Anticholinergic Medication Burden and Cognitive Subtypes in Parkinson's Disease without Dementia.

OBJECTIVE: Cognitive changes are heterogeneous in Parkinson's disease (PD). This study compared whether anticholinergic burden drives differences in cognitive domain performance and empirically-derived PD-cognitive phenotypes. METHOD: A retrospective chart review contained participants (n = 493) who had idiopathic PD without dementia. Participants' medications were scored (0-3) and summed based on the anticholinergic cognitive burden scale (ACBS). We examined the ACBS' relationship to five cognitive domain composites (normative z-scores) and three (K-means clustering based) cognitive phenotypes: cognitively intact, low executive function (EF), and predominately impaired EF/memory. Analyses included Spearman correlations, analysis of covariance, and Pearson chi-squared test. RESULTS: Overall, phenotypes did not differ in anticholinergic burden, and (after false-discovery-rate corrections) no cognitive domains related. When comparing those above and below the clinically relevant ACBS cutoff (i.e., score ≥3), no significant phenotype or domain differences were found. CONCLUSIONS: Anticholinergic medication usage did not drive cognitive performance in a large clinical sample of idiopathic PD without dementia.

Comparative study of machine learning methods for modeling associations between risk factors and future dementia cases.

A substantial portion of dementia risk can be attributed to modifiable risk factors that can be affected by lifestyle changes. Identifying the contributors to dementia risk could prove valuable. Recently, machine learning methods have been increasingly applied to healthcare data. Several studies have attempted to predict dementia progression by using such techniques. This study aimed to compare the performance of different machine-learning methods in modeling associations between known cognitive risk factors and future dementia cases. A subset of the AGES-Reykjavik Study dataset was analyzed using three machine-learning methods: logistic regression, random forest, and neural networks. Data were collected twice, approximately five years apart. The dataset included information from 1,491 older adults who underwent a cognitive screening process and were considered to have healthy cognition at baseline. Cognitive risk factors included in the models were based on demographics, MRI data, and other health-related data. At follow-up, participants were re-evaluated for dementia using the same cognitive screening process. Various performance metrics for all three machine learning algorithms were assessed. The study results indicate that a random forest algorithm performed better than neural networks and logistic regression in predicting the association between cognitive risk factors and dementia. Compared to more traditional statistical analyses, machine-learning methods have the potential to provide more accurate predictions about which individuals are more likely to develop dementia than others.

Identifying Game-Based Digital Biomarkers of Cognitive Risk for Adolescent Substance Misuse: Protocol for a Proof-of-Concept Study.

BACKGROUND: Adolescents at risk for substance misuse are rarely identified early due to existing barriers to screening that include the lack of time and privacy in clinic settings. Games can be used for screening and thus mitigate these barriers. Performance in a game is influenced by cognitive processes such as working memory and inhibitory control. Deficits in these cognitive processes can increase the risk of substance use. Further, substance misuse affects these cognitive processes and may influence game performance, captured by in-game metrics such as reaction time or time for task completion. Digital biomarkers are measures generated from digital tools that explain underlying health processes and can be used to predict, identify, and monitor health outcomes. As such, in-game performance metrics may represent digital biomarkers of cognitive processes that can offer an objective method for assessing underlying risk for substance misuse. OBJECTIVE: This is a protocol for a proof-of-concept study to investigate the utility of in-game performance metrics as digital biomarkers of cognitive processes implicated in the development of substance misuse. METHODS: This study has 2 aims. In aim 1, using previously collected data from 166 adolescents aged 11-14 years, we extracted in-game performance metrics from a video game and are using machine learning methods to determine whether these metrics predict substance misuse. The extraction of in-game performance metrics was guided by literature review of in-game performance metrics and gameplay guidebooks provided by the game developers. In aim 2, using data from a new sample of 30 adolescents playing the same video game, we will test if metrics identified in aim 1 correlate with cognitive processes. Our hypothesis is that in-game performance metrics that are predictive of substance misuse in aim 1 will correlate with poor cognitive function in our second sample. RESULTS: This study was funded by National Institute on Drug Abuse through the Center for Technology and Behavioral Health Pilot Core in May 2022. To date, we have extracted 285 in-game performance metrics. We obtained institutional review board approval on October 11, 2022. Data collection for aim 2 is ongoing and projected to end in February 2024. Currently, we have enrolled 12 participants. Data analysis for aim 2 will begin once data collection is completed. The results from both aims will be reported in a subsequent publication, expected to be published in late 2024. CONCLUSIONS: Screening adolescents for substance use is not consistently done due to barriers that include the lack of time. Using games that provide an objective measure to identify adolescents at risk for substance misuse can increase screening rates, early identification, and intervention. The results will inform the utility of in-game performance metrics as digital biomarkers for identifying adolescents at high risk for substance misuse. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/46990.

