Alzheimer Disease And Related Dementias Research Articles

Serious Mental Illness in Assisted Living Communities: Association With Nursing Home Placement

ObjectivesAssess prevalence of serious mental illness (SMI) alone, and co-occurring with Alzheimer disease and related dementias (ADRD), among Medicare beneficiaries in assisted living (AL). Examine the association between permanent nursing home (NH) placement and SMI, among residents with and without ADRD. Design2018-2019 retrospective cohort of Medicare beneficiaries in AL. Residents were followed for up to 2 years to track their NH placement. We used data from the Medicare Enrollment Database, the Medicare Beneficiary Summary File, Minimum Data Set, and a national directory of state-licensed AL communities. AL residents were identified using a validated, previously reported 9-digit zip code methodology. Setting and ParticipantsA cross-sectional study sample included 289,350 Medicare beneficiaries in 17,265 AL communities across 50 states and in the District of Columbia. MethodsThe outcome was permanent NH placement: a continuous stay for more than 90 days. Key independent variable was presence of SMI—schizophrenia, bipolar disorder, and major depression. Other covariates included sociodemographic factors and presence of other chronic conditions, including ADRD. A linear probability model with robust SEs, and AL-level random effects, was used to test the association between SMI diagnoses, ADRD, and their interactions on NH placement. ResultsMore than half (55.65%) of AL residents had a diagnosis of SMI, among them 93.2% had major depression, 28.5% schizophrenia, and 22.2% bipolar disorder. Individuals with schizophrenia and bipolar disorder had a significantly lower probability of NH placement, a 32% and a 15% decrease relative to the cohort mean, respectively. Placement risk was significantly greater for residents with ADRD compared to those without, increasing for those who also had schizophrenia or bipolar disorder, 12.9% and 1.5% relative to the sample mean, respectively. Conclusion and ImplicationsPresence of schizophrenia and bipolar disorder, in conjunction with ADRD, significantly increases the risk of long-term NH placement, suggesting that ALs may not be well prepared to care for these residents.

Dementia-Related Disparities in Adult Day Centers: Results of a Bivariate Analysis.

Adult day services (ADS) are a valuable resource for people living with Alzheimer's disease and Alzheimer's disease and related dementias (AD/ADRD) and serve a large population of late-life immigrants, often with limited English proficiency (LEP). This secondary data analysis examined potential disparities in diagnosis, dementia severity, medical complexity, and dementia-related behavioral problems in persons with AD/ADRD with LEP within the ADS setting. The current study used data from TurboTAR, the electronic health record for ADS in California. Bivariate analyses were conducted to examine differences in clinical management for those with and without LEP. Of 3,053 participants included in the study, 42.3% had LEP. Participants with LEP had higher rates of emergency department use and medication mismanagement. However, due to non-standard data collection, there was a significant amount of missing data on language preference (38.1%) and race/ethnicity (46.5%). Although these findings suggest LEP may play a role in the clinical management of persons with AD/ADRD in ADS, missing data caused by lack of standardized collection compromise the results. It is essential to improve data collection practices in ADS on language, race, and ethnicity to help identify health disparities and promote equitable care for marginalized older adults. [Journal of Gerontological Nursing, 50(4), 42-47.].

Racial, ethnic, and rural disparities in distance to physicians among decedents with Alzheimer's disease and related dementias in Washington State.

Distance to physicians may explain some of the disparities in Alzheimer's disease and related dementia (AD/ADRD) outcomes. We generated round trip distance between residences of decedents with AD/ADRD and the nearest neurologist and primary care physician in Washington State. The overall mean distance to the nearest neurologist and primary care physician was 17 and 4 miles, respectively. Non-Hispanic American Indian and/or Alaska Native and Hispanic decedents would have had to travel 1.12 and 1.07 times farther, respectively, to reach the nearest neurologist compared to non-Hispanic White people. Decedents in micropolitan, small town, and rural areas would have had to travel 2.12 to 4.01 times farther to reach the nearest neurologist and 1.14 to 3.32 times farther to reach the nearest primary care physician than those in metropolitan areas. These results underscore the critical need to identify strategies to improve access to specialists and primary care physicians to improve AD/ADRD outcomes. Distance to neurologists and primary care physicians among decedents with AD/ADRD American Indian and/or Alaska Native decedents lived further away from neurologists Hispanic decedents lived further away from neurologists Non-metropolitan decedents lived further away from neurologists and primary care Decrease distance to physicians to improve dementia outcomes.

The effectiveness of exercise interventions targeting sleep in older adults with cognitive impairment or Alzheimer's disease and related dementias (AD/ADRD): A systematic review and meta-analysis.

