Mean Years Of Education Research Articles

Disparities by Race and Ethnicity Among Adults Recruited for a Preclinical Alzheimer Disease Trial

Underrepresentation of many racial/ethnic groups in Alzheimer disease (AD) clinical trials limits generalizability of results and hinders opportunities to examine potential effect modification of candidate treatments. To examine racial and ethnic differences in recruitment methods and trial eligibility in a multisite preclinical AD trial. This cross-sectional study analyzed screening data from the Anti-Amyloid in Asymptomatic AD study, collected from April 2014 to December 2017. Participants were categorized into 5 mutually exclusive ethnic/racial groups (ie, Hispanic, Black, White, Asian, and other) using participant self-report. Data were analyzed from May through December 2020 and included 5945 cognitively unimpaired older adults between the ages of 65 and 85 years screened at North American study sites. Primary outcomes included recruitment sources, study eligibility, and ineligibility reasons. To assess the probability of trial eligibility, regression analyses were performed for the likelihood of being eligible after the first screening visit involving clinical and cognitive assessments. Screening data were included for 5945 participants at North American sites (mean [SD] age, 71.7 [4.9] years; 3524 women [59.3%]; 5107 White [85.9%], 323 Black [5.4%], 261 Hispanic [4.4%], 112 Asian [1.9%], and 142 [2.4%] who reported race or ethnicity as other). Recruitment sources differed by race and ethnicity. While White participants were recruited through a variety of sources, site local recruitment efforts resulted in the majority of Black (218 [69.2%]), Hispanic (154 [59.7%]), and Asian (61 [55.5%]) participants. Participants from underrepresented groups had lower mean years of education (eg, mean [SD] years: Hispanic participants, 15.5 [3.2] years vs White participants, 16.7 [2.8] years) and more frequently were women (226 [70.0%] Black participants vs 1364 [58.5%] White participants), were unmarried (184 [56.9%] Black participants vs 1364 [26.7%] White participants), and had nonspousal study partners (237 [73.4%] Black participants vs 2147 [42.0%] White participants). They were more frequently excluded for failure to meet cognitive inclusion criteria (eg, screen failures by specific inclusion criteria: 147 [45.5%] Black participants vs 1338 [26.2%] White participants). Compared with White participants, Black (odds ratio [OR], 0.43; 95% CI, 0.34-0.54; P < .001), Hispanic (OR, 0.53; 95% CI, 0.41-0.69; P < .001), and Asian participants (OR, 0.56; 95% CI, 0.38-0.82; P = .003) were less likely to be eligible after screening visit 1. Racial/ethnic groups differed in sources of recruitment, reasons for screen failure, and overall probability of eligibility in a preclinical AD trial. These results highlight the need for improved recruitment strategies and careful consideration of eligibility criteria when planning preclinical AD clinical trials.

Clinical profile of children in conflict with law residing in an Observation cum Juvenile Justice Home

Introduction: Juvenile delinquency is emerging as a matter of great concern in India; however, there is limited data on clinical profile of Juveniles in conflict from law from India. Methodology: It was a cross sectional study. Data was collected from 156 inmates of observation-cum-special home in Chandigarh using a semi structured format. Results: Mean age of the participants was 15.6 (±1.9) years of age with 6.8 (±2.2, range 2 to 12) years as mean years of education. There was history of past alleged act in 25% cases. Birth and developmental problems were found to be present in about one third inmates. Behavioral problems were reported to be present in as high as 82% inmates with about half of them reporting from than one problem. Substance use was present in 57% subjects and psychological issues like anxiety and sadness in 26% inmates. Psychosocial issues like violence at home and neighborhood were reported by 30% and 38% inmates respectively. Conclusion: Juveniles in conflict with law face many issues like behavioral problems, psychological issues, substance abuse, violence and neglect. Identification and management of these problems is necessary for reformation of juveniles and desistance from criminal behavior.

Characterization of HIV-Associated Neurocognitive Impairment in Middle-Aged and Older Persons With HIV in Lima, Peru.

