. As the cohort size for language studies is usually small due to extensive data collection efforts, the variability among persons makes language markers hard to generalize to unseen subjects. In this paper, we propose a novel subject harmonization tool to address the issue of distributional differences in language markers across subjects, thus enhancing the generalization performance of machine learning models. Our empirical results show that machine learning models built on our harmonized features have improved prediction performance on unseen data. The source code and experiment scripts are available at https://github.com/illidanlab/subject_harmonization.
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Affiliation(s)
- Bao Hoang
- Department of Computer Science and Engineering, Michigan State University, East Lansing, MI 48824, USA
| | - Yijiang Pang
- Department of Computer Science and Engineering, Michigan State University, East Lansing, MI 48824, USA
| | - Hiroko H. Dodge
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA02129, USA
| | - Jiayu Zhou
- Department of Computer Science and Engineering, Michigan State University, East Lansing, MI 48824, USA
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Trombetta BA, Wu C, Kuo E, de Geus MB, Dodge HH, Carlyle BC, Kivisäkk P, Arnold SE. Cerebrospinal fluid biomarker profiling of diverse pathophysiological domains in Alzheimer's disease. Alzheimers Dement (N Y) 2024; 10:e12440. [PMID: 38356471 PMCID: PMC10865489 DOI: 10.1002/trc2.12440] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION While Alzheimer's disease (AD) is defined by amyloid-β plaques and tau tangles in the brain, it is evident that many other pathophysiological processes such as inflammation, neurovascular dysfunction, oxidative stress, and metabolic derangements also contribute to the disease process and that varying contributions of these pathways may reflect the heterogeneity of AD. Here, we used a previously validated panel of cerebrospinal fluid (CSF) biomarkers to explore the degree to which different pathophysiological domains are dysregulated in AD and how they relate to each other. METHODS Twenty-five CSF biomarkers were analyzed in individuals with a clinical diagnosis of AD verified by positive CSF AD biomarkers (AD, n = 54) and cognitively unimpaired controls negative for CSF AD biomarkers (CU-N, n = 26) using commercial single- and multi-plex immunoassays. RESULTS We noted that while AD was associated with increased levels of only three biomarkers (MMP-10, FABP3, and 8OHdG) on a group level, half of all AD participants had increased levels of biomarkers belonging to at least two pathophysiological domains reflecting the diversity in AD. LASSO modeling showed that a panel of FABP3, 24OHC, MMP-10, MMP-2, and 8OHdG constituted the most relevant and minimally correlated set of variables differentiating AD from CU-N. Interestingly, factor analysis showed that two markers of metabolism and oxidative stress (24OHC and 8OHdG) contributed independent information separate from MMP-10 and FABP3 suggestive of two independent pathophysiological pathways in AD, one reflecting neurodegeneration and vascular pathology, and the other associated with metabolism and oxidative stress. DISCUSSION Better understanding of the heterogeneity among individuals with AD and the different contributions of pathophysiological processes besides amyloid-β and tau will be crucial for optimizing personalized treatment strategies. Highlights A panel of 25 highly validated biomarker assays were measured in CSF.MMP10, FABP3, and 8OHdG were increased in AD in univariate analysis.Many individuals with AD had increased levels of more than one biomarker.Markers of metabolism and oxidative stress contributed to an AD multianalyte profile.Assessing multiple biomarker domains is important to understand disease heterogeneity.
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Affiliation(s)
- Bianca A. Trombetta
- Department of Neurology, Alzheimer's Clinical and Translational Research UnitMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Chao‐Yi Wu
- Department of Neurology, Alzheimer's Clinical and Translational Research UnitMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Evan Kuo
- Department of Neurology, Alzheimer's Clinical and Translational Research UnitMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Matthijs B. de Geus
- Department of Neurology, Alzheimer's Clinical and Translational Research UnitMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Department of Cell & Chemical BiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Hiroko H. Dodge
- Department of Neurology, Alzheimer's Clinical and Translational Research UnitMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Becky C. Carlyle
- Department of Neurology, Alzheimer's Clinical and Translational Research UnitMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Department of Physiology, Anatomy and GeneticsUniversity of OxfordOxfordUK
- Kavli Institute for Nanoscience DiscoveryUniversity of OxfordOxfordUK
| | - Pia Kivisäkk
- Department of Neurology, Alzheimer's Clinical and Translational Research UnitMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Steven E. Arnold
- Department of Neurology, Alzheimer's Clinical and Translational Research UnitMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
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Fang F, Hughes TF, Weinstein A, Dodge HH, Jacobsen EP, Chang CCH, Snitz BE, Ganguli M. Social Isolation and Loneliness in a Population Study of Cognitive Impairment: The MYHAT Study. J Appl Gerontol 2023; 42:2313-2324. [PMID: 37518906 PMCID: PMC10825064 DOI: 10.1177/07334648231192053] [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: 08/01/2023] Open
Abstract
In this study, we examined associations of social isolation and loneliness with cognitive impairment among older adults from a Rust Belt region in Southwest Pennsylvania. We used data from the population-based Monongahela-Youghiogheny Healthy Aging Team (MYHAT) study. We found that (a) 11 items combined into two reliable composites of social isolation and loneliness; (b) unique to this study, providing unpaid help to others was an indicator of reduced social isolation; (c) social isolation and loneliness were positively associated with cognitive impairment; and (d) these associations were appreciably attenuated by general health and physical functional status and depressive symptoms, respectively. We concluded that social isolation and loneliness are differentially associated with older adults' cognitive health, and that their effects might operate through separate pathways. Approaches to address social isolation and loneliness should consider the community context and its implications for older adults' cognitive health.
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Affiliation(s)
- Fang Fang
- Research and Infrastructure Research Service (RISE) and Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Tiffany F. Hughes
- Department of Graduate Studies in Health and Rehabilitation Sciences, Bitonte College of Health and Human Services, Youngstown State University, Youngstown, OH, USA
| | - Andrea Weinstein
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hiroko H. Dodge
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Erin P. Jacobsen
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chung-Chou H. Chang
- Department of Medicine, and Department of Biostatistics, School of Medicine and School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Beth E. Snitz
- Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary Ganguli
- Departments of Psychiatry, Neurology, and Epidemiology, School of Medicine and School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Struble LM, Potempa K, Lichtenberg PA, Croff RL, Ellis A, Dodge HH. Including Socially Isolated Black, Older Old Adults (Aged 80 and Above) with and without Mild Cognitive Impairment in a Clinical Trial: Recruitment Strategies and Perspectives. J Multidiscip Healthc 2023; 16:3663-3673. [PMID: 38046050 PMCID: PMC10693244 DOI: 10.2147/jmdh.s427946] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 11/10/2023] [Indexed: 12/05/2023] Open
Abstract
Objective This study describes strategies for the recruitment of socially isolated older old Black individuals to participate in the "Internet-based conversational engagement clinical trial (I-CONECT)" (Clinical Trial.gov: NCT02871921) and lessons learned in this critical population segment. Methods Best practice strategies to recruit the target population included mass mailings, advertisements, and direct community outreach, including the collaboration with a community group created to reach Black individuals interested in research participation. We also made protocol changes to measure recruitment criteria for older old Black adults more accurately and to increase their participation. Results Descriptive data related to the challenges and successes in recruiting Black participants compared to the White participants is presented. The primary site contacted 17,523 primarily White potential participants and enrolled/randomized 145 White and 2 Asian/mixed race participants (0.8%). The Midwest site contacted 12,141 Black potential participants and enrolled/randomized 39 (0.3%) participants. Discussion While best practices were employed, several factors complicated recruitment, including the need to adjust recruitment criteria, navigate regional regulations, and respect diverse community preferences. Conclusion Older old African Americans are reachable and willing to participate in research when considering their beliefs and practices, influenced by their community and experience.
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Affiliation(s)
- Laura M Struble
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Kathleen Potempa
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Peter A Lichtenberg
- Institute of Gerontology and Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Raina L Croff
- Oregon Center for Aging and Technology (ORCATECH), Oregon Health & Science University, Portland, Oregon, USA
- Layton Aging and Alzheimer’s Disease Center, Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Alexis Ellis
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Hiroko H Dodge
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Kim H, Senders A, Simeon E, Sergi C, Huang SS, Dodge HH, McConnell KJ. State-Level Adverse Outcomes Among Long-Term Services and Supports Users With Alzheimer's Disease and Related Dementias. Med Care Res Rev 2023:10775587231207668. [PMID: 37872791 DOI: 10.1177/10775587231207668] [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] [Indexed: 10/25/2023]
Abstract
Home- and community-based services (HCBS) users, on average, experience hospitalizations more frequently than nursing facility residents. However, little is known about state-level variation in such adverse events among these groups. Using 2018 Medicare and Medicaid claims for dual-eligible beneficiaries with Alzheimer's disease and related dementias, we described hospitalization and emergency department (ED) visit rates among HCBS users and nursing facility residents and observed substantial state-level variation. In addition, consistent with prior evidence, we found more frequent hospitalizations and ED visits among HCBS users than nursing facility residents. The magnitude of this difference varied considerably across states, and the degree of variation was greatest among beneficiaries with six or more comorbid conditions. Our findings represent a crucial initial exploration of the state-level variation in adverse events among HCBS users and nursing facility residents, paving the way for further investigations into factors that contribute to this variability.
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Affiliation(s)
- Hyunjee Kim
- Oregon Health & Science University, Portland, OR, USA
| | | | - Erika Simeon
- Oregon Health & Science University, Portland, OR, USA
| | - Clint Sergi
- Oregon Health & Science University, Portland, OR, USA
| | | | - Hiroko H Dodge
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Schwab N, Wu CY, Galler J, DeRamus T, Ford A, Gerber J, Kitchen R, Rashid B, Riley M, Sather L, Wang X, Young C, Yang L, Dodge HH, Arnold SE. Feasibility of common, enjoyable game play for assessing daily cognitive functioning in older adults. Front Neurol 2023; 14:1258216. [PMID: 37900599 PMCID: PMC10602782 DOI: 10.3389/fneur.2023.1258216] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
Background Frequent digital monitoring of cognition is a promising approach for assessing endpoints in prevention and treatment trials of Alzheimer's disease and related dementias (ADRD). This study evaluated the feasibility of the MIND GamePack© for recurrent semi-passive assessment of cognition across a longitudinal interval. Methods The MIND GamePack consists of four iPad-based games selected to be both familiar and enjoyable: Word Scramble, Block Drop, FreeCell, and Memory Match. Participants were asked to play 20 min/day for 5 days (100 min) for 4 months. Feasibility of use by older adults was assessed by measuring gameplay time and game performance. We also evaluated compliance through semi-structured surveys. A linear generalized estimating equation (GEE) model was used to analyze changes in gameplay time, and a regression tree model was employed to estimate the days it took for game performance to plateau. Subjective and environmental factors associated with gameplay time and performance were examined, including daily self-reported questions of memory and thinking ability, mood, sleep, energy, current location, and distractions prior to gameplay. Results Twenty-six cognitively-unimpaired older adults participated (mean age ± SD = 71.9 ± 8.6; 73% female). Gameplay time remained stable throughout the 4-months, with an average compliance rate of 91% ± 11% (1946 days of data across all participants) and weekly average playtime of 210 ± 132 min per participant. We observed an initial learning curve of improving game performance which on average, plateaued after 22-39 days, depending on the game. Higher levels of self-reported memory and thinking ability were associated with more gameplay time and sessions. Conclusion MIND GamePack is a feasible and well-designed semi-passive cognitive assessment platform which may provide complementary data to traditional neuropsychological testing in research on aging and dementia.
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Affiliation(s)
- Nadine Schwab
- Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Chao-Yi Wu
- Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Jake Galler
- Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Thomas DeRamus
- Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Abaigeal Ford
- Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Jessica Gerber
- Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Robert Kitchen
- Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Barnaly Rashid
- Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Misha Riley
- Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Lauren Sather
- Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Xifeng Wang
- AbbVie, Inc., North Chicago, IL, United States
| | - Cathrine Young
- Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | | | - Hiroko H. Dodge
- Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Steven E. Arnold
- Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
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9
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Zhang M, Ho E, Nowinski CJ, Fox RS, Ayturk E, Karpouzian-Rogers T, Novack M, Dodge HH, Weintraub S, Gershon R. The Paradox in Positive and Negative Aspects of Emotional Functioning Among Older Adults with Early Stages of Cognitive Impairment. J Aging Health 2023:8982643231199806. [PMID: 37800686 DOI: 10.1177/08982643231199806] [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] [Indexed: 10/07/2023]
Abstract
Introduction: Emotional functioning in older adults is influenced by normal aging and cognitive impairment, likely heterogeneous across positive versus negative aspects of emotional functioning. Little is known about positive emotional experiences at the early stages of cognitive impairment. Methods: We assessed different aspects of emotional functioning among 448 participants aged 65+ (Normal Control (NC) = 276, Mild Cognitive Impairment (MCI) = 103, and mild dementia of the Alzheimer type (mild DAT) = 69) and tested moderators. Results: Compared to NC, older adults with MCI and mild DAT have maintained many positive aspects of emotional functioning, despite higher levels of negative affect, sadness, and loneliness. Among the oldest-old, the mild DAT group experienced higher fear and lower self-efficacy. Discussion: Older adults at early stages of cognitive impairment can experience positive aspects of emotional functioning, such as positive affect, purpose, and life satisfaction, all of which are important buildable psychological resources for coping.
