Telephone Interview For Cognitive Status Research Articles

THE DYNAMIC AND RECIPROCAL RELATIONSHIP BETWEEN PERCEIVED DISCRIMINATION AND COGNITIVE FUNCTION IN LATER LIFE

Abstract Studies have suggested that perceived discrimination is a potentially modifiable risk factor for cognitive health in later life. However, there is a lack of focus in the literature on the changes and directionality of the relationship between these two constructs. This study, based on socioemotional selectivity theory, investigates the dynamic and reciprocal relationship between perceived discrimination and cognitive function in later life. Data were drawn from four waves of the Health and Retirement Study (HRS; 2006, 2010, 2014, and 2018). We utilized a subsample of respondents who completed the psychosocial and lifestyle questionnaire in at least three waves. A total of 4,101 people who were 51 and older were included. Cognitive function was measured by the abbreviated version of the telephone interview for cognitive status (TICS-27). Perceived discrimination was measured using scores of the perceived everyday discrimination scale. Random intercept cross-lagged panel model (RI-CLPM) was utilized. Age was associated with lower perceived discrimination (b=-0.224, p<.0001). While lower cognitive function was cross-sectionally associated with higher perceived discrimination in all racial/ethnic groups, higher everyday discrimination predicted subsequent lower cognitive function only among White respondents. The model fit statistics were favorable: CFI=0.968; SRMR=0.045. Results suggested that a decline in cognitive function may exacerbate perceived discrimination which may result in further reduction of cognitive function in general. Lifetime experience of discrimination was discussed as a possible source of the racial/ethnic variations in the relationship. Further study is needed to examine whether this relationship holds among people with cognitive impairment or dementia.

CORRELATES OF SUBTLE COGNITIVE DYSFUNCTION IN A HIGHLY EDUCATED COHORT OF MID LIFE AND OLDER AFRICAN AMERICANS

Abstract Remote cognitive screening modalities can be an initial step in assessing cognitive health. This cross-sectional study examined how risk and protective factors relate to cognitive performance in non-demented African Americans aged 50 and older. Participants were part of the African American-United Memory and Aging Project (AA-UMAP), a geographically diverse cohort of college-educated adults recruited and evaluated via telephone and online. Demographic, health variables and activity engagement were self-reported through an online survey. Cognition (global cognition, memory, and psychomotor/attention) was measured remotely using the Telephone Interview for Cognitive Status (TICS-40; N = 143) and the CogState Brief Battery (CBB; N = 51). Health variables included a mental health composite (e.g., depression and/or anxiety) and a metabolic conditions composite (e.g., high cholesterol, hypertension, diabetes, and/or obesity). Activity engagement was assessed with self-reported physical, mental, and social lifestyle activities. Linear regression models indicated that older age was associated with slower psychomotor/attention performance (p < 0.01) and marginally lower learning/working memory accuracy (p = 0.08) even after adjusting for covariates (e.g., sex and education). Cognitive performance was unrelated to mental health, metabolic conditions, and lifestyle activity engagement. Neither health-related risk factors nor level of engagement activities were significantly associated with cognitive performance in this remotely screened sample of highly educated middle-aged and older African American adults. More studies of midlife and older African Americans are needed to obtain a more in-depth understanding of the degree to which biopsychosocial strengths and deficits in midlife may affect or alter later-life cognitive trajectories.

WITHIN-PERSON ASSOCIATIONS BETWEEN MARITAL DISSOLUTION AND SUBSEQUENT COGNITIVE FUNCTION IN MIDDLE AND LATER LIFE

Abstract In light of the growing burden associated with cognitive impairment and dementias on families and society accompanied by the dramatic shifts in late-life family demography, there is growing literature focusing on the relationship between marital biography and cognitive outcomes in middle and late adulthood. This study aimed to contribute to the literature by examining within-person linkages between cognitive outcomes associated with two forms of marital dissolutions experienced in later life—divorce and widowhood. Framed around the key concepts of the life course perspective, we examined within-person changes in cognitive function associated with divorce and widowhood transitions in middle and late adulthood. Drawing from 11 waves of longitudinal data from the Health and Retirement Study (1998-2018), we followed over twenty-three thousand married individuals 50 and older over the study period that spanned nearly two decades (person-wave observations N=128,033). Cognitive function at each wave was evaluated using a modified version of the Telephone Interview for Cognitive Status (m-TICS). Research aims were addressed using within-between random effects models that yielded within-person estimates unconfounded by person-level characteristics. Approximately 4.4% and 17.7% of the study sample experienced divorce and widowhood transitions during the observation period. The model results indicated that divorce transitions were unrelated to changes in cognitive function. Cognitive outcomes associated with widowhood transitions were heterogeneous for women and men, where women who transitioned to widowhood experienced increases in cognitive function, whereas men experienced reductions in cognitive function. These findings are discussed in the context of implications for practice and policy.