Sleep loss is associated with reduced health and quality of life, and increased risk of Alzheimer's disease and related dementias. Up to 66% of persons with Alzheimer's disease and related dementias experience poor sleep, which can predict or accelerate the progression of cognitive decline. Exercise is a widely accessible intervention for poor sleep that can protect against functional and cognitive decline. No previous systematic reviews have investigated the effectiveness of exercise for sleep in older adults with mild cognitive impairment or Alzheimer's disease and related dementias. We systematically reviewed controlled interventional studies of exercise targeting subjectively or objectively (polysomnography/actigraphy) assessed sleep in persons with mild cognitive impairment or Alzheimer's disease and related dementias. We conducted searches in PubMed, Embase, Scopus and Cochrane-Library (n = 6745). Nineteen randomised and one non-randomised controlled interventional trials were included, representing the experiences of 3278 persons with mild cognitive impairment or Alzheimer's disease and related dementias. Ten had low-risk, nine moderate-risk, and one high-risk of bias. Six studies with subjective and eight with objective sleep outcomes were meta-analysed (random-effects model). We found moderate- to high-quality evidence for the beneficial effects of exercise on self-reported and objectively-measured sleep outcomes in persons with mild cognitive impairment or Alzheimer's disease and related dementias. However, no studies examined key potential moderators of these effects, such as sex, napping or medication use. Our results have important implications for clinical practice. Sleep may be one of the most important modifiable risk factors for a range of health conditions, including cognitive decline and the progression of Alzheimer's disease and related dementias. Given our findings, clinicians may consider adding exercise as an effective intervention or adjuvant strategy for improving sleep in older persons with mild cognitive impairment or Alzheimer's disease and related dementias.

Impact of the COVID-19 Pandemic on Latino Families With Alzheimer Disease and Related Dementias: Qualitative Interviews With Family Caregivers and Primary Care Providers.

Latino individuals experience disparities in the care of Alzheimer disease and related dementias (ADRD) and have disproportionately high COVID-19 infection and death outcomes. We aimed to gain an in-depth understanding of the impact of the COVID-19 pandemic among Latino families with ADRD in the United States. This was a qualitative study of 21 informal caregivers of Latino individuals with ADRD and 23 primary care providers who serve Latino patients. We recruited participants nationwide using convenience and snowball sampling methods and conducted remote interviews in English and Spanish. We organized the transcripts for qualitative review to identify codes and themes, using a pragmatic approach, a qualitative description methodology, and thematic analysis methods. Qualitative analysis of transcripts revealed eight themes, including (1) the pandemic influenced mental and emotional health; (2) the pandemic impacted physical domains of health; (3) caregivers and care recipients lost access to engaging activities during the confinement; (4) the pandemic impacted Latino caregivers' working situation; (5) the pandemic impacted health care and community care systems; (6) health care and community care systems took measures to reduce the impact of the pandemic; (7) Latino families experienced barriers to remote communication during the pandemic; and (8) caregiver social support was critical for reducing social isolation and its sequalae. Latino families with ADRD experienced similar but also unique impacts compared to those reported in the general population. Unique impacts may result from Latino individuals' underserved status in the United States, commonly held cultural values, and their intersectionality with ADRD-related disability. Family caregiver social support was crucial during this time of adversity. These findings suggest the need for more equitable access, culturally appropriate and trustworthy content and delivery of health care and community services, as well as stronger financial and social supports for family caregivers.

Racial and Ethnic Differences in the Population-Attributable Fractions of Alzheimer Disease and Related Dementias.