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Affiliation(s)
- Manrui Zhang
- Feinberg School of Medicine, Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Emily Ho
- Feinberg School of Medicine, Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Cindy J Nowinski
- Feinberg School of Medicine, Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Department of Neurology, Northwestern University, Chicago, IL, USA
| | - Rina S Fox
- Feinberg School of Medicine, Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- College of Nursing, University of Arizona, Tuscon, AZ, USA
| | - Ezgi Ayturk
- College of Social Sciences and Humanities, KOC Universitesi, Istanbul, Turkey
| | - Tatiana Karpouzian-Rogers
- Department of Psychiatry and Behavioral Sciences, Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Miriam Novack
- Feinberg School of Medicine, Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Hiroko H Dodge
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sandra Weintraub
- Department of Psychiatry and Behavioral Sciences, Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Richard Gershon
- Feinberg School of Medicine, Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
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Dodge HH, Arnold SE. One step forward to personalized medicine? Alzheimers Dement (N Y) 2023; 9:e12435. [PMID: 38023621 PMCID: PMC10652033 DOI: 10.1002/trc2.12435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Hiroko H. Dodge
- Interdisciplinary Brain Center (IBC) and Department of NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Steven E. Arnold
- Interdisciplinary Brain Center (IBC) and Department of NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
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Garcia S, Askew RL, Kavcic V, Shair S, Bhaumik AK, Rose E, Campbell S, May N, Hampstead BM, Dodge HH, Heidebrink JL, Paulson HL, Giordani B. Mild Cognitive Impairment Subtype Performance in Comparison to Healthy Older Controls on the NIH Toolbox and Cogstate. Alzheimer Dis Assoc Disord 2023; 37:328-334. [PMID: 37862614 PMCID: PMC10873007 DOI: 10.1097/wad.0000000000000587] [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] [Received: 02/20/2023] [Accepted: 09/06/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Early detection is necessary for the treatment of dementia. Computerized testing has become more widely used in clinical trials; however, it is unclear how sensitive these measures are to early signs of neurodegeneration. We investigated the use of the NIH Toolbox-Cognition (NIHTB-CB) and Cogstate-Brief computerized neuropsychological batteries in the identification of mild cognitive impairment (MCI) versus healthy older adults [healthy control (HC)] and amnestic (aMCI) versus nonamnestic MCI (naMCI). Exploratory analyses include investigating potential racial differences. METHODS Two hundred six older adults were diagnosed as aMCI (n = 58), naMCI (n = 15), or cognitively healthy (HC; n = 133). RESULTS The NIH Toolbox-CB subtests of Flanker, Picture Sequence Memory, and Picture Vocabulary significantly differentiated MCI from HC. Further, subtests from both computerized batteries differentiated patients with aMCI from those with naMCI. Although the main effect of race differences was noted on tests and in diagnostic groups was significant, there were no significant race-by-test interactions. CONCLUSIONS Computer-based subtests vary in their ability to help distinguish MCI subtypes, though these tests provide less expensive and easier-to-administer clinical screeners to help identify patients early who may qualify for more comprehensive evaluations. Further work is needed, however, to refine computerized tests to achieve better precision in distinguishing impairment subtypes.
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Affiliation(s)
- Sarah Garcia
- Psychology Department, Stetson University, DeLand, FL, USA
| | | | | | - Sarah Shair
- Departments of Psychiatry, Neurology, Psychology, and School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Michigan Alzheimer’s Disease Research Center, Ann Arbor, MI, USA
| | - Arijit K Bhaumik
- Departments of Psychiatry, Neurology, Psychology, and School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Michigan Alzheimer’s Disease Research Center, Ann Arbor, MI, USA
| | - Edna Rose
- Departments of Psychiatry, Neurology, Psychology, and School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Michigan Alzheimer’s Disease Research Center, Ann Arbor, MI, USA
| | - Stephen Campbell
- Departments of Psychiatry, Neurology, Psychology, and School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Michigan Alzheimer’s Disease Research Center, Ann Arbor, MI, USA
| | - Nicolas May
- Michigan Alzheimer’s Disease Research Center, Ann Arbor, MI, USA
| | - Benjamin M. Hampstead
- Departments of Psychiatry, Neurology, Psychology, and School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Michigan Alzheimer’s Disease Research Center, Ann Arbor, MI, USA
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Hiroko H. Dodge
- Layton Aging and Alzheimer’s Disease Center, Department of Neurology, Oregon Health & Science University, Portland, OR
| | - Judith L Heidebrink
- Departments of Psychiatry, Neurology, Psychology, and School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Michigan Alzheimer’s Disease Research Center, Ann Arbor, MI, USA
| | - Henry L Paulson
- Departments of Psychiatry, Neurology, Psychology, and School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Michigan Alzheimer’s Disease Research Center, Ann Arbor, MI, USA
| | - Bruno Giordani
- Departments of Psychiatry, Neurology, Psychology, and School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Michigan Alzheimer’s Disease Research Center, Ann Arbor, MI, USA
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12
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Hantke NC, Kaye J, Mattek N, Wu CY, Dodge HH, Beattie Z, Woltjer R. Correlating continuously captured home-based digital biomarkers of daily function with postmortem neurodegenerative neuropathology. PLoS One 2023; 18:e0286812. [PMID: 37289845 PMCID: PMC10249904 DOI: 10.1371/journal.pone.0286812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/23/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Outcome measures available for use in Alzheimer's disease (AD) clinical trials are limited in ability to detect gradual changes. Measures of everyday function and cognition assessed unobtrusively at home using embedded sensing and computing generated "digital biomarkers" (DBs) have been shown to be ecologically valid and to improve efficiency of clinical trials. However, DBs have not been assessed for their relationship to AD neuropathology. OBJECTIVES The goal of the current study is to perform an exploratory examination of possible associations between DBs and AD neuropathology in an initially cognitively intact community-based cohort. METHODS Participants included in this study were ≥65 years of age, living independently, of average health for age, and followed until death. Algorithms, run on the continuously-collected passive sensor data, generated daily metrics for each DB: cognitive function, mobility, socialization, and sleep. Fixed postmortem brains were evaluated for neurofibrillary tangles (NFTs) and neuritic plaque (NP) pathology and staged by Braak and CERAD systems in the context of the "ABC" assessment of AD-associated changes. RESULTS The analysis included a total of 41 participants (M±SD age at death = 92.2±5.1 years). The four DBs showed consistent patterns relative to both Braak stage and NP score severity. Greater NP severity was correlated with the DB composite and reduced walking speed. Braak stage was associated with reduced computer use time and increased total time in bed. DISCUSSION This study provides the first data showing correlations between DBs and neuropathological markers in an aging cohort. The findings suggest continuous, home-based DBs may hold potential to serve as behavioral proxies that index neurodegenerative processes.
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Affiliation(s)
- Nathan C. Hantke
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States of America
- Oregon Center for Aging & Technology (ORCATECH), Portland, OR, United States of America
- Mental Health and Clinical Neuroscience Division, VA Portland Health Care System, Portland, OR, United States of America
| | - Jeffrey Kaye
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States of America
- Oregon Center for Aging & Technology (ORCATECH), Portland, OR, United States of America
| | - Nora Mattek
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States of America
- Oregon Center for Aging & Technology (ORCATECH), Portland, OR, United States of America
| | - Chao-Yi Wu
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States of America
- Oregon Center for Aging & Technology (ORCATECH), Portland, OR, United States of America
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Hiroko H. Dodge
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States of America
- Oregon Center for Aging & Technology (ORCATECH), Portland, OR, United States of America
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Zachary Beattie
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States of America
- Oregon Center for Aging & Technology (ORCATECH), Portland, OR, United States of America
| | - Randy Woltjer
- Department of Pathology and Laboratory Medicine, Oregon Health & Science University, Portland, OR, United States of America
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13
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Yuan F, Zhou W, Dodge HH, Zhao X. Short: Causal structural learning of conversational engagement for socially isolated older adults. Smart Health (Amst) 2023; 28:100384. [PMID: 37065441 PMCID: PMC10101035 DOI: 10.1016/j.smhl.2023.100384] [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] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Social isolation has become a growing public health concern in older adults and older adults with mild cognitive impairment. Coping strategies must be developed to increase social contact for socially isolated older adults. In this paper, we explored the conversational strategy between trained conversation moderators and socially isolated adults during a conversational engagement clinical trial (Clinicaltrials.gov: NCT02871921). We carried out structural learning and causality analysis to investigate the conversation strategies used by the trained moderators to engage socially isolated adults in the conversation and the causal effects of the strategy on engagement. Causal relations and effects were inferred between participants' emotions, the dialogue strategies used by moderators, and participants' following emotions. The results found in this paper may be used to support the development of cost-efficient, trustworthy AI- and/or robot-based platform to promote conversational engagement for older adults to address the challenges in social interaction.
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Affiliation(s)
- Fengpei Yuan
- Department of Mechanical, Aerospace and Biomedical Engineering, The University of Tennessee Knoxville, 1512 Middle Drive, Knoxville, TN, 37996, USA
| | - Wenjun Zhou
- Department of Business Analytics and Statistics, The University of Tennessee Knoxville, 916 Volunteer Blvd., Knoxville, TN, 37996, USA
| | - Hiroko H. Dodge
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Xiaopeng Zhao
- Department of Mechanical, Aerospace and Biomedical Engineering, The University of Tennessee Knoxville, 1512 Middle Drive, Knoxville, TN, 37996, USA
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Kallianpur KJ, Masaki KH, Chen R, Willcox BJ, Allsopp RC, Davy P, Dodge HH. Weak Social Networks in Late Life Predict Incident Alzheimer's Disease: The Kuakini Honolulu-Asia Aging Study. J Gerontol A Biol Sci Med Sci 2023; 78:663-672. [PMID: 36208464 PMCID: PMC10061568 DOI: 10.1093/gerona/glac215] [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] [Received: 03/15/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We assessed 10-year longitudinal associations between late-life social networks and incidence of all-cause dementia (ACD), Alzheimer's disease (AD), and vascular dementia (VaD) in Japanese-American men. METHODS We prospectively analyzed, from baseline (1991-1993) through 1999-2000, 2636 initially nondemented Kuakini Honolulu-Asia Aging Study participants who remained dementia-free during the first 3 years of follow-up. Global cognition was evaluated by the Cognitive Abilities Screening Instrument (CASI); depressive symptoms by the 11-item Center for Epidemiologic Studies Depression (CES-D) Scale; and social networks by the Lubben Social Network Scale (LSNS). Median split of LSNS scores defined weak/strong social network groups. A panel of neurologists and geriatricians diagnosed and classified dementia; AD and VaD diagnoses comprised cases in which AD or VaD, respectively, were considered the primary cause of dementia. RESULTS Median (range) baseline age was 77 (71-93) years. Participants with weak (LSNS score ≤29) versus strong (>29) social networks had higher age-adjusted incidence (in person-years) of ACD (12.6 vs. 8.7; p = .014) and AD (6.7 vs. 4.0; p = .007) but not VaD (2.4 vs. 1.4; p = .15). Kaplan-Meier curves showed a lower likelihood of survival free of ACD (log-rank p < .0001) and AD (p = .0006) for men with weak networks. In Cox proportional hazards models adjusting for age, education, APOE ɛ4, prevalent stroke, depressive symptoms, and CASI score (all at baseline), weak networks predicted increased incidence of ACD (hazard ratio [HR] = 1.52, p = .009) and AD (HR = 1.67, p = .014) but not VaD (p > .2). CONCLUSION Weak social networks may heighten the risk of dementia and AD, underscoring the need to promote social connectedness in older adults.