Racial disparities in epigenetic and cognitive aging

AbstractBackgroundRacial disparities in cognitive health are persistent and pervasive among older Americans. Black Americans have higher rates of cognitive impairment and dementia than their White counterparts and a significantly higher gap between epigenetic age and chronological age. Epigenetic aging measured by DNA methylation (DNAm) has been linked to cognitive outcomes in previous research, but these studies lacked racial diversity or did not account for important confounders. Rigorous evaluation of DNAm‐age’s contribution to cognitive health disparities is needed. We hypothesize that DNAm‐age gap, measured by two epigenetic clocks GrimAge and Dunedin Pace of Aging methylation (DPoAm), is associated with cognitive performance and decline and mediates significant portions of the Black‐White disparities in these outcomes.MethodWe performed retrospective analyses among 3278 non‐Hispanic participants (80.3% White, 19.7% Black) in the Health and Retirement Study whose 2016 epigenetic age is linked to survey responses and cognitive data. DNAm‐age gap is defined as the residual after regressing epigenetic age on chronological age. Cognitive outcomes are Telephone Interview for Cognitive Status (TICS) score in 2016 and change in TICS score from 2016 to 2018. We include age, gender, and measures of socioeconomic status, health status, and health behaviors as confounders. We implement multiple linear regression models to evaluate associations between DNAm‐age gap and cognitive outcomes and mediation models to evaluate the extent to which DNAm‐age gap mediates the relationship between race and cognitive outcomes.ResultWe found that although both GrimAge and DPoAm age gaps are associated with baseline cognitive performance and longitudinal decline in minimally adjusted models, only GrimAge remained a significant predictor after adjusting for confounders. Similarly, both GrimAge and DPoAm mediate a small but significant portion (∼6‐10%) of the racial disparities in cognitive performance and decline before adjusting for confounding variables. Socioeconomic status (education, wealth, and income) has the greatest attenuating effect.ConclusionAccelerated epigenetic aging for Black compared to White Americans may play a role in racial cognitive aging disparities. Follow‐up work is ongoing to determine the role of chronic psychosocial stressors and other important determinants of cognitive health in DNAm aging and racial disparities.

Feasibility of cognitive assessments post‐emergency department (ED) discharge: A longitudinal pilot study of Medicare‐enrolled adults 65 +

AbstractBackground50% of US adults living with Alzheimer’s disease and related dementias (ADRD) never receive a formal diagnosis. This compromises the wellbeing of persons living with ADRD and their care partners, increases health services utilization, and the costs‐of‐care. Wider screening and assessment for ADRD may increase access to supportive care that prevents or delays disease progression, ameliorates care partner burden, and alleviates costs.MethodA sample of Medicare‐enrolled individuals 65+ (n = 149) presenting to the Oregon Health & Sciences University (OHSU) emergency department (ED) in Portland, Oregon between May 2022 and January 2023 were recruited and administered the Telephone Interview for Cognitive Status (TICS) up to one‐month post‐discharge. Study participants were queried about their physical health via the modified cumulative illness rating scale (M‐CIRS), while their cognitive health was assessed via the PROMIS Cognitive Measure Questions on Mental Clarity. Care utilization patterns were measured via review of subjects’ electronic health records (EHR) for three years prior to study enrollment date focusing on total hospitalizations, ED visits, and primary care (PC) visits. These reviews measured health care utilization across three groups comparing individuals with (A) un‐diagnosed cognitive impairment with (B) cognitively healthy individuals, and (C) individuals with a formal ADRD diagnosis.ResultStudy enrollment rate was 25.8% (n = 149) of individuals meeting eligibility requirements. Enrollment was limited to patients with an OHSU PC affiliated provider excluding the majority (ineligible n = 1681, 74%) of Medicare‐enrolled ED patients (total ED users available for recruitment was n = 2,258). Of those contacted, 10% declined participation due to lack of interest and 4% declined due to cognitive or health restraints. Time to administer instrument suite ranged between 26‐33 minutes.ConclusionMedicare‐enrolled adults 65+ recently discharged from the ED appear to be an acceptable population to administer cognitive assessments. Findings during the recruitment process show success at enrolling this population to the study and administration times did not appear burdensome in duration for those enrolled. This study provides preliminary evidence supporting a focus on older ED patients to administer cognitive assessments, linking outcomes to the EHR, and ultimately providing a platform for future research on the impact of under‐diagnosed ADRD on health outcomes and utilization.

The Look AHEAD Aging Study: design, cohort characteristics, and cognitive function

