The Effect of Self-Reported Visual Impairment and Sleep on Cognitive Decline: Results of the Hispanic Community Health Study/Study of Latinos.

BACKGROUND: Visual impairment could worsen sleep/wake disorders and cognitive decline. OBJECTIVE: To examine interrelations among self-reported visual impairment, sleep, and cognitive decline in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Miami-site. METHOD: HCHS/SOL Miami-site participants ages 45-74 years (n = 665) at Visit-1, who returned for cognitive test 7-years later (SOL-INCA). Participants completed the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ), validated sleep questionnaires and test for obstructive sleep apnea (OSA) at Visit-1. We obtained verbal episodic learning and memory, verbal fluency, processing speed, and executive functioning at Visit-1 and at SOL-INCA. Processing speed/executive functioning were added to SOL-INCA. We examined global cognition and change using a regression-based reliable change index, adjusting for the time lapse between Visit-1 and SOL-INCA. We used regression models to test whether 1) persons with OSA, self-reported sleep duration, insomnia, and sleepiness have an increased risk for visual impairment, 2a) visual impairment is associated with worse cognitive function and/or decline, and 2b) sleep disorders attenuate these associations. RESULT: Sleepiness (ß= 0.04; p < 0.01) and insomnia (ß= 0.04; p < 0.001) were cross-sectionally associated with visual impairment, adjusting for sociodemographic characteristics, behavioral factors, acculturation, and health conditions. Visual impairment was associated with lower global cognitive function at Visit-1 (ß= -0.16; p < 0.001) and on average 7-years later (ß= -0.18; p < 0.001). Visual impairment was also associated with a change in verbal fluency (ß= -0.17; p < 0.01). OSA, self-reported sleep duration, insomnia, and sleepiness did not attenuate any of the associations. CONCLUSION: Self-reported visual impairment was independently associated with worse cognitive function and decline.

The relationship of semantic intrusions to different etiological subtypes of MCI and cognitively healthy older adults.

INTRODUCTION: There is increasing evidence that susceptibility to proactive semantic interference (PSI) and the failure to recover from PSI (frPSI) as evidenced by intrusion errors may be early cognitive markers of both preclinical and prodromal Alzheimer's disease (AD). METHODS: One hundred forty-five participants were administered extensive clinical and neuropsychological evaluations including the Loewenstein-Acevedo Scales for Semantic Interference and Learning (LASSI-L), a sensitive cognitive stress test measuring PSI and frPSI. Participants also underwent structural magnetic resonance imaging (MRI) and amyloid positron emission tomography/computed tomography (PET/CT) imaging. RESULTS: PSI and frPSI errors were much more prevalent in the mild cognitive impairment (MCI)-AD (amyloid positive) group than the other diagnostic groups. The number of intrusion errors observed across the other MCI groups without amyloid pathology and those with normal cognition were comparable. DISCUSSION: Semantic intrusion errors on the LASSI-L occur much less frequently in persons who have different types of non-AD-related MCI and may be used as an early cognitive marker of prodromal AD.

A Brief Version of the LASSI-L Detects Prodromal Alzheimer's Disease States.

BACKGROUND: The Loewenstein-Acevedo Scales for Semantic Interference and Learning (LASSI-L) is an increasingly utilized cognitive stress test designed to identify early cognitive changes associated with incipient neurodegenerative disease. OBJECTIVE: To examine previously derived cut-points for cognitively unimpaired older adults that were suggestive of performance impairment on multiple subscales of the LASSI-L. These cut-points were applied to a new sample of older adults who were cognitive healthy controls (HC: n = 26) and those on the Alzheimer's disease (AD) continuum from early stage mild cognitive impairment (EMCI: n = 28), late stage MCI (LMCI: n = 18) to mild AD (AD: n = 27). METHODS: All participants were administered the LASSI-L. All cognitively impaired participants were PET amyloid positive which likely reflects underlying AD neuropathology, while cognitively normal counterparts were deemed to have amyloid negative scans. RESULTS: There was a monotonic relationship between the number of deficits on LASSI-L subscales and independent classification of study groups with greater severity of cognitive impairment. Importantly, taken together, impairment on maximum learning ability and measures of proactive semantic interference (both reflected by cued recall and intrusion errors) correctly classified 74.1% of EMCI, 94.4% of LMCI, and 96.3% of AD. Only 7.7% of HC were incorrectly classified as having impairments. CONCLUSION: A modest number of LASSI-L subscales taking approximately 8 minutes to administer, had excellent discriminative ability using established cut-offs among individuals with presumptive stages of AD. This has potential implications for both clinical practice and clinical research settings targeting AD during early prodromal stages.

Preliminary Evaluation of the NIAAA/AAP Brief Alcohol Use Screener.

