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Background and Objectives Social isolation is a risk factor for cognitive decline and dementia. We conducted a randomized controlled clinical trial (RCT) of enhanced social interactions, hypothesizing that conversational interactions can stimulate brain functions among socially isolated older adults without dementia. We report topline results of this multisite RCT (Internet-based conversational engagement clinical trial [I-CONECT]; NCT02871921). Research Design and Methods The experimental group received cognitively stimulating semistructured conversations with trained interviewers via internet/webcam 4 times per week for 6 months (induction) and twice per week for an additional 6 months (maintenance). The experimental and control groups both received weekly 10 minutes telephone check-ins. Protocol modifications were required due to the coronavirus disease 2019 pandemic. Results A total of 186 participants were randomized. After the induction period, the experimental group had higher global cognitive test scores (Montreal Cognitive Assessment [primary outcome]; 1.75 points [ p  = .03]) compared with the control group. After induction, experimental group participants with normal cognition had higher language-based executive function (semantic fluency test [secondary outcome]; 2.56 points [ p  = .03]). At the end of the maintenance period, the experimental group of mild cognitive impairment subjects had higher encoding function (Craft Story immediate recall test [secondary outcome]; 2.19 points [ p  = .04]). Measure of emotional well-being improved in both control and experimental groups. Resting-state functional magnetic resonance imaging showed that the experimental group had increased connectivity within the dorsal attention network relative to the control group (p  = .02), but the sample size was limited. Discussion and Implications Providing frequent stimulating conversational interactions via the internet could be an effective home-based dementia risk-reduction strategy against social isolation and cognitive decline. Clinical Trials Registration Number NCT02871921 [ABSTRACT FROM AUTHOR]

Early detection of Mild Cognitive Impairment (MCI) leads to early interventions to slow the progression from MCI into dementia. Deep Learning (DL) algorithms could help achieve early non-invasive and low-cost detection of MCI. This paper presents the detection of MCI in older adults using DL models based only on facial features extracted from video-recorded conversations at home. We used the data collected from the I-CONECT behavioral intervention study (NCT02871921), where several sessions of semi-structured interviews between socially isolated older individuals and interviewers were video recorded. We develop a framework that extracts holistic spatial facial features using a convolutional autoencoder and temporal information using transformers. We proposed the Spatial-to-Temporal Attention Module (STAM) to detect the I-CONECT study participants' cognitive conditions (MCI vs. those with normal cognition (NC)) using facial and interaction features. The interaction features of the facial features improved the prediction performance compared with applying facial features solely. The detection accuracy using this combined method reached 88%, whereas the accuracy without applying the segments and sequences information of the facial features within a video on a certain theme was 84%. Overall, the results show that spatiotemporal facial features modeled using DL algorithms have a discriminating power for the detection of MCI. • The semi-structured interviews from the I-CONECT study are obtained for this work. • The facial features of participants from the videos are extracted using CAE on a frame level. • We proposed STAM which integrated temporal facial features to detect MCI participants. • The interaction feature during the interview improved STAM prediction performance. [ABSTRACT FROM AUTHOR]

Background: The ability to capture people's movement throughout their home is a powerful approach to inform spatiotemporal patterns of routines associated with cognitive impairment. The study estimated indoor room activities over 24 hours and investigated relationships between diurnal activity patterns and mild cognitive impairment (MCI).Methods: One hundred and sixty-one older adults (26 with MCI) living alone (age = 78.9 ± 9.2) were included from 2 study cohorts-the Oregon Center for Aging & Technology and the Minority Aging Research Study. Indoor room activities were measured by the number of trips made to rooms (bathroom, bedroom, kitchen, living room). Trips made to rooms (transitions) were detected using passive infrared motion sensors fixed on the walls for a month. Latent trajectory models were used to identify distinct diurnal patterns of room activities and characteristics associated with each trajectory.Results: Latent trajectory models identified 2 diurnal patterns of bathroom usage (high and low usage). Participants with MCI were more likely to be in the high bathroom usage group that exhibited more trips to the bathroom than the low-usage group (odds ratio [OR] = 4.1, 95% CI [1.3-13.5], p = .02). For kitchen activity, 2 diurnal patterns were identified (high and low activity). Participants with MCI were more likely to be in the high kitchen activity group that exhibited more transitions to the kitchen throughout the day and night than the low kitchen activity group (OR = 3.2, 95% CI [1.1-9.1], p = .03).Conclusions: The linkage between bathroom and kitchen activities with MCI may be the result of biological, health, and environmental factors in play. In-home, real-time unobtrusive-sensing offers a novel way of delineating cognitive health with chronologically-ordered movement across indoor locations. [ABSTRACT FROM AUTHOR]

Deep machine learning models including Convolutional Neural Networks (CNN) have been successful in the detection of Mild Cognitive Impairment (MCI) using medical images, questionnaires, and videos. This paper proposes a novel Multi-branch Classifier-Video Vision Transformer (MC-ViViT) model to distinguish MCI from those with normal cognition by analyzing facial features. The data comes from the I-CONECT, a behavioral intervention trial aimed at improving cognitive function by providing frequent video chats. MC-ViViT extracts spatiotemporal features of videos in one branch and augments representations by the MC module. The I-CONECT dataset is challenging as the dataset is imbalanced containing Hard-Easy and Positive–Negative samples, which impedes the performance of MC-ViViT. We propose a loss function for Hard-Easy and Positive–Negative Samples (HP Loss) by combining Focal loss and AD-CORRE loss to address the imbalanced problem. Our experimental results on the I-CONECT dataset show the great potential of MC-ViViT in predicting MCI with a high accuracy of 90.63% accuracy on some of the interview videos. • We propose MC-ViViT to detect MCI from facial videos in the I-CONECT Study. • We design the MC module to enrich the extracted spatio-temporal features. • We develop HP loss to address the inter-and intra-class imbalanced data. [ABSTRACT FROM AUTHOR]

Background: Incidence rates of dementia appear to be declining in high-income countries according to several large epidemiological studies. We aimed to describe declining incident dementia rates across successive birth cohorts in a U.S. population-based sample and to explore the influences of sex and education on these trends.Methods: We pooled data from two community-sampled prospective cohort studies with similar study aims and contiguous sampling regions: the Monongahela Valley Independent Elders Survey (1987-2001) and the Monongahela-Youghiogheny Healthy Aging Team (2006-Ongoing). We identified four decade-long birth cohorts spanning birth years 1902-1941. In an analysis sample of 3,010 participants (61% women, mean baseline age = 75.7 years, mean follow-up = 7.1 years), we identified 257 cases of incident dementia indicated by a Clinical Dementia Rating of 1.0 or higher. We used Poisson regression to model incident dementia rates by birth cohort, age, sex, education, and interactions of Sex × Cohort and Sex × Education. We further examined whether cohort effects varied by education, testing a Cohort × Education interaction and stratifying the models by education.Results: Compared to the earliest birth cohort (1902-1911), each subsequent cohort had a significantly lower incident dementia rate (1912-1921: incidence rate ratio [IRR] = 0.655, 95% confidence interval [95% CI] = 0.477-0.899; 1922-1931: IRR = 0.387, 95% CI = 0.265-0.564; 1932-1941: IRR = 0.233, 95% CI = 0.121-0.449). We observed no significant interactions of either sex or education with birth cohort.Conclusions: A decline in incident dementia rates was observed across successive birth cohorts independent of sex, education, and age. [ABSTRACT FROM AUTHOR]

Vascular mild cognitive impairment (MCI) is a critical disease. Its prognosis includes not only onset of vascular dementia, but also death by cardiovascular disease. The vascular risk factors for vascular MCI are treatable, and appropriate treatment can prevent or delay the progression to dementia. Therefore, this group is an excellent candidate for secondary prevention. However, community-dwelling older adults with vascular MCI are often undetected and are not clinically identified until they develop frank dementia. Furthermore, older adults with undetected vascular MCI often have decreased ability to follow their medication regimens and this poor medication adherence worsens their vascular comorbidities. This vicious cycle needs to be prevented through community-based interventions. There is evidence that treatment of hypertension or diabetes mellitus could lead to a reduced incidence of vascular MCI and dementia. In this review article, we first explain the background and etiology of vascular MCI. We then summarize phenotype of subcortical vascular dementia which is often unrecognized or "hidden" in the community. Then we introduce the Osaki-Tajiri and Kurihara Projects which have been conducted in Northern Japan, as an example of prevention projects aimed to identify early-stage vascular MCI in the community, reduce the risk factors and facilitate their treatment. Early identification of vascular MCI in the community could lead to a large reduction in the dementia burden worldwide. The outreach efforts presented here could be useful in developing secondary prevention strategies targeted to vascular MCI. [ABSTRACT FROM AUTHOR]