AbstractBackgroundData on cognitive trajectories and characteristics associated with cognitive resilience among older individuals with type 2 diabetes and overweight or obesity are scant. To date, the NIA‐funded Action for Health in Diabetes (Look AHEAD) Aging Study has enrolled 1245 individuals, ages 64 to 95 years, who have been richly characterized over 18 years of prior follow‐up with factors associated with cognitive aging.MethodVolunteers from the Look AHEAD clinical trial of a multidomain lifestyle intervention and its subsequent clinic‐based post‐trial observational phase were invited to join a 4‐year telephone‐based observational study that includes annual cognitive assessments to assess memory, attention/processing speed, executive function, and global cognitive function. A composite measure of cognitive function based on the average standardized cognitive function tests was used to capture global cognitive function. Mild cognitive impairment and probable dementia will be centrally adjudicated. Additional measures include depressive symptoms, physical function and abilities, medical events, medication use, and health related quality of life. Recruitment will be completed in early 2023.ResultThe enrolled cohort to date (N = 1590) includes 62% women, 32% individuals from traditionally under‐represented racial/ethnic minorities, 49% without college education, and 52% who had been randomly assigned to the lifestyle intervention. The mean (SD) age is 76.3 (5.6) and years of diabetes is 25.5 (5.5). When last measured, the mean BMI was 33.8 (6.3) kg/m2 and 4 m walk speed was 0.86 (0.22) m/sec. Of 1060 who were tested, 20.6% have one apoE‐e4 allele and 1.1% have two apoE‐e4 alleles. Modified Telephone Interview for Cognitive Status (TICSm) scores ranged from 12 to 48, with mean 34.7 (4.7), with no difference between intervention groups (p = 0.66). While TICSm scores tended to be lower for older participants, many still demonstrated relatively high levels of cognitive functioning, even into the 8th decade of life (attached figure).ConclusionThe Look AHEAD Aging study holds great promise to identify factors across two decades of follow‐up that are associated with cognitive resilience in a large cohort with type 2 diabetes and overweight or obesity. Our presentation will provide data on the full cohort and cognitive battery.

Comparing the effectiveness of a brief observational study protocol versus a telephone call for Alzheimer’s disease prevention trial prescreening

AbstractBackgroundMany Alzheimer’s disease (AD) clinical trials suffer from a high screen‐fail rate despite telephone pre‐screening, leading to a significant drain of time and resources. Thus, more efficient prescreening methods are required. Here, we examined whether prescreening through a brief on‐site observational study protocol could reduce clinical trial screen failure rate compared to telephone prescreening.MethodDe‐identified screening data from the AHEAD study (AD prevention trial) at the Brigham and Women’s Hospital (BWH) Center for Alzheimer Research and Treatment were used. Participants were referred for the AHEAD study screen either from a brief observational study protocol (Davis Memory and Aging Cohort [MAC]) or a telephone screen. MAC collects medical history, Mini‐Mental State Exam, Quick Dementia Rating System, and blood samples through a 60‐minute on‐site visit. Telephone screen uses medical history survey and Telephone Interview for Cognitive Status. We compared AHEAD screen failure rate due to (1) clinical exclusion criteria and (2) (for those with no clinical exclusion) amyloid‐β biomarker criteria (plasma, PET) between MAC and telephone screen referrals, using Fisher’s exact test.ResultThere was no significant difference in age, sex, race, or ethnicity between the MAC and Telephone prescreen groups (Table 1, MAC n = 61, telephone n = 55). The odds ratio (OR) for clinical screen‐fail for MAC (n = 9 out of 61, 15%) compared to telephone (n = 20 out of 55, 36%) was 0.31 (95% CI 0.12 to 0.80, p = 9.7×10−3). The OR for biomarker screen‐fail for MAC (n = 49 out of remaining 52, 94%) compared to telephone (n = 27 out of remaining 35, 77%) was 4.7 (95% CI 1.0 to 30.1, p = 0.024). The OR for randomization from MAC (n = 3 out of 61, 5%) compared to telephone (n = 8 out of 55, 15%) was not significantly different from 1 (p = 0.11).ConclusionOur findings show that, compared to a telephone screen, an on‐site prescreen assessing cognition, medical history, and venous access may prevent clinical trial screen fails attributable to clinical exclusion criteria and save participant/staff time and resources. However, an unexplained higher biomarker screen fail rate for the on‐site group offset this benefit, requiring further investigation.

Wisconsin Longitudinal Study (WLS), the Initial Lifetime’s Impact on Alzheimer’s Disease (WLS‐ILIAD): A Novel Opportunity to Study the Influence of Education on ADRD

AbstractBackgroundThe importance of education in shaping brain health and dementia risk are increasingly supported, although the mechanisms by which these life course factors impact late life cognition remain elusive due to a scarcity of full life‐course longitudinal studies. A new data collection wave of the Wisconsin Longitudinal Study (WLS), the Initial Lifetime’s Impact on Alzheimer’s Disease (WLS‐ILIAD), stands to address this gap. The WLS cohort is a randomly selected community sample that’s been followed since 1957, offering a wealth of prospectively collected lifespan data to pull from. Now that this cohort has reached their 80’s, the ILIAD study aims to detect dementia prevalence in this sample, and when combined with prior data waves, offers an unparalleled opportunity to explore how full life‐course and sociodemographic factors shape the relationship between education and dementia risk and resilience.MethodWLS‐ILIAD employs a multi‐phasic study design. In Phase 1, the modified Telephone Interview for Cognitive Status (TICS‐m) was administered to all eligible participants to screen for dementia risk. Those performing below cutoff (TICS‐m≤28) were selected for Phase 2 to complete more robust cognitive assessment and to obtain comprehensive health history. Cognitive diagnoses were determined by multidisciplinary consensus panel. Proxy assessments were employed for participants who were deceased or unable to complete the assessment.ResultPreliminary results indicate a response rate of ∼78%. Approximately 4,800 participants completed Phase 1, with 1,227 (26%) falling below cutoff for dementia risk (TICS‐m≤28). Of those completing Phase 2, 460 participants were classified as normal cognition, 443 mild cognitive impairment (MCI), and 197 dementia. Another 300 dementia cases were identified via proxy. Participants diagnosed with MCI or dementia tended to be older, ApoeE‐4 allele carriers, and had a lower high school IQ. Of those diagnosed with dementia, 88% reported no prior clinical workup or existing cognitive diagnosis.ConclusionResults of the WLS‐ILIAD study yields detailed cognitive diagnostic classifications for this sample. When combined with prospectively collected life course data, the WLS cohort offers a unique opportunity to explore the impact of education on risk and resilience factors for dementia outcomes, leading to important public policy and public health implications.

