American Participants Research Articles

Association of Chronic Anti‐GERD Medication Usage and Cognitive Decline in a Racially Diverse Elderly Population

AbstractBackgroundIt is understood that early medical intervention of various diseases, like cardiovascular or gastroenterological, is a potential way to mitigate the progression of cognitive decline and dementia. However, some medications’ mechanisms of action (MOA), may alter the metabolism of foods and absorption of nutrients and inhibit neurotransmitters. The long‐term influence of chronic medication use on cognition in a racially‐diverse elderly population is unknown. As such, we aim to investigate how chronic use of specific Anti‐GERD medications (e.g., proton pump inhibitors (PPI) and histamine 2 receptor antagonists (H2RA’s), may be associated with global cognitive decline and cognitive functional domainsMethodUtilizing data collected from a long‐running, community‐based study, the Chicago Health and Aging project (CHAP) which started in 1993, we examined the association of anti‐GERD medication use and cognition in n = 7742, 1268 (16%) PPI users and 939 (12%) H2RA users, aged ≥65 years. This study sample consists of 63% African American (AA) participants and 60% female participants. Recruitment and data collection occurred in triennial cycles. Medication use was assessed through direct observation while neuro‐cognition was evaluated using a battery of 4‐standardized cognitive tests. Using linear mixed effects change‐point models, adjusted for age, sex, education and race, we investigated whether chronic anti‐GERD medication usage is associated with cognitive declineResultOf anti‐GERD medication users, after starting the medication, chronic use of PPI’s was associated with a faster rate of global cognitive decline β = ‐0.028 (p≤0.000), memory score β = ‐0.023 (p≤0.000) and speed score β = ‐0.012 (p≤0.034). H2RA’s were not associated with global cognition or memory score but were suggestive for speed score β = ‐0.011 (p≤0.057). In models stratified by race and separately, sex, after starting, chronic PPI use was associated with faster global cognitive decline in AA β = ‐0.030 (p≤0.000), White β = ‐0.026 (p≤0.001) and female β = ‐0.037 (p≤0.000) but not male individuals. H2RA’s were only associated with faster global cognitive decline in White individuals β = ‐0.025 (p≤0.039)ConclusionChronic use of PPI’s and H2RA’s may be associated with faster rates of global cognitive decline and memory & speed scores in an elderly population. The associative results presented, demonstrate the need for further investigation into how medication usage potentially impacts cognition

Reorganization of functional brain networks in healthy aging and mild cognitive impairment during the visual motion discrimination task

AbstractBackgroundPreviously, we reported that there was significant decrease in spectral power for eyes‐closed resting state EEG (rsEEG) immediately following a visual motion discrimination task as compared to before task engagement in older adults – the so‐called Task Aftereffect (TA). Further, we have also shown that rsEEG TA differentiated between older adults with mild cognitive impairment (MCI) and healthy controls (HC), with the MCI participants showing more integrated topology in post‐ as compared to pre‐cognitive task rsEEG. We now report EEG topological changes during task performance with regards to: changes in functional network organization from the beginning to the end of the task and evidence for significant differences in topology between MCI patients and HC.MethodWe studied a sample of community dwelling African American older participants over age 60 years, with consensus‐based diagnosis for 51 HC and 39 MCI. EEG epochs extracted for analysis were two‐second epochs before the motion onset of each stimulus at the beginning, middle, and end of the full task. Functional connectivity between channels was assessed by the phase lag index. Minimum spanning tree (MST) was used to characterize network topology.ResultTime effect was confirmed, as network organization in all participants significantly improved with task progression. On average, brain topology became more integrated with higher leaf fraction and smaller average eccentricity. Moreover, our results show differences between groups in MST parameters over the whole task. Most differences were observed at the earliest timepoint at lower frequency range (theta and lower alpha) where average eccentricity was significantly decreased. Leaf fraction and maximal betweenness centrality were significantly increased in the MCI group as compared to HC.ConclusionThe change in network organization suggests that MCI require greater network integration across brain areas before repeated motion onset presentations. This could reflect compensatory brain mechanisms, especially as both groups did not show significant differences in task performance. These findings enhance our understanding of the functional brain network organization immediately prior to repeated responses in a visual perceptual task in MCI compared to HC. This emphasizes the potential for using graph‐theoretic measures as a valid tool for the early detection of cognitive impairment.

