Spanish-speaking Adults Research Articles

Influence of cognitive reserve on neuropsychological performance in subjective cognitive decline and mild cognitive impairment older adults

The analysis of the relationships between cognitive reserve and different cognitive domains has become a matter of interest since it can help us detect deviations from the typical ageing process. The main objective of our study was to analyse a structural equation model representing cognitive reserve’s relationships with three cognitive domains (episodic memory, working memory, and sentence comprehension) in older adults with subjective cognitive decline and mild cognitive impairment patients, in a cross-sectional study. A total of 266 Spanish-speaking older adults, from 65 to 80 years old, voluntarily participated in the study. The assessment protocol includes questionnaires as well as screening and domain-specific tests, providing relevant information for the classification of participants in the two groups previously mentioned (n1 = 150 and n2 = 116). The proposed model presented metric and configural invariance as well as stability across groups, since the indices reflecting goodness-of-fit reach acceptable values. Our hypotheses are partially confirmed since cognitive reserve strongly influences working memory and it does moderately in sentence comprehension in both groups, but it hardly influences episodic memory in the subjective cognitive decline group, while both are inversely associated in the patients’ group. Working memory could be considered as a mechanism through which cognitive reserve exerts its protector role on other cognitive domains: on sentence comprehension in both groups, and on episodic memory in the subjective cognitive decline group. However, in mild cognitive impairments patients, cognitive reserve does no longer influence episodic memory via working memory in a significant manner.

Culturally and Linguistically Informed Neuropsychological Evaluation Protocol for Primarily Spanish-Speaking Adults

The Latina(o)/Hispanic (L/H) population represents the largest and fastest-growing ethnic group in the United States. Migration patterns have evolved and greater diversity (i.e., country of origin) is evident, highlighting the ever-changing heterogeneity of this community and the need for the field of neuropsychology to ensure equitable care for linguistically and culturally diverse communities. This paper aims to provide a flexible protocol of neuropsychological instruments appropriate for primarily Spanish-speaking adults residing in the United States. Spanish measures were selected based on availability, translations/cultural modifications, accompanying normative data sets, and clinician experience/acumen. Bilingual/bicultural providers of neuropsychological services to Spanish speakers across the training spectrum working at U.S.-based medical centers implemented a multimodal approach (i.e., literature search, clinical practice parameters, and focus groups) in the development of a multi-domain primary protocol that includes core and supplemental measures that are appropriate for individuals with varying linguistic proficiency and sociocultural demographic characteristics. A multi-domain, evidence-based, flexible neuropsychological protocol is presented. Recommendations for test selection based on sociocultural demographic factors and examples of clinical assessment practices are provided via a case illustration. Most instruments included may be applied across cultural and regional backgrounds. Provision of neuropsychological services to primarily Spanish-speaking adults presents unique challenges. Existing Spanish measures and accompanying data rarely capture the heterogeneity of L/H individuals. Although Spanish has the largest number of neurocognitive instruments, relative to other languages, robust and representative norms continue to be scarce. Future studies should prioritize collecting normative data from educationally and geographically diverse samples.

Assessment of Symptom, Disability, and Financial Trajectories in Patients Hospitalized for COVID-19 at 6 Months