Background: Computer use is becoming a common activity in the daily life of older individuals and declines over time in those with mild cognitive impairment (MCI). The relationship between daily computer use (DCU) and imaging markers of neurodegeneration is unknown. Objective: The objective of this study was to examine the relationship between average DCU and volumetric markers of neurodegeneration on brain MRI. Methods: Cognitively intact volunteers enrolled in the Intelligent Systems for Assessing Aging Change study underwent MRI. Total in-home computer use per day was calculated using mouse movement detection and averaged over a one-month period surrounding the MRI. Spearman's rank order correlation (univariate analysis) and linear regression models (multivariate analysis) examined hippocampal, gray matter (GM), white matter hyperintensity (WMH), and ventricular cerebral spinal fluid (vCSF) volumes in relation to DCU. A voxel-based morphometry analysis identified relationships between regional GM density and DCU. Results: Twenty-seven cognitively intact participants used their computer for 51.3 minutes per day on average. Less DCU was associated with smaller hippocampal volumes (r = 0.48, p = 0.01), but not total GM, WMH, or vCSF volumes. After adjusting for age, education, and gender, less DCU remained associated with smaller hippocampal volume (p = 0.01). Voxel-wise analysis demonstrated that less daily computer use was associated with decreased GM density in the bilateral hippocampi and temporal lobes. Conclusions: Less daily computer use is associated with smaller brain volume in regions that are integral to memory function and known to be involved early with Alzheimer's pathology and conversion to dementia. Continuous monitoring of daily computer use may detect signs of preclinical neurodegeneration in older individuals at risk for dementia. [ABSTRACT FROM AUTHOR]

Background: Trials in Alzheimer’s disease are increasingly focusing on prevention in asymptomatic individuals. This poses a challenge in examining treatment effects since currently available approaches are often unable to detect cognitive and functional changes among asymptomatic individuals. Resultant small effect sizes require large sample sizes using biomarkers or secondary measures for randomized controlled trials (RCTs). Better assessment approaches and outcomes capable of capturing subtle changes during asymptomatic disease stages are needed. Objective: We aimed to develop a new approach to track changes in functional outcomes by using individual-specific distributions (as opposed to group-norms) of unobtrusive continuously monitored in-home data. Our objective was to compare sample sizes required to achieve sufficient power to detect prevention trial effects in trajectories of outcomes in two scenarios: (1) annually assessed neuropsychological test scores (a conventional approach), and (2) the likelihood of having subject-specific low performance thresholds, both modeled as a function of time. Methods: One hundred nineteen cognitively intact subjects were enrolled and followed over 3 years in the Intelligent Systems for Assessing Aging Change (ISAAC) study. Using the difference in empirically identified time slopes between those who remained cognitively intact during follow-up (normal control, NC) and those who transitioned to mild cognitive impairment (MCI), we estimated comparative sample sizes required to achieve up to 80% statistical power over a range of effect sizes for detecting reductions in the difference in time slopes between NC and MCI incidence before transition. Results: Sample size estimates indicated approximately 2000 subjects with a follow-up duration of 4 years would be needed to achieve a 30% effect size when the outcome is an annually assessed memory test score. When the outcome is likelihood of low walking speed defined using the individual-specific distributions of walking speed collected at baseline, 262 subjects are required. Similarly for computer use, 26 subjects are required. Conclusions: Individual-specific thresholds of low functional performance based on high-frequency in-home monitoring data distinguish trajectories of MCI from NC and could substantially reduce sample sizes needed in dementia prevention RCTs. [ABSTRACT FROM AUTHOR]

Background Trials aimed at preventing cognitive decline through cognitive stimulation among those with normal cognition or mild cognitive impairment are of significant importance in delaying the onset of dementia and reducing dementia prevalence. One challenge in these prevention trials is sample recruitment bias. Those willing to volunteer for these trials could be socially active, in relatively good health, and have high educational levels and cognitive function. These participants' characteristics could reduce the generalizability of study results and, more importantly, mask trial effects. We developed a randomized controlled trial to examine whether conversation-based cognitive stimulation delivered through personal computers, a webcam and the internet would have a positive effect on cognitive function among older adults with normal cognition or mild cognitive impairment. To examine the selectivity of samples, we conducted a mass mail-in survey distribution among community-dwelling older adults, assessing factors associated with a willingness to participate in the trial. Methods Two thousand mail-in surveys were distributed to retirement communities in order to collect data on demographics, the nature and frequency of social activities, personal computer use and additional health-related variables, and interest in the prevention study. We also asked for their contact information if they were interested in being contacted as potential participants in the trial. Results Of 1,102 surveys returned (55.1% response rate), 983 surveys had complete data for all the variables of interest. Among them, 309 showed interest in the study and provided their contact information (operationally defined as the committed with interest group), 74 provided contact information without interest in the study (committed without interest group), 66 showed interest, but provided no contact information (interest only group), and 534 showed no interest and provided no contact information (no interest group). Compared with the no interest group, the committed with interest group were more likely to be personal computer users (odds ratio (OR) = 2.78), physically active (OR = 1.03) and had higher levels of loneliness (OR = 1.16). Conclusion Increasing potential participants' familiarity with a personal computer and the internet before trial recruitment could increase participation rates and improve the generalizability of future studies of this type. [ABSTRACT FROM AUTHOR]

Background. The age-specific prevalence and incidence of dementia and cognitive impairment in the United States have either remained stable or even slightly declined during the 1980s–1990s. A suggested but untested reason for this improvement in cognitive function over time is higher educational attainment among more recent cohorts. Methods. We used data from two large prospective population-based epidemiological dementia studies conducted in two adjacent regions during the period 1987–2012. We examined whether (i) cohort effects could be observed in age-associated trajectories of cognitive functions and (ii) the observed cohort effects could be explained by educational attainment. Trajectories of neuropsychological tests tapping three domains (psychomotor speed, executive function, and language) were compared among cohorts born between 1902 and 1911, 1912 and 1921, 1922 and 1931, and 1932 and 1943. We examined Age × Cohort interactions in mixed-effects models with/without controlling for education effects. Results. Cohort effects in age-associated trajectories were observed in all three domains, with consistent differences between the earliest born cohort and the most recent cohort. Executive functions showed the strongest and persistent differences between the most recent and other three cohorts. Education did not attenuate any of these associations. Conclusions. Cohort effects were observed in all examined cognitive domains and, surprisingly, remained significant after controlling for educational effects. Factors other than education are likely responsible for the cohort effects in cognitive decline. [ABSTRACT FROM PUBLISHER]

There is a paucity of data regarding trends in dementia and its subtype prevalence in Japan. Our aims in the current paper are to: (1) summarize epidemiological studies of dementia in Japan including relevant details of study protocol and diagnostic criteria, (2) compare the age-specific prevalence of all-cause dementia among studies, and (3) assess the trends in Alzheimer's disease (AD) versus vascular dementia (VaD) over time. We reviewed diagnostic criteria, all-cause dementia prevalence, and the AD/VaD ratio from 8 large population studies of dementia in Japan. Compared with the Okinawa 1992 study, studies conducted in 1994, 1998, 2005, and 2008 had a higher prevalence of all-cause dementia using Poisson regression models, after controlling for age and sex. In contrast to the US and some European countries, all-cause dementia prevalence is increasing in Japan. The prevalence of AD as opposed to VaD seems to be increasing over time, but large variability in diagnostic criteria, possible regional variability, and differences in prevalence of subtypes of dementia between men and women make it difficult to draw a conclusion about this trend at the national level. Further studies, for example, comparing the population attributable risk of vascular diseases to the prevalence and incidence of dementia could help to clarify the regional variations in etiological subtypes. [ABSTRACT FROM AUTHOR]

