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Simon SS, Brucki SMD, Fonseca LM, Becker J, Cappi C, Marques AH, Heyn PC, Gonçalves PD, Martins SS, Busatto G, Bertola L, Suemoto CK, Nitrini R, Caramelli P, Yassuda MS, Miotto EC, Grinberg LT, Arce Renteria M, Alegria M, Stern Y, Rivera‐Mindt M. The (in)visible Brazilians: A perspective review on the need for brain health and dementia research with Brazilian immigrants in the United States. Alzheimers Dement (N Y) 2023; 9:e12425. [PMID: 37744309 PMCID: PMC10517444 DOI: 10.1002/trc2.12425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/23/2023] [Accepted: 08/26/2023] [Indexed: 09/26/2023]
Abstract
Introduction The Brazilian population in the United States (U.S.), a Latinx subgroup, is rapidly growing and aging but remains underrepresented in U.S. health research. In addition to group-specific genetic and environmental risks, Brazilian immigrants and their offspring in the U.S. likely have cumulative risks for health inequities.It is estimated that 71% of Brazilian immigrants in the U.S. are undocumented, which may limit healthcare access/utilization. Furthermore, mental health is reported as a health priority by Brazilian immigrants in the U.S., and there is a lack of research on Alzheimer's disease and related dementia (AD/ADRD) in this population. Methods We reviewed the scientific literature using traditional (e.g., PubMed) sources and databases generated by U.S. and Brazilian governments, as well as international organizations, and press articles. Results This perspective review lists recommendations for researchers, health providers, and policymakers to promote greater inclusion of U.S. Brazilian populations in health research and care. The review identifies research areas in need of attention to address health inequities and promote mental/brain health in Brazilian immigrants and their offspring living in the U.S. These research areas are: 1) epidemiological studies to map the prevalence and incidence of mental/brain health conditions; 2) research on aging and AD/ADRD risk factors among Brazilian populations in the U.S.; and 3) the need for greater representation of U.S-residing Brazilian population in other relevant research areas involving genetics, neuropathology, and clinical trials. Conclusions The recommendation and research efforts proposed should help to pave the way for the development of community-engagement research and to promote mental/brain health education, improvement of mental/brain health and AD/ADRD services, and the development of culturally-informed intervention to the U.S.-residing Brazilian communities. HIGHLIGHTS The Brazilian population in the United States is growing but is underrepresented in U.S. health research.Approximately 71% of Brazilian immigrants in the United States are undocumented, with an increased risk for health inequities.Mental health is reported as a central health priority by Brazilian immigrants in the United States.There is a lack of research on Alzheimer's disease and other dementias (ADRD) in Brazilian immigrants in the United States.Epidemiological research is needed to map the prevalence/incidence of mental health conditions and ADRD risk factors among Brazilian immigrants in the United States.
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Affiliation(s)
- Sharon Sanz Simon
- Cognitive Neuroscience DivisionDepartment of NeurologyColumbia UniversityVagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of NeurologyColumbia UniversityVagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
- Old Age Research Group, Department of PsychiatryUniversity of São Paulo Medical SchoolSão PauloSão PauloBrazil
| | | | - Luciana Mascarenhas Fonseca
- Old Age Research Group, Department of PsychiatryUniversity of São Paulo Medical SchoolSão PauloSão PauloBrazil
- Department of Community and Behavioral HealthElson S. Floyd College of MedicineWashington State UniversitySpokaneWashingtonUSA
| | - Jacqueline Becker
- Division of General Internal MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Carolina Cappi
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Seaver Autism Center for Research and TreatmentIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of PsychiatryClinics HospitalUniversity of São PauloSchool of MedicineSão PauloSão PauloBrazil
| | - Andrea Horvath Marques
- Elliott School International AffairsThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Patricia C. Heyn
- Center for Optimal AgingDepartment of Physical TherapyMarymount UniversityArlingtonVirginiaUSA
| | - Priscila Dib Gonçalves