Individuals who survived COVID-19 often report persistent symptoms, disabilities, and financial consequences. However, national longitudinal estimates of symptom burden remain limited. To measure the incidence and changes over time in symptoms, disability, and financial status after COVID-19-related hospitalization. A national US multicenter prospective cohort study with 1-, 3-, and 6-month postdischarge visits was conducted at 44 sites participating in the National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Network's Biology and Longitudinal Epidemiology: COVID-19 Observational (BLUE CORAL) study. Participants included hospitalized English- or Spanish-speaking adults without severe prehospitalization disabilities or cognitive impairment. Participants were enrolled between August 24, 2020, and July 20, 2021, with follow-up occurring through March 30, 2022. Hospitalization for COVID-19 as identified with a positive SARS-CoV-2 molecular test. New or worsened cardiopulmonary symptoms, financial problems, functional impairments, perceived return to baseline health, and quality of life. Logistic regression was used to identify factors associated with new cardiopulmonary symptoms or financial problems at 6 months. A total of 825 adults (444 [54.0%] were male, and 379 [46.0%] were female) met eligibility criteria and completed at least 1 follow-up survey. Median age was 56 (IQR, 43-66) years; 253 (30.7%) participants were Hispanic, 145 (17.6%) were non-Hispanic Black, and 360 (43.6%) were non-Hispanic White. Symptoms, disabilities, and financial problems remained highly prevalent among hospitalization survivors at month 6. Rates increased between months 1 and 6 for cardiopulmonary symptoms (from 67.3% to 75.4%; P = .001) and fatigue (from 40.7% to 50.8%; P < .001). Decreases were noted over the same interval for prevalent financial problems (from 66.1% to 56.4%; P < .001) and functional limitations (from 55.3% to 47.3%; P = .004). Participants not reporting problems at month 1 often reported new symptoms (60.0%), financial problems (23.7%), disabilities (23.8%), or fatigue (41.4%) at month 6. The findings of this cohort study of people discharged after COVID-19 hospitalization suggest that recovery in symptoms, functional status, and fatigue was limited at 6 months, and some participants reported new problems 6 months after hospital discharge.

Randomized controlled trial of prepregnancy lifestyle intervention to reduce recurrence of gestational diabetes mellitus

Preconception lifestyle intervention holds potential for reducing gestational diabetes mellitus, but clinical trial data are lacking. This study aimed to determine the effects of a prepregnancy weight loss intervention on gestational diabetes mellitus recurrence in women with overweight/obesity and previous gestational diabetes mellitus. A 2-site, randomized controlled trial comparing a prepregnancy lifestyle intervention with educational control was conducted between December 2017 and February 2022. A total of 199 English- and Spanish-speaking adults with overweight/obesity and previous gestational diabetes mellitus were randomized to a 16-week prepregnancy lifestyle intervention with ongoing treatment until conception or educational control. The primary outcome was gestational diabetes mellitus recurrence. Analyses excluded 6 participants who conceived but did not have gestational diabetes mellitus ascertained by standard methods. In the 63 (33%) women who conceived and had gestational diabetes mellitus ascertained (Ns=38/102 [37%] intervention vs 25/91 [28.0%] control; P=.17), those in the intervention group had significantly greater weight loss at 16 weeks compared with controls (4.8 [3.4-6.0] vs 0.7 [-0.9 to 2.3] kg; P=.001) and a greater proportion lost ≥5% of body weight (50.0% [17/34] vs 13.6% [3/22]; P=.005). There was no significant difference in the incidence of gestational diabetes mellitus recurrence between the intervention (57.9% [ns=23/38]) and the control group (44.0% [ns=11/25]; odds ratio, 1.8 [0.59-5.8]). Independent of group, greater prepregnancy weight loss predicted 21% lower odds of gestational diabetes mellitus recurrence (odds ratio, 0.79 [0.66-0.94]; P=.008). A ≥5% weight loss before conception reduced the odds of gestational diabetes mellitus recurrence by 82% (odds ratio, 0.18 [0.04-0.88]; P=.03). Lifestyle intervention produced considerable prepregnancy weight loss but did not affect gestational diabetes mellitus rates. Given that the conception rate was 50% lower than expected, this study was underpowered.

Linear and Nonlinear Effect of Years of Schooling, Sex, and Age on the CERAD-MX and Complementary Tasks in a Mexican Sample: A Cross-Sectional Study.

