Systematic Review and Meta-Analysis of the Effects of Dance on Cognition and Depression in Healthy Older Adults.

PURPOSE: Aging is associated with declines in cognition and mental health that might be ameliorated by physical activity (PA). Dance integrates multiple physical, cognitive, and social elements, and might be an avenue for improving cognition and mood. This systematic review and meta-analysis (SRMA) examined the effects of formal and traditional dance on cognition, depression, and anxiety in older adults. METHODS: Five database searches yielded 17 randomized control trials (RCT). RCTs were included if participants were ≥ 60 years and healthy or living with mild cognitive impairment (MCI). We examined interventions of dance against any comparison group. Records were independently screened, and data were extracted by 2 reviewers. We performed random-effects models using robust variance estimation and tested individual treatment, study, and outcome level moderators using the approximate Hotelling-Zhang test. RESULTS: 17 RCTs were included in the systematic review, but 13 RCTs were included in the meta-analysis which included 1,174 participants with a mean age of 70.7 years, and 66.3% were female. There were 76 effect sizes (Hedges' g) calculated from the 13 RCTs with a range between -0.97 through 2.88. The overall effect of dance interventions on cognition was significant, yet small (g = 0.27; 95% CI: 0.05, 0.50; p = 0.022), and the effect on depression was significant and nearly moderate (g = 0.43; 95% CI: 0.06, 0.80; p = 0.036); only one RCT examined anxiety and was not included. No moderator variables significantly explained variation in the effects of dance on cognitive function or depression (p > 0.05). CONCLUSIONS: Dance interventions can improve cognition and depression in older adults. Additional research is needed regarding the effects of dance on anxiety and depression in older adults.

Ecological Momentary Intervention to Replace Sedentary Time With Physical Activity to Improve Executive Function in Midlife and Older Latino Adults: Pilot Randomized Controlled Trial.

BACKGROUND: Exercise interventions often improve moderate to vigorous physical activity, but simultaneously increase sedentary time due to a compensatory resting response. A higher level of sedentary time is associated with a lower level of executive function, while increased moderate to vigorous physical activity is associated with improved global cognition and working memory among Latino adults. Latino adults are the fastest-growing minority group in the United States and are at high risk for cognitive decline, spend more time sedentary compared to non-Hispanic populations, and engage in low levels of physical activity. Interventions that are culturally appropriate for Latino adults to replace sedentary time with physical activity are critically needed. OBJECTIVE: This study aims to develop and test the feasibility and acceptability of an ecological momentary intervention (EMI; delivered in real time) that is individually designed to replace sedentary time with physical activity in Latino adults. METHODS: This pilot study randomized 39 (n=26, 67% female; mean age 61, SD 5.8 years) community-dwelling, Spanish-speaking Latino adults (1:1 allocation) to either a 6-week EMI program designed to replace sitting time with physical activity (20/39, 51%) or physical activity guidelines education (19/39, 49%). The program was conducted on the web and in Spanish. The intervention was individualized based on individual interview responses. The intervention included the use of a Fitbit activity monitor, weekly didactic phone meetings, interactive tools (SMS text messages), and coach-delivered feedback. Feasibility and acceptability were assessed via study satisfaction (Likert scales), motivation (ecological momentary assessment), retention, and compliance. Sedentary time and physical activity were assessed via 7-day actigraphy. Cognitive performance was assessed via the trail making test part A and B (part B=executive function) and via the National Institutes of Health Toolbox remote cognitive assessment. Statistical analysis included a linear model on change score from baseline, adjusting for age, sex, and education, emphasizing effect size. RESULTS: Participant satisfaction with EMI was high (9.4/10), with a high degree of motivation to replace sitting time with physical activity (9.8/10). The intervention compliance rate was 79% with low difficulty using the Fitbit (1.7/10). Weekly step count increased in the intervention group by 5543 steps (group difference: d=0.54; P=.05) and sedentary time decreased by a mean 348 (SD 485) minutes (group difference: d=0.47; P=.24) compared to controls, with moderately strong effect sizes. The trail making test part B improved in the intervention group (mean -35.26, SD 60.35 seconds), compared to the control group (mean 7.19, SD 46 seconds; group difference: d=0.74; P=.01). No group differences were observed in other cognitive measures. CONCLUSIONS: An individualized EMI designed for midlife and older Latino adults has the potential to replace sitting time with physical activity and improve executive functioning. The intervention was feasible and well received with a high degree of satisfaction. TRIAL REGISTRATION: ClinicalTrials.gov NCT04507464; https://tinyurl.com/44c4thk5.