Certain micronutrients are protective against cognitive decline. We examined whether there is any uniform pattern of circulating micronutrients cross–culturally that are associated with successful cognitive aging. For the U.S. sample, we used the stored serum/plasma of 115 participants, collected in Oregon, USA. The Okinawa sample consisted of 49 participants selected using similar inclusion criteria as the Oregon sample, from the Keys to Optimal Cognitive Aging Project. All participants were aged 85 years and older without cognitive impairment. We found that the Okinawan elders used fewer vitamin supplements but had similar levels of vitamin B12 and α-tocopherol, lower folate and γ-tocopherol, compared with Oregonian elders. That is, we did not find a uniform pattern of circulating micronutrients, suggesting that micronutrients other than those examined here or other lifestyle factors than nutrition could play an important role in achieving successful cognitive aging. [ABSTRACT FROM PUBLISHER]

Aim: It is highly desirable to develop a neuropsychological screening test which is sensitive to the early stage of Alzheimer's disease (AD), and is easy to administer at the primary care physician's (PCP's) office. Methods: Participants were 128 AD patients and 54 healthy volunteers. Brief cognitive screening tests were administered to the participants including the Mini-Mental State Examination (MMSE), Clock Drawing Test (CDT), Verbal Fluency Test (VFT), a Verbal Category Cued Memory test (CCMT) and the Scenery Picture Memory Test (SPMT). In the SPMT, a scenery picture of a living room containing 23 familiar objects was used. The administration of the SPMT comprised the first shallow memory session (Pict 1) and the second deep memory session (Pict 2). The area under the receiver–operator curve (AUC) was used to compare the efficacy of SPMT with other cognitive tests. Results: Pict 1, which requires less than 2 min to complete, had the same AUC as Pict 2, and showed significantly larger AUC than MMSE, CDT and VFT for all (MMSE 19–23) and very mild (MMSE ≥ 24) AD patients. When we conducted the similar analysis separately for those younger than 75 years and those aged 75 years or older, we obtained the same results as above among the older age group. Pict 1 showed larger AUC than CCMT in overall sample and also in the older age group, although the difference was not statistically significant. Conclusion: The SPMT could be useful for detection of mild and very mild AD in settings even where time is limited. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To compare, in a longitudinal cohort study, declines in specific cognitive domains on their ability to predict time to death, in the presence and absence of dementia, and to explore an explanatory role for vascular disease. DESIGN: Prospective population-based epidemiological study. SETTING: The mid-Monongahela valley of southwestern Pennsylvania from 1987 to 2002. PARTICIPANTS: Nine hundred eighty-nine community-dwelling adults aged 65 and older enrolled in the Monongahela Valley Independent Elders Survey. MEASUREMENTS: Biennial assessments of a range of cognitive domains for up to 12 years. Mortality was modeled as a function of decline in each domain, adjusting for vascular diseases and stratified according to age (≤75 (younger-old) and >75 (older-old)) using Cox proportional hazards modeling. RESULTS: Average annual declines in almost all cognitive domains were significant predictors of mortality in the cohort as a whole. However, after adjustment for dementia, only general cognition, processing speed, the language composite, and the executive function composite remained significant. Adjustment for vascular diseases did not alter the results. In the younger-old group, decline in memory (hazard ratio (HR)=21.4) and executive function (HR=25.5) remained strong predictors after adjustment for dementia and vascular disease. In the older-old group, decline in processing speed was a strong predictor of mortality before (HR=7.4) and after (HR=5.3) controlling for dementia and vascular diseases. CONCLUSION: Decline in most cognitive domains predicted mortality across the cohort, but declines in memory and learning were not independent of dementia. Different domains predicted mortality in the younger and older subgroups. [ABSTRACT FROM AUTHOR]

The brain maintains high levels of ascorbic acid (AA) despite a concentration gradient favoring diffusion from brain to peripheral tissues. Dietary antioxidants, including AA, appear to modify the risk of Alzheimer's disease (AD). The objective of this study was to test the hypothesis that neurodegeneration in AD is modified by brain levels of AA. Thirty-two patients with mild to moderate AD participated in a biomarker study involving standardized clinical assessments over one year. Cerebrospinal fluid (CSF) and serum were collected at baseline for AA and albumin content. Cognitive measures were collected at baseline and one year. CSF and plasma AA failed to predict cognitive decline independently, however, CSF: plasma AA ratio did. After adding CSF Albumin Index (an established marker of blood-brain barrier integrity) to the regression models the effect of CSF: plasma AA ratio as a predictor of cognitive decline was weakened. CSF: plasma AA ratio predicts rate of decline in AD. This relationship may indicate that the CSF: plasma AA ratio is an index of AA availability to the brain or may be an artifact of a relationship between blood-brain barrier impairment and neurodegeneration. [ABSTRACT FROM AUTHOR]

Background. Little is known regarding the normative levels of leisure activities among the oldest old and the factors that explain the age-associated decline in these activities. Methods. The sample included 303 cognitively intact community-dwelling elderly persons with no disability in Activities of Daily Living (ADL) and minimal dependency in Instrumental ADL (IADL) in Shiga prefecture, Japan. We examined (i) the nature and frequency of leisure activities, comparing the oldest old versus younger age groups; (ii) factors that explain the age-associated differences in frequencies of engagement in these activities; and (iii) domain-specific cognitive functions associated with these activities, using three summary index scores: physical and nonphysical hobby indexes and social activity index. Results. The oldest old (85 years old or older) showed significantly lower frequency scores in all activity indexes, compared with the youngest old (age 65-74 years). Gait speed or overall mobility consistently explained the age- associated reduction in levels of activities among the oldest old, whereas vision or hearing impairment and depressive symptoms explained only the decline in social activity. Frequency of engagement in nonphysical hobbies was significantly associated with all cognitive domains examined. Conclusions. Knowing the factors that explain age-associated decline in leisure activities can help in planning strategies for maintaining activity levels among elderly persons. [ABSTRACT FROM AUTHOR]

Background. Cognitive impairment in general is known to predict functional disability, but it is not clear whether performance on specific cognitive domains predicts future disability trends among nondemented elderly persons. Methods. In a representative elderly community-based cohort over up to 10 years of follow-up, we examined predictors of longitudinal trajectories in ability to perform Instrumental Activities of Daily Living (IADL) among nondemented elderly persons. We used trajectory analyses to identify homogeneous groups with respect to trends over time in the numbers of IADL disabilities and their association with baseline demographics, social engagement, depression, physical well-being, and general and domain-specific cognitive functions. We excluded from these analyses those individuals found to have dementia at baseline or at any time during follow-up. Results. Trajectory analysis revealed three homogeneous latent groups which we characterized as No Decline (no decline in abilities to perform IADL tasks over the course of study), Moderate Decline (some functional decline), and Sharp Decline (steep functional decline followed by death). Compared to the Sharp Decline group, the No Decline group was associated with higher baseline functions in all cognitive domains, and the Moderate Decline group was associated with higher baseline functions in all cognitive domains except psychomotor speed and naming. The Moderate and No Decline groups did not differ on any cognitive measure. Conclusion. Among community dwelling elderly persons who remained free from dementia throughout the study, poorer scores in all cognitive domains predicted sharp functional decline followed by death. [ABSTRACT FROM AUTHOR]

