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1.
J Neurovirol ; 2024 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-39134913

RESUMO

The impact of APOE on HIV and HCV disease course, cognition, and memory has been understudied in minoritized populations. This study examined whether scores on cognition and depression measures differed by APOE ε4 carrier status while considering HCV and HIV seropositivity and whether these measures were moderated by substance use. A retrospective analysis examined cognitive and psychological data from participants (n = 493) in the Miami Adult Studies on HIV (MASH) cohort. APOE genotyping was performed on banked blood samples. Multiple linear regression was employed to examine differences across participants living with and without HIV and/or HCV and by APOE ε4 genotype. APOE ε4 carriers living with HCV who used cannabis had higher depression scores than non-ε4 carriers, while nonusers had fewer depressive symptoms. APOE ε4 carriers living with HCV had better cognition scores after adjusting for cocaine, opiate, and cannabis use than non-ε4 carriers. Scores on cognitive and depression measures did not differ between APOE ε4 carriers and non-ε4 carriers in participants living with HIV, and substance use did not moderate this relationship. This study was the first of its kind to examine substance use as a moderator for cognition and depression among individuals with HIV and/or HCV stratified by APOE genotype. Findings support further research evaluating the frequency and duration of 1) domains of cognitive functioning impacted by APOE genotype relevant to substance use and 2) the influence of substance use on cognitive and depressive outcomes among adults living with HIV and HCV, HIV, or HCV.

2.
Matern Child Health J ; 26(10): 2070-2078, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35934723

RESUMO

OBJECTIVES: Negative perceptions of one's neighborhood are linked to poor mental and physical health. However, it is unclear how caregiver's neighborhood perception affects health outcomes in children. This study assessed the mediating effect of maternal wellbeing on the association between neighborhood perception and child wellbeing at different time points and overall. METHOD: A structural equation model (SEM) was used to evaluate whether maternal wellbeing mediates the influence of neighborhood perception on child wellbeing at different ages. The Fragile Families and Child Wellbeing Study data from years 3, 5, and 9 was analyzed. The delta method evaluated the mediation effect of maternal wellbeing, controlling for mothers' age. Direct and indirect effects of neighborhood perception at year 3 on child wellbeing at year 9 via maternal wellbeing at year 5 were analyzed via a longitudinal mediation with a two time points lag. RESULTS: Maternal wellbeing partially mediated the effect of neighborhood perception on child wellbeing at different ages. Longitudinal mediation analyses revealed that better neighborhood perception at year 3 improved maternal wellbeing at year 5 and child wellbeing at year 9; maternal wellbeing at year 5 partially mediated the effect of neighborhood perception at year 3 on child wellbeing at year 5. CONCLUSIONS FOR PRACTICE: Our findings suggest that it may be beneficial for mental health practitioners to discuss relationships between neighborhood environment and wellbeing with caregivers, with a focus on reframing negative self-perceptions. Future research should evaluate longitudinal relationships between changes in neighborhood infrastructure and corresponding wellbeing in caregivers and children.


Assuntos
Saúde da Criança , Características de Residência , Criança , Feminino , Humanos , Mães/psicologia , Poder Familiar/psicologia , Percepção
3.
J Geriatr Psychiatry Neurol ; 34(2): 102-118, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-32314661

RESUMO

Increasing rates of dementia spectrum disorders among Spanish-speaking geriatric populations necessitate the development of culturally appropriate cognitive screening tests that can identify neurodegenerative disorders in their earliest stages when emerging disease-modifying treatments are most likely to be effective. This scoping review identified 26 brief Spanish language cognitive screening tools (<20 minutes) by searching academic databases using a combination of search terms. Results suggest that the Mini-Mental Status Examination and Montreal Cognitive Assessment appear to be less valid than other screeners. Instruments such as the 7-Minute Screen and Mini-Cog evidence higher classification rates of dementia, while Phototest detected mild cognitive impairment at higher rates more consistently than other screeners. Different sensitivity and specificity outcomes and cutoffs were observed when the same cognitive screener was evaluated in different countries. Results indicate that it is imperative to increase nation-specific validation and normative data for these instruments to best serve diverse populations.


