Context-Recently asymptomatic middle-aged adult children of patients with Alzheimer Disease (AD) ... more Context-Recently asymptomatic middle-aged adult children of patients with Alzheimer Disease (AD) were found to exhibit fMRI deficits in the mesial temporal lobe during an encoding task. Whether this effect will be observed on other fMRI tasks is not yet known. This study examines the neural substrates of self-appraisal in people at risk for AD. Accurate appraisal of deficits is a problem for many AD patients, and prior fMRI studies of healthy young adults indicates that brain areas vulnerable to AD such as the anterior mesial temporal lobe and posterior cingulate are involved during self appraisal tasks. Objective-To determine whether parental family history of AD (FH) or the ε4 allele of the Apolipoprotein E gene (APOE4) exert independent effects on brain function during self-appraisal. Design-Cross-sectional factorial design in which APOE4 status (present/absent) was one factor, and FH status was the other. All participants received cognitive testing, genotyping and an fMRI task that required subjective self-appraisal (SA) decisions regarding trait adjective words in comparison to semantic decisions about the same words. Setting-An academic medical center with a research-dedicated 3.0 Tesla MRI facility. Participants-Cognitively normal middle-aged adults (N=110): 51 +FH; 59 −FH. Outcome measure-Blood oxygen-dependent contrast measured with T2* weighted echo-planar imaging. Results-FH and APOE4 status interacted in the posterior cingulate as well as left superior and medial frontal regions. There were main effects of FH (−FH > +FH) in left hippocampus, and ventral posterior cingulate. There were no main effects of APOE. Conclusion-These results suggest that a parental history of AD may influence brain function during subjective self-appraisal in regions commonly affected by AD. Although these participants were asymptomatic and middle-aged, the findings suggest there may be subtle alterations in brain function attributable to AD risk factors. Neuropathology studies of people at risk for Alzheimer disease (AD) suggest that AD may be preceded by a silent preclinical phase in which the brain incurs neuropathological change. 1-4 Both the apolipoprotein E gene (APOE) ε4 allele (APOE4) and first-degree family history
ciation between MMSE score and falls rate persisted (rate ratio 1.20, 95% CI 1.03-1.40, p = 0.021... more ciation between MMSE score and falls rate persisted (rate ratio 1.20, 95% CI 1.03-1.40, p = 0.021). Conclusion: Minimal decrements on the MMSE were associated with elevations in rate of falls, suggesting that subtle cognitive deficits reflected in MMSE scores above a cutoff consistent with a diagnosis of dementia, can influence risk for falls.
Factors contributing to increased risk for Alzheimer's disease (AD) include age, sex, genes, and ... more Factors contributing to increased risk for Alzheimer's disease (AD) include age, sex, genes, and family history of AD. Several risk factors for AD are endogenous; however accumulating evidence implicates modifiable risk factors in the pathogenesis of AD. Although the continued task of identifying new genes will be critical to learning more about the disease, several research findings suggest that potentially alterable environmental factors influence genetic contributions, providing targets for disease prevention and treatment. Here, we review midlife risk factors for AD, and address the potential for therapeutic intervention in midlife.
Background: Metabolic syndrome (MetS) has been associated with increased risk for Alzheimer’s dis... more Background: Metabolic syndrome (MetS) has been associated with increased risk for Alzheimer’s disease and related dementias (ADRD). Understanding the association of MetS risk factors to processing speed and executive function in the pre-clinical stages of ADRD in under-represented groups would offer insight on potential mechanisms through which MetS associates with ADRD risk. Objective: Examine association of MetS features and processing speed and executive function across three racial groups. Methods: Cognitively unimpaired adults from the Wisconsin Alzheimer’s Disease Research Center and the Wisconsin Registry for Alzheimer’s Disease Prevention completed blood-draws and neuropsychological testing. Six cognitive outcomes were assessed in association to MetS risk factors: Trailmaking Tests A and B, Animal Fluency, Digit Symbol, and composite scores for Processing Speed and Executive Function. Linear mixed effect models were used to assess the relationship between MetS risk factor co...
BackgroundWhen and how to communicate effectively the results of genetic and biomarker based pred... more BackgroundWhen and how to communicate effectively the results of genetic and biomarker based prediction, detection, and quantification of the brain substrates of dementia involve important ethical and legal issues critical for precision medicine. The urgency of the issue has increased as People Living with Dementia (PLwD) and with Risk for Dementia (PwRD) can access direct to consumer genetic testing, amyloid targeting drugs, and clinical amyloid PET scans. To address the need for effective dissemination and consultation, an advisory group was convened that welcomes all interested members.MethodMembers attend two meetings monthly via phone/computer/WebEx. One meeting is a targeted working group that focuses on the following: 1. Symptomatic (PLwD), 2. Asymptomatic (PwRD), 3. Research, 4. Ethics/Healthcare Law, 5. Trainee/Mentorship. These discussion groups hear from and present to stakeholders (PLwD/PwRD/caregivers, professional organizations, companies) to solicit feedback on the ef...
