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Background: The accelerated aging of the world's population will lead to an increase in the number of older people in the workforce. Computerized Cognitive Training (CCT) is effective in improving cognitive outcomes, but its benefits for older workers remain controversial. We investigate the real-world efficacy of CCT in the workplace, focusing on employees aged 50+ years from a public sector agency. Methods: Case managers (n = 82) were randomized to either an intervention group (24 40 min CCT sessions two times per week) or a waiting list passive control group. Cognitive ability, well-being, job satisfaction, and productivity outcome measures were collected and assessed before and after CCT or the comparable control wait time. Results: Participants undergoing CCT improved on a task of executive functioning (p = 0.04). There was a trend toward a change in work productivity after CCT (p = 0.09), with the control group showing a significant decrease (p = 0.02), while the intervention group remained stable. Conclusions: CCT during office hours has a positive effect on cognition and well-being without affecting productivity among white-collar office workers. CCT could be considered as an intervention to support the older workforce in managing the cognitive and behavioral challenges of changing workplace demands. [ABSTRACT FROM AUTHOR]

Cumulative lifetime adversity and social support were investigated as determinants of psychosocial adjustment (esteem, distress, hopefulness, positive outlook/future aspirations, and sense of purpose) over 12 months in 6-10-years-old HIV-infected, HIV-exposed uninfected and HIV-unexposed uninfected children from Uganda. Each determinant and psychosocial adjustment indicator was self-reported using standardized questionnaires administered at baseline, 6, and 12 months. Linear mixed effects models were used to relate time-varying lifetime adversity and social support to psychosocial adjustment over 12 months. Regardless of HIV status, higher adversity predicted lower esteem (coefficient b = -2.98, 95% confidence interval (CI): [-4.62, -1.35]) and increased distress (b =3.96, 95% CI: [1.29, 6.62]) but was not associated with hopefulness, positive outlook or sense of purpose. Low social support predicted higher distress (b =9.05, 95% CI: [7.36, 10.73]), lower positive outlook (b = -10.56, 95% CI: [-2.34, -8.79]) and low sense of purpose (b = -9.90, 95% CI: [-11.44, -8.36]) over 12 months. Pragmatic interventions that enhance coping with adversity and provide emotional/instrumental support should be tested for effectiveness in promoting resilient psychosocial adjustment trajectory in vulnerable children.

Caregiver's and child's self-reported quality of life (QOL) was defined using standardized questionnaires in a sample (N = 277) of 6-10 years old HIV-infected, HIV-exposed uninfected, and HIV-unexposed uninfected children from Uganda. Psychosocial stress (acute stress and cumulative lifetime adversity) and physiologic stress (dysregulations across 13 biomarkers), perinatal HIV status, and their interaction were related to child QOL via general linear models. Lower child- and caregiver-reported psychosocial stress were dose-dependently associated with higher QOL (acute stress: mean difference coefficient b = 8.1-14.8, effect size [ES] = 0.46-0.83). Lower allostasis was dose-dependently associated with higher QOL (b = 6.1-9.7, ES = 0.34-0.54). Given low caregiver acute stress, QOL for HIV-infected was similar to HIV-uninfected children; however, given high caregiver acute stress, a QOL disadvantage (b = -7.8, 95% CI: -12.8, -2.8; ES = -0.73) was evident for HIV-infected versus uninfected children. Testing of caregiver stress reduction interventions is warranted to increase wellbeing in dependent children.

Alzheimer's disease and related dementias (ADRD) present significant challenges including cognitive and functional loss, behavioral disruption, emotional distress, and significant financial burden. These stressors are amplified in minority groups, who experience higher rates of ADRD but less frequent and later diagnosis. There is therefore a critical need to identify tangible approaches to culturally informed dementia assessment and care for patients from diverse communities. Muslim patients and particularly Muslim women are among the populations most understudied in the ADRD space. Muslim patients may hold unique religious, spiritual, and cultural beliefs and practices that can impact care-seeking for dementia symptoms, diagnostic accuracy, and treatment uptake. This paper outlines culturally informed approaches to assessing and treating Muslim women and families at each stage of ADRD care, though many recommendations extend to the broader Muslim community and others of diverse racial-ethnic backgrounds. We provide concrete suggestions for building rapport within and leveraging common family structures, respecting principles of modesty and privacy for all women including those who observe hijab or niqab, and communicating dementia diagnosis and care in the context of spiritual and ethical beliefs. While not intended as a comprehensive and prescriptive guide, this review provides important points of consideration and discussion with patients of Muslim backgrounds. [ABSTRACT FROM AUTHOR]