Assuntos
Disfunção Cognitiva , Demência , Idoso , Cognição , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Demência/diagnóstico , Demência/epidemiologia , Humanos , Idioma , Testes de Estado Mental e Demência , Testes Neuropsicológicos , Sensibilidade e Especificidade
4.
Am J Geriatr Psychiatry ; 28(12): 1272-1283, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32900580

RESUMO

OBJECTIVE: Higher levels of loneliness in older adulthood predict cognitive decline, but research on mediating mechanisms is sparse. We examine multisystemic physiological risk, functional ability, self-rated health, depressive symptoms, and social participation as mediating processes for the association between loneliness and general cognitive ability over a 10-year follow-up in an older adult sample. METHODS: Three waves of data from 3,005 individuals (mean intake age: 69.30 (SD: 7.85) years; female = 51.61%) recruited during Wave 1 of the National Social Life, Health, and Aging Project were used to test whether hypothesized mediators collected at the 5-year follow-up explained effects of baseline loneliness on 10-year general cognitive ability. RESULTS: The relationship between baseline loneliness and 10-year general cognitive ability was not mediated by multisystemic physiological risk. Functional ability (b = -0.24, SE = 0.05, p <0.001), self-rated health (b = -0.08, SE = 0.02, p <0.001), depressive symptoms (b= -0.20, SE = 0.05, p <0.001), and social participation (b = -0.03, SE = 0.01, p = 0.016) significantly mediated effects. Indirect effects remained significant after adjusting for demographic covariates and 5-year general cognitive ability, except social participation. DISCUSSION: Loneliness may influence cognitive ability indirectly, signaling waning physical and psychiatric health more proximally correlated with cognitive ability. These mechanisms may serve as targets of intervention for cognitive maintenance in lonely older adults.


Assuntos
Disfunção Cognitiva , Solidão , Idoso , Envelhecimento , Cognição , Feminino , Humanos , Estudos Longitudinais
5.
J Appl Res Intellect Disabil ; 33(2): 180-192, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31694076

RESUMO

BACKGROUND: Transitioning to adult healthcare systems can be challenging, especially if left unaddressed for adolescents with special healthcare needs (ASHCN), such as those with autism spectrum disorder and attention-deficit/ hyperactivity disorder. While there is evidence of disparities between different demographics regarding general healthcare services, research on healthcare-specific transition planning is lacking. Thus, there is a critical need to continually investigate these disparities. METHOD: Using nationally representative data from the 2016 National Survey for Children's Health, several analyses were conducted to examine doctor-patient interactions and discussions about transitioning to adult health care. Accounting for demographic and diagnostic indicators allowed for the assessment of disparities. RESULTS: Findings revealed significant disparities between age, disability and race relative to various healthcare transition support services. CONCLUSIONS: Findings provide valuable information that can inform the development of training programmes for healthcare providers, influence policy, modify procedures and interventions and highlight the need for increased advocacy for ASHCN.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/terapia , Transtorno do Espectro Autista/terapia , Deficiências do Desenvolvimento/terapia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Deficiência Intelectual/terapia , Relações Médico-Paciente , Transição para Assistência do Adulto/estatística & dados numéricos , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Masculino
6.
BMC Psychiatry ; 19(1): 328, 2019 10 29.
Artigo em Inglês | MEDLINE | ID: mdl-31664964

RESUMO

The core symptoms and co-morbidities associated with autism spectrum disorders (ASD) affect daily living and quality of life. Existing pharmacological interventions are only able to attenuate some related symptoms but are unable to address the underlying etiologies associated with ASD. Anecdotal evidence, which claims benefit from the use of cannabis to treat symptoms among this population, has been gaining popularity as families seek solutions.This paper analyzed recent peer-reviewed literature to identify the current state of evidence regarding cannabis use for the ASD population. Systematic reviews, reports, and experimental studies were assessed to understand the current extent and nature of the evidence on the risks and benefits of cannabis use for ASD. At this time, three large-scale clinical trials are currently at varying stages of progress and publication of results. Only five small studies were identified that have specifically examined cannabis use in ASD. Given the sparse state of evidence directly assessed in this population, studies which examined effects of cannabis on shared pathological symptoms of ASD such as hyperactivity, sleep disorders, self-injury, anxiety, behavioral problems, and communication were also reviewed.Studies revealed mixed and inconclusive findings of cannabis effects for all conditions, except epilepsy. Adverse outcomes were also reported, which included severe psychosis, increased agitation, somnolence, decreased appetite, and irritability. In addition, a wide range of cannabis compositions and dosage were identified within the studies, which impact generalizability.There is currently insufficient evidence for cannabis use in ASD, which creates an urgent need for additional large-scale controlled studies to increase understanding of risks and benefits and also to examine the impact of "entourage effects." This will support discussions of treatment options between health care providers and ASD patients and their families. Evidence may lead to a desired new line of treatment or prevent adverse outcomes from unsubstantiated use amongst families aiming for symptom reduction.