A lumbar puncture (LP) is required to study cerebrospinal fluid (CSF) based biomarkers in preclin... more A lumbar puncture (LP) is required to study cerebrospinal fluid (CSF) based biomarkers in preclinical Alzheimer’s Disease (AD). However, participants are often reluctant to undergo an LP due to fear. Insufficient data on the experiences of participants from underrepresented groups may contribute to their greater reluctance to agree to LP procedures, impacting diversity in AD studies. This analysis explores racial differences in intra‐procedural and post‐procedural complications rates.
BackgroundThe COVID‐19 pandemic has posed substantial impact on people’s life and wellbeing, espe... more BackgroundThe COVID‐19 pandemic has posed substantial impact on people’s life and wellbeing, especially for the aging population who are at greater risk. This study compared the difference in the impact between older adults from underrepresented racial/ethnic groups (URGs) versus non‐URGs.MethodThe National Alzheimer’s Coordinating Center COVID‐19 Impact Survey was self‐reported by 221 participants aged 49‐99 years from the Wisconsin Alzheimer’s Disease Research Center clinical core between August and December, 2020. 43 participants who reported “Black or African American” or “American Indian or Alaska Native” in primary or secondary race or reported “Yes” to Hispanic” ethnicity were classified as URGs. The remaining 178 participants who reported only “White” or “Asian” in the primary and secondary races and “No” to “Hispanic” ethnicity were classified as non‐URGs. The survey inquired on (1) COVID‐19 symptoms, testing, diagnosis, and hospitalization; (2) worrying, social isolation, ...
Family caregiving is uniquely significant for elder care within American Indian/Alaska Native (AI... more Family caregiving is uniquely significant for elder care within American Indian/Alaska Native (AI/AN) communities. Compared to other populations, AI/AN older adults are disproportionately impacted by chronic conditions and AI/AN are more likely to be family caregivers. However, AI/AN are underrepresented in aging research. We describe a successful research partnership with the Oneida Nation of Wisconsin and report results of a recent survey of tribal members and affiliates (N=405), covering demographics of caregiving, awareness and use of home and community-based resources, and perceptions of factors impacting service use. Approximately 42% of respondents were current caregivers; of these, roughly one-third knew how to access various resources. Most common sources of knowledge were a health care/social worker or finding information on their own. Traditional cultural values were viewed as variably supportive of resource utilization, depending on service type. Implications for efforts...
Prevalence of dementia among American Indian/Alaska Natives (AI/AN) is higher than in white popul... more Prevalence of dementia among American Indian/Alaska Natives (AI/AN) is higher than in white populations, and AI/AN communities experience dementia care service gaps. This study explored perspectives within AI/AN communities regarding dementia, the family caregiver role, and home and community-based service use. Using tenets of Community-Based Participatory Research, qualitative interviews and a brief survey were conducted with 22 members of the Oneida Nation of Wisconsin (mean age 71 years, 73% female). Of the sample, 63.6% identified as a past or current family caregiver for a loved one with dementia. Awareness of services varied; 82% were aware of memory cafes, 75% knew of the caregiver support group, and 43% were familiar with dementia care specialist services. Thematic analysis revealed shared values of involving the family and community in dementia care, and offer guidance to support greater engagement in services. Implications for culturally-tailored service provision within A...
In their first and often only statistics course, health-care professionals are taught Bayes' theo... more In their first and often only statistics course, health-care professionals are taught Bayes' theorem in the context of diagnostic testing. They learn the concepts of sensitivity/specificity and predictive value positive/negative and how Bayes' theorem can assist in diagnostic decisionmaking. Then the class moves on often spending weeks on tests of significance. This paper will argue for changing this practice, and instead focusing such courses on statistics for decisionmaking beyond diagnostic testing. It will argue that such changes will make our health-care professionals better consumers of statistical information and better decision makers.
