Racial Discrimination and Private Regard Among Black Early Adolescents: Testing Between- and Within-Person Associations Over Time.

The current study examined concurrent and longitudinal associations between experiences of racial discrimination and private regard (i.e., feelings about being Black and other Black people) among 346 Black early adolescents who completed four assessments over two years. Between-person (interpersonal) and within-person (intrapersonal) effects were tested to provide a rigorous and comprehensive examination of these associations. There was minimal evidence of significant between-person effects in which youth experiencing varying levels of racial discrimination differed in their private regard. However, at the within-person level, there were significant negative concurrent associations between racial discrimination and private regard, indicating that youths' positive racial identity was undermined at times when they were encountering higher levels of racial discrimination than they typically did. Results highlight significant intrapersonal links between racial discrimination and private regard and underscore the continued need for interventions to eliminate racial discrimination and to support Black youth experiencing it.

Racial discrimination, depressive symptoms, and sleep problems among Blacks in the rural South.

OBJECTIVES: Experiences of racial discrimination are common for Black Americans and have been associated with depression and sleep disturbance, factors likely involved in the insidious development of health disparities. The current study replicates these associations and examines longitudinal linkages. METHOD: Black American couples (men: N = 248, Mage = 40, SD = 9; women: N = 277, Mage = 37, SD = 7) and their children, aged 9 to 14 (N = 276, Mage = 11, SD = 1), completed measures of experiences of racial discrimination, depressive symptoms, and sleep problems at baseline and 8-month follow-up. In separate analyses for men, women, and youth, we examined concurrent and prospective associations of racial discrimination with depressive symptoms and sleep problems, then used longitudinal indirect effect models to examine whether depressive symptoms in response to racial discrimination led to increased sleep problems, or vice versa. RESULTS: Racial discrimination was associated concurrently with depressive symptoms and sleep problems for all family members. Prospective associations were also found with depressive symptoms and sleep problems in fathers and youth, and sleep problems in mothers. Longitudinal models showed significant indirect effects of racial discrimination on change in sleep problems through depressive symptoms for fathers and mothers, and a similar, but nonsignificant, pattern in youth. There were no indirect effects on change in depressive symptoms through sleep problems. CONCLUSIONS: Persistent associations of racial discrimination with depressive symptoms and sleep problems reflect a lasting impact of racial discrimination. Because discrimination's effects on depression may contribute to increased sleep problems over time, interventions that buffer the effects of discrimination on depressive symptoms may also reduce sleep problems. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Differentiating Parkinson Disease Subtypes Using Clinical Balance Measures.

BACKGROUND AND PURPOSE: People with Parkinson disease (PD) present phenotypes that are characterized as tremor-dominant (TD) or postural instability/gait difficulty (PIGD) subtypes. Differentiation of subtypes allows clinicians to predict disease course and adjust treatment. We examined whether brief mobility and balance measures can discriminate PIGD from TD phenotypes. METHODS: We performed a cross-sectional study with individuals with PD (n = 104). Blinded raters assessed participants with the Unified Parkinson's Disease Rating Scale (UPDRS) or Movement Disorders Society revision (MDS-UPDRS), and balance assessments: 360° turn test, one-leg stance, a reactive postural control test, and tandem walk. Participants were classified as PIGD or TD based on the UPDRS or MDS-UPDRS assessment results. Differences in balance variables between subtypes were assessed with univariate analyses. Receiver operating characteristic (ROC) curve analyses were performed to investigate the ability of balance variables to differentiate PD subtypes. RESULTS: No differences between subtypes were observed for tandem walk or reactive postural control. Participants with PIGD performed worse on number of steps and time to complete the 360° turn test and on one-leg stance time. ROC curves showed only the 360° turn test discriminated PIGD from TD with high specificity (0.84). Post hoc analyses revealed that the 360° turn test is the most discriminatory for classifying PD subtypes in early stages of the disease. ROC analyses based on combined models including both the 360° test and tandem walk test performance increased the specificity to 0.97. DISCUSSION AND CONCLUSIONS: The 360° turn test requires minimal time to administer and may be useful in mild-moderate PD for distinguishing PIGD from TD subtypes.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A295).