Background: With widespread use of antiretroviral medications, people living with HIV (PWH) are living longer worldwide, increasing their risk of developing neurocognitive impairment (NCI). The proportion of Peruvians over age 60 is expected to increase to 25% of the population by 2050, including PWH. Therefore, the problem of aging and NCI, especially in the setting of HIV infection, is uniquely pressing. We sought to study the rates of and risk factors associated with NCI among middle-aged and older PWH in Lima, Peru.Materials and Methods: Sociodemographic, medical (infectious and non-infectious), and psychiatric comorbidity and laboratory data were collected. We administered a brief neuropsychological battery evaluating seven cognitive domains affected in HIV-associated NCI and a depression screening. Cognitive test raw scores were converted to T-scores that were demographically adjusted. Descriptive statistics were performed together with regression (unadjusted and adjusted) analyses to determine potential risk factors for NCI among PWH.Results: This was a cross-sectional study in which 144 PWH aged ≥40 years attending a large HIV clinic in Lima, Peru, were recruited from September 2019 to March 2020. Mean age was 51.6 ± 7.7 years, and mean years of education were 14.0 ± 3.1 with 15% females. Median [interquartile range (IQR)] current CD4 and nadir CD4 were 554 (371, 723) and 179 (83, 291), respectively, and 10% currently had AIDS. The prevalence of NCI was 28.5%, and many demonstrated difficulty with attention and working memory (70%). One-quarter of PWH had mild depression or worse on Patient Health Questionnaire 9 (PHQ-9 ≥ 5). In bivariate analyses, neither a depression history nor a higher PHQ-9 score correlated with NCI. No other non-communicable medical or psychiatric comorbidity nor HIV characteristic was predictive of NCI. Having a positive lifetime history of hepatitis B infection, pulmonary tuberculosis, or syphilis increased risk of NCI (PR 1.72; 95% CI 1.04–2.86) in unadjusted analyses, but not in adjusted analyses.Conclusions: NCI among older Peruvians with HIV was found to be highly prevalent with levels consistent with prior reports of HIV-associated NCI worldwide. Common latent HIV-associated co-infections, including latent syphilis, hepatitis B infection, or pulmonary tuberculosis, may increase the risk of NCI among middle-aged and older PWH in Peru.

Incidence of HIV in Sub-Saharan Africa, 2000\u20132015: The Interplay Between Social Determinants and Behavioral Risk Factors

HIV incidence in sub-Saharan Africa declined substantially between 2000 and 2015. In this analysis, we consider the relative associations of nine structural and individual determinants with this decline. A linear mixed effects model of logged HIV incidence rates versus determinants was used. The data were from mathematical modelling as part of the 2019 Global Burden of Disease Study in 43 sub-Saharan African countries. We used forwards selection to determine a single final model of HIV incidence rate. The association of economic variables and HIV knowledge with incidence was found to be driven by education, while ART coverage had the largest impact on other determinants’ coefficients. In the final model, education years per capita contributed the most to explaining variation in HIV incidence rates; a 1-year increase in mean education years was associated with a 0.39 (− 0.56; − 0.2, t = − 4.48 p < 0.01) % decline in incidence rate while a unit increase in ART coverage was associated with a 0.81 (− 1.34; − 0.28, t = − 3.01, p < 0.01) % decline in incidence rate.

Development and psychometric evaluation of the Test of Practical Judgment alternate form (Form B)

The Test of Practical Judgment (TOP-J) is increasingly used by neuropsychologists to measure everyday judgment ability in older adulthood. In the present study, we developed an alternate TOP-J Form B, which may be used to reduce practice effects for repeat assessment situations or in place of the original Form A. In developing the measure, special attention was given to limiting cultural bias and making items similar in content and difficulty to Form A. The TOP-J Form B was piloted in a clinical geriatric sample (N = 77) in the Midwestern U.S. Subsequently, older adults (N = 130) were recruited from several boroughs of New York City and surrounding areas (mean age = 77; mean years of education = 16; 69% female; 28% Black/African-American, 11% Hispanic). In this validation sample, both the 9-item and 15-item versions of the TOP-J Form B showed strong psychometric properties, including good unidimensional model fit in confirmatory factor analysis, preliminary convergent/divergent and criterion validity evidence, and strong inter-rater reliability, ICC (2, 1) = .93. The means and standard deviations for the TOP-J Form A and Form B were highly similar, particularly for the 9-item forms in which there was less than a one-point mean difference. Preliminary normative data for cognitively intact participants (n = 73) were established. We present means and standard deviations that will allow for the calculation of z scores as Form B scores were normally distributed. The newly developed TOP-J Form B should be useful in diverse clinical and research settings.