Strategies to prevent or delay Alzheimer's disease and related dementias (AD/ADRD) are urgently needed, and blood pressure (BP) management is a promising strategy. Yet the effects of different BP control strategies across the life course on AD/ADRD are unknown. Randomized trials may be infeasible due to prolonged follow-up and large sample sizes. Simulation analysis is a practical approach to estimating these effects using the best available existing data. However, existing simulation frameworks cannot estimate the effects of BP control on both dementia and cardiovascular disease. This manuscript describes the design principles, implementation details, and population-level validation of a novel population-health microsimulation framework, the MIchigan ChROnic Disease SIMulation (MICROSIM), for The Effect of Lower Blood Pressure over the Life Course on Late-life Cognition in Blacks, Hispanics, and Whites (BP-COG) study of the effect of BP levels over the life course on dementia and cardiovascular disease. MICROSIM is an agent-based Monte Carlo simulation designed using computer programming best practices. MICROSIM estimates annual vascular risk factor levels and transition probabilities in all-cause dementia, stroke, myocardial infarction, and mortality in a nationally representative sample of US adults 18+ using the National Health and Nutrition Examination Survey (NHANES). MICROSIM models changes in risk factors over time, cognition and dementia using changes from a pooled dataset of individual participant data from 6 US prospective cardiovascular cohort studies. Cardiovascular risks were estimated using a widely used risk model and BP treatment effects were derived from meta-analyses of randomized trials. MICROSIM is an extensible, open-source framework designed to estimate the population-level impact of different BP management strategies and reproduces US population-level estimates of BP and other vascular risk factors levels, their change over time, and incident all-cause dementia, stroke, myocardial infarction, and mortality. [ABSTRACT FROM AUTHOR]

In utero/peripartum antiretroviral therapy (IPA) exposure type was examined in relationship to mental health symptoms among 577 children with perinatally acquired HIV (CPHIV), children perinatally HIV exposed but uninfected (CHEU), and children HIV unexposed uninfected (CHUU). IPA exposure was categorized for CPHIV and CHEU as none, single‐dose nevirapine with or without zidovudine (sdNVP±AZT), sdNVP+AZT+lamivudine (3TC), or combination antiretroviral therapy (cART). Anxiety and depressive symptoms were reported at baseline, 6‐, and 12‐month follow‐up per behavioral assessment system for children. Multivariable linear mixed models were used to estimate differences (b) with 95% confidence intervals (95% CI) for IPA exposure types versus CHEU without IPA exposure. Depressive and anxiety symptoms were lower in CHUU relative to CHEU and CPHIV but did not differ between CPHIV and CHEU. CHEU with sdNVP±AZT exposure had greater anxiety (b = 0.51, 95% CI: [0.06, 0.96]) and depressive symptoms (b = 0.48, 95% CI: [0.07, 0.89]) than CHEU without IPA exposure. CHEU with sdNVP+AZT+3TC exposure had higher anxiety (b = 0.0.45, 95% CI: [0.03, 0.86]) and depressive symptoms (b = 0.72, 95% CI: [0.27, 1.17]) versus CHEU without IPA exposure. Depressive and anxiety symptoms were not different for CHEU and CPHIV exposed to cART (b = 0.12–0.60, 95% CI: [−0.41, 1.30]) and CHEU and CHUU (b = −0.04 to 0.08, 95% CI: [−0.24, 0.29]) without IPA exposure. Among CHEU, peripartum sdNVP±AZT and sdNVP+AZT+3TC but not cART compared to no IPA exposure was associated with clinically important elevations in anxiety and depressive symptoms. Monitoring of mental health trajectory of HIV‐affected children considering IPA is needed to inform mental health interventions. Patient Contribution: Caregivers and their dependents provided consent for participation and collaborated with study team to identify mutually convenient times for protocol implementation. [ABSTRACT FROM AUTHOR]