Association Between Motor Subtype and Visuospatial and Executive Function in Mild-Moderate Parkinson Disease.

OBJECTIVE: To compare participants with Parkinson disease (PD) motor subtypes, postural instability and gait difficulty (PIGD) (n=46) and tremor dominant (TD) (n=28), in cognitive and motor-cognitive assessments with the purpose of identifying associations between subtype and visuospatial, whole-body spatial, inhibition and/or switching, and planning and/or organizational aspects of cognitive and motor-cognitive function. DESIGN: Retrospective cohort study. Fisher exact test was used for categorical variables, while 2-sample independent t tests were used to analyze continuous variables. SETTING: Assessments took place at Emory University. PARTICIPANTS: Participants (N=72) were 40 years and older, had a clinical diagnosis of PD, exhibited 3 of the 4 cardinal signs of PD, had shown benefit from antiparkinsonian medications, and were in Hoehn and Yahr stages I-IV. Participants could walk 3 m or more with or without assistance. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Balance and mobility tests included Fullerton Advanced Balance Scale and the time needed to turn 360 degrees. Cognitive assessments included Montreal Cognitive Assessment, Brooks Spatial Memory Task, Color-Word Interference Test, Tower of London, Trail Making Test, Corsi Blocks, Serial 3s Subtraction, and Body Position Spatial Task. Motor-cognitive function measures included Four Square Step Test and Timed Up and Go. RESULTS: Participants with PIGD performed lower than those with TD symptoms on mental status (P=.005), spatial memory (P=.027), executive function (P=.0001-.034), and visuospatial ability (P=.048). CONCLUSIONS: Findings suggest that PIGD subtype is linked to greater deficits in spatial cognition, attentional flexibility and organizational planning, and whole-body spatial memory domains. These findings support the need for more personalized approaches to clinically managing PD.

Responsive parenting and Black mothers' postpartum sleep: Secondary analysis of a randomized controlled trial.

OBJECTIVE: To determine if an intervention designed to enhance early responsive parenting (RP) practices (e.g., reading infant cues, establishing bedtime routines) and promote infant sleep and soothing among Black families has secondary benefits for mothers' postpartum sleep. METHOD: This preregistered secondary analysis of the Sleep Strong African American Families randomized controlled trial investigated effects of an RP intervention versus a safety control condition on self-reported maternal sleep difficulties at 8 and 16 weeks postpartum and on actigraph-measured maternal sleep at 8 weeks postpartum. RESULTS: The 212 randomized mothers were Black/African American (100%) and non-Hispanic (98.6%) and averaged 22.7 years (SD = 4.5) of age. Among 138 mothers with useable actigraph data, RP mothers had a mean 20 [95% CI: 2, 37] minutes longer actigraph-measured total sleep time than controls at 8 weeks postpartum, after adjusting for age and other covariates likely to influence mothers' sleep (p = .04). Participation in the RP intervention did not significantly impact self-reported sleep difficulties or other actigraph-measured sleep parameters (e.g., efficiency) in either unadjusted or adjusted models, although RP effects on sleep difficulties and sleep efficiency were in the hypothesized directions. CONCLUSIONS: Interventions supporting responsive sleep parenting practices to increase infant sleep may also help first-time Black mothers get more sleep themselves during the postpartum period, even without an explicit focus on maternal sleep strategies. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Racial discrimination predicts depressive symptoms throughout adolescence among Black youth.

Experiences of racial discrimination are common among Black youth and predict worse mental health cross-sectionally and over time. Additional research is needed to address lingering questions regarding the direction of effect(s) underlying these patterns, differences in the magnitude of effects across adolescence, and gender differences. To address these gaps, the current study tested bidirectional linkages between racial discrimination and depressive symptoms at the between- (interpersonal) and within- (intrapersonal) level using 4 waves of data from 889 Black youth (54% female) from Georgia and Iowa. Participants reported experiences of racial discrimination and depressive symptoms at ages 10.6 years (Wave 1), 12.5 years (Wave 2), 15.7 years (Wave 3), and 18.8 years (Wave 4). The cross-lagged panel model (CLPM) was used to examine between-person associations over time, and the random intercept cross-lagged panel model (RI-CLPM) was used to examine within-person associations over time. Results were consistent across models, revealing significant concurrent associations between racial discrimination and depressive symptoms, significant lagged effects from racial discrimination to depressive symptoms, and no significant lagged effects from depressive symptoms to racial discrimination. Effects did not differ across adolescence, and there were few gender differences in the degree of association between racial discrimination and depressive symptoms. Findings provide rigorous evidence that experiencing greater racial discrimination is associated with increases in depressive symptoms throughout adolescence and add to a growing body of work showing that racial discrimination can undermine mental health and well-being among Black youth. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Gender differences in motor and non-motor symptoms in individuals with mild-moderate Parkinson's disease.