Sex/Gender Differences in the Diagnosis of Pain by Cognitive Status

AbstractBackgroundUnderdiagnosis of pain is common in women and in those with Alzheimer’s disease and related dementias (ADRD). However, sex/gender differences in pain interference, defined as pain that interferes with daily activities, have not been examined along the cognitive spectrum. We assess sex/gender differences in odds of physician‐diagnosed and self‐reported pain, by cognitive status: normal, cognitively impaired but not dementia (CIND), and dementia.MethodsWe will use data from the 2006 to 2018 waves of the Health and Retirement Study (HRS) linked to Medicare Claims. We will include participants aged 66 and older with at least one year of continued enrollment in Medicare. Our pain diagnosis measure will incorporate self‐reported pain interference, herein referred to as pain, with pain diagnosis in a three‐level variable: no pain, undiagnosed pain (self‐reported only), and diagnosed pain. Cognitive status (normal cognition, CIND, dementia) was measured using the Telephone Interview for Cognitive Status. We will use generalized estimating equation models to calculate gender disparities in the odds of pain diagnosis, by cognitive status. Here we present preliminary results, using cross‐sectional data from the 2018 HRS (n = 7,588) to examine self‐reported pain by cognitive status. We include descriptive statistics and logistic regression models, adjusted for age, race/ethnicity, years of education, marital status, depression, diabetes, arthritis, and obesity.ResultsWomen more often reported pain compared to men for those with normal cognition (women: 27.7%, men: 18.7%; p<0.001) and CIND (women: 32.6%, men: 18.9%; p<0.001). Among those with dementia, 29.9% of women and 22.7% of men reported pain (p = 0.108). For those with normal cognition and CIND, women had higher odds of reporting pain compared to men [normal cognition odds ratio (OR): 1.34, 95% confidence interval (CI): 1.16, 1.55); CIND OR: 1.84 95% CI: 1.38. 2.47]. However, no sex/gender disparity is observed among those with dementia (95% CI: 1.13, 95% CI: 0.66, 1.94).ConclusionsIn our preliminary analysis we found that the sex/gender disparity in self‐reported pain interference is not present among those with dementia. The final version of this work will incorporate the Medicare data from 2006 to 2018 so that we can assess sex/gender differences in clinician‐documented pain diagnosis.

Longitudinal sleep, pain interference, and depressive symptoms in cognitively impaired older adults

AbstractBackgroundPoor sleep, pain, and depression are interrelated factors in older adulthood that may impair cognition. Few studies have examined associations among sleep, pain interference (i.e., how pain interferes with daily living), and depression with cognitive status. Therefore, we investigated these associations in verbally communicative older adults with and without cognitive impairment (CI). We hypothesized that individuals with CI will be more impacted by all variables in relation to the control group.MethodSleep (Neuro‐QoL Sleep), pain interference (Brief Pain Inventory‐Short Form), depression (15‐item Geriatric Depression Scale), and cognitive function (Telephone Interview for Cognitive Status) were investigated in older adults (ages ≥ 65) with CI (N = 16) compared to age‐ and sex‐matched controls (N = 28). Sleep, pain, and depression data were collected weekly over six weeks to allow for a detailed assessment of potential changes in symptoms. Data analyses were conducted in R using linear mixed effects models and conditional growth curve analysis.ResultAcross our sample, we found that more sleep disturbances were associated with more severe depression (p<0.001), greater pain interference was associated with more severe depression (p<0.001), and more sleep disturbances were associated with greater pain interference (p<0.001). There was a significant interaction between cognitive status and sleep disturbances on depression (p = 0.0005), such that the CI group had a stronger positive relationship between sleep disturbances with depression severity. Similarly, there was a significant interaction between cognitive status and pain interference on depression (p<0.001), such that the CI group had a stronger positive relationship between pain interference and depression severity.ConclusionThe findings demonstrate that the relationship among sleep, pain, and depression remain a concern in older adults with CI. As sleep worsened, depression tended to increase across both groups, yet in those with CI, this finding was stronger. Similarly, as pain interference worsened, depression tended to worsen in both groups, but this association was stronger in those with CI. Additional attention to the assessment, prevention, and treatment of sleep disturbance, pain, and depression in people living with and without CI is warranted, especially as individuals with CI may have difficulties communicating these problems.

