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Objectives: To test the psychometric properties of several dementia care-related scales among Latinos in the US., Design: We leveraged secondary baseline data from a one-arm mHealth trial on dementia caregiver support. We included 100 responses for caregiver-focused scales and 88 responses for care recipient-focused scales. Scales included the Neuropsychiatric Inventory Questionnaire Severity and Distress scales, six-item Zarit Burden Inventory, Ten-item Center for Epidemiologic Studies Depression Scale, Geriatric Depression Inventory, Quality of Life in Alzheimer's Disease, and Single-item Satisfaction With Life Scale. We calculated concurrent validity using Pearson and Spearman correlations and expected correlations amongst all variables in line with the Stress Process Framework. We calculated internal consistency reliability using Cronbach's alpha., Results: All concurrent validity correlations followed the expected directionality, with 19/21 inter-scale correlations in the total sample reaching statistical significance (p<0.05), and 17/21 reaching at least a low correlation (0.3). Cronbach's alpha ranged from 0.832 to 0.879 in all scales in the total sample., Conclusion: The English and Spanish caregiver-administered scales tested in this manuscript have good psychometric properties., Clinical Implications: The dementia care-related scales are now appropriately available for use among US Latinos in research and clinical contexts.

Objectives: To examine the associations between participant intensity of engagement with a text message intervention, CuidaTEXT , and socio-demographic factors, acceptability measures, and clinical outcomes among Latino/a caregivers of individuals with dementia., Methods: CuidaTEXT is a six-month, bilingual, and bidirectional intervention. We enrolled 24 Latino/a caregivers in a one-arm feasibility trial. Participants received approximately one automatic daily text message and could engage with the intervention by texting specific keywords (e.g. STRESS to receive messages about stress-coping), and by chat-texting with a live coach. We used metrics and psychometric scales to quantify variables., Results: Participants sent a total of 1847 messages to CuidaTEXT . Higher intensity of engagement was associated with higher intervention satisfaction ( r  = 0.6, p  = 0.007), as were several other acceptability outcomes. We found no associations between intensity of engagement with CuidaTEXT and sociodemographic or clinical outcomes ( p  > 0.05)., Conclusion: Encouraging more intense engagement with CuidaTEXT might lead to higher levels of satisfaction with the intervention. However, it is possible that those who are highly satisfied, engage more intensely with CuidaTEXT . Future research should determine the directionality of these associations to optimize text message interventions., Clinical Implications: Creating more opportunities to increase the intensity of text message engagement with caregiver support interventions may improve caregiver satisfaction with them.

Introduction: Past Alzheimer's disease and related dementias (ADRD) research has not considered ways to ensure the representation of diverse sexual and gender minorities. This study used concept mapping (CM) to identify strategies for engaging and recruiting LGBTQIA+ older adults living with memory loss and their caregivers into ADRD research., Methods: CM, involving brainstorming, thematic analysis, and rating of strategies, was conducted with 46 members from one national and three local community advisory boards. Data was analyzed using The Concept Systems Global MAX™ web platform., Results: One hundred twenty-two solutions were identified from June through December 2022, and represented five key themes: aging focused, LGBTQIA+ specific, memory loss and caregiving support focused, physical advertisements, and other media. Promising strategies included partnering with LGBTQIA+ health centers, attending social groups for older adults, and increasing community representation in marketing., Discussion: Tailored strategies, building trust, and community involvement are essential for engaging LGBTQIA+ individuals living with memory loss or ADRD and their caregivers in ADRD-focused research., Highlights: Innovative ways to ensure the inclusion of LGBTQIA+ older adults in Alzheimer's disease and related dementias (ADRD) research can be bolstered through collaboration with key community stakeholders.Promising strategies for recruitment and engagement include partnering with LGBTQIA+ centers, attending social groups for older adults, and ensuring diverse representation in marketing.Tailored recruitment and engagement strategies are crucial for building trust with LGBTQIA+ populations to increase participation in ADRD research., Competing Interests: Brittany Klenczar‐Castro is supported by NIA grants R01AG083177 and R24AG066599, and AARGD‐22‐929144. Dr. Krystal R. Kittle is supported by AARF‐22‐927069, NIA R01AG083177, and P30AG062429. Dr. Joel G. Anderson is supported by NIA R24AG066599 and R01AG083177 and serves on the Board of Directors of Healing Beyond Borders (unpaid). Dr. Whitney Wharton is supported by NIA R24AG066599, R01AG066203, RF1AG051514, R01AG083177, and P30AG064200. Dr. Andrea Gilmore‐Bykovskyi is an employee of the University of Wisconsin‐Madison and, in the last 36 months, reports grants from the NIH and the NIA. Dr. N. Maritza Dowling is supported by R24AG066599 and R01AG083177. Dr. Jaime Perales‐Puchalt is supported by K01MD014177 and P30AG062429. Dr. Jason D. Flatt is supported by NIA grants K01AG056669, R01AG083177 and R24AG066599, and AARGD‐22‐929144. Author disclosures are available in the supporting information., (© 2024 The Author(s). Alzheimer's & Dementia: Translational Research & Clinical Interventions published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