Previous studies estimated that modifiable risk factors explain up to 40% of the dementia cases in the United States and that this population-attributable fraction (PAF) differs by race and ethnicity-estimates of future impact based on the risk factor prevalence in contemporary surveys. The aim of this study was to determine the race-specific and ethnicity-specific PAF of late-onset Alzheimer disease and related dementias (ADRDs) based on the risk factor prevalence and associations observed on the same individuals within a prospective cohort. Data were from Multiethnic Cohort Study participants (African American, Japanese American, Latino, Native Hawaiian, and White) enrolled in Medicare Fee-for-Service. We estimated the PAF based on the prevalence of risk factors at cohort baseline and their mutually adjusted association with subsequent ADRD incidence. Risk factors included low educational attainment and midlife exposures to low neighborhood socioeconomic status, unmarried status, history of hypertension, stroke, diabetes or heart disease, smoking, physical inactivity, short or long sleep duration, obesity, and low-quality diet, as well as APOE ε4 for a subset. Among 91,881 participants (mean age 59.3 at baseline, 55.0% female participants), 16,507 incident ADRD cases were identified from Medicare claims (1999-2016, mean follow-up 9.3 years). The PAF for nongenetic factors combined was similar in men (24.0% [95% CI 21.3-26.6]) and women (22.8% [20.3-25.2]) but varied across Japanese American (14.2% [11.1-17.2]), White (21.9% [19.0-24.7]), African American (27.8% [22.3-33.0]), Native Hawaiian (29.3% [21.0-36.7]), and Latino (33.3% [27.5-38.5]) groups. The combined PAF was attenuated when accounting for competing risk of death, in both men (10.4%) and women (13.9%) and across racial and ethnic groups (4.7%-25.5%). The combined PAF was also different by age at diagnosis and ADRD subtypes, higher for younger (65-74 years: 43.2%) than older (75-84 years: 32.4%; ≥85 years: 11.3%) diagnoses and higher for vascular or unspecified ADRD than for AD or Lewy body dementia. An additional PAF of 11.8% (9.9-13.6) was associated with APOE ε4, which together with nongenetic risk factors accounted for 30.6% (25.8-35.1) of ADRD. Known risk factors explained about a third of the ADRD cases but with unequal distributions across racial and ethnic groups.

Fracture-Induced Effects on the Onset & Progression of Alzheimer’s Disease

Alzheimer’s disease and related dementias (AD/ADRD) are multifactorial, highly heterogeneous, and complex age-dependent disorders that severely affect memory and cognitive function, impacting nearly 35.6 million people worldwide. In the elderly, dementia increases the risk of falls and fractures by 2-3 times, due in part to neurovascular instability, low bone mineral density due to pre-existing osteoporosis, and poor musculature supporting joints due to cachexia and/or sarcopenia.
 While the occurrence of fractures due to AD/ADRD is well documented, an association between fractures and AD/ADRD onset or progression is underappreciated and warrants additional investigation. We aim to investigate the mechanistic actions underlying fracture healing as a precipitating event for AD/ADRD pathogenesis.
 Four-month-old, male, 5xFAD (AD model) and wild-type control (C57BL/6) mice were divided into 2 groups: surgically induced femoral fractures and uninjured mice. Prior to surgery mice underwent baseline AD behavior testing including: spontaneous alternation in the y-maze, light-dark exploration in the open field, and active place avoidance assays. Mice are undergoing weekly x-ray imaging to monitor fracture healing progression and longitudinal AD behavior testing. 22 weeks post-surgery mice will be euthanized, and femurs and brains collected. Femurs will undergo uCT imaging and histological assessment of bone healing and immunohistochemical assessment of inflammatory markers. Brains will be processed for histology and neuroinflammatory marker analysis, including Aβ plaque deposition, tau tangles, neuronal survival, neurogenesis, and activation/proliferation of microglia and astrocytes.
 At the conclusion of the study, we expect to see an increase in neuroinflammatory markers and delayed fracture healing in the experimental 5xFAD group. We anticipate that compared to uninjured controls, femoral fracture results in cognitive decline, Aβaccumulation/neurodegeneration, increases in neuroinflammation, and vascular impairment. We anticipate finding a correlation between fracture and worsened AD outcomes. By uncovering the mechanisms underlying this relationship, we hope to guide future studies to develop more robust therapeutics.

The power of representation: Statistical analysis of diversity in US Alzheimer's disease genetics data.

Alzheimer's disease (AD) is a complex disease influenced by genetics and environment. More than 75 susceptibility loci have been linked to late-onset AD, but most of these loci were discovered in genome-wide association studies (GWAS) exclusive to non-Hispanic White individuals. There are wide disparities in AD risk across racially stratified groups, and while these disparities are not due to genetic differences, underrepresentation in genetic research can further exacerbate and contribute to their persistence. We investigated the racial/ethnic representation of participants in United States (US)-based AD genetics and the statistical implications of current representation. We compared racial/ethnic data of participants from array and sequencing studies in US AD genetics databases, including National Institute on Aging Genetics of Alzheimer's Disease Data Storage Site (NIAGADS) and NIAGADS Data Sharing Service (dssNIAGADS), to AD and related dementia (ADRD) prevalence and mortality. We then simulated the statistical power of these datasets to identify risk variants from non-White populations. There is insufficient statistical power (probability <80%) to detect single nucleotide polymorphisms (SNPs) with low to moderate effect sizes (odds ratio [OR]<1.5) using array data from Black and Hispanic participants; studies of Asian participants are not powered to detect variants OR <= 2. Using available and projected sequencing data from Black and Hispanic participants, risk variants with OR = 1.2 are detectable at high allele frequencies. Sample sizes remain insufficiently powered to detect these variants in Asian populations. AD genetics datasets are largely representative of USADRDburden. However,there is a wide discrepancy between proportional representation and statistically meaningful representation.Most variation identified in GWAS of non-Hispanic White individuals have low to moderate effects. Comparable risk variants in non-White populations are not detectable given current sample sizes, which could lead to disparities in future studies and drug development. We urge AD genetics researchers and institutions to continue investing in recruiting diverse participants and use community-based participatory research practices.

