Session
Alzheimer’s Disease and Related Dementias and Cognition
APHA 2022 Annual Meeting and Expo
Abstract
Establishing equity in Alzheimerâs disease and related dementias
APHA 2022 Annual Meeting and Expo
Background:
In 2021 the Alzheimerâs Disease and Related Dementias (ADRD) Program within the Idaho Department of Health and Welfare (IDHW) was formed with a mission to establish equity through expansion of ADRD and brain health awareness, education, support, and services.
Description
IDHW contracted with Boise State Universityâs (BSU) Center for the Study of Aging to conduct a landscape and needs assessment of areas not previously described (rural communities, educators, and ADRD Alliance members). Master of Public Health program students at BSU were provided intensive instruction on qualitative data collection and analysis and served as interviewers. This allowed for acquisition of information from 45 often unheard voices and enhanced the ADRD and cultural knowledge of emerging public health professionals.
Lessons learned
Itâs imperative that public health programs engage and connect students to diverse cultural backgrounds, settings, and experiences. Using web-based technologies allowed researchers to meet people where they were and conduct meaningful conversations.
Time needed to establish relationships with underrepresented populations (i.e., Tribal communities, Latinx, incarcerated individuals, LGBTQ+, etc.) must be recognized. The need to build relationships and meet individuals on their terms must be honored.
Itâs imperative that public health incorporate brain health into research, interventions, and programs.
Implications
Creating ripple effects of change and engaging students in efforts involving different perspectives and populations is essential in leading the path toward equity and cultural awareness. Efforts to include primary, secondary, and tertiary brain health prevention strategies must be continued and supported for meaningful and sustained change.
Abstract
Older African-American Adults with Alzheimerâs Disease Absent in Electrophysiological Research
APHA 2022 Annual Meeting and Expo
Background: Transitioning into clinical practice is an objective for electrophysiological research on Alzheimerâs disease (AD). Electrophysiological biomarkers for brain activity changes are being examined as potential diagnostic indicators of cognitive impairment, behavioral changes, genetic alterations, and functional tasks. These electrophysiological biomarkers remain un-identified in older African-American adults with AD. There is no research about the brain activity changes of older African-American adults with AD, limiting the clinical usefulness of electrophysiological biomarkers into the screening, diagnosing, and treatment of AD.
Purpose: To examine the current electrophysiological research on AD and how the absence of older African-American Adults with AD will impact the possible transition of this research into practice. This review will also discuss the positive impact on practice by researching the brain activity changes of this vulnerable population.
Methods: A PUBMED search was performed. Thirty-six peer-reviewed studies were selected from the extracted 100. The time range was from 2000 to 2021 and geographic locations of the studies were extended to identify studies with participants who were older persons of color with AD.
Results: Electrophysiological biomarkers significantly associated with biological processes related to the onset and progression of AD. They also related to symptoms of AD without depending on impaired cognition. Participants were predominantly older Caucasian adults with AD. Older African-American adults with AD were not included in any research about electrophysiological biomarkers.
Conclusion: This absence diminishes the clinical appropriateness of electrophysiological biomarkers and contributes to the current health disparities confronting older African-American adults with AD and their caregivers.
Abstract
Cognitive domain markers and risk factors of progression in subjective cognitive decline
APHA 2022 Annual Meeting and Expo
Background:
Subjective cognitive decline (SCD) is considered a preclinical stage of Alzheimerâs disease, but drivers and nature of progression remain unclear.
Objectives:
We evaluated risk factor differences and cognitive domain markers associated with progression over time between SCD decliners and non-decliners.
Methods:
A longitudinal analysis was performed on subjects with SCD at baseline from the NYU Alzheimerâs Disease Research Center. We included subjects classified as non-decliners (n = 27), who remained stable and decliners (n = 24), who progressed to mild cognitive impairment or worse, between the second to sixth follow-up visits. Adjusted linear and logistic mixed-effects examined group differences in demographic and APOE risk factors, and associations of psychometric test performance and comorbidities with longitudinal decline, respectively.
Results:
Mean (SD) age was 68.5 (11.3) vs. 66.3 (7.1) years (p =0.41), and follow-up time was 3.7 (1.97) vs. 6.3 (1.60) years, (p <0.001) for decliners vs. non-decliners. Subjects with lower years of education (14.9 (3.2) vs. 17.3 (2.1)) and those of Hispanic ethnicity (52.2% vs. 47.8%) were more likely to be decliners (p ⤠0.004 for both). There were no differences in APOE2 or APOE4 status between decliners vs. non-decliners. Decliners were approximately 7 times more likely (aOR: 6.67, p =0.002) to have hypercholesterolemia. SCD decliners were at increased risk for psychometric changes in memory, executive, and language domains (p < 0.001 for all).
Conclusions:
Although SCD has been primarily defined with regard to concerns about memory, SCD decliners are at increased risk for both amnestic and non-amnestic cognitive decline.
Abstract
Association of Sleep, APOE4 and Cognitive Performance in Minority Populations
APHA 2022 Annual Meeting and Expo
Background: Disturbed sleep is associated with cognitive performance. What is unknown is whether APOE-ε4 interacts with sleep to effect varying cognitive domain outcomes in minority populations.