Since evidence of adults' cognition decline is based on standardized testing, we developed regression-based continuous norms by linear regression (LR) and nonlinear quantile regression (NQR) with years of schooling (YoS), age, and sex as covariates on the Mexican adaptation of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD-MX) and complementary tasks. 392 healthy, Spanish-speaking Mexican adults (50.25% women) aged 18-59 completed the 15 CERAD-MX cognitive tasks and complementary tasks. We used raw scores and examined YoS-related effects considering sex and age as covariates. For the NQR, we used calibrated scores for sex and age. While LR represents one line across the performance, NQR differentiated several nonlinear performance bands by quantiles. LR showed positive relationships between YoS and cognitive performance with a funnel variance pattern. Therefore, this relationship is better represented with NQR than LR. A small, but significant, negative effect of age was found for this age range (18-59years). The band with fewer years of schooling (1-6) showed greater variability in the cognitive measures than those with more years of schooling (16-22). This study shows that NQR is useful for accurately positioning participants' performance relative to their peers. NQR accounts more than LR for the inconsistent variability of cognitive performance as a function of YoS by identifying the variability according to YoS (low, medium, high). Thus, NQR represents an appropriate way to construct norms for the cognitive performance of adults.

"Advocating for what we need": A CBPR approach to advance care planning in the Latinx older adult community.

Advance care planning (ACP) is low among Latinx older adults. We used community-based participatory research (CBPR) to identify ACP barriers/facilitators and design community-based ACP events. In partnership with community-based organizations, clinicians, and local government, we formed a Latinx Community Committee (n=13 community members). We then conducted 6 focus groups with Latinx-identifying, English or Spanish-speaking older adults (age ≥ 55), caregivers, and community leaders to assess ACP barriers/facilitators. We analyzed transcripts using thematic analysis and, based on these learnings, designed and implemented community-based ACP events. Using a validated survey, we assessed acceptability and pre-to-post-event ACP readiness (4-point scale; 4=most ready; 0.2 change considered meaningful) with Wilcoxon signed-rank tests. Focus groups included 10 Spanish-speaking older adults, 8 caregivers, and 10 community leaders. Themes highlighted the importance of ACP (e.g., means of advocacy), barriers (e.g., how to start conversations), and facilitators (e.g., trusted community spaces) in the Latinx community. Ninety-seven people attended 5 events targeting 3 Latinx populations (LGBTQI+, intergenerational, and older adults broadly). Overall pre-to-post-event ACP readiness increased (2.62 (SD 0.97) to 2.95 (SD 0.93); p=0.05). Readiness to document wishes increased significantly (2.44 (SD 1.0) to 2.98 (SD 0.95); p=0.003). Most reported being comfortable attending events (85%) and would recommend them to others (90%). This study describes a feasible, acceptable, and effective CBPR ACP intervention. Co-developed community events represent a promising approach to reducing disparities in ACP among the Latinx population.

Longitudinal decline in semantic versus letter fluency, but not their ratio, marks incident Alzheimer's disease in Latinx Spanish-speaking older individuals.

To compare longitudinal verbal fluency performance among Latinx Spanish speakers who develop Alzheimer's disease to those who do not develop dementia in absolute number of words produced on each task and their ratio to combine both scores. Participants included 833 Latinx Spanish-speaking older adults from a community-based prospective cohort in Manhattan. We performed growth curve modeling to investigate the trajectories of letter and semantic fluency, and their ratio (i.e., 'semantic index'), between individuals who developed Alzheimer's disease and those who did not (i.e., controls). The semantic index quantifies the proportion of words generated for semantic fluency in relation to the total verbal fluency performance. Letter fluency performance did not decline in controls; we observed a linear decline in those who developed Alzheimer's disease. Semantic fluency declined in both groups and showed an increased rate of change over time in the incident Alzheimer's disease group; in comparison, the control group had a linear and slower decline. There were no group differences in the longitudinal trajectory (intercept and slope) of the semantic index. A decline in letter fluency and a more rapid and accelerating decline over time in semantic fluency distinguished people who developed Alzheimer's disease from controls. Using the semantic index was not a superior marker of incident Alzheimer's disease compared to examining the two fluency scores individually. Results suggest the differential decline in verbal fluency tasks, when evaluated appropriately, may be useful for early identification of Alzheimer's disease in Latinx Spanish speakers, a historically understudied population.