Interaction between DNA methylation and neighborhood disadvantage may impact risk for cognitive decline among Mexican Americans enrolled in the Health and Aging Brain Study – Health Disparities (HABS‐HD) Cohort

AbstractBackgroundLiterature continues to indicate that social exposome factors such as neighborhood disadvantage, measured by the area deprivation index (ADI), is associated with cognitive decline, total brain volume, hippocampal volume and AD neuropathology. We hypothesize that epigenetic markers are implicated in the effect of neighborhood disadvantage on neurodegenerative biomarkers among Mexican Americans. We used existing Illumina EPIC Methylation chip and ADI data from 32 Mexican American participants enrolled in the Heath & Aging Brain Study ‐ Health Disparities (HABS‐HD) cohort to test whether differentially methylated sites and regions moderate a portion of the effect of ADI on risk for implicated AT(N) biomarkers.MethodThis study included Mexican American participants with information on DNA methylation, ADI, and Neurofilament Light (NfL), who were part of the Health and Aging Brain Study – Health Disparities (HABS‐HD). We considered 25 targeted epigenetic markers, which were previously identified to be associated with MCI or NfL from our group. We conducted preliminary analysis to assess associations between ADI and NfL using whole data (n = 812), and whether such association is moderated by one of the aforementioned targeted epigenetic markers using data with DNA methylation information (n = 32). Linear regression models were conducted to test the above effects and adjust for covariates.ResultResults of the linear regression models showed that ADI was significantly positively associated with NfL among Mexican Americans (p = 0.007) using whole data, but the moderation analysis revealed no significant moderating effects on such association for any of the targeted epigenetic markers. However, one CpG site, cg07413251, showed marginally significant interaction effects with ADI on the association with NfL (p = 0.056). The cg07413251 site maps to a CpG island located at chr3p24.1. The biological implications of differential methylation at this site are unknown and remain under investigation.ConclusionThe lack of significant results for moderation effects of the targeted epigenetic markers in our pilot study were likely due to the small sample size. In our future work, we will expand samples size significantly, improving power to better understand the role of disadvantaged neighborhoods in influencing cognitive function. Investigations into other biomarkers are underway.

Apathy, cognition and beta amyloid in African Americans in the AA‐FAIM cohort

AbstractBackgroundThe prodrome of cognitive declines and/or dementia may include late‐life neuropsychiatric symptoms such as apathy. In primarily non‐Hispanic White samples, apathy associates with both cognition and amyloid deposition in cognitively intact patients and those with Alzheimer’s disease (AD). However, little is known about these relationships in African Americans, who are both disproportionately affected by AD and under‐represented in AD research. Apathy could reflect higher levels of proteinopathy or occur co‐morbidly, exacerbating its deleterious effects. We examined associations between apathy and cognition and their potential moderation by plasma beta amyloid in cognitively healthy African American participants.MethodStudy participants enrolled in African Americans Fighting Alzheimer’s In Mid‐Life(AA‐FAIM, a linked study to the WRAP and Wisconsin ADRC) were included in the analytic sample (N = 166; Table 1) if they had ≥1 cognitive visits, plasma amyloid biomarker data, and apathy ratings by study partners using the Neuropsychiatric Inventory Questionnaire (NPI‐Q) or the Apathy Evaluation Scale (AES). Cognitive outcomes included performance on measures of processing speed, mental flexibility and immediate and delayed memory. We used linear mixed models to examine association of baseline apathy with cognitive performance measures at multiple time points, and the moderation of apathy‐cognition relationships by plasma Aβ42/40 ratio (C2N, USA). Apathy‐cognitive outcome pairings were selected based on significant findings from a proof‐of‐concept linear mixed effects analysis of the full Wisconsin ADRC sample.ResultResults are shown in Table 2. Among AA‐FAIM participants, NPI‐Q apathy was associated with RAVLT immediate (estimate = ‐7.7, p = .001) and delayed recall (estimate = ‐3.2, p = .001). However, AES was unrelated to Trails A or B performance. There were no associations between plasma amyloid or the Aβ42/40*apathy interaction term with any cognitive outcomes.ConclusionPartner‐rated apathy, but not plasma Aβ42/40, was related to cognition in our African American participants, an important finding given limited data available on this population. It will be critical to address apathy and its antecedents to improve the cognitive and affective health of African American older adults. Future research needs to expand cohorts to African American and other diverse populations to investigate disease mechanisms in Alzheimer’s disease and related dementias more inclusively.

Abstract A103: Joint associations of education and neighborhood socioeconomic status on smoking prevalence: The Multiethnic Cohort Study