Assessing the Feasibility and Acceptability of Smart Speakers in Behavioral Intervention Research With Older Adults: Mixed Methods Study.

BACKGROUND: Smart speakers, such as Amazon's Echo and Google's Nest Home, combine natural language processing with a conversational interface to carry out everyday tasks, like playing music and finding information. Easy to use, they are embraced by older adults, including those with limited physical function, vision, or computer literacy. While smart speakers are increasingly used for research purposes (eg, implementing interventions and automatically recording selected research data), information on the advantages and disadvantages of using these devices for studies related to health promotion programs is limited. OBJECTIVE: This study evaluates the feasibility and acceptability of using smart speakers to deliver a physical activity (PA) program designed to help older adults enhance their physical well-being. METHODS: Community-dwelling older adults (n=18) were asked to use a custom smart speaker app to participate in an evidence-based, low-impact PA program for 10 weeks. Collected data, including measures of technology acceptance, interviews, field notes, and device logs, were analyzed using a concurrent mixed analysis approach. Technology acceptance measures were evaluated using time series ANOVAs to examine acceptability, appropriateness, feasibility, and intention to adopt smart speaker technology. Device logs provided evidence of interaction with and adoption of the device and the intervention. Interviews and field notes were thematically coded to triangulate the quantitative measures and further expand on factors relating to intervention fidelity. RESULTS: Smart speakers were found to be acceptable for administering a PA program, as participants reported that the devices were highly usable (mean 5.02, SE 0.38) and had strong intentions to continue their use (mean 5.90, SE 0.39). Factors such as the voice-user interface and engagement with the device on everyday tasks were identified as meaningful to acceptability. The feasibility of the devices for research activity, however, was mixed. Despite the participants rating the smart speakers as easy to use (mean 5.55, SE 1.16), functional and technical factors, such as Wi-Fi connectivity and appropriate command phrasing, required the provision of additional support resources to participants and potentially impaired intervention fidelity. CONCLUSIONS: Smart speakers present an acceptable and appropriate behavioral intervention technology for PA programs directed at older adults but entail additional requirements for resource planning, technical support, and troubleshooting to ensure their feasibility for the research context and for fidelity of the intervention.

Comparing Physical Activity and Exercise Experiences, Values, and Beliefs of Latino, Latina, and/or Latine People and Non-Latino, Non-Latina, and/or Non-Latine People With Parkinson Disease: A Qualitative Study.

OBJECTIVE: The objective of this study was to examine and compare the beliefs, values, experiences, and barriers to and facilitators of exercise in Latino/a/e (Latino, Latina, and/or Latine) people and non-Latino/a/e (non-Latino, non-Latina, and/or non-Latine) people with Parkinson disease (PD). METHODS: This study involved a qualitative research design with data collection via focus groups of Latino/a/e and non-Latino/a/e people with PD. A semistructured interview protocol was used, and a theoretical (social ecological model) thematic analysis was used for data analysis. RESULTS: Twenty-five individuals (15 non-Latino/a/e and 10 Latino/a/e) participated across 5 focus groups. While there were several common themes among both groups, 7 themes related to exercise in the management of PD were unique to Latino/a/e participants: generalized versus specific knowledge of exercise components; family can have both facilitating and impeding roles; finances influence access to exercise and physical therapy; prior emotional experiences related to exercise and PD affect the future use of exercise; group exercise can have both facilitating and impeding roles; availability and access to a variety of modes and stratification of exercise classes for people with PD facilitate exercise; and cultural beliefs and expectations can impede the use of exercise at the population level. CONCLUSION: Latino/a/e people with PD have overlapping and unique themes related to the use of exercise. Distinctive factors must be addressed in physical activity interventions and during physical therapists' care of people with PD to maximize the use of exercise and ultimately improve health equity in this overburdened and underserved population. IMPACT: Physical therapists should provide information and education to their Latino/a/e patients with PD and family members on the frequency, intensity, type, and time of exercise and how to safely participate in physical activity in the home and community to best manage PD. Physical therapists and exercise professionals should work at the environmental level to increase access to affordable, culturally tailored, PD-specific exercise services and enhance community knowledge of PD.