REM Sleep Behavior Disorder in Parkinson's Disease: Change in Cognitive, Psychiatric, and Functional Outcomes from Baseline to 16-47-Month Follow-Up.

Rapid Eye Movement Sleep Behavior Disorder (RBD) is common in Parkinson's Disease (PD) and is associated with cognitive impairment; however, the majority of the evidence on the impact of RBD on multidomain cognitive batteries in PD is cross-sectional. This study evaluated the longitudinal impact of probable RBD (pRBD) on cognitive, psychiatric, and functional outcomes in people with PD. Case-control study. A total of 65 people with PD completed the study protocol at baseline and 16-to-47-month follow-up. Participants were classified as pRBD+ (n = 25) or pRBD- (n = 40) based on an established cutoff of 6 on the RBD Sleep Questionnaire (RBDSQ). Participants also completed a) comprehensive cognitive testing, b) self-report measures of depression, anxiety, and apathy, and c) performance-based and other-report forms of instrumental activities of daily living. Baseline mean age was 67.8 (SD = 8.1; range = 45-86) and baseline mean years of education was 16.4 (SD = 2.1; range = 12-20). The two groups did not differ on measured demographic characteristics. Baseline mean T-scores for cognitive tests were in the average range (46-55). Hierarchical linear models tested group differences in cognitive and functional decline from baseline to follow-up, controlling for appropriate demographic and psychiatric variables. Compared to the pRBD- group, pRBD+ participants showed greater decline in attention/working memory (r = -0.31; p = 0.01) and UPSA financial skills (r = -0.31; p = 0.01). No other group differences approached significance. RBD may differentially affect attention/working memory and financial abilities in PD. Results underscore the importance of regular RBD screening in older adults with PD in order to triage symptomatic patients to appropriate cognitive and medical interventions.

Gender Differences in a Sample of Egyptian University Students With Opioid Use Disorders Attributed to Tramadol

Background and Objective: Tramadol use is an overwhelming problem in Egypt. Males and females who use tramadol differ in their sociodemographic and clinical profiles. The aim of this study was to identify gender differences in tramadol use in students at Zagazig University, Egypt. Methods: A cross-sectional study included a total of 1135 undergraduate students, aged 17 to 34 years, from both sexes; males (n=674, 59.4%) and females (n=461, 40.6%), from 10 colleges in Zagazig University. Respondents were randomly selected to assess their tramadol use utilizing the drug use disorders identification test (DUDIT) and the drug use disorders identification test-extended (DUDIT-E). Results: Tramadol use was more prevalent in male than female students (19.7% vs. 2.4%). Both smoking and alcohol use were shared predictive factors for tramadol use in both sexes. The mean years of education and cannabis use predicted tramadol use in males, while only mean age predicted tramadol use in females. Among tramadol users, males were more likely than females to be smokers, polysubstance, and cannabis users, and to have a positive attitude toward tramadol use. Conclusions: Tramadol use was common among university students, with higher prevalence among males. Sex-related similarities and differences were present. Results can guide health policymakers to develop appropriate prevention and management strategies. Population-based longitudinal studies are warranted to explore the causal relationship between tramadol use and progression to other substances in both sexes.

Validity and reliability of “Cognitive Reserve Index Questionnaire” for the Turkish Population

BackgroundCognitive reserve (CR) is the ability to counteract brain damage through differential recruitment of brain networks. Besides, it has also been observed that lifetime intellectual enriching skills reduce the effect of disease burden on cognitive status. The Cognitive Reserve Index questionnaire (CRIq), which is a method for the quantitative measurement and comprehensive evaluation of the CR, that individuals have accumulated throughout their lifetimes. The present study aimed to adapt CRIq to the Turkish population. MethodsCRIq is a 20-item questionnaire consisting of 3 sub-scales (CRI-Education, CRI- Working Activity, CRI-Leisure Time). 271 females and 228 males, a total of 499 healthy volunteers participated in the study (mean age: 39.54±14.05, mean education years 13.14±4.84). Participants were evaluated with the “Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS)” and CRIq was applied. BICAMS was used to determine the validity of the CRIq. To determine the reliability, the questionnaire was applied again two weeks after the first application. Internal consistency and test-retest reliability were measured for reliability analysis. Independent sample t-test was conducted to observe the difference between genders. ResultsThe Cronbach alpha coefficient of the questionnaire was 0.78, and the reliability of the questionnaire was acceptable. The findings showed that inter-rater reliability was quite high (ICC:0.95, 95% CI=1.000, n=36). The correlation between the first and second application of the questionnaire was found to be acceptable for both the sub-scales and the whole questionnaire. The highest CRIq scores were shown for young adults in CRI-Education and CRI-LeisureTime, for the middle-aged in CRIq-WorkingActivity, no significant differences in total CRIq scores. The males scored significantly higher in CRIq total scores than females, but there was not a significant difference in CRI-LeisureTime between genders. ConclusionThe Turkish version of CRIq was found to be a valid and reliable method for evaluating cognitive reserve in healthy individuals.