Abstract Background: Smoking is the leading cause of cancer and cancer death. Individual- and neighborhood-level measures of socioeconomic status (SES) have been separately associated with racial and ethnic differences in smoking rates. However, the joint associations of individual- and neighborhood-level SES on smoking have not been studied. Thus, we examined the joint association of education and neighborhood SES (nSES) on smoking status in the Multiethnic Cohort (MEC) study. Methods: We conducted a cross-sectional study of the joint association of nSES and education with smoking for 166,475 MEC participants (26,350 African American, 50,207 Japanese American, 34,490 Latino, 12,326 Native Hawaiian, and 43,102 White participants) recruited from predominately Los Angeles County and Hawaii. Smoking status, education, and other demographics and health behaviors were reported at baseline (1993-1996). Neighborhood SES (nSES) was derived using 1990 US Census data on education, occupation, unemployment, household income, poverty, rent, and house values and assigned to geocoded baseline addresses; and categorized into quintiles using LA County and Hawaii nSES distributions. The joint nSES and education measure was categorized into 4 levels using high nSES (quintiles 4-5), low nSES (quintiles 1-3), high education (≥ high school), and low education (< high school). The study outcome was current smoking vs. non-smoking (never or former smoking). Poisson regression was used to estimate prevalence ratios (PR) and 95% CIs for the joint association of nSES and education with current smoking, adjusting for sex, race/ethnicity, marital status, physical activity, occupation, alcohol, obesity, 2015 healthy eating index, and clustering by census block group. Subgroup analyses were conducted by state (CA and HI), sex, and race/ethnicity. Results: For CA MEC participants, smoking prevalence was highest with low nSES and low education, followed by low nSES and high education, and high nSES and low education (PR=1.50, 1.33, and 1.29, respectively). This pattern was found in females but not males and in African American and Japanese American participants but not Latino or White participants. For HI MEC participants, smoking prevalence was highest with low nSES and low education, followed by high nSES and low education, and low nSES and high education (PR=1.41, 1.36, and 1.20, respectively). This pattern was found in males and females in HI and across all racial and ethnic groups. Interestingly, in Native Hawaiian participants, the smoking prevalence with low nSES and low education was similar to those with high nSES and low education (PR=1.54 and 1.52, respectively). Conclusion: In the MEC, smoking prevalence was highest in CA for females, African American, and Japanese American participants in joint SES categories with low nSES, while in HI, low education appeared more influential, especially among Native Hawaiian participants. These findings demonstrate the importance of considering both individual and neighborhood-level SES measures on smoking prevalence. Citation Format: Catherine P. Walsh, Younghan Lee, Salma Shariff-Marco, Lynne Wilkens, Loic Le Marchand, Christopher A. Haiman, Iona Cheng, S. Lani Park. Joint associations of education and neighborhood socioeconomic status on smoking prevalence: The Multiethnic Cohort Study [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A103.

Abstract C104: Addressing health disparities: Enhancing knowledge and screening practices for liver disease risk factors among African Americans

Abstract Background: Liver cancer poses a significant health burden globally, with racial and ethnic disparities in its incidence. Among these disparities, the Black population in the United States faces a heightened risk of liver cancer due to the higher prevalence of chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. This study aimed to evaluate the effectiveness of a culturally tailored educational intervention designed to enhance awareness of liver cancer prevention and screening among at-risk populations. Methods: Descriptive statistics were used to characterize participant demographics and clinical factors. Paired t-tests assessed the difference in knowledge scores before and after the intervention. Poisson regression with robust variance estimation determined the association between physicians' recommendations for testing and patients receiving blood tests. Results: The study included 137 African American participants. Prior to the intervention, the majority were aware that casual contact does not transmit HBV or HCV (79.6%) and that sharing needles for tattoos or drug injection can transmit the viruses (77.4%). The mean knowledge score increased significantly from 6.61 pre-intervention to 8.44 post-intervention (p-value<0.001). Poisson regression analysis showed that African American adults were less likely to receive physician recommendations for blood tests for HBV (RR=0.95, 95%CI:0.87,1.04) and HCV (RR=0.91, 95%CI:0.83,1.00) compared to other racial/ethnic groups. Conclusions: The culturally tailored educational intervention effectively improved knowledge of HBV and HCV among African American participants, indicating the importance of culturally sensitive programs in reducing liver cancer disparities. Efforts to increase awareness of liver disease and promote testing within the healthcare system are crucial for reducing the morbidity and mortality associated with HBV and HCV infections among African Americans. Character count (with spaces): 1,963 Acknowledgment: This study was supported by TUFCCC/HC Regional Comprehensive Cancer Health Disparity Partnership, Award Number U54 CA221704(5) from the National Cancer Institute of National Institutes of Health (NCI/NIH) and by NIGMS/NIH award # 1SC3GM131949[GXM1] . The author team would like to thank Community Advisory Board members, leaders, and staff members for collaborating with community/faith-based organization partners. We also acknowledge the research team staff of Planning Evaluation Core under TUFCCC/HC Regional Comprehensive Cancer Health Disparity Partnership for their support and contribution for their support and contributions to Community Outreach Core's data management. Its contents are solely the authors' responsibility and do not necessarily represent the official views of the NCI/NIH or the NIGMS/NIH. Citation Format: Jade A. Truehart, Thoin F. Begum, Keshanti Bruce, Lin Zhu, Ming-Chin Yeh, Evelyn Gonzalez, Marilyn A. Fraser, Ada Wong, Steven Zhu, Nathaly Rubio-Torio, Grace X. Ma, Yin Tan. Addressing health disparities: Enhancing knowledge and screening practices for liver disease risk factors among African Americans [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C104.

