Global rural health disparities in Alzheimer's disease and related dementias: State of the science.

INTRODUCTION: Individuals living in rural communities are at heightened risk for Alzheimer's disease and related dementias (ADRD), which parallels other persistent place-based health disparities. Identifying multiple potentially modifiable risk factors specific to rural areas that contribute to ADRD is an essential first step in understanding the complex interplay between various barriers and facilitators. METHODS: An interdisciplinary, international group of ADRD researchers convened to address the overarching question of: "What can be done to begin minimizing the rural health disparities that contribute uniquely to ADRD?" In this state of the science appraisal, we explore what is known about the biological, behavioral, sociocultural, and environmental influences on ADRD disparities in rural settings. RESULTS: A range of individual, interpersonal, and community factors were identified, including strengths of rural residents in facilitating healthy aging lifestyle interventions. DISCUSSION: A location dynamics model and ADRD-focused future directions are offered for guiding rural practitioners, researchers, and policymakers in mitigating rural disparities. HIGHLIGHTS: Rural residents face heightened Alzheimer's disease and related dementia (ADRD) risks and burdens due to health disparities. Defining the unique rural barriers and facilitators to cognitive health yields insight. The strengths and resilience of rural residents can mitigate ADRD-related challenges. A novel "location dynamics" model guides assessment of rural-specific ADRD issues.

Effectiveness of non-pharmaceutical interventions on cognitive function among non-demented African American and Latino older adults in the USA: a scoping review.

OBJECTIVE: African Americans and Latinos/Hispanics have a higher prevalence of dementia compared to non-Latino Whites. This scoping review aims to synthesize non-pharmaceutical interventions to delay or slow age-related cognitive decline among cognitively healthy African American and Latino older adults. DESIGN: A literature search for articles published between January 2000 and May 2019 was performed using the databases PubMed, CINAHL, PsycINFO and Web of Science. Relevant cited references and grey literature were also reviewed. Four independent reviewers evaluated 1,181 abstracts, and full-article screening was subsequently performed for 145 articles. The scoping review consisted of eight studies, which were evaluated according to the peer-reviewed original manuscript, non-pharmaceutical intervention, cognitive function as an outcome, separate reporting of results for African American and Latinos, minimum age of 40, and conducted in the US. A total of 8 studies were considered eligible and were analyzed in the present scoping review. RESULTS: Eight studies were identified. Four studies focused on African Americans and four focused on Latinos. Through the analysis, results indicated cognitive training-focused interventions were effective in improving memory, executive function, reasoning, visuospatial, psychological function, and speed among African Americans. Exercise interventions were effective in improving cognition among Latinos. CONCLUSION: This scoping review identified effective non-pharmaceutical interventions among African American and Latinos. Effective interventions focused on cognitive training alone for African Americans and exercise combined with group educational sessions for Latinos. Future research should explore developing culturally appropriate non-pharmaceutical interventions to reduce disparities and to enhance cognition among older African American and Latinos.

Measurement invariance of a neuropsychological battery across urban and rural older adults in Costa Rica.

This study evaluated the measurement invariance of a neuropsychological battery across rural and urban older adults from Costa Rica. Rural and urban older adults (N = 295) from the Epidemiology and Development of Alzheimer's Disease (EDAD) study in Costa Rica were assessed. The baseline factor model for the EDAD neuropsychological measures was identified with nine neuropsychological measures and three cognitive constructs: Verbal Memory, Spatial Reasoning, and Cognitive Flexibility. Measurement and structural invariance were established, and, then, group comparisons of the latent cognitive factors were conducted to explore regional disparities. The findings showed that most of the neuropsychological tests in EDAD can be directly compared across the groups, allowing for cognitive constructs comparisons. The rural sample showed a disadvantage in the Spatial Reasoning and Cognitive Flexibility abilities. When age and education were included in the models, differences between the regions disappeared. Having more years of education was associated with higher cognitive abilities, with a larger effect for the rural group. Norms for Costa Rican older adults should consider age and education adjustments. This study contributes to the growing area of measurement invariance in neuropsychological assessment as it highlights the importance of examining the comparability of assessment measures across different cultural groups.

Health-Related Quality of Life of Older Adults in Costa Rica as Measured by the Short-Form-36 Health Survey.

Objective: To test the validity of a common measure of health-related quality of life (Short-Form-36 [SF-36]) in cognitively healthy older adults living in rural and urban Costa Rica. Method: Confirmatory factor analysis was applied to SF-36 data collected in 250 older adults from San Jose and Guanacaste, Costa Rica. Results: The best fitting model for the SF-36 was an eight first-order factor structure. A high correlation between the Mental Component Summary and Physical Component Summary scores was found. Region differences indicated that rural dwellers perceive a poorer health-related quality of life compared with the urban group. Discussion: Costa Rican older adults perceived health as a unidimensional construct. Age and urbanity of older adult Costa Ricans should be appreciated when trying to measure self-reported physical and mental health. Cultural context of the individuals should be considered when studying health-related quality of life.