With increased longevity and growth in the number of older adults comes rising rates of individua... more With increased longevity and growth in the number of older adults comes rising rates of individuals with cognitive impairment and dementia. The expansion of this population has important implications for research on aging and dementia syndromes, namely increased enrollment of older individuals in clinical research. Ethical prerogatives, as well as historical underrepresentation of persons with dementia in research studies due to the perceived burden of traditional decisional capacity evaluations, necessitates the development of pragmatic approaches to ascertain decisional abilities in research settings. We outline a protocol used in the Wisconsin Alzheimer's Disease Research Center (ADRC) that adopts a stepped approach to the evaluation of decisional capacity meant to maximize study visit efficiency while preserving participant safety and autonomy. The protocol specifies the structure of the consent process and incorporates a brief semi-structured interview based on Appelbaum & Grisso's theoretical model for evaluating a patient's decisional capacity to provide informed consent to participate in research. This protocol is easily implemented in a research study visit and is designed to minimize participant burden and ensure reliable assessment of decisional capacity in older adults across a wide range of research protocols. The protocol emphasizes capacity optimization, using memory aids and other compensatory strategies to preserve participant autonomy while protecting welfare.
Background: As Alzheimer's disease and related dementias prevalence (ADRD) increases it will disp... more Background: As Alzheimer's disease and related dementias prevalence (ADRD) increases it will disproportionately burden racial and ethnic minority communities. Recent population-based evidence suggests that American Indians and Alaska Natives (AI/AN) are at increased risk for dementia relative to non-Hispanic Whites and Asians. Despite evidence that 1 of every 3 AI/AN elders will develop dementia, they remain substantially underrepresented in ADRD research. As of March 2019, only 248 of the 40,000+ individuals enrolled at Alzheimer's Disease Centers (ADC) were AI/AN. Subsequently, little is known about dementia etiology, progression, and care in AI/AN communities. We describe an ongoing partnership between the Oneida Nation of Wisconsin and the Wisconsin Alzheimer's Disease Research Center (ADRC) that seeks to address this knowledge gap and respond to the ADRD-related concerns in Wisconsin's Indian Country. Methods: We implemented an NIA-funded, community-based, culturally-relevant approach to address barriers to participation in ADRD research and access to services for persons with dementia. This approach is comprised of four aims: (1) Establish a Community Advisory Board (CAB) to guide culturallytailored outreach programs to increase research enrollment and retention of AI/AN participants, (2) Improve access to culturally appropriate dementia diagnostic services, (3) Survey of Oneida caregivers of persons with dementia to understand caregiving experiences, and (4) Initiate liaisons with ten other Wisconsin tribes. Results: Project leaders and Oneida CAB members meet monthly on Oneida lands, and ADRC staff attend quarterly meetings with an Inter-Tribal Elders Association. In 2018, project leaders held an inaugural National Conference on Dementia in Native American Communities. Preliminary results for Aim 1 are promising. Following establishment of the partnership, the number of AI/AN participants enrolled in the ADRC has increased tremendously (see Figure 1), and rises at a rate of two new participants per month. 77% of AI/AN participants also participate in an imaging sub-study. Conclusions: The Wisconsin ADRC has enrolled nearly a quarter of all AI/AN participants included in the combined ADC dataset. Actively prioritizing a collaborative partnership and investing in communitybased relationships was essential to our inclusion efforts with AI/AN communities. These elements are fundamental for establishing research and clinical efforts that effectively respond to the needs of AI/AN populations.
Objective Previous work has demonstrated that intra-individual cognitive variability (IICV) has p... more Objective Previous work has demonstrated that intra-individual cognitive variability (IICV) has predictive power similar to traditional Alzheimer’s disease (AD) biomarkers, such as CSF or hippocampal volume (HV) loss. Genetic factors, such as sex, have been identified as predictors of cognitive decline. Analysis of sex differences in IICV and other biomarkers may elucidate additional dimensions of this metric. Method Baseline neurocognitive test and neuroimaging data from 335 participants with ≥2 visits enrolled in the Wisconsin Alzheimer’s Disease Research Center Clinical Core were included. Z-scores were calculated comparing individual performance to group performance by test (Rey Auditory Verbal Learning Test (Learning and Delayed Recall), Trail Making Test (A and B), and either Boston Naming Test (BNT) or Multilingual Naming Test (MINT)). MINT scores were converted to BNT scores using the NACC Crosswalk Study. The standard deviation of z-scores across tests was calculated to det...