“The place where danger waits”: Ten years of the 1994 Crime Bill incarceration on cognitive function in older adults racialized as Black

AbstractBackgroundStructural racism may drive the constellation of structural determinants that increase racialized disparities in the risk for Alzheimer’s disease related dementias (ADRD). Structural racism via adverse policing increases exposure to negative police encounters that produce heightened vigilance, anxiety, and depressed mood in persons racialized as Black. Seminal research suggests high‐police contact and disparities in Black‐White incarceration are positively associated with risk for other health conditions. It is feasible that cumulative stress from anticipatory and recurrent police encounters disrupts the body’s homeostasis leading to accelerated cognitive aging.MethodWe used US county‐level incarceration data to compute the Black‐White difference in prison and jail rates for US counties between 1995‐2005 (succeeding the 1994 Crime Bill). We then averaged the decade and linked said data by county to individual‐level health data for participants racialized as Black >50 years in the Health and Retirement Study (N = 2,300) who completed the core interview between 2006‐18 (mean observation of 3.4 per participant). Cognitive function was assessed using a 27‐item global cognitive score from the modified Telephone Interview for Cognitive Status. A mixed effects model was used to estimate the cognitive effect of a one‐unit change in incarceration (1,000 additional persons racialized as Black compared to White) with covariates of age at baseline, gender, education, and living arrangement.ResultGreater Black‐White 10‐year difference in prison population was significantly associated with worse 2006 cognitive function (β ‐1.08, SE .45, 95% CI ‐1.96,‐.22). The adjusted model was significant for Black‐White difference in prison population with cognitive decline starting in 2006 (β .011, SE .006, 95% CI ‐.001, .023). The Black‐White difference in jail population was not significant.ConclusionTen‐year Black‐White disparities in prison population are associated with cognitive decline among people racialized as Black starting one year later. While the 1994 Crime Bill is a decades‐old federal policy, it put into place a fiscal infrastructure which local governments continue to use to fund prisons, increase average prison time, and implement adverse policing quotas. These findings suggest structural racism via adverse policing is meaningful to explore in the context of ADRD.

“Taxes, death, and trouble”: Role of structural socioeconomic racism on cognitive function for persons racialized as Black

AbstractBackgroundStructural racism has concentrated Americans racialized as Black in under‐resourced and disinvested neighborhoods. These same Americans experience higher rates of Alzheimer’s disease and related dementias (ADRD). Differences in socioeconomic opportunities structured by racism is a potential contributor to ADRD disparities. To investigate this hypothesis, we tested how life‐course exposure to area‐level measures of structural racism relate to late‐life cognitive test performance.MethodWe computed the Black‐White disparity in land ownership and value, residential and occupational segregation, and income, employment, and poverty at the county‐level using US Census data from 1930‐2010. We aggregated these data to the state‐level then created four unidimensional measures by life‐course period (Before‐Birth 1930‐50, Childhood 1960‐70, Adulthood 1980‐2000, Midlife 2010). We linked state‐ and life‐course‐period‐level data with individual‐level demographic and cognitive data from the US Health and Retirement Study. We included participants racialized as Black and born 1954‐59 (N = 1,172). We measured cognitive performance from repeated measures of the 27‐item global cognitive score from the modified Telephone Interview for Cognitive Status during 2010‐18 (average follow up of 4.1 years). Mixed effects models were used to test associations of life‐course‐period‐specific state‐level structural socioeconomic racism and cognitive change. Covariates were age, gender, education, Living arrangement, and year of death.ResultParticipants racialized as Black who lived in places with higher levels of area‐level structural socioeconomic racism experienced lower levels of cognition at baseline and at varying time points in the six‐year period—compared to those in places with lower structural socioeconomic racism. The effects of the life‐course‐period‐specific state‐level structural socioeconomic racism exposure on the slope were in the expected direction but not statistically different from zero (‐.02, SE 0.25, ‐.51, 4.7).ConclusionAmong participants racialized as Black in the HRS born during 1954‐59, effects of exposure to state‐level structural racism varied according to life course period of exposure. These findings reveal the utility of examining the impact of racist U.S. policies enacted in the past and present that influence health over time. In addition to exploring the epigenetic and in utero exposures that may contribute to ADRD risk later in life.

Fatigue Interacts with Amyloid Status To Predict Daily Working Memory Performance in Preclinical Alzheimer’s Disease

