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Roche L, Longacre ML. Nonpharmacological interventions in dementia and diversity of samples: A scoping review. Geriatr Nurs 2024; 55:311-326. [PMID: 38142547 DOI: 10.1016/j.gerinurse.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND A public health priority is the increasing number of people with dementia (PwD), and nonpharmacological interventions (NPIs) might offer support. We sought to synthesize types of NPIs tested among PwD and explore sample characteristics. METHODS This study was a scoping literature review. Eligible articles were identified using the search terms "nonpharmacological intervention" and "dementia". RESULTS 36 articles were included. Psychosocial NPIs were implemented the most (n=24) and music-based interventions were found to be the most effective. Gender, race, and ethnicity were not consistently reported (n=30, n=24, and n=6, respectively). White PwD had higher representation, with only 62.5% of studies including Black participants and 25% including Hispanic/Latino participants. Women made up a majority (>50%) of the sample in a greater number of studies (n=20). CONCLUSION Findings suggest that future studies need to be intentional about improving diversity of the sample, particularly with respect to including persons identifying as Black or Hispanic/Latino.
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Affiliation(s)
- L Roche
- College of Health Sciences, 241 Easton Hall, Arcadia University, 450 S. Easton Rd., Glenside, PA 19038, United States
| | - M L Longacre
- College of Health Sciences, 241 Easton Hall, Arcadia University, 450 S. Easton Rd., Glenside, PA 19038, United States.
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Mukadam N, Marston L, Lewis G, Mathur R, Lowther E, Rait G, Livingston G. South Asian, Black and White ethnicity and the effect of potentially modifiable risk factors for dementia: A study in English electronic health records. PLoS One 2023; 18:e0289893. [PMID: 37819899 PMCID: PMC10566703 DOI: 10.1371/journal.pone.0289893] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/02/2023] [Accepted: 07/28/2023] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION We aimed to investigate ethnic differences in the associations of potentially modifiable risk factors with dementia. METHODS We used anonymised data from English electronic primary care records for adults aged 65 and older between 1997 and 2018. We used Cox regression to investigate main effects for each risk factor and interaction effects between each risk factor and ethnicity. RESULTS We included 865,674 people with 8,479,973 person years of follow up. Hypertension, dyslipidaemia, obesity and diabetes were more common in people from minority ethnic groups than White people. The impact of hypertension, obesity, diabetes, low HDL and sleep disorders on dementia risk was increased in South Asian people compared to White people. The impact of hypertension was greater in Black compared to White people. DISCUSSION Dementia prevention efforts should be targeted towards people from minority ethnic groups and tailored to risk factors of particular importance.
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Affiliation(s)
- Naaheed Mukadam
- Division of Psychiatry, University College London, London, United Kingdom
| | - Louise Marston
- Primary Care & Population Health, University College London, London, United Kingdom
| | - Gemma Lewis
- Division of Psychiatry, University College London, London, United Kingdom
| | - Rohini Mathur
- Wolfson Institute of Population Health, Queen Mary University London, London, United Kingdom
| | - Ed Lowther
- Advanced Research Computing Centre, University College London, London, United Kingdom
| | - Greta Rait
- Primary Care & Population Health, University College London, London, United Kingdom
| | - Gill Livingston
- Division of Psychiatry, University College London, London, United Kingdom
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Moon HE, Kaholokula JK, MacLehose RF, Rote SM. Prevalence of Dementia in American Indians and Alaska Natives Compared to White, Black, and Hispanic Medicare Beneficiaries: Findings from the National Health and Aging Trends Study. J Racial Ethn Health Disparities 2023; 10:1527-1532. [PMID: 35710858 PMCID: PMC10184505 DOI: 10.1007/s40615-022-01338-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To estimate the prevalence of dementia among American Indian and Alaska Native (AIAN) Medicare beneficiaries and compare the prevalence of dementia in AIANs and other racial and ethnic minority groups-non-Hispanic Blacks (NHBs) and Hispanics-with non-Hispanic Whites (NHWs) Medicare beneficiaries. METHODS We used survey data from Round 5 of the National Health and Aging Trends Study (NHATS, 2015) (N = 7,449), a nationally representative study of Medicare beneficiaries ages 65 years and older. We used logistic regression to estimate the age- and sex-adjusted prevalence of dementia with 95% confidence intervals by race/ethnicity as well as prevalence differences between groups. RESULTS The majority of participants were between 65 and 74 years old. Approximately half of them were female. NHWs had a prevalence of 5% for dementia, and AIAIs had a prevalence of 9%, four percentage points higher than NHWs (95%CI 1%, 11%). We estimated a similar difference in the prevalence of dementia in AIAN Medicare beneficiaries compared to NHBs. CONCLUSION While previous research has reported that AIANs share a similar or lower prevalence of dementia than NHWs, our findings suggest a potentially higher prevalence of dementia among AIAN Medicare beneficiaries. A relatively small number of AIAN resulted in wide confidence intervals for many of our associations. Future research should focus on recruiting a larger sample and on dementia prevalence and unique risk factors within and among AIAN tribes.
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Affiliation(s)
- Heehyul E Moon
- Raymond A. Kent School of Social Work and Family Science, University of Louisville, Louisville, KY, USA.
| | - Joseph Keaweʻaimoku Kaholokula
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawaii at Mānoa, Honolulu, HI, USA
| | | | - Sunshine M Rote
- Raymond A. Kent School of Social Work and Family Science, University of Louisville, Louisville, KY, USA
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Becerril A, Pfoh ER, Hashmi AZ, Mourany L, Gunzler DD, Berg KA, Krieger NI, Krishnan K, Moore SE, Kahana E, Dawson NV, Luezas Shamakian L, Campbell JW, Perzynski AT, Dalton JE. Racial, ethnic and neighborhood socioeconomic differences in incidence of dementia: A regional retrospective cohort study. J Am Geriatr Soc 2023; 71:2406-2418. [PMID: 36928611 DOI: 10.1111/jgs.18322] [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: 07/26/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Evidence on the effects of neighborhood socioeconomic disadvantage on dementia risk in racially and ethically diverse populations is limited. Our objective was to evaluate the relative extent to which neighborhood disadvantage accounts for racial/ethnic variation in dementia incidence rates. Secondarily, we evaluated the spatial relationship between neighborhood disadvantage and dementia risk. METHODS In this retrospective study using electronic health records (EHR) at two regional health systems in Northeast Ohio, participants included 253,421 patients aged >60 years who had an outpatient primary care visit between January 1, 2005 and December 31, 2015. The date of the first qualifying visit served as the study baseline. Cumulative incidence of composite dementia outcome, defined as EHR-documented dementia diagnosis or dementia-related death, stratified by neighborhood socioeconomic deprivation (as measured by Area Deprivation Index) was determined by competing-risk regression analysis, with non-dementia-related death as the competing risk. Fine-Gray sub-distribution hazard ratios were determined for neighborhood socioeconomic deprivation, race/ethnicity, and clinical risk factors. The degree to which neighborhood socioeconomic position accounted for racial/ethnic disparities in the incidence of composite dementia outcome was evaluated via mediation analysis with Poisson rate models. RESULTS Increasing neighborhood disadvantage was associated with increased risk of EHR-documented dementia diagnosis or dementia-related death (most vs. least disadvantaged ADI quintile HR = 1.76, 95% confidence interval = 1.69-1.84) after adjusting for age and sex. The effect of neighborhood disadvantage on this composite dementia outcome remained after accounting for known medical risk factors of dementia. Mediation analysis indicated that neighborhood disadvantage accounted for 34% and 29% of the elevated risk for composite dementia outcome in Hispanic and Black patients compared to White patients, respectively. CONCLUSION Neighborhood disadvantage is related to the risk of EHR-documented dementia diagnosis or dementia-related death and accounts for a portion of racial/ethnic differences in dementia burden, even after adjustment for clinically important confounders.
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Affiliation(s)
- Alissa Becerril
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Elizabeth R Pfoh
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ardeshir Z Hashmi
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Center for Geriatric Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lyla Mourany
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Douglas D Gunzler
- Center for Healthcare Research and Policy, Case Western Reserve University at MetroHealth, Cleveland, Ohio, USA
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Kristen A Berg
- Center for Healthcare Research and Policy, Case Western Reserve University at MetroHealth, Cleveland, Ohio, USA
| | - Nikolas I Krieger
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kamini Krishnan
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, Ohio, USA
| | - Scott Emory Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Eva Kahana
- Sociology Department, Case Western Reserve University, Cleveland, Ohio, USA
| | - Neal V Dawson
- Center for Healthcare Research and Policy, Case Western Reserve University at MetroHealth, Cleveland, Ohio, USA
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | | | | | - Adam T Perzynski
- Center for Healthcare Research and Policy, Case Western Reserve University at MetroHealth, Cleveland, Ohio, USA
| | - Jarrod E Dalton
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
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Bancks MP, Byrd G, Caban-Holt A, Fitzpatrick AL, Forrester SN, Hayden KM, Heckbert SR, Kershaw KN, Rapp SR, Sachs BC, Hughes TM. Self-reported experiences of discrimination and incident dementia. Alzheimers Dement 2023; 19:3119-3128. [PMID: 36724324 PMCID: PMC10390651 DOI: 10.1002/alz.12947] [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: 07/29/2022] [Revised: 11/09/2022] [Accepted: 12/20/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Discrimination negatively impacts health and may contribute to racial/ethnic disparities in dementia risk. METHODS Experiences of lifetime and everyday discrimination were assessed among 6509 Multi-Ethnic Study of Atherosclerosis (MESA) participants. We assessed the association of discrimination with incidence of dementia including adjustment for important risk factors, cohort attrition, and we assessed for effect modification by race/ethnicity. RESULTS Prevalence of any lifetime discrimination in MESA was 42%, highest among Black adults (72%). Over a median 15.7 years of follow-up, there were 466 incident cases of dementia. Lifetime discrimination, but not everyday discrimination, was associated with incident dementia (Wald p = 0.03). Individuals reporting lifetime discrimination in ≥2 domains (compared to none) had greater risk for dementia (hazard ratio: 1.40; 95%: 1.08, 1.82) after adjustment for sociodemographic, clinical, and behavioral risk factors. Associations did not differ by race/ethnicity. CONCLUSIONS These findings demonstrate an association of greater experiences of lifetime discrimination with incident dementia.
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Affiliation(s)
| | - Goldie Byrd
- Wake Forest University School of Medicine, Winston-Salem, NC
| | | | | | | | | | | | | | - Stephen R. Rapp
- Wake Forest University School of Medicine, Winston-Salem, NC
| | - Bonnie C. Sachs
- Wake Forest University School of Medicine, Winston-Salem, NC
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Sherva R, Zhang R, Sahelijo N, Jun G, Anglin T, Chanfreau C, Cho K, Fonda JR, Gaziano JM, Harrington KM, Ho YL, Kremen WS, Litkowski E, Lynch J, Neale Z, Roussos P, Marra D, Mez J, Miller MW, Salat DH, Tsuang D, Wolf E, Zeng Q, Panizzon MS, Merritt VC, Farrer LA, Hauger RL, Logue MW. African ancestry GWAS of dementia in a large military cohort identifies significant risk loci. Mol Psychiatry 2023; 28:1293-1302. [PMID: 36543923 PMCID: PMC10066923 DOI: 10.1038/s41380-022-01890-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/02/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022]
Abstract
While genome wide association studies (GWASs) of Alzheimer's Disease (AD) in European (EUR) ancestry cohorts have identified approximately 83 potentially independent AD risk loci, progress in non-European populations has lagged. In this study, data from the Million Veteran Program (MVP), a biobank which includes genetic data from more than 650,000 US Veteran participants, was used to examine dementia genetics in an African descent (AFR) cohort. A GWAS of Alzheimer's disease and related dementias (ADRD), an expanded AD phenotype including dementias such as vascular and non-specific dementia that included 4012 cases and 18,435 controls age 60+ in AFR MVP participants was performed. A proxy dementia GWAS based on survey-reported parental AD or dementia (n = 4385 maternal cases, 2256 paternal cases, and 45,970 controls) was also performed. These two GWASs were meta-analyzed, and then subsequently compared and meta-analyzed with the results from a previous AFR AD GWAS from the Alzheimer's Disease Genetics Consortium (ADGC). A meta-analysis of common variants across the MVP ADRD and proxy GWASs yielded GWAS significant associations in the region of APOE (p = 2.48 × 10-101), in ROBO1 (rs11919682, p = 1.63 × 10-8), and RNA RP11-340A13.2 (rs148433063, p = 8.56 × 10-9). The MVP/ADGC meta-analysis yielded additional significant SNPs near known AD risk genes TREM2 (rs73427293, p = 2.95 × 10-9), CD2AP (rs7738720, p = 1.14 × 10-9), and ABCA7 (rs73505251, p = 3.26 × 10-10), although the peak variants observed in these genes differed from those previously reported in EUR and AFR cohorts. Of the genes in or near suggestive or genome-wide significant associated variants, nine (CDA, SH2D5, DCBLD1, EML6, GOPC, ABCA7, ROS1, TMCO4, and TREM2) were differentially expressed in the brains of AD cases and controls. This represents the largest AFR GWAS of AD and dementia, finding non-APOE GWAS-significant common SNPs associated with dementia. Increasing representation of AFR participants is an important priority in genetic studies and may lead to increased insight into AD pathophysiology and reduce health disparities.