Objective Intra-Individual Cognitive Variability (IICV) previously demonstrated predictive power ... more Objective Intra-Individual Cognitive Variability (IICV) previously demonstrated predictive power similar to AD biomarkers (i.e., CSF and hippocampal volume (HV) loss). Previous work suggested sex differences in relative HV and IICV. Additionally, IICV differs in whites and underrepresented racial groups (URG). Our objective was to analyze these sex differences in white and URG participants. Method Baseline neurocognitive test and neuroimaging data from 335 cognitively healthy participants with ≥2 visits enrolled in the Wisconsin ADRC Clinical Core were included. Z-scores were calculated comparing individual performance to group performance by test (Rey Auditory Verbal Learning Test (Learning and Delayed Recall), Trail Making Test (A and B), and either Boston Naming Test (BNT) or Multilingual Naming Test (MINT)). MINT scores were converted to BNT scores using the NACC Crosswalk Study. The standard deviation of z-scores across tests was calculated to determine IICV. Characteristics by...
Boston.Namin Total.Score Category.Fluen Raw.Score WAIS.R...Digi WMS.R...Log A.Raw.Scor WMS.R...Lo... more Boston.Namin Total.Score Category.Fluen Raw.Score WAIS.R...Digi WMS.R...Log A.Raw.Scor WMS.R...Log A.Raw.Scor MMSE... Tota Trail.Making.T Trail.Making.T WAIS.R...Digi Score WAIS.R...Digi Longest.Spa WAIS. R...Dig Raw.Score WAIS.R...Digi Longest.Spa Category.Fluen Raw.Score Boston.Namin Score Standard devia Proportion of Cumulative Pr UNIFORM DATA SET 2 (UDS-2) AND UNIFORM DATA SET 3 (UDS-3) IN NONHISPANIC WHITE PARTICIPANTS AND THOSE FROM UNDERREPRESENTED GROUPS ENROLLED IN THE WISCONSIN ALZHEIMER’S DISEASE RESEARCH CENTER’S CLINICAL CORE
Radio advertising 69.01% 50.98% Registries 61.97% 57.45% Television advertising 50.70% 73.68% Dor... more Radio advertising 69.01% 50.98% Registries 61.97% 57.45% Television advertising 50.70% 73.68% Dorothy Farrar Edwards, Carey E. Gleason, Hanna Blazel, Cynthia M. Carlsson, Alice Spalitta, Susan Stark, Sanjay Asthana, Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; William S. Middleton Memorial Veterans’ Hospital, Madison, WI, USA; University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Wisconsin Alzheimer’s Disease Research Center, Madison, WI, USA; Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Washington University Alzheimer’s Disease Research Center, St. Louis, MO, USA; Geriatric Research Education and Clinical Center, W.S. Middleton Memorial Veterans Hospital, Madison, WI, USA. Contact e-mail: [email protected]
Introduction: Studies use multiple measures of cognitive function to assess for dementia. By exam... more Introduction: Studies use multiple measures of cognitive function to assess for dementia. By examining concordance between objective and subjective questionnaires, we can gain insight into the benefits and drawbacks of these measures. Methods: New England Centenarian Study offspring participants (N=599, mean age 83.3+/-7.0 years) completed objective cognitive assessments (Telephone Interview for Cognitive Status, TICS-m) and informants completed the Dementia Questionnaire (DQ) which inquires about symptoms of cognitive and functional impairments. Dementia was indicated by a TICS-m score <27 (TICS+) or impairments in both memory and ADLs on the DQ (DQ+). Results: 44 offspring were TICS+ of which 55% (n=24) were also DQ+. Discordance was due to false-positive deflation of TICS scores from sensorimotor impairments, poor informant reliability/bias on the DQ, and the requirement of an ADL impairment for DQ+. For 62 who were DQ+, 39% (n=24) were TICS+. Discordance for DQ+ participants were due to overstatement of memory impairment by informants. Of the 555 who were TICS-, 93% were DQ-. Conclusion: Inherently, with questions that measure specific cognitive functions, the TICS is less prone to administrator bias. The DQ, however, is more ecologically valid; it is able to pick up on impairment in everyday life that cannot be detected by formal test questions; an advantage that is countered in part by informant bias. High concordance for negative dementia status suggests that either measure is sufficient for ruling out dementia whereas the lower concordance for positive dementia status indicates there is greater sensitivity by using the two together to detect dementia.
Ninety-eight percent of events occurred on Days 0-3. All 3 pts with later events also had events ... more Ninety-eight percent of events occurred on Days 0-3. All 3 pts with later events also had events on Day 0. In a multivariate model, only EF was a significant predictor of events, p=0.04. Of pts with EF < 40%, 16% had events vs 8% with EF Ն 40%, p < 0.005. The 3 pts with events after Day 3 had EF 40-43%. Conclusion: It is safe to discharge AMI pts after hospital Day 3, if they had successful primary PCI and have not experienced complications during Days 0-3. While EF predicts overall events, it is an imperfect tool for discharge planning.
