Clinical Manifestations.

BACKGROUND: Alzheimer's Disease (AD) and dementia inequities highlight the need to eliminate barriers and promote motivators for study engagement of underrepresented populations (URPs; e.g., non-Latinx Black, Latinx, sexual/gender minoritized populations). Lower educational attainment and URP status are associated with lower research engagement rates. This study examined whether engagement in this community-engaged research (CER) study of middle/older-age adults differs according to ethnoracial identity, gender identity, income, age, education, acculturation, sexual orientation, cardiovascular risk, healthcare access, ethnic discrimination, stress, and loneliness. METHOD: SALUD is an ongoing, longitudinal study in NYC whose aim is to examine genetic, cerebrovascular, sociocultural risk and resilience factors for dementia. CER strategies (i.e., sustained participation in community events/organizations, Community Science Partnership Board) were employed. The Perceived Stress Scale, UCLA Loneliness Scale, Perceived Ethnic Discrimination Questionnaire, Abbreviated Multidimensional Acculturation Scale, Healthcare Task Difficulty Questionnaire, and Northern Manhattan Study Neuromedical Evaluation were administered. Participants' progress was coded as retained or dropped out of the study (DOS) for each visit in the study. Cross-sectional analyses (t-tests, chi-square and Mann-Whitney U-tests) compared demographic, health, and psychosocial variables between those who completed the in-person neuropsychological visit (i.e., ∼5 hour comprehensive neuropsychological battery, blood draw, saliva sample, neuromedical interview and questionnaires in a hospital; INP-V) and MRI visit (i.e., ∼1 hour closed MRI scan; MRI-V) with those who DOS. RESULT: The sample (N = 145) was 53.8% female, older, and well-educated (M age = 65.25, SDage= 6.55, Meducation = 13.59, SDeducation= 3.23). URP study engagement was high: 31.7% non-Latinx Black, 34.5% Latinx, and 33.8% non-Latinx White. There were no significant differences in independent variables (e.g., ethnoracial, gender, discrimination) between the INP-V and DOS groups (all p's>.09). However, analyses revealed that the MRI-V group (M = 13.42, SD = 3.07) had significantly fewer years of education than the DOS group (M = 14.15, SD = 3.71) (t(143) = 2.69, p<.01, 95%CI [0.39, 2.58]) other differences were observed (ps>.05). CONCLUSION: This study's CER-based approach yielded a high level of URP study engagement. Contrary to previous findings, people with less education were more likely to complete the MRI visit suggesting a willingness to undergo more invasive procedures after establishing trust. CER-based AD studies may help URP participants overcome participation barriers through collaboration with the community.

Clinical Manifestations.

BACKGROUND: Older adults may experience decreased social support, which has been linked to cognitive decline and increased risk of dementia. Immigrants may also experience more social isolation due to discrimination and fear of deportation. This study examined social networks, nativity status, and neurocognitive functioning(NC) in an ethnoculturally diverse sample of middle/older adults. METHOD: Participants included 26 immigrants (Mage= 64.12, SD = 5.64) and 109 U.S.-born adults (Mage= 65.37, SD = 7.10). Participants completed a comprehensive NC battery and the Berkman-Syne Social Network Index(SNI; a well-validated self-reported questionnaire assessing close social support, where higher scores represent more social support). Demographically-adjusted norms were used to compute average global NC and domain T-scores. A series of hierarchical multiple regressions were computed to predict global and domain NC T-scores. SNI and age were entered at Step-One, the interaction term(age*SNI) was entered at Step-Two, and nativity status was entered at Step-Three. RESULT: Results revealed that the omnibus model was significantly associated with Attention/Working Memory(A/WM) (R² = .13; ps = .009) and Processing Speed(PS) (R² = .20; ps = .002). Notably Step-Three of the model significantly contributed to the association of AWM (R²Δ= .11; ps<.05) and PS (R²Δ= .09; ps<.05) beyond Step-One and Step-Two. For A/WM, the interaction term, and nativity status (𝛽s = .04-6.96, respectively; ps<.05) were significantly associated with A/WM. For PS, SNI, the interaction term, and nativity status (𝛽s = -3.91-8.17; ps<.05) were significantly associated with PS. Such that, there is a main effect of nativity status with immigrants scoring lower on measures of A/WM by 6.96 and PS by 8.17 units. Overall, there is a negative association between age and A/WM and PS but as SNI increases the relation between age and NC becomes positive. Only nativity status (𝛽s = 5.99-8.23; ps<.05) significantly predicted Memory, Verbal Fluency, and Global NC functioning scores. CONCLUSION: Findings show that among middle/older adults, both SNI and nativity status are associated with A/WM and PS, suggesting that a larger SNI can serve as a protective factor against the effects of aging on NC functioning. Importantly, even when SNI and age were not significantly related to NC T-scores, nativity status was. Nativity status likely serves as a proxy for other risk factors (e.g., healthcare access), which should be explored in future studies.