AbstractBackgroundSmartphone‐based cognitive assessment has the potential to reduce barriers to cognitive screening and increase sensitivity to detect preclinical Alzheimer’s disease (AD). Ecological momentary assessment of cognition is novel, and it is not yet well understood how psychological factors (i.e., mood, stress, and fatigue) may impact cognitive performance in remote, real‐world settings. We aimed to evaluate whether psychological factors influence daily cognitive performance differently between older adults with and without AD‐related pathologic change.MethodParticipants (N = 73) were cognitively unimpaired adults aged 60‐80 years (71% female, 89% White, 16.5 mean years of education) recruited for a digital cognitive assessment study. Participants had amyloid (Aβ) PET imaging results available from prior research participation [(n = 25 Aβ positive (Aβ+) and n = 48 Aβ negative (Aβ‐)]. A modified Telephone Interview for Cognitive Status (TICSm) score of ≥34 was used to indicate normal cognition. Participants completed 8 consecutive days of cognitive assessment using Mobile Monitoring of Cognitive Change (M2C2), a smartphone‐based testing platform developed as part of the National Institute of Aging’s Mobile Toolbox. Brief (i.e., 3‐4 minute) M2C2 sessions were assigned three times daily (morning, afternoon, and evening). Tasks included measures of visual working memory (WM, “Color shapes”), processing speed (PS, “Symbol search”), and episodic memory (EM, “Prices”). Multilevel modeling was used to examine the impact of self‐reported mood, stress, fatigue, and Aβ status on daily cognitive performance while controlling for age, sex, education, and time of day.ResultDaily fatigue was found to interact with amyloid status such that Aβ+ individuals performed worse on the WM task when experiencing higher levels of fatigue (Est. = .004, p = .01) Higher levels of daily stress were associated with poorer performance on the PS task (Est. = ‐.0005, p = .03) but no interaction with Aβ status was observed. There were no significant relationships between mood and cognitive performance.ConclusionWe demonstrated that psychological factors including fatigue and stress may impact performance on remote cognitive assessments. Results also suggested that fatigue may impact daily cognitive performance more among those with AD pathological change. These preliminary results suggest that psychological factors should be considered when determining optimal windows for remote cognitive screening.

U.S. Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk (U.S. POINTER): Baseline Characteristics of a Trial Cohort Enriched for Risk of Cognitive Decline

AbstractBackgroundU.S. POINTER is a two‐year clinical trial to evaluate whether lifestyle interventions targeting multiple risk factors protect cognitive function in older adults at increased risk for cognitive decline. We describe the baseline characteristics of the U.S. POINTER clinical trial cohort overall, and before and after changes in risk factor enrichment inclusion criteria.MethodU.S. POINTER is a Phase 3, multicenter, randomized 2‐year clinical trial of two lifestyle interventions varying in intensity and format, in older adults at increased risk for cognitive decline and dementia. The study closed enrollment with 2111 individuals at 5 sites (North Carolina, Northern California, Chicagoland, Houston, Rhode Island). Eligible participants were sedentary and consumed a suboptimum diet and met other risk enrichment criteria that included first degree family history of memory impairment, and suboptimum cardiovascular health status (meeting specific cut‐points of systolic blood pressure, LDL cholesterol or hemoglobin A1c). 20 months into enrollment, risk enrichment criteria were revised to account for two other factors: older age (70‐79 years), and African American/Black or Native American race or Hispanic/Latine ethnicity.ResultMean age at baseline is 68.2 years, 31% represent communities of color, 69% are women, and 30% are not college graduates. 58% reported maternal memory loss, mean systolic blood pressure = 131 mmHg, mean total cholesterol = 193 mg/dl, mean HbA1C = 5.9%, and mean body mass index (BMI) = 29.9 kg/m2. Mean adjusted modified Telephone Interview for Cognitive Status (TICSm) score is = 37.6 (max = 50 pts), Geriatric Depression Score (GDS) is = 1.8, and Short Physical Performance Battery Chair Stand Score (SPBC) is = 3.3. Some baseline characteristics (BMI, total cholesterol, SBBP chair stand) vary by clinical site. The change to risk score enrichment criteria (Table 1) increased representation of participants from communities of color and number of males in the study cohort.ConclusionU.S. POINTER successfully enrolled 2111 participants across 5 sites who are at high risk for cognitive decline and dementia, with appropriate representation by groups typically underrepresented in clinical trials, individuals aged 75 or older, and men, with the expansion of risk score enrichment criteria.

Prevalence and Severity Distribution of Alzheimer’s Disease in the United States from the Health and Retirement Study

AbstractBackgroundThere is limited data regarding Alzheimer’s disease (AD) prevalence by severity across the AD continuum. This study aimed to estimate prevalence of mild cognitive impairment (MCI) and mild, moderate, and severe AD in a representative sample of the United States (US) population.MethodData from the Health and Retirement Study (HRS), a bi‐annual national survey of older adults in the US, were analyzed (2014‐2018), applying cluster sampling weights. AD ascertainment from HRS was based on patient report of a clinical diagnosis (physician diagnosis‐based), or the test score of Modified Telephone Interview of Cognitive Status (TICS‐m) (cognitive performance‐based). Patients with MCI were identified with the cognitive performance‐based method only. MCI and AD severity stages were ascertained using a crosswalk between the scores of TICS‐m and the mini‐mental state examination (MMSE).ResultThe diagnosis‐based method identified 1.2%, 1.2%, 1.3% patients with AD in 2014, 2016 and 2018, respectively (2.2% pooled). The mean (SD) age was 79.4 (10.3) years, with 61% women and 22% had passed college education (combined across surveys). The cognitive performance‐based method identified 23%, 23%, 21% patients with MCI in 2014, 2016 and 2018, respectively (24% pooled), and 27%, 22%, 17% patients with AD in 2014, 2016 and 2018, respectively (30% pooled). For patients with MCI, the mean age was 67.3 (10.1) years, with 51% women and 36% passed college education; for patients with AD, the mean age was 72.8 (11.1) years, with 53% women and 28% had passed college education. Severity distributions are shown in Figure 1. Unweighted results were similar.ConclusionThe cognitive performance‐based method identified a substantially higher prevalence of AD than the diagnosis‐based method and enabled identification of MCI prevalence using HRS data. The prevalence of MCI was consistently higher than AD dementia severity categories over the years (2014, 2016, and 2018). The discordance in AD prevalence estimation between cognitive performance‐based and diagnosis‐based methods underscores a need for better understanding of clinical practice patterns in AD diagnosis, use of clinical assessment tools, and severity classification in the US.