Bridging the gap: Multi-omics profiling of brain tissue in Alzheimer's disease and older controls in multi-ethnic populations.

INTRODUCTION: Multi-omics studies in Alzheimer's disease (AD) revealed many potential disease pathways and therapeutic targets. Despite their promise of precision medicine, these studies lacked Black Americans (BA) and Latin Americans (LA), who are disproportionately affected by AD. METHODS: To bridge this gap, Accelerating Medicines Partnership in Alzheimer's Disease (AMP-AD) expanded brain multi-omics profiling to multi-ethnic donors. RESULTS: We generated multi-omics data and curated and harmonized phenotypic data from BA (n = 306), LA (n = 326), or BA and LA (n = 4) brain donors plus non-Hispanic White (n = 252) and other (n = 20) ethnic groups, to establish a foundational dataset enriched for BA and LA participants. This study describes the data available to the research community, including transcriptome from three brain regions, whole genome sequence, and proteome measures. DISCUSSION: The inclusion of traditionally underrepresented groups in multi-omics studies is essential to discovering the full spectrum of precision medicine targets that will be pertinent to all populations affected with AD. HIGHLIGHTS: Accelerating Medicines Partnership in Alzheimer's Disease Diversity Initiative led brain tissue profiling in multi-ethnic populations. Brain multi-omics data is generated from Black American, Latin American, and non-Hispanic White donors. RNA, whole genome sequencing and tandem mass tag proteomicsis completed and shared. Multiple brain regions including caudate, temporal and dorsolateral prefrontal cortex were profiled.

Correlates of missed or late versus timely diagnosis of dementia in healthcare settings.

INTRODUCTION: There is limited evidence about factors related to the timeliness of dementia diagnosis in healthcare settings. METHODS: In five prospective cohorts at Rush Alzheimer's Disease Center, we identified participants with incident dementia based on annual assessments and examined the timing of healthcare diagnoses in Medicare claims. We assessed sociodemographic, health, and psychosocial correlates of timely diagnosis. RESULTS: Of 710 participants, 385 (or 54%) received a timely claims diagnosis within 3 years prior to or 1 year following dementia onset. In logistic regressions accounting for demographics, we found Black participants (odds ratio [OR] = 2.15, 95% confidence interval [CI]: 1.21 to 3.82) and those with better cognition at dementia onset (OR = 1.48, 95% CI: 1.10 to 1.98) were at higher odds of experiencing a diagnostic delay, whereas participants with higher income (OR = 0.89, 95% CI: 0.81 to 0.97) and more comorbidities (OR = 0.94, 95% CI: 0.89 to 0.98) had lower odds. DISCUSSION: We identified characteristics of individuals who may miss the optimal window for dementia treatment and support. HIGHLIGHTS: We compared the timing of healthcare diagnosis relative to the timing of incident dementia based on rigorous annual evaluation. Older Black adults with lower income, higher cognitive function, and fewer comorbidities were less likely to be diagnosed in a timely manner by the healthcare system.

Associations of Nativity and the Role of the Hispanic Paradox on the Cognitive Health of Older Latinos Living in the United States.

Background: US-based Latinos have lower education and income combined with higher health risks than non-Latino whites, but often 'paradoxically' evidence better health-related outcomes. Less work has investigated this paradox for cognitive-related outcomes despite nativity diversity. Objective: We evaluated cognitive aging within older Latinos of diverse nativity currently living in the US and participating in Rush Alzheimer's Disease Center studies. Methods: Participants without baseline dementia, who completed annual neuropsychological assessments (in English or Spanish) were grouped by US-born (n = 117), Mexico-born (n = 173), and born in other Latin American regions (LAr-born = 128). Separate regression models examined associations between nativity and levels of (N = 418) or change in (n = 371; maximum follow-up ∼16 years) global and domain-specific cognition. Results: Demographically-adjusted linear regression models indicated that foreign-born nativity was associated with lower levels of global cognition and select cognitive domains compared to US-born Latinos. No associations of nativity with cognitive decline emerged from demographically-adjusted mixed-effects models; however, Mexico-born nativity appeared associated with slower declines in working memory compared to other nativity groups (p-values ≥ 0.051). Mexico-born Latinos had relatively higher vascular burden and lower education levels than other nativity groups; however, this did not alter results. Conclusions: Nativity differences in baseline cognition may be due, in part, to accumulated stressors related to immigration and acculturation experienced by foreign-born Latinos which may hasten meeting criteria for dementia later in life. In contrast, Mexico-born participants' slower working memory declines, taken in the context of other participant characteristics including vascular burden, suggests the Hispanic Paradox may relate to factors with the potential to affect cognition.