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Affiliation(s)
- Kalpana J Kallianpur
- Kuakini Center for Translational Research on Aging, Kuakini Medical Center, Honolulu, Hawaii, USA
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, University of Hawaii, Honolulu, Hawaii, USA
| | - Kamal H Masaki
- Kuakini Center for Translational Research on Aging, Kuakini Medical Center, Honolulu, Hawaii, USA
- Department of Geriatric Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Randi Chen
- Kuakini Center for Translational Research on Aging, Kuakini Medical Center, Honolulu, Hawaii, USA
| | - Bradley J Willcox
- Kuakini Center for Translational Research on Aging, Kuakini Medical Center, Honolulu, Hawaii, USA
- Department of Geriatric Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Richard C Allsopp
- Kuakini Center for Translational Research on Aging, Kuakini Medical Center, Honolulu, Hawaii, USA
| | - Philip Davy
- Kuakini Center for Translational Research on Aging, Kuakini Medical Center, Honolulu, Hawaii, USA
| | - Hiroko H Dodge
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
- Layton Aging and Alzheimer’s Disease Center, Oregon Health & Science University, Portland, Oregon, USA
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15
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Liu G, Xue Z, Zhan L, Dodge HH, Zhou J. Detection of Mild Cognitive Impairment from Language Markers with Crossmodal Augmentation. Pac Symp Biocomput 2023; 28:7-18. [PMID: 36540960 PMCID: PMC9782729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Mild cognitive impairment is the prodromal stage of Alzheimer's disease. Its detection has been a critical task for establishing cohort studies and developing therapeutic interventions for Alzheimer's. Various types of markers have been developed for detection. For example, imaging markers from neuroimaging have shown great sensitivity, while its cost is still prohibitive for large-scale screening of early dementia. Recent advances from digital biomarkers, such as language markers, have provided an accessible and affordable alternative. While imaging markers give anatomical descriptions of the brain, language markers capture the behavior characteristics of early dementia subjects. Such differences suggest the benefits of auxiliary information from the imaging modality to improve the predictive power of unimodal predictive models based on language markers alone. However, one significant barrier to the joint analysis is that in typical cohorts, there are only very limited subjects that have both imaging and language modalities. To tackle this challenge, in this paper, we develop a novel crossmodal augmentation tool, which leverages auxiliary imaging information to improve the feature space of language markers so that a subject with only language markers can benefit from imaging information through the augmentation. Our experimental results show that the multi-modal predictive model trained with language markers and auxiliary imaging information significantly outperforms unimodal predictive models.
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Affiliation(s)
- Guangliang Liu
- Department of Computer Science and Engineering, Michigan State University, East Lansing, MI 48824, USA
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16
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Pang Y, Kukull W, Sano M, Albin RL, Shen C, Zhou J, Dodge HH. Predicting Progression from Normal to MCI and from MCI to AD Using Clinical Variables in the National Alzheimer's Coordinating Center Uniform Data Set Version 3: Application of Machine Learning Models and a Probability Calculator. J Prev Alzheimers Dis 2023; 10:301-313. [PMID: 36946457 PMCID: PMC10033942 DOI: 10.14283/jpad.2023.10] [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: 01/15/2023]
Abstract
Clinical trials are increasingly focused on pre-manifest and early Alzheimer's disease (AD). Accurately predicting clinical progressions from normal to MCI or from MCI to dementia/AD versus non-progression is challenging. Accurate identification of symptomatic progressors is important to avoid unnecessary treatment and improve trial efficiency. Due to large inter-individual variability, biomarker positivity and comorbidity information are often insufficient to identify those destined to have symptomatic progressions. Using only clinical variables, we aimed to predict clinical progressions, estimating probabilities of progressions with a small set of variables selected by machine learning approaches. This work updates our previous work that was applied to the National Alzheimer's Coordinating Center (NACC) Uniform Data Set Version 2 (V2), by using the most recent version (V3) with additional analyses. We generated a user-friendly conversion probability calculator which can be used for effectively pre-screening trial participants.
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Affiliation(s)
- Y Pang
- Hiroko H. Dodge, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA,
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17
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Lahna D, Roese N, Woltjer R, Boespflug EL, Schwartz D, Grinstead J, Dodge HH, Wall R, Kaye JA, Rooney WD, Silbert LC. Postmortem 7T MRI for guided histopathology and evaluation of cerebrovascular disease. J Neuropathol Exp Neurol 2022; 82:57-70. [PMID: 36343095 PMCID: PMC9764082 DOI: 10.1093/jnen/nlac103] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Postmortem (PM) magnetic resonance imaging (MRI) can serve as a bridge between in vivo imaging and histology by connecting MRI observed macrostructural findings to histological staining and microstructural changes. Data were acquired from 20 formalin-fixed brains including T2, T1, PD, and T2*-weighted images of left hemispheres and 6-mm-thick coronal slices. Tissue slices were bisected, aligned to MR images and used to guide histological sampling. Markers of myelin and oligodendroglia alterations were semiquantitatively rated and compared within white matter hyperintensities (WMHs) and normal-appearing white matter. Tissue priors were created from 3T in vivo data and used to guide segmentation of WMH. PM WMH and hemisphere volumes were compared to volumes derived from in vivo data. PM T2 WMH and T1 hemisphere volumes were correlated with in vivo 3T FLAIR WMH and T1 hemisphere volumes. WMH showed significant myelin loss, decreased GFAP expression and increased vimentin expression. MR-visible perivascular spaces and cortical microvascular lesions were successfully captured on histopathological sections. PM MRI can quantify cerebrovascular disease burden and guide tissue sampling, allowing for more comprehensive characterization of cerebrovascular disease that may be used to study etiologies of age-related cognitive change.
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Affiliation(s)
- David Lahna
- NIA-Layton Alzheimer’s Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Natalie Roese
- NIA-Layton Alzheimer’s Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Randy Woltjer
- NIA-Layton Alzheimer’s Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA
- Department of Pathology, Oregon Health & Science University, Portland, Oregon, USA
| | - Erin L Boespflug
- NIA-Layton Alzheimer’s Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Daniel Schwartz
- NIA-Layton Alzheimer’s Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Hiroko H Dodge
- NIA-Layton Alzheimer’s Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rachel Wall
- NIA-Layton Alzheimer’s Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA
- Veterans Affairs Portland Health Care System, Portland, Oregon, USA
| | - Jeffrey A Kaye
- NIA-Layton Alzheimer’s Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - William D Rooney
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Lisa C Silbert
- NIA-Layton Alzheimer’s Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA
- Veterans Affairs Portland Health Care System, Portland, Oregon, USA
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18
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Schwartz DL, Roese NE, Hurworth J, Lahna D, Krajbich V, Kaye JA, Dodge HH, Woltjer R, Silbert LC. Ex vivo
quantitative amyloid and perivascular space measurements in white and gray matter on immunohistological microscopy in AD, MCI, and cognitively intact individuals. Alzheimers Dement 2022. [DOI: 10.1002/alz.069132] [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: 12/24/2022]
Affiliation(s)
| | | | - Justin Hurworth
- NIA‐Layton Aging & Alzheimer's Disease Research Center, Neuroimaging Core, Oregon Health & Science University Portland OR USA
| | - David Lahna
- NIA‐Layton Aging & Alzheimer's Disease Center; Neuroimaging Core, Oregon Health & Science University Portland OR USA
| | | | - Jeffrey A Kaye
- NIA‐Layton Aging & Alzheimer's Disease Research Center Portland OR USA
| | - Hiroko H Dodge
- NIA‐Layton Aging & Alzheimer's Disease Center, Oregon Health & Science University Portland OR USA
| | | | - Lisa C Silbert
- NIA‐Layton Aging & Alzheimer's Disease Center, Oregon Health & Science University Portland OR USA
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19
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Pang Y, Zhou J, Albin RL, Sano M, Shen C, Kukull WA, Dodge HH. Predicting Conversions from Normal to MCI and from MCI to AD with Clinical Variables in the National Alzheimer’s Coordinating Center Uniform Data Set Version 3: Application of Big Data Analytics and Transition Probability Calculators. Alzheimers Dement 2022. [DOI: 10.1002/alz.065231] [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: 12/24/2022]
Affiliation(s)
| | - Jiayu Zhou
- Michigan State University East Lansing MI USA
| | - Roger L. Albin
- VA Ann Arbor Healthcare System Ann Arbor MI USA
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA Ann Arbor MI USA
- Michigan Alzheimer’s Disease Center Ann Arbor MI USA
| | - Mary Sano
- Department of Psychiatry, Alzheimer’s Disease Research Center, Icahn School of Medicine at Mount Sinai New York NY USA
| | | | - Walter A. Kukull
- National Alzheimer’s Coordinating Center, University of Washington Seattle WA USA
- University of Washington Seattle WA USA
| | - Hiroko H Dodge
- NIA‐Layton Aging & Alzheimer’s Disease Center, Oregon Health & Science University Portland OR USA
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20
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Chen L, Asgari M, Dodge HH. Efficacy in linguistic characteristics: I‐CONECT project. Alzheimers Dement 2022. [DOI: 10.1002/alz.059652] [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: 12/24/2022]
Affiliation(s)
- Liu Chen
- NIA‐Layton Aging & Alzheimer’s Disease Center, Oregon Health & Science University Portland OR USA
| | - Meysam Asgari
- NIA‐Layton Aging & Alzheimer’s Disease Center, Oregon Health & Science University Portland OR USA
| | - Hiroko H Dodge
- NIA‐Layton Aging & Alzheimer’s Disease Center, Oregon Health & Science University Portland OR USA
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21
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Chen L, Dodge HH, Asgari M. Measures of Voice Quality as Indicators of Mild Cognitive Impairment. Alzheimers Dement 2022. [DOI: 10.1002/alz.067393] [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: 12/24/2022]
Affiliation(s)
- Liu Chen
- NIA‐Layton Aging & Alzheimer’s Disease Center, Oregon Health & Science University Portland OR USA
| | - Hiroko H Dodge
- NIA‐Layton Aging & Alzheimer’s Disease Center, Oregon Health & Science University Portland OR USA
| | - Meysam Asgari
- NIA‐Layton Aging & Alzheimer’s Disease Center, Oregon Health & Science University Portland OR USA
- Oregon Health & Science University Portland OR USA
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22
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Grill J, Berkness T, Carrillo MC, Snyder HM, Aisen P, Sperling RA, Petersen RC, Aggarwal NT, Bell KL, Burns JM, Donohue MC, Dodge HH, Espeland MA, Gillen DL, Geldmacher DS, Heidebrink JL, Jicha GA, Olichney JM, Rafii MS, Rentz DM, Salloway SP, Sethuraman G, Smith AG, Raman R. The Institute on Methods and Protocols for Advancement of Clinical Trials for ADRD (IMPACT‐AD): An update after two years of conduct. Alzheimers Dement 2022. [DOI: 10.1002/alz.064617] [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: 12/24/2022]
Affiliation(s)
- Joshua Grill
- Institute for Memory Impairments and Neurological Disorders University of California Irvine Irvine CA USA
| | - Tyler Berkness
- Alzheimer’s Therapeutic Research Institute University of Southern California San Diego CA USA
| | | | | | - Paul Aisen
- Alzheimer’s Therapeutic Research Institute University of Southern California San Diego CA USA
| | - Reisa A. Sperling
- Brigham and Women’s Hospital Harvard Medical School Boston MA USA
- Massachusetts General Hospital Brigham and Women’s Hospital Harvard Medical School Boston MA USA
| | | | - Neelum T. Aggarwal
- Rush Alzheimer’s Disease Center, Department of Neurological Sciences Chicago IL USA
| | - Karen L. Bell
- Department of Neurology Columbia University Vagelos College of Physicians and Surgeons New York NY USA
| | - Jeffrey M. Burns
- University of Kansas Alzheimer’s Disease Research Center Fairway KS USA
| | - Michael C. Donohue
- Alzheimer’s Therapeutic Research Institute Keck School of Medicine University of Southern California San Diego CA USA
| | - Hiroko H Dodge
- Layton Aging & Alzheimer’s Disease Center, Oregon Health & Science University Portland OR USA
| | | | | | | | | | | | | | - Michael S Rafii
- Alzheimer’s Therapeutic Research Institute University of Southern California San Diego CA USA
