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Background: 'Cognitive reserve' (CR) refers to a model of active protection against cognitive decline conferred by the adaptability of one's cognitive processes. Research on life‐course accumulation of reserve and impact of factors like gender is limited. We examined long‐term effects of CR on episodic memory in two population‐based cohorts. Methods: Participants consists of two cohorts from the PATH Through Life project with 12 years (4 waves) of follow‐up, with had an average of 14.6 and 13.9 years of education. The mid‐life cohort (MA) was aged 40‐44 at baseline (mean age 42.6, 52.7% self‐reported female;47.3% male, 0% other gender, N = 2513) and the older cohort (OA) was aged 60‐64 at baseline (mean age 62.5, 48.1% female, 49.9% male, 0% other gender, N = 2403). A baseline composite CR measure included education, occupational complexity, and cognitive and social engagement measured by the RIASEC scales. Episodic memory (Immediate and delayed recall) was assessed with a 16‐word list. Multilevel models adjusting for baseline age, self‐reported gender, race, APOE and non‐English speaking background; evaluated the effect of both baseline and longitudinal change in CR on the longitudinal change in episodic memory. Results: On average, women performed better than men on the episodic memory tasks. Compared with participants in the top tertile of CR, those middle and lowest tertiles had larger decline in episodic memory in both MA and OA. Interactions with APOE were not significant, but among those with medium (model derived beta weights 95% CI: 0.35 (0.01‐0.69)) and high (0.48(0.07‐0.90)) CR, women showed less decline than men. Each component of CR (education, occupational complexity, and RIASEC) was protective against decline in immediate and delayed recall. Increase in RIASEC score over time was protective (MA (0.05, (0.04‐0.07); OA 0.13, (0.11‐0.16)) with a larger effect seen in OA. Conclusion: The current study demonstrated protective effects against cognitive decline for all types of CR measured in both middle and older‐age groups. Increases in CR over time were also protective. The benefits of CR were highest for older women who comprise the age and gender group at most risk of Alzheimer's disease, indicating the need for CR interventions. [ABSTRACT FROM AUTHOR]

Background: In a previous study, we demonstrated that the enzyme plasminogen activator inhibitor‐1 (PAI‐1), which inhibits plasmin synthesis in the central nervous system (CNS), is increased in the serum of patients with Alzheimer's disease (AD). In addition to reducing the accumulation of Ab, plasmin in the CNS regulates the synthesis of the trophic factor brain‐derived neurotrophic factor (BDNF) which appears to be altered in the brain of patients with AD. We investigated whether BDNF serum levels in AD and amnestic mild cognitive impairment (aMCI) patients are altered compared to cognitively healthy controls. Moreover, we examined the PAI‐1/BDNF ratio in these patient groups and correlated with cognitive scores as measured by Mini‐Mental State Examination (MMSE). Method: 40 AD, 40 aMCI and 10 healthy controls were recruited. Venous blood was collected and BDNF serum concentration were quantified by sandwich ELISAs. Comparisons among the experimental groups (AD dementia, aMCI patients, and cognitively healthy controls) on BDNF serum levels were performed using univariate analyses of variance (ANOVA). Pearson correlation coefficients were calculated to explore relationships between biochemical and clinical data. The level of statistical significance was set at p<0.05. Result: The results showed that BDNF serum levels are decreased in AD as compared to aMCI patients (p <.05). In addition, there was a positive correlation between PAI‐1 and BDNF serum levels (r =.190, p <.05). Furthermore, PAI‐1/BDNF ratio was significantly increased in AD patients as compared to aMCI (p <.001) and controls (p <.001). Lastly, PAI‐1/BDNF ratio negatively correlated with MMSE score (r = ‐.508, p <.001). Conclusion: These data suggest that in AD a reduction of plasmin caused by PAI‐1 may negatively affect the production of BDNF and promote disease progression. Our results also demonstrate that the PAI‐1/BDNF ratio is increased in AD patients compared with aMCI and controls. They also suggest that this ratio could be used as a marker of AD in a state of overt cognitive impairment, as supported by the strong negative correlation between PAI‐1/BDNF ratio and MMSE. [ABSTRACT FROM AUTHOR]