An Update on the Building Bridges Study: Examining the effects of two interventions on trust in medical researchers and research attitudes among African American participants

AbstractBackgroundData suggest that establishing trust supports willingness to participate in research studies; yet there is a shortage of standardized systematic studies testing the effectiveness of various methods of building trust. The Building Bridges pilot study examined ways of establishing trust in communities of color comparing two different interventions.MethodUsing African American community leaders’ input, we conducted a mixed method study to investigate participants’ 1) preferred format for community‐based interventions, 2) comfort with discussing dementia with researchers/healthcare providers, and 3) attitudes of trust about research and researchers. African American subjects (age ≥ 45 years) without self‐reported cognitive impairment completed research attitudes (RAQ) and trust in medical researcher questionnaires, pre‐ and post‐intervention; individual medication reviews (n = 48) and/or public community talks (n = 49). Quantitatively, we compared pre‐ and post‐ intervention outcomes with paired Wilcoxon non‐parametric sign rank tests; all qualitative themes were analyzed using Nvivo QSR 12.ResultParticipants’ mean age was 64 (SD = 9.9). See Table 1 for demographics. Quantitatively, there was greater change in research attitudes and trust following a medication review intervention compared to experiencing a community talk (Figure 1); e.g., participants expressed “positive views about medical research in general” on questionnaires following medication reviews (p = 0.007). Qualitatively, we found a similar trend during our focus group discussions. Focus group members expressed more comfort with the medication review than the community talk resulting from “positive bedside manners, positive feedback, personal 1‐on‐1 interactions and race concordance.” Focus group participants noted a willingness to participate in future studies because of trust built from their Building Bridges team interactions. “Commonality, better connection, relatability, affinity and cultural similarities” all influenced trust and willingness to participate in future studies. Factors found to reduce trust included: “negative feedback, stereotypes, predominantly white practitioners in medicine and research, clinician unskillfulness, and not feeling seen as a “whole person” by providers” (Figure 2).ConclusionFindings continue to support our hypothesis that more personalized community engagement approaches have a greater influence on participants’ research attitudes and build interest in research. Additional studies of person‐centered recruitment strategies are essential to understanding how to improve trust and positive research attitudes among communities of color.

Drivers of underreport of memory loss in mild cognitive impairment due to Alzheimer’s and vascular disease

AbstractBackgroundWe examined self‐ and informant‐based report of memory loss in mild cognitive impairment due to Alzheimer’s disease (AD‐MCI) and vascular disease (Va‐MCI). We hypothesized that drivers of underreport would differ based on etiology and participant characteristics.MethodThis retrospective cross‐sectional study included participants with AD‐MCI (n = 2874) and Va‐MCI (n = 376) in the National Alzheimer’s Coordinating center dataset (NACC). Report of memory loss by the participant and informant was recorded as a binary (yes/no) value. We examined the role of demographic variables (age, sex, education, race, ethnicity) and neuropsychological variables (anxiety, depression on NPI‐Q) in driving underreporting of memory loss using Fisher’s exact test.ResultCompared to AD‐MCI, Va‐MCI was associated with significantly more underreport of memory loss by participants (24.5% vs 19.7%, p = 0.031) and informants (31.4% vs 21.6%, p<0.0001). Black/African American participants displayed higher rates of underreport in both AD‐MCI (27.1% vs. 18.4%, p<0.0001) and Va‐MCI (37.8% vs. 20.8%, p = 0.0022). Informant underreport was increased in both AD‐MCI and Va‐MCI for participants who were female (AD: 24.3% vs 18.6%, p = 0.0002; Va:38.1% vs 22.2%, p = 0.0011) and Black/African American (AD: 35.1% vs 19.3%, p<0.0001; Va: 48.8% vs. 26.5%, p = 0.0002), and in AD‐MCI for participants who had less than 16 years of education (AD: 23.9% vs 20.3%, p = 0.0262). In both AD‐MCI and Va‐MCI, anxiety associated with less underreport in both participants (AD: 13.1% vs 22.0%, p<0.0001; Va: 15.91% vs. 31.2%, p = 0.0071) and informants (AD: 10.8% vs. 25.5%, p<0.0001; Va: 15.9% vs. 37.4%, p = 0.0002). Underreport was similarly lowered with depression in participants (AD: 14.7% vs 21.4%, p<0.0001; Va: 15.1% vs 28.3%, p = 0.0146) and informants (AD: 11.5% vs 25.2%, p<0.0001; Va: 17.4% vs. 36.8%, p = 0.0008).ConclusionPersons with MCI and who have likely vascular presentations, or who are female, Black/African American, or have lower education are at increased risk for self‐ and/or informant‐based underreport of memory loss. Affective symptoms appear to increase the likelihood of correctly reporting memory loss. These factors may be particularly important in influencing interview‐based MCI detection and would suggest extra vigilance in persons at‐risk for self‐ or informant‐based misreport.