Clinical Manifestations.

BACKGROUND: COVID-19 pandemic stress differentially affects older adults and persons from minoritized, underrepresented populations (URPs; e.g., Black, Latinx), yet potential protective factors are not well understood. This study aimed to evaluate whether pandemic-related social and emotional stressors negatively affect functional capacity, mental health, and cognitive outcomes in an ethnoculturally diverse sample of middle-aged and older adults. METHOD: Cross-sectional data were obtained from adults (55± years) participating in SALUD, an ongoing study examining risk and resilience factors for dementia in diverse populations. Participants completed a well-validated, comprehensive battery of questionnaires and cognitive assessments. Aggregate scores of social and emotional pandemic stressors (e.g., more anxiety, loneliness) from Item 3 of the Pandemic Stress Index (PSI-3) were examined in association with demographics, Patients Assessment of Own Functioning Inventory (PAOFI; self-reported functional status measure), and Patient Health Questionnaire-2 (PHQ-2; self-report depressive symptomatology measure). Demographically-adjusted norms were used to compute Global Neurocognition (NC) and eight domain-specific NC average T-scores (e.g., learning, memory). Spearman's correlations, Kruskal-Wallis, Mann-Whitney U-tests were used for non-normal variables. RESULT: The sample included 110 adults (37.3% Non-Latinx Black [NLB], 33.6% Latinx, and 29.1%, non-Latinx White [NLW]; 63% female; M age = 65.27 [SD = 7.11]; M ed = 13.89 [SD = 3.07]). Age was negatively correlated with the PSI-3 (rs = -.25, p<.01), but education (rs= -.05, p = .59) and gender (U<.01, p = .99) were not. PSI-3 differed across ethnocultural groups (H = 8.00, p = .02), such that Latinx participants had the highest PSI-3 scores. However, this relationship became non-significant after accounting for age (p = .11). PAOFI impairment scores (rs = .37, p = .01) and PHQ-2 scores (rs = .29, p = .01) were positively related to the PSI-3, but Global NC and domain-specific NC average T-scores were not significant (rs = -.08 - .10, ps> .05). CONCLUSION: In this ethnoculturally diverse sample, findings suggest older adults may be more resilient to pandemic-related stress. Older age was associated with lower social and emotional pandemic stress, while greater functional impairment and depression were moderately associated with higher pandemic-related stress. As pandemic-related increases in psychosocial stressors (e.g., worry and depression) continue to affect middle-aged and older adults, longitudinal research should investigate the risk and resilience factors that may buffer against developing these negative outcomes.

Neuropathogenesis of HIV and emerging therapeutic targets.

INTRODUCTION: HIV infection causes a wide range of neurological complications, many of which are among the most common complications of chronic HIV infection in the era of combined antiretroviral therapy. These neurological conditions arise due to complex interactions between HIV viral proteins and neuronal and glial cells that lead to the activation of various inflammatory and neurotoxic pathways across the nervous system. AREAS COVERED: This review summarizes the current literature on the pathogenesis and clinical manifestations of neurological injuries associated with HIV in the brain, spinal cord, and peripheral nervous system. Molecular pathways relevant for possible therapeutic targets or advancements are emphasized. Gaps in knowledge and current challenges in therapeutic design are also discussed. EXPERT OPINION: Several challenges exist in the development of therapeutic targets for HIV-associated cognitive impairments. However, recent developments in drug delivery systems and treatment strategies are encouraging. Treatments for HIV-associated pain and peripheral sensory neuropathies currently consist of symptomatic management, but a greater understanding of their pathogenesis can lead to the development of targeted molecular therapies and disease-modifying therapies. HIV-associated autonomic dysfunction may affect the course of systemic disease via disrupted neuro-immune interactions; however, more research is needed to facilitate our understanding of how these processes present clinically.