Introduction: Recruitment of sufficient and diverse participants into clinical research for Alzheimer's disease and related dementias remains a formidable challenge. The primary goal of this manuscript is to provide an overview of an approach to diversifying research recruitment and to provide case examples of several methods for achieving greater diversity in clinical research enrollment., Methods: The University of Kansas Alzheimer's Disease Research Center (KU ADRC) developed MyAlliance for Brain Health (MyAlliance), a service-oriented recruitment model. MyAlliance comprises a Primary Care Provider Network, a Patient and Family Network, and a Community Organization Network, each delivering tailored value to relevant parties while facilitating research referrals., Results: We review three methods for encouraging increased diversity in clinical research participation. Initial outcomes reveal an increase in underrepresented participants from 17% to 27% in a research registry. Enrollments into studies supported by the research registry experienced a 51% increase in proportion of participants from underrepresented communities., Discussion: MyAlliance shifts power, resources, and knowledge to community advocates, promoting brain health awareness and research participation, and demands substantial financial investment and administrative commitment. MyAlliance offers valuable lessons for building sustainable, community-centered research recruitment infrastructure, emphasizing the importance of localized engagement and cultural understanding., Highlights: MyAlliance led to a significant increase in the representation of underrepresented racial and ethnic groups and individuals from rural areas.The service-oriented approach facilitated long-term community engagement and trust-building, extending partnerships between an academic medical center and community organizations.While effective, MyAlliance required substantial financial investment, with costs including infrastructure development, staff support, partner organization compensation, and promotional activities, underscoring the resource-intensive nature of inclusive research recruitment efforts., Competing Interests: The authors have no conflicts to disclose. Author disclosures are available in the supporting information., (© 2024 The Author(s). Alzheimer's & Dementia: Translational Research & Clinical Interventions published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

Background: The Reducing Disability in Alzheimer's Disease in Kansas City (RDAD-KC) intervention has been shown to improve the health of individuals with dementia and caregiver dyads. This manuscript reports the results of implementing the RDAD among individuals with intellectual disabilities and caregiver dyads., Methods: Nine community agencies deployed the 12-week intervention. We assessed changes in individuals with intellectual disabilities' behavioural symptom related severity and physical activity, and caregivers' behavioural symptom-related distress, unmet needs, and caregiver strain., Results: Forty-four dyads enrolled, and 23 (~60 years, 48% female) completed ≥75% of the intervention. We observed decreases in behavioural symptom related severity (p = .07) and increases in physical activity (p = .20) among individuals with intellectual disabilities. We also observed decreases in behavioural symptom related distress (p = .14), unmet needs (p = .50), and caregiver strain (p = .50) among caregivers., Conclusions: The RDAD-KC intervention showed promising, although statistically non-significant, benefits among individuals with intellectual disabilities and their caregivers., (© 2024 John Wiley & Sons Ltd.)