• DNP-led initiative increased rates of AD conversation documentation by 26% in FQHC. • Quality improvement results demonstrated that the system-wide change was sustained. • A new EMR template was created to document conversations with CPT codes. • Staff shared responsibilities for AD conversation documentation during wellness visit. • Accommodated cultural needs with Spanish-speaking staff and translated documents. As life expectancy increases, long periods of comorbidity and low quality of life commonly precede death. Advance care planning within primary care settings is necessary to increase patient agency and prioritize personal wishes. This article disseminates a quality improvement initiative within a federally qualified health center. New procedures were developed to systematically track advance directive conversations using current procedural terminology codes. The systems change resulted in a substantial and sustained increase in advance directive conversation documentation. The increase was presumably due to the implementation of small-scale changes, providers' commitment to geriatric primary care, increases in appointment times, allocation of tasks across disciplines, availability of Spanish speaking staff and translated forms, and the change to record keeping that enabled codes to be easily captured and tracked in the electronic medical record. This work may inform future quality improvement efforts to boost advance care planning among underserved populations in diverse settings. [ABSTRACT FROM AUTHOR]

This paper presents a set of eleven functional Dynamic Neuromuscular Stabilization (DNS) tests corresponding with specific infantile developmental stages, clarifying desired postural-locomotion patterns from a developmental perspective, while also describing frequently-observed disturbances of these patterns. [ABSTRACT FROM AUTHOR]

Background: Blood‐based biomarkers give the possibility of having a less invasive, more acceptable to patients, and cost‐ and time‐efficient screening tool. Therefore, blood‐based biomarkers represent an ideal addition to cerebrospinal fluid (CSF) and neuroimaging biomarkers. Standard examination of neurocognitive disorders, such as lumbar punction or brain PET scan, cannot be performed within general practice. Given the high prevalence of these diseases, alternatives such as blood‐based biomarkers would represent a significant advance. The aim of this study was to investigate whether levels of p‐tau 181 and neurofilament light chain (NfL) in serum and plasma can differentiate cognitively unimpaired (CU) elderly individuals from individuals in the stage of aMCI and dementia. Method: A total of 75 biomarker‐defined individuals from the Czech Brain Aging Study were recruited for the study, including the CU, individuals in the aMCI stage, and individuals in the stage of dementia syndrome with various etiology (AD, FTLD or LBD). Commercial ELISA kits were used for the assessment of standard biomarkers from CSF (Aß42, Aß40, pTau, tTau). Plasma and serum samples were analyzed using a Quanterix SR‐X analyzer with Simoa technology. Receiver operating characteristic analyses of the concentrations of p‐tau 181 and NfL in plasma and serum were performed using the R statistical software and GraphPad Prism. Result: Plasma NfL, AUC 0.9861 (95% CI, 0.9439 to 1.000), and serum NfL with AUC 0.9583 (95% CI, 0.8774 to 1.000) differentiated aMCI and dementia from CU with high predictive accuracy. The results were significant for plasma p‐tau 181 too with AUC 0.7869 (95% CI, 0.6474 to 0.9265), along with serum p‐tau 181 with AUC 0.7623 (95% CI, 0.6292 to 0.8954). Conclusion: Plasma and serum p‐tau 181 and NfL may be potentially useful and cost‐effective biomarkers for differentiating cognitively unimpaired elderly individuals from those at aMCI and dementia stages in general health care settings. [ABSTRACT FROM AUTHOR]

The number of Americans ages 65 and older is projected to more than double over the next four decades and to equal nearly one-fourth of the entire population by 2060. Recognizing that the health care workforce in the United States is not sufficiently prepared to meet the care needs of this growing population, the National Academy of Medicine has recommended curricular enhancements for health professional educational programs. To meet this challenge, the University of South Florida College of Nursing applied curriculum mapping principles and concepts to examine and align Family Nurse Practitioner and Adult-Gerontology Primary Care Nurse Practitioner program curricula for congruence with Partnership for Health in Aging multidisciplinary geriatric competencies. Through this process, we developed a geriatric-specific curriculum map and threaded geriatric-specific content, learning experiences, and learning assessment strategies to promote attainment of all 23 competencies. Given the growing role that nurse practitioners are projected to play in the delivery of primary care for older adults in the future, it is imperative that colleges and schools of nursing provide students with learning experiences to support attainment of the knowledge and skills graduates will need to care for older adults in practice. The techniques and strategies described here represent our approach. • The health care workforce in the United States is not sufficiently prepared to meet the needs of a growing older adult population. • Nurse practitioners will play a key role in meeting the care needs of older adults over the next four decades; Schools and colleges of nursing must prepare graduates with the knowledge and skills required. • Curriculum mapping can be used to evaluate and promote vertical and horizontal integration of geriatric content, learning experiences, and learning assessments in nurse practitioner curricula. [ABSTRACT FROM AUTHOR]