Recalling Biobank Participants to Clinical Study of Alzheimer’s Disease – FinnGen Pilot Study

AbstractBackgroundPopulation‐based biobanks that comprehensively ascertain health and genetic data hold promise to facilitate identification of Alzheimer’s disease (AD) trial participants. We conducted a pilot study in individuals with mild impairment in cognition or AD to assess the feasibility of recalling biobank participants. We also tested the utility of computer‐ and telephone‐based cognitive assessments as cost‐effective alternatives to in‐person neuropsychological testing and investigated plasma‐based biomarkers.MethodsWe utilized FinnGen, a large population‐based biobank study of up to 500,000 participants representing almost 10% of the Finnish population. Single‐center cross‐sectional study included individuals with ICD‐10 codes for AD (G30) and mild cognitive disorder (MCD; F06.7). Dementia screening instruments were in‐person Mini‐Mental State Examination (MMSE) and telephone interview for dementia (TELE). Episodic memory was assessed with three trial word list tasks in three formats; in‐person, with web‐based tool and with the modified Telephone Interview for Cognitive Status including three learning trials. Each of these yielded immediate and delayed free recall measures. Blood samples were collected to determine plasma‐based biomarkers: amyloid beta (Aβ)1‐40 to Aβ1‐42 ratio, glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL) and phosphorylated‐tau181 (pTau‐181).ResultsA total of 78% (110/140) of a pre‐specified FinnGen sub‐cohort were successfully reached. Of those, 39% (43/110) were willing to participate and 19% (N = 27, mean age = 72y, 13 women) completed the study. FinnGen and hospital records largely matched. For 8/12, MCD was due to other reasons than early AD. MMSE and TELE correlated .818 (p< .001). Immediate and delayed recall measures correlated across three formats: from .584 to .679 (p’s<.003) and from .250 to .424 (p’s: .031 ‐ .218), respectively. AD group had higher levels of GFAP (p = .002) and pTau‐181 (p = .020). TELE was negatively correlated with GFAP (p = .011), NfL (p = .001) and pTau‐181 (p = .006). Moreover, p‐Tau181 had negative correlations with episodic memory measures (all r’s< ‐.202) with telephone‐administered immediate recall reaching statistical significance (r = ‐.394, p = .042).ConclusionsInformative, customized clinical recall studies from FinnGen are feasible. Remote testing is a cost‐effective approach in recall studies. Next phase of our study aims to invite cognitively unimpaired FinnGen participants for screening of high AD risk individuals.

Clinical Manifestations.

Subjective Cognitive Decline (SCD) is a condition characterized by consistent cognitive complaints in cognitively unimpaired (CU) individuals and is associated with progressive cognitive impairment, especially in the context of Alzheimer's disease (AD). We aimed to show the study protocol and the preliminary results of the Brazilian Subjective Cognitive Decline (BRASCODE) Cohort. CU individuals with > 65 years old and cognitive complaints were recruited. Exclusion criteria were previous diagnosis of dementia, uncontrolled neuropsychiatric/clinical illness, or cerebrovascular disease. The assessment was performed exclusively by phone calls. It consisted of a brief cognitive (Modified Telephone Interview for Cognitive Status - TICS-M) and anxiety/depression screenings, in addition to the SCD-scale (Figure 1). Between March and November 2022, 52 SCD patients were included, 73.1% (n = 38) women. Their median interquartile range (IQR) age was 70 (68-73) years old, with 16 (9.25-19) years of formal education and median score of 28.5 (IQR 26,30) on Mini Mental State Examination (MMSE) (Table 1). Percentage of agreement on the presence of cognitive complaints between informants and patients was 38.5%. The main SCD-plus criteria were the age at onset of SCD ≥ 60 years old (84.6%, n = 44) and concerns associated with SCD (78.8%, n = 41). The key findings of the neuropsychological assessment are reported in Table 2. Deficits were observed mainly in memory and executive functioning domains. Explorative analysis showed that Cognitive Reserve Scale scores correlated positively with MMSE (rho = 0.311; p = 0.02) and with formal education (rho = 0.541; p<0.001) and negatively with CDR-sum of boxes (rho = -0.307; p = 0.03). The prevalence of APOE ε4 carriers was 29.8% (n = 14) and a dementia family history was more frequent in APOE ε4 carriers - 12 (85.7%) - than non-carries, 12 (36.4%). The increase in the sample size, especially with individuals with low education, associated with AD biomarkers analysis and long-term follow-up may bring valuable information about the progression of SCD to cognitive decline in Brazil. We estimate that a total of 150 individuals will be included by the end of 2023.