BACKGROUND: Parkinson's disease (PD) affects both men and women with documented gender differences across functional domains, with findings varying among reports. Knowledge regarding gender differences in PD for different geographic locations is important for further understanding of the disease and for developing personalized gender-specific PD assessment tools and therapies. OBJECTIVE: This study aimed to examine gender differences in PD-related motor, motor-cognitive, cognitive, and psychosocial function in people with PD from the southern United States (US). METHODS: 199 (127 men and 72 women; M age: 69.08±8.94) individuals with mild-moderate idiopathic PD (Hoehn &Yahr (H&Y) Median = 2, stages I-III) from a large metro area in the southeastern US were included in this retrospective, cross-sectional study. Motor, motor-cognitive, cognitive, and psychosocial data were obtained using standardized and validated clinical tests. Univariate analyses were performed, adjusting for age and housing type. RESULTS: After adjustment for age, housing, PD duration and fall rate, men exhibited statistically significantly greater motor (Movement Disorders Society (MDS)-Unified Parkinson Disease Rating Scale (UPDRS)-II) and non-motor (MDS-UPDRS-I) impact of PD, and more severe motor signs (MDS-UPDRS-III). Men exhibited worse PD-specific health-related quality of life related to mobility, activities of daily living, emotional well-being, cognitive impairment, communication, and more depressive symptoms. Men performed worse on a subtraction working memory task. Women had slower fast gait speed. CONCLUSIONS: In the southeastern United States, men may experience worse PD-related quality of life and more depression than women. Many non-motor and motor variables that are not PD specific show no differences between genders in this cohort. These findings can contribute to the development of gender-sensitive assessment and rehabilitation policies and protocols for people with PD.

Psychosocial Effects of Remote Reading with Telephone Support versus In-Person Health Education for Diverse, Older Adults.

This study evaluated initial information about psychosocial differences of 130 diverse, older adults (M age: 70.8 ± 9.2 years) who received a "low-tech" remote (independent reading with telephone support) or in-person education through DREAMS (Developing a Research Participation Enhancement and Advocacy Training Program for Diverse Seniors) health seminar series. Outcomes on measures of depression, quality of life, and spatial extent of lifestyle of 115 completers were analyzed at baseline, immediately post-intervention, and 8-week follow-up. Adjusted at baseline, psychosocial outcomes were compared between groups at post-test and 8-week follow-up using adjusted mean differences. Post-participation, compared to remote participants, in-person participants had significantly lower depression on Beck Depression Inventory-II, Geriatric Depression Scale, and significantly higher mental quality of life on Short Form-12. This study links knowledge acquisition via in-person learning with decreased stress, depression, and increased quality of life among seniors. Identifying effective educational delivery methods may increase clinical research involvement for aging communities.

Remote versus In-Person Health Education: Feasibility, Satisfaction, and Health Literacy for Diverse Older Adults.