Assuntos
Transtorno do Espectro Autista/tratamento farmacológico , Maconha Medicinal/uso terapêutico , Humanos
7.
Aging Clin Exp Res ; 31(9): 1283-1297, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30535620

RESUMO

OBJECTIVE: A lack of understanding of the causes of attrition in longitudinal studies of older adults may lead to higher attrition rates and bias longitudinal study results. In longitudinal epidemiological studies of Alzheimer's disease and related dementias, high rates of attrition may cause a systematic underestimation of dementia prevalence and skew the characterization of the disease. This can compromise the generalizability of the study results and any inferences based on the surviving sample may grossly misrepresent the importance of the risk factors for dementia. The National Institute on Aging outlined a National Strategy for Recruitment and Participation in Alzheimer's Disease Clinical Research to address this problem, providing evidence of the magnitude of this problem. METHOD: To explore predictors of attrition, this study examined the National Alzheimer's Coordinating Center (NACC) Uniform Data Set, a repository of observations of older adults spanning 11 years, using survival analysis. Four samples were examined: the full sample (n = 30,433), the alive subsample excluding those who died (n = 24,231), the MRI sample [participants with complete MRI data (n = 1104)], and the alive MRI subsample [participants with MRI data excluding those who died (n = 947)]. RESULTS: Worsening cognitive impairment, neuropsychiatric symptoms, and difficulty with functional activities predicted attrition, as did lower hippocampal volume in the MRI subsample. Questionable co-participant reliability and an informant other than a spouse also increased risk of attrition. DISCUSSION: Special considerations exist in recruiting and retaining older adults in longitudinal studies, and results of baseline psychological, functional, and cognitive functioning should be used to identify targeted retention strategies.


Assuntos
Doença de Alzheimer , Progressão da Doença , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/mortalidade , Doença de Alzheimer/fisiopatologia , Disfunção Cognitiva/psicologia , Conjuntos de Dados como Assunto , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Reprodutibilidade dos Testes , Fatores de Risco
8.
Int J Mol Sci ; 20(23)2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31810189

RESUMO

Single cell gel electrophoresis, also known as the comet assay, has become a widespread DNA damage assessment tool due to its sensitivity, adaptability, low cost, ease of use, and reliability. Despite these benefits, this assay has shortcomings, such as long assay running time, the manipulation of multiple slides, individually, through numerous process steps, the challenge of working in a darkened environment, and reportedly considerable inter- and intra-laboratory variation. All researchers typically perform the comet assay based upon a common core approach; however, it appears that some steps in this core have little proven basis, and may exist, partly, out of convenience, or dogma. The aim of this study was to critically re-evaluate key steps in the comet assay, using our laboratory's protocol as a model, firstly to understand the scientific basis for why certain steps in the protocol are performed in a particular manner, and secondly to simplify the assay, and decrease the cost and run time. Here, the shelf life of the lysis and neutralization buffers, the effect of temperature and incubation period during the lysis step, the necessity for drying the slides between the electrophoresis and staining step, and the need to perform the sample workup and electrophoresis steps under subdued light were all evaluated.


Assuntos
Ensaio Cometa/métodos , Monitoramento Ambiental/métodos , Análise de Célula Única/métodos , Dano ao DNA/genética , Humanos , Laboratórios/normas , Temperatura
9.
J Intellect Disabil ; 23(1): 97-116, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28847208

RESUMO

In Florida, the Agency for Persons with Disabilities provides waivers for adults with the following types of disabilities: intellectual disability, autism spectrum disorder, cerebral palsy, spina bifida, Down syndrome, and Prader-Willi syndrome. This review examined the peer-reviewed literature to indicate and assess the common needs for individuals with intellectual and developmental disabilities. Current models of service delivery, the efficacy of these services, and remaining gaps in the need fulfillment of individuals within the six diagnostic categorizations of interest were examined. Severity level within each diagnostic category was plotted on a matrix according to whether the needs of individuals were minimal, moderate, severe, or universal. The study found that sexual health education, socialization, and adult-focused medical care are universal needs among the six conditions. The study indicates that health-care professionals must work toward addressing the many unmet needs in comprehensive life span care services for adult individuals with neurodevelopmental disorders.