Methods: We conducted a cross-sectional analysis of baseline data on 10,254 [non-Hispanic White (n=7900), Black/African-American (n=1428), Hispanic (n=627) and Asian (n=299)] cognitive-normal subjects from the National Alzheimer's Coordinating Center Uniform Data set. We characterized SD using an item on the Neuropsychiatric Inventory Questionnaire. Generalized linear models examined between and within SD group differences on psychometric test performance across racial categories, and interactive associations of APOE genotype, SD, and race on psychometric tests performance. All models included age, sex, education, hypertension, and diabetes.
Results: Overall, the mean (sd) age was 71.1 (10.3) years and education was 15.7 (3.0) years. Prevalence of SD was 10% (Whites), 6.1% (Blacks), 18.2% (Hispanics), and 7.4% (Asians). Within racial groups, SD subjects were at increased risk for worse psychometric scores in: executive, and language domains in Whites; language domain in Blacks; memory, executive, and language domains in Hispanics; and visuospatial memory domain in Asians (p â¤0.001 for all). The interactive associations of APOE genotype, SD, and race on psychometric test performance were significant (p â¤0.001 for all). Hispanic SD subjects with 1 or 2 APOE ε4 alleles were at increased risk for worse psychometric scores in memory, executive function, visuospatial, attention, processing speed and language domains (p â¤0.001 for all).
Conclusion: These findings suggest that APOE-ε4 interacts with sleep to effect varying cognitive domain outcomes within and between minority populations.
Abstract
The Healthy Brain Initiative: Linking Adverse Childhood Experiences (ACEs), behavioral, and clinical risk factors with subjective cognitive decline in an aging population
APHA 2022 Annual Meeting and Expo
Background. The CDCâs Healthy Brain Initiative encourages an interdisciplinary approach to addressing the burden of subjective cognitive decline (SCD) as the aging population continues to increase. This study is one of the first to evaluate associations between ACEs, SCD, and other modifiable risk factors since the COVID-19 pandemic.
Methods. Data from the 2020 BRFSS survey was assessed using multivariate logistic regression to evaluate associations among ACE scores, behavioral, and clinical risk factors and SCD. Models were weighted to account for the complex survey design.
Results. Approximately eight percent (8.1%) of survey respondents reported experiencing SCD within the past 12 months. Adjusted regression analysis revealed that conditions such as depression (aOR: 2.82; 95%CI: 2.26, 3.51), obesity (aOR: 1.76, 95% CI: 1.12, 2.75), arthritis (aOR: 1.28; 95% CI: 1.03, 1.58), diabetes (aOR: 1.33; 95% CI: 1.05, 1.69), and sedentary lifestyle (aOR: 1.30; 95% CI: 1.03, 1.65) were significantly associated with SCD. Two or more ACEs also significantly increased the odds of SCD (aOR: 1.69; 95% CI: 1.36, 2.10; p<0.001). SCD was associated with experiencing more than three falls in a year (aOR: 2.97; 95% CI: 2.15, 4.20) and sleeping > nine hours/night (aOR: 2.07; 95% CI: 1.38, 3.11).
Conclusions. Findings can be used to inform primary and secondary prevention efforts aimed at addressing modifiable risk factors (e.g., physical activity, depression, and sleep) to support healthy aging. The role of ACEs as determinants of brain health across the life course should also be considered in the design of clinical and community-based interventions.
Abstract
Investigating the feasibility of creating a disease registry in Egypt: a case study of dementia
APHA 2022 Annual Meeting and Expo
Disease registries have emerged worldwide to help tackle the impact of chronic diseases by providing accurate data on several aspects of the disease care process. Age-associated diseases, particularly dementia, are growing worldwide with several implications and increased economic burden, especially in lower-income countries. In Egypt, there is a lack of accurate dementia prevalence and statistics data which hinders the establishment of appropriate disease management and care strategies. A national dementia registry would provide a massive valuable source of patient data that will significantly advance the disease management strategies and quality of patient care and impact health policy and decision-making. This study investigates the feasibility of creating a disease registry for dementia in Egypt through interviewing relevant national and international experts to evaluate their perceptions, knowledge, and opinions, then provide recommendations for the most appropriate registry model to be developed in Egypt. Several core themes emerged from the analysis of expertsâ interviews discussing many points that should direct the creation of any registry in Egypt. Learning from other successful registries, comparing their experiences, and applying them to the Egyptian culture imposes an excellent opportunity for the registry establishment. The findings clearly provided the proposed best practices to be followed while initiating a national registry in Egypt in terms of functionality, planning, comprehension, governance, ethics, and challenges to avoid. The initiating process should start with a leading institution that brings together the potential stakeholders and defines clear purpose and objectives of the registry to direct the planning and design. A primary phase should be the first step to test the functionality and effectiveness of the process then expansion of data and coverage can be a second step. Taken together, developing such a dataset is beneficial to the Egyptian healthcare system, which makes the investment worthwhile. Support and collaborative work from all stakeholders, along with suitable funding, are essential elements of the proper implementation of the project. Yet, it might seem to be an opportune time for initiating this kind of registry to address the needs and at the same time benefit from the strategic opportunities.