OBJECTIVES: Health education may improve health in geriatric patients. To evaluate differences between remote and in-person education, the DREAMS (Developing a Research Participation Enhancement and Advocacy Training Program for Diverse Seniors) health seminar series compared in-person and remote learning groups to assess feasibility, satisfaction, adherence, health literacy, and cognitive outcomes. RESEARCH DESIGN: Nonrandomized two-arm interventions occurred remotely or in-person. About 130 diverse, older adults (M age: 70.8 ± 9.2 years; in-person n = 95; remote, n = 35) enrolled. Data from 115 completers (In-person n = 80; Remote n = 35) were analyzed for performance outcomes. Feasibility, adherence, and satisfaction benchmarks were evaluated at baseline, immediately post intervention, and 8 weeks post intervention. Adjusting for baseline performances, outcomes on health literacy and cognitive measures were compared between groups after intervention (at posttest and at 8-week follow-up) using adjusted mean differences (ß coefficients). RESULTS: Eighty in-person and all remote participants completed at least six modules. Both programs had high satisfaction, feasibility, and strong adherence. After adjusting for demographic covariates and baseline values, cognitive and motor cognitive measures between groups were domain specific (e.g., global cognition, executive function, spatial memory, mental tracking capacity, and cognitive integration). DISCUSSION AND IMPLICATIONS: This work explores feasible measures of knowledge acquisition and its link to health literacy and cognitive outcomes. Identifying effective delivery methods may increase involvement in clinical research. Future studies may encourage remote learning for increased accessibility.

Interpretive Qualitative Evaluation Informs Research Participation and Advocacy Training Program for Seniors: A Pilot Study.

Background: An 8-week educational intervention co-taught by medical students and faculty was designed to foster communication between clinical researchers and populations of interest to ultimately increase participation in clinical research by older adults, including underrepresented groups. Weekly topics focused on age-related changes and health conditions, socio-contextual factors impacting aging populations, and wellness strategies. Objectives: To evaluate the successes and weaknesses of an educational intervention aimed at increasing the participation of older adults in clinical research. Design: A focus group was assembled after an 8-week educational intervention, titled DREAMS, to obtain participants' feedback on the program, following a pre-formulated interview guide. Settings: Participants were interviewed in a health center office environment in the United States of America in April of 2016. Participants: A post-intervention focus group was conducted with a group of eight older adults (mean age = 75.8 ± 11.4 years) from 51 total participants who completed the intervention. Methods: The focus group was interviewed loosely following a pre-formed question guide. Participants were encouraged to give honest feedback. The conversation was recorded, transcribed verbatim, and analyzed using thematic analyses. Results: While participants viewed most aspects of the study as a success and stated that it was a productive learning experience, most participants had suggestions for improvements in the program content and implementation. Specifically, the composition of and direction to small breakout groups should be carefully considered and planned in this population, and attention should be paid to the delivery of sensitive topic such as death and dementia. A clear main benefit of this programmatic approach is the development of a rapport amongst participants and between participants and clinical researchers. Conclusions: The results provide useful insights regarding improving participation among hard-to-reach and historically underrepresented groups of older adults in clinical research. Future iterations of this program and similar educational interventions can use these findings to better achieve the programmatic objectives.

Longitudinal Effects of Racial Discrimination on Depressive Symptoms Among Black Youth: Between- and Within-Person Effects.

OBJECTIVE: Black youth experience racial discrimination at high rates. This study sought to further understand the longitudinal effects of racial discrimination on the mental health of Black youth by examining cross-lagged associations between perceived racial discrimination and depressive symptoms at the between-person (interindividual) level and the within-person (intraindividual) level. METHOD: A group of 346 Black youths (mean age 10.9 years) from the rural southern United States reported racial discrimination and depressive symptoms 4 times over 24.5 months. A cross-lagged panel model was used to examine between-person concurrent and lagged effects, and a random intercept cross-lagged panel model was used to examine within-person concurrent and lagged effects. RESULTS: There were significant concurrent associations at all waves in both models. Additionally, there were significant lagged effects from perceived racial discrimination to depressive symptoms, but not from depressive symptoms to perceived racial discrimination, in both models. CONCLUSION: Youth experiencing higher levels of racial discrimination subsequently develop more depressive symptoms than youth experiencing less discrimination (between-person effects), and youth experiencing higher levels of discrimination relative to their own average subsequently report increases in depressive symptoms (within-person effects). These findings provide a rigorous test of conceptual models outlining the harmful effects of racial discrimination on mental health, add to a growing body of work documenting these effects on Black youth, and underscore the need for systemic changes to reduce the amount of discrimination Black youth experience and for interventions to promote resilience among Black youth in the face of cultural marginalization.

Childhood maltreatment and resource acquisition in African American women: The role of self-esteem.