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Affiliation(s)
- Richard Sherva
- National Center for PTSD, Behavioral Sciences Division, VA Boston Healthcare System, Boston, MA, USA
- Boston University Chobanian & Avedisian School of Medicine, Biomedical Genetics, Boston, MA, USA
| | - Rui Zhang
- National Center for PTSD, Behavioral Sciences Division, VA Boston Healthcare System, Boston, MA, USA
| | - Nathan Sahelijo
- Boston University Chobanian & Avedisian School of Medicine, Biomedical Genetics, Boston, MA, USA
| | - Gyungah Jun
- Boston University Chobanian & Avedisian School of Medicine, Biomedical Genetics, Boston, MA, USA
| | - Tori Anglin
- VA Informatics and Computing Infrastructure (VINCI), Salt Lake City, UT, USA
| | - Catherine Chanfreau
- VA Informatics and Computing Infrastructure (VINCI), Salt Lake City, UT, USA
| | - Kelly Cho
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
- Division of Aging, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jennifer R Fonda
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02118, USA
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Educational and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - J Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
- Division of Aging, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kelly M Harrington
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02118, USA
| | - Yuk-Lam Ho
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
| | - William S Kremen
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA, USA
| | - Elizabeth Litkowski
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- VA Eastern Colorado Healthcare System, Aurora, CO, USA
| | - Julie Lynch
- VA Informatics and Computing Infrastructure (VINCI), Salt Lake City, UT, USA
| | - Zoe Neale
- National Center for PTSD, Behavioral Sciences Division, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02118, USA
| | - Panos Roussos
- Center for Disease Neurogenomics, Departments of Psychiatry and Genetics and Genomic Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Center for Dementia Research, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
- Mental Illness Research Education and Clinical Center (MIRECC), James J. Peters VA Medical Center, Bronx, New York, NY, USA
| | - David Marra
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02118, USA
| | - Jesse Mez
- Boston University Chobanian & Avedisian School of Medicine, Biomedical Genetics, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Mark W Miller
- National Center for PTSD, Behavioral Sciences Division, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02118, USA
| | - David H Salat
- Neuroimaging Research for Veterans Center, VA Boston Healthcare System, Boston, MA, USA
| | - Debby Tsuang
- Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Erika Wolf
- National Center for PTSD, Behavioral Sciences Division, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02118, USA
| | - Qing Zeng
- VA Washington DC Healthcare System, Washington, DC, USA
| | - Matthew S Panizzon
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
| | - Victoria C Merritt
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, USA
| | - Lindsay A Farrer
- Boston University Chobanian & Avedisian School of Medicine, Biomedical Genetics, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Boston University Alzheimer's Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Department of Ophthalmology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Richard L Hauger
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA, USA
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, USA
| | - Mark W Logue
- National Center for PTSD, Behavioral Sciences Division, VA Boston Healthcare System, Boston, MA, USA.
- Boston University Chobanian & Avedisian School of Medicine, Biomedical Genetics, Boston, MA, USA.
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02118, USA.
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
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Stites SD, Coe NB. Let's Not Repeat History's Mistakes: Two Cautions to Scientists on the Use of Race in Alzheimer's Disease and Alzheimer's Disease Related Dementias Research. J Alzheimers Dis 2023; 92:729-740. [PMID: 36806503 PMCID: PMC10123855 DOI: 10.3233/jad-220507] [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: 02/19/2023]
Abstract
Alzheimer's disease and Alzheimer's disease related dementias (AD/ADRD) research has advanced gene and biomarker technologies to aid identification of individuals at risk for dementia. This innovation is a lynchpin in development of disease-modifying therapies. The emerging science could transform outcomes for patients and families. However, current limitations in the racial representation and inclusion of racial diversity in research limits the relevance of these technologies: AD/ADRD research cohorts used to define biomarker cutoffs are mostly White, despite clinical and epidemiologic research that shows Black populations are among those experiencing the greatest burdens of AD/ADRD. White cohorts alone are insufficient to characterize heterogeneity in disease and in life experiences that can alter AD/ADRD's courses. The National Institute on Aging (NIA) has called for increased racial diversity in AD/ADRD research. While scientists are working to implement NIA's plan to build more diverse research cohorts, they are also seeking out opportunities to consider race in AD/ADRD research. Recently, scientists have posed two ways of including race in AD/ADRD research: ancestry-based verification of race and race-based adjustment of biomarker test results. Both warrant careful examination for how they are impacting AD/ADRD science with respect to specific study objectives and the broader mission of the field. If these research methods are not grounded in pursuit of equity and justice, biases they introduce into AD/ADRD science could perpetuate, or even worsen, disparities in AD/ADRD research and care.
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Affiliation(s)
- Shana D. Stites
- Department of Psychiatry, Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Norma B. Coe
- Department of Medical Ethics and Health Policy, Perelman School of Medicine and Co-Director of the Population Aging Research Center (PARC), University of Pennsylvania, Philadelphia, PA, USA
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Affiliation(s)
- Gwen Yeo
- Stanford University School of Medicine, Stanford, California
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9
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Abstract
IMPORTANCE The racial and ethnic diversity of the US, including among patients receiving their care at the Veterans Health Administration (VHA), is increasing. Dementia is a significant public health challenge and may have greater incidence among older adults from underrepresented racial and ethnic minority groups. OBJECTIVE To determine dementia incidence across 5 racial and ethnic groups and by US geographical region within a large, diverse, national cohort of older veterans who received care in the largest integrated health care system in the US. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study within the VHA of a random sample (5% sample selected for each fiscal year) of 1 869 090 participants aged 55 years or older evaluated from October 1, 1999, to September 30, 2019 (the date of final follow-up). EXPOSURES Self-reported racial and ethnic data were obtained from the National Patient Care Database. US region was determined using Centers for Disease Control and Prevention (CDC) regions from residential zip codes. MAIN OUTCOMES AND MEASURES Incident diagnosis of dementia (9th and 10th editions of the International Classification of Diseases). Fine-Gray proportional hazards models were used to examine time to diagnosis, with age as the time scale and accounting for competing risk of death. RESULTS Among the 1 869 090 study participants (mean age, 69.4 [SD, 7.9] years; 42 870 women [2%]; 6865 American Indian or Alaska Native [0.4%], 9391 Asian [0.5%], 176 795 Black [9.5%], 20 663 Hispanic [1.0%], and 1 655 376 White [88.6%]), 13% received a diagnosis of dementia over a mean follow-up of 10.1 years. Age-adjusted incidence of dementia per 1000 person-years was 14.2 (95% CI, 13.3-15.1) for American Indian or Alaska Native participants, 12.4 (95% CI, 11.7-13.1) for Asian participants, 19.4 (95% CI, 19.2-19.6) for Black participants, 20.7 (95% CI, 20.1-21.3) for Hispanic participants, and 11.5 (95% CI, 11.4-11.6) for White participants. Compared with White participants, the fully adjusted hazard ratios were 1.05 (95% CI, 0.98-1.13) for American Indian or Alaska Native participants, 1.20 (95% CI, 1.13-1.28) for Asian participants, 1.54 (95% CI, 1.51-1.57) for Black participants, and 1.92 (95% CI, 1.82-2.02) for Hispanic participants. Across most US regions, age-adjusted dementia incidence rates were highest for Black and Hispanic participants, with rates similar among American Indian or Alaska Native, Asian, and White participants. CONCLUSIONS AND RELEVANCE Among older adults who received care at VHA medical centers, there were significant differences in dementia incidence based on race and ethnicity. Further research is needed to understand the mechanisms responsible for these differences.
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Affiliation(s)
- Erica Kornblith
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
| | - Amber Bahorik
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
- Northern California Institute for Research and Education, San Francisco
| | - W John Boscardin
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Department of Medicine, University of California, San Francisco
| | - Feng Xia
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Northern California Institute for Research and Education, San Francisco
| | - Deborah E Barnes
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Kristine Yaffe
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
- Northern California Institute for Research and Education, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Department of Neurology, University of California, San Francisco
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Farfel JM, Leurgans SE, Capuano AW, de Moraes Sampaio MC, Wilson RS, Schneider JA, Bennett DA. Dementia and autopsy-verified causes of death in racially-diverse older Brazilians. PLoS One 2021; 16:e0261036. [PMID: 34910735 PMCID: PMC8673625 DOI: 10.1371/journal.pone.0261036] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/22/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND While dementia has been associated with specific causes of death, previous studies were relatively small autopsy series or population-based studies lacking autopsy confirmation and were restricted to Non-Latinx Whites. Here, we examine the association of dementia with autopsy-verified causes of death in racially-diverse older Brazilians. METHODS As part of the Pathology, Alzheimer´s and Related Dementias Study (PARDoS), a community-based study in Brazil, we included 1941 racially-diverse deceased, 65 years or older at death. We conducted a structured interview with legal informants including the Clinical Dementia Rating (CDR) Scale for dementia proximate to death. Causes of death were assessed after full-body autopsy and macroscopic examination of the brain, thoracic and abdominal/pelvic organs. Up to four causes of death were reported for each decedent. Causes of death were classified as circulatory, infectious, cancer and other. Logistic regression was used to determine associations of dementia with cause of death, controlling for age, sex, race, and education. RESULTS Dementia was associated with a higher odds of an infectious cause of death (OR = 1.81, 95%CI:1.45-2.25), and with a lower odds of a circulatory disease as cause of death (OR = 0.69, 95%CI:0.54-0.86) and cancer as cause of death (OR = 0.41, 95%CI:0.24-0.71). Dementia was associated with a higher odds of pneumonia (OR = 1.92, 95%CI:1.53-2.40) and pulmonary embolism (OR = 2.31, 95%CI:1.75-3.05) as causes of death and with a lower odds of acute myocardial infarction (OR = 0.42, 95%CI:0.31-0.56) and arterial disease (OR = 0.76, 95%CI:0.61-0.94) as causes of death. CONCLUSION Racially-diverse older Brazilians with dementia had a higher odds of an infectious cause of death and a lower odds of cancer and circulatory disease as causes of death than those without dementia.
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Affiliation(s)
- Jose M. Farfel
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States of America
- Department of Pathology, Rush University Medical Center, Chicago, IL, United States of America
- Health Sciences Program, Instituto de Assistência Medica ao Servidor Público do Estado (IAMSPE), São Paulo, Brazil
| | - Sue E. Leurgans
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States of America
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, United States of America
| | - Ana W. Capuano
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States of America
- Health Sciences Program, Instituto de Assistência Medica ao Servidor Público do Estado (IAMSPE), São Paulo, Brazil
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, United States of America
| | | | - Robert S. Wilson
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States of America
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, United States of America
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, IL, United States of America
| | - Julie A. Schneider
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States of America
- Department of Pathology, Rush University Medical Center, Chicago, IL, United States of America
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, United States of America
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States of America
- Health Sciences Program, Instituto de Assistência Medica ao Servidor Público do Estado (IAMSPE), São Paulo, Brazil
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, United States of America
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11
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de Havenon A, Anadani M, Stulberg E, Rost N, Prabhakaran S, Sheth KN. Hispanic Ethnicity and Risk of Incident Cognitive Impairment in Relation to Systolic Blood Pressure. Hypertension 2021; 78:1665-1666. [PMID: 34365813 PMCID: PMC8516701 DOI: 10.1161/hypertensionaha.121.17599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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12
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Stebbins RC, Edwards JK, Plassman BL, Yang YC, Noppert GA, Haan M, Aiello AE. Immune function, cortisol, and cognitive decline & dementia in an aging latino population. Psychoneuroendocrinology 2021; 133:105414. [PMID: 34563836 PMCID: PMC8600484 DOI: 10.1016/j.psyneuen.2021.105414] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/06/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The etiology of dementias and cognitive decline remain largely unknown. It is widely accepted that inflammation in the central nervous system plays a critical role in the pathogenesis of dementia. However, less is known about the role of the peripheral immune system and interactions with cortisol, though evidence suggests that these, too, may play a role. METHODS Using data from 1337 participants aged 60+ years from the Sacramento Area Latino Study of Aging (observational cohort) we investigated variation in trajectories of cognitive decline by pathogen IgG and cytokine levels. Linear mixed effects models were used to examine the association between baseline Interleukin (IL)-6, C-reactive protein, tumor necrosis factor (TNF)-α, and five persistent pathogens' IgG response and trajectories of cognition over 10 years, and to examine interactions between immune biomarkers and cortisol. Stratified cumulative incidence functions were used to assess the relation between biomarkers and incident dementia. Inverse probability weights accounted for loss-to-follow-up and confounding. RESULTS IL-6, TNF-α, and CMV IgG were statistically significantly associated with a higher log of Modified Mini-Mental State Examination errors (IL-6, β=0.0935 (95%CI: 0.055, 0.13), TNF-alpha β= 0.0944 (95%CI: 0.032, 0.157), and CMV, β= 0.0409 (95%CI: 0.013, 0.069)). Furthermore, cortisol interacted with HSV-1 and IL-6, and CRP for both cross-sectional cognitive function and rate of decline. No statistically significant relationship was detected between biomarkers and incidence of dementia. CONCLUSIONS These findings support the theory that the peripheral immune system may play a role in cognitive decline but not incident dementia. Furthermore, they identify specific markers amenable for intervention for slowing decline.
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Affiliation(s)
- Rebecca C Stebbins
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Social, Genetic, & Developmental Psychiatry CentreInstitute of Psychiatry, Psychology, and Neuroscience King's College London, London, United Kingdom.
| | - Jessie K Edwards
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Brenda L Plassman
- Departments of Psychiatry and Neurology, Duke University School of Medicine, Durham, NC, United States
| | - Y Claire Yang
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Sociology, Lineberger Cancer Center University of North Carolina at Chapel Hill, United States
| | - Grace A Noppert
- Social Environment and Health, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
| | - Mary Haan
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
| | - Allison E Aiello
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Hayward MD, Farina MP, Zhang YS, Kim JK, Crimmins EM. The Importance of Improving Educational Attainment for Dementia Prevalence Trends From 2000 to 2014, Among Older Non-Hispanic Black and White Americans. J Gerontol B Psychol Sci Soc Sci 2021; 76:1870-1879. [PMID: 33481025 PMCID: PMC8557827 DOI: 10.1093/geronb/gbab015] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES While a number of studies have documented a notable decline in age-standardized prevalence in dementia in the U.S. population, relatively little is known about how dementia has declined for specific age and race groups, and the importance of changing educational attainment on the downward trend. We assess (a) how the trends in dementia prevalence may have differed across age and race groups and (b) the role of changing educational attainment in understanding these trends. METHODS This article estimates a series of logistic regression models using data from the Health and Retirement Study (2000-2014) to assess the relative annual decline in dementia prevalence and the importance of improving educational attainment for non-Hispanic Whites and non-Hispanic Blacks. RESULTS Consistent with other studies, we found significant declines in dementia for non-Hispanic Blacks and non-Hispanic Whites across this period. Nonetheless, these declines were not uniform across age and race groups. Non-Hispanic Blacks aged 65-74 years had the steepest decline in this period. We also found that improved educational attainment in the population was fundamentally important in understanding declining dementia prevalence in the United States. DISCUSSION This study shows the importance of improvement in educational attainment in the early part of the twentieth century to understand the downward trend in dementia prevalence in the United States from 2000 to 2014.