Assuntos
Transtorno do Espectro Autista/terapia , Paralisia Cerebral/terapia , Atenção à Saúde/estatística & dados numéricos , Deficiências do Desenvolvimento/terapia , Deficiência Intelectual/terapia , Avaliação das Necessidades/estatística & dados numéricos , Disrafismo Espinal/terapia , Adulto , Humanos
10.
J Women Aging ; 31(2): 140-164, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29319430

RESUMO

This study examined biological sex differences in the development of mild cognitive impairment (MCI) and probable Alzheimer's disease (AD) development as predicted by changes in the hippocampus or white matter hyperintensities. A secondary data analysis of the National Alzheimer's Coordinating Center Uniform Data Set was conducted. We selected samples of participants with normal cognition at baseline who progressed to MCI (n = 483) and those who progressed to probable AD (n = 211) to determine if hippocampal volume or white matter hyperintensities (WMH) at baseline predicted progression to probable AD or MCI and whether the rate of progression differed between men and women. The survival analyses indicated that changes in hippocampal volumes affected the progression to probable AD (HR = 0.535, 95% CI [0.300-0.953]) only among women. White men had an increased rate of progression to AD (HR = 4.396, CI [1.012-19.08]; HR = 4.665, 95% CI [1.072-20.29]) compared to men in other race and ethnic groups. Among women, increases in hippocampal volume ratio led to decreased rates of progressing to MCI (HR = 0.386, 95% CI [0.166-0.901]). Increased WMH among men led to faster progression to MCI (HR = 1.048. 95% CI [1.011-1.086]). Women and men who were older at baseline were more likely to progress to MCI. In addition, results from longitudinal analyses showed that women with a higher CDR global score, older age at baseline, or more disinhibition symptoms experienced higher odds of MCI development. Changes in hippocampal volumes affect the progression to or odds of probable AD (and MCI) more so among women than men, while changes in WMH affected the progression to MCI only among men.


Assuntos
Doença de Alzheimer/patologia , Disfunção Cognitiva/patologia , Hipocampo/patologia , Fatores Sexuais , Substância Branca/patologia , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/etiologia , Disfunção Cognitiva/complicações , Disfunção Cognitiva/diagnóstico por imagem , Progressão da Doença , Feminino , Hipocampo/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética/estatística & dados numéricos , Masculino , Tamanho do Órgão , Valor Preditivo dos Testes , Substância Branca/diagnóstico por imagem
11.
J Int Neuropsychol Soc ; 24(2): 176-187, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28918757

RESUMO

OBJECTIVES: The aim of this study was to determine the presence and severity of potential cultural and language bias in widely used cognitive and other assessment instruments, using structural MRI measures of neurodegeneration as biomarkers of disease stage and severity. METHODS: Hispanic (n=75) and White non-Hispanic (WNH) (n=90) subjects were classified as cognitively normal (CN), amnestic mild cognitive impairment (aMCI) and mild dementia. Performance on the culture-fair and educationally fair Fuld Object Memory Evaluation (FOME) and Clinical Dementia Rating Scale (CDR) between Hispanics and WNHs was equivalent, in each diagnostic group. Volumetric and visually rated measures of the hippocampus entorhinal cortex, and inferior lateral ventricles (ILV) were measured on structural MRI scans for all subjects. A series of analyses of covariance, controlling for age, depression, and education, were conducted to compare the level of neurodegeneration on these MRI measures between Hispanics and WNHs in each diagnostic group. RESULTS: Among both Hispanics and WNH groups there was a progressive decrease in volume of the hippocampus and entorhinal cortex, and an increase in volume of the ILV (indicating increasing atrophy in the regions surrounding the ILV) from CN to aMCI to mild dementia. For equivalent levels of performance on the FOME and CDR, WNHs had greater levels of neurodegeneration than did Hispanic subjects. CONCLUSIONS: Atrophy in medial temporal regions was found to be greater among WNH than Hispanic diagnostic groups, despite the lack of statistical differences in cognitive performance between these two ethnic groups. Presumably, unmeasured factors result in better cognitive performance among WNH than Hispanics for a given level of neurodegeneration. (JINS, 2018, 24, 176-187).