The impact of inflammation on plasma biomarkers of Alzheimer’s Disease

AbstractBackgroundPlasma biomarkers of Alzheimer’s disease have been proposed as less expensive, less invasive and readily scalable biomarkers for use as diagnostic biomarkers, predictors of risk and progression and inclusion criteria for clinical trials. Our previous work has shown that medical comorbities such as dyslipidemia, diabetes, kidney disease and hypertension can impact the levels of these biomarkers and there are ethnic differences in this relationship. The current study extended this work by investigating the effect of inflammation on levels of plasma biomarkers of amyloid, tau and neurodegeneration in an ethnically diverse cohort.MethodData from 651 cognitively unimpaired non‐Hispanic White and 646 cognitively unimpaired Mexican American participants from the Health & Aging Brain Study‐ Health Disparities study were analyzed. Plasma markers of Aβ40, Aβ42, total tau and NfL were assayed using the ultrasensitive Simoa (single‐molecule array) technology. The relationship of peripheral inflammatory biomarkers (IL‐6, IL‐10, TNFα & CRP) to each of the AD plasma biomarkers was analyzed using partial correlation controlling for age, sex and APOE4 positivity.ResultHigher levels of Aβ40, Aβ42, total tau and NfL were associated with elevated IL‐6, IL‐10 and TNFα for both ethnic groups. CRP was not significantly associated with any of the AD biomarkers for either group. Although the Mexican American participants had significantly lower Aβ40 (p = .000) and higher total tau (p = .000) than non‐Hispanic White participants, the two groups did not differ significantly on the level of any of the inflammatory markers.ConclusionThe level of plasma AD biomarkers is influenced by the presence of peripheral inflammatory cytokines. CRP a non‐specific acute phase marker of inflammation is not related to plasma AD biomarkers in cognitively unimpaired older adults. Ethnicity in this bi‐ethnic study was not a factor in this relationship. Additional research investigating medical co‐morbidities as a factor in the inflammation‐AD plasma biomarker relationship is needed. As with medical co‐morbidities the level of inflammation may affect the interpretation and application of the plasma AD biomarkers in this study.

The role of intraminority relations in perceptions of cultural appropriation.

Adopting the customs of outgroup cultures (e.g., cultural appropriation) is controversial. Across six experiments, we examined perceptions of cultural appropriation from the perspective of Black Americans (N = 2,069), particularly focusing on the identity of the appropriator and its implications for theoretical understanding of appropriation. Participants expressed more negative emotion and considered appropriation of their cultural practices less acceptable than comparable behaviors that were not appropriative (Studies A1-A3). However, participants perceived White appropriators more negatively than Latine (but not Asian) appropriators, ultimately suggesting that negative perceptions of appropriation do not merely stem from concerns about preserving rigid ingroup-outgroup boundaries. We originally predicted that shared oppression experiences would be key to different responses to appropriation. Instead, our findings most strongly supported the notion that differences in judgments of appropriation by different cultural groups are primarily tied to perceptions of similarity (or difference) across groups-rather than oppression similarity itself. For example, when Asian Americans and Black Americans were framed as part of a common ingroup, Black American participants expressed less negativity toward Asian Americans' appropriative acts. These findings suggest that perceived similarities or shared experiences shape the likelihood of welcoming outgroups into one's cultural practices. More broadly, they suggest that the construction of identities is key to perceptions of appropriation, even independent from the way in which people appropriate. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Associations between depressive symptoms, glial fibrillary acid protein, and cognitive decline in a population‐based study

AbstractBackgroundDepressive symptoms are a known risk factor for dementia, and higher concentrations of glial fibrillary acid protein (GFAP) is associated with a faster rate of cognitive decline. However, it is unknown whether the two risk factors increase the risk of cognitive decline additively.MethodThis investigation is based on 1,169 participants from the Chicago Health and Aging Project (CHAP), a population‐based cohort study, who completed at least two cognitive performance assessments with baseline serum GFAP measurement. Depressive symptoms were determined utilizing a modified version of the Center for Epidemiologic Studies‐Depression Scale. A composite global cognitive function score was calculated using cognitive performance testing. Linear mixed effects regression models were conducted to examine the association of depressive symptoms and GFAP concentrations on baseline global cognitive function and the annual rate of cognitive decline. Regression models also adjusted for age, race, sex, education, chronic medical conditions, and their interactions with time.ResultOur study sample consisted of 60% African American participants and 63% female participants and had an average age of 77 (SD = 6.0) years. In our sample, 21% had few depressive symptoms (0‐2), and the remaining 79% had more depressive symptoms (3‐10). We found a statistically significant interaction between depressive symptoms and GFAP (β = ‐111 (SE = .039), p = .005) on global cognitive function. Stratified analysis showed that the associations between the log of GFAP and global cognitive function were statistically significant for participants with few (0‐2) depressive symptoms (β = ‐.223 (SE = .087), p = .010) and more (3‐10) depressive symptoms (β = ‐.781 (SE = .198), p = .000). Statistically significant associations were also observed between the log of GFAP and global cognitive decline for participants with few (β = ‐.069 (SE = .017), p = .000) and more (β = ‐.100 (SE = .040), p = .012) depressive symptoms.ConclusionOur findings show additive effects of depressive symptoms in the association between the log of GFAP with baseline global cognitive function and rate of cognitive decline. Prevention and treatment of depression in old age can significantly impact the risk of progressive cognitive decline, especially among individuals with higher concentrations of GFAP.