Background: Cognitive dysfunction predicts mortality in heart failure (HF). Computerized cognitive training (CCT) has shown preliminary efficacy in improving cognitive function. However, the relationship between CCT and mortality is unclear. Aims were to evaluate (1) long-term efficacy of CCT in reducing 24-month mortality and (2) age, HF severity, global cognition, memory, working memory, depressive symptoms, and health-related quality of life as predictors of 24-monthmortality among patientswith HF.Methods: In this prospective longitudinal study, 142 patients enrolled in a 3-arm randomized controlled trial were followed for 24 months. Logistic regression was used to achieve the aims. Results: Across 24months, 16 patients died (CCT, 8.3%; control groups, 12.8%). Computerized cognitive training did not predict 24-monthmortality (odds ratio [OR], 0.65). Older age (OR, 1.08), worse global cognition (OR, 0.73), memory (OR, 0.81), and depressive symptoms (OR, 1.10) at baseline predicted 24-month mortality. Conclusions: Efficacious interventions are needed to improve global cognition, memory, and depressive symptoms and reduce mortality in HF. [ABSTRACT FROM AUTHOR]

Objective: Valid estimates of premorbid cognitive functioning (PMIQ) are crucial for the assessment of older adults at risk for Alzheimer's disease. We investigated the relationship between the NIH Toolbox-Cognition Battery's (NIHTB-CB) Oral Reading Recognition (ORR) subtest and Wechsler Test of Adult Reading scores (WTAR, convergent validity). We also compared ORR to NIHTB-CB Flanker scores, where null relationships were expected (discriminant validity). Methods: The WTAR and NIHTB-CB were administered to 130 cognitively normal (CN) and 113 participants with mild cognitive impairment (MCI). Participants were community-dwelling, older Black and White adults, ages 55–88 years. Data analysis used uncorrected standard scores and Bayesian bivariate correlations. Supplemental materials include intraclass correlations. Results: ORR and WTAR scores were strongly positively associated, while ORR and Flanker scores were unrelated. This pattern held when restricting analyses to the two cognitive status groups, the two racial groups, and the four race-by-diagnosis subgroups. Conclusion: The findings demonstrate convergent and discriminant validity and support NIHTB-CB ORR scores as valid estimates of scores on a PMIQ measure in older Black and White adults with and without MCI. [ABSTRACT FROM AUTHOR]

Objective: Few studies have evaluated in-home teleneuropsychological (teleNP) assessment and none, to our knowledge, has evaluated the National Alzheimer's Coordinating Center's (NACC) Uniform Data Set version 3 tele-adapted test battery (UDS v3.0 t-cog). The current study evaluates the reliability of the in-home UDS v3.0 t-cog with a prior in-person UDS v3.0 evaluation. Method: One hundred and eighty-one cognitively unimpaired or cognitively impaired participants from a longitudinal study of memory and aging completed an in-person UDS v3.0 and a subsequent UDS v3.0 t-cog evaluation (∼16 months apart) administered either via video conference (n = 122) or telephone (n = 59). Results: We calculated intraclass correlation coefficients (ICCs) between each time point for the entire sample. ICCs ranged widely (0.01–0.79) but were generally indicative of "moderate" (i.e., ICCs ranging from 0.5–0.75) to "good" (i.e., ICCs ranging from 0.75–0.90) agreement. Comparable ICCs were evident when looking only at those with stable diagnoses. However, relatively stronger ICCs (Range: 0.35–0.87) were found between similarly timed in-person UDS v3.0 evaluations. Conclusions: Our findings suggest that most tests on the UDS v3.0 t-cog battery may serve as a viable alternative to its in-person counterpart, though reliability may be attenuated relative to the traditional in-person format. More tightly controlled studies are needed to better establish the reliability of these measures. [ABSTRACT FROM AUTHOR]