| | - Dorene M. Rentz
- Brigham and Women’s Hospital Harvard Medical School Boston MA USA
- Massachusetts General Hospital Harvard Medical School Boston MA USA
| | - Stephen P. Salloway
- Alpert Medical School of Brown University Providence RI USA
- Butler Hospital Providence RI USA
| | - Gopalan Sethuraman
- Alzheimer’s Therapeutic Research Institute University of Southern California San Diego CA USA
| | | | - Rema Raman
- Alzheimer’s Therapeutic Research Institute University of Southern California San Diego CA USA
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23
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Dodge HH, Wu C, Albin RL, Hampstead BM, Kaye JA, Wild K, Silbert LC. I‐CONECT: Efficacy in Primary and Secondary outcomes. Alzheimers Dement 2022. [DOI: 10.1002/alz.059655] [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: 12/24/2022]
Affiliation(s)
- Hiroko H Dodge
- NIA‐Layton Aging & Alzheimer’s Disease Center, Oregon Health & Science University Portland OR USA
| | - Chao‐Yi Wu
- NIA‐Layton Aging & Alzheimer’s Disease Center, Oregon Health & Science University Portland OR USA
| | - Roger L. Albin
- VA Ann Arbor Healthcare System Ann Arbor MI USA
- Michigan Alzheimer’s Disease Center Ann Arbor MI USA
| | - Benjamin M. Hampstead
- VA Ann Arbor Healthcare System Ann Arbor MI USA
- Michigan Alzheimer’s Disease Research Center Ann Arbor MI USA
| | - Jeffrey A Kaye
- NIA‐Layton Aging & Alzheimer’s Disease Research Center, Oregon Health & Science University Portland OR USA
- Portland Veterans Affairs Health Care System Portland OR USA
| | - Katherine Wild
- NIA‐Layton Aging & Alzheimer’s Disease Center, Oregon Health & Science University Portland OR USA
| | - Lisa C Silbert
- Portland Veterans Affairs Health Care System Portland OR USA
- NIA‐Layton Aging & Alzheimer’s Disease Research Center Portland OR USA
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Yu K, Hampstead BM, Wild K, Silbert LC, Dodge HH. Examining I‐CONECT Intervention Effect on Psychosocial Wellbeing. Alzheimers Dement 2022. [DOI: 10.1002/alz.059654] [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: 12/24/2022]
Affiliation(s)
- Kexin Yu
- University of Southern California Los Angeles CA USA
| | - Benjamin M. Hampstead
- Michigan Alzheimer’s Disease Research Center Ann Arbor MI USA
- VA Ann Arbor Healthcare System Ann Arbor MI USA
| | - Katherine Wild
- NIA‐Layton Aging & Alzheimer’s Disease Center, Oregon Health & Science University Portland OR USA
| | - Lisa C Silbert
- NIA‐Layton Aging & Alzheimer’s Disease Research Center Portland OR USA
- Portland Veterans Affairs Health Care System Portland OR USA
| | - Hiroko H Dodge
- Layton Aging & Alzheimer’s Disease Center, Oregon Health & Science University Portland OR USA
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Kallianpur KJ, Masaki KH, Chen R, Willcox BJ, Allsopp RC, Dodge HH. Social Networks and Incident Alzheimer’s Disease: the Kuakini Honolulu‐Asia Aging Study. Alzheimers Dement 2022. [DOI: 10.1002/alz.064370] [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: 12/24/2022]
Affiliation(s)
- Kalpana J Kallianpur
- Kuakini Center for Translational Research on Aging Honolulu HI USA
- John A. Burns School of Medicine, University of Hawaii Honolulu HI USA
| | - Kamal H Masaki
- Kuakini Center for Translational Research on Aging Honolulu HI USA
- John A. Burns School of Medicine, University of Hawaii Honolulu HI USA
| | - Randi Chen
- Kuakini Center for Translational Research on Aging Honolulu HI USA
| | - Bradley J Willcox
- Kuakini Center for Translational Research on Aging Honolulu HI USA
- John A. Burns School of Medicine, University of Hawaii Honolulu HI USA
| | - Richard C Allsopp
- Kuakini Center for Translational Research on Aging Honolulu HI USA
- John A. Burns School of Medicine, University of Hawaii Honolulu HI USA
| | - Hiroko H Dodge
- Oregon Health & Science University Portland OR USA
- Layton Aging & Alzheimer’s Disease Center, Oregon Health & Science University Portland OR USA
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Pruitt PJ, Lahna D, Schwartz DL, Peltier S, Silbert LC, Dodge HH. Social engagement intervention increases dorsal attention network functional connectivity in socially‐isolated older‐old adults: I‐CONECT. Alzheimers Dement 2022. [DOI: 10.1002/alz.059653] [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: 12/24/2022]
Affiliation(s)
| | - David Lahna
- Oregon Health & Science University Portland OR USA
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Yu K, Wild K, Dowling NM, Kaye JA, Silbert LC, Dodge HH. Emotional characteristics of socially isolated older adults with MCI using tablet administered NIH toolbox: I-CONECT study. Alzheimers Dement (Amst) 2022; 14:e12372. [PMID: 36381558 PMCID: PMC9652485 DOI: 10.1002/dad2.12372] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 11/15/2022]
Abstract
Introduction Examining the emotional functioning of individuals with mild cognitive impairment (MCI) could help describe their cognitive status and inform the development of interventions. This study compared the emotional characteristics of socially isolated older adults with and without MCI. Methods We used baseline data from the Internet-based Conversational Engagement Clinical Trial. Emotional characteristics were assessed with the National Institutes of Health Toolbox Emotion Battery (NIHTB-EB). MCI status was determined with a consensus clinical diagnosis. Results This study included 163 participants (mean age = 81.2 years, non-Hispanic Black = 20.7%, MCI = 52.8%). MCI was associated with higher negative affect and lower psychological well-being. Non-Hispanic Black participants scored lower in sadness, higher in positive affect, and higher in meaning and purpose than non-Hispanic White participants. Conclusion Older adults with MCI experience more negative emotions and worse psychological well-being than those with normal cognition. The NIHTB-EB appears to be a sensitive tool to detect emotional characteristics associated with cognitive decline.
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Affiliation(s)
- Kexin Yu
- NIA‐Layton Aging and Alzheimer's Disease CenterOregon Center for Aging & TechnologyDepartment of NeurologyOregon Health & Science UniversityPortlandOregonUSA
| | - Katherine Wild
- NIA‐Layton Aging and Alzheimer's Disease CenterOregon Center for Aging & TechnologyDepartment of NeurologyOregon Health & Science UniversityPortlandOregonUSA
| | - N. Maritza Dowling
- Department of Acute and Chronic CareSchool of Nursingand Department of Epidemiology & BiostatisticsMilken Institute of Public HealthGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Jeffrey A. Kaye
- NIA‐Layton Aging and Alzheimer's Disease CenterOregon Center for Aging & TechnologyDepartment of NeurologyOregon Health & Science UniversityPortlandOregonUSA
- Portland Veterans Affairs Health Care SystemPortlandOregonUSA
| | - Lisa C. Silbert
- NIA‐Layton Aging and Alzheimer's Disease CenterOregon Center for Aging & TechnologyDepartment of NeurologyOregon Health & Science UniversityPortlandOregonUSA
- Portland Veterans Affairs Health Care SystemPortlandOregonUSA
| | - Hiroko H. Dodge
- NIA‐Layton Aging and Alzheimer's Disease CenterOregon Center for Aging & TechnologyDepartment of NeurologyOregon Health & Science UniversityPortlandOregonUSA
- Department of NeurologyHarvard Medical SchoolMassachusetts General HospitalBostonMassachusettsUSA
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Wu CY, Dodge HH, Gothard S, Mattek N, Wright K, Barnes LL, Silbert LC, Lim MM, Kaye JA, Beattie Z. Unobtrusive Sensing Technology Detects Ecologically Valid Spatiotemporal Patterns of Daily Routines Distinctive to Persons With Mild Cognitive Impairment. J Gerontol A Biol Sci Med Sci 2022; 77:2077-2084. [PMID: 34608939 PMCID: PMC9536445 DOI: 10.1093/gerona/glab293] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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] [Received: 05/20/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The ability to capture people's movement throughout their home is a powerful approach to inform spatiotemporal patterns of routines associated with cognitive impairment. The study estimated indoor room activities over 24 hours and investigated relationships between diurnal activity patterns and mild cognitive impairment (MCI). METHODS One hundred and sixty-one older adults (26 with MCI) living alone (age = 78.9 ± 9.2) were included from 2 study cohorts-the Oregon Center for Aging & Technology and the Minority Aging Research Study. Indoor room activities were measured by the number of trips made to rooms (bathroom, bedroom, kitchen, living room). Trips made to rooms (transitions) were detected using passive infrared motion sensors fixed on the walls for a month. Latent trajectory models were used to identify distinct diurnal patterns of room activities and characteristics associated with each trajectory. RESULTS Latent trajectory models identified 2 diurnal patterns of bathroom usage (high and low usage). Participants with MCI were more likely to be in the high bathroom usage group that exhibited more trips to the bathroom than the low-usage group (odds ratio [OR] = 4.1, 95% CI [1.3-13.5], p = .02). For kitchen activity, 2 diurnal patterns were identified (high and low activity). Participants with MCI were more likely to be in the high kitchen activity group that exhibited more transitions to the kitchen throughout the day and night than the low kitchen activity group (OR = 3.2, 95% CI [1.1-9.1], p = .03). CONCLUSIONS The linkage between bathroom and kitchen activities with MCI may be the result of biological, health, and environmental factors in play. In-home, real-time unobtrusive-sensing offers a novel way of delineating cognitive health with chronologically-ordered movement across indoor locations.
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Affiliation(s)
- Chao-Yi Wu
- Department of Neurology, Oregon Health & Science University (OHSU), School of Medicine, Portland, Oregon, USA
- Oregon Center for Aging & Technology (ORCATECH), OHSU, Portland, Oregon, USA
| | - Hiroko H Dodge
- Department of Neurology, Oregon Health & Science University (OHSU), School of Medicine, Portland, Oregon, USA
- Oregon Center for Aging & Technology (ORCATECH), OHSU, Portland, Oregon, USA
| | - Sarah Gothard
- Department of Neurology, Oregon Health & Science University (OHSU), School of Medicine, Portland, Oregon, USA
- Oregon Center for Aging & Technology (ORCATECH), OHSU, Portland, Oregon, USA
| | - Nora Mattek
- Department of Neurology, Oregon Health & Science University (OHSU), School of Medicine, Portland, Oregon, USA
- Oregon Center for Aging & Technology (ORCATECH), OHSU, Portland, Oregon, USA
| | - Kirsten Wright
- Department of Neurology, Oregon Health & Science University (OHSU), School of Medicine, Portland, Oregon, USA
- Oregon Center for Aging & Technology (ORCATECH), OHSU, Portland, Oregon, USA
| | - Lisa L Barnes
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
- Rush Alzheimer’s Disease Center, Rush Medical College, Chicago, Illinois, USA
| | - Lisa C Silbert
- Department of Neurology, Oregon Health & Science University (OHSU), School of Medicine, Portland, Oregon, USA
- Oregon Center for Aging & Technology (ORCATECH), OHSU, Portland, Oregon, USA
- Department of Neurology, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
| | - Miranda M Lim
- Department of Neurology, Oregon Health & Science University (OHSU), School of Medicine, Portland, Oregon, USA
- Department of Neurology, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
| | - Jeffrey A Kaye
- Department of Neurology, Oregon Health & Science University (OHSU), School of Medicine, Portland, Oregon, USA
- Oregon Center for Aging & Technology (ORCATECH), OHSU, Portland, Oregon, USA
| | - Zachary Beattie
- Department of Neurology, Oregon Health & Science University (OHSU), School of Medicine, Portland, Oregon, USA
- Oregon Center for Aging & Technology (ORCATECH), OHSU, Portland, Oregon, USA
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Miller LM, Steele JS, Wu CY, Kaye J, Dodge HH, Gonzales MM, Lyons KS. Depressive symptoms in older adult couples: Associations with dyadic physical health, social engagement, and close friends. Front Psychiatry 2022; 13:989182. [PMID: 36177214 PMCID: PMC9513127 DOI: 10.3389/fpsyt.2022.989182] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/24/2022] [Indexed: 02/02/2023] Open
Abstract
Objective The objective of this study was to examine associations between level of depressive symptoms in older adult spouse/partner couples and their physical health and social factors (social activity and number of close friends). Methods Using data from 116 community-dwelling couples (age 76.2 ± 8.5), we simultaneously analyzed associations between depressive symptoms (Geriatric Depression Scale, range 0-11) and dyadic physical health, engagement in social activities, and connectedness with close friends. Results Greater engagement in social activities was associated with fewer depressive symptoms in men, whereas more close friendships were associated with fewer depressive symptoms in women, controlling for partner effects, age, education, and cognitive function, with good model fit. Additionally, more disparate physical health within the couple (latent incongruence score) was associated with greater depressive symptoms in men. Discussion Less social activity and fewer close friends were associated with depressive symptoms in older adult couples, but may be distinctly influential depending on gender and in the context of the older adult couple's physical health.