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Affiliation(s)
| | | | - Yuan S Zhang
- University of North Carolina at Chapel Hill, USA
| | - Jung Ki Kim
- University of Southern California, Los Angeles, USA
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14
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Inoue M, Hasegawa M, Tompkins CJ, Donnelly CM. Culturally Responsive Companion Program for a Japanese Woman with Dementia in a U.S. Nursing Home. J Cross Cult Gerontol 2021; 36:309-320. [PMID: 34324047 DOI: 10.1007/s10823-021-09434-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2021] [Indexed: 11/26/2022]
Abstract
The older foreign-born population is predicted to increase in the United States. As a whole, this population in the long-term care setting is more likely to face greater challenges associated with loneliness and social isolation due to their smaller social networks, language and cultural differences. The benefits of person-centered care have been widely recognized and may be a potential remedy for such challenges felt by older immigrants. Using a qualitative case study approach, this study explored the staff perceptions of a culturally responsive companion program provided to an older Japanese woman with advanced dementia in the long-term care setting to understand the potential benefits of such a program. The first theme that emerged was that the client benefitted from the program in regard to her physical wellbeing, emotional wellbeing, language communication and cultural support. Given the support of Japanese companions, the client was able to express her needs and health symptoms effectively and the staff were subsequently able to provide culturally-sensitive care. The second theme that emerged was the perceived benefits received by the staff. The companion program improved the staff's ability to provide quality care for the resident. This study implies that culturally responsive companion programs may benefit foreign-born older individuals in improving their wellbeing in long-term care settings.
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Affiliation(s)
- Megumi Inoue
- Department of Social Work, George Mason University, 4400 University Drive, MSN: 1F8, Fairfax, VA, 22181, USA.
| | | | - Catherine J Tompkins
- Department of Social Work, George Mason University, 4400 University Drive, MSN: 1F8, Fairfax, VA, 22181, USA
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Tsoy E, Kiekhofer RE, Guterman EL, Tee BL, Windon CC, Dorsman KA, Lanata SC, Rabinovici GD, Miller BL, Kind AJH, Possin KL. Assessment of Racial/Ethnic Disparities in Timeliness and Comprehensiveness of Dementia Diagnosis in California. JAMA Neurol 2021; 78:657-665. [PMID: 33779684 PMCID: PMC8008426 DOI: 10.1001/jamaneurol.2021.0399] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [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: 09/11/2020] [Accepted: 12/29/2020] [Indexed: 12/12/2022]
Abstract
Importance The US aging population is rapidly becoming more racially and ethnically diverse. Early diagnosis of dementia is a health care priority. Objective To examine the associations between race/ethnicity and timeliness of dementia diagnosis and comprehensiveness of diagnostic evaluation. Design, Setting, and Participants This retrospective cross-sectional study used 2013-2015 California Medicare fee-for-service data to examine the associations of race/ethnicity, individual factors, and contextual factors with the timeliness and comprehensiveness of dementia diagnosis. Data from 10 472 unique beneficiaries were analyzed. The sample was selected on the basis of the following criteria: presence of 1 or more claims; no diagnoses of dementia or mild cognitive impairment in 2013 to 2014; continuous enrollment in Medicare Parts A and B; Asian, Black, Hispanic, or White race/ethnicity; and incident diagnoses of dementia or mild cognitive impairment in January through June 2015. Data analyses were conducted from November 1, 2019, through November 10, 2020. Main Outcomes and Measures Timeliness of diagnosis, defined as incident diagnosis of mild cognitive impairment vs dementia, and comprehensiveness of diagnostic evaluation, defined as presence of the following services in claims within 6 months before or after the incident diagnosis date: specialist evaluation, laboratory testing, and neuroimaging studies. Results The sample comprised 10 472 unique Medicare beneficiaries with incident diagnoses of dementia or mild cognitive impairment (6504 women [62.1%]; mean [SD] age, 82.9 [8.0] years) and included 993 individuals who identified as Asian (9.5%), 407 as Black (3.9%), 1255 as Hispanic (12.0%), and 7817 as White (74.6%). Compared with White beneficiaries, those who identified as Asian (odds ratio, 0.46; 95% CI, 0.38-0.56), Black (odds ratio, 0.73; 95% CI, 0.56-0.94), or Hispanic (odds ratio, 0.62; 95% CI, 0.52-0.72) were less likely to receive a timely diagnosis. Asian beneficiaries (incidence rate ratio, 0.81; 95% CI, 0.74-0.87) also received fewer diagnostic evaluation elements. These associations remained significant after adjusting for age, sex, comorbidity burden, neighborhood disadvantage, and rurality. Conclusions and Relevance These findings highlight substantial disparities in the timeliness and comprehensiveness of dementia diagnosis. Public health interventions are needed to achieve equitable care for people living with dementia across all racial/ethnic groups.
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Affiliation(s)
- Elena Tsoy
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Rachel E. Kiekhofer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Elan L. Guterman
- Department of Neurology, University of California, San Francisco, San Francisco
| | - Boon Lead Tee
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Charles C. Windon
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Karen A. Dorsman
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas
| | - Serggio C. Lanata
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
- Global Brain Health Institute, University of California, San Francisco, San Francisco
| | - Gil D. Rabinovici
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco
- Associate Editor, JAMA Neurology
| | - Bruce L. Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
- Global Brain Health Institute, University of California, San Francisco, San Francisco
| | - Amy J. H. Kind
- Division of Geriatrics, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
- Geriatrics Research Education and Clinical Center, Madison Veterans Affairs Hospital, Madison, Wisconsin
| | - Katherine L. Possin
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
- Global Brain Health Institute, University of California, San Francisco, San Francisco
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van de Vorst IE, van Campen JJPCM, Moll van Charante EP, Schmand BBA, Goudsmit M. [Screening of dementia in first generation migrants]. Ned Tijdschr Geneeskd 2021; 165:D5425. [PMID: 33793130] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The number of patients with dementia is increasing over time. There is evidence that the prevalence in ethnic minority groups is even higher. Diagnosing dementia in first generation non-western migrants is often difficult due to language and cultural barriers, low education, and illiteracy. In this article we recommend the use of two validated screening tools (the RUDAS, Rowland Universal Dementia assessment scale and the IQCODE, Informant Questionnaire of Cognitive Decline in the elderly) elucidated by two case descriptions.
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Chen CJ, Liu X, Chiou JS, Hang LW, Li TM, Tsai FJ, Ko CH, Lin TH, Liao CC, Huang SM, Liang WM, Lin YJ. Effects of Chinese herbal medicines on dementia risk in patients with sleep disorders in Taiwan. J Ethnopharmacol 2021; 264:113267. [PMID: 32822822 DOI: 10.1016/j.jep.2020.113267] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/18/2020] [Accepted: 08/08/2020] [Indexed: 06/11/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Sleep disorders affect an estimated 150 million people worldwide and result in adverse health, safety, and work performance-related outcomes that have important economic consequences. In Taiwan, Chinese herbal medicine (CHM) is a complementary natural medicine and has been widely used as an adjunctive therapy. AIM OF THE STUDY This study aimed to investigate the effect of CHM on dementia risk in patients with sleep disorders in Taiwan. MATERIALS AND METHODS We identified 124,605 patients with sleep disorders between the ages of 20 and 60 years. Of these, 5876 CHM users and 5876 non-CHM users were matched according to age and gender. The chi-squared test, Cox proportional hazard model, Kaplan-Meier method, and log-rank test were used for the comparisons. Association rule mining and network analysis were applied to determine a CHM pattern specialized for sleep disorders. RESULTS More CHM users did not use sleeping pills than non-CHM users. CHM users had a lower risk of dementia than non-CHM users after adjusting for age, gender, and sleeping pill use (hazard ratio (HR): 0.469, 95% CI = 0.289-0.760; p-value = 0.002). The cumulative incidence of dementia was lower among CHM users (long-rank test, p-value < 0.001). Association rule mining and network analysis showed that Ye-Jiao-Teng (YJT; Caulis Polygoni Multiflori; Polygonum multiflorum Thunb), Suan-Zao-Ren-Tang (SZRT), Jia-Wei-Xiao-Yao-San (JWXYS), He-Huan-Pi (HHP; Cortex Albizziae; Albizia julibrissin Durazz.), and Suan-Zao-Ren (SZR; Semen Zizyphi Spinosae; Ziziphus jujuba Mill.) were important CHMs for patients with sleep disorders in Taiwan. CONCLUSIONS A comprehensive list of herbal medicines may be useful for the clinical treatment of patients with sleep disorders, and for future scientific investigations into the prevention of dementia in these patients.
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Affiliation(s)
- Chao-Jung Chen
- Genetic Center, Proteomics Core Laboratory, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
| | - Xiang Liu
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Gaithersburg, MD, USA.
| | - Jian-Shiun Chiou
- Department of Health Services Administration, China Medical University, Taichung, Taiwan.
| | - Liang-Wen Hang
- Sleep Medicine Center, Department of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Respiratory Therapy, College of Health Care, China Medical University, Taichung, Taiwan.
| | - Te-Mao Li
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.
| | - Fuu-Jen Tsai
- Genetic Center, Proteomics Core Laboratory, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; School of Chinese Medicine, China Medical University, Taichung, Taiwan; Department of Biotechnology and Bioinformatics, Asia University, Taichung, Taiwan.
| | - Cheng-Hang Ko
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.
| | - Ting-Hsu Lin
- Genetic Center, Proteomics Core Laboratory, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
| | - Chiu-Chu Liao
- Genetic Center, Proteomics Core Laboratory, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
| | - Shao-Mei Huang
- Genetic Center, Proteomics Core Laboratory, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
| | - Wen-Miin Liang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan.
| | - Ying-Ju Lin
- Genetic Center, Proteomics Core Laboratory, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; School of Chinese Medicine, China Medical University, Taichung, Taiwan.
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Gardener H, Levin B, DeRosa J, Rundek T, Wright CB, Elkind MS, Sacco RL. Social Connectivity is Related to Mild Cognitive Impairment and Dementia. J Alzheimers Dis 2021; 84:1811-1820. [PMID: 34719491 PMCID: PMC8783295 DOI: 10.3233/jad-210519] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Evidence supports a relationship between loneliness, social isolation, and dementia, but less is known about whether social connections confer protection against cognitive decline in disadvantaged neighborhoods. OBJECTIVE This longitudinal population-based study examines the relationship between social connectivity and cognitive impairment in a multi-ethnic cohort with low socioeconomic status and high vascular disease risk. METHODS Northern Manhattan Study participants self-reported frequency of social visits, phone calls, satisfaction with social visits, number of friends, and loneliness at baseline, and were followed prospectively with a series of neuropsychological assessments. Social connectivity was examined in relation to incident mild cognitive impairment (MCI)/dementia using logistic regression adjusting for demographics and vascular risk factors. RESULTS Among 952 participants (mean age at first neuropsychological assessment = 69±8 years, 62% women, 17% Black, 13% white, 68% Hispanic), 24% developed MCI/dementia. Participants who had phone contact with friends/family 2 + times/week (91%) had a lower odds of MCI/dementia (OR = 0.52, 95% CI = 0.31-0.89), with no association for frequency of in-person visits. Compared to those who were neither socially isolated (≥3 friends) nor lonely (reference, 73%), those who were socially isolated and lonely (3%) had an increased odds of MCI/dementia (OR = 2.89, 95% CI = 1.19-7.02), but differences were not observed for those who were socially isolated but not lonely (10%, OR = 1.05, 95% CI = 0.60-1.84), nor those who were lonely but not isolated (11%, OR = 1.58, 95% CI = 0.97-2.59). CONCLUSION This study raises the possibility that social connections confer some protection for cognitive health in the face of adversity and supports potential opportunities for community social interventions for improving cognition in disadvantaged populations.
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Affiliation(s)
- Hannah Gardener
- Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Bonnie Levin
- Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Janet DeRosa
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Tatjana Rundek
- Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Clinton B. Wright
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Mitchell S.V. Elkind
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ralph L. Sacco
- Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL, USA
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Farfel JM, Barnes LL, Capuano A, de Moraes Sampaio MC, Wilson RS, Bennett DA. Informant-Reported Discrimination, Dementia, and Cognitive Impairment in Older Brazilians. J Alzheimers Dis 2021; 84:973-981. [PMID: 33935076 PMCID: PMC9113828 DOI: 10.3233/jad-201436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Self-reported discrimination is a source of psychosocial stress that has been previously associated with poor cognitive function in older African Americans without dementia. OBJECTIVE Here, we examine the association of discrimination with dementia and cognitive impairment in racially diverse older Brazilians. METHODS We included 899 participants 65 years or older (34.3% Black) from the Pathology, Alzheimer's and Related Dementias Study (PARDoS), a community-based study of aging and dementia. A structured interview with informants of the deceased was conducted. The interview included the Clinical Dementia Rating (CDR) Scale for the diagnosis of dementia and cognitive impairment proximate to death and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) as a second measure of cognitive impairment. Informant-reported discrimination was assessed using modified items from the Major and Everyday Discrimination Scales. RESULTS Discrimination was reported by informants of 182 (20.2%) decedents and was more likely reported by informants of Blacks than Whites (25.3% versus 17.6%, p = 0.006). Using the CDR, a higher level of informant-reported discrimination was associated with higher odds of dementia (OR: 1.24, 95% CI 1.08 -1.42, p = 0.002) and cognitive impairment (OR: 1.21, 95% CI: 1.06 -1.39, p = 0.004). Similar results were observed using the IQCODE (estimate: 0.07, SE: 0.02, p = 0.003). The effects were independent of race, sex, education, socioeconomic status, major depression, neuroticism, or comorbidities. CONCLUSION Higher level of informant-reported discrimination was associated with higher odds of dementia and cognitive impairment in racially diverse older Brazilians.