Gender Differences in Sexual Coercion Perpetration: Investigating the Role of Alcohol-use and Cognitive Risk Factors.

Studies have shown that alcohol is involved in 50 to 75% of all sexual coercion situations. Significant associations have been established between alcohol-use and sexual coercion perpetration and cognitive factors have been proposed to play an important role in this association. However, the current knowledge on the relationship between alcohol-use, cognitive factors, and sexual coercion perpetration is mostly based on male samples. Therefore, the purpose of this article is to investigate gender differences associated with the role of alcohol-use and cognitive factors in sexual coercion perpetration. To do so, 742 participants (562 women, 180 men) completed an online questionnaire assessing (1) alcohol-use, (2) perpetration of sexual coercion, and (3) cognitions related to sexuality or alcohol (misperception of sexual intent, alcohol-related expectancies, alcohol-related rape myth acceptance [RMA]). Results revealed that (1) for both men and women, alcohol-use as well as cognitive variables allowed to discriminate perpetrators from non-perpetrators, (2) perpetrators, whether male or female, did not differ significantly on any of the risk factors, except for alcohol-related RMA, (3) a prediction model that considered cognitive variables, as well as alcohol-use significantly contributed to the explanation of both male and female sexual coercion, and (4) the prediction model explained three times the amount of variance in sexual coercion perpetrated by men compared to women. On the one hand, these results highlight similarities in risk factors towards sexual coercion perpetration for both men and women. Perpetrators, regardless of their gender, seem to exhibit similar alcohol-use, alcohol-related expectancies, and tendencies to misinterpret sexual intent, making these risk factors potential prevention and intervention targets for both genders. On the other hand, these results emphasize the need to break away from male-based sexual coercion explanatory models and consider other variables towards a better understanding of female sexual coercion perpetration.

Testing the Effectiveness of Two Psychosocial Interventions on Socio-Cognitive Risk Factors for HIV/AIDS in Mozambican Women: A Randomized Controlled Trial.

The objective of this study was to evaluate the efficacy of two psychosocial interventions (Didactic and ACCENT) on socio-cognitive risk factors, in vulnerable Mozambican women at risk for HIV/AIDS infection. The study design was a randomized controlled trial on Mozambican women at HIV/AIDS risk (n = 150). The participants were randomized into three groups: Didactic Intervention (experimental group), ACCENT intervention (experimental group), and control group. We used an adapted version of the Women's Health Questionnaire, which includes a series of scales and questionnaires assessing psychosocial relevant dimensions to female protection towards HIV/AIDS: HIV/AIDS knowledge, condom use negotiation self-efficacy, and perceived barriers against safer sex. Both interventions were equally effective in increasing HIV/AIDS knowledge. The ACCENT intervention was especially effective in promoting condom use negotiation self-efficacy and in decreasing perceived barriers against safer sex, essential variables for sexual protection. These results support the adaptation of Western interventions to the African context.

Long-term exposure to ambient air pollution, APOE-ε4 status, and cognitive decline in a cohort of older adults in northern Manhattan.

BACKGROUND: There is mounting evidence that long-term exposure to air pollution is related to accelerated cognitive decline in aging populations. Factors that influence individual susceptibility remain largely unknown, but may involve the apolipoprotein E genotype E4 (APOE-ε4) allele. OBJECTIVES: We assessed whether the association between long-term exposure to ambient air pollution and cognitive decline differed by APOE-ε4 status and cognitive risk factors. METHODS: The Washington Heights Inwood Community Aging Project (WHICAP) is a prospective study of aging and dementia. Neuropsychological testing and medical examinations occur every 18-24 months. We used mixed-effects models to evaluate whether the association between markers of ambient air pollution (nitrogen dioxide [NO2]), fine [PM2.5], and coarse [PM10] particulate matter) and the rate of decline in global and domain-specific cognition differed across strata defined by APOE-ε4 genotypes and cognitive risk factors, adjusting for sociodemographic factors and temporal trends. RESULTS: Among 4821 participants with an average of 6 years follow-up, higher concentrations of ambient air pollution were associated with more rapid cognitive decline. This association was more pronounced among APOE-ε4 carriers (p < 0.001). A one interquartile range increase in NO2 was associated with an additional decline of 0.09 standard deviations (SD) (95%CI -0.1, -0.06) in global cognition across biennial visits among APOE-ε4 positive individuals and a 0.07 SD (95%CI -0.09, -0.05) decline among APOE-ε4 negative individuals. Results for PM2.5, PM10 and cognitive domains were similar. The association between air pollutants and rate of cognitive decline also varied across strata of race-ethnicity with the association strongest among White non-Hispanic participants. CONCLUSIONS: These results add to the body of evidence on the adverse impact of ambient air pollution on cognitive aging and brain health and provide new insights into the genetic and behavioral factors that may impact individual susceptibility.