- Department of EpidemiologyColumbia University Mailman School of Public HealthNew YorkNew YorkUSA
| | - Silvia S. Martins
- Department of EpidemiologyColumbia University Mailman School of Public HealthNew YorkNew YorkUSA
| | - Geraldo Busatto
- Laboratory of Psychiatric Neuroimaging (LIM‐21)Department of PsychiatryUniversity of São Paulo Medical SchoolSão PauloSão PauloBrazil
| | - Laiss Bertola
- Department of PsychiatryEscola Paulista de Medicina, Universidade Federal de São PauloSão PauloBrazil
| | - Claudia Kimie Suemoto
- Division of GeriatricsDepartment of Clinical MedicineUniversity of São Paulo Medical SchoolSão PauloSão PauloBrazil
| | - Ricardo Nitrini
- Old Age Research Group, Department of PsychiatryUniversity of São Paulo Medical SchoolSão PauloSão PauloBrazil
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Research GroupFaculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMinas GeraisBrazil
| | - Monica Sanches Yassuda
- Department of NeurologyUniversity of São Paulo Medical SchoolSão PauloSão PauloBrazil
- Gerontology, School of Arts, Sciences, and HumanitiesUniversity of São PauloSão PauloSão PauloBrazil
| | - Eliane Correa Miotto
- Old Age Research Group, Department of PsychiatryUniversity of São Paulo Medical SchoolSão PauloSão PauloBrazil
| | - Lea Tenenholz Grinberg
- Memory and Aging CenterDepartment of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of PathologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- LIM‐22Department of PathologyUniversity of São Paulo Medical SchoolSão PauloSão PauloBrazil
- Global Brain Health InstituteUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Miguel Arce Renteria
- Cognitive Neuroscience DivisionDepartment of NeurologyColumbia UniversityVagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of NeurologyColumbia UniversityVagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Margarita Alegria
- Disparities Research UnitDepartment of MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
| | - Yaakov Stern
- Cognitive Neuroscience DivisionDepartment of NeurologyColumbia UniversityVagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of NeurologyColumbia UniversityVagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Monica Rivera‐Mindt
- Department of PsychologyFordham UniversityNew YorkNew YorkUSA
- Department of NeurologyIcahn School of MedicineNew YorkNew YorkUSA
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Short SAP, Wilkinson K, Schulte J, Renteria MA, Cheung KL, Nicoli CD, Howard VJ, Cushman M. Plasma Pro-Enkephalin A and Incident Cognitive Impairment: The Reasons for Geographic and Racial Differences in Stroke Cohort. J Am Heart Assoc 2023:e029081. [PMID: 37260023 PMCID: PMC10381999 DOI: 10.1161/jaha.122.029081] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Background Cardiovascular disease is a risk factor for cognitive impairment. Evidence links both lower and higher concentration of the circulating opioid pro-enkephalin A (PENK-A) with stroke risk. We studied the association of plasma PENK-A with incident cognitive impairment. Methods and Results REGARDS (Reasons for Geographic and Racial Differences in Stroke) is a prospective cohort study of 30 239 adults enrolled from 2003 to 2007. Baseline PENK-A was measured in a nested case-control study of 462 participants who developed cognitive impairment over 4.7 years, and 556 controls. Logistic regression and spline plots adjusted for confounders estimated odds ratios (ORs) of cognitive impairment by baseline PENK-A. Interaction terms tested for differences in associations by age, sex, and race. Baseline PENK-A was comparable between cases and controls. There were significant differences in the association of PENK-A with cognitive impairment by sex and age (adjusted P=0.003 and 0.06, respectively). In women but not men, spline plots showed that higher and lower PENK-A were associated with decreased odds of cognitive impairment (ORs for 10th and 90th percentiles versus median, 0.65 [95% CI, 0.43-0.96] and 0.64 [95% CI, 0.41-0.99]), with no difference by age. In men ≥65 years of age but not younger men, higher PENK-A was associated with decreased odds for cognitive impairment (OR for fourth versus first quartile 0.47 [95% CI, 0.22-0.99]); this pattern was not confirmed with spline plotting. Conclusions High and low levels of circulating opioid PENK-A were associated with decreased odds of future cognitive impairment in specific subgroups. Additional research is warranted to understand the biology underlying this association and the observed differences by sex.