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Affiliation(s)
- Jose M. Farfel
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
- Health Sciences Program, Instituto de Assistência Medica ao Servidor Público do Estado (IAMSPE), São Paulo, Brazil
| | - Lisa L. Barnes
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, IL, USA
| | - Ana Capuano
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
- Health Sciences Program, Instituto de Assistência Medica ao Servidor Público do Estado (IAMSPE), São Paulo, Brazil
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, USA
| | | | - Robert S. Wilson
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, IL, USA
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
- Health Sciences Program, Instituto de Assistência Medica ao Servidor Público do Estado (IAMSPE), São Paulo, Brazil
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, USA
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Wright CB, DeRosa JT, Moon MP, Strobino K, DeCarli C, Cheung YK, Assuras S, Levin B, Stern Y, Sun X, Rundek T, Elkind MS, Sacco RL. Race/Ethnic Disparities in Mild Cognitive Impairment and Dementia: The Northern Manhattan Study. J Alzheimers Dis 2021; 80:1129-1138. [PMID: 33646162 PMCID: PMC8150441 DOI: 10.3233/jad-201370] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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] [Accepted: 01/18/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Variability in dementia rates across racial and ethnic groups has been estimated at 60%. Studies suggest disparities in Caribbean Hispanic and Black populations, but community-based data are limited. OBJECTIVE Estimate the prevalence of mild cognitive impairment (MCI) and dementia in the racially and ethnically diverse community-based Northern Manhattan Study cohort and examine sociodemographic, vascular risk factor, and brain imaging correlates. METHODS Cases of MCI and dementia were adjudicated by a team of neuropsychologists and neurologists and prevalence was estimated across race/ethnic groups. Ordinal proportional odds models were used to estimate race/ethnic differences in the prevalence of MCI or dementia adjusting for sociodemographic variables (model 1), model 1 plus potentially modifiable vascular risk factors (model 2), and model 1 plus structural imaging markers of brain integrity (model 3). RESULTS There were 989 participants with cognitive outcome determinations (mean age 69±9 years; 68% Hispanic, 16% Black, 14% White; 62% women; mean (±SD) follow-up five (±0.6) years). Hispanic and Black participants had greater likelihood of MCI (20%) and dementia (5%) than White participants accounting for age and education differences. Hispanic participants had greater odds of MCI or dementia than both White and Black participants adjusting for sociodemographic variables, vascular risk factors, and brain imaging factors. White matter hyperintensity burden was significantly associated with greater odds of MCI or dementia (OR = 1.3, 1.1 to 1.6), but there was no significant interaction by race/ethnicity. CONCLUSION In this diverse community-based cohort, cross-sectional data revealed significant race/ethnic disparities in the prevalence of MCI and dementia. Longer follow-up and incidence data are needed to further clarify these relationships.
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Affiliation(s)
- Clinton B. Wright
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Janet T. DeRosa
- Department of Neurology, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Michelle P. Moon
- Department of Neurology, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Kevin Strobino
- Department of Neurology, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Charles DeCarli
- Department of Neurology, University of California at Davis, Davis, CA, USA
| | - Ying Kuen Cheung
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Stephanie Assuras
- Department of Neurology, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Bonnie Levin
- Evelyn F McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Yaakov Stern
- Department of Neurology, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Xiaoyan Sun
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tatjana Rundek
- Evelyn F McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mitchell S.V. Elkind
- Department of Neurology, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Ralph L. Sacco
- Evelyn F McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
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21
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Tolea MI, Chrisphonte S, Galvin JE. The Effect of Sociodemographics, Physical Function, and Mood on Dementia Screening in a Multicultural Cohort. Clin Interv Aging 2020; 15:2249-2263. [PMID: 33293802 PMCID: PMC7719316 DOI: 10.2147/cia.s257809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 10/28/2020] [Indexed: 12/03/2022] Open
Abstract
PURPOSE To assess age, sex, race and ethnicity disparities in cognitive function in community-dwelling older adults and identify factors that contribute to these disparities. PATIENTS AND METHODS Cognitive performance (global and domain-specific) and self-reported cognitive function were compared among Black (N=57), Hispanic (N=139), and White (N=108) older adults. The impact of socioeconomic status (SES), physical functionality, and mood indicators was assessed with a combination of hierarchical general linear models and mediation analysis. RESULTS Poorer cognitive performance and higher levels of impairment were found in older adults from racial and ethnic backgrounds. The contribution of lower SES to the observed racial and ethnic disparities in objective cognitive performance was 33% in Hispanics and about 20% in Blacks, while poorer physical functionality explained over half of the differences between Black and White participants. Higher self-reported cognitive impairment in minorities was explained by lower SES and higher depressive symptoms in Hispanics but not in Blacks. CONCLUSION Performance on objective memory testing and self-reported cognition are greatly influenced by relevant biological, sociodemographic and medical variables. Dementia screening programs should be tailored to individual sociodemographic groups based on contributors that are specific to each group.
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Affiliation(s)
- Magdalena I Tolea
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stephanie Chrisphonte
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - James E Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
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22
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Stanaway FF, Blyth FM, Naganathan V, Le Couteur DG, Ribeiro R, Hirani V, Waite LM, Handelsman DJ, Seibel MJ, Cumming RG. Mortality Paradox of Older Italian-Born Men in Australia: The Concord Health and Ageing in Men Project. J Immigr Minor Health 2020; 22:102-109. [PMID: 30840179 DOI: 10.1007/s10903-019-00874-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Italian migrants are one of the largest groups of older migrants in Australia. Past research has found lower mortality rates in Italian migrants but it is unclear if this persists into older age. Data came from 334 Italian-born and 849 Australian-born men aged 70 years and over participating in a longitudinal study of men's ageing. Male Italian migrants were more likely to smoke, be overweight, and have lower socio-economic status (SES). They also had higher morbidity from diabetes, chronic pain, dementia and depressive symptoms but lower morbidity from heart disease and cancer. There was no age-adjusted mortality difference. However, adjusting for SES, lifestyle and morbidity differences revealed a 25% lower mortality rate (adjusted HR = 0.75; 95% CI 0.57, 0.98) in Italian-born men. Compared to their Australian-born counterparts, older Italian-born men have a lower mortality than expected considering their lower SES, higher smoking and higher morbidity.
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Affiliation(s)
- Fiona F Stanaway
- Sydney School of Public Health, Sydney University, Edward Ford Building, Camperdown, NSW, 2006, Australia.
| | - Fiona M Blyth
- Concord Clinical School, Concord Hospital, Concord, NSW, 2139, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, The Ageing and Alzheimers Institute, Concord Hospital and Sydney University, Concord, NSW, 2139, Australia
| | - David G Le Couteur
- Centre for Education and Research on Ageing, The Ageing and Alzheimers Institute, Concord Hospital and Sydney University, Concord, NSW, 2139, Australia
| | - Rosilene Ribeiro
- Centre for Education and Research on Ageing, The Ageing and Alzheimers Institute, Concord Hospital and Sydney University, Concord, NSW, 2139, Australia
- School of Life and Environmental Science, Charles Perkins Centre, Sydney University, Camperdown, 2006, NSW, Australia
| | - Vasant Hirani
- School of Life and Environmental Science, Charles Perkins Centre, Sydney University, Camperdown, 2006, NSW, Australia
| | - Louise M Waite
- Centre for Education and Research on Ageing, The Ageing and Alzheimers Institute, Concord Hospital and Sydney University, Concord, NSW, 2139, Australia
| | - David J Handelsman
- ANZAC Research Institute, Concord Hospital, Sydney University, Concord, 2139, NSW, Australia
| | - Markus J Seibel
- School of Life and Environmental Science, Charles Perkins Centre, Sydney University, Camperdown, 2006, NSW, Australia
| | - Robert G Cumming
- Sydney School of Public Health, Sydney University, Edward Ford Building, Camperdown, NSW, 2006, Australia
- Centre for Education and Research on Ageing, The Ageing and Alzheimers Institute, Concord Hospital and Sydney University, Concord, NSW, 2139, Australia
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Martinez-Miller EE, Robinson WR, Avery CL, Yang YC, Haan MN, Prather AA, Aiello AE. Longitudinal Associations of US Acculturation With Cognitive Performance, Cognitive Impairment, and Dementia. Am J Epidemiol 2020; 189:1292-1305. [PMID: 32440686 DOI: 10.1093/aje/kwaa088] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 05/08/2020] [Accepted: 05/13/2020] [Indexed: 12/17/2022] Open
Abstract
US Latinos, a growing, aging population, are disproportionately burdened by cognitive decline and dementia. Identification of modifiable risk factors is needed for interventions aimed at reducing risk. Broad sociocultural context may illuminate complex etiology among culturally diverse Latinos. Among 1,418 older (≥60 years), low-socioeconomic position (SEP) Latinos (predominantly of Mexican descent) in Sacramento, California, we examined whether US acculturation was associated with cognitive performance, cognitive decline, and dementia/ cognitive impairment without dementia over a 10-year period and whether education modified the associations (Sacramento Area Latino Study on Aging, 1998-2008). Analyses used linear mixed models, competing-risk regression, and inverse probability of censoring weights for attrition. Participants with high US acculturation had better cognitive performance (0.21 fewer cognitive errors at grand-mean-centered age 70 years) than those with low acculturation after adjustment for sociodemographic factors, practice effects, and survey language. Results may have been driven by cultural language use rather than identity factors (e.g., ethnic identity, interactions). Rate of cognitive decline and risk of dementia/cognitive impairment without dementia did not differ by acculturation, regardless of education (β = 0.00 (standard error, 0.00) and hazard ratio = 0.81 (95% confidence interval: 0.49, 1.35), respectively). High US acculturation was associated with better cognitive performance among these older, low-SEP Latinos. Acculturation may benefit cognition when SEP is low. Future studies should incorporate extended longitudinal assessments among more diverse groups.
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Cullum S, Dudley M, Kerse N. The case for a bicultural dementia prevalence study in Aotearoa New Zealand. N Z Med J 2020; 133:119-125. [PMID: 33119575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Sarah Cullum
- Senior Lecturer, Department of Psychological Medicine, The University of Auckland, Auckland
| | - Makarena Dudley
- Senior Lecturer, School of Psychology, The University of Auckland, Auckland
| | - Ngaire Kerse
- Joyce Cook Chair in Ageing Well, School of Population Health, The University of Auckland, Auckland
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25
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Umberson D, Donnelly R, Xu M, Farina M, Garcia MA. Death of a Child Prior to Midlife, Dementia Risk, and Racial Disparities. J Gerontol B Psychol Sci Soc Sci 2020; 75:1983-1995. [PMID: 31760426 PMCID: PMC7566971 DOI: 10.1093/geronb/gbz154] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 03/12/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES This study considers whether experiencing the death of a child prior to midlife (by parental age 40) is associated with subsequent dementia risk, and how such losses, which are more common for black than for white parents, may add to racial disparities in dementia risk. METHODS We use discrete-time event history models to predict dementia incidence among 9,276 non-Hispanic white and 2,182 non-Hispanic black respondents from the Health and Retirement Study, 2000-2014. RESULTS Losing a child prior to midlife is associated with increased risk for later dementia, and adds to disparities in dementia risk associated with race. The death of a child is associated with a number of biosocial variables that contribute to subsequent dementia risk, helping to explain how the death of child may increase risk over time. DISCUSSION The death of a child prior to midlife is a traumatic life course stressor with consequences that appear to increase dementia risk for both black and white parents, and this increased risk is explained by biosocial processes likely activated by bereavement. However, black parents are further disadvantaged in that they are more likely than white parents to experience the death of a child, and such losses add to the already substantial racial disadvantage in dementia risk.
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Affiliation(s)
- Debra Umberson
- Population Research Center, The University of Texas at Austin
- Department of Sociology, The University of Texas at Austin
| | - Rachel Donnelly
- Department of Sociology, Vanderbilt University, Nashville, Tennessee
| | - Minle Xu
- Population Research Center, The University of Texas at Austin
- Department of Sociology, The University of Texas at Austin
| | - Matthew Farina
- Population Research Center, The University of Texas at Austin
- Department of Sociology, The University of Texas at Austin
| | - Michael A Garcia
- Population Research Center, The University of Texas at Austin
- Department of Sociology, The University of Texas at Austin
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26
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George KM, Lutsey PL, Kucharska-Newton A, Palta P, Heiss G, Osypuk T, Folsom AR. Life-Course Individual and Neighborhood Socioeconomic Status and Risk of Dementia in the Atherosclerosis Risk in Communities Neurocognitive Study. Am J Epidemiol 2020; 189:1134-1142. [PMID: 32383452 PMCID: PMC7666419 DOI: 10.1093/aje/kwaa072] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 09/11/2019] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 01/30/2023] Open
Abstract
We examined associations of individual- and neighborhood-level life-course (LC) socioeconomic status (SES) with incident dementia in the Atherosclerosis Risk in Communities cohort. Individual- and neighborhood-level SES were assessed at 3 life epochs (childhood, young adulthood, midlife) via questionnaire (2001-2002) and summarized into LC-SES scores. Dementia was ascertained through 2013 using cognitive exams, telephone interviews, and hospital and death certificate codes. Cox regression was used to estimate hazard ratios of dementia by LC-SES scores in race-specific models. The analyses included data from 12,599 participants (25% Black) in the United States, with a mean age of 54 years and median follow-up of 24 years. Each standard-deviation greater individual LC-SES score was associated with a 14% (hazard ratio (HR) = 0.86, 95% confidence interval (CI): 0.81, 0.92) lower risk of dementia in White and 21% (HR = 0.79, 95% CI: 0.71, 0.87) lower risk in Black participants. Education was removed from the individual LC-SES score and adjusted for separately to assess economic factors of LC-SES. A standard-deviation greater individual LC-SES score, without education, was associated with a 10% (HR = 0.90, 95% CI: 0.84, 0.97) lower dementia risk in White and 15% (HR = 0.85, 95% CI: 0.76, 0.96) lower risk in Black participants. Neighborhood LC-SES was not associated with dementia. We found that individual LC-SES is a risk factor for dementia, whereas neighborhood LC-SES was not associated.