SECONDARY USE OF NIH AD/ADRD DATA RESOURCES FOR BIOMEDICAL RESEARCH

Abstract People are living longer than ever before, and the world’s population aged 60 and older is expected to increase from 1 billion to 2.1 billion by 2050. As populations get older, they become more susceptible to age-related diseases such as Alzheimer’s Disease and Related Dementias (AD/ADRD), which affects more than 55 million individuals worldwide. The National Institutes of Health (NIH) aims to prevent and treat diseases such as AD/ADRD through generalist and disease-specific data resources that foster findable, interconnected, and interoperable data to accelerate biomedical innovations and medical interventions that improve human health. The goal of this assessment was to understand the value of AD/ADRD secondary data use from NIH genomic and multi-omics data resources: NIA Genetics of Alzheimer’s Disease Data Storage Site (NIAGADS), database of Genotypes and Phenotypes (dbGaP), AD Knowledge Portal (ADKP), and Gene Expression Omnibus (GEO). List of AD/ADRD datasets were retrieved through database searches or directly from repository staff (N=183). Citation frequency of data accessions were used to determine utilization of AD/ADRD genomic and multi-omics datasets in published literature. iSearch tool was used to assess secondary use drivers in resulting publications. Query of data accessions in Pubmed Central returned 284 unique publications. iSearch clustering by term showed that genomic datasets were used to study genetic risk factors of AD/ADRD while multi-omics datasets were used to functionally characterize genetic risk variants, identify gene regulatory networks, and biomarkers associated with neurodegenerative diseases. These findings indicate the usefulness of AD/ADRD secondary data to the scientific literature.

MEASURING UNMET NEEDS FOR COMMUNITY-DWELLING CONSUMERS OF HOME- AND COMMUNITY-BASED SERVICES USING NCI-AD DATA

Abstract Rebalancing efforts have focused on helping more people age in the community rather than institutional settings. Yet, we know little of whether actual services being offered meet consumer needs. HCBS provides intermittent services and supports to consumers and variability can create increased reliance on informal caregivers, contributing to unmet need. This can be especially true for consumers living with Alzheimer’s disease and Alzheimer’s disease and related dementias (AD/ADRD), whose needs may fluctuate and intensify as functional and/or cognitive impairments advance. This presentation examines unmet need among a national sample of older adult (65+) consumers of publicly funded HCBS, using data from the National Core Indicators - Aging and Disability (NCI-AD) survey from 2016-2019. We restrict our sample to community-dwelling older adults, where community-dwelling includes: own or family house/apartment, senior living apartment/complex, group home, adult family home, foster, or host home. Our results showed that services that were most commonly used were home-based services (57%), with at least half of the consumers using two different services to support their needs. Factors associated with wanting more services included being a woman, living alone, having a physical disability, and a diagnosis of AD/ADRD. Older adults with AD/ADRD desired more services than those without AD/ADRD, with additional desired services for caregiver supports and transportation. Our findings speak to the need to measure and improve person-centered quality of publicly-funded HCBS for older adults, with particular attention to the needs of those living with AD/ADRD.

A GREEN ACTIVITY PRESCRIPTION PROGRAM FOR CHINESE AMERICANS LIVING WITH DEMENTIA

Abstract Asian Americans account for approximately 161,000 cases of Alzheimer’s disease and related dementias (AD/ADRD) among adults ages 65 and older in the United States. Chinese Americans have among the highest incidences of AD/ADRD, and have experienced underdiagnosis, cultural stigmas, and less access to dementia care. In New York City specifically, 28.6% of Chinese American seniors live in poverty, leading to environmental racism, a lower likelihood of engagement in activities, decreased quality of life, and an increased risk of cognitive decline and developing dementia. Recommendations to support activity engagement among Chinese Americans include fostering social cohesion and linking individuals to local activity resources. Green activity prescriptions (GAPs) are one approach to achieving these objectives, and combine nature, social contexts, and meaningful activities to improve health and well-being. GAPs are co-designed with participants based on their interests, needs, and available community resources. Examples include: animal-assisted interventions, gardening, green exercise (walking), and conservation projects (composting). Past studies have provided evidence that these components have improved well-being for PLWD, supported function, and provided meaningful engagement. Yet, these early studies neglected Chinese Americans. GAPs have potential to support the health and well-being of Chinese American PLWD by addressing health inequalities and providing accessible, low-cost care, all while sustaining local green resources. Here we present the study design and implementation outcomes, including recruitment and engagement strategies, of a GAP intervention utilizing a community-based participatory approach aimed at supporting the health and well-being of Chinese American PLWD residing in lower-socioeconomic households within Brooklyn, NY.

