Authors: Dal Pan, Gerald | Stern, Yaakov | Sano, Mary | Mayeux, Richard
Article Type: Research Article
Abstract: Clock-drawing is a widely used bedside test of constructional ability, but it has never been systematically studied or standardized. We examined 87 clocks drawn by neurologically impaired patients and age-matched controls, and propose a set of criteria for scoring clocks. Patients with probable Alzheimer's disease and other dementias have gross impairments in clock-drawing. These deficits include poor spatial arrangement of numbers, incorrect numerical sequence, insertion of stray lines, and addition of extra numbers. In Alzheimer's disease, the total score on the clock-drawing test correlates with the score on the Modified “Mini-Mental State” Examination. Non-demented patients with Parkinson's disease showed only …defects in the spatial organization of the numbers, and non-demented patients with other diseases perform as well as controls. Show more
DOI: 10.3233/BEN-1989-2104
Citation: Behavioural Neurology, vol. 2, no. 1, pp. 39-48, 1989
Authors: Neugroschl, Judith | Sewell, Margaret | De La Fuente, Angelica | Umpierre, Mari | Luo, Xiaodong | Sano, Mary
Article Type: Short Communication
Abstract: In dementia trials, minority participation is low. We assessed attitudes toward research in a community based urban poor minority sample of elderly adults attending senior center talks using the 7-item Research Attitudes Questionnaire (RAQ). Presentations on cognitive aging were given at senior centers, and 123 attendees completed the RAQ-7. On trust and safety questions, a significant minority (42–48%) responded neutrally or negatively. Encouragingly, on questions concerning the importance of research, 72–81% answered positively. More work can be done to capitalize on these findings to engage and foster trust, and this can be a focus of outreach.
Keywords: Attitude, dementia, elderly, memory, minority, research
DOI: 10.3233/JAD-151072
Citation: Journal of Alzheimer's Disease, vol. 53, no. 1, pp. 69-72, 2016
Authors: Li, Clara | Neugroschl, Judith | Luo, Xiaodong | Zhu, Carolyn | Aisen, Paul | Ferris, Steven | Sano, Mary
Article Type: Research Article
Abstract: Background: Subjective cognitive complaint is a sensitive marker of decline. Objective: This study aimed to (1) examine reliability of subjective cognitive complaint using the Cognitive Function Instrument (CFI), and (2) assess the utility of the CFI to detect cognitive decline in non-demented elders. Methods: Data from a four-year longitudinal study at multiple Alzheimer’s Disease Cooperative Study (ADCS) sites were extracted (n = 644). Of these, 497 had Clinical Dementia Rating (CDR) global scores of 0 and 147 had a CDR of 0.5. Mean age and education were 79.5±3.6 and 15.0±3.1 years, respectively. All participants and their study partners completed the subject …and study partner CFI yearly. Modified Mini-Mental State Exam (mMMSE) and Free and Cued Selective Reminding Test (FCSRT) were administered. Scores below the predetermined cut-off scores on either measure at annual visit were triggers for a full diagnostic evaluation. Cognitive decline was defined by the absence/presence of the trigger. Results: Three-month test retest reliability showed that inter-class coefficients for subject and study partner CFI were 0.76 and 0.78, respectively. Generalized estimating equation method revealed that both subject and study partner CFI change scores and scores from previous year were sensitive to cognitive decline in the CDR 0 group (p < 0.05). In the CDR 0.5 group, only the study partner CFI change score predicted cognitive decline (p < 0.05). Conclusion: Cognitive decline was predicted differentially by CDR level with subject CFI scores providing the best prediction for those with CDR 0 while study partner CFI predicted best for those at CDR 0.5. Show more
Keywords: Cognitive decline, healthy older adults, non-demented elders, subjective cognitive complaints
DOI: 10.3233/JAD-161294
Citation: Journal of Alzheimer's Disease, vol. 60, no. 2, pp. 427-437, 2017
Authors: Guerrero-Berroa, Elizabeth | Ravona-Springer, Ramit | Schmeidler, James | Heymann, Anthony | Soleimani, Laili | Sano, Mary | Leroith, Derek | Preiss, Rachel | Zukran, Ruth | Silverman, Jeremy M. | Beeri, Michal Schnaider
Article Type: Research Article