Purpose: We examined differential effects of cognitive impairment on each of the activities of daily living (ADI) and instrumental activities of doily living (IADI) tasks. Design and Methods: In a 3-year follow-up of community-dwelling elderly persons in Azuchi, Japan, we assessed cognition by using the Hasegawa Dementia Scale. We examined (a) the cross-sectional association between cognitive impairment and functional disability in each ADL-IADL item; (b) cognitive impairment as a risk factor for incident disability in each ADI-IADI item, through logistic regression models; and (c) probabilities of incident loss of ADL-IADL abilities or death in 3 years, using multinomial logistic regression models. We also calcutated the population attributable risk (PAR%) of cognitive impairment on incident loss of task-specific ADL-IADL abilities. Results: Cross-sectionally, the severity of cognitive impairment was associated with disability in each ADL-IADL task, with larger effects shown for ADL items. Longitudinally, minimally or mildly cognitively impaired individuals had a significantly higher risk of losing functional abilities compared with those with intact cognition. The PAR% indicated that cognitive impairment accounts for 11% to 36% of incident disability in ADL-IADL tasks, with the highest PAR% shown for the ability to feed oneself. Implications: Cognitively impaired subjects are heterogeneous; the severity of cognitive impairment has a different impact on incident loss of task- specific ADL-IADL abilities, and comorbidities could affect disabilities differently. Consideration of these heterogeneities will enrich future studies on the impact of cognitive impairment on ADL-IADL abilities. [ABSTRACT FROM AUTHOR]

The purpose of this preliminary study was to examine associations between leaving home to engage in bingo or gambling activity and indices of physical and mental health and social support among a representative community cohort of 1016 elderly people. Cross-sectional and longitudinal data gathered from a prospective epidemiological study in a rural, low socio-economic status, area of Pennsylvania was employed. The cohort had a mean age of 78.8 (SD = 5.1) (range 71-97) and participated in three consecutive biennial "waves" of data collection. Nearly half (47.7%) of the cohort reported gambling. To predict gambling, the independent variables included age, sex, education, employment, social support, depressive symptoms, self-rated health, alcohol use, cigarette use, and cognitive functioning. In cross-sectional, univariate analyses, gambling was associated with younger age, sex (male), fewer years of education, greater social support, lower depression scores, better self-rated health, alcohol use in the past year, and higher cognitive functioning. In a cross-sectional multiple regression model, younger age, greater social support, and alcohol use in the past year remain strongly and independently associated with gambling activity. Longitudinally, age, sex, social support, alcohol use, and gambling are predictive of future gambling activity. The results revealed that gambling may offer a forum of social support to older adults who are often isolated as they age. [ABSTRACT FROM AUTHOR]

Over 10 years, a community-based sample age 65 ≥ years, with a starting cohort size of 1,206, was assessed biennially with the Mini-Mental State Exam; the Consortium to Establish a Registry for Alzheimer's Disease battery; Immediate and Delayed Recall of a Story; Verbal Fluency for P and S, Fruits and Animals; Clock Drawing; Temporal Orientation; and Trail Making tests. We report distributions of scores over time, at each wave, in (a) all individuals who were assessed at that wave, whether or not they participated in all waves, and (b) the Survivor subgroup of 425 participants who completed all tests at all 5 waves. Scores and factor structures remained remarkably stable over the study period. The most marked decline over time was seen on the Trail Making tests. As the survivors are de facto a largely healthy and motivated group, their data can be considered population-based healthy norms and may serve as a reference for other studies conducting repeated evaluations using the same tests. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To compare the use of lipid-lowering drugs in community-dwelling older adults with and without dementia. DESIGN: Comparison of lipid-lowering drug use by demented cases and nondemented controls based on secondary analysis of data from a longitudinal epidemiologic study. SETTING: Longitudinal study of a largely rural, low- socioeconomic-status, community-based cohort of older persons residing in the mid-Monongahela Valley of South-west Pennsylvania (the Monongahela Valley Independent Elders Survey). PARTICIPANTS: Eight hundred forty-five individuals of mean ± standard deviation (SD) age of 80.5 ± 4.6, participating in the fifth biennial wave of data collection. MEASUREMENTS: Demographics; medical history; medication regimen (including examination of prescription bottle labels); self-report of most recent visit to primary care physician (PCP); and standardized clinical assessment to determine presence of dementia, including Clinical Dementia Rating (CDR). RESULTS: One hundred seventy participants (20.1% of total subject cohort) had dementia, with a CDR of 0.5 or greater. Mean ages of demented and nondemented individuals were 83.5 ± 5.1 and 79.8 ± 4.2, respectively. Similar proportions, 87.7% and 89.5%, of these groups reported PCP visits in the previous year. Of the total sample, 9.4% (3.5% of the demented and 10.8% of the nondemented) were taking lipid-lowering drugs. After adjustment for age, sex, education, visit with PCP within the past year, and potential confounding clinical and lifestyle variables (self-reported heart disease, stroke or transient ischemic attacks, hypertension, smoking, and alcohol consumption), dementia was associated with a lower likelihood of taking a lipid-lowering drug (odds ratio = 0.39, 95% confidence interval = 0.16–0.95). In post hoc subgroup analyses, similar results were found when restricting lipid-lowering drugs to statins alone but were not statistically significant. Drug use was not... [ABSTRACT FROM AUTHOR]

Discontent among American blacks arid women is examined with indicators of the anomia of despair and distrust, and of job and financial dissatisfaction. Nine years of General Social Survey data covering 1973 through 1987 show that blacks' discontent exceeds whites' in most instances examined; and black women more frequently show significantly higher discontent than other race/gender groups. Also, blacks' discontent more often exceeds whites' among persons high in SES than among those low in SES. But gender main effects arc almost nonexistent and white women almost never show more discontent than other race/gender groups. This unexpected finding may be related to white women's greater identification with race than gender and their perception of general but not personal discrimination. Failure of the gender/discontent relationships to differ with the American president in office may have a similar explanation. But, as expected, racial differences in discontent tended to be higher during the Nixon/Ford and Reagan administrations than Carter's. [ABSTRACT FROM AUTHOR]

Studies the characteristics of widows who were able to exit from poverty and the magnitude of the increase of their income at the time of exit. Background on poverty among widows in the United States; Use of the event history approach from the data gathered from Survey of Income and Program Participation; Predictors of transition out of poverty; Reliance on food stamps and pensions.

Background: Policymakers advocate care integration models to enhance Medicare and Medicaid service coordination for dually eligible individuals. One rapidly expanding model is the fully integrated dual eligible (FIDE) plan, a sub‐type of the dual eligible special needs plan (D‐SNP) in which a parent insurer manages Medicare and Medicaid spending for dually eligible individuals. We examined healthcare utilization differences among dually eligible individuals aged 65 years or older enrolled in D‐SNPs by plan type (FIDE vs non‐FIDE). Methods: Using 2018 Medicare Advantage encounters and Medicaid claims of FIDE and non‐FIDE enrollees in six states (AZ, CA, FL, NY, TN, WI), we compared healthcare utilization between plan types, adjusting for enrollee characteristics and county indicators. We applied propensity score weighting to address differences between FIDE and non‐FIDE plan enrollees. Results: In our main analysis, which included all dually eligible individuals in our sample, we observed no significant difference in healthcare utilization between FIDE and non‐FIDE plan enrollees. However, we identified some differences in healthcare utilization between FIDE and non‐FIDE plan enrollees in subgroup analyses. For example, among home and community‐based service (HCBS) users, FIDE plan enrollees had 6.0 fewer hospitalizations per 1000 person‐months (95% CI: −7.9, −4.0) and were 7.0 percentage points more likely to be discharged to home (95% CI: 2.6, 11.5) after hospitalization, compared to non‐FIDE plan enrollees. Conclusion: While we found no differences in healthcare utilization between FIDE and non‐FIDE plan enrollees when considering all dually eligible individuals in our sample, some differences emerged when focusing on subgroups. For example, HCBS users with FIDE plans had fewer hospitalizations and were more likely to be discharged to their home following hospitalization, compared to HCBS users with non‐FIDE plans. These findings suggest that FIDE plans may improve care coordination for specific subsets of dually eligible individuals. See related article by Parsons et al. in this issue. [ABSTRACT FROM AUTHOR]