Effects of a Motor Imagery Task on Functional Brain Network Community Structure in Older Adults: Data from the Brain Networks and Mobility Function (B-NET) Study.

Elucidating the neural correlates of mobility is critical given the increasing population of older adults and age-associated mobility disability. In the current study, we applied graph theory to cross-sectional data to characterize functional brain networks generated from functional magnetic resonance imaging data both at rest and during a motor imagery (MI) task. Our MI task is derived from the Mobility Assessment Tool–short form (MAT-sf), which predicts performance on a 400 m walk, and the Short Physical Performance Battery (SPPB). Participants (n = 157) were from the Brain Networks and Mobility (B-NET) Study (mean age = 76.1 ± 4.3; % female = 55.4; % African American = 8.3; mean years of education = 15.7 ± 2.5). We used community structure analyses to partition functional brain networks into communities, or subnetworks, of highly interconnected regions. Global brain network community structure decreased during the MI task when compared to the resting state. We also examined the community structure of the default mode network (DMN), sensorimotor network (SMN), and the dorsal attention network (DAN) across the study population. The DMN and SMN exhibited a task-driven decline in consistency across the group when comparing the MI task to the resting state. The DAN, however, displayed an increase in consistency during the MI task. To our knowledge, this is the first study to use graph theory and network community structure to characterize the effects of a MI task, such as the MAT-sf, on overall brain network organization in older adults.

The Five-Point Test: Normative data for middle-aged and elderly Spaniards

The Five-Point Test (5PT) is a neuropsychological tool for examining design or figural fluency. In this study, we aimed to provide normative data for the 5PT in Spain. Also, we aimed to compare the norms collected in our research with other normative studies from other populations to evaluate a potential cross-cultural application of 5PT. One hundred and ninety-two healthy subjects aged were enrolled. The mean age was 68.48 ± 9.68 years old (range 50–89), and mean years of education were 10.65 ± 5.22. There were 117 (60.9%) women. The overlapping interval strategy was used to maximize the sample size. Age- and education-adjusted scores were estimated using linear regression analysis. Intraclass correlation coefficient was used to calculate agreement with norms from other countries. Age and years of formal education showed moderate correlations with the scores, while the influence of sex was non-significant. Intraclass correlation coefficient (absolute agreement) between Spanish and German norms was 0.956 (95% confidence interval 0.906–0.978). Norms for unique designs at 1, 2, and 3 minutes are provided. Our study confirms the influence of age and education on design fluency and provides normative data for people older than 50 years old. We hypothesize that 5PT might be a useful test in cross-cultural settings.

Successful Aging Among Older Hispanics

Successful Aging has been defined as the absence of objective physical, cognitive, and social difficulties. More recently, self-rated successful aging (SRSA) has been recognized as an important outcome in its own right. The purpose of this study was to assess SRSA and its correlates among older Hispanics/Latinos. Seventy-four Hispanic/Latino adults age 50+ (31.9% primarily Spanish-speaking; 62.5% women, mean age=69.6±12.2, mean years of education=14.3±3.3) completed a measure of SRSA (scaled from 1 [lowest] to 10 [highest]), and self-report measures of hypothesized correlates, including culturally-relevant factors (language use, acculturation, fatalism, familism, perceived discrimination and frame of reference), as well as physical (perception of physical health and physical performance), cognitive (perception of cognitive problems), and psychosocial correlates (social functioning and resilience). Fifty-five percent of the participants reported SRSA of 8 or above (mean=7.99±, range: 3-10). Factors that were significantly associated with SRSA in univariable models, were entered into a multiple linear regression on SRSA. The final multivariable model explained 58.5% of the variance on SRSA (F(3,54)=27.8, p<.001) and showed that social functioning (B=.21; p=.031), resilience (B=.34; p=.002), and perception of physical health (scaled from 1 [highest] to 5 [lowest]), (B=-.43; p<.001) were independent predictors of SRSA. Culturally-relevant factors were not independently associated with SRSA in the multivariable model. While future longitudinal studies would be better suited to address causality, the present cross-sectional findings indicate psychosocial correlates of SRSA are as important as physical correlates among older Latinos. Future studies might examine whether culturally relevant factors modify these associations.