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Affiliation(s)
- Kristen M George
- Correspondence to Dr. Kristen M. George, Department of Public Health Sciences, University of California Davis Medical Center, Medical Sciences 1-C, One Shields Avenue, Davis, CA 95616 (e-mail: )
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27
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Herat-Gunaratne R, Cooper C, Mukadam N, Rapaport P, Leverton M, Higgs P, Samus Q, Burton A. "In the Bengali Vocabulary, There Is No Such Word as Care Home": Caring Experiences of UK Bangladeshi and Indian Family Carers of People Living With Dementia at Home. Gerontologist 2020; 60:331-339. [PMID: 31587053 DOI: 10.1093/geront/gnz120] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We aimed to explore experiences of South Asian carers of people with dementia receiving health or social care in the United Kingdom, purposively recruited to encompass a range of migration, economic and cultural experiences. While previous work in this area has reported carers' understanding of, and attitudes to dementia, we explored how carers' cultural identities and values influenced their experiences, negotiation of the caring role and relationship with services. RESEARCH DESIGN AND METHODS We conducted semi-structured interviews with 10 Bangladeshi and Indian family carers of people living with dementia at home. We recruited participants from community settings in London and Bradford, UK. Interviews were audio recorded, transcribed and thematically analyzed. RESULTS We identified 4 themes: an expectation and duty to care, expectation and duty as a barrier to accessing formal care (family carer reluctance, care recipient reluctance, and service organization), culturally (in)sensitive care, and the importance of support from informal care networks. DISCUSSION AND IMPLICATIONS Interviewees described tensions between generations with different understandings of familial care obligations. Expectations to manage led to burden and guilt, and the cost of caring, in terms of lost employment and relationships was striking. Unlike in previous studies, interviewees wanted to engage and be supported by services, but were frequently offered care models they could not accept. There was a tension between a state-provided care system obliged to provide care when there are no alternatives, and family carers who feel a duty to always provide alternatives. Informal social networks often provided valued support.
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Affiliation(s)
| | - Claudia Cooper
- Division of Psychiatry, University College London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | | | | | | | - Paul Higgs
- Division of Psychiatry, University College London, UK
| | - Quincy Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
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28
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Baghirathan S, Cheston R, Hui R, Chacon A, Shears P, Currie K. A grounded theory analysis of the experiences of carers for people living with dementia from three BAME communities: Balancing the need for support against fears of being diminished. Dementia (London) 2020. [PMID: 30318901 DOI: 10.1177/2f1471301218804714] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
An estimated 25,000 people of Black, Asian and other Minority Ethnic (BAME) origins live with dementia in UK - a number which is expected to increase sevenfold by 2051. People from many BAME communities experience dementia in a markedly different way to their white British counterparts. For instance diagnosis is more likely to occur at an advanced stage of the illness, while there is a lower take-up of mainstream dementia services. This research study focused on the experiences of caregivers for family and friends living with dementia from South Asian, African Caribbean and Chinese communities in Bristol. Data were collected through interviews with 27 participants and 8 focus groups attended by 76 participants. Additionally, interviews were carried out with 16 paid staff and volunteers working for Voluntary and Community Sector Organisations (VCSOs) that provided services for older people from these three communities. As concepts emerged during data analysis, so these were checked with each community. The grounded theory, 'fear of diminishment' was present across all communities: participants both needed and wanted support, but they were reluctant to accept this if it came at the cost of being diminished as a person. To resolve this dilemma, informants turned to BAME-led VCSOs, which provided ongoing support and advocated on behalf of their members. However, the services provided by these VCSOs varied and reflected differences in the ways in which communities enacted the theory. Given the increasing importance of cultural diversity within dementia care, this study has important implications for communities across the UK and elsewhere, and points towards the need for sustainable and equitable resourcing of dementia care within BAME-led VCSOs.
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Affiliation(s)
| | - Richard Cheston
- Health and Social Sciences, University of the West of England, UK
| | - Rosa Hui
- Bristol and Avon Chinese Women's Group, UK
| | | | - Paula Shears
- Alzheimer's Society, Bristol Dementia Wellbeing Service, UK
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29
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Pettigrew C, Brichko R, Black B, O’Connor MK, Austrom MG, Robinson MT, Lindauer A, Shah RC, Peavy GM, Meyer K, Schmitt FA, Lingler JH, Domoto-Reilly K, Farrar-Edwards D, Albert M. Attitudes toward advance care planning among persons with dementia and their caregivers. Int Psychogeriatr 2020; 32:585-599. [PMID: 31309906 PMCID: PMC6962575 DOI: 10.1017/s1041610219000784] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To examine factors that influence decision-making, preferences, and plans related to advance care planning (ACP) and end-of-life care among persons with dementia and their caregivers, and examine how these may differ by race. DESIGN Cross-sectional survey. SETTING 13 geographically dispersed Alzheimer's Disease Centers across the United States. PARTICIPANTS 431 racially diverse caregivers of persons with dementia. MEASUREMENTS Survey on "Care Planning for Individuals with Dementia." RESULTS The respondents were knowledgeable about dementia and hospice care, indicated the person with dementia would want comfort care at the end stage of illness, and reported high levels of both legal ACP (e.g., living will; 87%) and informal ACP discussions (79%) for the person with dementia. However, notable racial differences were present. Relative to white persons with dementia, African American persons with dementia were reported to have a lower preference for comfort care (81% vs. 58%) and lower rates of completion of legal ACP (89% vs. 73%). Racial differences in ACP and care preferences were also reflected in geographic differences. Additionally, African American study partners had a lower level of knowledge about dementia and reported a greater influence of religious/spiritual beliefs on the desired types of medical treatments. Notably, all respondents indicated that more information about the stages of dementia and end-of-life health care options would be helpful. CONCLUSIONS Educational programs may be useful in reducing racial differences in attitudes towards ACP. These programs could focus on the clinical course of dementia and issues related to end-of-life care, including the importance of ACP.
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Affiliation(s)
- Corinne Pettigrew
- Department of Neurology, Johns Hopkins School of Medicine, 1620 McElderry St., Baltimore, MD, 21205, USA
| | - Rostislav Brichko
- Department of Neurology, Johns Hopkins School of Medicine, 1620 McElderry St., Baltimore, MD, 21205, USA
| | - Betty Black
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 5300 Alpha Commons Dr., Baltimore, MD 21224, USA
| | - Maureen K. O’Connor
- Department of Neurology, Boston University School of Medicine, 72 East Concord St., B-7800, Boston, MA 02118, USA
| | - Mary Guerriero Austrom
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16 St., Goodman Hall, Suite 2800, Indianapolis, IN 46202, USA
| | - Maisha T. Robinson
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Allison Lindauer
- Department of Neurology, Layton Aging and Alzheimer’s Disease Center, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR 97239, USA
| | - Raj C. Shah
- Department of Family Medicine and the Rush Alzheimer’s Disease Center, Rush University Medical Center, 1750 W. Harrison Street., Suite 1000, Chicago, IL 60612, USA
| | - Guerry M. Peavy
- Department of Neurosciences, University of California, San Diego School of Medicine, 9444 Medical Center Drive, Suite 1-100, La Jolla, CA 92037, USA
| | - Kayla Meyer
- Department of Neurology, University of Kansas Medical Center, 4350 Shawnee Mission Parkway, MS 6002, Fairway, KS 66205, USA
| | - Frederick A. Schmitt
- Department of Neurology & Sanders-Brown Center on Aging, University of Kentucky, 800 South Limestone St., Lexington, KY 40536, USA
| | - Jennifer H. Lingler
- Department of Health & Community Systems, University of Pittsburgh School of Nursing, 415 Victoria Hall, 3500 Victoria St., Pittsburgh, PA 15261, USA
| | - Kimiko Domoto-Reilly
- Department of Neurology, University of Washington, 325 9th Ave., 3 Floor West Clinic, Seattle, WA 98104, USA
| | - Dorothy Farrar-Edwards
- Department of Kinesiology-Occupational Therapy, University of Wisconsin Madison School of Education, 2170 Medical Sciences Center, 1300 University Ave., Madison, WI 53706, USA
| | - Marilyn Albert
- Department of Neurology, Johns Hopkins School of Medicine, 1620 McElderry St., Baltimore, MD, 21205, USA
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30
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Bradley K, Smith R, Hughson JA, Atkinson D, Bessarab D, Flicker L, Radford K, Smith K, Strivens E, Thompson S, Blackberry I, LoGiudice D. Let's CHAT (community health approaches to) dementia in Aboriginal and Torres Strait Islander communities: protocol for a stepped wedge cluster randomised controlled trial. BMC Health Serv Res 2020; 20:208. [PMID: 32164678 PMCID: PMC7069169 DOI: 10.1186/s12913-020-4985-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Documented rates of dementia and cognitive impairment not dementia (CIND) in older Aboriginal and Torres Strait Islander Peoples is 3-5 times higher than the rest of the population, and current evidence suggests this condition is under-diagnosed and under-managed in a clinical primary care setting. This study aims to implement and evaluate a culturally responsive best practice model of care to optimise the detection and management of people with cognitive impairment and/or dementia, and to improve the quality of life of carers and older Aboriginal and Torres Islander Peoples with cognitive impairment. METHODS/DESIGN The prospective study will use a stepped-wedge cluster randomised controlled trial design working with 12 Aboriginal Community Controlled Health Services (ACCHSs) across four states of Australia. Utilising a co-design approach, health system adaptations will be implemented including (i) development of a best practice guide for cognitive impairment and dementia in Aboriginal and Torres Strait Islander communities (ii) education programs for health professionals supported by local champions and (iii) development of decision support systems for local medical software. In addition, the study will utilise a knowledge translation framework, the Integrated Promoting Action on Research Implementation in Health Services (iPARIHS) Framework, to promote long-term sustainable practice change. Process evaluation will also be undertaken to measure the quality, fidelity and contextual influences on the outcomes of the implementation. The primary outcome measures will be rates of documentation of dementia and CIND, and evidence of improved management of dementia and CIND among older Indigenous peoples attending Aboriginal and Torres Strait Islander primary care services through health system changes. The secondary outcomes will be improvements to the quality of life of older Indigenous peoples with dementia and CIND, as well as that of their carers and families. DISCUSSION The Let's CHAT Dementia project will co-design, implement and evaluate a culturally responsive best practice model of care embedded within current Indigenous primary health care. The best practice model of care has the potential to optimise the timely detection (especially in the early stages) and improve the ongoing management of people with dementia or cognitive impairment. TRIAL REGISTRATION ACTRN12618001485224. Date of registration: 04 of September 2019.
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Affiliation(s)
- Kate Bradley
- The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Royal Melbourne Hospital, Royal Park Campus, Administration Building 21, 34 -54 Poplar Road, Melbourne, Victoria 3052 Australia
| | - Robyn Smith
- The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Royal Melbourne Hospital, Royal Park Campus, Administration Building 21, 34 -54 Poplar Road, Melbourne, Victoria 3052 Australia
| | - Jo-anne Hughson
- The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Royal Melbourne Hospital, Royal Park Campus, Administration Building 21, 34 -54 Poplar Road, Melbourne, Victoria 3052 Australia
| | - David Atkinson
- The University of Western Australia, Rural Clinical School of Western Australia , PO Box 1377, Broome, 6725 Australia
| | - Dawn Bessarab
- The University of Western Australia, M303, 35 Stirling Highway, Perth, 6009 Australia
| | - Leon Flicker
- The University of Western Australia, Rural Clinical School of Western Australia , PO Box 1377, Broome, 6725 Australia
| | - Kylie Radford
- Neuroscience Research Australia, 139 Barker Street, Sydney, NSW 2031 Australia
- The School of Medical Sciences, University of New South Wales, Sydney, NSW Australia
| | - Kate Smith
- University of Western Australia, 35 Stirling Highway, Perth, 6009 Australia
| | | | - Sandra Thompson
- The University of Western Australia, 167 Fitzgerald St, Geraldton, WA 6530 Australia
| | | | - Dina LoGiudice
- The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Royal Melbourne Hospital, Royal Park Campus, Administration Building 21, 34 -54 Poplar Road, Melbourne, Victoria 3052 Australia
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Luth EA, Russell DJ, Brody AA, Dignam R, Czaja SJ, Ryvicker M, Bowles KH, Prigerson HG. Race, Ethnicity, and Other Risks for Live Discharge Among Hospice Patients with Dementia. J Am Geriatr Soc 2020; 68:551-558. [PMID: 31750935 PMCID: PMC7056492 DOI: 10.1111/jgs.16242] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 08/09/2019] [Revised: 10/06/2019] [Accepted: 10/10/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The end-of-life trajectory for persons with dementia is often protracted and difficult to predict, placing these individuals at heightened risk of live discharge from hospice. Risks for live discharge due to condition stabilization or failure to decline among patients with dementia are not well established. Our aim was to identify demographic, health, and hospice service factors associated with live discharge due to condition stabilization or failure to decline among hospice patients with dementia. DESIGN Retrospective cohort study. SETTING A large not-for-profit agency in New York City. PARTICIPANTS A total of 2629 hospice patients with dementia age 65 years and older. MEASUREMENTS Primary outcome was live discharge from hospice due to condition stabilization or failure to decline (vs death). Measures include demographic factors (race/ethnicity, Medicaid, sex, age, marital status, parental status), health characteristics (primary dementia diagnosis, comorbidities, functional status, prior hospitalization), and hospice service (location, length of service, number and timing of nurse visits). RESULTS Logistic regression models indicated that compared with white hospice patients with dementia, African American and Hispanic hospice patients with dementia experienced increased risk of live discharge (African American: adjusted odds ratio [aOR] = 2.42; 95% confidence interval [CI] = 1.34-4.38; Hispanic: aOR = 2.99; 95% CI = 1.81-4.94). Home hospice (aOR = 7.57; 95% CI = 4.04-14.18), longer length of service (aOR = 1.04; 95% CI = 1.04-1.05), and more days between nurse visits and discharge (aOR = 1.86; 95% CI = 1.56-2.21) were also associated with live discharge. CONCLUSION To avoid burdensome and disruptive transitions out of hospice in patients with dementia, interventions to reduce live discharge due to condition stabilization or failure to decline should be tailored to meet the needs of African American, Hispanic, and home hospice patients. Policies regarding sustained hospice eligibility should account for the variable and protracted end-of-life trajectory of patients with dementia. J Am Geriatr Soc 68:551-558, 2020.