Anxiety sensitivity mediates gender differences in post-concussive symptoms in a clinical sample.

Traumatic brain injury (TBI) is both prevalent and potentially disabling. Extant literature has demonstrated women to report greater post-concussive symptoms (PCS) compared to men, highlighting the necessity of investigations into malleable, gender-linked risk factors for PCS that hold promise for reducing this gender disparity. Anxiety Sensitivity (AS) and Distress Tolerance (DT) are gender-linked risk factors that may be related to PCS. Despite a breadth of research supporting elevated AS and reduced DT in women, no study to date has investigated whether AS and DT mediate gender differences in PCS. The current sample was composed of 59 participants selected from a larger study based on their report of a past TBI. Findings indicated that AS, but not DT, significantly mediated gender differences in PCS. The present results suggest that AS is a cognitive risk factor that can partially account for the gender disparity in the expression of PCS. AS may influence an individual's interpretation of PCS as dangerous, thereby amplifying the perception of PCS severity. This suggests that efforts to reduce the burden of TBI may benefit from targeting AS in prevention and treatment paradigms, especially among women.

The effects of autobiographical memory flexibility (MemFlex) training: An uncontrolled trial in individuals in remission from depression.

BACKGROUND AND OBJECTIVES: Impaired cognitive processing is a key feature of depression. Biases in autobiographical memory retrieval (in favour of negative and over-general memories) directly impact depression symptoms, but also influence downstream cognitive factors implicated in the onset and maintenance of the disorder. We introduce a novel cognitive intervention, MemFlex, which aims to correct these biases in memory retrieval and thereby modify key downstream cognitive risk and maintenance factors: rumination, impaired problem solving, and cognitive avoidance. METHOD: Thirty eight adults with remitted Major Depressive Disorder completed MemFlex in an uncontrolled clinical trial. This involved an orientation session, followed by self-guided completion of six workbook-based sessions over one-month. Assessments of cognitive performance and depression symptoms were completed at pre- and post-intervention. RESULTS: Results demonstrated medium-sized effects of MemFlex in improving memory specificity and problem solving, and decreasing rumination, and a small effect in reducing cognitive avoidance. No significant change was observed in residual symptoms of depression. LIMITATIONS: This study was an uncontrolled trial, and has provided initial evidence to support a larger-scale, randomized controlled trial. CONCLUSIONS: These findings provide promising evidence for MemFlex as a cost-effective, low-intensity option for reducing cognitive risk associated with depression.

Multimethod prediction of physical parent-child aggression risk in expectant mothers and fathers with Social Information Processing theory.

The Social Information Processing (SIP) model postulates that parents undergo a series of stages in implementing physical discipline that can escalate into physical child abuse. The current study utilized a multimethod approach to investigate whether SIP factors can predict risk of parent-child aggression (PCA) in a diverse sample of expectant mothers and fathers. SIP factors of PCA attitudes, negative child attributions, reactivity, and empathy were considered as potential predictors of PCA risk; additionally, analyses considered whether personal history of PCA predicted participants' own PCA risk through its influence on their attitudes and attributions. Findings indicate that, for both mothers and fathers, history influenced attitudes but not attributions in predicting PCA risk, and attitudes and attributions predicted PCA risk; empathy and reactivity predicted negative child attributions for expectant mothers, but only reactivity significantly predicted attributions for expectant fathers. Path models for expectant mothers and fathers were remarkably similar. Overall, the findings provide support for major aspects of the SIP model. Continued work is needed in studying the progression of these factors across time for both mothers and fathers as well as the inclusion of other relevant ecological factors to the SIP model.

Parent-Child Aggression Risk in Expectant Mothers and Fathers: A Multimethod Theoretical Approach.

The current investigation evaluated whether cognitive processes characteristic of the Social Information Processing model predicted parent-child aggression (PCA) risk independent of personal vulnerabilities and resiliencies. This study utilized a multimethod approach, including analog tasks, with a diverse sample of 203 primiparous expectant mothers and 151 of their partners. Factors considered in this study included PCA approval attitudes, empathy, reactivity, negative child attributions, compliance expectations, and knowledge of non-physical discipline alternatives; additionally, vulnerabilities included psychopathology symptoms, domestic violence victimization, and substance use, whereas resiliencies included perceived social support, partner relationship satisfaction, and coping efficacy. For both mothers and fathers, findings supported the role of greater approval of PCA attitudes, lower empathy, more overreactivity, more negative attributions, and higher compliance expectations in relation to elevated risk of PCA. Moreover, personal vulnerabilities and resiliencies related to PCA risk for mothers; however, fathers and mothers differed on the nature of these relationships with respect to vulnerabilities as well as aspects of empathy and PCA approval attitudes. Findings provide evidence for commonalities in many of the factors investigated between mothers and fathers with some notable distinctions. Results are discussed in terms of how findings could inform prevention programs.