Home- and community-based services (HCBS) users, on average, experience hospitalizations more frequently than nursing facility residents. However, little is known about state-level variation in such adverse events among these groups. Using 2018 Medicare and Medicaid claims for dual-eligible beneficiaries with Alzheimer's disease and related dementias, we described hospitalization and emergency department (ED) visit rates among HCBS users and nursing facility residents and observed substantial state-level variation. In addition, consistent with prior evidence, we found more frequent hospitalizations and ED visits among HCBS users than nursing facility residents. The magnitude of this difference varied considerably across states, and the degree of variation was greatest among beneficiaries with six or more comorbid conditions. Our findings represent a crucial initial exploration of the state-level variation in adverse events among HCBS users and nursing facility residents, paving the way for further investigations into factors that contribute to this variability. [ABSTRACT FROM AUTHOR]

Background: Social isolation and low levels of physical activity are strong drivers for frailty, which is linked to poor health outcomes and transition to long-term care. Frailty is multifactorial, and thus an integrated approach is needed to maintain older adults' health and well-being. Intergenerational programs represent a novel multifactorial approach to target frailty, social isolation and physical decline but these have not yet been rigorously tested in Australia. Here, we present the results of our pilot study which aimed to test the feasibility of a 10-week intergenerational program between older adults and preschool children. Methods: A non-randomised wait-listed controlled trial was conducted. Participants were allocated to either the intervention or wait-list control group. The intervention group received 10 weekly 2-h intergenerational sessions led by trained child educators; the control group continued with their usual routine and received their intergenerational program after the 10-week control period. All participants were assessed at baseline and 10 weeks. The primary outcome was the feasibility and acceptability of the program including measures of recruitment eligibility, adherence and effective data collection across the multiple domains important for frailty, including functional mobility and balance, grip strength, cognitive function, mood, social engagement, quality of life and concerns about falling. Results: Nineteen adults were included, with nine in the intervention and ten in the control group. A total of 42% of older adults screened were eligible, 75% of participants were present at each intervention session and the overall attrition rate was 21% (n = 4). The reasons for participant absence were primarily health-related. Missing data was minimal for the majority of assessments but more apparent for the cognitive testing where completion rates ranged from 53 to 79% for baseline tests and 73 to 100% for those who received follow-up testing. Conclusions: The high program compliance and low attrition show that a 10-week intergenerational program embedded in the local community, designed for community-living older adults and preschool children, is feasible and acceptable to older adults. Our next trial will test the efficacy of intergenerational programs in this setting. [ABSTRACT FROM AUTHOR]

Background: Cortical gray matter (GM) and white matter (WM) deterioration are signals of neurodegeneration and increased dementia risk; however, their specific etiologies in dementia-free aging is unclear.Objective: The objective of this study was to examine potentially modifiable risk factors of GM and WM degeneration in a well-characterized cohort of dementia-free elderly.Methods: 96 Okinawan elderly participants (age 83.6) from the Keys to Optimal Cognitive Aging Project (KOCOA) underwent MRI and cognitive evaluation. Serum markers of inflammation (interleukin-6 (IL-6), high sensitivity C-reactive protein), cerebrovascular disease (systolic blood pressure (SBP) 140+, hemoglobin A1C (HgbA1C), total cholesterol), and essential minerals (copper (Cu), magnesium, and calcium) were examined in relation to mean cortical thickness (MCT) and white matter hyperintensities (WMH), adjusting for age and gender. Voxel-based morphometry (VBM) analyses identified relationships between regional GM density and the above markers.Results: Decreased MCT was associated with SBP 140 + (p = 0.029) and increased serum IL-6 (p = 0.036), HgbA1C (p = 0.002), and Cu (p = 0.025). In VBM analyses, increased IL-6, HgbA1C, and Cu were associated with decreased GM density in temporal lobe regions. HgbA1C (p = 0.004) was associated with greater WMH volume.Conclusions: Peripheral markers of Cu, CVD risk, and inflammation are associated with MRI-markers of decreased brain health in dementia-free Okinawan elderly, with regional cortical thinning in areas involved in early accumulation of Alzheimer's disease pathology. Results identify potentially modifiable biomarkers as targets in the prevention of dementia in older individuals. [ABSTRACT FROM AUTHOR]

Background: Trials aimed at preventing cognitive decline through cognitive stimulation among those with normal cognition or mild cognitive impairment are of significant importance in delaying the onset of dementia and reducing dementia prevalence. One challenge in these prevention trials is sample recruitment bias. Those willing to volunteer for these trials could be socially active, in relatively good health, and have high educational levels and cognitive function. These participants' characteristics could reduce the generalizability of study results and, more importantly, mask trial effects. We developed a randomized controlled trial to examine whether conversation-based cognitive stimulation delivered through personal computers, a webcam and the internet would have a positive effect on cognitive function among older adults with normal cognition or mild cognitive impairment. To examine the selectivity of samples, we conducted a mass mail-in survey distribution among community-dwelling older adults, assessing factors associated with a willingness to participate in the trial.Methods: Two thousand mail-in surveys were distributed to retirement communities in order to collect data on demographics, the nature and frequency of social activities, personal computer use and additional health-related variables, and interest in the prevention study. We also asked for their contact information if they were interested in being contacted as potential participants in the trial.Results: Of 1,102 surveys returned (55.1% response rate), 983 surveys had complete data for all the variables of interest. Among them, 309 showed interest in the study and provided their contact information (operationally defined as the committed with interest group), 74 provided contact information without interest in the study (committed without interest group), 66 showed interest, but provided no contact information (interest only group), and 534 showed no interest and provided no contact information (no interest group). Compared with the no interest group, the committed with interest group were more likely to be personal computer users (odds ratio (OR) = 2.78), physically active (OR = 1.03) and had higher levels of loneliness (OR = 1.16).Conclusion: Increasing potential participants' familiarity with a personal computer and the internet before trial recruitment could increase participation rates and improve the generalizability of future studies of this type.Trial Registration: The trial was registered on 29 March 2012 at ClinicalTirals.gov (ID number NCT01571427). [ABSTRACT FROM AUTHOR]

Background: Outcome measures available for use in Alzheimer's disease (AD) clinical trials are limited in ability to detect gradual changes. Measures of everyday function and cognition assessed unobtrusively at home using embedded sensing and computing generated "digital biomarkers" (DBs) have been shown to be ecologically valid and to improve efficiency of clinical trials. However, DBs have not been assessed for their relationship to AD neuropathology. Objectives: The goal of the current study is to perform an exploratory examination of possible associations between DBs and AD neuropathology in an initially cognitively intact community-based cohort. Methods: Participants included in this study were ≥65 years of age, living independently, of average health for age, and followed until death. Algorithms, run on the continuously-collected passive sensor data, generated daily metrics for each DB: cognitive function, mobility, socialization, and sleep. Fixed postmortem brains were evaluated for neurofibrillary tangles (NFTs) and neuritic plaque (NP) pathology and staged by Braak and CERAD systems in the context of the "ABC" assessment of AD-associated changes. Results: The analysis included a total of 41 participants (M±SD age at death = 92.2±5.1 years). The four DBs showed consistent patterns relative to both Braak stage and NP score severity. Greater NP severity was correlated with the DB composite and reduced walking speed. Braak stage was associated with reduced computer use time and increased total time in bed. Discussion: This study provides the first data showing correlations between DBs and neuropathological markers in an aging cohort. The findings suggest continuous, home-based DBs may hold potential to serve as behavioral proxies that index neurodegenerative processes. [ABSTRACT FROM AUTHOR]

Background We assessed 10-year longitudinal associations between late-life social networks and incidence of all-cause dementia (ACD), Alzheimer's disease (AD), and vascular dementia (VaD) in Japanese-American men. Methods We prospectively analyzed, from baseline (1991–1993) through 1999–2000, 2636 initially nondemented Kuakini Honolulu-Asia Aging Study participants who remained dementia-free during the first 3 years of follow-up. Global cognition was evaluated by the Cognitive Abilities Screening Instrument (CASI); depressive symptoms by the 11-item Center for Epidemiologic Studies Depression (CES-D) Scale; and social networks by the Lubben Social Network Scale (LSNS). Median split of LSNS scores defined weak/strong social network groups. A panel of neurologists and geriatricians diagnosed and classified dementia; AD and VaD diagnoses comprised cases in which AD or VaD, respectively, were considered the primary cause of dementia. Results Median (range) baseline age was 77 (71–93) years. Participants with weak (LSNS score ≤29) versus strong (>29) social networks had higher age-adjusted incidence (in person-years) of ACD (12.6 vs. 8.7; p =.014) and AD (6.7 vs. 4.0; p =.007) but not VaD (2.4 vs. 1.4; p =.15). Kaplan–Meier curves showed a lower likelihood of survival free of ACD (log-rank p <.0001) and AD (p =.0006) for men with weak networks. In Cox proportional hazards models adjusting for age, education, APOE ɛ4, prevalent stroke, depressive symptoms, and CASI score (all at baseline), weak networks predicted increased incidence of ACD (hazard ratio [HR] = 1.52, p =.009) and AD (HR = 1.67, p =.014) but not VaD (p >.2). Conclusion Weak social networks may heighten the risk of dementia and AD, underscoring the need to promote social connectedness in older adults. [ABSTRACT FROM AUTHOR]