Assuntos
Amnésia , Disfunção Cognitiva , Demência , Progressão da Doença , Córtex Entorrinal/patologia , Hipocampo/patologia , Hispânico ou Latino , Ventrículos Laterais/patologia , Degeneração Neural , População Branca , Idoso , Amnésia/etnologia , Amnésia/patologia , Amnésia/fisiopatologia , Atrofia/patologia , Disfunção Cognitiva/etnologia , Disfunção Cognitiva/patologia , Disfunção Cognitiva/fisiopatologia , Demência/etnologia , Demência/patologia , Demência/fisiopatologia , Córtex Entorrinal/diagnóstico por imagem , Feminino , Hipocampo/diagnóstico por imagem , Hispânico ou Latino/estatística & dados numéricos , Humanos , Ventrículos Laterais/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Degeneração Neural/diagnóstico por imagem , Degeneração Neural/etnologia , Degeneração Neural/patologia , Índice de Gravidade de Doença , População Branca/etnologia
12.
Int J Geriatr Psychiatry ; 33(1): 200-211, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28560728

RESUMO

OBJECTIVE: Alzheimer's disease (AD) is a neurodegenerative disease, manifesting in clinically observable deficits in memory, thinking, and behavior that disproportionately affects older adults. Susceptibility genes, such as apolipoprotein ε4, have long been associated with an increased risk of AD diagnosis. Studies have shown associations between depression and increased risk of AD development. Furthermore, findings from previous investigations suggest mixed effects in the use of psychotropic medication in older adults. The hypothesis for this study is that antidepressant use modifies the increased hazard of depression or such that a non-significant hazard will result with respect to eventual AD development. METHODS: Utilizing data from the National Alzheimer's Coordinating Center, we examined evaluations of 11,443 cognitively intact participants. Survival analysis was used to explore relationships between depression, apolipoprotein E, AD diagnosis, and antidepressant use. RESULTS: An analytical sample of 8732 participants with normal cognition was examined. Among users of antidepressant medication, the hazard, in most cases, was no longer statistically significant. One generic medication showed protective benefits for users (p < 0.001). In addition, there was a statistically significant relationship between recent depression (n = 2083; p < 0.001), lifetime depression (n = 2068; p < 0.05), and ε4 carrier status (n = 2470; p < 0.001) and AD development. CONCLUSIONS: The findings suggest that a mechanism related to antidepressant use may reduce the hazard of eventual AD. Furthermore, the findings reinforce the association between depression, apolipoprotein E (APOE) ε4, and AD diagnosis. This study contributes to the emerging literature exploring interventions aimed at decreasing the risk of AD by targeting potentially modifiable psychosocial risk factors such as depression. Copyright © 2017 John Wiley & Sons, Ltd.


Assuntos
Doença de Alzheimer/tratamento farmacológico , Antidepressivos/uso terapêutico , Apolipoproteína E4 , Transtorno Depressivo/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/genética , Doença de Alzheimer/psicologia , Apolipoproteína E4/genética , Apolipoproteínas E/genética , Feminino , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Risco
13.
Aging Ment Health ; 22(12): 1577-1584, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29077487

RESUMO

OBJECTIVES: Alzheimer's disease (AD) dementia is a neurodegenerative condition, which leads to impairments in memory. This study predicted that sleep disturbance, depression, and anxiety increase the hazard of AD, independently and as comorbid conditions. METHODS: Data from the National Alzheimer's Coordinating Center was used to analyze evaluations of 12,083 cognitively asymptomatic participants. Survival analysis was used to explore the longitudinal effect of depression, sleep disturbance, and anxiety as predictors of AD. The comorbid risk posed by depression in the last two years coupled with sleep disturbance, lifetime depression and sleep disturbance, clinician-verified depression and sleep disturbance, sleep disturbance and anxiety, depression in the last two years and anxiety, lifetime depression and anxiety, and clinician-verified depression and anxiety were also analyzed as predictors of AD through main effects and additive models. RESULTS: Main effects models demonstrated a strong hazard of AD development for those reporting depression, sleep disturbance, and anxiety as independent symptoms. The additive effect remained significant among comorbid presentations. CONCLUSION: Findings suggest that sleep disturbance, depression, and anxiety are associated with AD development among cognitively asymptomatic participants. Decreasing the threat posed by psychological symptoms may be one avenue for possibly delaying onset of AD.


