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This research seeks to contribute new understanding of color disparities and gender in cognitive aging among older adults residing in Puerto Rico. We use the island-representative Puerto Rican Elderly Health Conditions (PREHCO) longitudinal study that measures cognitive health at baseline and cognitive decline between waves. In pooled models, we discern little or no color disparities in cognition at baseline. Sex-stratified models of baseline cognition indicate that Trigueño men slightly outperform white men. In contrast, color disparities in cognitive decline are apparent. In just four years between the two waves of PREHCO, on a 20-point cognitive test scale, Black men experienced 0.78 more points of cognitive decline, while Trigueño men experienced 0.44 more points of cognitive decline than white men in Puerto Rico. Mestiza women experience 0.80 less points of cognitive decline relative to white women. Nearly all of the color/race association with cognitive decline appears to be independent from health behaviors and conditions, individual human capital attainment, and family background. While lower-status color groups more frequently report discrimination, discrimination does not mediate the impact of color/skin tone and cognitive performance, suggesting the importance of further research on the role of broader dimensions of life course structural racism.

IntroductionDespite high dementia prevalence in Hispanic populations globally, especially Caribbean Hispanics, no study has comparatively examined the association between education and dementia among Hispanics living in the Caribbean Islands and older adults in the United States.MethodsWe used data on 6107 respondents aged 65 and older in the baseline wave of the population-based and harmonized 10/66 survey from Cuba, the Dominican Republic, and Puerto Rico, collected between 2003 and 2008, and 11,032 respondents aged 65 and older from the U.S.-based Health and Retirement Study data in 2014, a total of 17,139 individuals. We estimated multivariable logistic regression models examining the association between education and dementia, adjusted for age, income, assets, and occupation. The models were estimated separately for the Caribbean population (pooled and by setting) and the U.S. population by race/ethnicity (Hispanic, Black, and White), followed by pooled models across all populations.ResultsIn the Caribbean population, the relative risk of dementia among low versus high educated adults was 1.45 for women (95% confidence interval [CI] 1.17, 1.74) and 1.92 (95% CI 1.35, 2.49) for men, smaller compared to those in the United States, especially among non-Hispanic Whites (women: 2.78, 95% CI 1.94, 3.61; men: 5.98, 95% CI 4.02, 7.95).DiscussionThe differential associations between education and dementia across the Caribbean and US settings may be explained by greater disparities in social conditions in the United States compared to the Caribbean, such as access to health care, healthy behaviors, and social stressors, which serve as potentially important mediators.

The phosphoinositide phosphatase synaptojanin 1 (SYNJ1) is a key regulator of synaptic function. We first tested whether SYNJ1 contributes to phenotypic variations in familial Alzheimer's disease (FAD) and show that SYNJ1 polymorphisms are associated with age of onset in both early- and late-onset human FAD cohorts. We then interrogated whether SYNJ1 levels could directly affect memory. We show that increased SYNJ1 levels in autopsy brains from adults with Down syndrome (DS/AD) are inversely correlated with synaptophysin levels, a direct readout of synaptic integrity. We further report age-dependent cognitive decline in a mouse model overexpressing murine Synj1 to the levels observed in human sporadic AD, triggered through hippocampal hyperexcitability and defects in the spatial reproducibility of place fields. Taken together, our findings suggest that SYNJ1 contributes to memory deficits in the aging hippocampus in all forms of AD.

To get a rich description of the barriers to using assistive technology (AT) among men and women ≥65 years living in poor and disadvantaged communities in Puerto Rico, an issue not well described among older people. We conducted qualitative interviews assisted by videos of AT and guided by the Matching Person and Technology Model and the Gender Analysis Framework with a purposive sample of 23 men and women. Participants were asked questions regarding reasons for not using AT, willingness for using AT, their identified gender roles and gender-related activities, and bargaining positions. They were also asked about their access to resources to acquire AT, bargaining positions, the stigma associated with AT use, and the characteristics of AT. Directed content analysis with input from a Community Advisory Board was used for the interpretation of the results. The predominant barrier (for both men and women) to using AT devices were: lack of information about AT s and access to money for their purchase, lack of availability and cost of such devices, and (self)-stigma. More women than men experienced limited access to AT services, limited access to and control of money, limited skills for using AT, and less bargaining power for making independent decisions. More men than women expressed a lack of functional need and personal preferences other than using AT devices for managing difficulties in activities. There are gender differences concerning the multilevel barriers to using AT devices among older Hispanics residing in low-income communities. Older Hispanic men and women in this study experienced different obstacles to using assistive technology (AT) they need for compensating their functional disabilities in daily living activities. Women in this study reported having less access to money and AT services, diminished skills for using AT devices, and less power to make independent decisions to access AT devices compared to men. To ensure the equitable provision of AT, cultural as well as gender-related factors concerning AT use need to be considered. Future research should focus on women's functional health, also should focus on the development of gender-sensitive and culturally competent AT interventions to improve older Hispanics from poor communities function and opportunities for ageing at their homes and in their communities. [ABSTRACT FROM AUTHOR]