The Effects of Word Use and Personality Pathology on Depression and Suicidal Behavior in Older Adult Inpatients

Few prior studies have examined whether word use is associated with personality pathology or is linked to depression and suicidal behavior in older adult inpatients. In this study, older adult depressed inpatients (N = 51; age M= 67, SD = 8.9; mean years of education = 15.49, SD = 2.6) provided narratives about high and low points in life, health challenges, and interpersonal conflicts, and completed measures of personality pathology (NEO Five Factor Inventory, Inventory of Interpersonal Problems-Personality Disorders-25), depression (Geriatric Depression Scale), and suicidal ideation or behavior (SCID-5). The Linguistic Inquiry and Word Count (LIWC) text analysis tool was used to examine the frequency of self-referential, negative emotion, or absolutist word use. After adjusting for word count, age, and occupational and marital status, the use of self-referential words in narratives about high points of life predicted suicidal behavior (OR = .563, p = .002), but word use did not predict depression or personality pathology. In regression analyses, neuroticism and maladaptive interpersonal functioning predicted depression (ß = .417, p = .002; ß = .364, p = .009, respectively) but not suicidal behavior. Together, these preliminary findings suggest that in depressed older adult inpatients, depression and suicidal behavior may have qualitatively different predictors.

Functional neural correlates of the WAIS‐IV Block Design Test in older adult with mild cognitive impairment and Alzheimer’s disease dementia

AbstractBackgroundWhile the Wechsler Adult Intelligence Scale IV (WAIS‐IV) Block Design Test (BDT) has is widely used in both research and clinical setting as a measure of cognitive decline in the aging population, its functional neural substrates has not been clearly identified. Hence, the aim of the current study is to identify the functional neural correlates of the BDT in older adults with mild cognitive impairment (MCI) and Alzheimer’s disease (AD) dementia patients.MethodThe current study includes 213 cognitively impaired (135 MCI and 78 AD dementia) middle and old‐aged adults. All participants underwent comprehensive clinical and neuropsychological assessments and 18F‐fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) scans. The BDT performance was assessed using the Wechsler Adult intelligence scale‐IV Korean version. Voxel‐wise analyses were used to investigate the correlation between regional cerebral glucose metabolism and BDT performance. The same analyses were conducted on the subgroups categorized by clinical severity based on the Clinical Dementia Rating.ResultThe participants had a mean age of 73.1 (SD = 7.4) years, mean years of education of 9.8 (SD = 4.9), mean BDT score of 20.9 (SD = 9.1), and 67.1% were female. Significant positive correlations between the BDT performance and regional cerebral glucose metabolism were found bilaterally in the inferior parietal lobule and thalamus, the right superior temporal gyrus and left occipital precuneus.ConclusionThe findings indicated that BDT performance in MCI and AD dementia patients functionally relies on the brain regions known to be associated with motor and executive functions as well as visuospatial functions.

The FNAME yields equivalent results differentiating amnestic mild cognitive impairment from subjective cognitive decline and healthy controls in Mexico and the Netherlands

AbstractBackgroundThe Face‐Name Associative Memory Exam (FNAME) has been shown to detect memory deficits early in the spectrum of Alzheimer’s disease. In this study, we used a newly developed and further extended version of the FNAME, to evaluate the discriminating ability of this test in amnestic cognitive decline (aMCI), amnestic subjective cognitive decline (aSMD), and healthy controls (HC) in two different cultures, namely Mexico and the Netherlands.MethodParticipants were recruited in two sites, in Mexico (n= 69) and the Netherlands (n= 55). The mean age of the subjects was 69.3 ±6 years, and the mean years of education 15.5 ±5 years. In this study we used a newly extended version of the FNAME that was developed in both countries concurrently. A total of 42 aMCI, 43 aSCD, and 32 HC were assessed. We used a mixed model ANOVA, with the factors FNAME (7 subtests), GROUPS (aMCI, aSCD, HC), and the SITES (Mexico, the Netherlands) and post hoc t‐tests.ResultCrucially, a high interaction of FNAME x GROUPS was revealed. Subsequent t–tests showed that the FNAME was able to detect differences between aMCI and aSCD/HC. No significant differences were observed between aSCD and HC. The three‐way interaction’s effect was non‐significant (F= 1.7, p= 0.07). As expected, we found a significant main effect of FNAME (F= 228.4, p&lt; 0.001) demonstrating differences of demands of the subtests (e.g., recall, recognition), as well as a main effect of GROUPS (F= 2.1, p= 0.02). A two‐way interaction of FNAME x SITES was similarly revealed (F= 2.95, p&lt; 0.001), reflecting a difference regarding the performance between sites.ConclusionThis newly adapted and extended version of the FNAME test is able to differentiate aMCI subjects from aSCD and EC both in Mexico and in the Netherlands. Further studies should focus on better understanding the differences in performance in these countries.