Assuntos
Doença de Alzheimer/etiologia , Ansiedade/complicações , Depressão/complicações , Transtornos do Sono-Vigília/complicações , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/epidemiologia , Ansiedade/epidemiologia , Comorbidade , Depressão/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Fatores de Risco , Transtornos do Sono-Vigília/epidemiologia , Estados Unidos/epidemiologia
14.
J Natl Med Assoc ; 110(4): 314-325, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30126555

RESUMO

Approximately 5.5 million individuals are diagnosed with Alzheimer's disease (AD) dementia, a number which includes those with mild cognitive impairment and asymptomatic individuals with biomarkers of AD. There is a higher incidence of mild cognitive impairment (MCI) in African American populations as compared to White populations, even when controlling for sociodemographic factors. The existing body of ethnically/racially targeted research on MCI has been limited by few studies with the ability to generalize to African American communities. This study sought to examine whether medical conditions which occur at a higher rate in African American individuals increase the hazard of subsequent MCI development. A secondary data analysis of the National Alzheimer's Coordinating Center Uniform Data Set was employed to examine the associations between health conditions (congestive heart failure, traumatic brain injury, diabetes, hypertension, hypercholesterolemia, B12 deficiency, thyroid disease) and their relationship to MCI. The analytic sample included 2847 participants with 9872 observations. Binary logistic generalized estimating equation modeling was used to examine repeated measures over the course of 1-11 observations. Education was associated with MCI development, specifically those with some college or college graduates (p < 0.001) and more than college (p = 0.002). Female sex was associated with development of MCI (p < 0.001). African Americans with traumatic brain injury (TBI) were more likely to develop MCI (p < 0.001) compared to those with no reports of a TBI. Inactive thyroid conditions decreased the risk of MCI development (p = 0.005) compared to those without thyroid disease. Though vascular factors are often attributed to higher mortality and neurodegeneration in African Americans, congestive heart failure, diabetes, high cholesterol, hypertension, diabetes, nor seizures were associated with an increased risk of MCI development. Findings from this study provide formative data to develop targeted interventions for subsets of the African American community, including those with higher educational levels, those with TBI, and those with a history of thyroid disease. While it may not be possible to prevent MCI development, it is possible to modify lifestyle behaviors contributing to these health conditions, such as falls that are often experienced by older adults. Practitioners can increase awareness, knowledge, and resources relevant to clients.


Assuntos
Negro ou Afro-Americano , Doença Crônica/psicologia , Disfunção Cognitiva/etnologia , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/etnologia , Disfunção Cognitiva/etiologia , Conjuntos de Dados como Assunto , Feminino , Humanos , Modelos Logísticos , Masculino , Fatores de Risco , Fatores Sexuais
15.
Gerodontology ; 35(4): 407-416, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30074263

RESUMO

OBJECTIVE: The objective of this study is to propose empirically and conceptually supported interventions that might increase the capability and opportunity to provide of oral hygiene care and oral cancer screening in long-term nursing care facilities. BACKGROUND: Improving the oral health in the older adult population is a priority of the Healthy People 2020 initiative. Poor oral health disproportionably affects older populations, which indicates lower participation in regular oral health care (OHC) that includes screening and early detection of oral cancer. MATERIAL AND METHODS: A rigorous recruitment protocol yielded a purposive sample of nursing home Administrators and Directors of Nursing who participated in nine discrete focus groups (n = 34) in several regions of Massachusetts. Interview data were integrated with a conceptual framework of the Health Belief Model and the "capability," "opportunity," "motivation" and "behavior" of the COM-B system to identify potential interventions to increase oral health and oral cancer screening. We used NVivo to identify conceptual themes related to potential intervention targets. RESULTS: Participants identified several impediments to oral hygiene and cancer screening in the context of the conceptual model. High barriers, low opportunities and low motivation were themes identified as potential targets for intervention. CONCLUSIONS: Our findings suggest that the intervention likely to increase OHC and consequently oral cancer screening include: training certified nurses' aides using dental students and volunteers; educating family members about OHC and oral cancer screening, and increasing oral cancer awareness.


Assuntos
Atitude do Pessoal de Saúde , Detecção Precoce de Câncer , Administradores de Instituições de Saúde , Assistência de Longa Duração , Enfermeiros Administradores , Casas de Saúde , Higiene Bucal , Atitude Frente a Saúde , Família , Feminino , Grupos Focais , Humanos , Masculino , Massachusetts , Motivação , Assistentes de Enfermagem/educação , Saúde Bucal , Aceitação pelo Paciente de Cuidados de Saúde
16.
Int J Geriatr Psychiatry ; 32(12): 1312-1321, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-27805724