BACKGROUND: Early discrimination and prediction of cognitive decline are crucial for the study of neurodegenerative mechanisms and interventions to promote cognitive resiliency. METHODS: Our research is based on resting‐state electroencephalography (EEG) and the current dataset includes 137 consensus‐diagnosed, community‐dwelling Black Americans (ages 60–90 years, 84 healthy controls [HC]; 53 mild cognitive impairment [MCI]) recruited through Wayne State University and Michigan Alzheimer's Disease Research Center. We conducted multiscale analysis on time‐varying brain functional connectivity and developed an innovative soft discrimination model in which each decision on HC or MCI also comes with a connectivity‐based score. RESULTS: The leave‐one‐out cross‐validation accuracy is 91.97% and 3‐fold accuracy is 91.17%. The 9 to 18 months' progression trend prediction accuracy over an availability‐limited subset sample is 84.61%. CONCLUSION: The EEG‐based soft discrimination model demonstrates high sensitivity and reliability for MCI detection and shows promising capability in proactive prediction of people at risk of MCI before clinical symptoms may occur. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Identifying mild cognitive impairment (MCI) patients at risk for dementia could facilitate early interventions. Using electronic health records (EHRs), we developed a model to predict MCI to all‐cause dementia (ACD) conversion at 5 years. METHODS: Cox proportional hazards model was used to identify predictors of ACD conversion from EHR data in veterans with MCI. Model performance (area under the receiver operating characteristic curve [AUC] and Brier score) was evaluated on a held‐out data subset. RESULTS: Of 59,782 MCI patients, 15,420 (25.8%) converted to ACD. The model had good discriminative performance (AUC 0.73 [95% confidence interval (CI) 0.72–0.74]), and calibration (Brier score 0.18 [95% CI 0.17–0.18]). Age, stroke, cerebrovascular disease, myocardial infarction, hypertension, and diabetes were risk factors, while body mass index, alcohol abuse, and sleep apnea were protective factors. DISCUSSION: EHR‐based prediction model had good performance in identifying 5‐year MCI to ACD conversion and has potential to assist triaging of at‐risk patients. Highlights: Of 59,782 veterans with mild cognitive impairment (MCI), 15,420 (25.8%) converted to all‐cause dementia within 5 years.Electronic health record prediction models demonstrated good performance (area under the receiver operating characteristic curve 0.73; Brier 0.18).Age and vascular‐related morbidities were predictors of dementia conversion.Synthetic data was comparable to real data in modeling MCI to dementia conversion. Key Points: An electronic health record–based model using demographic and co‐morbidity data had good performance in identifying veterans who convert from mild cognitive impairment (MCI) to all‐cause dementia (ACD) within 5 years.Increased age, stroke, cerebrovascular disease, myocardial infarction, hypertension, and diabetes were risk factors for 5‐year conversion from MCI to ACD.High body mass index, alcohol abuse, and sleep apnea were protective factors for 5‐year conversion from MCI to ACD.Models using synthetic data, analogs of real patient data that retain the distribution, density, and covariance between variables of real patient data but are not attributable to any specific patient, performed just as well as models using real patient data. This could have significant implications in facilitating widely distributed computing of health‐care data with minimized patient privacy concern that could accelerate scientific discoveries. [ABSTRACT FROM AUTHOR]

We sought to determine whether the biomarkers of chronic inflammation predict cognitive decline in a prospective observational study. We measured baseline serum soluble urokinase plasminogen activator receptor (suPAR) and high sensitivity C‐reactive protein (hs‐CRP) levels in 282 participants of the University of Michigan Memory and Aging Project. Cognitive function was measured using the Montreal Cognitive Assessment (MoCA) and the Clinical Dementia Rating (CDR) scale for up to five time points. SuPAR and hs‐CRP levels were not significantly higher in participants with mild cognitive impairment (n = 97) or dementia (n = 59), compared to those with normal cognitive function (n = 126). Overall, 14% of participants experienced significant cognitive decline over the study period. The change in MoCA or CDR scores over time did not differ significantly according to baseline suPAR or hs‐CRP levels. Chronic systemic inflammation, as measured by serum suPAR or hs‐CRP levels, is unlikely to contribute significantly to cognitive decline. [ABSTRACT FROM AUTHOR]