Background: Latino individuals experience disparities in the care of Alzheimer disease and related dementias (ADRD) and have disproportionately high COVID-19 infection and death outcomes., Objective: We aimed to gain an in-depth understanding of the impact of the COVID-19 pandemic among Latino families with ADRD in the United States., Methods: This was a qualitative study of 21 informal caregivers of Latino individuals with ADRD and 23 primary care providers who serve Latino patients. We recruited participants nationwide using convenience and snowball sampling methods and conducted remote interviews in English and Spanish. We organized the transcripts for qualitative review to identify codes and themes, using a pragmatic approach, a qualitative description methodology, and thematic analysis methods., Results: Qualitative analysis of transcripts revealed eight themes, including (1) the pandemic influenced mental and emotional health; (2) the pandemic impacted physical domains of health; (3) caregivers and care recipients lost access to engaging activities during the confinement; (4) the pandemic impacted Latino caregivers' working situation; (5) the pandemic impacted health care and community care systems; (6) health care and community care systems took measures to reduce the impact of the pandemic; (7) Latino families experienced barriers to remote communication during the pandemic; and (8) caregiver social support was critical for reducing social isolation and its sequalae., Conclusions: Latino families with ADRD experienced similar but also unique impacts compared to those reported in the general population. Unique impacts may result from Latino individuals' underserved status in the United States, commonly held cultural values, and their intersectionality with ADRD-related disability. Family caregiver social support was crucial during this time of adversity. These findings suggest the need for more equitable access, culturally appropriate and trustworthy content and delivery of health care and community services, as well as stronger financial and social supports for family caregivers., (© Jaime Perales-Puchalt, Jill Peltzer, Monica Fracachan-Cabrera, G Adriana Perez, Mariana Ramírez, K Allen Greiner, Jeffrey Murray Burns. Originally published in JMIRx Med (https://med.jmirx.org).)

Despite the general positive outcomes of the Diabetes Prevention Program (DPP), the program's reach, adherence, and effectiveness among Latinos are still suboptimal. Text-message DPP can potentially overcome barriers and improve DPP outcomes for this group. We aimed to assess the feasibility, acceptability, and preliminarily effectiveness of a culturally and linguistically adapted text-message DPP for Latinos. We enrolled 26 eligible Spanish-speaking Latino adults at risk of developing type 2 diabetes (A1c = 5.7%-6.4%, body mass index ≥25) in a 6-month culturally and linguistically adapted text-message DPP. Participants received (i) two to three daily automated text-messages about healthy eating, physical activity, problem-solving skills, lifestyle change motivation, and logistics, (ii) on-demand keyword-driven messages, and (iii) on-demand chat messages with a DPP coach. Outcomes included feasibility (e.g. adherence), acceptability (e.g. satisfaction), and preliminary effectiveness (e.g. weight loss). Twenty-four participants completed the program and follow-up assessments. Participants' mean body weight changed from 191.2 to 186.7 pounds (P = .004); 45.8% of participants lost ≥3%, and 29.2% lost ≥5% of body weight. Body mass index and waist circumference were also reduced [0.9 kg/m2 (P = .003) and 1.1 cm (P = .03), pre-post]. Self-reported physical activity frequency was increased (P = .003). No statistically significant changes in diet quality were found. Most participants were satisfied with the program and perceived it to help prevent diabetes. Our pilot study of an innovative text-message DPP for Latinos demonstrated the program was acceptable, feasible, and potentially effective. Using text-message for DPP can reduce barriers to in-person participation by increasing the program's reach without compromising fidelity and effectiveness., (© Society of Behavioral Medicine 2023. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: To test the feasibility, acceptability, and preliminary efficacy of CuidaTEXT : a bidirectional text message intervention to support Latino dementia family caregivers., Methods: CuidaTEXT is a six-month, bilingual intervention tailored to caregiver needs (e.g., education, problem-solving, resources). We used convenience sampling and reached 31 potential participants via clinics, registries, community promotion, and online advertising. We enrolled 24 Latino caregivers in a one-arm trial and assessed feasibility, acceptability, and preliminary efficacy within six months., Results: None of the participants unsubscribed from CuidaTEXT and 83.3% completed the follow up survey. Most participants (85.7%) reported reading most text messages thoroughly. All participants reported being very or extremely satisfied with the intervention. Participants reported that CuidaTEXT helped a lot (vs not at all, a little, or somehow) in caring for their care recipient (71.4%; n = 15), for themselves (66.7%; n = 14), and understanding more about dementia (85.7%; n = 18). Compared to baseline, at six months caregiver behavioral symptom distress (0-60) decreased from 19.8 to 12.0 and depression (0-30) from 8.8 to 5.4 (p < .05)., Conclusions: CuidaTEXT demonstrated high levels of feasibility, acceptability, and preliminary efficacy among Latino caregivers., Clinical Implications: CuidaTEXT's feasibility and potential for widespread implementation holds promise in supporting Latino caregivers of people with dementia.