Cognitive test norms and comparison to normal cognition and mild cognitive impairment: A population‐based study among community‐dwelling Filipinos

AbstractBackgroundClinicians use neuropsychological assessment to screen individuals for cognitive impairment since it more convenient and can detect impaired parts of cognition to provide early treatment. This study is aimed to differentiate the cognitive performance on the Alzheimer’s Disease Assessment Scale – Cognition (ADAS‐Cog) among the older adults with normal cognition and with MCI.MethodThe sample composed of 302 participants aged ≥60 years old who met the score of 25 in the Mini‐mental status examination (MMSE). Psychologists would then administer cognitive measures (ADAS‐Cog, logical memory recognition and delayed recall, verbal fluency on animals and vegetables, digit span forward and backward, digit symbol, and trailmaking A and B) upon meeting. ADAS‐Cog total and subtest scores were compared across the two groups. Receiver operating characteristics (ROC) analysis were performed and, sensitivity and specificity were calculated.ResultMost of the participants are female (81.8%) compared to males (17.9%). 64.2% has normal cognition while 35.8% of them have MCI. The mean age was 69.16 (±5.77) years and mean years of education of 9.11 (±3.57). The MCI group they have a cut‐off ADAS‐Cog score of 13.57(±5.49) (sensitivity= 0.63; specificity= 0.69) while the normal group have a score of 9.96 (±4.79). It also showed significant difference (t=5.971; p≤0.01) among the groups; domains showed a significant relationship i.e.: word list recall, naming, commands, ideational praxis, orientation, word list recognition (p≤0.01) and constructional praxis (p=0.015). Other cognitive measures besides digit symbol (t=1.578; p=0.116) are significant i.e. logical memory recognition and recall, verbal fluency on animals and vegetables, digit span forward and backward, and trailmaking A and B (p≤0.01).ConclusionThe ADAS‐Cog is inapplicable as a screening tool for MCI but specific for MCI diagnosis. There is significant difference found between functional impairment among MCI and normal cognition in the overall and subtests scores.

Abstract 14087: Psychosocial Determinants of Health Predict Depressive Symptoms and Anxiety in Rural Caregivers

Introduction: Caregivers have an 82% increased risk of cardiovascular disease (CVD) compared to non-caregivers. Depressive symptoms (DS) and anxiety increase CVD risk, and these are worse in rural dwellers. Knowing predictors of DS and anxiety in rural caregivers of patients with chronic illness is important to reduce CVD risk. Purpose: To identify predictors of DS and anxiety in rural caregivers at risk for CVD using a social determinants of health (SDH) model. Method: In this cross-sectional study we measured multiple SDH. These variables included sociodemographic (i.e., age, gender, race, marital status, health insurance, education, financial status), behavioral (i.e., smoking and body mass index [BMI]), and psychosocial (i.e., caregiver burden measured by the Zarit Burden Interview, perceived stress by the Cohen Perceived Stress Scale, and social support by the Medical Outcomes Study Social Support Survey) factors. The outcomes of DS were measured by the Patient Health Questionnaire-9 and anxiety by the Brief Symptom Inventory – Anxiety subscale. Data were analyzed using two separate multiple regression models, one for DS and one for anxiety. As depression and anxiety are often comorbid, they were considered predictors in the appropriate models. Results: In the 262 participants (mean age 53±13, 78% female, 96% Caucasian, 70% were married), mean years of education were 14±2, 56.1% had enough money to make ends meet, and 55% had no insurance or Medicaid only. Significant predictors of worse DS were higher caregiver burden (β=0.05, p=0.004), higher perceived stress (β=2.04, p=0.001), and higher anxiety (β=3.79, p= &lt;0.001). Predictors of worse anxiety, were younger age (β=-0.006, p=0.03), higher caregiver burden (β=0.006, p=0.009), lower social support (β=-0.004, p=0.05), and higher DS (β=0.08, p=&lt;0.001). Conclusion: Predictors of DS and anxiety in these rural caregivers were psychosocial variables. Caregiver CVD Interventions could be optimized by including stress management, education about the psychological effects of caregiving, and social support components. Future research is needed on the role of DS and anxiety in CVD to better support rural caregivers at highest risk.