Objectives: This study examines the role of personality in cognitive performance, adherence, and satisfaction with regular cognitive self-monitoring.Materials and Methods: One hundred fifty-seven cognitively healthy older adults, age 55+, completed the 44-item Big-Five Inventory and were subsequently engaged in online monthly cognitive monitoring using the Cogstate Brief Battery for up to 35 months (M=14 mo, SD=7 mo). The test measures speed and accuracy in reaction time, visual learning, and working memory tasks.Results: Neuroticism, although not related to cognitive performance overall (P>0.05), was related to a greater increase in accuracy (estimate=0.07, P=0.04) and speed (estimate=-0.09, P=0.03) on One Card Learning. Greater conscientiousness was related to faster overall speed on Detection (estimate=-1.62, P=0.02) and a significant rate of improvement in speed on One Card Learning (estimate=-0.10, P<0.03). No differences in satisfaction or adherence to monthly monitoring as a function of neuroticism or conscientiousness were observed.Conclusions: Participants volunteering for regular cognitive monitoring may be quite uniform in terms of personality traits, with personality traits playing a relatively minor role in adherence and satisfaction. The more neurotic may exhibit better accuracy and improve in speed with time, whereas the more conscientious may perform faster overall and improve in speed on some tasks, but the effects appear small. [ABSTRACT FROM AUTHOR]

Study design: Matched pair study. Introduction: Differences in hand-muscle strength/dexterity between dominant (DH) and non-dominant (NDH) hand in Charcot-Marie-Tooth disease (CMT) are not wellunderstood. Purpose of the study: To compare muscle strength/dexterity between DH and NDH and to correlate manual dexterity, strength and sensory function. Patients and methods: Thirty CMT patients were studied using functional muscle testing (FMT) and strength (dynamometry), dexterity (the Nine Hole Peg Test [NHPT]), and JebseneTaylor Hand Function [JTT]), and sensory function (the Nottingham Sensory Assessment [NSA]). Results: Scores were worse for DH than NDH on FMT (p = 0.043) and NHPT (p = 0.014) but not on JTT (p = 0.098), handgrip strength (p = 0.710) or tripod pinch (p = 0.645). NSA did not correlate significantly with any tests (p0s0.05). Conclusions: In CMT disease, DH appears more impaired than NDH in terms of function and dexterity. Greater muscle weakness in DH may also emerge as CMT progresses. [ABSTRACT FROM AUTHOR]

The article presents an analysis of a subjective report of change in sleep pattern and its possible relation to an increased risk of incident all-cause dementia and Alzheimer disease (AD). Other topics discussed include the likely impact of vascular health and/or depressive symptoms to the link between change in sleep pattern and dementia, the effect of demographic factors, lifestyle factors and apolipoprotein E epsilon 4 allele (apoE∈4), and the change in the 3 groups of sleep pattern.

The article examines the postural function of the diaphragm with and without chronic low back pain. According to the author, trunk stabilization and postural trunk control could play a vital role in the etiology of low back pain while the function of the diaphragm could affect how the trunk is stabilized, especially during postural activity. The author notes that studies have shown that the pelvic girdle and lumbar spine are reflexively stabilized and braced before extremity movements.

The article discusses a study which investigated the risk of arrest in adults diagnosed with schizophrenia and bipolar disorder. Data from the Florida Medicaid were analyzed to identify people with schizophrenia, bipolar disorder and schizoaffective disorder, as well as their antipsychotic medication. The study found that reduced arrest was associated with outpatient visits and treatment with second-generation atypical antipsychotics (SGAs).

Objectives: Nursing home (NH) hospitalizations place an enormous economic burden on an already overtaxed American healthcare system. Hospitalizations for "ambulatory care-sensitive" (ACS) conditions are considered preventable, as these are physical health conditions that can potentially be treated safely in a NH. The authors examined risk factors, including mental disorders and dementia, for hospitalization of Medicaid-enrolled NH residents with ACS conditions during fiscal year 2003-2006. Methods: The authors merged Medicaid claims and enrollment data and Online Survey Certification and Reporting information for 72,251 Medicaid-enrolled NH residents in 647 NHs in Florida. The authors identified at least one ACS hospitalization in 8,382 residents for a total of 10,091 hospital admissions (18.5% of all hospitalizations). The authors used Cox proportional hazard regression to assess time to the first ACS hospitalization. Results: In a fully adjusted model, younger age, non-white race, dementia, and serious mental disorder were associated with greater risk of ACS hospitalization. In addition, residents with a diagnosed mental disorder and no dementia incurred relatively high expenditures for ACS hospitalizations. Among facility characteristics, participants from for-profit facilities, facilities that were not a member of a chain, had more Medicaid recipients, and fewer than 120 beds had greater risk of ACS hospitalizations. Conclusions: Attention to the identified predictors of hospitalization for ACS conditions, which are potentially preventable, could reduce the risk and cost of these hospitalizations among Medicaid-enrolled NH residents. The need to reduce unnecessary hospitalization will become only more urgent as the population ages and healthcare expenses continue to escalate. [ABSTRACT FROM AUTHOR]