Context-Recently asymptomatic middle-aged adult children of patients with Alzheimer Disease (AD) ... more Context-Recently asymptomatic middle-aged adult children of patients with Alzheimer Disease (AD) were found to exhibit fMRI deficits in the mesial temporal lobe during an encoding task. Whether this effect will be observed on other fMRI tasks is not yet known. This study examines the neural substrates of self-appraisal in people at risk for AD. Accurate appraisal of deficits is a problem for many AD patients, and prior fMRI studies of healthy young adults indicates that brain areas vulnerable to AD such as the anterior mesial temporal lobe and posterior cingulate are involved during self appraisal tasks. Objective-To determine whether parental family history of AD (FH) or the ε4 allele of the Apolipoprotein E gene (APOE4) exert independent effects on brain function during self-appraisal. Design-Cross-sectional factorial design in which APOE4 status (present/absent) was one factor, and FH status was the other. All participants received cognitive testing, genotyping and an fMRI task that required subjective self-appraisal (SA) decisions regarding trait adjective words in comparison to semantic decisions about the same words. Setting-An academic medical center with a research-dedicated 3.0 Tesla MRI facility. Participants-Cognitively normal middle-aged adults (N=110): 51 +FH; 59 −FH. Outcome measure-Blood oxygen-dependent contrast measured with T2* weighted echo-planar imaging. Results-FH and APOE4 status interacted in the posterior cingulate as well as left superior and medial frontal regions. There were main effects of FH (−FH > +FH) in left hippocampus, and ventral posterior cingulate. There were no main effects of APOE. Conclusion-These results suggest that a parental history of AD may influence brain function during subjective self-appraisal in regions commonly affected by AD. Although these participants were asymptomatic and middle-aged, the findings suggest there may be subtle alterations in brain function attributable to AD risk factors. Neuropathology studies of people at risk for Alzheimer disease (AD) suggest that AD may be preceded by a silent preclinical phase in which the brain incurs neuropathological change. 1-4 Both the apolipoprotein E gene (APOE) ε4 allele (APOE4) and first-degree family history
ciation between MMSE score and falls rate persisted (rate ratio 1.20, 95% CI 1.03-1.40, p = 0.021... more ciation between MMSE score and falls rate persisted (rate ratio 1.20, 95% CI 1.03-1.40, p = 0.021). Conclusion: Minimal decrements on the MMSE were associated with elevations in rate of falls, suggesting that subtle cognitive deficits reflected in MMSE scores above a cutoff consistent with a diagnosis of dementia, can influence risk for falls.
Factors contributing to increased risk for Alzheimer's disease (AD) include age, sex, genes, and ... more Factors contributing to increased risk for Alzheimer's disease (AD) include age, sex, genes, and family history of AD. Several risk factors for AD are endogenous; however accumulating evidence implicates modifiable risk factors in the pathogenesis of AD. Although the continued task of identifying new genes will be critical to learning more about the disease, several research findings suggest that potentially alterable environmental factors influence genetic contributions, providing targets for disease prevention and treatment. Here, we review midlife risk factors for AD, and address the potential for therapeutic intervention in midlife.
Background: Metabolic syndrome (MetS) has been associated with increased risk for Alzheimer’s dis... more Background: Metabolic syndrome (MetS) has been associated with increased risk for Alzheimer’s disease and related dementias (ADRD). Understanding the association of MetS risk factors to processing speed and executive function in the pre-clinical stages of ADRD in under-represented groups would offer insight on potential mechanisms through which MetS associates with ADRD risk. Objective: Examine association of MetS features and processing speed and executive function across three racial groups. Methods: Cognitively unimpaired adults from the Wisconsin Alzheimer’s Disease Research Center and the Wisconsin Registry for Alzheimer’s Disease Prevention completed blood-draws and neuropsychological testing. Six cognitive outcomes were assessed in association to MetS risk factors: Trailmaking Tests A and B, Animal Fluency, Digit Symbol, and composite scores for Processing Speed and Executive Function. Linear mixed effect models were used to assess the relationship between MetS risk factor co...
BackgroundWhen and how to communicate effectively the results of genetic and biomarker based pred... more BackgroundWhen and how to communicate effectively the results of genetic and biomarker based prediction, detection, and quantification of the brain substrates of dementia involve important ethical and legal issues critical for precision medicine. The urgency of the issue has increased as People Living with Dementia (PLwD) and with Risk for Dementia (PwRD) can access direct to consumer genetic testing, amyloid targeting drugs, and clinical amyloid PET scans. To address the need for effective dissemination and consultation, an advisory group was convened that welcomes all interested members.MethodMembers attend two meetings monthly via phone/computer/WebEx. One meeting is a targeted working group that focuses on the following: 1. Symptomatic (PLwD), 2. Asymptomatic (PwRD), 3. Research, 4. Ethics/Healthcare Law, 5. Trainee/Mentorship. These discussion groups hear from and present to stakeholders (PLwD/PwRD/caregivers, professional organizations, companies) to solicit feedback on the ef...