324 - Twelve-month progress of online intervention to prevent cognitive decline: Maintain Your Brain

Authors:Henry Brodaty, Megan Heffernan, Gavin Andrews, Kaarin Anstey, Maria Fiatarone Singh, Louisa Jorm, Nicola Lautenschlager, Anthony Maeder, John McNeill, Perminder Sachdev, Michael Valenzuela, Maintain Your Brain Collaborative Team.Abstract:In the absence of disease modifying interventions for Alzheimer’s disease (AD) and other dementias there is an increased interest in dementia prevention. An issue for population-based lifestyle preventative approaches is scalability. An internet-based multicomponent Maintain Your Brain (MYB) randomised trial is currently underway.Invitations to participate in Maintain Your Brain were emailed or mailed to people aged 55-77 years from the 45 and Up study, a population-based cohort study of one in ten people aged 45 years and older (n = 267,000). To be enrolled into the study participants were required to have risk factors that made them eligible for at least one of the available modules. Modules were designed to address physical inactivity and health risks associated with inactivity (Physical Activity), adherence to a Mediterranean-type diet and health risks associated with poor nutrition (Nutrition), cognitive activity (Brain Training) and mental wellbeing (Peace of Mind).During recruitment 96,418 invitations were sent and 14,064 (14%) provided consent. Of those who completed baseline over 90% were eligible for at least two modules of the intervention. Overall, 6,236 (44%) were enrolled resulting in an overall recruitment rate of 6%, or 50% of those eligible at screening. The final sample was 64% female with a mean age of 64.9yrs (SD = 5.8, range 55-77 yrs) and mean years of education of 12.9yrs (SD = 3.0, range 2-22 yrs).Recruitment rates in MYB were comparable to other clinical trials targeting older people and who included online recruitment strategies. This is promising for the willingness of participants to engage with trials that use online rather than traditional in-person methods. Although the baseline withdrawal number (3%) remained stable after randomisation (4%), a further 25% of participants did not attempt any activities. These rates continued at the annual assessments when 4% withdrew, 31% completed no follow-up activities, 14% partially completed and 55% completed all.Online lifestyle interventions have capacity to reach broad segments of the 55-77 year old population, the majority of whom may benefit from support activities shown to be effective in reducing risk of cognitive decline and ultimately delay onset of dementia. The challenge with this new approach is encouraging continued engagement with the program over time.

Prevalence of musculoskeletal disorders and rheumatic diseases in an Argentinean indigenous Wichi community.

To estimate the prevalence of musculoskeletal disorders (MSK) and rheumatic diseases in an indigenous Wichi population in Argentina. This is a cross-sectional, community-based study using the Community-Oriented Program for the Control of Rheumatic Diseases (COPCORD) methodology in ≥ 18-year-old subjects. Validated surveys were conducted by trained interviewers. Subjects with MSK pain (positive cases) were evaluated by internists and rheumatologists for diagnosis and treatment. A total of 648 interviews were performed (90.4% of the census population). Mean age was 37.5years (SD 14.8), and 379 (58.5%) were female. The mean years of education was 7.0 (SD 3.7); 552 subjects (85.2%) were covered by the public health care system. A total of 216 (33.3%) subjects had MSK pain in the last 7days. Rheumatic disease prevalence was as follows: mechanical back pain (19.0%), rheumatic regional pain syndrome (5.2%), osteoarthritis (3.2%), rheumatoid arthritis (RA) (3.2%), inflammatory back pain (1.2%), undifferentiated arthritis (0.3%), Sjögren syndrome (0.15%), and fibromyalgia (0.15%). RA patients included 19 (90.5%) women and 9 (42.9%) with RA family history. One hundred percent were seropositive and 66.7% showed radiologic erosions. The mean of Disease Activity Score [DAS-28 (ESR)] at the time of diagnosis was 5.1 (SD 1.5) and the Health Assessment Questionnaire Disability Index (HAQ-DI) was 0.8 (SD 0.4). RA prevalence was 3.2%, one of the highest reported using the COPCORD methodology in indigenous and non-indigenous peoples in Latin America, with a high percentage of family cases. Pain and functional capacity were the variables allowing patients' early referral to a specialist. Key Points • The RA prevalence was 3.2%, one of the highest reported using COPCORD methodology in indigenous and non-indigenous peoples in Latin America. • The patients with RA had high percentage of familiar history of RA. • The pain and functional capacity were the variables associated with a diagnosis of any rheumatic disease and should be considered for early referral. • The mean of the delay in the diagnosis was 5.8years. In this community, the lack of the "migration health" phenomenon may be a social determinant that negatively impacts their health.