The Telephone Language Screener (TLS): standardization of a novel telephone-based screening test for language impairment.

This study aimed at developing and standardizing the Telephone Language Screener (TLS), a novel, disease-nonspecific, telephone-based screening test for language disorders. The TLS was developed in strict pursuance to the current psycholinguistic standards. It comprises nine tasks assessing phonological, lexical-semantic and morpho-syntactic components, as well as an extra Backward Digit Span task. The TLS was administered to 480 healthy participants (HPs), along with the Telephone-based Semantic Verbal Fluency (t-SVF) test and a Telephone-based Composite Language Index (TBCLI), as well as to 37 cerebrovascular/neurodegenerative patients-who also underwent the language subscale of the Telephone Interview for Cognitive Status (TICS-L). An HP subsample was also administered an in-person language battery. Construct validity, factorial structure, internal consistency, test-retest and inter-rater reliability were tested. Norms were derived via Equivalent Scores. The capability of the TLS to discriminate patients from HPs and to identify, among the patient cohort, those with a defective TICS-L, was also examined. The TLS was underpinned by a mono-component structure and converged with the t-SVF (p < .001), the TBCLI (p < .001) and the in-person language battery (p = .002). It was internally consistent (McDonald's ω = 0.67) and reliable between raters (ICC = 0.99) and at retest (ICC = 0.83). Age and education, but not sex, were predictors of TLS scores. The TLS optimally discriminated patients from HPs (AUC = 0.80) and successfully identified patients with an impaired TICS-L (AUC = 0.92). In patients, the TLS converged with TICS-L scores (p = 0.016). The TLS is a valid, reliable, normed and clinically feasible telephone-based screener for language impairment.

Association Between Mid-arm Muscle Circumference and Cognitive Function: A Longitudinal Study of Chinese Adults.

Dementia affects 55 million people worldwide and low muscle mass may be associated with cognitive decline. Mid-arm muscle circumference (MAMC) correlates with dual-energy Xray absorptiometry and bioelectrical impedance analyses, yet are not routinely available. Therefore, we examined the association between MAMC and cognitive performance in older adults. We included community-dwelling adults ≥55years from the China Health and Nutrition Survey. Cognitive function was estimated based on a subset of the modified Telephone Interview for Cognitive Status (0-27, low-high) during years (1991, 1993, 1997, 2000, 2004, 2006, 2009, 2011, 2015, 2018). A multivariable linear mixed-effects model was used to test whether MAMC was associated with rate of cognitive decline across age groups and cognitive function overall. Of 3702 adults (53% female, 63.2 ± 7.3years), mean MAMC was 21.4cm ± 3.0 and baseline cognitive score was 13.6 points ±6.6. We found no evidence that the age-related rate of cognitive decline differed by MAMC (P = .77). Declines between 5-year age groups ranged from -.80 [SE (standard error) .18] to -1.09 [.22] for those at a mean MAMC, as compared to -.86 [.25] to -1.24 [.31] for those at a 1 MAMC 1 standard deviation above the mean. Higher MAMC was associated with better cognitive function with .13 [.06] higher scores for each corresponding 1 standard deviation increase in MAMC across all ages. Higher MAMC at any age was associated with better cognitive performance in older adults. Understanding the relationship between muscle mass and cognition may identify at-risk subgroups needing targeted interventions to preserve cognition.

Food Insecurity, Race and Ethnicity, and Cognitive Function Among United States Older Adults

BackgroundCognitive impairment and dementia are severe public health issues in aging populations, which can be exacerbated by insufficient or unhealthy dietary intake. Food (in)security status is linked to cognitive function among older adults, but the relationship is complex and can vary by sociodemographic characteristics. ObjectiveThis article aimed to investigate the association between food insecurity and cognitive function among United States older adults and explore potential variations by race and ethnicity groups. MethodsWe prospectively examined changes in cognitive function and incidence of cognitive impairment alongside the presence of self-reported food insecurity among older adults of different racial and ethnic groups. Data were from the 2012–2018 Health and Retirement Study (HRS) and the 2013 Health Care and Nutrition Study (HCNS), including N = 6,638 United States adults aged 50 years and older. Food insecurity was measured by a self-reported United States Household Food Security Survey Module, and cognitive function was assessed by the modified version of the Telephone Interview for Cognitive Status. ResultsResults showed that 17% of United States older adults reported food insecurity in the 2013 HCNS. Compared with food secure older adults, those reporting food insecurity experienced worsened cognitive functioning over time (B = −0.63, p < .001), and they were more likely to have onset of cognitive impairment (OR= 1.46, p < .001) in the 6-y observation. Compared with non-Hispanic White older adults, being non-Hispanic Black, non-Hispanic Other, or Hispanic was associated with 2.96, 2.09, or 1.26 odds (p < .001) of cognitive impairment (2012–2018), respectively. Older adults of racial and ethnic minority groups also had higher risks of experiencing the double burden of cognitive impairment alongside food insecurity compared with non-Hispanic White older adults. ConclusionFindings underscore racial and ethnic structural disparities in food security and cognitive health in the United States aging population.