A lumbar puncture (LP) is required to study cerebrospinal fluid (CSF) based biomarkers in preclin... more A lumbar puncture (LP) is required to study cerebrospinal fluid (CSF) based biomarkers in preclinical Alzheimer’s Disease (AD). However, participants are often reluctant to undergo an LP due to fear. Insufficient data on the experiences of participants from underrepresented groups may contribute to their greater reluctance to agree to LP procedures, impacting diversity in AD studies. This analysis explores racial differences in intra‐procedural and post‐procedural complications rates.
BackgroundThe COVID‐19 pandemic has posed substantial impact on people’s life and wellbeing, espe... more BackgroundThe COVID‐19 pandemic has posed substantial impact on people’s life and wellbeing, especially for the aging population who are at greater risk. This study compared the difference in the impact between older adults from underrepresented racial/ethnic groups (URGs) versus non‐URGs.MethodThe National Alzheimer’s Coordinating Center COVID‐19 Impact Survey was self‐reported by 221 participants aged 49‐99 years from the Wisconsin Alzheimer’s Disease Research Center clinical core between August and December, 2020. 43 participants who reported “Black or African American” or “American Indian or Alaska Native” in primary or secondary race or reported “Yes” to Hispanic” ethnicity were classified as URGs. The remaining 178 participants who reported only “White” or “Asian” in the primary and secondary races and “No” to “Hispanic” ethnicity were classified as non‐URGs. The survey inquired on (1) COVID‐19 symptoms, testing, diagnosis, and hospitalization; (2) worrying, social isolation, ...
Family caregiving is uniquely significant for elder care within American Indian/Alaska Native (AI... more Family caregiving is uniquely significant for elder care within American Indian/Alaska Native (AI/AN) communities. Compared to other populations, AI/AN older adults are disproportionately impacted by chronic conditions and AI/AN are more likely to be family caregivers. However, AI/AN are underrepresented in aging research. We describe a successful research partnership with the Oneida Nation of Wisconsin and report results of a recent survey of tribal members and affiliates (N=405), covering demographics of caregiving, awareness and use of home and community-based resources, and perceptions of factors impacting service use. Approximately 42% of respondents were current caregivers; of these, roughly one-third knew how to access various resources. Most common sources of knowledge were a health care/social worker or finding information on their own. Traditional cultural values were viewed as variably supportive of resource utilization, depending on service type. Implications for efforts...
Prevalence of dementia among American Indian/Alaska Natives (AI/AN) is higher than in white popul... more Prevalence of dementia among American Indian/Alaska Natives (AI/AN) is higher than in white populations, and AI/AN communities experience dementia care service gaps. This study explored perspectives within AI/AN communities regarding dementia, the family caregiver role, and home and community-based service use. Using tenets of Community-Based Participatory Research, qualitative interviews and a brief survey were conducted with 22 members of the Oneida Nation of Wisconsin (mean age 71 years, 73% female). Of the sample, 63.6% identified as a past or current family caregiver for a loved one with dementia. Awareness of services varied; 82% were aware of memory cafes, 75% knew of the caregiver support group, and 43% were familiar with dementia care specialist services. Thematic analysis revealed shared values of involving the family and community in dementia care, and offer guidance to support greater engagement in services. Implications for culturally-tailored service provision within A...
In their first and often only statistics course, health-care professionals are taught Bayes' theo... more In their first and often only statistics course, health-care professionals are taught Bayes' theorem in the context of diagnostic testing. They learn the concepts of sensitivity/specificity and predictive value positive/negative and how Bayes' theorem can assist in diagnostic decisionmaking. Then the class moves on often spending weeks on tests of significance. This paper will argue for changing this practice, and instead focusing such courses on statistics for decisionmaking beyond diagnostic testing. It will argue that such changes will make our health-care professionals better consumers of statistical information and better decision makers.