Actívatexto: Feasibility and Acceptability of a Mobile Intervention That Promotes Smoking Cessation and Physical Activity among Latinos.

The purpose of this study was to assess the feasibility and acceptability of a mobile intervention that promotes smoking cessation and physical activity among Latinos living in the United States. Twenty Latino adults who smoked and did not meet recommended levels of physical activity were recruited using community-based recruitment strategies. Participants received Actívatexto, a theory-based, culturally accommodated, 12-week text messaging intervention (available in English and Spanish) that promotes smoking cessation and physical activity. Actívatexto integrates four components: (i) a text messaging program, (ii) a wearable device, (iii) an online dashboard where the research team manages participants' incoming and outgoing data from both the text messaging program and wearable device, and (iv) nicotine replacement therapies (NRT). We assessed self-reported 7-day point prevalence smoking abstinence at month 3, weekly minutes of moderate to vigorous physical activity (MVPA), pharmacotherapy adherence, and satisfaction. At baseline, participants' mean age was 47.3 years old (SD 16.0), 55% of participants were female, and 60% indicated that Spanish was their language of preference. Seventy-five percent of participants smoked 1-10 cigarettes daily and 35% smoked their first cigarette within 5 minutes after waking up. At month 3, 14 participants (70%) self-reported 7-day point prevalence smoking abstinence (90% follow-up rate). Fitbit-assessed mean minutes of MVPA per week increased from 113 (SD 127; range: 0-399) at week 1 to 177 (SD 163; range: 0-513) at month 3 (P = 0.15). Sixteen participants (88.9%, 16/18) reported NRT use in the past 90 days. Most participants reported being extremely satisfied or satisfied with the intervention (88.9%, 16/18). SIGNIFICANCE: Actívatexto resulted in a noteworthy cessation rate at month 3 (70%), increased mean weekly minutes of MVPA, produced high use of NRT, and was well received by participants. Additional testing in a randomized clinical trial is warranted to assess the efficacy of the intervention.

Bridging the Gap: Multi-Omics Profiling of Brain Tissue in Alzheimer's Disease and Older Controls in Multi-Ethnic Populations.

INTRODUCTION: Multi-omics studies in Alzheimer's disease (AD) revealed many potential disease pathways and therapeutic targets. Despite their promise of precision medicine, these studies lacked African Americans (AA) and Latin Americans (LA), who are disproportionately affected by AD. METHODS: To bridge this gap, Accelerating Medicines Partnership in AD (AMP-AD) expanded brain multi-omics profiling to multi-ethnic donors. RESULTS: We generated multi-omics data and curated and harmonized phenotypic data from AA (n=306), LA (n=326), or AA and LA (n=4) brain donors plus Non-Hispanic White (n=252) and other (n=20) ethnic groups, to establish a foundational dataset enriched for AA and LA participants. This study describes the data available to the research community, including transcriptome from three brain regions, whole genome sequence, and proteome measures. DISCUSSION: Inclusion of traditionally underrepresented groups in multi-omics studies is essential to discover the full spectrum of precision medicine targets that will be pertinent to all populations affected with AD.

Addressing Cognitive Assessment Disparities Among Hispanic Adults: Adapting the MoCA-SA for Improved Accuracy and Accessibility Among Spanish-speakers.