Abstract: Background: Type 2 diabetes (T2D) is a metabolic condition associated with poor clinical and cognitive outcomes including vascular disease, depressive symptoms, cognitive impairment, and dementia. In the general elderly population, depression has been consistently identified as a risk factor for cognitive impairment/decline. However, the association between depression and cognitive function in T2D has been understudied. Objective: We investigated the association between depression and cognitive function in a large sample of cognitively normal elderly with T2D. Methods: In this cross-sectional study, we examined 738 participants, aged 65–88 years old, enrolled in the Israel Diabetes and Cognitive Decline study. For each cognitive …domain (Episodic Memory, Executive Function, Attention/Working Memory, Language/Semantic Categorization) and Overall Cognition, multiple linear regressions assessed its association with depression (score greater than 5 on the 15-item version of the Geriatric Depression Scale [GDS]), adjusting for age, sex, and education. Results: Depression (n = 66, 8.9%) was associated with worse performance on tasks of Executive Function (p = 0.004), Language/Semantic Categorization (p < 0.001), and Overall Cognition (p < 0.002), but not Episodic Memory (p = 0.643) or Attention/Working Memory (p = 0.488). Secondary analyses using GDS as a continuous variable did not substantially change the results. Adjusting also for a history of antidepressant medication use slightly weakened the findings. Conclusion: Significant associations of depression with several cognitive domains and Overall Cognition even in cognitively normal elderly with T2D, suggest that depression may have a role in impaired cognitive function in T2D, which may be attenuated by antidepressants. Show more
Keywords: Cognitive domains, cognitive function, depressive symptoms, diabetes
DOI: 10.3233/JAD-170778
Citation: Journal of Alzheimer's Disease, vol. 65, no. 2, pp. 683-692, 2018
Authors: Huang, Chuan | Kritikos, Minos | Clouston, Sean A.P. | Deri, Yael | Serrano-Sosa, Mario | Bangiyev, Lev | Santiago-Michels, Stephanie | Gandy, Sam | Sano, Mary | Bromet, Evelyn J. | Luft, Benjamin J.
Article Type: Research Article
Abstract: Background: Individuals who participated in response efforts at the World Trade Center (WTC) following 9/11/2001 are experiencing elevated incidence of mild cognitive impairment (MCI) at midlife. Objective: We hypothesized that white matter connectivity measured using diffusion spectrum imaging (DSI) would be restructured in WTC responders with MCI versus cognitively unimpaired responders. Methods: Twenty responders (mean age 56; 10 MCI/10 unimpaired) recruited from an epidemiological study were characterized using NIA-AA criteria alongside controls matched on demographics (age/sex/occupation/race/education). Axial DSI was acquired on a 3T Siemen’s Biograph mMR scanner (12-channel head coil) using a multi-band diffusion sequence. Connectometry examined whole-brain tract-level differences …in white matter integrity. Fractional anisotropy (FA), mean diffusivity (MD), and quantified anisotropy were extracted for region of interest (ROI) analyses using the Desikan-Killiany atlas. Results: Connectometry identified both increased and decreased connectivity within regions of the brains of responders with MCI identified in the corticothalamic pathway and cortico-striatal pathway that survived adjustment for multiple comparisons. MCI was also associated with higher FA values in five ROIs including in the rostral anterior cingulate; lower MD values in four ROIs including the left rostral anterior cingulate; and higher MD values in the right inferior circular insula. Analyses by cognitive domain revealed nominal associations in domains of response speed, verbal learning, verbal retention, and visuospatial learning. Conclusions: WTC responders with MCI at midlife showed early signs of neurodegeneration characterized by both increased and decreased white matter diffusivity in regions commonly affected by early-onset Alzheimer’s disease. Show more
Keywords: Alzheimer’s disease, diffusion spectrum imaging, incident mild cognitive impairment, midlife, white matter connectivity, World Trade Center responders
DOI: 10.3233/JAD-201237
Citation: Journal of Alzheimer's Disease, vol. 80, no. 3, pp. 1209-1219, 2021
Authors: Karran, Martha | Guerrero-Berroa, Elizabeth | Schmeidler, James | Lee, Pearl G. | Alexander, Neil | Nabozny, Martina | West, Rebecca K. | Beeri, Michal Schnaider | Sano, Mary | Silverman, Jeremy M.