OBJECTIVE: Childhood maltreatment (CM) is a public health crisis that results in negative physical, mental health, and psychosocial (e.g., resource attainment) outcomes. Resource attainment is a critical outcome for marginalized populations, such as low-income African American women. This study addresses the gap in the literature regarding the association between CM and effectiveness of resource attainment and the potential mediating role of self-esteem in this association for African American women. METHOD: Data were gathered from a large public inner-city, university-affiliated health care system in the Southeastern United States. Participants selected were low-income African American women who have experienced intimate partner violence (IPV) and have attempted suicide in the prior year. The participants for this study completed the Childhood Trauma Questionnaire, the Beck Self-Esteem Scale, and the Effectiveness in Obtaining Resources Scale. RESULTS: Mediation analyses using bootstrapping with 213 women revealed the powerful role self-esteem plays in explaining the link between CM and resource attainment in low-income African American women. Specifically, overall CM and four of its subtypes (emotional abuse, physical abuse, emotional neglect, and physical neglect) were all associated with decreased resource attainment via the effect of decreased self-esteem. Sexual abuse was the only subtype of CM not significantly associated with self-esteem nor effectiveness of resource attainment. CONCLUSION: This research highlights the importance of screening for CM, its subtypes, and resource attainment in this population and bolstering self-esteem through psychological interventions to increase women's capacity to effectively secure necessary community resources. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Protective parenting behavior buffers the impact of racial discrimination on depression among Black youth.

The adverse impact of racial discrimination on youth, and particularly its impact on the development of depressive symptoms, has prompted attention regarding the potential for family processes to protect youth from these erosive effects. Evidence from non-experimental studies indicates that protective parenting behavior (PPB) which occurs naturally in many Black families can buffer youth from the negative impact of racial discrimination. Of interest is whether "constructed resilience" developed through family-centered prevention programming can add to this protective buffering. The current paper examines the impact of constructed resilience in the form of increased protective parenting using 295 families randomly assigned either to a control condition or to the Protecting Strong African American Families (ProSAAF) program, a family-based prevention program previously shown to enhance protective parenting. We found that baseline racial discrimination was predictive of change in youths' depressive symptoms across the pre-post study period. Second, we found that parents participating in ProSAAF, relative to those randomly assigned to the control group, significantly improved in their use of an intervention targeting PPB. Third, we found a significant effect of change in PPB on the association of discrimination with change in depressive symptoms. Finally, we found that ProSAAF participation buffered the impact of racial discrimination on change in depressive symptoms through change in PPB. Results provide experimental support for constructed resilience in the form of change in PPB and call for increased attention to the development of family-based intervention programs to protect Black youth from the pernicious effects of racial discrimination. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A Pilot randomized clinical trial of adapted tango to improve cognition and psychosocial function in African American women with family history of Alzheimer's disease (ACT trial).

Alzheimer's disease (AD) is a devastating, progressive neurodegenerative disease resulting in memory loss and a severe reduction in the ability to perform activities of daily living. Ethnicity-related genetic factors promoting the development of dementias among African Americans (AA) and increased risk among women for developing AD indicates that AA women with a parental history of AD are at great risk for developing AD. This phase I study assessed the impact of a 12 week, 20-lesson adapted Argentine Tango intervention (n = 24) to a no-contact control group (n = 10) on measures of plasma inflammatory markers, cognition, and motor and psychosocial performance in middle-aged AA woman at increased risk for AD by virtue of parental history. Some woman (n = 16) were also caregivers; thus, the impact of the intervention on caregiving burden was examined in this subset. Preliminary analysis of efficacy was conducted with significance tests on biomarkers and key measures of cognition, including visuospatial and executive function, balance, and strength. After 12 weeks, Tango participants had significantly decreased inflammatory cytokine, including reductions in IL-7 (p = 0.003), IFN-γ (p = 0.011), TNFα (p = 0.011), and MCP-1 (p = 0.042) compared to controls. Large effects were noted for the Tango group on tests of executive functioning (d = 0.89), and inhibition (p = 0.031). Participants in Tango improved in dynamic and static balance (p = 0.018) and functional lower body strength (p = 0.023). Secondary assessment revealed trends favoring the intervention group were noted in spatial cognition and executive function. Moderate effects were noted in caregiving burden measures among the subset of caregivers. These data demonstrate substantial reductions in inflammatory biomarkers along with cognitive and motor improvements through a non-pharmacologic, affordable intervention among a small, well-characterized cohort of AA women with a parental history of AD.