A Systematic Review of the Relationship between Familism and Mental Health Outcomes in Latino Population.

Background:Familismo or familism is a cultural value frequently seen in Hispanic cultures, in which a higher emphasis is placed on the family unit in terms of respect, support, obligation, and reference. Familism has been implicated as a protective factor against mental health problems and may foster the growth and development of children. This study aims at measuring the size of the relationship between familism and mental health outcomes of depression, suicide, substance abuse, internalizing, and externalizing behaviors. Methods: Thirty-nine studies were systematically reviewed to assess the relationship between familism and mental health outcomes. Data from the studies were comprised and organized into five categories: depression, suicide, internalizing symptoms, externalizing symptoms, and substance use. The Cohen's d of each value (dependent variable in comparison to familism) was calculated. Results were weighted based on sample sizes (n) and total effect sizes were then calculated. It was hypothesized that there would be a large effect size in the relationship between familism and depression, suicide, internalizing, and externalizing symptoms and substance use in Hispanics. Results: The meta-analysis showed small effect sizes in the relationship between familism and depression, suicide and internalizing behaviors. And no significant effects for substance abuse and externalizing behaviors. Discussion: The small effects found in this study may be explained by the presence of moderator variables between familism and mental health outcomes (e.g., communication within the family). In addition, variability in the Latino samples and in the measurements used might explain the small and non-significant effects found.

Mental Health Literacy toward Schizophrenia in College Students from El Salvador and the United States of America / Conocimiento sobre Esquizofrenia en Estudiantes Universitarios de El Salvador y los Estados Unidos de América

ABSTRACT The present study tested the hypothesis that El Salvador (E.S.) college students will show less knowledge, recognition, and help-seeking attitudes, and more social distance and negative attributions toward schizophrenia than will U.S. students. It is also of interest in this study to investigate if E.S. college students would have lower mental health literacy and thus, more social distance attitudes toward schizophrenia, than would U.S. students. Discriminant function analysis (DFA) was used. The predicted variable was country of membership: El Salvador and the U.S. The predictors were recognition, knowledge, social distance, helpseeking attitudes, and negative attribution toward schizophrenic patients. The participants (N = 340) were students from a university in E.S. and in California. Through a survey, participants were asked to diagnose a person described in a case vignette. Knowledge of schizophrenia and social distance attitudes were measured. Principal component analyses using oblimin rotation were conducted to build composite factors from the observed variables. The discriminant function accurately predicted 74.4% of the participants' country of membership, X(1) = 75.23, p < 0.001. At the individual level, 69.9% of individuals from the U.S. and 77.5% of individuals from E.S. were correctly classified. Furthermore, results indicated that U.S. students recognized schizophrenia at a higher rate, compared to E.S. students. In the E.S. group, social distance attitudes differed with level of MHL. These findings are troublesome in that social distance attitudes inhibit help-seeking behavior. Education programs aimed at promoting mental health awareness among the E.S. population are indicated.

RESUMEN El presente estudio investigó la diferencia en conocimiento sobre esquizofrenia, su identificación, actitudes de búsqueda de ayuda, distanciamiento social y atribuciones negativas entre estudiantes universitarios salvadoreños y estadounidenses. También fue de interés en este estudio explorar si los estudiantes universitarios salvadoreños con menor nivel de conocimiento buscarían mayor distanciamiento social hacia una persona con esquizofrenia, que los estudiantes estadounidenses. Se utilizó análisis de función discriminante (DFA). La variable predicha fue país de pertenencia: El Salvador y Estados Unidos. Los predictores fueron el reconocimiento, el conocimiento, la distancia social, la actitud hacia búsqueda de ayuda y la atribución negativa a las personas con esquizofrenia. Los participantes (N = 340) fueron estudiantes de una universidad en E.S. y en California. A través de una encuesta, se pidió a los participantes que diagnosticaran a una persona, a través de una historia de caso. Se midió el conocimiento sobre la esquizofrenia y las actitudes de distanciamiento social. Se utilizó análisis de componentes principales (PCA) con rotación oblimin para construir factores compuestos de las variables observadas. La función discriminante predijo con precisión el 74.4% del país de pertenencia de los participantes, x (1) = 75.23, p < 0.001. A nivel individual, el 69.9% de los individuos de los Estados Unidos y el 77.5% de los individuos de E.S. fueron clasificados correctamente. Los resultados indicaron que los estudiantes estadounidenses reconocían la esquizofrenia a una tasa más alta, en comparación con los estudiantes salvadoreños. En el grupo de E.S., las actitudes de distancia social diferían con el nivel de conocimiento sobre esquizofrenia. Estos hallazgos son problemáticos porque las actitudes de distancia social (estigma) obstaculizan la búsqueda de ayuda. Se recomiendan programas educativos dirigidos a promover la concientización sobre salud mental entre la población salvadoreña.