Background: Brain connectivity has been proposed to identify people at risk for mild cognitive impairment (MCI). Existing work has mainly focused on functional connectivity which reflects the mutual dependence between brain regions. Effective connectivity, which represents the directed connectivity from one brain region to the other, is expected to provide more details on directed information flow in the brain network. The present study investigates how cognitive engagement changes the effective connectivity in the brain. Method: Our research focuses on task‐based EEG (64‐channel), where participants were asked to perform a motion direction discrimination task. The current dataset includes 56 consensus‐diagnosed, community‐dwelling African Americans (ages 60‐90 years, 28 healthy controls (HC) and 28 MCI patients) recruited through the Wayne State Institute of Gerontology and Michigan Alzheimer's Disease Research Center with subjective cognitive complaints. We evaluated the effective connectivity at different time periods of the motion‐detection task across all the possible EEG region pairs using causalized convergent cross‐mapping (cCCM) of the current source density. For each task trial, the successive time periods being examined included: (I) stimulus onset to Go indication, (II) Go indication to motion‐stop, and (III) the button‐press period. For each subject, we calculated the mean, maximum and minimum of the cCCM vector for each EEG region pair and each time‐period, then selected the region pairs where the cCCM‐based effective connectivity of HC and MCI show a significant difference (p‐value<0.05). Result: Our analysis indicated that typically, MCI participants show more active effective connectivity or need more effort from stimulus onset to Go indication and then to motion stop, but HC participants show higher maximum and minimum effective connectivity values during the button‐press period, where coherent coordination is required among many region pairs. Conclusion: HC and MCI do show significant differences in effective connectivity during each of the three periods of a motion detection task (marked by stimulus onset, Go indication, and button‐press) over many region pairs. Our analysis provides a massive pool of possible features for future biomarker development for effective discrimination of HC and MCI. Funding: NSF‐2032709/Li; NIH‐1R21AG046637‐01A1/Kavcic and NIH‐1R01AG054484‐01A1/Kavcic; NIH‐P30AG053760/Paulson and NIH‐P30AG072931/Paulson. [ABSTRACT FROM AUTHOR]

Background: Cognitive assessment of older adults typically includes symptom reports and objective evaluations. However, there is often poor agreement between these measures. Cultural norms, stress, and anxiety may also influence cognitive self-appraisal and performance. Little research describes how other factors affect the self-report/objective test discrepancies noted in the literature. Objective: This study investigated whether the disparity between subjective cognitive concerns and objective cognitive performance is related to measures of anxiety and stress in older Black and African American adults. Methods: Telephone screenings were administered to 206 older adults (ages 64–94) during the first year of the pandemic. Demographic data, objective memory (Telephone Interview for Cognitive Status [TICS-m]), an adaptation of the subjective memory measure, the Cognitive Change Questionnaire, emphasizing executive functioning in everyday life [CCQ-e]), Generalized Anxiety Disorder-7 (GAD-7), and Perceived Stress Scale-4 (PSS4) were measured. Metacognition Discrepancy Index (MDI) was calculated from the standardized residual after regressing TICS-m on CCQ-e scores to quantify the discrepancy between cognitive self-appraisal and objective cognitive functioning. Results: Neither GAD-7 nor PSS-4 moderated the relationship between TICS-m and CCQ-e, and TICS-m scores weakly predicted subjective CCQ-e scores (F(1, 197)=4.37, p = 0.038, R2 = 0.022). The MDI correlated with stress and anxiety (rs = 0.294, 0.396, ps < 0.001). Conclusion: Discrepancies exist between objectively measured and self-evaluated cognition. Elevations in stress and anxiety are associated with greater overestimation of cognitive difficulties relative to objective performance. Pandemic-related stressors may have worsened anxiety and diminished self-appraisal of cognitive abilities for some individuals, while others may remain reluctant to acknowledge impairments. Social and emotional factors are meaningful considerations in assessing cognitive difficulties. [ABSTRACT FROM AUTHOR]