Background: To respect people's preference for aging in place and control costs, many state Medicaid programs have enacted policies to expand home and community‐based services as an alternative to nursing facility care. However, little is known about the use of Medicaid long‐term services and supports (LTSS) at a national level, particularly among dual‐eligible beneficiaries with Alzheimer's disease and related dementias (ADRD). Methods: Using Medicare and Medicaid claims of 30 states from 2016, we focused on dual‐eligible beneficiaries 65 years or older with ADRD and described their use of any form of LTSS and sub‐types of LTSS (home‐based, community‐based, and nursing facility services) across states. Results: We found that 80.5% of dual‐eligible beneficiaries with ADRD received some form of Medicaid LTSS in 2016. The most common LTSS setting was nursing facility (46.7%), followed by home (31.5%) and community (12.2%). There was sizeable state variation in the percentage of dual‐eligible beneficiaries with ADRD who used any form of LTSS (ranging from 61% in Maine to 96% in Montana). The type of LTSS used also varied widely across states. For example, home‐based service use ranged from 9% in Maine, Arizona, and South Dakota to 62% in Oregon. Nursing facility services were the most common type of LTSS in most states. However, home‐based service use exceeded nursing facility use in Oregon, Alaska, and California. Conclusions: Our findings suggest substantially different use of LTSS across states among dual‐eligible beneficiaries with ADRD. Given the importance of LTSS for this population and their families, a deeper understanding of state LTSS policies and other factors that contribute to wide state variation in LTSS use will be necessary to improve access to LTSS across states. [ABSTRACT FROM AUTHOR]

Objective: Periventricular white matter hyperintensities (pvWMHs) are commonly observed on MRI in older individuals and are associated with cognitive and motor decline. The etiology of pvWMH remains unknown. Venous collagenosis has been implicated, which may also interfere with perivascular fluid flow leading to dilation of perivascular spaces (PVS). Here, we examine relationships between in vivo pvWMH volume and ex vivo morphological quantification of collagenosis and the PVS in veins and arteries. Methods: Brain tissue from 25 Oregon Alzheimer's Disease Research Center subjects was selected to cover the full range of WMH burden. Tissue from white matter abutting the ventricle was stained with Masson's trichrome and smooth muscle actin. An automated hue based algorithm identified and segmented vessel into collagenized vessel walls, lumen, and PVS. Multiple linear regressions with pvWMH volume as the dependent variable and either collagen thickness or PVS width were performed with covariates of vessel diameter, age at death, sex, and interval between MRI and death. Results: PVS width and collagen thickness were significantly correlated in both arteries (r = 0.21, p = 0.001) and veins (r = 0.23, p = 0.001). Increased venous collagen (p = 0.017) was a significant predictor of higher pvWMH burden while arterial collagen was not (p = 0.128). Neither PVS width in arteries (p = 0.937) nor veins (p = 0.133) predicted pvWMH burden. Interpretation: These findings are consistent with a model in which venous collagenosis mediates the relationship between vascular risk factors and pvWMH. This study confirms the importance of changes to the venous system in contributing to MRI white matter lesions commonly observed with advanced age. ANN NEUROL 2022;92:992–1000 Summary for Social Media: White matter hyperintensities are a common MRI finding in the aged population and are associated with risk of stroke, mild cognitive impairment, dementia, and overall mortality. While likely vascular in origin, the precise mechanisms by which they develop remain elusive. White matter hyperintensities may be caused by deposition of collagen in veins and consequently be related to the size of the periventricular space. Our results show that while collagen deposition in veins is correlated with the size of the periventricular space, only collagenosis was predictive of white matter hyperintensity burden. This study confirms the importance of changes to the venous system in contributing to MRI white matter lesions commonly observed with advanced age and presents an underexplored biological mechanism by which these changes may impact health. [ABSTRACT FROM AUTHOR]

Background/Objectives: The coronavirus disease 2019 (COVID‐19) global outbreak allowed a natural experiment to observe how older adults changed social patterns and how it affected their emotional well‐being. We studied the frequency and modes of social contact and their effects on older adults' mood before and during the COVID‐19 pandemic. Design: Phone‐based surveys were administered weekly before and during the COVID‐19 pandemic. Setting: Participants were recruited from Portland, Oregon, and Detroit, Michigan. Participants: Older adults ≥75 years old (n = 155, age = 81.0 ± 4.5, 72.3% women) were included in a randomized controlled trial, the Internet‐Based Conversational Engagement Clinical Trial (I‐CONECT). Measurements: Low mood was self‐reported as feeling downhearted or blue for three or more days in the past week. Social contact was self‐reported by the amount of time spent in interactions, with whom (family, friends, others), and via which modes (in‐person, phone/video call, text/email/letter). Results: A total of 5525 weeks of data were derived from 155 participants. Before the COVID‐19 pandemic, average social interaction time spent in‐person, on phone/video call, and via text/email/letter was 406, 141, and 68 min/week, respectively. During the COVID‐19 pandemic, time spent in‐person was reduced by 135 min/week, while time spent via phone/video call and writing increased by 33 and 26 mins/week, respectively. In‐person family contact was associated with less low mood regardless of the pandemic (odds ratio = 0.92, p < 0.05). There was a COVID‐19 × text/email/letter with friends interaction (odds ratio = 0.77, p = 0.03), suggesting that during the COVID‐19 pandemic, an increase of 1 h of writing with friends per week was associated with a 23% decrease in the likelihood of experiencing low mood. Conclusion: The lost in‐person time relating to COVID‐19 restrictions tended to be partially compensated for with increased calls and writing time, although overall social interaction time decreased. During the COVID‐19 pandemic, at least two types of social interactions (writing to friends and in‐person family time) showed promise for mitigating low mood for older adults with limited social resources. [ABSTRACT FROM AUTHOR]

Abstract: Physical performance measures predict health and function in older populations. Walking speed in particular has consistently predicted morbidity and mortality. However, single brief walking measures may not reflect a person''s typical ability. Using a system that unobtrusively and continuously measures walking activity in a person''s home we examined walking speed metrics and their relation to function. In 76 persons living independently (mean age, 86) we measured every instance of walking past a line of passive infra-red motion sensors placed strategically in their home during a four-week period surrounding their annual clinical evaluation. Walking speeds and the variance in these measures were calculated and compared to conventional measures of gait, motor function and cognition. Median number of walks per day was 18±15. Overall mean walking speed was 61±17cm/s. Characteristic fast walking speed was 96cm/s. Men walked as frequently and fast as women. Those using a walking aid walked significantly slower and with greater variability. Morning speeds were significantly faster than afternoon/evening speeds. In-home walking speeds were significantly associated with several neuropsychological tests as well as tests of motor performance. Unobtrusive home walking assessments are ecologically valid measures of walking function. They provide previously unattainable metrics (periodicity, variability, range of minimum and maximum speeds) of everyday motor function. [Copyright &y& Elsevier]

This study presents normative data for the Speed and Capacity of Language Processing (SCOLP) test from an older American sample. The SCOLP comprises 2 subtests: Spot-the-Word, a lexical decision task, providing an estimate of premorbid intelligence, and Speed of Comprehension, providing a measure of information processing speed. Slowed performance may result from normal aging, brain damage (e.g., head injury), or dementing disorders or may represent the intact performance of someone who always performed at the low end of normal. The SCOLP enables the clinician to differentiate between these possibilities. Adequate age-appropriate norms to differentiate dementia from normal aging do not exist. We present data from 424 older community-dwelling Americans (75-94 years old). The results confirm that information processing speed slows with increasing age. By contrast, increasing age has little effect on lexical decision. Thus, our data suggest that the SCOLP shows promise as a tool to help distinguish between normal aging and the early stages of dementia. [ABSTRACT FROM AUTHOR]

Examines human apoliporotein E (APOE) polymorphism in a rural older population-based sample in North India. Distribution of APOE genotypes and allele frequencies according to age, sex and caste/religion; Prevalence of APOE genotype in the examined group; Association of APOE alleles with several diseases.