With increased longevity and growth in the number of older adults comes rising rates of individua... more With increased longevity and growth in the number of older adults comes rising rates of individuals with cognitive impairment and dementia. The expansion of this population has important implications for research on aging and dementia syndromes, namely increased enrollment of older individuals in clinical research. Ethical prerogatives, as well as historical underrepresentation of persons with dementia in research studies due to the perceived burden of traditional decisional capacity evaluations, necessitates the development of pragmatic approaches to ascertain decisional abilities in research settings. We outline a protocol used in the Wisconsin Alzheimer's Disease Research Center (ADRC) that adopts a stepped approach to the evaluation of decisional capacity meant to maximize study visit efficiency while preserving participant safety and autonomy. The protocol specifies the structure of the consent process and incorporates a brief semi-structured interview based on Appelbaum & Grisso's theoretical model for evaluating a patient's decisional capacity to provide informed consent to participate in research. This protocol is easily implemented in a research study visit and is designed to minimize participant burden and ensure reliable assessment of decisional capacity in older adults across a wide range of research protocols. The protocol emphasizes capacity optimization, using memory aids and other compensatory strategies to preserve participant autonomy while protecting welfare.
Background: As Alzheimer's disease and related dementias prevalence (ADRD) increases it will disp... more Background: As Alzheimer's disease and related dementias prevalence (ADRD) increases it will disproportionately burden racial and ethnic minority communities. Recent population-based evidence suggests that American Indians and Alaska Natives (AI/AN) are at increased risk for dementia relative to non-Hispanic Whites and Asians. Despite evidence that 1 of every 3 AI/AN elders will develop dementia, they remain substantially underrepresented in ADRD research. As of March 2019, only 248 of the 40,000+ individuals enrolled at Alzheimer's Disease Centers (ADC) were AI/AN. Subsequently, little is known about dementia etiology, progression, and care in AI/AN communities. We describe an ongoing partnership between the Oneida Nation of Wisconsin and the Wisconsin Alzheimer's Disease Research Center (ADRC) that seeks to address this knowledge gap and respond to the ADRD-related concerns in Wisconsin's Indian Country. Methods: We implemented an NIA-funded, community-based, culturally-relevant approach to address barriers to participation in ADRD research and access to services for persons with dementia. This approach is comprised of four aims: (1) Establish a Community Advisory Board (CAB) to guide culturallytailored outreach programs to increase research enrollment and retention of AI/AN participants, (2) Improve access to culturally appropriate dementia diagnostic services, (3) Survey of Oneida caregivers of persons with dementia to understand caregiving experiences, and (4) Initiate liaisons with ten other Wisconsin tribes. Results: Project leaders and Oneida CAB members meet monthly on Oneida lands, and ADRC staff attend quarterly meetings with an Inter-Tribal Elders Association. In 2018, project leaders held an inaugural National Conference on Dementia in Native American Communities. Preliminary results for Aim 1 are promising. Following establishment of the partnership, the number of AI/AN participants enrolled in the ADRC has increased tremendously (see Figure 1), and rises at a rate of two new participants per month. 77% of AI/AN participants also participate in an imaging sub-study. Conclusions: The Wisconsin ADRC has enrolled nearly a quarter of all AI/AN participants included in the combined ADC dataset. Actively prioritizing a collaborative partnership and investing in communitybased relationships was essential to our inclusion efforts with AI/AN communities. These elements are fundamental for establishing research and clinical efforts that effectively respond to the needs of AI/AN populations.
Objective Previous work has demonstrated that intra-individual cognitive variability (IICV) has p... more Objective Previous work has demonstrated that intra-individual cognitive variability (IICV) has predictive power similar to traditional Alzheimer’s disease (AD) biomarkers, such as CSF or hippocampal volume (HV) loss. Genetic factors, such as sex, have been identified as predictors of cognitive decline. Analysis of sex differences in IICV and other biomarkers may elucidate additional dimensions of this metric. Method Baseline neurocognitive test and neuroimaging data from 335 participants with ≥2 visits enrolled in the Wisconsin Alzheimer’s Disease Research Center Clinical Core were included. Z-scores were calculated comparing individual performance to group performance by test (Rey Auditory Verbal Learning Test (Learning and Delayed Recall), Trail Making Test (A and B), and either Boston Naming Test (BNT) or Multilingual Naming Test (MINT)). MINT scores were converted to BNT scores using the NACC Crosswalk Study. The standard deviation of z-scores across tests was calculated to det...