Abstract
Patterns of Limitation in Physical Function in Late Midlife Associated with Late-Onset Alzheimerâs Disease and Related Dementias: A Cluster Analysis
APHA 2022 Annual Meeting and Expo
INTRODUCTION: The number of people living with dementia is expected to triple worldwide by 2050 unless effective measures to prevent or delay the onset of the disease are implemented. Prevention studies are inconclusive as to effectiveness, partially because of inappropriate subjects in midlife. If pattern(s) of functional decline in midlife associate with late-onset Alzheimerâs Disease and Related Dementias (ADRD), preventative efforts could be better studied and targeted.
METHODS: Using a longitudinal study of adults aged 51-59 years in 1998 without symptoms of ADRD, we used cluster analysis and multinomial regression to identify patterns of functional impairment and their association with future ADRD.
RESULTS: Three groups of adults with differing patterns of functional impairment were at greater risk of future ADRD. Four measures of function contributed to the clusters including difficulty with: 1) walking one block; 2) climbing one flight of stairs; 3) pushing/pulling a large object; and 4) lifting 10 lbs. The first group had difficulty with climbing one flight of stairs. The second group all had difficulty with lifting 10 pounds and pushing or pulling a large object, but only one-fourth had difficulty in climbing stairs. The third group had difficulty with all four measures of function.
CONCLUSIONS: Results imply that improved large muscle strength could decrease future risk of ADRD. Screening for four self-reported measures of function among adults in midlife may be used for targeted interventions.
Abstract
Moderating role of race and ethnicity between long-term sleep disturbances and dementia risk
APHA 2022 Annual Meeting and Expo
Background:
Despite extensive support for the association between sleep and dementia risk, no prior research has examined the moderating role of race and ethnicity. Our study analyzed racial and ethnic differences in sleep disturbances among older adults, and whether race and ethnicity moderates the relationship between long-term sleep disturbances and dementia risk.
Methods:
Ten waves of data (2011-2020) were analyzed from the National Health and Aging Trends Study, a large nationally representative U.S. sample of 5,362 White, Black, Hispanic, and Asian older adults. Sleep disturbances were combined into a longitudinal score and measures included: sleep-onset insomnia, sleep-maintenance insomnia, and sleep medication usage. Cox models analyzed time to dementia diagnosis. All models adjusted for sociodemographics and health, and applied survey sampling weights.
Results:
There were significant racial and ethnic differences in each of the three sleep disturbances. In particular, Black, Hispanic, and Asian older adults exhibited more frequent long-term disturbances in sleep-onset insomnia and sleep-maintenance insomnia compared to White older adults. Race and ethnicity was a significant moderator in the relationship between sleep-onset insomnia and dementia risk. Specifically, Asian older adults with sleep-onset insomnia had a significantly higher dementia risk (aHR=3.93, 95% CI=1.02-15.21).
Conclusions:
Both insomnia types were more prevalent among minority older adults. Sleep-onset insomnia in particular was shown to significantly increase dementia risk for only Asian older adults. These findings indicate the importance of sleep hygiene to reduce disparities in dementia risk. Future research should explore pathways contributing to increased dementia risk among Asian older adults with sleep-onset difficulty.
Abstract
The impact of depression and stressful life events on subjective cognitive functioning among low-income Asian and African American elderly aged 65 and above
APHA 2022 Annual Meeting and Expo
Background: Alzheimer's disease and related dementia (ADRD) is a long-term public health issue in the United States, and its adverse impact on the health of minority elderly population has been increasing. Depression and stressful life events are associated with cognitive impairment. However, the burden of ADRD and depression comorbidity among Asian and African Americans elderly is understudied.
Methods: Participants (n=470) aged 65 and older were recruited from Asian and African American community-based organizations in the Greater Philadelphia Area and New York City. Using a cross-sectional survey, we assessed subjective cognitive function with the Cognitive Failure Questionnaire (CFQ, Cronbachâs alpha=0.96). We tested depression severity with Patient Health Questionnaire (PHQ-9), and stressful life events (SLE) impact score was measured with a 6-item scale with excellent internal consistency (Cronbachâs alpha=0.94).
Results: Bivariate analysis showed that depression (r=-0.64, p<0.001) and SLE impact (r=-0.50, p<0.001) were significantly negatively correlated to CFQ scores. With demographics controlled for, depression severity (Coef. =-1.79, p<0.001) and SLE (Coef. =-0.46, p=0.014) remained significant predictors of subjective cognitive function. We also found that male gender, higher education levels, having $20k or higher annual household income, and higher English proficiency were significantly associated with better subjective cognitive functioning.
Conclusions: The findings demonstrate the associations between depression, stressful life events, and subjective cognitive functioning among Asian and African American elderly. Targeted interventions will be developed in improving cognitive performance and mental health among understudied older Asian and African Americans, especially among those who suffer from depression and stressful life events.