RESUMO

OBJECTIVES: Anxiety diagnoses occur in 17.1% in people age 65 years and older. Individuals with anxiety may be at a higher risk of the development of probable Alzheimer's disease (AD). Previous literature has suggested that anxiolytic medications may exacerbate the risk of AD development. This study explored anxiolytic medication as a potential moderator of AD risk in older adults. METHODS: A secondary data analysis of the National Alzheimer's Coordinating Center Uniform Data Set was undertaken, analyzing observations from 12,083 participants with normal cognition at the first visit. Survival analysis was utilized to examine if anxiolytic medication use by those with anxiety and/or APOE ɛ4 moderates the hazard of AD and/or MCI development. RESULTS: The hazard of probable AD (HR = 3.50, [2.77 - 4.44], p < .0001) or MCI (HR = 2.13, [1.85-2.44], p < .0001) development was statistically significant for those with anxiety. This hazard was no longer statistically significant when specific anxiolytics were used. ɛ4 carriers experienced a statistically significant hazard of AD (HR = 1.92, [1.52-2.41], p < .001) and MCI (HR = 1.17, [1.04-1.32], p < .05) development. This effect was moderated by the use of anxiolytics. DISCUSSION: The results of this study suggest that anxiolytics may moderate the effect of anxiety on MCI and AD development, specifically indicating a neutralized hazard for those with ɛ4 carriers with anxiety. Copyright © 2016 John Wiley & Sons, Ltd.


Assuntos
Doença de Alzheimer/tratamento farmacológico , Ansiolíticos/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/tratamento farmacológico , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Análise de Sobrevida
17.
Health Care Women Int ; 38(12): 1289-1312, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28825525

RESUMO

Older adults are at highest risk of cancer and yet have the lowest rates of cancer screening participation. Older minority adults bear the burden of cancer screening disparities leading to late stage cancer diagnoses. This investigation, utilization data from the 2008 wave of the Health and Retirement study examined the cultural and emotional factors thought to influence cervical cancer screening among older Hispanic women. We utilized logistic regression models to conduct the analyses. Findings indicate that the emotional factors were not significant but the cultural factor, time orientation was a significant predictor for older Hispanics' cervical cancer screening behaviors.


Assuntos
Características Culturais , Detecção Precoce de Câncer/estatística & dados numéricos , Emoções , Hispânico ou Latino/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Neoplasias do Colo do Útero/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Detecção Precoce de Câncer/psicologia , Feminino , Disparidades em Assistência à Saúde/etnologia , Hispânico ou Latino/estatística & dados numéricos , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Fatores Socioeconômicos , Estados Unidos , Neoplasias do Colo do Útero/etnologia , Neoplasias do Colo do Útero/prevenção & controle
18.
Int Psychogeriatr ; 28(9): 1409-24, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27020605

RESUMO

BACKGROUND: Alzheimer's disease (AD) is a neurodegenerative brain disease that causes cognitive impairment and dementia. Within the US, AD is the most common form of dementia in the elderly, affecting 1 in 10 people over the age of 65. Sleep disturbance has been called a "public health epidemic" and, like depression, is a prodromal symptom of AD but may also contribute to the risk of developing AD. It was hypothesized that sleep disturbance, depression, and the apolipoprotein E (APOE) genotype increase the likelihood of AD. METHODS: Utilizing data from the National Alzheimer's Coordinating Center, information from evaluations of 11,453 cognitively asymptomatic participants was analyzed. Survival analysis was used to explore the independent relationships between depression, sleep disturbance, and APOE genotypes with eventual AD diagnosis. Cox proportional hazard models were utilized to explore the main effects and synergistic effects of psychosocial factors as moderated by APOE genotypes. RESULTS: This study reinforced the association between APOE and AD. The hazard of developing AD was eight times higher for those with recent depression and the Ɛ4 homozygote (HR = 8.15 [3.70-17.95]). Among Ɛ4 carriers with clinician-verified depression, the hazard was ten times that of the reference group (HR = 10.11 [4.43-23.09]). The hazard for Ɛ4 carriers reporting sleep disturbance was almost 7 times greater than the reference group (HR = 6.79 [2.38-19.37]). CONCLUSION: Findings suggest that sleep disturbance, depression, and APOE Ɛ4 genotype are associated with AD during follow-up evaluations among a group of initially cognitively asymptomatic participants. This study contributes to the literature base exploring an increased hazard or risk of AD due to potential modifiable risk factors as well as genetic biomarkers, such as APOE.