Nuestra Recuperación [Our Recovery]: using photovoice to understand the factors that influence recovery in Latinx populations

BackgroundPhotovoice is a form of visual ethnography intended to engage impacted communities in research followed by action to ameliorate the injustices under study. Photovoice has increased in use, especially in collaboration with Latinx communities addressing health inequities. The Latinx population comprises nearly 18% of the overall United States population and according to the census is projected to reach just under 30% by 2060. This diverse panethnic community faces significant structural barriers in accessing services. Racism and the resulting marginalization, specifically, contributes to limited access to recovery services and treatment. Making meaningful advances in substance use disorder training, intervention and policy necessitates learning alongside the Latinx community.MethodsWe partnered with a Latinx serving integrated behavioral health and primary care setting in Boston Massachusetts to explore barriers and facilitators to recovery using photovoice. Spanish-speaking Latinx adults with a substance use disorder participated. The group met for three photovoice sessions over a six-week period. Together group members critically analyzed photographs using the SHOWeD method.ResultsFindings indicate a sense of purpose and meaning, security, faith and housing are important elements of recovery. The results illustrated the importance of sources of connection in maintaining sobriety. Through this photovoice project, Latinx Spanish speaking participants highlighted barriers and facilitators to their substance use disorder recovery which spanned individual, community, and structural levels.ConclusionsThe experiences and voices of the Latinx community are crucial to drive discussions that advance policy (e.g., housing stability and access), enhance providers’ understanding of Latinx Spanish-speakers' substance use disorder recovery, and inform culturally and linguistically appropriate services. This study demonstrated that photovoice is highly acceptable and feasible among Latinx clients receiving substance use disorder services. Visual images related to housing, faith, etc. communicate challenges, power structures, as well as hopes to policymakers at multiple levels (e.g., institution/ agency, state).

Comparison of Newest Vital Sign and Brief Health Literacy Screen scores in a large, urban Hispanic cohort

ObjectivePrior studies comparing subjective and objective health literacy measures have yielded inconsistent results. Our aim was to examine the concordance between Newest Vital Sign (NVS) and Brief Health Literacy Screen (BHLS) scores in a large cohort of English- and Spanish-speaking urban Hispanic adults. MethodsItem means, standard deviations, corrected-item total correlations, Cronbach’s alpha, and Spearman correlations and area under receiver operating characteristic (AUROC) curve analysis were used to compare NVS and BHLS items and total scores. ResultsN = 2988 (n = 1259 English; n = 1729 Spanish). Scores on both measures demonstrated good internal consistency (NVS: α = .843 English, .846 Spanish; BHLS: α = .797 English, .846 Spanish) but NVS items had high difficulty; more than half of respondents scored 0. Measures were only weakly correlated (rs = .21, p < .001, English; rs = .19, p < .001, Spanish). The AUROC curves were .606 (English) and .605 (Spanish) for discriminating the lowest NVS scoring category. ConclusionSubjective health literacy scores were poor predictors of objective scores. Objective scores demonstrated floor effects, precluding discrimination at low levels of the trait continuum. Practice implicationsSubjective health literacy scores may fail to identify individuals with limited health literacy.

Over-the-Counter Product-Apixaban Interactions: Patient Perspectives on Information-Seeking.