We aimed to prospectively assess the change in neuropsychiatric symptoms among people who develop cognitive impairment and have a history of post-traumatic stress disorder (PTSD). We analyzed longitudinal data from the National Alzheimer's Coordinating Center Unified Data Set (March 2015 to December 2021). Analyses included individuals who were cognitively normal and who had nonmissing assessment of PTSD at the initial visit and had at least 1 follow-up visit with cognitive impairment. We compared the difference in the mean neuropsychiatric symptom score at the first Unified Data Set visit versus the first visit with a Clinical Dementia Rating of 0.5 between those with and without a history of PTSD. The mean neuropsychiatric symptom score change did not differ between those with and without a history of PTSD (1.06 vs. 0.77, respectively; P =0.79). The null results found in this study warrant future research. Several methodological limitations might explain these results., Competing Interests: J.P.P. and his institution are currently receiving grants from the NIH (K01MD014177, R21AG065755, and P30 AG035982). O.L.M. and her institution are currently receiving grants from the NIH (R01AG067541 and P30AG072972). W.A.K. and his institution are currently receiving grants from the NIH, principally U24 AG072122. The remaining authors declare no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Dementia increases the risk of polypharmacy. Timely detection and optimal care can stabilize or delay the progression of dementia symptoms, which may in turn reduce polypharmacy. We aimed to evaluate the change in polypharmacy use among memory clinic patients living with dementia who participated in a dementia care program compared to those who did not. We hypothesized that patients in the dementia care program would reduce their use of polypharmacy compared to those who were not in standard care., Methods: We retrospectively analyzed data extracted from electronic medical records from a university memory clinic. Data from a total of 381 patients were included in the study: 107 in the program and 274 matched patients in standard care. We used adjusted odds ratios to assess the association between enrollment in the program and polypharmacy use at follow-up (five or more concurrent medications), controlling for baseline polypharmacy use and stratified polypharmacy use by prescription and over-the-counter (OTC)., Results: The two groups did not differ in the use of five or more overall and prescription medications at follow-up, controlling for the use of five or more of the respective medications at baseline and covariates. Being in the program was associated with a three-fold lower odds of using five or more OTC medications at follow-up (adjusted odds ratio = 0.30; p <0.001; 95% Confidence interval = 0.15-0.58) after controlling for using five or more OTC medications at baseline and covariates., Conclusions: Dementia care may reduce polypharmacy of OTC medications, potentially reducing risky drug-drug interactions. More research is needed to infer causality and understand how to reduce prescription medication polypharmacy., (© 2023 The University of Kansas Medical Center.)

Introduction: We developed demographically-adjusted normative data for Spanish- and English-speaking Latinos on the Version 3.0 of the National Alzheimer's Coordinating Center Uniform Data Set Neuropsychological Battery (UDS3-NB)., Methods: Healthy Latino adults (N = 437) age 50-94 (191 Spanish- and 246 English-speaking) enrolled in Alzheimer's Disease Research Centers completed the UDS3-NB in their preferred language. Normative data were developed via multiple linear regression models on UDS3-NB raw scores stratified by language group with terms for demographic characteristics (age, years of formal education, and sex)., Results: Younger age and more years of education were associated with better performance on most tests in both language groups, with education being particularly influential on raw scores among Spanish-speakers. Sex effects varied across tests and language groups., Discussion: These normative data are a crucial step toward improving diagnostic accuracy of the UDS3-NB for neurocognitive disorders among Latinos in the United States and addressing disparities in Alzheimer's disease and related dementias., Highlights: We developed normative data on the UDS3-NB for Latinos in the US ages 50-94. Younger age and more years of education were linked to better raw scores in several cognitive tests. Education was particularly influential on raw scores among Spanish-speakers. Sex effects varied across tests and between English- and Spanish-speaking Latinos. These normative data might improve diagnostic accuracy of the UDS3-NB among Latinos., (© 2023 the Alzheimer's Association.)