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Affiliation(s)
- Lyndsey M. Miller
- School of Nursing, Oregon Health and Science University, Portland, OR, United States
- Oregon Center for Aging and Technology, Oregon Health & Science University (OHSU), Portland, OR, United States
- National Institute on Aging (NIA) - Layton Aging and Alzheimer's Disease Research Center, OHSU, Portland, OR, United States
| | - Joel S. Steele
- Department of Psychology, Portland State University, Portland, OR, United States
| | - Chao-Yi Wu
- Oregon Center for Aging and Technology, Oregon Health & Science University (OHSU), Portland, OR, United States
- National Institute on Aging (NIA) - Layton Aging and Alzheimer's Disease Research Center, OHSU, Portland, OR, United States
| | - Jeffrey Kaye
- Oregon Center for Aging and Technology, Oregon Health & Science University (OHSU), Portland, OR, United States
- National Institute on Aging (NIA) - Layton Aging and Alzheimer's Disease Research Center, OHSU, Portland, OR, United States
| | - Hiroko H. Dodge
- Oregon Center for Aging and Technology, Oregon Health & Science University (OHSU), Portland, OR, United States
- National Institute on Aging (NIA) - Layton Aging and Alzheimer's Disease Research Center, OHSU, Portland, OR, United States
| | - Mitzi M. Gonzales
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Sciences Center San Antonio, San Antonio, TX, United States
| | - Karen S. Lyons
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, United States
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Lutz MW, Khachaturian AS, Zetterberg H, Blennow K, Willette AA, Mielke MM, Hayden KM, Dodge HH, Tang Y, Greenberg BD, Kukull WA, Khachaturian ZS. Biomarkers of Alzheimer syndrome and related dementias: A&D author's guide. Alzheimers Dement 2022; 18:1595-1601. [PMID: 36005812 PMCID: PMC9514317 DOI: 10.1002/alz.12772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Indexed: 01/24/2023]
Affiliation(s)
- Michael W. Lutz
- Department of NeurologyDuke University School of MedicineDurhamNCUSA
| | - Ara S. Khachaturian
- Alzheimer's & Dementia: The Journal of the Alzheimer's AssociationRockvilleMDUSA
| | - Henrik Zetterberg
- Department of Psychiatry and NeurochemistryInstitute of Neuroscience and PhysiologyThe Sahlgrenska Academy at the University of GothenburgMölndalSweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University HospitalMölndalSweden
- Department of Neurodegenerative DiseaseUCL Institute of Neurology, Queen SquareLondonUK
- UK Dementia Research Institute at UCLLondonUK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water BayHong KongChina
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of GothenburgGothenburgSweden
| | - Auriel A. Willette
- Department of Food Science and Human NutritionIowa State UniversityAmesIAUSA
- IAC Tracker Inc.AmesIAUSA
| | - Michelle M. Mielke
- Department of Epidemiology and PreventionWake Forest University School of MedicineWinston‐SalemNCUSA
| | - Kathleen M. Hayden
- Department of Social Sciences and Health PolicyDivision of Public Health SciencesWake Forest University School of Medicine, Winston‐SalemNCUSA
| | - Hiroko H. Dodge
- Department of NeurologyLayton Aging and Alzheimer's Disease CenterOregon Health & Science UniversityPortlandORUSA
| | - Yi Tang
- Department of Neurology, Innovation Center for Neurological DisordersXuanwu Hospital, Capital Medical UniversityNational Center for Neurological DisordersBeijingChina
| | - Barry D. Greenberg
- Department of Neurology, Director, Alzheimer's Disease Translational CenterJohns Hopkins University School of MedicineBaltimoreMDUSA
- Alzheimer's & Dementia: Translational Research and Clinical InterventionsBaltimoreMDUSA
| | - Walter A Kukull
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
| | - Zaven S Khachaturian
- Alzheimer's & Dementia: The Journal of the Alzheimer's AssociationRockvilleMDUSA
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Weintraub S, Karpouzian-Rogers T, Peipert JD, Nowinski C, Slotkin J, Wortman K, Ho E, Rogalski E, Carlsson C, Giordani B, Goldstein F, Lucas J, Manly JJ, Rentz D, Salmon D, Snitz B, Dodge HH, Riley M, Eldes F, Ustsinovich V, Gershon R. ARMADA: Assessing reliable measurement in Alzheimer's disease and cognitive aging project methods. Alzheimers Dement 2022; 18:1449-1460. [PMID: 34786833 PMCID: PMC9110564 DOI: 10.1002/alz.12497] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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] [Received: 01/07/2021] [Revised: 07/26/2021] [Accepted: 09/07/2021] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Early detection of cognitive decline in older adults is a public health priority. Advancing Reliable Measurement in Alzheimer's Disease and Cognitive Aging (ARMADA), a multisite study, is validating cognition, emotion, motor, and sensory modules of the National Institutes of Health Toolbox for Assessment of Neurological and Behavioral Function (NIHTB) in the aging spectrum from cognitively normal to dementia of the Alzheimer's type (DAT). METHODS Participants 65 to 85 years old, in demographic groups racially proportional to the general US population, are recruited in one of three groups to validate the NIHTB: cognitively normal, amnestic mild cognitive impairment (aMCI), or mild DAT. Additional special emphasis cohorts include (1) Blacks in the three clinical groups; (2) Spanish-speakers in the three clinical groups; (3) cognitively normal, population-proportional, over age 85. DISCUSSION Longitudinal study will determine whether NIHTB can predict cognitive decline and is associated with Alzheimer's disease biomarkers. Here, we detail the methods for the ARMADA study.
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Affiliation(s)
- Sandra Weintraub
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine
| | - Tatiana Karpouzian-Rogers
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine
| | - John Devin Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - Cindy Nowinski
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
- Department of Neurology, Northwestern University Feinberg School of Medicine
| | - Jerry Slotkin
- Center for Health Assessment Research and Translation, University of Delaware
| | - Katy Wortman
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - Emily Ho
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - Emily Rogalski
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine
| | - Cynthia Carlsson
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health and Wisconsin Alzheimer’s Disease Research Center
| | | | | | - John Lucas
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL
| | - Jennifer J. Manly
- Department of Neurology, Columbia University, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University
| | - Dorene Rentz
- Departments of Neurology, Massachusetts General Hospital and Brigham and Women’s Hospital, Harvard Medical School
| | - David Salmon
- Department of Neurosciences, University of California San Diego
| | - Beth Snitz
- Department of Neurology, University of Pittsburgh
| | - Hiroko H. Dodge
- Department of Neurology, Layton Aging and Alzheimer’s disease Center, Oregon Health & Science University
| | - Michaela Riley
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine
| | - Fatima Eldes
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University Feinberg School of Medicine
| | - Vitali Ustsinovich
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - Richard Gershon
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
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Jicha GA, Abner EL, Arnold SE, Carrillo MC, Dodge HH, Edland SD, Fargo KN, Feldman HH, Goldstein LB, Hendrix J, Peters R, Robillard JM, Schneider LS, Titiner JR, Weber CJ. Committee on High-quality Alzheimer's Disease Studies (CHADS) consensus report. Alzheimers Dement 2022; 18:1109-1118. [PMID: 34590417 PMCID: PMC8960469 DOI: 10.1002/alz.12461] [Citation(s) in RCA: 2] [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] [Received: 02/04/2021] [Revised: 06/14/2021] [Accepted: 07/30/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Consensus guidance for the development and identification of high-quality Alzheimer's disease clinical trials is needed for protocol development and conduct of clinical trials. METHODS An ad hoc consensus committee was convened in conjunction with the Alzheimer's Association to develop consensus recommendations. RESULTS Consensus was readily reached for the need to provide scientific justification, registration of trials, institutional review board oversight, conflict of interest disclosure, funding source disclosure, defined trial population, recruitment resources, definition of the intervention, specification of trial duration, appropriate payment for participant engagement, risk-benefit disclosure as part of the consent process, and the requirement to disseminate and/or publish trial results even if the study is negative. CONCLUSIONS This consensus guidance should prove useful for the protocol development and conduct of clinical trials, and may further provide a platform for the development of education materials that may help guide appropriate clinical trial participation decisions for potential trial participants and the general public.
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Affiliation(s)
- Greg A. Jicha
- Department of Neurology & the Sanders‐Brown Center on AgingUniversity of KentuckyLexingtonKentuckyUSA
| | - Erin L. Abner
- Department of Epidemiology & the Sanders‐Brown Center on AgingUniversity of KentuckyLexingtonKentuckyUSA
| | - Steven E. Arnold
- Department of NeurologyMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | | | - Hiroko H. Dodge
- Department of Neurology & Layton Aging and Alzheimer's Disease CenterOregon Health & Science UniversityPortlandOregonUSA
| | - Steven D. Edland
- Division of BiostatisticsSchool of Public Health and Human Longevity ScienceUniversity of California, San DiegoSan DiegoCaliforniaUSA
| | - Keith N. Fargo
- Alzheimer's Association, Chicago, Illinois, USA (affiliation at time of publication is CMT Research Foundation, Atlanta, Georgia, USA)
| | - Howard H. Feldman
- Department of NeuroscienceUniversity of CaliforniaSan DiegoCaliforniaUSA
| | | | - James Hendrix
- Alzheimer's Association, Chicago, Illinois, USA (affiliation at time of publication is LuMind IDSC Foundation, Burlington, Massachusetts, USA)
| | - Ruth Peters
- Department of PsychologyUniversity of New South WalesSydneyNew South WalesAustralia,Neuroscience Research AustraliaSydneyNew South WalesAustralia,School of Public HealthImperial CollegeLondonUK
| | - Julie M. Robillard
- Division of Neurology, Department of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Lon S. Schneider
- Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
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Chen L, Asgari M, Dodge HH. OPTIMIZE WAV2VEC2S ARCHITECTURE FOR SMALL TRAINING SET THROUGH ANALYZING ITS PRE-TRAINED MODELS ATTENTION PATTERN. Proc IEEE Int Conf Acoust Speech Signal Process 2022; 2022:7112-7116. [PMID: 37193061 PMCID: PMC10185057 DOI: 10.1109/icassp43922.2022.9747831] [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] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Transformer-based automatic speech recognition (ASR) systems have shown their success in the presence of large datasets. But, in medical research, we have to create ASR for the non-typical population, i.e. pre-school children with speech disorders, with small training dataset. To increase training efficiency on small datasets, we optimize the architecture of Wav2Vec 2.0, a variation of Transformer, through analyzing its pre-trained model's block-level attention pattern. We show that block-level patterns can serve as an indicator for narrowing down the optimization direction. To ensure the reproducibility of our experiments, we leverage Librispeech-100-clean as training data to simulate the limited data condition. We leverage two techniques, local attention mechanism and cross-block parameter sharing, with counter-intuitive configurations. Our optimized architecture outperforms the vanilla architecture about 1.8% absolute word error rate (WER) on dev-clean and 1.4% on test-clean.
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Affiliation(s)
- Liu Chen
- Oregon Health & Science University Department of Pediatrics Portland, Oregon, USA
| | - Meysam Asgari
- Oregon Health & Science University Department of Pediatrics Portland, Oregon, USA
| | - Hiroko H Dodge
- Oregon Health & Science University Department of Neurology Portland, Oregon, USA
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Breitner J, Dodge HH, Khachaturian ZS, Khachaturian AS. "Exceptions that prove the rule"-Why have clinical trials failed to show efficacy of risk factor interventions suggested by observational studies of the dementia-Alzheimer's disease syndrome? Alzheimers Dement 2022; 18:389-392. [PMID: 35245406 PMCID: PMC8940699 DOI: 10.1002/alz.12633] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Indexed: 12/28/2022]
Affiliation(s)
- John Breitner
- Douglas Hospital Research Center and McGill University, Quebec, Canada
| | - Hiroko H. Dodge
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
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Wu CY, Mattek N, Wild K, Miller LM, Kaye JA, Silbert LC, Dodge HH. Can changes in social contact (frequency and mode) mitigate low mood before and during the COVID-19 pandemic? The I-CONECT project. J Am Geriatr Soc 2022; 70:669-676. [PMID: 34881436 PMCID: PMC8904274 DOI: 10.1111/jgs.17607] [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] [Received: 09/02/2021] [Revised: 10/27/2021] [Accepted: 11/23/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND/OBJECTIVES The coronavirus disease 2019 (COVID-19) global outbreak allowed a natural experiment to observe how older adults changed social patterns and how it affected their emotional well-being. We studied the frequency and modes of social contact and their effects on older adults' mood before and during the COVID-19 pandemic. DESIGN Phone-based surveys were administered weekly before and during the COVID-19 pandemic. SETTING Participants were recruited from Portland, Oregon, and Detroit, Michigan. PARTICIPANTS Older adults ≥75 years old (n = 155, age = 81.0 ± 4.5, 72.3% women) were included in a randomized controlled trial, the Internet-Based Conversational Engagement Clinical Trial (I-CONECT). MEASUREMENTS Low mood was self-reported as feeling downhearted or blue for three or more days in the past week. Social contact was self-reported by the amount of time spent in interactions, with whom (family, friends, others), and via which modes (in-person, phone/video call, text/email/letter). RESULTS A total of 5525 weeks of data were derived from 155 participants. Before the COVID-19 pandemic, average social interaction time spent in-person, on phone/video call, and via text/email/letter was 406, 141, and 68 min/week, respectively. During the COVID-19 pandemic, time spent in-person was reduced by 135 min/week, while time spent via phone/video call and writing increased by 33 and 26 mins/week, respectively. In-person family contact was associated with less low mood regardless of the pandemic (odds ratio = 0.92, p < 0.05). There was a COVID-19 × text/email/letter with friends interaction (odds ratio = 0.77, p = 0.03), suggesting that during the COVID-19 pandemic, an increase of 1 h of writing with friends per week was associated with a 23% decrease in the likelihood of experiencing low mood. CONCLUSION The lost in-person time relating to COVID-19 restrictions tended to be partially compensated for with increased calls and writing time, although overall social interaction time decreased. During the COVID-19 pandemic, at least two types of social interactions (writing to friends and in-person family time) showed promise for mitigating low mood for older adults with limited social resources.