Objectives: Population ageing will lead to a dramatic increase in dementia prevalence globally. Recent evidence suggests a decline in dementia incidence in HIC due to increasing education levels and improvements in cardiovascular health. Although, most of the increase will occur in low and middle-income countries (LMICs), there are no recent estimates of dementia prevalence and incidence in LMICs. The present study aimed to examine new trends on dementia prevalence and incidence in Latin-America and associations of socioeconomic determinants and cardiovascular risk factors. Methods: Sample size included older adults from Latin America (Cuba, Dominican Republic [DR], Puerto Rico [PR], and Mexico) drawn from the 10/66 Dementia Research Group study. We compare wave 1 (2003–2006) with wave 3 (2016 – 2019) of 10/66 studies. The main outcome was dementia prevalence relative to previous waves. Dementia diagnosis was determined according to the 10/66 dementia criteria. All the 10/66 waves used the same standardized assessments and protocols. Results: Comparing the first wave (2003 - 2006) with the third wave (2016 - 2019) in four Latin American countries – Cuba, the Dominican Republic, Mexico, and Peru – reveals significant trends in dementia prevalence. Preliminary data suggest an increase in the Dominican Republic, Mexico, and Peru, while Cuba slightly declined, from 12.4 percent in Wave 1 to 10.1 percent in Wave 3. In contrast, the Dominican Republic's age-adjusted prevalence rose from 11.5 percent to 13.6 percent, Peru from 9.2 percent to 16.8 percent, and Mexico from 8.3 percent to 17.1 percent. Despite, improvements in levels of education, increases in dementia prevalence were associated with higher rates of cardiovascular disease and cardiovascular risk factors, including diabetes, hypertension, obesity and heart disease in the later-born cohorts. Self-reported stroke is also rising. Conclusions: The increasing prevalence of dementia in LAC underscores the urgent need for targeted health interventions. Prevention strategies should emerge as a key focus in the battle against dementia in Latin America. Addressing modifiable risk factors can significantly impact the incidence and prevalence ofdementia. [ABSTRACT FROM AUTHOR]

Introduction: Apolipoprotein E (APOE) is considered the major susceptibility gene for developing Alzheimer's disease. However, the strength of this risk factor is not well established across diverse Hispanic populations. Methods: We investigated the associations among APOE genotype, dementia prevalence, and memory performance (immediate and delayed recall scores) in Caribbean Hispanics (CH), African Americans (AA), Hispanic Americans (HA) and non‐Hispanic White Americans (NHW). Multivariable logistic regressions and negative binomial regressions were used to examine these associations by subsample. Results: Our final dataset included 13,516 participants (5198 men, 8318 women) across all subsamples, with a mean age of 74.8 years. Prevalence of APOE ε4 allele was similar in CHs, HAs, and NHWs (21.8%–25.4%), but was substantially higher in AAs (33.6%; P < 0.001). APOE ε4 carriers had higher dementia prevalence across all groups. Discussion: APOE ε4 was similarly associated with increased relative risk of dementia and lower memory performance in all subsamples. [ABSTRACT FROM AUTHOR]

Introduction: Progranulin (GRN) mutations occur in frontotemporal lobar degeneration (FTLD) and in Alzheimer's disease (AD), often with TDP‐43 pathology. Methods: We determined the frequency of rs5848 and rare, pathogenic GRN mutations in two autopsy and one family cohort. We compared Braak stage, β‐amyloid load, hyperphosphorylated tau (PHFtau) tangle density and TDP‐43 pathology in GRN carriers and non‐carriers. Results: Pathogenic GRN mutations were more frequent in all cohorts compared to the Genome Aggregation Database (gnomAD), but there was no evidence for association with AD. Pathogenic GRN carriers had significantly higher PHFtau tangle density adjusting for age, sex and APOE ε4 genotype. AD patients with rs5848 had higher frequencies of hippocampal sclerosis and TDP‐43 deposits. Twenty‐two rare, pathogenic GRN variants were observed in the family cohort. Discussion: GRN mutations in clinical and neuropathological AD increase the burden of tau‐related brain pathology but show no specific association with β‐amyloid load or AD. [ABSTRACT FROM AUTHOR]