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Affiliation(s)
- Samuel A P Short
- Larner College of Medicine University of Vermont Burlington VT USA
| | - Katherine Wilkinson
- Department of Pathology and Laboratory Medicine, Larner College of Medicine University of Vermont Burlington VT USA
| | | | - Miguel Arce Renteria
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology Columbia University College of Physicians and Surgeons New York NY USA
| | - Katharine L Cheung
- Department of Pathology and Laboratory Medicine, Larner College of Medicine University of Vermont Burlington VT USA
- Department of Medicine, Larner College of Medicine University of Vermont Burlington VT USA
| | - Charles D Nicoli
- Department of Medicine Walter Reed National Military Medical Center Bethesda MD USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health University of Alabama at Birmingham Birmingham AL USA
| | - Mary Cushman
- Department of Pathology and Laboratory Medicine, Larner College of Medicine University of Vermont Burlington VT USA
- Department of Medicine, Larner College of Medicine University of Vermont Burlington VT USA
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Evangelista ND, Renteria MA, Mobley TM, Fox‐Fuller JT, Minto L, Avila JF, Deters KD, Medina LD, Bettcher BM. Selection Factors Influencing Participation in National Alzheimer’s Coordinating Center (NACC) Studies Compared to the Nationally Representative Health and Retirement Study (HRS). Alzheimers Dement 2022. [DOI: 10.1002/alz.065949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | - Taylor M Mobley
- University of California, Los Angeles Fielding School of Public Health Los Angeles CA USA
| | - Joshua T. Fox‐Fuller
- Massachusetts General Hospital, Harvard Medical School Boston MA USA
- Boston University Boston MA USA
| | - Lex Minto
- Georgia State University Atlanta GA USA
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Briceno EM, Renteria MA, Chang W, Lewandowski‐Romps L, Heeringa SG, Garcia NM, Morgenstern LB. The association between bilingual semantic fluency and episodic memory among bilingual Mexican American older adults. Alzheimers Dement 2022. [DOI: 10.1002/alz.065971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | - Wen Chang
- University of Michigan Ann Arbor MI USA
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Petrosyan S, Renteria MA, Manly JJ, Narayanan S, Lee J. Effects of multilingualism on cognition among older Indian adults in the nationally representative LASI‐DAD study. Alzheimers Dement 2022. [DOI: 10.1002/alz.065968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | | | - Jinkook Lee
- University of Southern California Los Angeles CA USA
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Fletcher E, Gavett B, Crane P, Soldan A, Hohman T, Farias S, Widaman K, Groot C, Renteria MA, Zahodne L, DeCarli C, Mungas D. A robust brain signature region approach for episodic memory performance in older adults. Brain 2021; 144:1089-1102. [PMID: 33895818 PMCID: PMC8105039 DOI: 10.1093/brain/awab007] [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: 01/25/2020] [Revised: 10/11/2020] [Accepted: 10/30/2020] [Indexed: 01/26/2023] Open
Abstract
The brain signature concept aims to characterize brain regions most strongly associated with an outcome of interest. Brain signatures derive their power from data-driven searches that select features based solely on performance metrics of prediction or classification. This approach has important potential to delineate biologically relevant brain substrates for prediction or classification of future trajectories. Recent work has used exploratory voxel-wise or atlas-based searches, with some using machine learning techniques to define salient features. These have shown undoubted usefulness, but two issues remain. The preponderance of recent work has been aimed at categorical rather than continuous outcomes, and it is rare for non-atlas reliant voxel-based signatures to be reported that would be useful for modelling and hypothesis testing. We describe a cross-validated signature region model for structural brain components associated with baseline and longitudinal episodic memory across cognitively heterogeneous populations including normal, mild impairment and dementia. We used three non-overlapping cohorts of older participants: from the UC Davis Aging and Diversity cohort (n = 255; mean age 75.3 ± 7.1 years; 128 cognitively normal, 97 mild cognitive impairment, 30 demented and seven unclassified); from Alzheimer's Disease Neuroimaging Initiative (ADNI) 1 (n = 379; mean age 75.1 ± 7.2; 82 cognitively normal, 176 mild cognitive impairment, 121 Alzheimer's dementia); and from ADNI2/GO (n = 680; mean age 72.5 ± 7.1; 220 cognitively normal, 381 mild cognitive impairment and 79 Alzheimer's dementia). We used voxel-wise regression analysis, correcting for multiple comparisons, to generate an array of regional masks corresponding to different association strength levels of cortical grey matter with baseline memory and brain atrophy with memory change. Cognitive measures were episodic memory using Spanish and English Neuropsychological Assessment Scales instruments for UC Davis and ADNI-Mem for ADNI 1 and ADNI2/GO. Performance metric was the adjusted R2 coefficient of determination of each model explaining outcomes in two cohorts other than where it was computed. We compared within-cohort performances of signature models against each other and against other recent signature models of episodic memory. Findings were: (i) two independently generated signature region of interest models performed similarly in a third separate cohort; (ii) a signature region of interest generated in one imaging cohort replicated its performance level when explaining cognitive outcomes in each of other, separate cohorts; and (iii) this approach better explained baseline and longitudinal memory than other recent theory-driven and data-driven models. This suggests our approach can generate signatures that may be easily and robustly applied for modelling and hypothesis testing in mixed cognition cohorts.