CONTEXT: Patients taking direct-acting oral anticoagulants (DOACs) may be at risk for bleeding if they take interacting over-the-counter (OTC) products, yet little information exists about why patients may or may not seek information about potential interactions. OBJECTIVE: To investigate perspectives of patients taking apixaban (a commonly prescribed DOAC) regarding seeking information about OTC products. STUDY DESIGN and ANALYSIS: Semi-structured interviews were analyzed using thematic analysis. SETTING: Two large academic medical centers. POPULATION: English-, Mandarin-, Cantonese-, or Spanish-speaking adults taking apixaban. OUTCOME MEASURES: Themes associated with information-seeking about potential apixaban-OTC product interactions. RESULTS: Forty-six patients aged 28-93 years (35% Asian, 15% Black, 24% Hispanic, and 20% White; 58% women), were interviewed. Respondents took 172 total OTC products, of which the most common were: vitamin D and/or calcium (15%), non-vitamin non-mineral dietary supplements (13%), acetaminophen (12%), NSAIDS/aspirin (9%), and multivitamins (9%). Themes related to lack of information-seeking about OTC products included: 1) failure to recognize that apixaban-OTC product interactions might exist; 2) beliefs that providers are responsible for disseminating information about interactions; 3) previous suboptimal interactions with providers; 4) infrequent OTC product use; and 5) lack of prior problems with OTC product use (with or without concomitant apixaban use). Conversely, themes associated with seeking information included: 1) believing that patients are responsible for their own medication-related safety; 2) greater trust in providers; 3) unfamiliarity with the OTC product; and 4) prior medication-related problems. Patients noted that information sources ranged from in-person sources (e.g., physicians, pharmacists) to online and written materials. CONCLUSIONS: Patients taking apixaban raised reasons for information-seeking about OTC products related to their perceptions of OTC products, provider-patient interactions, and their prior experiences with and frequency of OTC product use. Greater patient education about the need for information-seeking about potential DOAC-OTC product interactions may be needed at the time of prescribing.

A SOCIAL CONNECTION HEALTH INTERVENTION FOR ISOLATED LATINX OLDER ADULTS AT RISK OF DEMENTIA

Abstract COVID-19 exacerbated the “epidemic of loneliness.” Although loneliness and social isolation are social determinants of health and Alzheimer’s dementia (AD), culturally and linguistically responsive social connection interventions tailored to Spanish-Speaking community-dwelling immigrant older adults at higher risk of AD are lacking. UCLA’s Hispanic Neuropsychiatric Center of Excellence (HNCE) collaborated with Los Angeles County Department of Mental Health (LACDMH) to develop and implement a community-partnered social connection group intervention via Telehealth. All clients are homebound due to physical, psychiatric, and/or medical conditions. The main objective was to reduce feelings of loneliness by combining brain health education with skill-based exercises promoting self-efficacy, trust, belonging, and resilience by effectively communicating their needs in a psychologically safe group space. The effectiveness of the pilot intervention, however, required multiple refinements accounting for structural-social barriers, culture, language, and histories of trauma in country of origin and post-immigration to the United States.

Changes in Glycemic Control Following Use of a Spanish-Language, Culturally Adapted Diabetes Program: Retrospective Study

Several barriers to diabetes treatment and care exist, particularly in underserved medical communities. This study aimed to evaluate a novel, culturally adapted, Spanish-language mHealth diabetes program for glycemic control. Professional Spanish translators, linguists, and providers localized the entirety of the Vida Health Diabetes Management Program into a culturally relevant Spanish-language version. The Spanish-language Vida Health Diabetes Management Program was used by 182 (n=119 women) Spanish-speaking adults with diabetes. This app-based program provided access to culturally adapted educational content on diabetes self-management, one-on-one remote counseling and coaching sessions, and on-demand in-app messaging with bilingual (Spanish and English) certified health coaches, registered dietitian nutritionists, and certified diabetes care and education specialists. Hemoglobin A1c (HbA1c) was the primary outcome measure, and a 2-tailed, paired t test was used to evaluate changes in HbA1c before and after program use. To determine the relationship between program engagement and changes in glycemic control, a cluster-robust multiple regression analysis was employed. We observed a significant decrease in HbA1c of -1.23 points between baseline (mean 9.65%, SD 1.56%) and follow-up (mean 8.42%, SD 1.44%; P<.001). Additionally, we observed a greater decrease in HbA1c among participants with high program engagement (high engagement: -1.59%, SD 1.97%; low engagement: -0.84%, SD 1.64%; P<.001). This work highlights improvements in glycemic control that were clinically as well as statistically significant among Spanish-preferring adults enrolled in the Vida Health Spanish Diabetes Management Program. Greater improvements in glycemic control were observed among participants with higher program engagement. These results provide needed support for the use of digital health interventions to promote meaningful improvements in glycemic control in a medically underserved community.