OBJECTIVES: Hispanic adults display a higher likelihood of early-stage cognitive decline than their White counterparts yet receive fewer clinical diagnoses. This troubling trend highlights the significance of longitudinal surveys like the National Social Life, Health, and Aging Project (NSHAP) in monitoring cognitive changes in aging Hispanics. Using NSHAP's Rounds 2 and 3, we observed notable cognitive score differences between English and Spanish speakers, as assessed by the survey-adapted version of the Montreal Cognitive Assessment (MoCA-SA). Our study aims to discern if statistical adjustments can reduce measurement variance in global cognition scores between these language groups. METHODS: We applied modification indexes, two-parameter item response theory models, and split-sample testing to pinpoint items that exhibit resilience to language-related bias among our Hispanic sample. From this analysis, an abbreviated version of the MoCA-SA, termed MoCA-SAA, was introduced. Subsequently, we juxtaposed the performance and predictive validity of both MoCA versions against four consequential outcomes indicative of cognitive decline. RESULTS: Our refined methodologies enabled the identification of consistent items across both language cohorts. The MoCA-SAA demonstrated a performance and predictive validity in line with the original MoCA-SA concerning outcomes linked to cognitive deterioration. DISCUSSION: The translated measures ensure the inclusion of Hispanic Spanish speakers in NSHAP, who might otherwise be overlooked. The statistical adjustment outlined in this study offers a means to mitigate potential measurement disparities when assessing overall cognition. Despite these advancements, we acknowledge persistent issues related to the translation of the MoCA-SA into Spanish that warrant further attention.

Social Cognitive Theory Variables as Correlates of Physical Activity Behavior Among Hispanics With Multiple Sclerosis.

OBJECTIVE: To examine the association between social cognitive theory (SCT) variables and physical activity (PA) behavior in Hispanic adults with multiple sclerosis (MS). DESIGN: Observational, survey study. SETTING: General community. PARTICIPANTS: Inclusion criteria: (a) age 18 years or older, (b) self-identify as Hispanic or Latino, (c) diagnosis of MS, and (d) English or Spanish as primary language. Two hundred forty-three individuals opened the survey, 24 individuals did not meet inclusion criteria, and 66 individuals were excluded due to not completing any of the SCT variable measures (N=153). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE(S): PA was measured using the Godin Leisure Time Exercise Questionnaire (GLTEQ) total and Health Contribution Scores (HCS). SCT variables included standard measures of exercise self-efficacy, planning, goal setting, outcome expectations, social support, and functional impairment. RESULTS: The final sample included 153 participants with a mean (SD) age of 43 (11) years, 78% identified as women, 57% were employed, and 63% had a college degree or higher. The mean (SD) MS disease duration was 11 (9) years, 74% of participants reported relapsing remitting MS, and median (interquartile range) Patient Determined Disease Steps (PDDS) score was 3.0 (3.0). Significant correlations were observed between all SCT variables and both GLTEQ total and GLTEQ HCS scores (P<.001). Forward stepwise regression with Akaike's Information Criterion (AICC) identified PDDS, age, exercise planning, exercise self-efficacy, and exercise goal setting as the most appropriate covariates and SCT variables to include in a multivariable model examining independent contributions on GLTEQ HCS scores. The multivariable, linear regression analysis indicated that PDDS (Standardized B=-.280, P<.001), exercise planning (Standardized B=.214, P<.05), and exercise self-efficacy (Standardized B=.183, P<.05) explained 42.4% of variance in GLTEQ HCS scores. CONCLUSIONS: This study provides a contribution to the literature by identifying SCT variables that correlate with PA behavior among Hispanics with MS that may guide the creation of culturally appropriate PA programs.

Sociodemographic disparities in sedentary time among US youth vary by period of the day.

INTRODUCTION: Studies have reported sex and race/ethnicity disparities in sedentary time (ST), but none have evaluated ST by well-defined periods of the weekday (before school, during school, afterschool, and evening) and weekend day (morning, afternoon, and evening). Comparing sex and race/ethnicity disparities in ST at different periods of a weekday and weekend day can deepen our understanding of disparities and inform intervention efforts. This study tests sex and race/ethnicity disparities in ST by period of day in a representative sample of US youth. METHODS: Youth (N = 2,972) from the 2003-2006 NHANES waves reported demographic variables and wore an accelerometer for 7 consecutive days to assess ST. Linear regressions were conducted to test relationships between sex and race/ethnicity and ST (min/hour) during each period of a weekday and weekend day. ST differences by sex and race/ethnicity were calculated to identify the periods of the day presenting the largest opportunity to reduce disparities. RESULTS: Females were more sedentary than males during school (p < 0∙0001), afterschool (p < 0∙0001), and weekday evenings (p < 0∙0001) after controlling for covariates. After controlling for covariates, race/ethnicity only was a significant predictor of ST during weekend mornings (p < 0∙0001). During school and afterschool emerged as the periods with the largest opportunities to reduce sex disparities in ST. Weekend mornings were identified as the largest opportunity to reduce race/ethnic disparities in ST. CONCLUSIONS: Sex disparities in ST appear to be driven mostly by the during school period of the day, while race/ethnic disparities in ST seem to be driven by the weekend morning period. Future intervention work should consider these periods when aiming to reduce ST disparities in youth.