Background: Identification of older individuals with increased risk for cognitive decline can contribute not only to personal benefits (e.g., early treatment, evaluation of treatment), but could also benefit clinical trials (e.g., patient selection). We propose that baseline resting-state electroencephalography (rsEEG) could provide markers for early identification of cognitive decline. Objective: To determine whether rsEEG theta/beta ratio (TBR) differed between mild cognitively impaired (MCI) and healthy older adults. Methods: We analyzed rsEEG from a sample of 99 (ages 60–90) consensus-diagnosed, community-dwelling older African Americans (58 cognitively typical and 41 MCI). Eyes closed rsEEGs were acquired before and after participants engaged in a visual motion direction discrimination task. rsEEG TBR was calculated for four midline locations and assessed for differences as a function of MCI status. Hemispheric asymmetry of TBR was also analyzed at equidistant lateral electrode sites. Results: Results showed that MCI participants had a higher TBR than controls (p = 0.04), and that TBR significantly differed across vertex location (p < 0.001) with the highest TBR at parietal site. MCI and cognitively normal controls also differed in hemispheric asymmetries, such that MCI show higher TBR at frontal sites, with TBR greater over right frontal electrodes in the MCI group (p = 0.003) and no asymmetries found in the cognitively normal group. Lastly, we found a significant task aftereffect (post-task compared to pre-task measures) with higher TBR at posterior locations (Oz p = 0.002, Pz p = 0.057). Conclusion: TBR and TBR asymmetries differ between MCI and cognitively normal older adults and may reflect neurodegenerative processes underlying MCI symptoms. [ABSTRACT FROM AUTHOR]

Background: Interest in the NIH Toolbox Cognition Battery (NIHTB‐CB) for the clinical assessment of older adults is burgeoning. Longitudinal neuropsychological assessments are the most sensitive way to establish cognitive decline and dementia risk of older adults. The psychometric property of measurement invariance is essential to valid interpretations of change. However, few studies have evaluated the stability of NIHTB‐CB scores in a sample of cognitively normal older adults with subjective cognitive decline (SCD). This study aims to analyze measurement consistency of NIHTB‐CB performance over 6 months. Method: N = 29 cognitively normal, older Black adult women (65‐81 years of age) with SCD were administered the NIHTB‐CB at baseline and six‐month follow‐up. Diagnostic status was determined via consensus conference following NACC UDS guidelines. We evaluated the mean change by matched‐pairs t‐tests, and measurement consistency by two‐way mixed effects models of intraclass correlations coefficients and Bland‐Altman plots. Uncorrected standard scores and fully corrected T scores were analyzed from NIHTB‐CB Cognition Composites of Total Cognition, Fluid Cognition, and Crystallized Cognition. Result: There were no significant mean differences from baseline to follow‐up for corrected and uncorrected Total Cognition Scores. The uncorrected Fluid Score significantly increased by 2.5 points at follow‐up (t(28) = 2.18, p =.04), and the corrected Crystallized Score increased by 1.8 points at follow‐up (t(28) = ‐2.25, p =.03). The uncorrected Crystallized Score and the corrected Fluid Score did not differ across assessments. Consistency for the uncorrected and corrected Total scores was good, (ICC(3,1) = 0.83 and 0.80, respectively). Similarly, consistency for uncorrected and corrected Fluid Scores was also good (ICC(3,1) = 0.77 and 0.78). Consistency was excellent for uncorrected Crystallized Scores (ICC(3,1) =.92), but good for corrected scores (ICC(3,1) =.87). Discrepancy scores (baseline vs follow‐up) derived from uncorrected scores for the three composites were unrelated to age and education. Bland‐Altman plots of uncorrected scores for the Composite Scores were consistent with the ICC analyses, showing good agreement between measures. Conclusion: NIHTB‐CB corrected and uncorrected composite scores have good longitudinal psychometric properties in a sample of older Black adult women with SCD, a relatively under‐investigated examinee sample. These findings also suggest that change in fluid or crystallized cognition over six months is unlikely in persons with SCD. [ABSTRACT FROM AUTHOR]