Cognitive Testing of PAIN Report It-Spanish in Monolingual Hispanic Adults.

A Spanish language computerized tool would facilitate cancer pain assessment and management for the underserved population of native Spanish speakers who do not speak or lack command of the English language. Our aim was to identify Spanish-speaking adults' understanding and interpretation of the PAIN Report It-Spanish items and instructions as well as translation and technical issues. In a cross-sectional study, 20 mostly monolingual Spanish-speaking adults engaged in 1.5- to 2-hour, audio-recorded cognitive interviews as they completed the multidimensional PAIN Report It-Spanish. Three bilingual researchers conducted content data analysis. Sixteen women and 4 men generally understood the translated text, but some had interpretation issues regarding the 0 to 10 number scale and understanding of the pain quality descriptors. Many participants found the program easy to complete, even when they had problems in some areas. Most participants welcomed the opportunity to report pain in their native language and appreciated research to help Hispanics with the management of their pain. PAIN Report It-Spanish is a valid tool to assess pain in a Spanish-speaking population. Improved orientation to the pain reporting tasks and alternate translations for several problematic/confusing Spanish words require additional study, especially among underrepresented black Hispanics and males. Findings indicate that Spanish-speaking adults (1) easily use a body outline to report their pain location, (2) may use a 0 to 10 scale differently than other individuals, and (3) may have a limited repertoire of pain quality and pattern descriptors.

Late phonological development in Williams syndrome.

Williams syndrome is a neurodevelopmental genetic disorder characterized by a unique phenotype, including mild to moderate intellectual disability and an uneven neuropsychological profile of relative strengths and weaknesses. Language structure components (i.e., phonology, morphosyntax, and vocabulary) have been considered an area of specific ability compared to pragmatic language use. However, research on phonological development in Williams syndrome is very scarce, and it suggests atypical patterns. Therefore, the aim of the present study was to explore the profiles of late phonological development in Spanish-speaking children, adolescents, and adults with Williams syndrome, based on the analysis of five classes of processes (Syllable Structure, Substitution, Omission, Assimilation, and Addition) in spontaneous speech. The phonological profiles of seven children (aged 3-8 years), and seven adolescents and young adults (aged 14-25 years) with Williams syndrome were compared with two normative groups of typically developing (TD) children at different stages of late phonological development (aged 3 and 5 years). The frequency of phonological processes in the group of children with Williams syndrome was similar to that of 3-year-old TD children, which suggests that they would be in the first stage of late phonological development (expansion stage). The group of older individuals with Williams syndrome showed a much lower frequency of processes, similar to that of 5-year-old TD children in the last stage of phonological development (resolution stage). However, their phonological processes appeared to be persistent and independent of chronological age. Furthermore, asynchronies in quantitative and qualitative profiles (relative frequency) indicated atypical and complex trajectories in late phonological development, which cannot be described as simply delayed or protracted. Remarkable individual differences were observed, especially in the group of adolescents and adults with Williams syndrome, although the majority of cases conformed to the modal profiles of their groups. A major tendency for Omission, including final consonant deletion, may be considered atypical and specific to Williams syndrome at all ages. The results of the present study raise the need for continued and appropriate phonological assessment and treatment for people with Williams syndrome across the lifespan.