Detection of Mild Cognitive Impairment Using Convergent Cross‐Mapping Based on Resting‐State EEG Signals among Community‐Dwelling African American Participants

AbstractBackgroundAccurate and early detection of mild cognitive impairment (MCI) is critical for interventions to promote cognitive resiliency. EEG‐based detection of MCI is attracting considerable attention from the research community due to its accessibility, affordability and increasing accuracy.MethodOur research is based on resting‐state EEG (64‐channel, eye‐closed). The current dataset includes 90 consensus‐diagnosed, community‐dwelling African Americans (ages 60‐90 years, 51 normal cognition, NC; 39 Mild Cognitive Impairment, MCI) recruited through the Wayne State Institute of Gerontology Healthy Black Elders Center and the Michigan Alzheimer’s Disease Research Center, all with subjective cognitive complaints.From an information‐theoretic perspective, causality measures the effective connectivity or directed information transfer from one brain region to another. Convergent cross‐mapping has attracted considerable attention recently since it was proven to be able to detect causal coupling in both deterministic and random settings. In this research, we propose to develop an EEG‐based MCI detection model by exploiting cross‐mapping causality analysis.We first derived the current source density (CSD) from EEG signals and performed cross‐mapping based causality analysis between the CSD signals of all the possible pairs across the selected EEG regions of interest. We then conducted joint time‐frequency‐spatial analysis on the cross‐mapping causation and selected features which are likely to reflect the differences between NC and MCI. The selected features were then fed into a machine‐learning algorithm for discrimination of NC and MCI.ResultBy tuning the observing window size and the number of features used, we obtained a series of different configurations of the discrimination model between NC and MCI, each with its own estimation accuracy. The overall result is a combined output of the model under different configurations, which improve the reliability and sensitivity of the discrimination model. For the 90‐sample dataset we are working with, the leave‐one‐out cross‐validation accuracy of our model is 97.78%.ConclusionOur analysis indicates that, potentially, EEG‐based cross‐mapping causality analysis may serve as a promising assessment tool for early detection of people at risk of MCI and dementia, even when just relying on resting state EEG.Funding: NSF‐2032709/Li; NIH‐1R21AG046637‐01A1/Kavcic and NIH‐1R01AG054484‐01A1/Kavcic; NIH‐ P30AG05376004/Paulson

Racial and Ethnic Differences in the Risk of Dementia under Hypothetical Blood‐Pressure‐Lowering Interventions: The Multi‐Ethnic Study of Atherosclerosis

AbstractBackgroundBlack and Latino people have a higher risk of Alzheimer’s disease and related dementias (ADRD) as well as ADRD comorbidities, including hypertension. Since hypertension is perhaps the most important modifiable vascular risk factor for the development of ADRD, we aimed to study whether sustained hypothetical interventions to reduce systolic blood pressure (SBP) would differentially change ADRD risk across racial/ethnic groups.MethodWe used 19 years of follow‐up data from the Multi‐Ethnic Study of Atherosclerosis. The study population included 6806 individuals between 44 and 84 years old, free of clinically recognized CVD and dementia diagnosis at baseline. We defined two sustained interventions on SBP based on continually maintaining SBP below (1) 120 mmHg and (2) 140 mmHg. We considered incident dementia diagnoses as outcome. We applied the parametric g‐formula to adjust for baseline and time‐varying confounding. Baseline covariates included sex, age, education level, income, health insurance, and clinical variables (e.g. diabetes). Time‐varying covariates included SBP, total cholesterol, low‐density lipoprotein, body mass index, health behaviors (e.g. alcohol use), myocardial infarction, stroke, and coronary heart disease diagnosis.ResultMean age was 62.1 (SD = 10.2), 52.9% were female, 38.5% (2617) self‐identified as White, 27.8% (1890) as Black, 21.9% (1495) as Latino and 11.8% (804) as Chinese American. The observed 19‐year risk for dementia was 8.6%. Compared to no specified intervention, maintaining SBP below 120 mmHg was associated with an overall dementia risk reduction of about 5% in the full study population (risk ratio (RR): 0.95, 95%CI: 0.88, 1.02). The estimated RRs for this same comparison were: 0.95(95%CI: 0.87, 1.03) for White participants, 0.93 for Black participants (95%CI: 0.81,1.06), 0.92 for Latino participants (95%CI:0.81, 1.09), and 1.15 for Chinese American participants (95%CI: 0.74,1.63) (Table 1). Of note, the proportion of participants who would have had to have been intervened differed by race/ethnicity, where 92% Black participants, 82% of White and Chinese American, and 86% of Latino participants would have had to have been intervened to maintain SBP below 120 mmHg.ConclusionOur results highlight a heterogenous effect that should be considered for implementation of blood pressure control strategies.