Latin Dance Effects on Cardiorespiratory Fitness and Physical Function in Middle-Aged and Older Latino Adults.

We tested if a dance trial yielded improvements in physical function and cardiorespiratory fitness (CRF) in middle-aged/older Latino adults. Physical activity was assessed using the Community Healthy Activities Model Program for Seniors, physical function with the Short Physical Performance Battery (SPPB) protocol, and estimated CRF with the Jurca nonexercise test model. Multivariate analysis of covariance models found significant change in SPPB protocol total scores, F(1, 329) = 4.23, p = .041, and CRF, F(1, 329) = 5.16, p = .024, between the two study arms in favor of the dance group. Mediation models found moderate- to vigorous-intensity physical activity to mediate to mediate between group and SPPB scores (ß = 0.054, 95% confidence interval [0.0142, 0.1247]). Moderate- to vigorous-intensity physical activity and total physical activity were found to partially mediate between group and CRF (ß = 0.02, 95% confidence interval [-0.0261, 0.0751]), with the direct pathway no longer being significant (p > .05). This provides support for Latin dance programs to have an effect on SPPB protocol and CRF.

Acculturation in Context and Brain Health in Older Latino Adults: A Diffusion Tensor Imaging Study.

BACKGROUND: Latinos are at higher risk of developing mild cognitive impairment (MCI) and Alzheimer's disease than non-Latino Whites. Acculturation factors may influence this risk, yet there are few studies that have examined associations of acculturation, particularly in the context of socioenvironmental and familial factors, and brain health in older Latinos. OBJECTIVE: To examine potential associations between acculturation in context and brain health in older Latinos. METHODS: Using three previously established composites of acculturation-in-context, (acculturation-related: nativity status, language preference, acculturation scores; contextually-related socioenvironmental: perceived discrimination, loneliness/social isolation, social network size; and familism), and diffusion-tensor imaging (DTI), associations with white matter structural integrity were examined in 92 Latino adults without dementia participating in one of three epidemiological studies of aging. Linear regression models were used to test associations with DTI-derived metrics (fractional anisotropy, FA; trace) as separate outcomes and acculturation composite scores as individual predictors, while adjusting for age, sex, education, scanner, and white matter hyperintensities (voxelwise and total volumes normalized by intracranial volume). RESULTS: Higher scores on the socioenvironmental composite were associated with lower FA in two clusters of left-hemisphere connections. Cluster 1 was dominated by both short association pathways connecting frontal regions and projection pathways connecting frontal regions with the thalamus. Cluster 2 was dominated by long association pathways connecting parietal, frontal, and temporal regions. CONCLUSIONS: This study of older Latino adults demonstrated an association between reduced brain white matter integrity and contextually related socioenvironmental experiences known to increase risk of MCI and Alzheimer's disease.

Characterizing longitudinal change in accelerometry-based moderate-to-vigorous physical activity in the Hispanic Community Health Study/Study of Latinos and the Framingham Heart Study.