Article Type: Research Article
Abstract: Background: Type 2 diabetes mellitus (T2DM) is prevalent in the general United States population, and in the veteran population. T2DM has consistently been linked to increased risk for cognitive impairment, dementia, and Alzheimer’s disease. Computerized cognitive training (CCT) is practical and inexpensive cognitive interventions that is an alternative to medication. Objective: To report the recruitment methods and challenges to date in an ongoing two-site randomized controlled trial (RCT) of CCT on cognitive function and T2DM management in an older non-demented veteran population. Methods: Veterans are recruited primarily by targeted mailings or by direct contact at clinics and presentations. Results: From …1,459 original contacts, 437 expressed initial interest, 111 provided informed consent, and 97 completed baseline assessments. Participants from the two VA Medical Centers differed in demographics and baseline characteristics. Comparing recruitment methods, the proportion of individuals contacted who were ultimately consented was significantly less from mailings (5%) than other sources (20%), primarily face– to-face clinic visits (χ 2 (1) = 38.331, p < 0.001). Conclusions: Mailings are cost-effective, but direct contact improved recruitment. Not using or lacking access to computers and ineligibility were major reasons for non-participation. Within-site comparisons of demographically diverse sites can address confounding of demographic and other site differences. Show more
Keywords: Cognition, computer games, research subject recruitment, type 2 diabetes mellitus, veterans, Clinical Trials registration number, NCT01736124
DOI: 10.3233/JAD-180952
Citation: Journal of Alzheimer's Disease, vol. 69, no. 2, pp. 401-411, 2019
Authors: Carrión-Baralt, José R. | Meléndez-Cabrero, Josefina | Rodríguez-Ubiñas, Heide | Schmeidler, James | Beeri, Michal Schnaider | Angelo, Gary | Sano, Mary | Silverman, Jeremy M.
Article Type: Research Article
Abstract: APOE ε4 is a major risk factor for Alzheimer's disease. It has also been associated with cognitive impairment and cognitive decline in young-olds, but the impact of the ε4 allele on cognitive function in very late life is still unclear. The object of this study was to evaluate the association of the ε4 allele of APOE with the cognitive performance of a sample of non-demented oldest-olds. Eighty-seven Spanish-speaking Puerto Rican non-demented nonagenarians were administered a complete neuropsychological assessment and provided a blood sample used for APOE genotyping. A factor analysis generated two factors: 1) verbal memory; and 2) visuo-spatial, naming …and attention tasks, accounting for 43.6% of the overall variance in the 13 original neuropsychological variables. The multivariate analysis reflected, after controlling for gender, education, and age, the APOE ε4 carriers performed better in overall cognition (both factors analyzed together) than non-carriers (T2 = 0.082, F(2,80) = 3.289, p = 0.042). Neither gender nor the gender by APOE ε4 status interaction was associated with differences in cognition. In conclusion, the results of this study suggest that, among these Puerto Rican non-demented nonagenarians, being an APOE ε4 allele carrier is associated with better cognition. Show more
Keywords: APOE, cognition, Hispanic, nonagenarian
DOI: 10.3233/JAD-2009-1160
Citation: Journal of Alzheimer's Disease, vol. 18, no. 3, pp. 533-540, 2009
Authors: Li, Clara | Neugroschl, Judith | Zhu, Carolyn W. | Aloysi, Amy | Schimming, Corbett A. | Cai, Dongming | Grossman, Hillel | Martin, Jane | Sewell, Margaret | Loizos, Maria | Zeng, Xiaoyi | Sano, Mary
Article Type: Review Article
Abstract: Mobile technologies are becoming ubiquitous in the world, changing the way we communicate and provide patient care and services. Some of the most compelling benefits of mobile technologies are in the areas of disease prevention, health management, and care delivery. For all the advances that are occurring in mobile health, its full potential for older adults is only starting to emerge. Yet, existing mobile health applications have design flaws that may limit usability by older adults. The aim of this paper is to review barriers and identify knowledge gaps where more research is needed to improve the accessibility of mobile …health use in aging populations. The same observations might apply to those who are not elderly, including individuals suffering from severe mental or medical illnesses. Show more
Keywords: Design considerations, mHealth, mobile health, mobile technology, older adults