Dental Caries, Race and Incident Ischemic Stroke, Coronary Heart Disease, and Death.

Dental caries is a highly prevalent disease worldwide. In the United States, untreated dental caries is present in >1 in 5 adults. The objective of this study was to determine the relationship between dental caries and incident ischemic stroke, coronary heart disease (CHD) events, and death. The dental cohort (n=6351) of the ARIC study (Atherosclerosis Risk in Communities) was followed for incident ischemic stroke, CHD event, and all-cause mortality. Of all the participants at visit 4 (n=11 656), those who were unable to go through dental examination, or with prevalent ischemic stroke and CHD events, were excluded. The full-mouth dental examination was conducted at visit 4 (1996-1998), assessing dental caries. The dose response of decayed, missing, and filled surfaces due to caries was assessed and related to the outcome. Outcomes were assessed through the end of 2019. Additionally, the effect of regular dental care utilization on dental caries was evaluated. Participants with ≥1 dental caries had an increased risk of stroke (adjusted hazard ratio [HR], 1.40 [95% CI, 1.10-1.79]) and death (adjusted HR, 1.13 [95% CI, 1.01-1.26]) but not for CHD events (adjusted HR, 1.13 [95% CI, 0.93-1.37]). The association of dental caries and ischemic incident stroke was significantly higher in the African American population compared with the White subgroup (interaction term P=0.0001). Increasing decayed, missing, and filled surfaces were significantly associated with stroke (adjusted HR, 1.006 [95% CI, 1.001-1.011]) and death (adjusted HR, 1.003 [95% CI, 1.001-1.005]) but not CHD (adjusted HR, 1.002 [95% CI, 1.000-1.005]). Regular dental care utilization lowered (adjusted odds ratio, 0.19 [95% CI, 0.16-0.22]; P<0.001) the chance of caries. Among the cohort, dental caries was independently associated with the risk of ischemic stroke and death, with the effect higher in African American participants. Regular dental care utilization was associated with a lower chance of caries, emphasizing its relevance in the prevention of these events.

Research Globally, Learn Globally: An Innovative Course-Based Research Project Through Collaborative Online International Learning (COIL) Among Nutrition Students From American and Mexican Universities

The current article describes a 12-week course-based research project through Collaborative Online International Learning (COIL) among nutrition students from American and Mexican universities. Students were divided into small research teams, developed questionnaires, and conducted online surveys with college students in their home institutions. After a data collection period, each research team analyzed data and compared results between American and Mexican participants. Based on their study results, each research team developed a proposed 6-month nutrition intervention project for college students. Post-COIL project survey results demonstrate that students rated high in the areas of overall COIL experience, the duration and time of interaction in the COIL project, technologies, interaction with peers and professors, global and cultural competency, and overall satisfaction of the project. This research also highlights the importance of a course-based research project in student critical thinking skills and science literacy. Future research is needed to effectively evaluate the synergistic effects of COIL and a course-based research project on student learning across the globe.

The influence of musical parameters and subjective musical ratings on perceptions of culture

Recent research suggests that music can affect evaluations of other groups and cultures. However, little is known about the objective and subjective musical parameters that influence these evaluations. We aimed to fill this gap through two studies. Study 1 collected responses from 52 American participants who listened to 30 folk-song melodies from different parts of the world. Linear mixed-effects models tested the influence of objective and subjective musical parameters of these melodies on evaluations of the cultures from which they originated. Musical parameters consistently predicted cultural evaluations. The most prominent musical parameter was musical velocity, a measure of number of pitch onsets, predicting more cultural warmth, competence and evolvedness and less cultural threat. Next, with a sample of 212 American participants, Study 2 used a within-subjects experiment to alter the tempo and dissonance for a subset of six melody excerpts from Study 1, testing for causal effects. Linear mixed-effects models revealed that both dissonance and slow tempo predicted more negative cultural evaluations. Together, both studies demonstrate how musical parameters can influence cultural perceptions. Avenues for future research are discussed.

“We usually see a lot of delay in terms of coming for or seeking care”: an expert consultation on COVID testing and care pathways in seven low- and middle-income countries