BACKGROUND: Physical activity promotes health and is particularly important during middle and older age for decreasing morbidity and mortality. We assessed the correlates of changes over time in moderate-to-vigorous physical activity (MVPA) in Hispanic/Latino adults from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL: mean [SD] age 49.2 y [11.5]) and compared them to a cohort of primarily White adults from the Framingham Heart Study (FHS: mean [SD] 46.9 y [9.2]). METHODS: Between 2008 and 2019, we assessed accelerometry-based MVPA at two time points with an average follow-up of: 7.6 y, SD 1.3 for HCHS/SOL, and 7.8 y, SD 0.7 for FHS. We used multinomial logistic regression to relate socio-demographic and health behaviors with changes in compliance with 2018 US recommendations for MVPA from time 1 to time 2 (remained active or inactive; became active or inactive) across the two cohorts. RESULTS: In HCHS/SOL mean MVPA was 22.6 (SD, 23.8) minutes at time 1 and dropped to 16.7 (19.0) minutes at time 2. In FHS Mean MVPA was 21.7 min (SD, 17.7) at time 1 and dropped to 21.3 min (SD, 19.2) at time 2. Across both cohorts, odds of meeting MVPA guidelines over time were about 6% lower in individuals who had lower quality diets vs. higher, about half in older vs. younger adults, about three times lower in women vs. men, and 9% lower in individuals who had a higher vs. lower BMI at baseline. Cohorts differed in how age, gender, income, education, depressive symptoms, marital status and perception of general health and pain associated with changes in physical activity. High income older Hispanics/Latino adults were more likely to become inactive at the follow-up visit as were HCHS/SOL women who were retired and FHS participants who had lower levels of education and income. Higher depressive symptomology was associated with becoming active only in HCHS/SOL women. Being male and married was associated with becoming inactive in both cohorts. Higher perception of general health and lower perception of pain were associated with remaining active only in FHS adults. CONCLUSIONS: These findings highlight potentially high-risk groups for targeted MVPA intervention.

Day-of-the-Week and Time-of-the-Day Patterns of Sedentary Behavior in the Hispanic Community Health Study/Study of Latinos.

PURPOSE: Existing sedentary behavior interventions have largely achieved mixed results. Conventionally, interventions have attempted to reduce sedentary behavior using a full-day approach. An alternative strategy may be to target specific periods during the day and/or week. This study examined the day-of-the-week (Monday to Sunday) and time-of-the-day patterns (3-and 6-h periods) of sedentary behavior among U.S. Hispanics/Latinos adults. METHODS: Participants ( n = 12,241) from the Hispanic Community Health Study/Study of Latinos, a multisite community-based prospective cohort study of Hispanic/Latino adults, were studied. Sedentary behavior was assessed for 1 wk using a hip-mounted accelerometer through total sedentary time, sedentary time in bouts ≥60 min, and total number of sedentary breaks. The temporal patterns of sedentary behavior metrics were evaluated using linear mixed effect models accounting for the Hispanic Community Health Study/Study of Latinos complex survey design. RESULTS: There were statistically significant variations in temporal patterns across day-of-the-week and time-of-the-day periods for all three metrics ( P < 0.001). Adults were more sedentary on weekends than on weekdays and most sedentary on Sundays. The time-of-the-day patterns had a U-curve pattern wherein adults were most sedentary late at night, became less sedentary throughout the day, reached peak activeness around noon, then gradually became more sedentary into the evening. These patterns were largely robust across seasonality and most sociodemographic characteristics, including age, employment status, work shift schedule, acculturation, and field center. CONCLUSIONS: Our findings suggest that early mornings, evenings, and weekends were the more sedentary periods in this cohort of Hispanic/Latino adults, characterized by higher volumes of sedentary time, higher volumes of time in prolonged sedentary bouts, and fewer number of sedentary breaks than other time periods, highlighting important windows of opportunity to reduce sedentary behavior.

A call to address structural barriers to Hispanic/Latino representation in clinical trials on Alzheimer's disease and related dementias: A micro-meso-macro perspective.

Introduction: This perspective paper addresses the US Hispanic/Latino (herein, Latino) experience with regards to a significant public health concern-the underrepresentation of Latino persons in Alzheimer's disease and related dementias (AD/ADRD) clinical trials. Latino individuals are at increased risk for AD/ADRD, experience higher disease burden, and low receipt of care and services. We present a novel theoretical framework-the Micro-Meso-Macro Framework for Diversifying AD/ADRD Trial Recruitment-which considers multi-level barriers and their impact on Latino trial recruitment. Methods: Based on a review of the peer-reviewed literature and our lived experience with the Latino community, we drew from our interdisciplinary expertise in health equity and disparities research, Latino studies, social work, nursing, political economy, medicine, public health, and clinical AD/ADRD trials. We discuss factors likely to impede or accelerate Latino representation, and end with a call for action and recommendations for a bold path forward. Results: In the 200+ clinical trials conducted with over 70,000 US Americans, Latino participants comprise a fraction of AD/ADRD trial samples. Efforts to recruit Latino participants typically address individual- and family-level factors (micro-level) such as language, cultural beliefs, knowledge of aging and memory loss, limited awareness of research, and logistical considerations. Scientific efforts to understand recruitment barriers largely remain at this level, resulting in diminished attention to upstream institutional- and policy-level barriers, where decisions around scientific policies and funding allocations are ultimately made. These structural barriers are comprised of inadequacies or misalignments in trial budgets, study protocols, workforce competencies, healthcare-related barriers, criteria for reviewing and approving clinical trial funding, criteria for disseminating findings, etiological focus and social determinants of health, among others. Conclusion: Future scientific work should apply and test the Micro-Meso-Macro Framework for Diversifying AD/ADRD Trial Recruitment to examine structural recruitment barriers for historically underrepresented groups in AD/ADRD research and care.