Aims: We aim to establish the feasibility and acceptability of the Tele‐STELLA (Support via Telehealth: Living and Learning with Advancing Alzheimer's Disease and Related Dementias) intervention. We will also assess the efficacy of the intervention in reducing the frequency of behavioural symptoms of dementia as well as family Care Partner reactivity to the symptoms. Design: This is a multi‐component, quasi‐experimental study that focuses on facilitating effective management of behavioural symptoms that occur in the later stages of dementia. Methods: Family Care Partners (n = 124) for persons with Alzheimer's disease will participate in two 8‐week videoconferencing components that address behavioural symptoms—in both the persons with Alzheimer's disease and their Care Partners. In the first component ('Nova'), Care Partners work with one nurse for an hour/week for 4 weeks, then they join a small group for another 4 weeks. In the second component ('Constellation'), Care Partners work in a larger group to hone skills and knit supportive relationships. Behavioural symptom frequency and Care Partner reactivity to the behaviours will be measured prior to, during and after the intervention. The study is funded by the United States National Institute on Aging (R01AG067546); funding was initiated as on February, 2021. Discussion: Tele‐STELLA fills a gap in current videoconference‐based psychoeducational interventions in that it offers real‐time interaction with nurses and peers. The intervention was designed with feedback by pilot participants. This study will assess Tele‐STELLA in its current, novel format; thus, preparing it for a larger, future randomized controlled trial. Impact: Tele‐STELLA addresses symptoms that occur in the later stages of dementia, providing families with tools to facilitate effective behavioural management. Because Tele‐STELLA is implemented via videoconferencing, it targets Care Partners who face barriers to support, such as cost and transportation. Trial Registration: This trial is registered with ClinicalTrials.gov (#NCT04627662). [ABSTRACT FROM AUTHOR]

Objective: Approximately 6.5 million Americans ages 65 and older have Alzheimer's disease and related dementias, a prevalence projected to triple by 2060. While subtle impairment in cognition and instrumental activities of daily living (IADLs) arises in the mild cognitive impairment (MCI) phase, early detection of these insidious changes is difficult to capture given limitations. Traditional IADL assessments administered infrequently are less sensitive to early MCI and not conducive to tracking subtle changes that precede significant declines. Continuous passive monitoring of IADLs using sensors and software in home environments is a promising alternative. The purpose of this study was to determine which remotely monitored IADLs best distinguish between MCI and normal cognition. Participants and Methods: Participants were 65 years or older, independently community-dwelling, and had at least one daily medication and home internet access. Clinical assessments were performed at baseline. Electronic pillboxes (MedTracker) and computer software (Worktime) measured daily medication and computer habits using the Oregon Center for Aging and Technology (ORCATECH) platform. The Survey for Memory, Attention, and Reaction Time (SMART; Trail A, Trail B, and Stroop Tests) is a self-administered digital cognitive assessment that was deployed monthly. IADL data was aggregated for each participant at baseline (first 90 days) in each domain and various features developed for each. The receiver operating characteristic area under the curve (ROC-AUC) was calculated for each feature. Results: Traditional IADL Questionnaires. At baseline, 103 participants (normal n = 59, Mage = 73.6±5.5; MCI n = 44, Mage = 76.0±6.1) completed three functional questionnaires (Functional Activities Questionnaire; Measurement of Everyday Cognition (ECog), both self-report and informant). The Informant ECog demonstrated the highest AUC (72% AUC, p = <.001). Remotely monitored in-home IADLs and self-administered brief online cognitive test performance. Eighty-four had medication data (normal n = 48, Mage = 73.2±5.4; MCI n = 36, Mage = 75.6±6.9). Four features related to pillbox-use frequency (73% AUC) and four features related to pillbox-use time (62% AUC) were developed. The discrepancy between self-reported frequency of use versus actual use was the most discriminating (67% AUC, p =.03). Sixty-six had computer data (normal n = 38, Mage = 73.6±6.1; MCI n = 28, Mage = 76.6±6.8). Average usage time showed 64% AUC (p =.048) and usage variability showed 60% AUC (p =.18). One hundred and two completed the SMART (normal n = 59, Mage = 73.6±5.5; MCI n = 43, Mage = 75.9±6.2). Eleven features related to survey completion time demonstrated 80% AUC in discriminating cognition. Eleven features related to the number of clicks during the survey demonstrated 70% AUC. Lastly, seven mouse movement features demonstrated 71% AUC. Conclusions: Pillbox use frequency combined features and self-administered brief online cognitive test combined features (e.g., completion times, mouse cursor movements) have acceptable to excellent ability to discriminate between normal cognition and MCI and are relatively comparable to informant rated IADL questionnaires. General computer usage habits demonstrated lower discriminatory ability. Our approach has applied implications for detecting and tracking older adults' declining cognition and function in real world contexts. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editors discuss various articles within the issue on topics including prevalence and incidence rates of dementia in Asian countries, role of biological and genetic risk factors in dementia, and characterization of dementia in diverse populations.

In the past decade a large body of evidence has accumulated on risk factors for dementia, primarily from Europe and North America. Drawing on recent integrative reviews and a consensus workshop, the International Research Network on Dementia Prevention developed a consensus statement on priorities for future research. Significant gaps in geographical location, representativeness, diversity, duration, mechanisms, and research on combinations of risk factors were identified. Future research to inform dementia risk reduction should fill gaps in the evidence base, take a life-course, multi-domain approach, and inform population health approaches that improve the brain-health of whole communities. [ABSTRACT FROM AUTHOR]

Background and Objectives Social isolation is associated with a higher risk of dementia. We previously conducted and showed the efficacy of an intervention which uses conversation (the core component of social interactions) as a tool to enhance cognitive function. We now explore whether cognitive improvements through conversation-based intervention depend on an individual's personality. Research Design and Methods We reexamined data from a 6-week randomized controlled trial (ClinicalTrials.gov Number: NCT01571427) to determine whether conversation-based intervention effects were moderated by personality traits in 83 older adults (mean age = 80.51 years, 49 cognitively intact, 34 individuals with mild cognitive impairment). The intervention group participated in daily 30-min face-to-face semi-structured conversations with trained interviewers through a web-enabled system for 6 weeks. At baseline, psychosocial questionnaires and a neuropsychological battery were completed. Results Intervention group participants with high agreeableness, conscientiousness, and extraversion exhibited significant improvements in language-based executive function tasks beyond changes in the control group (p s <.05). An opposite pattern for delayed recall memory and working memory tasks emerged among highly extraverted participants (p s <.05). Discussion and Implications Our exploratory findings suggest the adaptive role of personality traits in conversation-based cognitive interventions may be limited to tasks incorporating a language component, and offer initial evidence for personalized approaches to cognitive health in late life. [ABSTRACT FROM AUTHOR]

Background: Although there are known clinical measures that may be associated with risk of future falls in older adults, we are still unable to predict when the fall will happen. Our objective was to determine whether unobtrusive in-home assessment of walking speed can detect a future fall.Method: In both ISAAC and ORCATECH Living Laboratory studies, a sensor-based monitoring system has been deployed in the homes of older adults. Longitudinal mixed-effects regression models were used to explore trajectories of sensor-based walking speed metrics in those destined to fall versus controls over time. Falls were captured during a 3-year period.Results: We observed no major differences between those destined to fall (n = 55) and controls (n = 70) at baseline in clinical functional tests. There was a longitudinal decline in median daily walking speed over the 3 months before a fall in those destined to fall when compared with controls, p < .01 (ie, mean walking speed declined 0.1 cm s-1 per week). We also found prefall differences in sensor-based walking speed metrics in individuals who experienced a fall: walking speed variability was lower the month and the week just before the fall compared with 3 months before the fall, both p < .01.Conclusions: While basic clinical tests were not able to differentiate who will prospectively fall, we found that significant variations in walking speed metrics before a fall were measurable. These results provide evidence of a potential sensor-based risk biomarker of prospective falls in community living older adults. [ABSTRACT FROM AUTHOR]