Improved Mobility, Cognition, and Disease Severity in Corticobasal Degeneration of an African American Man After 12 Weeks of Adapted Tango: A Case Study.

Corticobasal degeneration (CBD) has no available treatment to slow disease progression and generally resists drug therapy. Corticobasal degeneration has symptoms and decreased quality of life similar to Parkinson disease. Adapted Tango, a successful rehabilitation for Parkinson, may address CBD. A 63-yr-old African American man with CBD (alias: YD; CBD duration = 2 yrs) was evaluated for motor, cognitive, and psychosocial function before, immediately after, 1 mo after, and 6 mos after 12 wks of 20, biweekly 90-min adapted-tango lessons. After intervention, disease-related motor symptoms improved and YD reported fewer problems in nonmotor experiences of daily living, which include mood, cognition, pain, fatigue, etc. Motor symptoms remained above baseline at 6-mo posttest. YD's balance confidence improved after intervention but declined below baseline at 6-mo posttest. Quality of life was maintained despite worsened depression. YD improved or maintained executive function, and visuospatial function and attention at posttest and 1-mo posttest. At posttest, YD maintained mobility and improved on dynamic balance. At 1-mo posttest, most mobility measures had improved relative to baseline. However, YD showed executive function and overall motor decline 6 mos after intervention. Adapted tango may have temporarily slowed disease progression and improved or maintained mobility and cognition. Gains were poorly maintained after 6 mos. Further study is warranted.

Effects of a Health Education and Research Participation Enhancement Program on Participation and Autonomy in Diverse Older Adults.

Social engagement and autonomy are vital for life satisfaction among older adults. We measured multiple domains of social participation and autonomy in 120 adults over age 55 years that were part of an educational program at pretest, posttest, and follow-up. Quantitative and qualitative data were analyzed for differences between Black and White participants. White participants reported worse engagement in the family role domain and a lower Total Participation Score at posttest than pretest; however, scores returned to baseline levels by follow-up. Black participants reported better levels of participation in the social relationship domain at follow-up than at pretest. We found no evidence of qualitative differences between racial groups. Barriers to social participation and autonomy included challenges related to health, ageism, transportation, and mobility. Adequate housing, social support, socialization, and perception of individual utility contributed to feeling independent. Educational programs for older adults may provide an opportunity for increased social participation.

The association between Parkinson's disease symptom side-of-onset and performance on the MDS-UPDRS scale part IV: Motor complications.

INTRODUCTION: Parkinson's disease (PD) is a neurodegenerative condition associated with aging characterized by loss of dopamine-producing neurons in the substantia nigra pars compacta and a reduction in dopamine levels in the striatum. PD is commonly treated using dopamine-replacement medication called levodopa. Levodopa has decreasing efficacy over time. Periods when levodopa is not effective at controlling symptoms of PD are called "OFF-time" or "medication-related motor fluctuations," (MRMF). One characteristic of PD is unilateral side of symptom onset. Previous studies have found that side of onset was associated with differential motor and cognitive PD-related symptoms. The main study objective was to examine differences in left and right onset PD patients and OFF-time as measured by the Movement Disorders Society Unified Parkinson Disease Rating Scale (MDS-UPDRS) Part IV Sum Score and Part IV item scores. METHODS: 64 individuals with mild-moderate PD (age: M(SD) = 68.72 (8.88)), years with PD: M(SD) = 6.61 (5.05); Hoehn and Yahr stage Med (1st, 3rd quartile) = 2.0 (2.0, 3.0) were assessed with the MDS-UPDRS parts I-IV. We conducted two-tailed independent sample t-tests to examine the differences between PD patients with left versus right onset. RESULTS: Right onset PD was significantly associated with more overall MRMF (p = 0.01), more OFF-time (p = 0.04), greater impact of motor fluctuations on daily life (p = 0.02) and more complex (unpredictable) MRMF (p = 0.01). CONCLUSION: People with right onset PD have more complications with levodopa treatment. Alternative and/or adjuvant treatments to levodopa may be particularly beneficial for those with right onset PD.