Regional differences in the global burden of age-related macular degeneration

BackgroundAge-related Macular Degeneration (AMD) is the leading cause of blindness. This study aims to analyze regional differences on the global burden of AMD and help direct related policy making.MethodsDisability-adjusted life years (DALY) data were collected from the Global Burden of Disease Study (GBD) 2017 to estimate the AMD burden. Mean education years, human development index (HDI) and Public Health Expenditure were extracted from the Human Development Report 2018, and latitude data were obtained from the Google Earth. These four factors were analyzed to see their importance in regional differences of AMD burden, using Kruskal-Wallis test, Dunn’s multiple comparisons test as well as regression analysis.ResultsGlobal age-standardized DALY rates have decreased since 2011. Based on the WHO region system, age-standardized DALY rates in African and Eastern Mediterranean region were significantly lower than those of other four regions. Linear regression analysis indicated that age-standardized DALY rates were inversely related to HDI and mean education years.ConclusionsThe age-standardized AMD burden had a decreasing tendency recently. Lower socioeconomic status and fewer education years were associated with higher AMD burden. The finding of this study may highlight the importance of national development and education on relieving AMD burden.

EVALUATING THE COGNITIVE EFFECTS OF EXERCISE PRIMING AND TRANSCRANIAL DIRECT CURRENT STIMULATION IN MILD COGNITIVE IMPAIRMENT AND MILD ALZHEIMER'S DISEASE: THE EXPRESS STUDY

Introduction Current pharmacotherapies for Alzheimer's disease (AD) are only modestly effective. There remains a critical need for treatments focused on early stages of the disease, when quality of life is still potentially excellent. While transcranial direct current stimulation (tDCS) has been shown to improve memory in some people with Mild Cognitive Impairment (MCI) and mild AD with minimal side-effects, recent evidence suggests that tDCS works better when brain circuits are active. As exercise increases brain activity using mechanisms that may support tDCS response, it may be an effective primer given before tDCS. This study assesses whether exercise priming with tDCS can help improve memory in MCI and mild AD, and whether this combination improves memory better than exercise or tDCS alone. Methods In this 5-week, randomized, blinded, sham-controlled clinical trial, eligible patients receive either 1) combined exercise and tDCS, 2) exercise and sham tDCS, or 3) exercise education only and tDCS. Repeated measures analyses of covariance will be conducted to evaluate between-group differences on cognitive outcomes over time. Results Blinded preliminary findings are presented (N=10, mean age=74±6?years, 50% female, mean years of education=16.2±2.5?years, mean Montreal Cognitive Assessment (MoCA) score= 21.5±2.9). There was a significant effect of treatment over time on Word Recall scores (F(2,7)=5.5, p=0.036). There were no statistically significant differences between groups over times on MoCA (F(2,7)=3.6, p=0.085) or Word Recognition scores (F(2,7)=4.5, p=0.054). Participants randomized to exercise education only with tDCS did not increase their exercise frequency or intensity according to the Leisure Time Exercise Questionnaire. Participants randomized to exercise priming were able to exercise at a moderate-intensity level for the last two weeks of the study when receiving combined tDCS or sham tDCS treatment. Overall adherence to study interventions was 98%. Conclusions Recruitment is ongoing (N=10/30). Updated results will be presented. This study may identify a new, feasible, non-invasive combination therapy that improves cognitive function in MCI and early stages of AD, therefore having major health implications. This research was funded by: Canadian Institutes of Health Research