Background: Dementia has no cure, but interventions can stabilize the progression of cognitive, functional, and behavioral symptoms. Primary care providers (PCPs) are vital for the early detection, and long-term management of these diseases, given their gatekeeping role in the healthcare system. However, PCPs rarely implement evidence-based dementia care due to time limitations and knowledge about diagnosis and treatment. Training PCPs may help address these barriers., Objective: We explored the preferences of PCPs for dementia care training programs., Methods: We conducted qualitative interviews with 23 PCPs recruited nationally via snowball sampling. We conducted remote interviews and organized the transcripts for qualitative review to identify codes and themes, using thematic analysis methods., Results: PCP preferences varied regarding many aspects of ADRD training. Preferences varied regarding how to best increase PCP participation in training, and what content and materials were needed to help them and the families they serve. We also found differences regarding the duration and timing of training, and the modality of training sessions (remote versus in-person)., Conclusion: The recommendations arising from these interviews have the potential to inform the development and refinement of dementia training programs to optimize their implementation and success.

There are 5.8 million Americans with Alzheimer's disease and this number is rising. Social Work can play a key role. Yet, like other disciplines, the field is ill prepared for the growing number of individuals and family members who are impacted physically, emotionally and financially. Compounding the challenge, the number of social work students identifying interest in the field is low. This mixed methods concurrent study assessed the preliminary efficacy of a day-long education event among social work students from eight social work programs. Pre- post-training survey included: 1) dementia knowledge, assessed with the Dementia Knowledge Assessment Scale, and 2) negative attitudes towards dementia, assessed by asking students to identify three words that reflected their thoughts on dementia, which were later rated as positive, negative or neutral by three external raters. Bivariate analyses showed that dementia knowledge (mean difference= 9.9) and attitudes (10% lower) improved from pre- to post-training (p<0.05). Collaboration between social work programs can increase student access to strength-based dementia education. Such programs hold the potential of improving dementia capability within the field of Social Work., Competing Interests: Disclosure: The authors report no conflicts of interest

Background: Lesbian and gay older adults have health disparities that are risk factors for Alzheimer's disease, yet little is known about the neurocognitive aging of sexual minority groups., Objective: To explore cross-sectional and longitudinal dementia outcomes for adults in same-sex relationships (SSR) and those in mixed-sex relationships (MSR)., Methods: This prospective observational study utilized data from the National Alzheimer's Coordinating Center Uniform Data Set (NACC UDS) collected from contributing Alzheimer's Disease Research Centers. Participants were adults aged 55+ years at baseline with at least two visits in NACC UDS (from September 2005 to March 2021) who had a spouse, partner, or companion as a co-participant. Outcome measures included CDR® Dementia Staging Instrument, NACC UDS neuropsychological testing, and the Functional Activities Questionnaire. Multivariable linear mixed-effects models accounted for center clustering and repeated measures by individual., Results: Both MSR and SSR groups experienced cognitive decline regardless of baseline diagnosis. In general, MSR and SSR groups did not differ statistically on cross-sectional or longitudinal estimates of functioning, dementia severity, or neuropsychological testing, with two primary exceptions. People in SSR with mild cognitive impairment showed less functional impairment at baseline (FAQ M = 2.61, SD = 3.18 vs. M = 3.97, SD = 4.53, respectively; p < 0.01). The SSR group with dementia had less steep decline in attention/working memory (β estimates = -0.10 versus -0.18; p < 0.01)., Conclusion: Participants in SSR did not show cognitive health disparities consistent with a minority stress model. Additional research into protective factors is warranted.