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Affiliation(s)
| | - David J. Russell
- Center for Home Care Policy & Research, Visiting Nurse
Service of New York
- Department of Sociology Appalachian State University
| | - Abraham A. Brody
- New York University College of Nursing
- James J Peters Bronx VA Medical Center, GRECC
| | - Ritchell Dignam
- Center for Home Care Policy & Research, Visiting Nurse
Service of New York
| | | | - Miriam Ryvicker
- Center for Home Care Policy & Research, Visiting Nurse
Service of New York
| | - Kathryn H. Bowles
- Center for Home Care Policy & Research, Visiting Nurse
Service of New York
- University of Pennsylvania School of Nursing
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Abstract
This project aims to improve health literacy in Indigenous communities through the development of evidence-based culturally relevant health promotion materials on dementia that bridge the gap between Indigenous and Western perspectives of the illness. The research team worked in partnership with Health Canada's First Nations and Inuit Home and Community Care Program (FNIHCC) and consulted with Indigenous elders to utilize a two-eyed seeing framework that draws upon Indigenous knowledge and Western biomedicine. A consolidated review of materials and research involving Indigenous perspectives of Alzheimer's and age-related dementias led to the development of two culturally appropriate fact sheets. Two Indigenous-specific fact sheets were developed "What is Dementia? Indigenous Perspectives and Cultural Understandings" and "Signs and Symptoms of Dementia: An Indigenous Guide." The fact sheets prioritize Indigenous knowledge and pay particular attention to Indigenous languages, diverse Indigenous cultures, and literacy levels. The content uses phrasing and words from Indigenous people involved in the research to share information. Biomedical concepts and words were included when necessary but language or presentation of these aspects were often modified to reflect Indigenous conceptualizations. This project provides a foundation for evidence-based knowledge translation in relation to cultural safety in dementia care. Specifically, the researchers outline how health care providers can develop culturally appropriate health promotion material, thus increasing Indigenous cultural understandings of dementia and health literacy.
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Affiliation(s)
- Sharlene Webkamigad
- School of Rural and Northern Health, Laurentian University, Sudbury, ON, Canada
| | - Wayne Warry
- University of Minnesota, Medical School Duluth, 624 E 1st Street, Unit 201, Duluth, MN, 55805, USA
| | - Melissa Blind
- University of Minnesota, Medical School Duluth, 624 E 1st Street, Unit 201, Duluth, MN, 55805, USA
| | - Kristen Jacklin
- University of Minnesota, Medical School Duluth, 624 E 1st Street, Unit 201, Duluth, MN, 55805, USA.
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Shiekh SI, Forbes H, Mathur R, Smeeth L, Pearce N, Warren-Gash C. Ethnicity and risk of diagnosed dementia after stroke: a cohort study using the Clinical Practice Research Datalink. J Epidemiol Community Health 2020; 74:114-119. [PMID: 31699799 PMCID: PMC6993022 DOI: 10.1136/jech-2019-212825] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/20/2019] [Accepted: 10/09/2019] [Indexed: 01/30/2023]
Abstract
INTRODUCTION The UK has over 1.2 million stroke survivors. Stroke is a major risk factor for dementia, and along with other risk factors such as hypertension and diabetes, is more common among Black, Asian and other ethnic minorities (BAME). We aimed to explore whether diagnosed dementia differed by ethnicity among adult stroke survivors. METHODOLOGY Using the UK Clinical Practice Research Datalink and linked hospital data, we conducted a cohort study among patients aged ≥40 years who had an incident stroke between 2005 and 2016. We fitted multivariable Cox proportional hazard models to estimate ethnic differences in the risk of poststroke dementia, adjusting for major clinical and social confounders. RESULTS Our cohort comprised 45 474 stroke survivors (mean age 72.6 years, 49% female), of whom 95.7% were White, 2.0% South Asian, 1.2% Black and 1.1% of Mixed/Other ethnicity. Of these, 4624 (10.2%) were diagnosed with poststroke dementia over a median follow-up of 3.26 years. Compared with the White ethnic group, those of Black ethnicity were 42% more likely to be diagnosed with dementia (adjusted HR 1.42, 95% CI 1.05 to 1.93). There was no association between any other ethnic group and poststroke dementia diagnosis. DISCUSSION There was good evidence that those of Black ethnicity had higher risk of diagnosed dementia poststroke. Further understanding of the mechanisms of this relationship could help target interventions at communities most at risk of dementia poststroke.
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Affiliation(s)
- Suhail Ismail Shiekh
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Harriet Forbes
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Rohini Mathur
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Charlotte Warren-Gash
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
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Hyun J, Hall CB, Sliwinski MJ, Katz MJ, Wang C, Ezzati A, Lipton RB. Effect of Mentally Challenging Occupations on Incident Dementia Differs Between African Americans and Non-Hispanic Whites. J Alzheimers Dis 2020; 75:1405-1416. [PMID: 32417772 PMCID: PMC7874241 DOI: 10.3233/jad-191222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Engaging in mentally challenging activities may protect against dementia in late life. However, little is known whether the association between mentally challenging activities and dementia risk varies with race/ethnicity. OBJECTIVE The current study investigates whether having jobs with higher mental stimulation is differentially associated with a decreased risk of dementia between African Americans (AAs) and non-Hispanic Whites (nHWs). METHODS The sample consisted of 1,079 individuals (66% nHWs, 28% AAs; age = 78.6±5.3) from the longitudinal Einstein Aging Study. Occupation information of each participant was collected retrospectively at baseline and was linked to the substantive complexity of work score from the Dictionary of Occupational Titles. Cox proportional hazards models were used to evaluate the associations of occupational complexity with risk of dementia. RESULTS Individuals whose jobs had moderate-to-high levels of complexity, compared to those with the lowest complexity, were at modestly decreased risk for incident dementia. When stratified by race, moderate-to-high levels of occupational complexity were significantly associated with lower risk of developing dementia for AAs (HR = 0.35). When risk of dementia was evaluated based on the combinations of race×occupational complexity, AAs with lowest occupational complexity showed the highest risk of developing dementia, while other combinations exhibited lower risk of developing dementia (HRs = 0.36~0.43). CONCLUSION Our results suggest that moderate-to-high levels of complexity at work are associated with a decreased risk of incident dementia in AAs. Understanding the differential effects of mentally challenging occupations across race/ethnicity may suggest important intervention strategies that could mitigate racial disparities in dementia rates.
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Affiliation(s)
- Jinshil Hyun
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Charles B. Hall
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Martin J. Sliwinski
- Department of Human Development and Family Studies and Center for Healthy Aging, Pennsylvania State University, University Park, PA, USA
| | - Mindy J. Katz
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Cuiling Wang
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ali Ezzati
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Richard B. Lipton
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
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Melgarejo JD, Aguirre-Acevedo DC, Gaona C, Chavez CA, Calmón GE, Silva ER, de Erausquin GA, Gil M, Mena LJ, Terwilliger JD, Arboleda H, Scarmeas N, Lee JH, Maestre GE. Nighttime Blood Pressure Interacts with APOE Genotype to Increase the Risk of Incident Dementia of the Alzheimer's Type in Hispanics. J Alzheimers Dis 2020; 77:569-579. [PMID: 32675415 PMCID: PMC7577347 DOI: 10.3233/jad-200430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Dementia of the Alzheimer's type (DAT) impacts Hispanics disproportionately, with almost a twofold elevated risk of developing DAT, as well as earlier onset of the disease, than in non-Hispanic Whites. However, the role of main risk factors for DAT, such as APOE-ɛ4 and blood pressure (BP) levels, remains uncertain among Hispanics. OBJECTIVE To investigate the association of APOE-ɛ4 and BP levels, measures with 24-h ambulatory BP monitoring, with incidence of DAT in an elderly cohort of Hispanics. METHODS 1,320 participants from the Maracaibo Aging Study, free of dementia at the baseline, and with ambulatory BP measurements and APOE genotype available were included. Adjusted Cox proportional models were performed to examine 1) the incidence of DAT and 2) the relationship between BP levels and DAT according to APOE genotypes. Models were adjusted by competing risk of death before the onset of DAT. Model performance was assessed by likelihood test. RESULTS The average follow-up time was 5.3 years. DAT incidence was 5.8 per 1000 person-year. APOE-ɛ4 carriers had a higher risk of DAT. In unadjusted analyses, conventional, 24-h, and nighttime systolic BP levels were significantly higher in participants who developed DAT and of APOE-ɛ4 carriers (p < 0.05). After adjustment for competing risks, only higher nighttime systolic BP was associated with DAT incidence, but only among subjects carrying APOE-ɛ4. CONCLUSION In this Hispanic population, both APOE-ɛ4 genotype and assessment of nocturnal systolic BP (rather than diurnal or office BP) were necessary to estimate DAT risk.
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Affiliation(s)
- Jesus D. Melgarejo
- Laboratory of Neuroscience, University of Zulia, Maracaibo, Venezuela
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, KU University of Leuven, Leuven, Belgium
| | | | - Ciro Gaona
- Laboratory of Neuroscience, University of Zulia, Maracaibo, Venezuela
| | - Carlos A. Chavez
- Laboratory of Neuroscience, University of Zulia, Maracaibo, Venezuela
| | - Gustavo E. Calmón
- Instituto de Investigación de Enfermedades Cardiovasculares de la Universidad del Zulia, Facultad de Medicina, Universidad del Zulia, Maracaibo, Venezuela
| | - Eglé R. Silva
- Instituto de Investigación de Enfermedades Cardiovasculares de la Universidad del Zulia, Facultad de Medicina, Universidad del Zulia, Maracaibo, Venezuela
| | - Gabriel A. de Erausquin
- Department of Neurology, and Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA
- Alzheimer’s Disease Resource Center for Minority Aging Research, University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Mario Gil
- Alzheimer’s Disease Resource Center for Minority Aging Research, University of Texas Rio Grande Valley, Brownsville, TX, USA
- Department of Psychological Science and Department of Neurosciences, University of Texas Rio Grande Valley, School of Medicine, Edinburg, TX, USA
| | - Luis J. Mena
- Department of Informatics, Universidad Politécnica de Sinaloa, Mazatlán, México
| | - Joseph D. Terwilliger
- Departments of Psychiatry and Genetics & Development, Columbia University Medical Center, New York, NY, USA
- Sergievsky Center & Department of Epidemiology, Columbia University Medical Center, New York, NY, USA
- Division of Medical Genetics, New York State Psychiatric Institute, New York, NY, USA
- Division of Public Health Genomics, National Institute for Health and Welfare, Helsinki, Finland
| | - Humberto Arboleda
- Neurosciences Research Group, School of Medicine, Nacional University of Colombia, Bogotá, Colombia
- Genetic Institute, National University of Colombia, Bogotá, Colombia
| | - Nikolaos Scarmeas
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain and Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Joseph H. Lee
- Sergievsky Center & Department of Epidemiology, Columbia University Medical Center, New York, NY, USA
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain and Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, School of Public Health, Columbia University, New York, NY, USA
| | - Gladys E. Maestre
- Laboratory of Neuroscience, University of Zulia, Maracaibo, Venezuela
- Alzheimer’s Disease Resource Center for Minority Aging Research, University of Texas Rio Grande Valley, Brownsville, TX, USA
- Department of Neurosciences, University of Texas Rio Grande Valley School of Medicine, Brownsville, TX, USA
- Department of Human Genetics University of Texas Rio Grande Valley School of Medicine, Brownsville, TX, USA
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Gianattasio KZ, Ciarleglio A, Power MC. Development of Algorithmic Dementia Ascertainment for Racial/Ethnic Disparities Research in the US Health and Retirement Study. Epidemiology 2020; 31:126-133. [PMID: 31567393 PMCID: PMC6888863 DOI: 10.1097/ede.0000000000001101] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Disparities research in dementia is limited by lack of large, diverse, and representative samples with systematic dementia ascertainment. Algorithmic diagnosis of dementia offers a cost-effective alternate approach. Prior work in the nationally representative Health and Retirement Study has demonstrated that existing algorithms are ill-suited for racial/ethnic disparities work given differences in sensitivity and specificity by race/ethnicity. METHODS We implemented traditional and machine learning methods to identify an improved algorithm that: (1) had ≤5 percentage point difference in sensitivity and specificity across racial/ethnic groups; (2) achieved ≥80% overall accuracy across racial/ethnic groups; and (3) achieved ≥75% sensitivity and ≥90% specificity overall. Final recommendations were based on robustness, accuracy of estimated race/ethnicity-specific prevalence and prevalence ratios compared to those using in-person diagnoses, and ease of use. RESULTS We identified six algorithms that met our prespecified criteria. Our three recommended algorithms achieved ≤3 percentage point difference in sensitivity and ≤5 percentage point difference in specificity across racial/ethnic groups, as well as 77%-83% sensitivity, 92%-94% specificity, and 90%-92% accuracy overall in analyses designed to emulate out-of-sample performance. Pairwise prevalence ratios between non-Hispanic whites, non-Hispanic blacks, and Hispanics estimated by application of these algorithms are within 1%-10% of prevalence ratios estimated based on in-person diagnoses. CONCLUSIONS We believe these algorithms will be of immense value to dementia researchers interested in racial/ethnic disparities. Our process can be replicated to allow minimally biasing algorithmic classification of dementia for other purposes.