AIMS: To assess the concurrent validity of the two-item NIAAA/American Academy of Pediatrics Brief Alcohol Use Screener, a developmentally sensitive assessment instrument, in a school-based sample of adolescents. METHOD: The sample consisted of 756 adolescents (53% girls; Mage = 13.7 years; SD = 1.6 years) in the 6th (n = 192), 8th (n = 283), and the 10th (n = 281) grades from Miami-Dade County, FL and Prince George's County, MD. Adolescents completed the NIAAA/AAP Brief Alcohol Use Screener, which consists of two items asking about adolescents' alcohol use and about peers' alcohol use during the last year. Peer-Risk is categorized into 'No Peer-Risk' versus 'Heightened Concern'; Self-Risk is categorized into 'No-Risk,' 'Low-Risk,' 'Moderate-Risk' or 'High-Risk,' based on alcohol use patterns and age. Adolescents also completed measures of recent alcohol use and four previously validated screener instruments. RESULTS: Relative to the self-use 'No-Risk' category, adolescents classified into the 'Low-,' 'Moderate-' and 'High-Risk' categories reported progressively greater alcohol use and misuse during the last 90 days. Similar patterns were observed between the Peer-Risk categories. Combined, the two NIAAA/AAP screener items were positively related to recent alcohol use and outperformed the other screeners examined. CONCLUSIONS: Results from the present study support the concurrent validity of the single and combined items of the NIAAA/AAP Brief Alcohol Use Screener, as well as the measure's favorable concurrent validity compared to four previously validated screener instruments. SHORT SUMMARY: The current results support the concurrent validity of the single and combined items of the NIAAA/AAP Brief Alcohol Use Screener, as well as the measure's favorable concurrent validity compared to four previously validated screener instruments, in a school-based sample of adolescents.

Linkage of 1986-2009 National Health Interview Survey with 1981-2010 Florida Cancer Data System.

BACKGROUND: National survey data linked with state cancer registry data has the potential to create a valuable tool for cancer prevention and control research. A pilot project-developed in a collaboration of the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS) and the Florida Cancer Data System (FCDS) at the University of Miami -links the records of the 1986-2009 National Health Interview Survey (NHIS) and the 1981-2010 FCDS. The project assesses the feasibility of performing a record linkage between NCHS survey data and a state-based cancer registry, as well as the value of the data produced. The linked NHIS-FCDS data allow researchers to follow NHIS survey participants longitudinally to examine factors associated with future cancer diagnosis, and to assess the characteristics and quality of life among cancer survivors. METHODS: This report provides a preliminary evaluation of the linked national and state cancer data and examines both analytic issues and complications presented by the linkage. CONCLUSIONS: Residential mobility and the number of years of data linked in this project create some analytic challenges and limitations for the types of analyses that can be conducted. However, the linked data set offers the ability to conduct analyses not possible with either data set alone.

Age-related macular degeneration and smoking cessation advice by eye care providers: a pilot study.

Smoking is a modifiable risk factor for age-related macular degeneration (AMD), the leading cause of irreversible vision loss in the United States. We conducted a pilot study among eye care providers and AMD patients to assess smoking cessation preferences and cessation services offered at a large academic medical center. Most patients who smoke reported never being advised to quit smoking, although most eye care providers reported that they had advised smokers to quit. Two-thirds of providers expressed a desire for additional training and resources to support patient quit attempts, indicating the need for the integration of smoking cessation opportunities in the clinic setting.

Sensory impairment among older US workers.

We used 1997-2004 National Health Interview Survey data to evaluate the prevalence of sensory impairment among US workers 65 years and older. Hearing impairment prevalence was 3 times that of visual impairment (33.4% vs 10.2%), and 38% of older workers reported experiencing either impairment. Farm operators, mechanics, and motor vehicle operators had the highest prevalence of sensory impairment. Workplace screening and accommodations, including sensory protection devices for older workers, are warranted given the greater risk for injuries among the sensory impaired.

Trends in reported visual impairment in United States adults.

The purpose of this study was to assess if rates of reported visual impairment (VI) in the United States (US) are declining. The 1997-2005 National Health Interview Survey is an annual probability survey of US households (n = 289,442 adults 18 years of age and older). Participants responding yes to either question were classified as visually impaired: 1) "Do you have any trouble seeing, even when wearing glasses or contact lenses?" 2) "Are you blind or unable to see at all?" Prevalence rates were adjusted for survey design; weighted linear regression models were used to examine VI trends. Annual rates of any VI ranged from 8.6% to 10.0% with a non-significant annual downward trend of -0.04%. Significant downward trends were noted in adults who reported an eye care provider contact in the previous 12 months (-0.18%; [standard error = 0.08], p = 0.047), adults with diabetes (-0.81%; [standard error = 0.30], p = 0.01) and adults 80 years of age and older (-0.46% [0.19]; p = 0.021). Pooled analyses with adjustment for sociodemographic and diabetes status suggested that reductions in VI tended to occur in adults with eye care provider contacts. Downward trends in reported VI in older adults may be due to improvements in the treatment of ocular disease, increased eye care utilization in those with VI, or both. These findings require verification in population-based studies with clinical acuity measures in order to specifically assess the effect of eye care utilization on VI prevalence trends.

National Health Interview Survey mortality among US farmers and pesticide applicators.

BACKGROUND: The mortality experience of pesticide-exposed workers across the US has not been thoroughly studied. METHODS: Cox regression mortality analyses adjusted for the complex sample survey design were performed on mortality-linked 1986-1994 National Health Interview Survey (NHIS) data. RESULTS: Nine thousand four hundred seventy-one farmers and pesticide applicators with 571 deaths were compared to 438,228 other US workers with 11,992 deaths. Age-adjusted risk of accidental death, as well as cancers of the nervous and lymphatic/hematopoietic systems, was significantly elevated in male and female pesticide-exposed workers; breast, prostate, and testicular cancer mortality risks were not elevated. CONCLUSIONS: Compared to all other workers, farmers and pesticide applicators were at greater risk of accidental mortality. These pesticide-exposed workers were not at an increased risk of cancers possibly associated with exposure to estrogen analogue compounds, but were at an increased risk of hematopoietic and nervous system cancers. NHIS mortality follow-up represents an important occupational health surveillance instrument.