Effects of Brief Daily Kundalini Yoga Meditation on Self-Esteem, Mood and Emotional Self-Efficacy: A Randomized Comparison Study

This randomized comparison study measured the impact of brief daily use of two types of kundalini yoga meditation from the Yogi Bhajan lineage on self-esteem, regulatory emotional self-efficacy, and positive and negative affect in a non-clinical sample of 46 Spanish-speaking adults residing in Spain. Results of the two meditation types—Kirtan Kriya and Internal Conflict Resolution—are compared. Results showed that both types of meditation had positive impacts on all study variables, though the degree of change and effect size depended on the type of meditation used. Results point to these relevant forms of brief daily meditation as simple and inexpensive tools to improve welfare and support positive personality development in populations without psychological pathologies.

Spanish validation of the Brief Problem Gambling Screen in patients with substance use disorders.

Problematic Gambling or Gambling Disorder (GD) can act by initiating and maintaining the problem of substance addiction. Despite this, there are no rapid screening tools validated in Spanish. The Brief Problem Gambling Screen (BPGS) has proven to be one of the most sensitive tools for detecting GD and populations at risk. This study aims to validate the Spanish version of the original five-item BPGS. A sample of 100 Spanish-speaking adults with substance use disorder were recruited from an addiction treatment center. The participants were administered the Spanish version of BPGS. It showed strong item reliability properties (Ω = 0.93). Sensitivity and specificity values were excellent (0.93 each), also positive (0.7) and negative (0.99) predictive values suggest high discriminant power when compared to non-GD subjects. Statistically significant strong correlation with a gold-standard measure (Problem Gambling Severity Index) was found (r = 0.8, p < 0.01). Similar psychometric properties were found in at-risk gambler patients. In conclusion, the BPGS seems to be an adequate screening instrument in Spanish-speaking clinical population, and also identifies at-risk of GD subjects.

Está abriendo, la abrió: Lexical knowledge, verb type, and grammatical aspect shape child heritage speakers’ direct object omission in Spanish

Objectives: This study investigates the influence of lexical knowledge, progressive aspect, and verb type on bilingual children’s direct object expression in Spanish. Methodology: Sixty-one child heritage speakers of Spanish, ages 3;3-8;8, and 10 Spanish-speaking adults in the United States completed a task designed to elicit Spanish transitive verbs and direct objects. The children’s comprehension of Spanish vocabulary was measured by a standardized test. Data and Analysis: The children produced 743 transitive verbs, which were coded for grammatical aspect, comparing progressive and non-progressive forms, and for whether the verbs were “mixed” (verbs that routinely occur with or without a direct object among adults) or “non-mixed” (verbs that generally occur with a direct object among adults). Findings: The adults rarely omitted directed objects, whereas the children frequently did. Mixed-effects logistic regression analyses demonstrate that the higher the children’s Spanish vocabulary score, the less they omitted. Furthermore, progressive verb forms and mixed verbs increased the likelihood of omission. The progressive effect is interpreted as a reflection of children’s tendency to associate atelicity with intransitivity. The mixed-verb effect is interpreted as reflecting a lack of understanding of the discourse conditions that render omission infelicitous with mixed verbs. These two verb-level effects dissipated with age, suggesting a loosening of the atelicity–intransitivity association and an increasing awareness of the discourse conditions that guide direct object expression. Originality: The study demonstrates that bilingual children’s omission patterns are guided by progressive aspect and verb type, thus revealing an intricate and nuanced developmental pathway. Implications: While previous research has shown that bilingual children omit more direct objects than monolingual children, this study reveals important systematicities in bilingual children’s omission patterns. Studying child heritage speakers’ grammars in their own right paves the way for a deeper understanding of the systematic nature of the developing heritage grammar.

The Pictorial Screening Memory Test (P-MIS) for Adults with Moderate Intellectual Disability and Alzheimer's Disease.