INTEROCEPTIVE ACCURACY ENHANCES DECEPTION DETECTION WITH GREATER AGE

Abstract Financial exploitation of older adults is a growing concern, with millions of seniors scammed annually, costing billions, and resulting in devastating consequences for health, independence, and well-being. Exploitation risk is exacerbated in Alzheimer’s disease and related dementias (AD/ADRD). Detecting deception is challenging, especially for older adults who tend to believe others are truthful. Understanding the neurobiological mechanisms underlying this susceptibility is essential to design effective intervention toward reducing exploitation in aging. In this research we demonstrate the importance of interoceptive awareness─the ability to interpret body signals─in deception detection in older adults. Seventy-six young (18-34 years) and 74 older (53-82 years) adults completed a heartbeat counting task to assess their interoceptive awareness. They also engaged in deception detection paradigms across two distinct, ecologically valid tasks: i) a lie detection task in which they made veracity judgments of genuine and deceptive individuals, and ii) a phishing email detection task to capture accuracy in online deception detection. Greater interoceptive awareness was associated with greater lie detection accuracy. Furthermore, with greater chronological age among older adults, greater interoceptive awareness was associated with better accuracy in both detecting deceptive individuals and phishing emails. These findings support interoceptive awareness as a relevant factor for interventions aimed at enhancing deception detection abilities in aging. Project results will advance insight into the neurobiology of deception detection to inform effective translation into intervention in mitigating exploitation risk in aging and eventually ADRD.

Proteome-wide Analyses Identified Cortical Proteins Associated With Resilience for Varied Cognitive Abilities.

Prior work suggests that cognitive resilience may contribute to the heterogeneity of cognitive decline. This study examined whether distinct cortical proteins provide resilience for different cognitive abilities. Participants were from the Religious Orders Study or the Rush Memory and Aging Project who had undergone annual assessments of 5 cognitive abilities and postmortem assessment of 9 Alzheimer disease and related dementia (ADRD) pathologies. Proteome-wide examination of the dorsolateral prefrontal cortex using tandem mass tag and liquid chromatography-mass spectrometry yielded 8,425 high-abundance proteins. We applied linear mixed-effect models to quantify residual cognitive change (cognitive resilience) of 5 cognitive abilities by regressing out cognitive decline related to age, sex, education, and indices of ADRD pathologies. Then we added terms for each of the individual proteins to identify cognitive resilience proteins associated with the different cognitive abilities. We included 604 decedents (69% female; mean age at death = 89 years) with proteomic data. A total of 47 cortical proteins that provide cognitive resilience were identified: 22 were associated with specific cognitive abilities, and 25 were common to at least 2 cognitive abilities. NRN1 was the only protein that was associated with more than 2 cognitive abilities (semantic memory: estimate = 0.020, SE = 0.004, p = 2.2 × 10-6; episodic memory: estimate = 0.029, SE = 0.004, p = 5.8 × 10-1; and working memory: estimate = 0.021, SE = 0.004, p = 1.2 × 10-7). Exploratory gene ontology analysis suggested that among top molecular pathways, mitochondrial translation was a molecular mechanism providing resilience in episodic memory, while nuclear-transcribed messenger RNA catabolic processes provided resilience in working memory. This study identified cortical proteins associated with various cognitive abilities. Differential associations across abilities may reflect distinct underlying biological pathways. These data provide potential high-value targets for further mechanistic and drug discovery studies to develop targeted treatments to prevent loss of cognition.