Rationale and Design of a Clinical Trial of Adapted Tango to Improve Negative Health Impacts in Middle Aged African-American Female Caregivers of Persons with Alzheimer's Disease (ACT Trial).

Alzheimer's disease (AD) is a devastating progressive neurodegenerative disease resulting in memory loss and a severe reduction in ability to perform activities of daily living. The role of caring for someone with AD frequently falls to female family members, often daughters. The burden of caregiving can increase stress and anxiety and cause health decline in the caregiver. The combination of ethnicity-related genetic factors promoting the development of dementias among African-Americans (AA) and the increased risk among women for developing AD means that AA women who are caregivers of a parent with AD are at great risk for developing dementias including AD. The proposed study would compare the cognitive, motor, and psychosocial benefits of a well-established 12 week, 20-lesson adapted Argentine Tango intervention (N = 30) to a no-contact control group (N = 10) in middle-aged (45-65 years) AA women who are caregivers of a parent with AD in the metro Atlanta area.

Internally Guided Lower Limb Movement Recruits Compensatory Cerebellar Activity in People With Parkinson's Disease.

Background: Externally guided (EG) and internally guided (IG) movements are postulated to recruit two parallel neural circuits, in which motor cortical neurons interact with either the cerebellum or striatum via distinct thalamic nuclei. Research suggests EG movements rely more heavily on the cerebello-thalamo-cortical circuit, whereas IG movements rely more on the striato-pallido-thalamo-cortical circuit (1). Because Parkinson's (PD) involves striatal dysfunction, individuals with PD have difficulty generating IG movements (2). Objectives: Determine whether individuals with PD would employ a compensatory mechanism favoring the cerebellum over the striatum during IG lower limb movements. Methods: 22 older adults with mild-moderate PD, who had abstained at least 12 h from anti-PD medications, and 19 age-matched controls performed EG and IG rhythmic foot-tapping during functional magnetic resonance imaging. Participants with PD tapped with their right (more affected) foot. External guidance was paced by a researcher tapping participants' ipsilateral 3rd metacarpal in a pattern with 0.5 to 1 s intervals, while internal guidance was based on pre-scan training in the same pattern. BOLD activation was compared between tasks (EG vs. IG) and groups (PD vs. control). Results: Both groups recruited the putamen and cerebellar regions. The PD group demonstrated less activation in the striatum and motor cortex than controls. A task (EG vs. IG) by group (PD vs. control) interaction was observed in the cerebellum with increased activation for the IG condition in the PD group. Conclusions: These findings support the hypothesized compensatory shift in which the dysfunctional striatum is assisted by the less affected cerebellum to accomplish IG lower limb movement in individuals with mild-moderate PD. These findings are of relevance for temporal gait dysfunction and freezing of gait problems frequently noted in many people with PD and may have implications for future therapeutic application.

The DREAMS Team: Creating community partnerships through research advocacy training for diverse older adults.

The DREAMS Team research advocacy training program helps clinical faculty and health students introduce basic clinical research concepts to diverse older adults to galvanize their active involvement in the research process. Older adults are frequently underrepresented in clinical research, due to barriers to participation including distrust, historical mistreatment, and their lack of health literacy. The DREAMS Team program aims to involve diverse older adults throughout all phases of research and increase research participation, thereby contributing to the growth of quality patient-centered, evidence-based health care. This course was developed for clinical faculty to deliver to diverse adults aged 55+ in eight 50-minute lectures, followed by half-hour small group discussions moderated by health students. A pilot cohort of 24 individuals was assessed for satisfaction post-program, and self-efficacy before and after the program. Older adult participants improved on a survey measure of self-efficacy, and indicated satisfaction on a post-program questionnaire. All agreed or strongly agreed that they enjoyed participating, and that classes enhanced knowledge/skills about the topics, were high quality, and provided useful information. Twenty-two out of 24 individuals who completed the program indicated they planned to get involved as research advocates. The DREAMS Team program can be offered either on its own, or as a follow-up program to a general health education course led by health students and/or professional researchers or clinicians. Educating older adults about the research process and advocacy through interactive seminars led by congenial and respectful researchers and health students may remove some barriers to research participation and involvement among diverse older adults.