The search for early biomarkers of mild cognitive impairment (MCI) has been central to the Alzheimer's Disease (AD) and dementia research community in recent years. To identify MCI status at the earliest possible point, recent studies have shown that linguistic markers such as word choice, utterance and sentence structures can potentially serve as preclinical behavioral markers. Here we present an adaptive dialogue algorithm (an AI-enabled dialogue agent) to identify sequences of questions (a dialogue policy) that distinguish MCI from normal (NL) cognitive status. Our AI agent adapts its questioning strategy based on the user's previous responses to reach an individualized conversational strategy per user. Because the AI agent is adaptive and scales favorably with additional data, our method provides a potential avenue for large-scale preclinical screening of neurocognitive decline as a new digital biomarker, as well as longitudinal tracking of aging patterns in the outpatient setting. [ABSTRACT FROM AUTHOR]

Background: Cerebrovascular disease is a common cause of dementia in older adults, and potentially preventable with early intervention. Oxylipins are produced from the oxidation of long-chain polyunsaturated fatty acids (PUFA) possessing potent vascular effects. Oxylipins generated from the cytochrome P450 pathway are enzymatically converted to diols by soluble epoxide hydrolase (sEH); sEH products have been associated with small vessel ischemic disease. Little is known about oxylipins' impact on markers of dementia risk.Objective: An exploratory examination of the association between omega-6 and omega-3 derived oxylipins, brain MRI, and cognition.Methods: Thirty-seven non-demented participants with controlled hypertension (mean age 65.6 years) were enrolled in a dementia prevention study investigating fish oil and lipoic acid on preserving cognitive function. Baseline associations between plasma oxylipins, white matter hyperintensity (WMH), and Trails-B were examined using linear regression. P450-derived diol/epoxide ratio was an indirect measure of sEH activity.Results: Omega-6 derived 9-HODE was associated with increased WMH (p = 0.017) and reduced grey matter volume (p = 0.02). Omega-6 P450-derived diol/epoxide ratio 9,10-DiHOME/9,10-EpOME was associated with increased WMH (p = 0.035) and poorer performance on Trails-B (p = 0.05); ratio14,15-DHET/14,15-EET was associated with increased WMH (p = 0.045). Omega-3 P450-derived diol/epoxide ratio 19,20-DiHDPE/19,20-EpDPE was associated with increased WMH (p = 0.04) and poorer performance on Trails-B (p = 0.04). Arachidonic acid was associated with better performance on Trails-B (p = 0.012); Omega-3 derived 16,17-EpDPE was associated with decreased WMH (p = 0.005).Conclusions: With the exception of arachidonic acid, it was specific oxylipin products, not their parent PUFAs, that were associated with unfavorable and favorable MRI and cognitive markers of dementia risk. [ABSTRACT FROM AUTHOR]

Background: While being obese in mid-life is associated with an increased risk of dementia and cognitive decline in late-life, being obese in late-life is shown to be associated with a lower risk of these outcomes in some studies. This phenomenon is known as the "obesity paradox", but the underlying reasons and potential sex difference have not been well understood.Objective: To investigate the association between cognition and waist circumference (WC), an alternative measure of body fat which can be measured easier than body mass index (BMI), among older adults in each generation of late-life for men and women separately.Methods: Three hundred thirty-five participants were used in the current study who were identified by random sampling of residents aged 65-74, 75-84, and 85 + years in Takashima County, Shiga Prefecture, Japan during 2005-2006. Associations between WC and domain-specific cognitive functions measured by 12 neuropsychological tests were examined using multivariable linear regression models with covariates: age, education, and hypertension.Results: Larger WC was associated with better attention/working memory among 65-74-year old women and with better learning/acquisition among 65-74-year-old men, while larger WC was associated with worse learning/acquisition, memory, attention/working memory, and language/fluency among 75-84-year old men.Conclusion: We found age and sex differences in the association between WC and domain-specific cognitive functions. Among older old men (age 75-84), larger WC had negative effects on various domains including memory, attention, language, and executive functions, while we did not find any negative effects of larger WC on cognition among women in any age groups. [ABSTRACT FROM AUTHOR]

Frailty has been established as a risk factor for falls, and prefrailty also seems a risk; however, few studies have focused on the association between falls and each of the five components of frailty proposed by Fried. In the present study, we sought to elucidate the association between prefrailty and falls, and moreover, the association of frailty component with falls. Participants were community‐dwelling older people who had cognitive complaints but not dementia (N = 447, male 54.6%). Prefrailty was defined as exhibiting one or two of the five Fried criteria. Frail individuals were excluded. Background characteristics were compared between the prefrail and robust groups, and multiple regression analysis was performed to investigate the associations between fall history within the past year and factors that were significantly different between the groups. We also performed logistic regression analysis with adjustment for age, education and gender to assess associations with frailty components. We found that prefrailty was associated with fall history. Depressed mood was also significantly associated with fall history. Among the five frailty criteria, exhaustion was significantly associated with falls. Prefrailty, especially the criteria of exhaustion, and depressed mood were associated with fall history. [ABSTRACT FROM AUTHOR]

Motivation Heterogeneous diseases such as Alzheimer's disease (AD) manifest a variety of phenotypes among populations. Early diagnosis and effective treatment offer cost benefits. Many studies on biochemical and imaging markers have shown potential promise in improving diagnosis, yet establishing quantitative diagnostic criteria for ancillary tests remains challenging. Results We have developed a similarity-based approach that matches individuals to subjects with similar conditions. We modeled the disease with a Gaussian process, and tested the method in the Alzheimer's Disease Big Data DREAM Challenge. Ranked the highest among submitted methods, our diagnostic model predicted cognitive impairment scores in an independent dataset test with a correlation score of 0.573. It differentiated AD patients from control subjects with an area under the receiver operating curve of 0.920. Without knowing longitudinal information about subjects, the model predicted patients who are vulnerable to conversion from mild-cognitive impairment to AD through the similarity network. This diagnostic framework can be applied to other diseases with clinical heterogeneity, such as Parkinson's disease. [ABSTRACT FROM AUTHOR]

T1-weighted MRI has been extensively used to extract imaging biomarkers and build classification models for differentiating Alzheimer's disease (AD) patients from healthy controls, but only recently have brain connectome networks derived from diffusion-weighted MRI been used to model AD progression and various stages of disease such as mild cognitive impairment (MCI). MCI, as a possible prodromal stage of AD, has gained intense interest recently, since it may be used to assess risk factors for AD. Little work has been done to combine information from both white matter and gray matter, and it is unknown how much classification power the diffusion-weighted MRI-derived structural connectome could provide beyond information available from T1-weighted MRI. In this paper, we focused on investigating whether diffusion-weighted MRI-derived structural connectome can improve differentiating healthy controls subjects from those with MCI. Specifically, we proposed a novel feature-ranking method to build classification models using the most highly ranked feature variables to classify MCI with healthy controls. We verified our method on two independent cohorts including the second stage of Alzheimer's Disease Neuroimaging Initiative (ADNI2) database and the National Alzheimer's Coordinating Center (NACC) database. Our results indicated that 1) diffusion-weighted MRI-derived structural connectome can complement T1-weighted MRI in the classification task; 2) the feature-rank method is effective because of the identified consistent T1-weighted MRI and network feature variables on ADNI2 and NACC. Furthermore, by comparing the top-ranked feature variables from ADNI2, NACC, and combined dataset, we concluded that cross-validation using independent cohorts is necessary and highly recommended. [ABSTRACT FROM AUTHOR]