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Affiliation(s)
- Evan Fletcher
- Department of Neurology, UC Davis School of Medicine, Sacramento, CA, USA
| | - Brandon Gavett
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Paul Crane
- University of Washington, Seattle, WA, USA
| | - Anja Soldan
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Timothy Hohman
- Department of Neurology, Vanderbilt Memory and Alzheimer’s Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah Farias
- Department of Neurology, UC Davis School of Medicine, Sacramento, CA, USA
| | - Keith Widaman
- Graduate School of Education, UC Riverside, Riverside, CA, USA
| | - Colin Groot
- Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Laura Zahodne
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Charles DeCarli
- Department of Neurology, UC Davis School of Medicine, Sacramento, CA, USA
| | - Dan Mungas
- Department of Neurology, UC Davis School of Medicine, Sacramento, CA, USA
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Armstrong N, Tom S, Renteria MA, Casaletto K, Weuve J, Simonsick EM, Manly J, Zahodne LB. DYNAMIC, BIDIRECTIONAL LONGITUDINAL RELATIONSHIP BETWEEN LEISURE ACTIVITY ENGAGEMENT AND COGNITIVE PERFORMANCE. Innov Aging 2019. [PMCID: PMC6845453 DOI: 10.1093/geroni/igz038.3254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Engagement in leisure activities, i.e., intellectual, social, and physical activities, may reduce the risk of incident dementia, yet little is known about the longitudinal, dynamic relationship between overall leisure activity engagement and cognition in older adulthood. Using data from a survey measure of 13 leisure activities, e.g., doing unpaid volunteer work and playing cards, games, or bingo, and a neuropsychological battery collected concurrently over 14 years from 2,259 multi-ethnic participants (mean age of 76.0 years) in the Washington Heights-Inwood Columbia Aging Project, we used a parallel process latent growth curve model of trajectories of both leisure activity engagement and cognitive z-scores (global cognitive performance, language, memory, and visuospatial ability). Estimates were adjusted for baseline age, years of education, sex, race/ethnicity, recruitment year, occupation (unskilled, skilled, and housewife), and baseline income. More baseline activity engagement (range, 0-13, higher indicating more engagement) was associated with higher baseline cognitive performance, i.e., global cognitive performance (estimate=0.129, standard error, SE=0.017, p<0.001), language (estimate=0.146, SE=0.020, p<0.001), memory (estimate=0.141, SE=0.025, p<0.001), and visuospatial ability (estimate=0.111, SE=0.020, p<0.001). Decline in leisure activity engagement were associated with decline in global cognitive performance (estimate=0.002, SE=0.000, p<0.001), language (estimate=0.002, SE=0.000, p<0.001), memory (estimate=0.002, SE=0.001, p<0.001), and visuospatial ability (estimate=0.001, SE=0.000, p=0.001). While both level and change in overall leisure activity engagement and cognitive performance were correlated, level of one did not predict change in the other. Similar relationships were found when examining leisure activity categories. This suggests a dynamic, bidirectional relationship between leisure activity engagement and cognitive performance among older adults.
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Affiliation(s)
| | - Sarah Tom
- Department of Neurology, Columbia University Medical Center, New York, New York, United States
| | - Miguel Arce Renteria
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, New York, New York, United States
| | - Kaitlin Casaletto
- University of California, San Francisco, San Francisco, California, United States
| | - Jennifer Weuve
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States
| | - Eleanor M Simonsick
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute On Aging, NIH, Baltimore, Maryland, United States
| | - Jennifer Manly
- University of Michigan, Ann Arbor, Michigan, United States
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