BackgroundRapid diagnostic testing may support improved treatment of COVID patients. Understanding COVID testing and care pathways is important for assessing the impact and cost-effectiveness of testing in the real world, yet there is limited information on these pathways in low-and-middle income countries (LMICs). We therefore undertook an expert consultation to better understand testing policies and practices, clinical screening, the profile of patients seeking testing or care, linkage to care after testing, treatment, lessons learnt and expected changes in 2023.MethodsWe organized a qualitative consultation with ten experts from seven LMICs (India, Indonesia, Malawi, Nigeria, Peru, South Africa, and Zimbabwe) identified through purposive sampling. We conducted structured interviews during six regional consultations, and undertook a thematic analysis of responses.ResultsParticipants reported that, after initial efforts to scale-up testing, the policy priority given to COVID testing has declined. Comorbidities putting patients at heightened risk (e.g., diabetes) mainly relied on self-identification. The decision to test following clinical screening was highly context-/location-specific, often dictated by local epidemiology and test availability. When rapid diagnostic tests were available, public sector healthcare providers tended to rely on them for diagnosis (alongside PCR for Asian/Latin American participants), while private sector providers predominantly used polymerase chain reaction (PCR) tests. Positive test results were generally taken at ‘face value’ by clinicians, although negative tests with a high index of suspicion may be confirmed with PCR. However, even with a positive result, patients were not always linked to care in a timely manner because of reluctance to receiving care or delays in returning to care centres upon clinical deterioration. Countries often lacked multiple components of the range of therapeutics advised in WHO guidelines: notably so for oral antivirals designed for high-risk mild patients. Severely ill patients mostly received corticosteroids and, in higher-resourced settings, tocilizumab.ConclusionsTesting does not always prompt enhanced care, due to reluctance on the part of patients and limited therapeutic availability within clinical settings. Any analysis of the impact or cost-effectiveness of testing policies post pandemic needs to either consider investment in optimal treatment pathways or constrain estimates of benefits based on actual practice.

Changes in Body Mass Index and Incident Mild Cognitive Impairment Among African American Older Adults.

Previous research suggests a decline in body mass index (BMI) among older adults is associated with negative health outcomes, including mild cognitive impairment (MCI) and incident dementia. However, no studies have examined the effects of education or developing MCI on BMI trajectories over time. The purpose of this investigation was to characterize trajectories of change in BMI among older adults who develop MCI. Participants were from the Minority Aging Research Study (MARS), a longitudinal cohort study of cognitive decline and Alzheimer's disease in older African Americans living in the greater Chicago, Illinois, area. The study included annual clinical evaluations of cognitive status, as well as measurements of height and weight for BMI calculation. Older African American participants without cognitive impairment at baseline were included in the present analysis (N = 436, 78% women, mean baseline age = 72 [SD = 5.7], mean education = 15 [SD = 3.5]). In piecewise linear mixed-effects models that included a random intercept and 2 random slopes, BMI declined over time (B = -0.20, SE = 0.02, p < .001), with a faster decline after MCI diagnosis (additional decline, B = -0.15, SE = 0.06, p = .019). Older age was associated with lower baseline BMI (B = -0.19, SE = 0.05, p < .001), as was higher education (B = -0.34, SE = 0.09, p < .001). Further, higher education was associated with a slower decline in BMI before MCI (B = 0.02, SE = 0.006, p = .001), but a faster decline after MCI (B = -0.06, SE = 0.022, p = .003). These results suggest an accelerated decline in BMI following an MCI diagnosis, with higher education related to an even faster BMI decline.

Cultural variation inneural responses to social but not monetary reward outcomes.

European Americans view high-intensity, open-mouthed 'excited' smiles more positively than Chinese because they value excitement and other high arousal positive states more. This difference is supported by reward-related neural activity, with European Americans showing greater Nucleus Accumbens (NAcc) activity to excited (vs calm) smiles than Chinese. But do these cultural differences generalize to all rewards, and are they related to real-world social behavior? European American (N = 26) and Chinese (N = 27) participants completed social and monetary incentive delay tasks that distinguished between the anticipation and receipt (outcome) of social and monetary rewards while undergoing Functional Magnetic Resonance Imaging (FMRI). The groups did not differ in NAcc activity when anticipating social or monetary rewards. However, as predicted, European Americans showed greater NAcc activity than Chinese when viewing excited smiles during outcome (the receipt of social reward). No cultural differences emerged when participants received monetary outcomes. Individuals who showed increased NAcc activity to excited smiles during outcome had friends with more intense smiles on social media. These findings suggest that culture plays a specific role in modulating reward-related neural responses to excited smiles during outcome, which are associated with real-world relationships.

Americans weigh an attended emotion more than Koreans in overall mood judgments

Face ensemble coding is the perceptual ability to create a quick and overall impression of a group of faces, triggering social and behavioral motivations towards other people (approaching friendly people or avoiding an angry mob). Cultural differences in this ability have been reported, such that Easterners are better at face ensemble coding than Westerners are. The underlying mechanism has been attributed to differences in processing styles, with Easterners allocating attention globally, and Westerners focusing on local parts. However, the remaining question is how such default attention mode is influenced by salient information during ensemble perception. We created visual displays that resembled a real-world social setting in which one individual in a crowd of different faces drew the viewer's attention while the viewer judged the overall emotion of the crowd. In each trial, one face in the crowd was highlighted by a salient cue, capturing spatial attention before the participants viewed the entire group. American participants’ judgment of group emotion more strongly weighed the attended individual face than Korean participants, suggesting a greater influence of local information on global perception. Our results showed that different attentional modes between cultural groups modulate social-emotional processing underlying people’s perceptions and attributions.