Objective: Polygenic risk scores (PRSs) assess the individual genetic propensity to a condition by combining sparse information scattered across genetic loci, often displaying small effect sizes. Most PRSs are constructed in European-ancestry populations, limiting their use in other ethnicities. Here we constructed and validated a PRS for late-onset Alzheimer's Disease (LOAD) in Caribbean Hispanics (CH).Methods: We used a CH discovery (n = 4,312) and independent validation sample (n = 1,850) to construct an ancestry-specific PRS ("CH-PRS") and evaluated its performance alone and with other predictors using the area under curve (AUC) and logistic regression (strength of association with LOAD and statistical significance). We tested if CH-PRS predicted conversion to LOAD in a subsample with longitudinal data (n = 1,239). We also tested the CH-PRS in an independent replication CH cohort (n = 200) and brain autopsy cohort (n = 33). Finally, we tested the effect of ancestry on PRS by using European and African American discovery cohorts to construct alternative PRSs ("EUR-PRS", "AA-PRS").Results: The full model (LOAD ~ CH-PRS + sex + age + APOE-ɛ4), achieved an AUC = 74% (ORCH-PRS  = 1.51 95%CI = 1.36-1.68), raising to >75% in APOE-ɛ4 non-carriers. CH-PRS alone achieved an AUC = 72% in the autopsy cohort, raising to AUC = 83% in full model. Higher CH-PRS was significantly associated with clinical LOAD in the replication CH cohort (OR = 1.61, 95%CI = 1.19-2.17) and significantly predicted conversion to LOAD (HR = 1.93, CI = 1.70-2.20) in the longitudinal subsample. EUR-PRS and AA-PRS reached lower prediction accuracy (AUC = 58% and 53%, respectively).Interpretation: Enriching diversity in genetic studies is critical to provide an effective PRS in profiling LOAD risk across populations. ANN NEUROL 2021. [ABSTRACT FROM AUTHOR]

Background and Aims: The growth of the elderly population poses challenges and opportunities in society. As we age, normal changes occur that can affect functionality and independence. Aging is associated with brain changes that result in cognitive decline. The most common cause of cognitive decline among the elderly is Alzheimer's disease (AD). It is characterized by a progressive spectrum of memory problems that affect the functional capacity of the elderly and their ability to perform activities of daily living, increasing the level of dependence and the social, emotional, and economic burden on caregivers. Alzheimer's disease is the 6th leading cause of death in the United States and the 4th leading cause of death in Puerto Rico. These challenges can only be addressed through clinical research for managing conditions, non-pharmacological treatments and therapies, and educational initiatives covering basic aspects of geriatrics aimed at healthcare professionals, direct service providers, and caregivers. These efforts will provide effective management alternatives when intervening with the elderly population and the public. The aims are: to discuss the educational initiative with Dominican caregivers, to review advances in Alzheimer's disease research, to present the translation and cultural validation of Cognitive Stimulation Therapy as a non-pharmacological intervention for patients in the early stages of MCI and Alzheimer's, and to raise awareness about the importance of physical literacy through the eight (8) Movement Patterns of Brain Dance for older adults. [ABSTRACT FROM AUTHOR]

To gain a deep understanding of the person, environment, and occupation-related self-management strategies used to overcome disabilities in daily living activities. In this concurrent transformative mixed method design guided by the Person, Environment, Occupation-Performance Model we assessed 12 older women functional disabilities using the PROMIS Physical Function Short Form 20, followed by in-depth interviews about their strategies for dealing with these disabilities. The sample's PROMIS mean T-score was below the national average. The sample predominantly used occupation-related strategies to overcome difficulties in daily living activities and these strategies were moderated by personal and cultural factors such as psychological and spirituality. The most frequently used strategy for self-care and instrumental activities of daily living were changing the method of performance and activity pacing for functional mobility. The strategies used by these participants can be used for the development of disability self-management interventions to increase Hispanic woman's function. [ABSTRACT FROM AUTHOR]