Objective Intra-Individual Cognitive Variability (IICV) previously demonstrated predictive power ... more Objective Intra-Individual Cognitive Variability (IICV) previously demonstrated predictive power similar to AD biomarkers (i.e., CSF and hippocampal volume (HV) loss). Previous work suggested sex differences in relative HV and IICV. Additionally, IICV differs in whites and underrepresented racial groups (URG). Our objective was to analyze these sex differences in white and URG participants. Method Baseline neurocognitive test and neuroimaging data from 335 cognitively healthy participants with ≥2 visits enrolled in the Wisconsin ADRC Clinical Core were included. Z-scores were calculated comparing individual performance to group performance by test (Rey Auditory Verbal Learning Test (Learning and Delayed Recall), Trail Making Test (A and B), and either Boston Naming Test (BNT) or Multilingual Naming Test (MINT)). MINT scores were converted to BNT scores using the NACC Crosswalk Study. The standard deviation of z-scores across tests was calculated to determine IICV. Characteristics by...
Boston.Namin Total.Score Category.Fluen Raw.Score WAIS.R...Digi WMS.R...Log A.Raw.Scor WMS.R...Lo... more Boston.Namin Total.Score Category.Fluen Raw.Score WAIS.R...Digi WMS.R...Log A.Raw.Scor WMS.R...Log A.Raw.Scor MMSE... Tota Trail.Making.T Trail.Making.T WAIS.R...Digi Score WAIS.R...Digi Longest.Spa WAIS. R...Dig Raw.Score WAIS.R...Digi Longest.Spa Category.Fluen Raw.Score Boston.Namin Score Standard devia Proportion of Cumulative Pr UNIFORM DATA SET 2 (UDS-2) AND UNIFORM DATA SET 3 (UDS-3) IN NONHISPANIC WHITE PARTICIPANTS AND THOSE FROM UNDERREPRESENTED GROUPS ENROLLED IN THE WISCONSIN ALZHEIMER’S DISEASE RESEARCH CENTER’S CLINICAL CORE
Radio advertising 69.01% 50.98% Registries 61.97% 57.45% Television advertising 50.70% 73.68% Dor... more Radio advertising 69.01% 50.98% Registries 61.97% 57.45% Television advertising 50.70% 73.68% Dorothy Farrar Edwards, Carey E. Gleason, Hanna Blazel, Cynthia M. Carlsson, Alice Spalitta, Susan Stark, Sanjay Asthana, Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; William S. Middleton Memorial Veterans’ Hospital, Madison, WI, USA; University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Wisconsin Alzheimer’s Disease Research Center, Madison, WI, USA; Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Washington University Alzheimer’s Disease Research Center, St. Louis, MO, USA; Geriatric Research Education and Clinical Center, W.S. Middleton Memorial Veterans Hospital, Madison, WI, USA. Contact e-mail: [email protected]
Introduction: Studies use multiple measures of cognitive function to assess for dementia. By exam... more Introduction: Studies use multiple measures of cognitive function to assess for dementia. By examining concordance between objective and subjective questionnaires, we can gain insight into the benefits and drawbacks of these measures. Methods: New England Centenarian Study offspring participants (N=599, mean age 83.3+/-7.0 years) completed objective cognitive assessments (Telephone Interview for Cognitive Status, TICS-m) and informants completed the Dementia Questionnaire (DQ) which inquires about symptoms of cognitive and functional impairments. Dementia was indicated by a TICS-m score <27 (TICS+) or impairments in both memory and ADLs on the DQ (DQ+). Results: 44 offspring were TICS+ of which 55% (n=24) were also DQ+. Discordance was due to false-positive deflation of TICS scores from sensorimotor impairments, poor informant reliability/bias on the DQ, and the requirement of an ADL impairment for DQ+. For 62 who were DQ+, 39% (n=24) were TICS+. Discordance for DQ+ participants were due to overstatement of memory impairment by informants. Of the 555 who were TICS-, 93% were DQ-. Conclusion: Inherently, with questions that measure specific cognitive functions, the TICS is less prone to administrator bias. The DQ, however, is more ecologically valid; it is able to pick up on impairment in everyday life that cannot be detected by formal test questions; an advantage that is countered in part by informant bias. High concordance for negative dementia status suggests that either measure is sufficient for ruling out dementia whereas the lower concordance for positive dementia status indicates there is greater sensitivity by using the two together to detect dementia.
Ninety-eight percent of events occurred on Days 0-3. All 3 pts with later events also had events ... more Ninety-eight percent of events occurred on Days 0-3. All 3 pts with later events also had events on Day 0. In a multivariate model, only EF was a significant predictor of events, p=0.04. Of pts with EF < 40%, 16% had events vs 8% with EF Ն 40%, p < 0.005. The 3 pts with events after Day 3 had EF 40-43%. Conclusion: It is safe to discharge AMI pts after hospital Day 3, if they had successful primary PCI and have not experienced complications during Days 0-3. While EF predicts overall events, it is an imperfect tool for discharge planning.
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