Assuntos
Doença de Alzheimer/genética , Doença de Alzheimer/psicologia , Apolipoproteína E4/genética , Demência/genética , Depressão/psicologia , Idoso , Idoso de 80 Anos ou mais , Demência/diagnóstico , Demência/psicologia , Feminino , Interação Gene-Ambiente , Genótipo , Humanos , Masculino , Modelos de Riscos Proporcionais , Estudos Prospectivos , Transtornos do Sono-Vigília/psicologia
19.
JMIR Res Protoc ; 13: e55507, 2024 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-39133532

RESUMO

BACKGROUND: Older Latino adults with HIV are at increased risk for mild cognitive impairment and earlier onset of aging-related cognitive decline. Improvements in cognitive functioning and cognitive outcomes are possible among people with HIV who adopt health promotion behaviors. However, health promotion interventions for older Latino adults with HIV have not been extensively used or widely recognized as viable treatment options. Happy Older Latinos are Active (HOLA) is a multicomponent, health promotion intervention that is uniquely tailored for older Latino adults with HIV. OBJECTIVE: This study aims to (1) determine the feasibility and acceptability of an adapted version of HOLA aimed at improving cognitive functioning among older Latino adults with HIV; (2) explore whether HOLA will produce changes in cognitive functioning; (3) explore whether HOLA will produce changes in activity, psychosocial functioning, or biomarkers of cognition; and (4) explore whether changes in activity, psychosocial functioning or cognitive biomarkers correlate with changes in cognition, while accounting for genetic risk for dementia. METHODS: A single-arm pilot trial with 30 Latino (aged 50 years and older) men and women with HIV was conducted to assess feasibility, acceptability, and preliminary effects on cognition. Participants were assessed at 2 time points (baseline and postintervention) on measures of neurocognitive and psychosocial functioning. In addition, blood samples were collected to determine biomarkers of cognition at baseline and postintervention. Successful recruitment was defined as meeting 100% of the targeted sample (N=30), with 20% (n=6) or less of eligible participants refusing to participate. Adequate retention was defined as 85% (n=25) or more of participants completing the postintervention assessment and acceptability was defined as 80% (n=38) or more of sessions attended by participants. RESULTS: Participant recruitment began on February 22, 2022, and was completed on August 15, 2022. The last study visit took place on February 20, 2023. Data analysis is currently ongoing. CONCLUSIONS: Encouraging findings from this exploratory study may provide a blueprint for scaling up the HOLA intervention to a larger cohort of older Latino adults with HIV who may be currently experiencing or are at risk for HIV-related cognitive challenges. TRIAL REGISTRATION: ClinicalTrials.gov NCT04791709; https://clinicaltrials.gov/study/NCT04791709. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55507.


Assuntos
Disfunção Cognitiva , Infecções por HIV , Promoção da Saúde , Hispânico ou Latino , Humanos , Hispânico ou Latino/psicologia , Projetos Piloto , Masculino , Feminino , Infecções por HIV/psicologia , Infecções por HIV/prevenção & controle , Infecções por HIV/etnologia , Disfunção Cognitiva/etnologia , Disfunção Cognitiva/prevenção & controle , Promoção da Saúde/métodos , Pessoa de Meia-Idade , Idoso , Assistência à Saúde Culturalmente Competente
20.
Cereb Circ Cogn Behav ; 6: 100201, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38312309

RESUMO

Anxiety has been associated with a greater risk of Alzheimer's disease (AD). Existing research has identified structural differences in regional brain tissue in participants with anxiety, but results have been inconsistent. We sought to determine the association between anxiety and regional brain volumes, and the moderation effect of APOE ε4. Using data from participants in the National Alzheimer's Coordinating Center (NACC) Uniform Data Set, with complete imaging (MRI) and biomarker data (n = 1533), multiple linear regression estimated the adjusted effect of anxiety on 30 structural MRI regions. The moderation effect of APOE ε4 on the relation between structural MRI regions and anxiety was assessed as was the moderation effect of cognitive status. False discovery rate was used to adjust for multiple comparisons. After controlling for intracranial volume, age, sex, years of education, race, Hispanic ethnicity, and cognitive status, seven MRI regions demonstrated lower volumes among participants with anxiety: total cerebrum gray matter volume, right hippocampus volume, hippocampal volume (total), right and left frontal lobe cortical gray matter volume, and right and total temporal lobe cortical gray matter volume. Findings suggest that anxiety is associated with significant atrophy in multiple brain regions, with corresponding ventricular enlargement. Future research should investigate if anxiety-related changes to brain morphology contribute to greater AD risk.

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