Accountable Care Organization Attribution and Post-Acute Skilled Nursing Facility Outcomes for People Living With Dementia

ObjectivesUnder the Accountable Care Organization (ACO) model, reductions in healthcare spending have been achieved by targeting post-acute care, particularly in skilled nursing facilities (SNFs). People with Alzheimer disease and related dementias (ADRD) are frequently discharged to SNF for post-acute care and may be at particular risk for unintended consequences of SNF cost reduction efforts. We examined SNF length of stay (LOS) and outcomes among ACO-attributed and non–ACO-attributed ADRD patients. DesignObservational serial cross-sectional study. Setting and ParticipantsTwenty percent national random sample of fee-for-service Medicare beneficiaries (2013-2017) to identify beneficiaries with a diagnosis of ADRD and with a hospitalization followed by SNF admission (n = 263,676). MethodsOur primary covariate of interest was ACO (n = 66,842) and non-ACO (n = 196,834) attribution. Hospital readmission and death were measured for 3 time periods (<30, 31-90, and 91-180 days) following hospital discharge. We used 2-stage least squares regression to predict LOS as a function of ACO attribution, and patient and facility characteristics. ResultsACO-attributed ADRD patients have shorter SNF LOS than their non-ACO counterparts (31.7 vs 32.8 days; P < .001). Hospital readmission rates for ACO vs non-ACO differed at ≤30 days (13.9% vs 14.6%; P < .001) but were similar at 31-90 days and 91-180 days. No significant difference was observed in mortality post–hospital discharge for ACO vs non-ACO at ≤30 days; however, slightly higher mortality was observed at 31-90 days (8.4% vs 8.8%; P = .002) and 91-180 days (7.6% vs 7.9%; P = .011). No significant association was found between LOS and readmission, with small effects on mortality favoring ACOs in fully adjusted models. Conclusions and ImplicationsBeing an ACO-attributed patient is associated with shorter SNF LOS but is not associated with changes in readmission or mortality after controlling for other factors. Policies that shorten LOS may not have adverse effects on outcomes for people living with dementia.

Call for Collecting and Reporting Disaggregated Data for Centering Racial Inclusion and Equity in the U.S. and Globally: Examining Multimorbidity and Risk for Cognitive Impairment in the Asian American Populations

AbstractBackgroundAsian American subgroups are underrepresented in Alzheimers Disease and Related Dementias (ADRD) research in the U.S. and globally.MethodOur approach was threefold: First, we identified data collection and reporting gaps for ADRD among Asian Americans in the U.S from multiple nationally representative surveys, e.g. Health and Retirement Survey, Medical Expenditure Panel Survey, and the Census. Second, we examined multi‐morbidity (e.g. diabetes, hypertension, cardiovascular disease and stroke) burden among a specific group of Asian Americans, South Asian Indians. Third, we provide knowledge gaps and recommendations for inclusion of Asian Americans to center racial equity in ADRD science.ResultDespite being a highly heterogeneous group and diverse in terms of culture, diet, language, Asian Americans are lumped together in national surveys. The three national surveys we examined in the U.S. have not collected disaggregated data on Asian Americans, a group that is growing in the U.S. Moreover, there is a lack of disease registers for different groups of Asian Americans which makes it difficult to assess and quantify the prevalence and burden of ADRD in this group. Due to a lack of systematic data collection efforts, the extent of dementia burden and classification of dementia cannot be accurately examined in the sub‐groups of Asian Americans. The data gaps in the collection and reporting of data on sub‐groups of Asian Americans prevent from designing culturally and linguistically sensitive interventions which are highly needed for sub‐groups of Asian Americans. South Asian Indians, a sub‐group of Asian Americans, considered to be of higher socioeconomic background in the U.S. were seldom omitted from the minority classification despite having a higher burden of multiple chronic conditions such as diabetes, hypertension, cardiovascular disease, and stroke, i.e. multi‐morbidity combinations which can greatly contribute to increased ADRD risk in this sub‐group.ConclusionThere is a critical need for the collection and reporting of disaggregated ADRD data on Asian Americans for centering racial equity in ADRD science in the U.S. Such efforts will aid in the understanding of mechanistic pathways for vascular cognitive impairment via inclusion of unique Asian populations that have been underrepresented in ADRD research both in the U.S. and globally.

Compensatory versus Rehabilitative Dysphagia Management Approaches are More Frequently Recommended in Hospitalized Persons with Alzheimer’s Disease and Related Dementias