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Affiliation(s)
- Chao-Yi Wu
- Department of Neurology, Oregon Health & Science University (OHSU), Portland, Oregon,Oregon Center for Aging & Technology (ORCATECH), OHSU, Portland, Oregon
| | - Nora Mattek
- Department of Neurology, Oregon Health & Science University (OHSU), Portland, Oregon,Oregon Center for Aging & Technology (ORCATECH), OHSU, Portland, Oregon
| | - Katherine Wild
- Department of Neurology, Oregon Health & Science University (OHSU), Portland, Oregon,Oregon Center for Aging & Technology (ORCATECH), OHSU, Portland, Oregon
| | - Lyndsey M. Miller
- Oregon Center for Aging & Technology (ORCATECH), OHSU, Portland, Oregon,School of Nursing, OHSU, Portland, Oregon
| | - Jeffrey A. Kaye
- Department of Neurology, Oregon Health & Science University (OHSU), Portland, Oregon,Oregon Center for Aging & Technology (ORCATECH), OHSU, Portland, Oregon
| | - Lisa C. Silbert
- Department of Neurology, Oregon Health & Science University (OHSU), Portland, Oregon,Oregon Center for Aging & Technology (ORCATECH), OHSU, Portland, Oregon,Department of Neurology, Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Hiroko H. Dodge
- Department of Neurology, Oregon Health & Science University (OHSU), Portland, Oregon,Oregon Center for Aging & Technology (ORCATECH), OHSU, Portland, Oregon
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Peters R, Dodge HH, James S, Jicha GA, Meyer PF, Richards M, Smith AD, Yassine HN, Abner E, Hainsworth AH, Kehoe PG, Beckett N, Anderson CS, Anstey KJ. The epidemiology is promising, but the trial evidence is weak. Why pharmacological dementia risk reduction trials haven't lived up to expectations, and where do we go from here? Alzheimers Dement 2022; 18:507-512. [PMID: 34726352 DOI: 10.1002/alz.12393] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Received: 01/10/2021] [Revised: 04/14/2021] [Accepted: 05/06/2021] [Indexed: 01/26/2023]
Abstract
There is an urgent need for interventions that can prevent or delay cognitive decline and dementia. Decades of epidemiological research have identified potential pharmacological strategies for risk factor modification to prevent these serious conditions, but clinical trials have failed to confirm the potential efficacy for such interventions. Our multidisciplinary international group reviewed seven high-potential intervention strategies in an attempt to identify potential reasons for the mismatch between the observational and trial results. In considering our findings, we offer constructive recommendations for the next steps. Overall, we observed some differences in the observational evidence base for the seven strategies, but several common methodological themes that emerged. These themes included the appropriateness of trial populations and intervention strategies, including the timing of interventions and other aspects of trials methodology. To inform the design of future clinical trials, we provide recommendations for the next steps in finding strategies for effective dementia risk reduction.
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Affiliation(s)
- Ruth Peters
- Neuroscience Research, Randwick, New South Wales, Australia
- Department of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Hiroko H Dodge
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Sarah James
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | | | - Pierre-Francois Meyer
- Center for Studies on the Prevention of Alzheimer's Disease (PREVENT-AD), Verdun, Québec, Canada
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - A David Smith
- OPTIMA, Department of Pharmacology, University of Oxford, Oxford, UK
| | - Hussein N Yassine
- Departments of Medicine and Neurology, University of Southern California, Los Angeles, California, USA
| | - Erin Abner
- University of Kentucky, Lexington, Kentucky, USA
| | - Atticus H Hainsworth
- Molecular and Clinical Sciences Research Institute, St Georges, University of London, London, UK
- Department of Neurology, St George's Hospital, London, UK
| | | | - Nigel Beckett
- Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Craig S Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Kaarin J Anstey
- Neuroscience Research, Randwick, New South Wales, Australia
- Department of Psychology, University of New South Wales, Sydney, New South Wales, Australia
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Reynolds C, Mattek N, Lim MM, Beattie Z, Dodge HH, Kaye J. Association Between Mild Cognitive Impairment and Seasonal Rest-Activity Patterns of Older Adults. Front Digit Health 2022; 4:809370. [PMID: 35281221 PMCID: PMC8904352 DOI: 10.3389/fdgth.2022.809370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Abstract
Seasonal variation in rest-activity patterns has been observed in healthy adult populations. This study examined seasonal variation in total time spent overnight in the bedroom by cognitively intact older adults and older adults with mild cognitive impairment (MCI). We hypothesize that seasonal variation in rest-activity patterns is observed in the cognitively intact group and that this variation is disturbed in those with MCI. Study participants were 128 older adults; mean age 85.2 years. Ninety-eight were cognitively intact, and 30 had been diagnosed with MCI. All were enrolled in an ongoing longitudinal study using in-home passive monitoring technology. Infrared presence sensors were placed throughout each participant's home to monitor movement and presence in each room of the home. Activity data was collected from the sensors over a period of up to 527 days. Overnight time in bedroom was found to vary seasonally for the cognitively intact group, with longer times spent overnight in the bedroom during the winter months. This seasonal variation was not observed for those with non-amnestic MCI. MCI is associated with an attenuation of seasonal variation in total time spent in the bedroom at night. Detection of changes in infradian sleep patterns may be an early marker of cognitive decline. Which key determinants are driving these disturbed rhythms, such as features intrinsic to changes in the brain or to environmental factors or external cues, remains an important question for ongoing and future studies.
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Affiliation(s)
- Christina Reynolds
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- *Correspondence: Christina Reynolds
| | - Nora Mattek
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, United States
- National Institute on Aging (NIA)-Layton Aging and Alzheimer's Disease Center, Portland, OR, United States
| | - Miranda M. Lim
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Veterans Affairs (VA) Portland Health Care System, Portland, OR, United States
| | - Zachary Beattie
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, United States
- National Institute on Aging (NIA)-Layton Aging and Alzheimer's Disease Center, Portland, OR, United States
| | - Hiroko H. Dodge
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, United States
- National Institute on Aging (NIA)-Layton Aging and Alzheimer's Disease Center, Portland, OR, United States
| | - Jeffrey Kaye
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, United States
- National Institute on Aging (NIA)-Layton Aging and Alzheimer's Disease Center, Portland, OR, United States
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Tang F, Chen J, Dodge HH, Zhou J. The Joint Effects of Acoustic and Linguistic Markers for Early Identification of Mild Cognitive Impairment. Front Digit Health 2022; 3:702772. [PMID: 35224534 PMCID: PMC8878676 DOI: 10.3389/fdgth.2021.702772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/29/2021] [Accepted: 12/27/2021] [Indexed: 12/14/2022] Open
Abstract
In recent years, behavioral markers such as spoken language and lexical preferences have been studied in the early detection of mild cognitive impairment (MCI) using conversations. While the combination of linguistic and acoustic signals have been shown to be effective in detecting MCI, they have generally been restricted to structured conversations in which the interviewee responds to fixed prompts. In this study, we show that linguistic and acoustic features can be combined synergistically to identify MCI in semi-structured conversations. Using conversational data from an on-going clinical trial (Clinicaltrials.gov: NCT02871921), we find that the combination of linguistic and acoustic features on semi-structured conversations achieves a mean AUC of 82.7, significantly (p < 0.01) out-performing linguistic-only (74.9 mean AUC) or acoustic-only (65.0 mean AUC) detections on hold-out data. Additionally, features (linguistic, acoustic and combination) obtained from semi-structured conversations outperform their counterparts obtained from structured weekly conversations in identifying MCI. Some linguistic categories are significantly better at predicting MCI status (e.g., death, home) than others.
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Affiliation(s)
- Fengyi Tang
- Department of Computer Science of Engineering, Michigan State University, East Lansing, MI, United States
| | - Jun Chen
- Department of Bioinformatics, University of Michigan, Ann Arbor, MI, United States
| | - Hiroko H. Dodge
- Department of Neurology, Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, United States
| | - Jiayu Zhou
- Department of Computer Science of Engineering, Michigan State University, East Lansing, MI, United States,*Correspondence: Jiayu Zhou
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Wu CY, Gothard S, Mattek N, Wright KM, Kaye JA, Dodge HH, Beattie Z. Life activity patterns and mild cognitive impairment in older adults. Alzheimers Dement 2022. [PMID: 34971060 DOI: 10.1002/alz.051423] [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: 11/09/2022]
Abstract
BACKGROUND Shifting and diminished circadian and activity rhythms characterize older adults with cognitive impairment, but studies rarely consider both temporal and spatial aspects of life activity patterns. We examined hourly in-home and out-of-home activity patterns using latent group trajectory models to characterize older adults with and without mild cognitive impairment (MCI). METHOD One hundred and seven older adults (19 with MCI) living alone (age=81.1±7.8, 76.6% women) from the Oregon Center for Aging & Technology (ORCATECH) were included. MCI was determined by the Clinical Dementia Rating (CDR) score = 0.5. In-home and out-of-home activities were collected via passive infrared motion sensors in each room and contact sensors on the doors to the home for one month. Daily life activity patterns were estimated based on: 1) the hourly average amount of time the participant spent in each major life space (bathroom; bedroom; kitchen; living room) and out-of-home, and 2) the hourly average number of trips the participant made to each room and out-of-home. RESULT Latent trajectory models identified two distinct patterns for three features: time spent out-of-home (high/low outdoor), time spent in the kitchen (high/low kitchen occupancy), and trips to the bathroom (more/fewer bathroom trips) from 5 am to 1 pm. Older adults with MCI were more likely to follow a pattern of low outdoor time (β=-2.65; p=0.03), high kitchen occupancy (β=1.68; p=0.01), and more bathroom trips (β=1.60; p=0.02) than those with intact cognition. There were no differences in the bedroom patterns or time spent in the bathroom in older adults with and without MCI from 5 am to 1 pm. Potential covariates were controlled in the models (age, gender, years of education, sleep duration, gait speed, and the number of rooms in the house). CONCLUSION Different social and mealtime activity patterns from early morning to early afternoon may signal cognitive changes and contraction of life-space. These may be caused by environmental, as well as chronobiological changes accompanying MCI. Unobtrusive measurement of in-home and out-of-home activity patterns may be useful for integrating with chronotherapies in developing strategies to mitigate potential daily mal-entrainment for older adults at risk for MCI and dementia.
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Affiliation(s)
- Chao-Yi Wu
- Oregon Health & Science University, Portland, OR, USA.,Oregon Center for Aging & Technology (ORCATECH), Portland, OR, USA
| | - Sarah Gothard
- Oregon Health & Science University, Portland, OR, USA.,Oregon Center for Aging & Technology (ORCATECH), Portland, OR, USA
| | - Nora Mattek
- Oregon Health & Science University, Portland, OR, USA.,Oregon Center for Aging & Technology (ORCATECH), Portland, OR, USA
| | | | - Jeffrey A Kaye
- Oregon Health & Science University, Portland, OR, USA.,Oregon Center for Aging & Technology (ORCATECH), Oregon Health & Science University, Portland, OR, USA
| | - Hiroko H Dodge
- Oregon Health & Science University, Portland, OR, USA.,Oregon Center for Aging & Technology (ORCATECH), Portland, OR, USA
| | - Zachary Beattie
- Oregon Health & Science University, Portland, OR, USA.,Oregon Center for Aging & Technology (ORCATECH), Portland, OR, USA
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Tang F, Chen J, Dodge HH, Zhou J. The joint effects of audio and linguistic markers for early identification of mild cognitive impairment. Alzheimers Dement 2022. [PMID: 34971065 DOI: 10.1002/alz.055365] [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: 11/10/2022]
Abstract
BACKGROUND In recent years, speech-related behavioral markers such as spoken language and lexical preferences have been studied in the early detection of mild cognitive impairment (MCI). While the combination of linguistic and acoustic signals has been shown to be effective in detecting MCI, they have generally been restricted to structured conversations in which the interviewee responds to fixed prompts. In this study, we propose a stratification scheme that proves to be effective in extracting quality linguistic and acoustic MCI markers in semi-structured more natural conversational settings. METHOD We obtained transcripts and audio recordings from an ongoing single blind randomized controlled clinical trial NCT02871921. Briefly this clinical trial aims to improve psychological well-being and cognitive functions of the non-demented (normal or MCI) older adults aged 75 and older by enhancing their social interactions. The experimental group receives 30 minutes of semi-structured conversations (video chats) with interviewers four times per week, for up to one year. Recruitment started in July 2018 and we used the data from the first 39 participants enrolled in the experimental group with audio and transcribed data as of March 2020 in the current analysis. Our stratification scheme eliminates drastic train-test distribution mismatch, allowing for apples-to-apples comparison across participant conversations, despite drastic variations in word choices, sentence structure and length of conversations - obstacles that typically present challenges to the semi-structured conversational setting for automatic acoustic marker extraction. RESULTS Figure 1 gives an overview of our MCI prediction pipeline. The combination of linguistic and audio features achieve a mean AUC of 82.7, significantly (p<0.01) out-performing linguistic-only (AUC = 74.9) or acoustic-only (AUC = 65.0) detections on hold-out data. Our subtopic stratification method identifies several conserved clusters (Figure 2) in interview structure, allowing more balanced train-test split in terms of linguistic properties, despite the semi-structured nature of conversations. CONCLUSION A combination of linguistic and audio features improves the ability to detect MCI beyond that achieved by each feature alone in semi-structured conversation. Our method provides a potentially valuable approach for using speech for early detection of MCI and clinical trials enrichment.