In this study, we examined normative data and diagnostic accuracy of a pictorial screening test to detect memory impairment for mild cognitive impairment (MCI) and Alzheimer’s disease (AD) in Spanish-speaking adults with intellectual disability (ID). A total of 94 volunteers with ID (60 controls, 17 MCI, and 17 AD), were evaluated by neuropsychological tests including the PMIS-ID in a cross-sectional validation study. Discriminative validity between the MCI, AD, and control group was analyzed by the area under the ROC curve. A cut-off score of 4.5 on the immediate recall trial had a sensitivity of 69% and a specificity of 80% to detect memory impairment (AUC = 0.685; 95% CI = 0.506–0.863) in the AD group. The PMIS-ID is a useful screening test to rule out a diagnosis of memory decline in people with moderate level of ID and AD, and it shows good psychometric properties.

Validation of the abbreviated Lubben Social Network Scale (LSNS-6) and its association with self-rated health amongst older adults in Puerto Rico.

Social isolation is a well-established determinant of late-life well-being, and it may be particularly relevant for older adults in Puerto Rico following Hurricane María. The abbreviated Lubben Social Network Scale (LSNS-6) is a widely used measure of social isolation, but it has not been validated with Spanish-speaking older adults. The objectives of this study were to (1) assess the psychometric properties of a Spanish-language LSNS-6 and (2) examine its association with self-rated health (SRH) and psychological sense of community (PSOC). Data came from face-to-face survey interviews with a nonprobability sample of 154 community-dwelling older adults in Puerto Rico 2 years after Hurricane María. We assessed the LSNS-6's internal consistency reliability and convergent validity. We then conducted structural equational modelling consisting of (1) a measurement model using confirmatory factor analysis to test the factor structure of the LSNS-6 and (2) a structural model using path analysis to examine the direct effect of social isolation on SRH and to test the role of PSOC as a mediator in this relationship. The LSNS-6 demonstrated acceptable internal consistency reliability (α=0.74) and convergent validity, r(151)=-0.33, p < 0.001. A correlated two-factor model (Family and Friends) provided the best fit (comparative fit index=0.986, Tucker-Lewis index=0.975, root mean square error of approximation=0.082, standardised root mean squared residual=0.033). Path model results show the Friends factor was negatively associated with SRH (β=-0.31, p=0.045), whilst the Family factor was nonsignificant. The Friends factor had a statistically significant indirect effect on SRH through PSOC (β=0.08, 95% CI [0.01, 0.29]). Our findings provide insight into the effect of social isolation on health amongst older adults in Puerto Rico and highlight the potential role of PSOC for assessment and intervention with older adults in post-disaster settings.

Depressive Symptoms and Perception of COVID-19 Risk in Ohio Adults

Background: We assessed the relationship between depressive symptoms and perceived COVID-19 risk in the next month. Methods: This analysis used survey data collected during a July 2020 cross-sectional study using a household-based probability sampling design. A total of 615 noninstitutionalized, English- and/or Spanish-speaking adults in Ohio were included. Depressive symptoms screening occurred using the Patient Health Questionnaire-2 (PHQ-2). We applied survey weights so that presented analyses represent the adult population in Ohio. We performed log-risk regression modeling (generalized linear model with binomial distribution and log link) to estimate unadjusted and covariate-adjusted prevalence ratios examining the association between screening positive for depressive symptoms and perceived risk of COVID-19 in the next month. Results: The study population was majority female (59.1%) and White (90.3%). The mean age was 55.9 years (standard deviation (SD)=17.3). About 1 in 20 (4.6%) screened positive for depressive symptoms. A positive depressive symptoms screen was not significantly associated with perceived risk of COVID-19 in the next month (prevalence ratio [PR]=0.75; 95% confidence interval [CI]=0.25–2.24). After confounder adjustment, the adjusted prevalence ratio (aPR) was nearly unchanged (aPR=0.78; 95% CI=0.24–2.55). Conclusion: As depression is often associated with anxiety and pessimism toward the future, the lack of association between depressive symptoms screening and perception of COVID-19 risk in the next month is surprising. Social withdrawal, which is also associated with depression, may have concealed any increased perceived COVID-19 risk, as depressed individuals who remained socially isolated may have had lower perceived COVID-19 risk.