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Affiliation(s)
- Kan Z. Gianattasio
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University
| | - Adam Ciarleglio
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University
| | - Melinda C. Power
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University
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Abstract
The purpose of this study is to explore variations in family support for Latino dementia caregivers and describe the role of the family in dementia caregiver stress processes. Content analysis is utilized with themes derived inductively from 16 in-depth interviews with Latino caregivers recruited in California from 2002 to 2004. Three types of family support are described: extensive (instrumental and emotional support from family, n = 3), limited (instrumental support from one family member, n = 7), and lacking (no support from family, n = 6). Most caregivers report limited support, high risk for burnout and distress, and that dementia-related neuropsychiatric symptoms are obstacles to family unity. Caregivers with extensive support report a larger family size, adaptable family members, help outside of the family, and formalized processes for spreading caregiving duties across multiple persons. Culturally competent interventions should take into consideration diversity in Latino dementia care by (a) providing psychoeducation on problem solving and communication skills to multiple family members, particularly with respect to the nature of dementia and neuropsychiatric symptoms, and by (b) assisting caregivers in managing family tensions - including, when appropriate, employing tactics to mobilize family support.
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Affiliation(s)
- Sunshine Rote
- Kent School of Social Work, University of Louisville, Louisville, KY, USA.
| | - Jacqueline Angel
- Lyndon B. Johnson School of Public Affairs and Department of Sociology, The University of Texas at Austin, Austin, TX, USA
| | - Ladson Hinton
- Psychiatry and Behavioral Sciences, University of California- Davis, Davis, CA, USA
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Forrester SN, Gallo JJ, Whitfield KE, Thorpe RJ. A Framework of Minority Stress: From Physiological Manifestations to Cognitive Outcomes. Gerontologist 2019; 59:1017-1023. [PMID: 30169640 PMCID: PMC6858824 DOI: 10.1093/geront/gny104] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [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: 04/25/2018] [Indexed: 12/31/2022] Open
Abstract
Cognitive impairment and dementia continue to threaten the aging population. Although no one is immune, certain groups, namely black older persons, are more likely to have a diagnosis of certain dementias. Because researchers have not found a purely biological reason for this disparity, they have turned to a biopsychosocial model. Specifically, black persons in the United States are more likely to live with social conditions that affect their stress levels which in turn affect physiological regulation leading to conditions that result in higher levels of cognitive impairment or dementia. Here we discuss some of these social conditions such as discrimination, education, and socioeconomic status, and how physiological dysregulation, namely allostatic load that can lead to cognitive impairment and dementia in black persons especially.
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Affiliation(s)
- Sarah N Forrester
- Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Joseph J Gallo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Roland J Thorpe
- Departmnet of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Dudley M, Menzies O, Elder H, Nathan L, Garrett N, Wilson D. Mate wareware: Understanding 'dementia' from a Māori perspective. N Z Med J 2019; 132:66-74. [PMID: 31581183] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIM To investigate Māori (Indigenous people of Aotearoa New Zealand) understandings of dementia, its causes, and ways to manage a whānau (extended family) member with dementia. METHOD We undertook kaupapa Māori research (Māori informed research) with 223 kaumātua (Māori elders) who participated in 17 focus groups across seven study regions throughout Aotearoa New Zealand and eight whānau from the Waikato region. We audio recorded all interviews, transcribed them and then coded and categorised the data into themes. RESULTS Mate wareware (becoming forgetful and unwell) ('dementia') affects the wairua (spiritual dimension) of Māori. The findings elucidate Māori understandings of the causes of mate wareware, and the role of aroha (love, compassion) and manaakitanga (hospitality, kindness, generosity, support, caring) involved in caregiving for whānau living with mate wareware. Participants perceived cultural activities acted as protective factors that optimised a person's functioning within their whānau and community. CONCLUSION Whānau are crucial for the care of a kaumātua with mate wareware, along with promoting healthy wairua for all. Whanau urgently need information to assist with their knowledge building and empowerment to meet the needs of a member affected by mate wareware. This requires collaborative healthcare practice and practitioners accessing the necessary mātauranga Māori (Māori knowledge) to provide culturally appropriate and comprehensive care for whānau.
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Scherrer JF, Morley JE, Salas J, Floyd JS, Farr SA, Dublin S. Association Between Metformin Initiation and Incident Dementia Among African American and White Veterans Health Administration Patients. Ann Fam Med 2019; 17:352-362. [PMID: 31285213 PMCID: PMC6827650 DOI: 10.1370/afm.2415] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/08/2019] [Accepted: 03/26/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE African American patients are more likely to experience cognitive decline after type 2 diabetes mellitus onset than white patients. Metformin use has been associated with a lower risk of dementia compared with sulfonylureas. Evidence for whether this association differs by race is sparse. METHODS Veterans Health Administration (VHA) medical record data were obtained for 73,761 African American and white patients aged ≥50 years who used the VHA from fiscal years 2000 to 2015. Patients were free of dementia and diabetes medications during fiscal years 2000 and 2001 and subsequently initiated metformin or sulfonylurea monotherapy. For race and age subgroups, Cox proportional hazards models using propensity scores and inverse probability of treatment weighting to control for confounding were computed to measure the association between metformin vs sulfonylurea initiation and incident dementia. RESULTS After controlling for confounding, among patients aged ≥50 years, metformin vs sulfonylurea use was associated with a significantly lower risk of dementia in African American patients (hazard ratio [HR] = 0.73; 95% CI, 0.6-0.89) but not white patients (HR = 0.96; 95% CI, 0.9-1.03). The strongest magnitude of association between metformin and dementia was observed among African American patients aged 50 to 64 years (HR = 0.6; 95% CI, 0.45-0.81). Among those aged 65 to 74 years, metformin was significantly associated with lower risk of dementia in both races. Metformin was not associated with dementia in patients aged ≥75 years. CONCLUSIONS Metformin vs sulfonylurea initiation was associated with a substantially lower risk of dementia among younger African American patients. These results may point to a novel approach for reducing the risk of dementia in African Americans with type 2 diabetes mellitus.
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Affiliation(s)
- Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, Missouri
- Harry S. Truman Veterans Administration Medical Center, Research Service, Columbia, Missouri
| | - John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St Louis, Missouri
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, Missouri
- Harry S. Truman Veterans Administration Medical Center, Research Service, Columbia, Missouri
| | - James S Floyd
- Department of Epidemiology, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington
| | - Susan A Farr
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St Louis, Missouri
- Saint Louis Veterans Affairs Medical Center, Research Service, John Cochran Division, St Louis, Missouri
| | - Sascha Dublin
- Department of Epidemiology, University of Washington, Seattle, Washington
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
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Affiliation(s)
- Michael Ashby
- Cancer, Chronic Disease and Sub-Acute Stream, Royal Hobart Hospital, Tasmanian Health Service, Medical Ethics and Death Studies, School of Medicine, College of Health and Medicine, University of Tasmania, Repatriation Centre, 90 Davey Street, Hobart, TAS, 7000, Australia.
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Abstract
OBJECTIVES A nationwide cohort study on the risk of dementia onset after first diagnosis of Parkinson's disease (PD) is lacking. This study aims to assess 11 years of incidence and the HRs for developing dementia in patients with PD compared with matched controls. DESIGN A population-based cohort study. SETTING National Health Insurance database in Taiwan. PARTICIPANTS A total of 5932 patients with PD were identified, and 29 645 age-matched, sex-matched and index year-matched PD-free individuals were randomly selected. OUTCOME MEASURES All subjects were linked to the claim data to identify the first diagnosis of dementia. The Poisson assumption was used to estimate the incidence rate. Cause-specific hazards models with a partitioning of time at 1 year to account for proportionality were used to estimate the risk of dementia onset. RESULTS The median duration from the first diagnosis of PD to the development of dementia was 9.02 years. In the first partition (≦ 1 year), the incidence of dementia in the PD and control groups was 114.49 and 9.76 per 1000 person-years, respectively, with an adjusted HR of 6.43 (95% CI 5.46 to 7.57). In the second partition (>1 year), the incidence of dementia in the PD and control groups was 30.99 and 10.83 per 1000 person-years, with an adjusted HR of 2.42 (95% CI 2.23 to 2.61). Notably, in the second partition, both men and women aged <70 years had the highest HR (3.82, 95% CI 2.79 to 5.22 and 4.27, 95% CI 3.25 to 5.63, respectively). CONCLUSIONS This study noted an increased risk of dementia after a diagnosis of PD. The magnitude of effect estimation was higher in men in the first partition but was similar in both genders in the second partition. PD patients aged <70 years have the highest risk of dementia in any given partition time.
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Affiliation(s)
- Chih-Ching Liu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu Sun
- Department of Neurology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Pei-Chen Lee
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Susan C Hu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Kramarow EA, Tejada-Vera B. Dementia Mortality in the United States, 2000-2017. Natl Vital Stat Rep 2019; 68:1-29. [PMID: 31112120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Objectives-This report presents data on mortality attributable to dementia. Data for dementia as an underlying cause of death from 2000 through 2017 are shown by selected characteristics such as age, sex, race and Hispanic origin, and state of residence. Trends in dementia deaths overall and by specific cause are presented. The reporting of dementia as a contributing cause of death is also described. Methods-Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia. Using multiple cause-of-death data files, dementia is considered to include deaths attributed to unspecified dementia; Alzheimer disease; vascular dementia; and other degenerative diseases of nervous system, not elsewhere classified. Results-In 2017, a total of 261,914 deaths attributable to dementia as an underlying cause of death were reported in the United States. Forty-six percent of these deaths were due to Alzheimer disease. In 2017, the age-adjusted death rate for dementia as an underlying cause of death was 66.7 deaths per 100,000 U.S. standard population. Age-adjusted death rates were higher for females (72.7) than for males (56.4). Death rates increased with age from 56.9 deaths per 100,000 among people aged 65-74 to 2,707.3 deaths per 100,000 among people aged 85 and over. Age-adjusted death rates were higher among the non-Hispanic white population (70.8) compared with the non-Hispanic black population (65.0) and the Hispanic population (46.0). Age-adjusted death rates for dementia varied by state and urbanization category. Overall, age-adjusted death rates for dementia increased from 2000 to 2017. Rates were steady from 2013 through 2016, and increased from 2016 to 2017. Patterns of reporting the individual dementia causes varied across states and across time.
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Gilsanz P, Corrada MM, Kawas CH, Mayeda ER, Glymour MM, Quesenberry CP, Lee C, Whitmer RA. Incidence of dementia after age 90 in a multiracial cohort. Alzheimers Dement 2019; 15:497-505. [PMID: 30797730 DOI: 10.1016/j.jalz.2018.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 08/01/2018] [Revised: 12/03/2018] [Accepted: 12/11/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Little is known about dementia incidence in diverse populations of oldest-old, the age group with highest dementia incidence. METHODS Incident dementia diagnoses from 1/1/2010 to 9/30/2015 were abstracted from medical records for 2350 members of an integrated health care system in California (n = 1702 whites, n = 375 blacks, n = 105 Latinos, n = 168 Asians) aged ≥90 in 2010. We estimated race/ethnicity-specific age-adjusted dementia incidence rates and implemented Cox proportional hazards models and Fine and Gray competing risk of death models adjusted for demographics and comorbidities in midlife and late-life. RESULTS Dementia incidence rates (n = 771 cases) were lowest among Asians (89.9/1000 person-years), followed by whites (96.9/1000 person-years), Latinos (105.8/1000 person-years), and blacks (121.5/1000 person-years). Cox regression and competing risk models estimated 28% and 36% higher dementia risk for blacks versus whites adjusting for demographics and comorbidities. DISCUSSION Patterns of racial/ethnic disparities in dementia seen in younger older adults continue after the age of 90 years, though smaller in magnitude.
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Affiliation(s)
- Paola Gilsanz
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Maria M Corrada
- Department of Neurology, University of California, Irvine, Irvine, CA, USA; Department of Epidemiology, University of California, Irvine, Irvine, CA, USA
| | - Claudia H Kawas
- Department of Neurology, University of California, Irvine, Irvine, CA, USA; Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, USA
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | | | - Catherine Lee
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Rachel A Whitmer
- Kaiser Permanente Division of Research, Oakland, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA; Department of Public Health Sciences, University of California, Davis, Davis, CA, USA.
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Bieber A, Nguyen N, Meyer G, Stephan A. Influences on the access to and use of formal community care by people with dementia and their informal caregivers: a scoping review. BMC Health Serv Res 2019; 19:88. [PMID: 30709345 PMCID: PMC6359781 DOI: 10.1186/s12913-018-3825-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 12/17/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The literature describes the obstacles to sufficient care faced by people with dementia and their informal caregivers. Although factors influencing access and utilisation are frequently studied, the body of knowledge lacks an overview of aspects related to influence. The frequently used Behavioural Model of Health Care Use (BM) could be used to structure and explain these aspects. An adaptation of the BM emphasises psychosocial influences and appears to enrich the understanding of the use of long-term care for dementia. METHODS We conducted a scoping review with the aim of providing an overview of the aspects influencing the access to and utilisation of formal community care in dementia. Our search covered the PubMed, CINAHL, Social Science Citation Index and PsychInfo databases, as well as grey literature. Two researchers assessed the full texts for eligibility. A data extraction form was developed and tested. We analysed the main topics investigated by the studies and mapped and described the investigated psychosocial aspects according to the BM after narratively summarising the findings. We used the Mixed Method Appraisal Tool (MMAT) to critically appraise the included studies. RESULTS A total of 94 studies were included: n = 55 with quantitative designs, 35 with qualitative designs and four with mixed methods. The studies investigated different services, mainly focusing on health care services. One third of the studies provided information regarding the severity of dementia. The most frequently investigated main topics were ethnicity and attitudes towards services. Psychosocial aspects were frequently investigated, although few studies considered the perspectives of people with dementia. Approximately half of the studies reported a theoretical framework. The adapted BM facilitated the structuring and description of psychosocial aspects. However, this instrument did not address topics beyond the scope of psychosocial aspects, such as sociodemographic characteristics. CONCLUSIONS The access to and utilisation of formal community care for dementia can only be partly explained by individual influencing aspects. Therefore, a theoretical framework would likely help to describe this complex subject. Our findings indicate that the psychosocial categories of the adapted BM enriched the original BM, and that people with dementia should more often be included in healthcare service research to ensure a better understanding of the barriers to accessing formal community care.