Neighborhood-level social vulnerability and individual-level cognitive and motor functioning over time in older non-Latino Black and Latino adults.

Introduction: Despite known health disparities in cognitive aging, a comprehensive rationale for the increased burden in older minoritized populations including non-Latino Black and Latino adults has yet to be elucidated. While most work has focused on person-specific risk, studies are increasingly assessing neighborhood-level risk. We evaluated multiple aspects of the environmental milieu that may be critical when considering vulnerability to adverse health outcomes. Methods: We investigated associations between a Census-tract derived Social Vulnerability Index (SVI) and level of and change in cognitive and motor functioning in 780 older adults (590 non-Latino Black adults, ∼73 years old at baseline; 190 Latinos, ∼70 years old baseline). Total SVI scores (higher = greater neighborhood-level vulnerability) were combined with annual evaluations of cognitive and motor functioning (follow-up ranged from 2 to 18 years). Demographically-adjusted mixed linear regression models tested for associations between SVI and cognitive and motor outcomes in analyses stratified by ethno-racial group. Results: For non-Latino Black participants, higher SVI scores were associated with lower levels of global cognitive and motor functioning-specifically, episodic memory, motor dexterity and gait-as well as longitudinal change in visuospatial abilities and hand strength. For Latinos, higher SVI scores were associated with lower levels of global motor functioning only-specifically, motor dexterity; there were no significant associations between SVI and change in motor functioning. Discussion: Neighborhood-level social vulnerability is associated with cognitive and motor functioning in non-Latino Black and Latino older adults, although associations appear to contribute to level more so than longitudinal change.

Stability and change in acculturation-related characteristics in older Latinos: Implications for culturally compatible ADRD research.

Introduction: Acculturation-related characteristics, that is, factors directly connected to culture and familial relationships, are associated with engaged research participation within Latino communities. Despite this, little empirical data exists on whether acculturation changes over time in older Latinos, which has potential implications for Alzheimer's disease and related dementias (ADRD) research study design including longer duration clinical trial implementation. Methods: Self-identified Latinos (n = 222; mean age = 71, 76% female) participating in one of three ongoing longitudinal community-based cohort studies of aging who reported their nativity outside of the United States/District of Columbia (US/DC) contributed, on average, 4.0 ± 1.2 years of annually collected data. This included acculturation-related characteristics of total, language-, and social-based scores from the Short Acculturation Scale for Hispanics (SASH) and total and domain-specific scores from an abbreviated Sabogal Familism questionnaire. We used ordinal mixed effects models and linear mixed effects models (as appropriate) to assess change in acculturation metrics after adjusting for age, sex, education, income, and duration of time in the US/DC. Results: Although none of the SASH metrics changed over time (P-values ≥ 0.25), all Familism metrics declined over time (P-values ≤ 0.044). Additionally, select participant-based characteristics including years of education were significantly (and differentially) associated with level of, but not change in, acculturation-related outcomes. Discussion: Results suggest that specific acculturation-related factors (i.e., familism) change over time in older Latinos, and participant-based characteristics associated with baseline levels of (but not change in) acculturation more generally. Thus, acculturation-related characteristics are not all static, trait-like qualities but rather a multi-faceted, and at times evolving, construct. Considering this dynamic phenotyping is important when contextualizing older Latinos' lived experience, and when designing, adapting, and conducting ADRD clinical trials and other health-related interventions.