AbstractBackgroundPersons with Alzheimer’s disease and Related Dementias (AD/ADRD) frequently develop difficulty swallowing (dysphagia). Two general categories of dysphagia management approaches are initiated by Speech‐Language Pathologists (SLP): compensatory (e.g., modifying fluid/food characteristics) and rehabilitative (exercise‐based). While compensations may improve swallowing safety (no airway invasion) and efficiency (no residue) in the short term, they do not actively target swallowing muscles (e.g. rehabilitative approaches) to induce lasting change in physiology. Additionally, compensatory recommendations are often based on clinical examinations (Desai, 2020) that do not permit visualization of swallowing possible with instrumental assessment (e.g. videofluoroscopic swallow study, ‘VFS’) which may lead to recommendations that are misaligned with swallowing physiology. This study aimed to elucidate whether the frequency of compensatory versus rehabilitative recommendations differs based on VFS findings. Specifically, we sought to characterize: 1) dysphagia management recommendations and 2) VFS findings contributing to these recommendations in a cohort of hospitalized patients with AD/ADRD.MethodThe retrospective sample included all inpatients (n = 122) with AD/ADRD (≥50 years) referred for a VFS at an academic hospital in 2014. AD/ADRD was determined by a diagnosis in the EHR and/or if the patient was taking medication(s) prescribed for AD/ADRD. Dysphagia management recommendations and VFS outcomes including swallowing safety (Penetration‐Aspiration Scale (Rosenbek, 1995) ‘PAS’ scores), efficiency (oropharyngeal residue), and biomechanical impairments (as identified by the SLP) were abstracted from the EHR. The absence (PAS scores 1,2, or 4) or presence (PAS scores 3,5,6, 7, or 8) of airway invasion was further classified (Steele, 2017). Descriptive statistics were calculated to analyze the data.ResultAll recommendations were compensatory with no rehabilitative treatments offered (Table 1). Across recommendations, pharyngeal phase impairments (e.g., pharyngeal delay) and inefficiency (e.g., vallecular residue) on VFS were more common than oral phase impairments/inefficiency. While relatively infrequent, airway invasion was most observed in the pill, solid, and liquid modification groups (Table 2).ConclusionIn this cohort, all dysphagia treatment recommendations were compensatory approaches focused on optimizing swallowing safety and efficiency. While these recommendations were aligned with VFS findings reflecting pharyngeal phase impairments/inefficiency, they highlight a missed opportunity to address swallowing impairments by directly targeting underlying physiology with a rehabilitative approach.

Real‐time Memory‐related Neurofeedback Training Improves Intrinsic Brain Oscillations in Older Adults

AbstractBackgroundMild cognitive impairment (MCI), manifesting as working memory deficits for example, is the most common and earliest symptom of Alzheimer’s disease and related dementias (AD/ADRD). To combat the brain aging processes, early intervention is needed. Electroencephalogram (EEG)‐based neurofeedback (NF) has been found to be beneficial in treating a variety of brain disorders. Increased intrinsic delta power and decreased alpha is associated with brain aging and AD pathologies. We have developed an ERP‐based NF protocol to reward memory‐related potentials. In this study, we aim to evaluate the effect of NF training protocol.MethodThree older males (ages, 63, 78, and 79) participated in a newly developed NF training protocol including baseline and memory‐related NF training (twice a week). Each participant was recorded using 90‐second of eyes closed (EC) before multiple NF sessions during each visit. Their brain signals were collected with a 14‐channel wireless electroencephalogram (EEG) headset and processed in real‐time. The NF training contained 2 sham sessions followed by 2 intervention sessions. Compared to the intervention, visual feedback in the sham was provided in random order rather than triggered by participants’ ERP fluctuations. The EEG signal collected with EC before the experiment (Baseline, T0), 3 days after the sham (Sham, T1), and 3 days after the intervention (post‐intervention, T2) were preprocessed as 4s epoch windows and computed as the delta, theta, alpha, beta, and gamma band power. The average EEG band powers from T0, T1, and T2 and memory performances from the three participants were calculated.ResultThe working memory performance (accuracy and reaction times during retrievals of memory target and rejection of nontarget) did not show significant change among the three participants. In contrast, the EC intrinsic delta and alpha power changed towards brainwaves seen in younger brains after several sessions of NF training. Additionally, sham also improves in the alpha band (associated with attention and vigilance).ConclusionThe pilot results demonstrated the effectiveness of a newly developed NF training using working memory related potentials in two out of three older adults. The results indicate the promise of cognitive enhancement using event‐related potentials‐based NF training in real time.

Associations between white matter integrity of the cingulum bundle, surrounding gray matter regions, and cognition across the dementia continuum.