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Affiliation(s)
- Anja Bieber
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Natalie Nguyen
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Astrid Stephan
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Gilsanz P, Mayeda ER, Glymour MM, Quesenberry CP, Mungas D, DeCarli CS, Whitmer RA. Birth in High Infant Mortality States and Dementia Risk in a Cohort of Elderly African American and White Health Care Members. Alzheimer Dis Assoc Disord 2019; 33:1-6. [PMID: 30106754 PMCID: PMC6374212 DOI: 10.1097/wad.0000000000000270] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 12/15/2022]
Abstract
IMPORTANCE Birth in areas with high infant mortality rates (IMRs) has been linked to worse long-term health outcomes, yet it is completely unknown if it impacts dementia risk. METHODS In total 6268 health care members were followed for dementia diagnosis from 1996 to 2015. Birth state IMRs from 1928 were ranked into quartile (worst IMRs quartile range, whites: 69 to 129 deaths/1000 live births, Non-whites: 129 to 277 deaths/1000 live births). Cox proportional hazard models estimated the dementia risk associated with birth state IMR quartile adjusting for demographics and lifecourse health indicators. RESULTS Compared with whites born outside of states in the worst IMR quartile, African Americans born in states in the worst IMR quartile had 92% increased dementia risk (HR=1.92; 95% CI: 1.42, 2.59), and African Americans born outside those states had 36% increased risk (HR=1.36; 95% CI: 1.20, 1.53). There was no association between birth state IMR and dementia risk among whites. CONCLUSIONS Birth in states with the highest rates of infant mortality was associated with elevated dementia risk among African Americans but not whites. The large absolute difference in IMRs likely reflects harsher early childhood conditions experienced by African Americans. These findings suggest that childhood conditions may play a role in racial disparities in dementia rates.
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Affiliation(s)
- Paola Gilsanz
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Elizabeth Rose Mayeda
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | | | - Dan Mungas
- Department of Neurology, University of California, Davis, Sacramento, CA, USA
| | - Charles S. DeCarli
- Department of Neurology, University of California, Davis, Sacramento, CA, USA
| | - Rachel A Whitmer
- Department of Public Health, University of California, Davis, Davis, CA, USA
- Kaiser Permanente Division of Research, Oakland, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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Beeri MS, Lin HM, Sano M, Ravona-Springer R, Liu X, Bendlin BB, Gleason CE, Guerrero-Berroa E, Soleimani L, Launer LJ, Ehrenberg S, Lache O, Seligman YK, Levy AP. Association of the Haptoglobin Gene Polymorphism With Cognitive Function and Decline in Elderly African American Adults With Type 2 Diabetes: Findings From the Action to Control Cardiovascular Risk in Diabetes-Memory in Diabetes (ACCORD-MIND) Study. JAMA Netw Open 2018; 1:e184458. [PMID: 30646354 PMCID: PMC6324406 DOI: 10.1001/jamanetworkopen.2018.4458] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
IMPORTANCE African American individuals have higher dementia risk than individuals of white race/ethnicity. They also have higher rates of type 2 diabetes, which may contribute to this elevated risk. This study examined the association of the following 2 classes of alleles at the haptoglobin (Hp) locus that are associated with poor cognition, cardiovascular disease, and mortality: Hp 1-1 (associated with poor cognition and cerebrovascular disease) and Hp 2-1 and Hp 2-2 (associated with greater risk of myocardial infarction and mortality). An additional polymorphism in the promoter region of the Hp 2 allele, restricted to individuals of African descent, yields a fourth genotype, Hp 2-1m. African American adults have a higher prevalence of Hp 1-1 (approximately 30%) compared with individuals of white race/ethnicity (approximately 14%), but the potential role of the Hp genotype in cognition among elderly African American individuals with type 2 diabetes is unknown. OBJECTIVE To assess the association of the Hp genotypes with cognitive function and decline in elderly African American adults with type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTS This cohort study used publicly available data and specimens from the Action to Control Cardiovascular Risk in Diabetes-Memory in Diabetes (ACCORD-MIND) study to investigate the association of the Hp genotypes with cognitive function and decline in 466 elderly African American participants with type 2 diabetes. The hypothesis was that the Hp 1-1 genotype compared with the other genotypes would be associated with more cognitive impairment and faster cognitive decline in elderly African American adults with type 2 diabetes. The initial ACCORD trial was performed from October 28, 1999, to September 15, 2014. This was a multicenter clinical study performed in an academic setting. EXPOSURES The Hp genotypes were determined from serum samples by polyacrylamide gel electrophoresis and by enzyme-linked immunosorbent assay. MAIN OUTCOMES AND MEASURES The Mini-Mental State Examination (MMSE) was used to measure cognitive function and change after 40 months. The MMSE score ranges from 0 to 30 points; higher scores represent better cognition. Associations were examined with analysis of covariance and linear regression, adjusting for age, sex, education, baseline glycated hemoglobin level, systolic blood pressure, diastolic blood pressure, cholesterol level, creatinine level, and treatment arm (intensive vs standard). The cognitive change model adjusted also for the baseline MMSE score. RESULTS Among 466 African American study participants (mean [SD] age, 62.3 [5.7] years), 64.8% were women, and the genotype prevalences were 29.4% (n = 137) for Hp 1-1, 36.1% (n = 168) for Hp 2-1, 10.9% (n = 51) for Hp 2-1m, and 23.6% (n = 110) for Hp 2-2. The groups differed in their baseline MMSE scores (P = .006): Hp 1-1 had the lowest MMSE score (mean [SE], 25.68 [0.23]), and Hp 2-1m had the highest MMSE score (mean [SE], 27.15 [0.36]). Using the least squares method, the 40-month decline was significant for Hp 1-1 (mean [SE], -0.41 [0.19]; P = .04) and for Hp 2-2 (mean [SE], -0.68 [0.21]; P = .001). However, the overall comparison across the 4 groups did not reach statistical significance for the fully adjusted model. The interaction of age with the Hp 1-1 genotype on MMSE score decline estimate per year change was significant (mean [SE], -0.87 [0.37]; P = .005), whereas it was not significant for Hp 2-1 (mean [SE], 0.06 [0.37]; P = .85), Hp 2-1m (mean [SE], -0.06 [0.51]; P = .89), and Hp 2-2 (mean [SE], -0.44 [0.41]; P = .29), indicating that cognitive decline in Hp 1-1 carriers was accentuated in older ages, whereas it was not significant for the other Hp genotypes. CONCLUSIONS AND RELEVANCE In this study, the Hp 1-1 genotype, which is 2-fold (approximately 30%) more prevalent among African American individuals than among individuals of white race/ethnicity, was associated with poorer cognitive function and greater cognitive decline than the other Hp genotypes. The Hp gene polymorphism may explain the elevated dementia risk in African American adults. The neuropathological substrates and mechanisms for these associations merit further investigation.
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Affiliation(s)
- Michal S. Beeri
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
| | - Hung-Mo Lin
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mary Sano
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ramit Ravona-Springer
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
- The Memory and Psychogeriatric Clinic, Sheba Medical Center, Tel Hashomer, Israel
| | - Xiaoyu Liu
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Barbara B. Bendlin
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin–Madison
| | - Carey E. Gleason
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin–Madison
| | - Elizabeth Guerrero-Berroa
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Psychology, Lehman College, The City University of New York, Bronx
| | - Laili Soleimani
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lenore J. Launer
- Laboratory of Epidemiology and Population Science, National Institute on Aging, National Institutes of Health, Bethesda, Maryland
| | - Scott Ehrenberg
- currently a student at Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Orit Lache
- Department of Medicine, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yaakov K. Seligman
- Department of Medicine, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Andrew P. Levy
- Department of Medicine, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Ornstein KA, Zhu CW, Bollens-Lund E, Aldridge MD, Andrews H, Schupf N, Stern Y. Medicare Expenditures and Health Care Utilization in a Multiethnic Community-based Population With Dementia From Incidence to Death. Alzheimer Dis Assoc Disord 2018; 32:320-325. [PMID: 29734263 PMCID: PMC6215747 DOI: 10.1097/wad.0000000000000259] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION While individuals live with dementia for many years, utilization and expenditures from disease onset through the end-of-life period have not been examined in ethnically diverse samples. METHODS We used a multiethnic, population-based, prospective study of cognitive aging (Washington Heights-Inwood Columbia Aging Project) linked to Medicare claims to examine total Medicare expenditures and health care utilization among individuals with clinically diagnosed incident dementia from disease onset to death. RESULTS High-intensity treatment (hospitalizations, life-sustaining procedures) was common and mean Medicare expenditures per year after diagnosis was $69,000. Non-Hispanic blacks exhibited higher spending relative to Hispanics and non-Hispanic whites 1 year after diagnosis. Non-Hispanic blacks had higher total (mean=$205,000) Medicare expenditures from diagnosis to death compared with non-Hispanic whites (mean=$118,000). Hispanics' total expenditures and utilization after diagnosis was similar to non-Hispanic whites despite living longer with dementia. DISCUSSION Health care spending for patients with dementia after diagnosis through the end-of-life is high and varies by ethnicity.
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Affiliation(s)
- Katherine A Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
| | - Carolyn W Zhu
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
- James J Peters VA Medical Center, Bronx, NY
| | - Evan Bollens-Lund
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
| | - Melissa D Aldridge
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
| | | | - Nicole Schupf
- Epidemiology, Mailman School of Public Health, Columbia University, New York
| | - Yaakov Stern
- Department of Neurology, Cognitive Neuroscience Division, Columbia University Medical Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain
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Chin SY, Lopez V, Tan ML, Goh YS. "I Would Like to Be Heard." Communicating With Singaporean Chinese Patients With Dementia: A Focused Ethnography Study. J Transcult Nurs 2018; 30:331-339. [PMID: 30227768 DOI: 10.1177/1043659618800535] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Although first-generation Singaporean Chinese were mainly immigrants from Mainland China, the communication patterns of Singaporean Chinese in the present-day context differs from Mainland Chinese. This difference could be attributed to the subculture but is not conclusive. This study aimed to explore the experiences of nursing staff communicating with Singaporean Chinese with dementia in Singapore. METHOD A focused ethnographic study was conducted in a long-term care setting for people with dementia, where data were obtained using nonparticipant observations and semistructured interviews. Data analyses were conducted using Braun and Clarke's thematic analysis. RESULTS Nineteen nursing staff were interviewed. The central theme of "embracing diversity and accepting differences" was supported by three subthemes: acknowledging cultural differences, understanding the patients, and overcoming communicative challenges. CONCLUSIONS This study highlighted the need for nurses to understand cultural characteristics among Singaporean Chinese with dementia especially on emotional expressions when they are not understood by others.
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Affiliation(s)
- Si-Ying Chin
- 1 National University Hospital, National University Health System, Singapore
| | - Violeta Lopez
- 2 Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore
- 3 Alice Lee Centre for Nursing Studies, National University Health System, Singapore
| | | | - Yong-Shian Goh
- 2 Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore
- 3 Alice Lee Centre for Nursing Studies, National University Health System, Singapore
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Malik AT, Quatman CE, Phieffer LS, Ly TV, Khan SN. Incidence, risk factors and clinical impact of postoperative delirium following open reduction and internal fixation (ORIF) for hip fractures: an analysis of 7859 patients from the ACS-NSQIP hip fracture procedure targeted database. Eur J Orthop Surg Traumatol 2018; 29:435-446. [PMID: 30229446 DOI: 10.1007/s00590-018-2308-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/29/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Delirium is one of the most common acute psychiatric disturbances taking place in patients, particularly elderly, following hip fractures. Using a validated national surgical database, we sought to define the incidence, risk factors and clinical impact associated with the occurrence of delirium following open reduction and internal fixation (ORIF) for hip fracture. METHODS The 2016 American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) Hip Fracture Targeted Procedure file-was retrieved and merged with the ACS-NSQIP 2016 file. A total of 7859 patients were finally included in the study. RESULTS A total of 2177 (27.7%) patients experienced an episode of delirium following the procedure. Adjusted analysis showed an increasing age ≥ 65 years (p < 0.001), partially dependent functional health status prior to surgery (p = 0.001), bleeding disorder (p = 0.012), preoperative dementia (p < 0.001), preoperative delirium (p < 0.001), being bed-ridden postoperatively (p < 0.001), no weight bearing as tolerated on first postoperative day (p < 0.001), an ASA grade > II (p < 0.001), non-emergency case (p = 0.010) and a prolonged length of stay > 3 days (p < 0.001). In addition, Black or African-American ethnicity had a lower odds of developing postoperative delirium (p = 0.020) as compared to Whites. Moreover, postoperative delirium was significantly associated with non-home discharge disposition (p < 0.001), higher odds of 30-day readmissions (p < 0.001) and 30-day mortality (p < 0.001). CONCLUSION This study identifies several risk factors associated with the occurrence of postoperative delirium in patients undergoing ORIF for hip fracture. Surgeons can utilize these data to risk stratify and consequently tailor an appropriate preoperative and postoperative care protocol to prevent the occurrence of delirium.
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Affiliation(s)
| | - Carmen E Quatman
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Laura S Phieffer
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Thuan V Ly
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Safdar N Khan
- The Ohio State University Wexner Medical Center, Columbus, OH, USA.
- The Benjamin R. and Helen Slack Wiltberger Endowed Chair in Orthopaedic Spine Surgery, Wexner Medical Center at The Ohio State University, Columbus, OH, USA.
- Division of Spine Surgery, Department of Orthopaedic Surgery, Wexner Medical Center at The Ohio State University, Columbus, OH, USA.
- Department of Integrated Systems Engineering, Clinical Faculty, Spine Research Institute, Wexner Medical Center at The Ohio State University, Columbus, OH, USA.
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