Objective: Diet may be associated with risk of dementia and Alzheimer disease (AD). The authors examined the association between fruit and vegetable consumption in midlife and risk for all types of dementia and AD. Methods: Participants were 3,779 members of the Swedish Twin Registry who completed a diet questionnaire approximately 30 years before cognitive screening and full clinical evaluation for dementia as part of the study of dementia in Swedish Twins (HARMONY) study. Among the participants, 355 twins were diagnosed with dementia. Among these, 81 twin pairs were discordant for dementia (50 discordant for AD). Data were analyzed with logistic regression for the entire sample using generalized estimating equations to adjust for relatedness of twins and with conditional logistic regression for the co-twin control design. Results: In fully adjusted models, a medium or great proportion of fruits and vegetables in the diet, compared with no or small, was associated with a decreased risk of dementia and AD. This effect was observed among women and those with angina. Similar, but nonsignificant, odds ratios were found in the co-twin control analyses. Conclusion: The findings suggest that higher fruit and vegetable consumption may reduce the risk of dementia, especially among women and those with angina pectoris in midlife. [ABSTRACT FROM AUTHOR]

Abstract: Background: There is significant attention to the growing elderly African American population and estimating who and how many within this population will be affected by cognitive impairment. Objective: The etiology of cognitive impairment has not been well studied in African Americans and the contribution of genetic and environmental influences to cognitive impairment is not clear. Methods: We calculated concordance rates and heritability for cognitive impairment in 95 same-sexed pairs of African American twins from the Carolina African American Twin Study on Aging (CAATSA). The sample had an average age of 59.6 years (SD = 8.6 years, range 50-88 years) and 60% were female. The Telephone Interview for Cognitive Status (TICS) was used to assess cognitive impairment with a lower cutoff based on our previous research with African Americans. Results: Thirteen of the monozygotic (MZ) twins (30.2%) and 9 of the dizygotic (DZ) twins (17.3%) were cognitively impaired. The concordance rate was 72% for MZ and 45% for DZ. We found the heritability for cognitive impairment to be 54%. Conclusions: The study findings indicate that cognitive impairment is highly heritable, suggesting that genetics may play a relatively large role in the development of cognitive impairment in African American twins. [Copyright &y& Elsevier]

The article focuses on the study which examines nursing home organizational characteristics and specific job characteristics of staff in relation to turnover of nursing assistants to provide insight to possible retention strategies. The result of the cross-sectional data were based from the 2004 National Nursing Home Survey with 25% of the facilities with the lowest turnover rates with low and high turnover compared with moderate turnover. The result reveals that job characteristics including higher wages and union membership associated with greater odds for health insurance, employee assistance benefits and involvement in resident care planning.

Objectives: Previous research has suggested that mental stimulation in different life periods may protect against dementia or delay disease onset. This study aimed to explore the association between work complexity factors at midlife and dementia risk in late life under the hypothesis that high work complexity may modulate the increased dementia risk clue to low education. Design: Population-based follow-up study. Setting: Urban. Participants: A cohort of 931 nondemented subjects, aged 75+ years fro,n the Kungsholmen Project, Stockholm, examined twice over 6 years. Measurements: Incident dementia cases were identified using Diagnostic and Statistical Manual of Mental Disorders, 3rd-Edition Revised criteria. Primary occupations were assigned into categories according to the Nordic Occupational Classification and matched to the 1970 US. Census to score the level of work complexity with data, people, and things by using a preformed matrix. Results: Lower dementia risk was associated with complexity of work with both data (age and gender adjusted relative risk [aRR]. 0.85, 95% confidence interval [Cl]. 0.75- 0.95) and with people (aRR. 0.88, 95% U. 0.80 - 0.97). Adjusting for education led to similar results, although no longer statistically significant. Further, the highest degrees of complexity of work with data that involves analyzing, coordinating, and synthesizing data were associated with lower dementia risk even, among lower educated subjects (relative risk. 0.52, 95% Cl. 0.29 - 0.95). No gender differences were detected. Conclusions: This study suggests that work complexity with data and people is related to lower risk of dementia and that the highest levels of work complexity may modulate the higher dementia risk due to low education. [ABSTRACT FROM AUTHOR]