DOI: 10.3233/JAD-200485
Citation: Journal of Alzheimer's Disease, vol. 79, no. 1, pp. 1-8, 2021
Authors: Sewell, Margaret C. | Neugroschl, Judith | Umpierre, Mari | Chin, Shehan | Zhu, Carolyn W. | Velasco, Nelly | Gonzalez, Sabrina | Acabá-Berrocal, Alexandra | Bianchetti, Luca | Silva, Gabriela | Collazo, Alma | Sano, Mary
Article Type: Research Article
Abstract: Background: Latinx elders are underrepresented in dementia research. In a previous study we assessed research attitudes in urban minority elders and found a significant minority expressed neutral to negative attitudes relating to trust, safety, and personal responsibility to help research. Objective: To assess the impact of a composite intervention on attitudes toward research and research participation among elderly Latinx. The intervention was a collaboratively produced research participation video shown during presentations with our elderly community advisory board (CAB) as co-presenters. Methods: The video was created by the ADRC and CAB. All senior center attendees were eligible to participate. Afterwards, the …Research Attitudes Questionnaire (RAQ) and a brief questionnaire on the impact of the video were administered. Using Wilcoxon Rank Sum Tests, Chi Square, and OLS regressions, RAQ responses were compared to those from a historical cohort from similar centers. Results: 74 in the “Historical Cohort 1” and 104 in “Intervention Cohort 2” were included. RAQ total score was higher in Cohort 2 than Cohort 1 (28.5 versus 26.1, p < 0.05) after controlling for age, education, and country of origin. In response to the question “Has the video influenced your willingness and interest to participate in research”, 88.7%of the participants in Cohort 2 reported being “more” or “much more” interested in research. Conclusion: Tailoring community research recruitment programs to include relatable peers using novel recruitment techniques may have positive implications for improving enrollment of diverse elderly individuals in research. Show more
Keywords: Attitudes towards research, diversity, elder minorities, minorities in research, research participation
DOI: 10.3233/JAD-210027
Citation: Journal of Alzheimer's Disease, vol. 82, no. 2, pp. 771-779, 2021
Authors: Greenwood, Tiffany A. | Beeri, Michal S. | Schmeidler, James | Valerio, Daniel | Raventós, Henriette | Mora-Villalobos, Lara | Camacho, Karla | Carrión-Baralt, José R. | Angelo, Gary | Almasy, Laura | Sano, Mary | Silverman, Jeremy M.
Article Type: Research Article
Abstract: We sought to identify cognitive phenotypes for family/genetic studies of successful cognitive aging (SCA; maintaining intact cognitive functioning while living to late old age). We administered a battery of neuropsychological tests to nondemented nonagenarians (n = 65; mean age = 93.4 ± 3.0) and their offspring (n = 188; mean age = 66.4 ± 5.0) from the Central Valley of Costa Rica. After covarying for age, gender, and years of education, as necessary, heritability was calculated for cognitive functions at three pre-defined levels of complexity: specific neuropsychological functions (e.g., delayed recall, sequencing), three higher level cognitive domains (memory, executive functions, …attention), and an overall neuropsychological summary. The highest heritability was for delayed recall (h2 = 0.74, se = 0.14, p < 0.0001) but significant heritabilities involving memory were also observed for immediate recall (h2 = 0.50), memory as a cognitive domain (h2 = 0.53), and the overall neuropsychological summary (h2 = 0.42). Heritabilities for sequencing (h2 = 0.42), fluency (h2 = 0.39), abstraction (h2 = 0.36), and the executive functions cognitive domain (h2 = 0.35) were also significant. In contrast, the attention domain and memory recognition were not significantly heritable in these families. Among the heritable specific cognitive functions, a strong pleiotropic effect (i.e., evidence that these may be influenced by the same gene or set of genes) for delayed and immediate recall was identified (bivariate statistic = 0.934, p < 0.0001) and more modest but significant effects were found for four additional bivariate relationships. The results support the heritability of good cognitive function in old age and the utilization of several levels of phenotypes, and they suggest that several measures involving memory may be especially useful for family/genetic studies of SCA. Show more
Keywords: Family studies, hispanic population, neuropsychological phenotype, oldest-old, successful cognitive aging
DOI: 10.3233/JAD-2011-110782
Citation: Journal of Alzheimer's Disease, vol. 27, no. 4, pp. 897-907, 2011