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Affiliation(s)
- Fengyi Tang
- Michigan State University, East Lansing, MI, USA
| | - Jun Chen
- University of Michigan, Ann Arbor, MI, USA
| | - Hiroko H Dodge
- NIA-Layton Aging & Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA
| | - Jiayu Zhou
- Michigan State University, East Lansing, MI, USA
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Wu C, Beattie Z, Mattek N, Sharma N, Kaye J, Dodge HH. Reproducibility and replicability of high-frequency, in-home digital biomarkers in reducing sample sizes for clinical trials. Alzheimers Dement (N Y) 2021; 7:e12220. [PMID: 35005204 PMCID: PMC8719347 DOI: 10.1002/trc2.12220] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Reproducibility and replicability of results are rarely achieved for digital biomarkers analyses. We reproduced and replicated previously reported sample size estimates based on digital biomarker and neuropsychological test outcomes in a hypothetical 4-year early-phase Alzheimer's disease trial. METHODS Original data and newly collected data (using a different motion sensor) came from the Oregon Center for Aging & Technology (ORCATECH). Given trajectories of those with incident mild cognitive impairment and normal cognition would represent trajectories of the control and experimental groups in a hypothetical trial, sample sizes to provide 80% power to detect effect sizes ranging from 20% to 50% were calculated. RESULTS For the reproducibility, identical P-values and slope estimates were found with both digital biomarkers and neuropsychological test measures between the previous and current studies. As for the replicability, a greater correlation was found between original and replicated sample size estimates for digital biomarkers (r = 0.87, P < .001) than neuropsychological test outcomes (r = 0.75, P < .001). DISCUSSION Reproducibility and replicability of digital biomarker analyses are feasible and encouraged to establish the reliability of findings.
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Affiliation(s)
- Chao‐Yi Wu
- Department of NeurologyOregon Health & Science University (OHSU)PortlandOregonUSA
- Oregon Center for Aging & Technology (ORCATECH)OHSUPortlandOregonUSA
| | - Zachary Beattie
- Department of NeurologyOregon Health & Science University (OHSU)PortlandOregonUSA
- Oregon Center for Aging & Technology (ORCATECH)OHSUPortlandOregonUSA
| | - Nora Mattek
- Department of NeurologyOregon Health & Science University (OHSU)PortlandOregonUSA
- Oregon Center for Aging & Technology (ORCATECH)OHSUPortlandOregonUSA
| | - Nicole Sharma
- Department of NeurologyOregon Health & Science University (OHSU)PortlandOregonUSA
- Oregon Center for Aging & Technology (ORCATECH)OHSUPortlandOregonUSA
| | - Jeffrey Kaye
- Department of NeurologyOregon Health & Science University (OHSU)PortlandOregonUSA
- Oregon Center for Aging & Technology (ORCATECH)OHSUPortlandOregonUSA
| | - Hiroko H. Dodge
- Department of NeurologyOregon Health & Science University (OHSU)PortlandOregonUSA
- Oregon Center for Aging & Technology (ORCATECH)OHSUPortlandOregonUSA
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Peters R, Breitner J, James S, Jicha GA, Meyer P, Richards M, Smith AD, Yassine HN, Abner E, Hainsworth AH, Kehoe PG, Beckett N, Weber C, Anderson C, Anstey KJ, Dodge HH. Dementia risk reduction: why haven't the pharmacological risk reduction trials worked? An in-depth exploration of seven established risk factors. Alzheimers Dement (N Y) 2021; 7:e12202. [PMID: 34934803 PMCID: PMC8655351 DOI: 10.1002/trc2.12202] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 06/03/2021] [Accepted: 06/18/2021] [Indexed: 12/21/2022]
Abstract
Identifying the leading health and lifestyle factors for the risk of incident dementia and Alzheimer's disease has yet to translate to risk reduction. To understand why, we examined the discrepancies between observational and clinical trial evidence for seven modifiable risk factors: type 2 diabetes, dyslipidemia, hypertension, estrogens, inflammation, omega-3 fatty acids, and hyperhomocysteinemia. Sample heterogeneity and paucity of intervention details (dose, timing, formulation) were common themes. Epidemiological evidence is more mature for some interventions (eg, non-steroidal anti-inflammatory drugs [NSAIDs]) than others. Trial data are promising for anti-hypertensives and B vitamin supplementation. Taken together, these risk factors highlight a future need for more targeted sample selection in clinical trials, a better understanding of interventions, and deeper analysis of existing data.
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Affiliation(s)
- Ruth Peters
- Neuroscience ResearchSydneyNew South WalesAustralia
- Department of Psychology University of New South WalesSydneyNew South WalesAustralia
| | - John Breitner
- Douglas Hospital Research Center and McGill UniversityQuebecCanada
| | - Sarah James
- MRC Unit for Lifelong Health and Ageing at UCLUniversity College LondonLondonUK
| | | | - Pierre‐Francois Meyer
- Center for Studies on the Prevention of Alzheimer's Disease (PREVENT‐AD)VerdunQuebecCanada
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCLUniversity College LondonLondonUK
| | - A. David Smith
- OPTIMADepartment of PharmacologyUniversity of OxfordOxfordUK
| | - Hussein N. Yassine
- Departments of Medicine and NeurologyUniversity of Southern CaliforniaCaliforniaUSA
| | - Erin Abner
- University of KentuckyLexingtonKentuckyUSA
| | - Atticus H. Hainsworth
- Molecular and Clinical Sciences Research InstituteSt GeorgesUniversity of LondonLondonUK
- Department of NeurologySt George's HospitalLondonUK
| | | | | | | | - Craig Anderson
- The George Institute for Global HealthSydneyNew South WalesAustralia
| | - Kaarin J. Anstey
- Neuroscience ResearchSydneyNew South WalesAustralia
- Department of Psychology University of New South WalesSydneyNew South WalesAustralia
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Zhang M, Ho E, Nowinski C, Fox R, Novack M, Dodge HH, Weintraub S, Gershon R. Differences in emotional health across cognitively normal adults and with mild cognitive impairment and Alzheimer’s disease: Results from the Advancing Reliable Measurement in Alzheimer’s Disease and Cognitive Aging (ARMADA) study. Alzheimers Dement 2021. [DOI: 10.1002/alz.054555] [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]
Affiliation(s)
- Manrui Zhang
- Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Emily Ho
- Northwestern University Feinberg School of Medicine Chicago IL USA
| | | | - Rina Fox
- Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Miriam Novack
- Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Hiroko H Dodge
- Oregon Center for Aging & Technology (ORCATECH) Portland OR USA
- NIA‐Layton Aging & Alzheimer's Disease Center, Oregon Health & Science University Portland OR USA
| | - Sandra Weintraub
- Northwestern University Feinberg School of Medicine Chicago IL USA
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Wu C, Mattek N, Fleming N, Scavone C, Wild K, Kaye JA, Dodge HH. Type and frequency of social contacts associated with low mood before and during the COVID-19 pandemic in older adults: I-CONECT project. Alzheimers Dement 2021; 17 Suppl 11:e052385. [PMID: 34971039 PMCID: PMC9011740 DOI: 10.1002/alz.052385] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Social isolation is a risk factor for dementia, but the underlying mechanism is not well understood. It is possible that lack of social contacts negatively affects emotional well-being, which leads to cognitive decline. To shed light on this potential mediation mechanism, we examined changes in type and frequency of social contacts and their effects on mood using data collected before and during the COVID-19 pandemic among socially isolated older adults aged 75 and older. METHOD The data come from an ongoing randomized controlled trial, the Internet-Based Conversational Engagement Clinical Trial (I-CONECT, ClinicalTirals.gov: NCT02871921). One hundred forty-six participants (age=81.0±4.5, 71.9% women) who were in the trial both before and during the pandemic and whose data were available as of November of 2020 were included in the current analysis. Weekly health questionnaires administered on all participants regardless of treatment assignments were collected before and during the COVID-19 pandemic. Low mood ("Blueness") was self-reported as feeling downhearted or blue for three or more days in the past week (YES/NO). Social contacts were self-reported by amount of time they had interacted, with whom (family; friends; others), and via which modalities (in-person; phone/video call; text/email). RESULT A total of 4,774 weeks of survey data were analyzed (3,047 before COVID 19). The weekly average time spent in-person, on phone/video call, and via text/email were 282, 113, and 44 minutes, respectively. During the COVID-19 pandemic, participants on average spent 82 minutes less in total social contact per week (in-person: reduced 123 minutes, video/call: increased 28 minutes, text/email: increased 13 minutes per week). Generalized estimating equation model revealed that in-person family contact was associated with less blueness regardless of the pandemic (OR=0.91, p=0.04). There was a COVID*text/email time with friends interaction (OR=0.68, p=0.03), suggesting that during the COVID-19 pandemic, an increase of 1 hour of texting/emailing with friends per week was associated with 32% decrease in experiencing blueness three or more days per week. CONCLUSION In-person family time is beneficial for mental health. While in-person contacts become less frequent during the COVID-19 pandemic, increased text/email time with friends becomes an alternative to maintain mental health for socially isolated older adults.