Previous Alzheimer's disease and related dementias (AD/ADRD) research studies have illustrated the significance of studying alterations in white matter (WM). Fewer studies have examined how WM integrity, measured with diffusion tensor imaging (DTI), is associated with volume of gray matter (GM) regions and measures of cognitive function in aged participants spanning the dementia continuum. Magnetic resonance imaging and cognitive data were collected from 241 Boston University Alzheimer's Disease Research Center participants who spanned from cognitively normal controls to amnestic mild cognitive impairment to having dementia. Primary DTI tracts of interest were the cingulum ventral (CV) and cingulum dorsal (CD) pathways. GM regions of interest (ROIs) were in the medial temporal lobe (MTL), prefrontal cortex, and retrosplenial cortex. Analyses of covariance models were used to assess differences in WM integrity across groups (control, amnestic mild cognitive impairment, and dementia). Multiple linear regression models were used to assess associations between WM integrity and GM volume, and with measures of memory and executive function. Differences in WM integrity were shown in both cingulum pathways in participants across the dementia continuum. Associations between WM integrity of both cingulum pathways and volume of selected GM ROIs were widespread. Functionally significant associations were found between WM of the CV pathway and memory, independent of MTL GM volume. Differences in WM integrity of the cingulum bundle and surrounding GM ROI are likely related to the progression of AD/ADRD. Such differences should continue to be studied, particularly in association with memory performance.

Scoping Literature Review: Experiences of Sexual and Gender Minority Older Adults, With Diagnoses of Dementia, Who Use Residential Long-Term Services and Supports.

The number of sexual and gender minority (SGM) older adults utilizing residential long-term supports and services (LTSS) will increase in the forthcoming decades. Paradoxically, while requiring more LTSS services than their non-SGM counterparts, SGM older adults are less likely to access these services, partly due to fears of discrimination. Furthermore, SGM older adults living with Alzheimer's disease and related dementias (AD/ADRD) present unique challenges and opportunities for LTSS facilities. This article provides a scoping review on the intersection between experiences of SGM older adults with AD/ADRD who use residential LTSS. This review identified three themes: (1) the experiences of discrimination among SGM residents in LTSS facilities, (2) the need for comprehensive staff training in residential LTSS to ensure proper care of SGM populations, and (3) the crucial role of inclusive facility policies. As the number of SGM older adults is expected to increase, further research is necessary.

Mindfulness-Based App to Reduce Stress in Caregivers of Persons With Alzheimer Disease and Related Dementias: Protocol for a Single-Blind Feasibility Proof-of-Concept Randomized Controlled Trial.

Informal caregivers (ie, individuals who provide assistance to a known person with health or functional needs, often unpaid) experience high levels of stress. Caregiver stress is associated with negative outcomes for both caregivers and care recipients. Mindfulness-based interventions (MBIs) show promise for improving stress, emotional distress, and sleep disturbance in caregivers of persons with Alzheimer disease and related dementias (ADRD). Commercially available mobile mindfulness apps can deliver MBIs to caregivers of persons with ADRD in a feasible and cost-effective manner. We are conducting a single-blind feasibility proof-of-concept randomized controlled trial (RCT; National Institutes of Health [NIH] stage 1B) comparing 2 free mobile apps: the active intervention Healthy Minds Program (HMP) with within-app text tailored for addressing stress among caregivers of persons with ADRD, versus Wellness App (WA), a time- and dose-matched educational control also tailored for caregivers of persons with ADRD. We aim to recruit 80 geographically diverse and stressed caregivers of persons with ADRD. Interested caregivers use a link or QR code on a recruitment flyer to complete a web-based eligibility screener. Research assistants conduct enrollment phone calls, during which participants provide informed consent digitally. After participants complete baseline surveys, we randomize them to the mindfulness-based intervention (HMP) or educational control podcast app (WA) and instruct them to listen to prescribed content for 10 minutes per day (70 minutes per week) for 12 weeks. Caregivers are blinded to intervention versus control. The study team checks adherence weekly and contacts participants to promote adherence as needed. Participants complete web-based self-report measures at baseline, posttest, and follow-up; weekly process measures are also completed. Primary outcomes are a priori set feasibility benchmarks. Secondary outcomes are stress, emotional distress, sleep disturbance, caregiver burden, mindfulness, awareness, connection, insight, and purpose. We will calculate 1-sided 95% CI to assess feasibility benchmarks. Effect sizes of change in outcomes will be used to examine the proof of concept. Recruitment started on February 20, 2023. We have enrolled 27 caregivers (HMP: n=14; WA: n=13) as of June 2023. Funding began in August 2022, and we plan to finish enrollment by December 2023. Data analysis is expected to begin in May 2024 when all follow-ups are complete; publication of findings will follow. Through this trial, we aim to establish feasibility benchmarks for HMP and WA, as well as establish a proof of concept that HMP improves stress (primary quantitative outcome), emotional distress, sleep, and mindfulness more than WA. Results will inform a future efficacy trial (NIH stage II). HMP has the potential to be a cost-effective solution to reduce stress in caregivers of persons with ADRD, benefiting caregiver health and quality of care as well as patient care. ClinicalTrials.gov NCT05732038; https://clinicaltrials.gov/study/NCT05732038. DERR1-10.2196/50108.