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Affiliation(s)
- Chao‐Yi Wu
- Oregon Health & Science UniversityPortlandORUSA,Oregon Center for Aging & Technology (ORCATECH)PortlandORUSA
| | - Nora Mattek
- Oregon Health & Science UniversityPortlandORUSA,Oregon Center for Aging & Technology (ORCATECH)PortlandORUSA
| | - Nicole Fleming
- Oregon Health & Science UniversityPortlandORUSA,Oregon Center for Aging & Technology (ORCATECH)PortlandORUSA
| | | | - Katherine Wild
- Oregon Health & Science UniversityPortlandORUSA,Oregon Center for Aging & Technology (ORCATECH)PortlandORUSA
| | - Jeffrey A Kaye
- Oregon Health & Science UniversityPortlandORUSA,Oregon Center for Aging & Technology (ORCATECH), Oregon Health & Science UniversityPortlandORUSA
| | - Hiroko H Dodge
- Oregon Health & Science UniversityPortlandORUSA,Oregon Center for Aging & Technology (ORCATECH)PortlandORUSA
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Yu K, Wild K, Silbert LC, Kaye JA, Dodge HH. Emotion characteristics of older adults with MCI among a socially isolated cohort using NIH toolbox: I‐CONECT Study. Alzheimers Dement 2021. [DOI: 10.1002/alz.053026] [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: 11/09/2022]
Affiliation(s)
- Kexin Yu
- University of Southern California Los Angeles CA USA
| | - Katherine Wild
- NIA‐Layton Aging & Alzheimer's Disease Center, Oregon Health & Science University Portland OR USA
- Oregon Center for Aging & Technology (ORCATECH) Portland OR USA
| | - Lisa C Silbert
- Oregon Center for Aging & Technology (ORCATECH), Oregon Health & Science University Portland OR USA
- NIA‐Layton Aging & Alzheimer's Disease Center; Neuroimaging Core, Oregon Health & Science University Portland OR USA
- Portland Veterans Affairs Health Care System Portland OR USA
| | - Jeffrey A Kaye
- NIA‐Layton Aging & Alzheimer's Disease Center, Oregon Health & Science University Portland OR USA
- Oregon Center for Aging & Technology (ORCATECH), Oregon Health & Science University Portland OR USA
- Portland Veterans Affairs Health Care System Portland OR USA
| | - Hiroko H Dodge
- NIA‐Layton Aging & Alzheimer's Disease Center, Oregon Health & Science University Portland OR USA
- Oregon Center for Aging & Technology (ORCATECH) Portland OR USA
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Chan KCG, Barnes LL, Saykin AJ, Sano M, Au R, Craft S, Teylan MA, Levey AI, Weintraub S, Kukull WA, Dodge HH. Racial‐ethnic differences in baseline and longitudinal change in neuropsychological test scores in the NACC Uniform Data Set 3.0. Alzheimers Dement 2021. [DOI: 10.1002/alz.054653] [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: 11/05/2022]
Affiliation(s)
- Kwun Chuen Gary Chan
- University of Washington Seattle WA USA
- National Alzheimer's Coordinating Center, University of Washington Seattle WA USA
| | - Lisa L. Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center Chicago IL USA
| | | | - Mary Sano
- Department of Psychiatry, Alzheimer's Disease Research Center, Icahn School of Medicine at Mount Sinai New York NY USA
| | - Rhoda Au
- Boston University Alzheimer’s Disease Center, Boston University Boston MA USA
| | | | - Merilee A. Teylan
- National Alzheimer's Coordinating Center, University of Washington Seattle WA USA
| | - Allan I Levey
- Emory Goizueta Alzheimer's Disease Research Center Atlanta GA USA
| | - Sandra Weintraub
- Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Walter A. Kukull
- University of Washington Seattle WA USA
- National Alzheimer's Coordinating Center, University of Washington Seattle WA USA
| | - Hiroko H Dodge
- Layton Aging & Alzheimer's Disease Center, Oregon Health & Science University Portland OR USA
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47
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Bowman GL, Murchison CF, Silbert LC, Dodge HH, Hagen K, Lahna D, Harris WS, Kaye JA, Quinn JF, Shinto L. Randomized trial of n‐3 PUFA for cerebral white matter hyperintensities, medial temporal lobe atrophy and white matter integrity in older non‐demented adults: Per‐protocol and ApoE stratified results. Alzheimers Dement 2021. [DOI: 10.1002/alz.055682] [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: 11/06/2022]
Affiliation(s)
- Gene L Bowman
- NIA‐Layton Aging & Alzheimer's Disease Center, Oregon Health & Science University Portland OR USA
| | | | - Lisa C Silbert
- NIA‐Layton Aging & Alzheimer's Disease Center; Neuroimaging Core, Oregon Health & Science University Portland OR USA
| | - Hiroko H Dodge
- NIA‐Layton Aging & Alzheimer's Disease Center, Oregon Health & Science University Portland OR USA
| | | | - David Lahna
- NIA‐Layton Aging & Alzheimer's Disease Center; Neuroimaging Core, Oregon Health & Science University Portland OR USA
| | - William S Harris
- OmegaQuant Analytics Sioux Falls SD USA
- University of South Dakota Sioux Falls SD USA
| | - Jeffrey A Kaye
- NIA‐Layton Aging & Alzheimer's Disease Center, Oregon Health & Science University Portland OR USA
| | | | - Lynne Shinto
- Oregon Health & Science University Portland OR USA
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48
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Wu CY, Dodge HH, Reynolds C, Barnes LL, Silbert LC, Lim MM, Mattek N, Gothard S, Kaye JA, Beattie Z. In-Home Mobility Frequency and Stability in Older Adults Living Alone With or Without MCI: Introduction of New Metrics. Front Digit Health 2021; 3:764510. [PMID: 34766104 PMCID: PMC8575720 DOI: 10.3389/fdgth.2021.764510] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/29/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Older adults spend a considerable amount of time inside their residences; however, most research investigates out-of-home mobility and its health correlates. We measured indoor mobility using room-to-room transitions, tested their psychometric properties, and correlated indoor mobility with cognitive and functional status. Materials and Methods: Community-dwelling older adults living alone (n = 139; age = 78.1 ± 8.6 years) from the Oregon Center for Aging & Technology (ORCATECH) and Minority Aging Research Study (MARS) were included in the study. Two indoor mobility features were developed using non-parametric parameters (frequency; stability): Indoor mobility frequency (room-to-room transitions/day) was detected using passive infrared (PIR) motion sensors fixed on the walls in four geographic locations (bathroom; bedroom; kitchen; living room) and using door contact sensors attached to the egress door in the entrance. Indoor mobility stability was estimated by variances of number of room-to-room transitions over a week. Test-retest reliability (Intra-class coefficient, ICC) and the minimal clinically important difference (MCID) defined as the standard error of measurement (SEM) were generated. Generalized estimating equations models related mobility features with mild cognitive impairment (MCI) and functional status (gait speed). Results: An average of 206 days (±127) of sensor data were analyzed per individual. Indoor mobility frequency and stability showed good to excellent test-retest reliability (ICCs = 0.91[0.88-0.94]; 0.59[0.48-0.70]). The MCIDs of mobility frequency and mobility stability were 18 and 0.09, respectively. On average, a higher indoor mobility frequency was associated with faster gait speed (β = 0.53, p = 0.04), suggesting an increase of 5.3 room-to-room transitions per day was associated with an increase of 10 cm/s gait speed. A decrease in mobility stability was associated with MCI (β = -0.04, p = 0.03). Discussion: Mobility frequency and stability in the home are clinically meaningful and reliable features. Pervasive-sensing systems deployed in homes can objectively reveal cognitive and functional status in older adults who live alone.
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Affiliation(s)
- Chao-Yi Wu
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
- Oregon Center for Aging & Technology (ORCATECH), Oregon Health & Science University, Portland, OR, United States
| | - Hiroko H. Dodge
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
- Oregon Center for Aging & Technology (ORCATECH), Oregon Health & Science University, Portland, OR, United States
| | - Christina Reynolds
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
- Oregon Center for Aging & Technology (ORCATECH), Oregon Health & Science University, Portland, OR, United States
| | - Lisa L. Barnes
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, United States
- Rush Alzheimer's Disease Center, Rush Medical College, Chicago, IL, United States
| | - Lisa C. Silbert
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
- Oregon Center for Aging & Technology (ORCATECH), Oregon Health & Science University, Portland, OR, United States
- Department of Neurology, Veterans Affairs Portland Health Care System, Portland, OR, United States
| | - Miranda M. Lim
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
- Department of Neurology, Veterans Affairs Portland Health Care System, Portland, OR, United States
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, United States
- Department of Medicine, Oregon Health & Science University, Portland, OR, United States
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, United States
- National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, Portland, OR, United States
| | - Nora Mattek
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
- Oregon Center for Aging & Technology (ORCATECH), Oregon Health & Science University, Portland, OR, United States
| | - Sarah Gothard
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
- Oregon Center for Aging & Technology (ORCATECH), Oregon Health & Science University, Portland, OR, United States
| | - Jeffrey A. Kaye
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
- Oregon Center for Aging & Technology (ORCATECH), Oregon Health & Science University, Portland, OR, United States
| | - Zachary Beattie
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
- Oregon Center for Aging & Technology (ORCATECH), Oregon Health & Science University, Portland, OR, United States
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49
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Leese MI, Bernstein JPK, Dorociak KE, Mattek N, Wu CY, Beattie Z, Dodge HH, Kaye J, Hughes AM. Older Adults' Daily Activity and Mood Changes Detected During the COVID-19 Pandemic Using Remote Unobtrusive Monitoring Technologies. Innov Aging 2021; 5:igab032. [PMID: 34671706 PMCID: PMC8499772 DOI: 10.1093/geroni/igab032] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Indexed: 11/14/2022] Open
Abstract
Background and Objectives The coronavirus disease 2019 (COVID-19) pandemic has limited older adults' access to in-person medical care, including screenings for cognitive and functional decline. Remote, technology-based tools have shown recent promise in assessing changes in older adults' daily activities and mood, which may serve as indicators of underlying health-related changes (e.g., cognitive decline). This study examined changes in older adults' driving, computer use, mood, and travel events prior to and following the COVID-19 emergency declaration using unobtrusive monitoring technologies and remote online surveys. As an exploratory aim, the impact of mild cognitive impairment (MCI) on these changes was assessed. Research Design and Methods Participants were 59 older adults (41 cognitively intact and 18 MCI) enrolled in a longitudinal aging study. Participants had their driving and computer use behaviors recorded over a 5-month period (75 days pre- and 76 days post-COVID emergency declaration) using unobtrusive technologies. Measures of mood, overnight guests, and frequency of overnight travel were also collected weekly via remote online survey. Results After adjusting for age, gender, and education, participants showed a significant decrease in daily driving distance, number of driving trips, highway driving, and nighttime driving, post-COVID-19 as compared to pre-COVID-19 (p < .001) based on generalized estimating equation models. Further, participants spent more time on the computer per day post-COVID-19 (p = .03). Participants endorsed increases in blue mood (p < .01) and loneliness (p < .001) and decreases in travel away from home and overnight visitors (p < .001) from pre- to post-COVID-19. Cognitive status did not impact these relationships. Discussion and Implications From pre- to post-COVID-19 emergency declaration, participants drove and traveled less, used their computer more, had fewer overnight visitors, and reported greater psychological distress. These results highlight the behavioral and psychological effects of stay-at-home orders on older adults who are cognitively intact and those with MCI.
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Affiliation(s)
- Mira I Leese
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | | | | | - Nora Mattek
- Oregon Center for Aging & Technology (ORCATECH), NIA-Layton Aging and Alzheimer's Disease Center, Portland, USA.,Department of Neurology and Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
| | - Chao-Yi Wu
- Oregon Center for Aging & Technology (ORCATECH), NIA-Layton Aging and Alzheimer's Disease Center, Portland, USA.,Department of Neurology and Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
| | - Zachary Beattie
- Oregon Center for Aging & Technology (ORCATECH), NIA-Layton Aging and Alzheimer's Disease Center, Portland, USA.,Department of Neurology and Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
| | - Hiroko H Dodge
- Oregon Center for Aging & Technology (ORCATECH), NIA-Layton Aging and Alzheimer's Disease Center, Portland, USA.,Department of Neurology and Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
| | - Jeffrey Kaye
- Oregon Center for Aging & Technology (ORCATECH), NIA-Layton Aging and Alzheimer's Disease Center, Portland, USA.,Department of Neurology and Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
| | - Adriana M Hughes
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA.,Minneapolis VA Health Care System, Minnesota, Minneapolis, USA
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50
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Yu K, Wild K, Potempa K, Hampstead BM, Lichtenberg PA, Struble LM, Pruitt P, Alfaro EL, Lindsley J, MacDonald M, Kaye JA, Silbert LC, Dodge HH. The Internet-Based Conversational Engagement Clinical Trial (I-CONECT) in Socially Isolated Adults 75+ Years Old: Randomized Controlled Trial Protocol and COVID-19 Related Study Modifications. Front Digit Health 2021; 3:714813. [PMID: 34713183 PMCID: PMC8521795 DOI: 10.3389/fdgth.2021.714813] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/15/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Increasing social interactions through communication technologies could offer a cost-effective prevention approach that slows cognitive decline and delays the onset of Alzheimer's disease. This paper describes the protocol of an active project named "Internet-based conversational engagement clinical trial (I-CONECT)" (ClinicalTrials.gov: NCT02871921). The COVID-19 pandemic related protocol modifications are also addressed in the current paper. Methods: I-CONECT is a multi-site, assessor-blind, randomized controlled behavioral intervention trial (RCT). We aim to randomize 320 socially isolated adults 75+ years old [160 Caucasian and 160 African American participants, 50:50 split between those with normal cognition and mild cognitive impairment (MCI)] recruited from the community to either the video chat intervention group or the control group (1:1 allocation). Those in the video chat group receive a computer and Internet service for the duration of the study, which they use to video chat with study staff for 30 min/day 4×/week for 6 months (high dose), and then 2×/week for an additional 6 months (maintenance dose). Both video chat and control groups have a brief (about 10 min) telephone check-in with study staff once per week. The primary outcome is the change in global cognitive function measured by Montreal Cognitive Assessment (MoCA) from baseline to 6 months. Secondary outcomes include changes in cognition in memory and executive function domains, emotional well-being measured by NIH Toolbox emotional battery, and daily functional abilities assessed with the Revised Observed Tasks of Daily Living (OTDL-R). Eligible participants have MRIs at baseline and 6 months. Participants contribute saliva for genetic testing (optional consent), and all video chats, weekly check-in calls and neuropsychological assessment sessions are recorded for speech and language analysis. The pandemic halted research activities and resulted in protocol modifications, including replacing in-person assessment with remote assessment, remote deployment of study equipment, and revised targeted sample size. Discussion: This trial provides user-friendly hardware for the conversational-based intervention that can be easily provided at participants' homes. The trial aspires to use age and culture-specific conversational materials and a related platform developed in this trial for enhancing cognitive reserve and improving cognitive function.
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Affiliation(s)
- Kexin Yu
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
- Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA, United States
| | - Katherine Wild
- Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Kathleen Potempa
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, United States
| | - Benjamin M. Hampstead
- Mental Health Service, Veterans Affairs Medical Center Ann Arbor Healthcare System, Ann Arbor, MI, United States
- Research Program on Cognition and Neuromodulation Based Interventions, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Peter A. Lichtenberg
- The Institute of Gerontology, Wayne State University, Detroit, MI, United States
| | - Laura M. Struble
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Patrick Pruitt
- Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, OR, United States
- The Institute of Gerontology, Wayne State University, Detroit, MI, United States
| | - Elena L. Alfaro
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, United States
| | - Jacob Lindsley
- The School of Psychological Science, Oregon State University, Corvallis, OR, United States
| | | | - Jeffrey A. Kaye
- Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Lisa C. Silbert
- Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Hiroko H. Dodge
- Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, OR, United States
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