Objective: African Americans and Latinos/Hispanics have a higher prevalence of dementia compared to non-Latino Whites. This scoping review aims to synthesize non-pharmaceutical interventions to delay or slow age-related cognitive decline among cognitively healthy African American and Latino older adults., Design: A literature search for articles published between January 2000 and May 2019 was performed using the databases PubMed, CINAHL, PsycINFO and Web of Science. Relevant cited references and grey literature were also reviewed. Four independent reviewers evaluated 1,181 abstracts, and full-article screening was subsequently performed for 145 articles. The scoping review consisted of eight studies, which were evaluated according to the peer-reviewed original manuscript, non-pharmaceutical intervention, cognitive function as an outcome, separate reporting of results for African American and Latinos, minimum age of 40, and conducted in the US. A total of 8 studies were considered eligible and were analyzed in the present scoping review., Results: Eight studies were identified. Four studies focused on African Americans and four focused on Latinos. Through the analysis, results indicated cognitive training-focused interventions were effective in improving memory, executive function, reasoning, visuospatial, psychological function, and speed among African Americans. Exercise interventions were effective in improving cognition among Latinos., Conclusion: This scoping review identified effective non-pharmaceutical interventions among African American and Latinos. Effective interventions focused on cognitive training alone for African Americans and exercise combined with group educational sessions for Latinos. Future research should explore developing culturally appropriate non-pharmaceutical interventions to reduce disparities and to enhance cognition among older African American and Latinos.

Background: Latinx family caregivers of individuals with dementia face many barriers to caregiver support access. Interventions to alleviate these barriers are urgently needed., Objective: This study aimed to describe the development of CuidaTEXT, a tailored SMS text messaging intervention to support Latinx family caregivers of individuals with dementia., Methods: CuidaTEXT is informed by the stress process framework and social cognitive theory. We developed and refined CuidaTEXT using a mixed methods approach that included thematic analysis and descriptive statistics. We followed 6 user-centered design stages, namely, the selection of design principles, software vendor collaboration, evidence-based foundation, caregiver and research and clinical advisory board guidance, sketching and prototyping, and usability testing of the prototype of CuidaTEXT among 5 Latinx caregivers., Results: CuidaTEXT is a bilingual 6-month-long SMS text messaging-based intervention tailored to caregiver needs that includes 1-3 daily automatic messages (n=244) about logistics, dementia education, self-care, social support, end of life, care of the person with dementia, behavioral symptoms, and problem-solving strategies; 783 keyword-driven text messages for further help with the aforementioned topics; live chat interaction with a coach for further help; and a 19-page reference booklet summarizing the purpose and functions of the intervention. The 5 Latinx caregivers who used the prototype of CuidaTEXT scored an average of 97 out of 100 on the System Usability Scale., Conclusions: CuidaTEXT's prototype demonstrated high usability among Latinx caregivers. CuidaTEXT's feasibility is ready to be tested., (©Jaime Perales-Puchalt, Mariola Acosta-Rullán, Mariana Ramírez-Mantilla, Paul Espinoza-Kissell, Eric Vidoni, Michelle Niedens, Edward Ellerbeck, Ladson Hinton, Linda Loera, A Susana Ramírez, Esther Lara, Amber Watts, Kristine Williams, Jason Resendez, Jeffrey Burns. Originally published in JMIR Aging (https://aging.jmir.org), 28.04.2022.)

Background: Optimal care can improve lives of families with dementia but remains under-implemented. Most healthcare professional training is in person, time-intensive, and does not focus on key aspects such as early detection, and cultural competency., Objective: We explored the acceptability and preliminary effectiveness of a training, The Dementia Update Course, which addressed these issues. We hypothesized that the training would lead to increased levels of perceived dementia care competency among key healthcare workers, namely primary care providers (PCPs) and health navigators (HNs)., Methods: We conducted pre-post training assessments among 22 PCPs and 32 HNs. The 6.5-h training was remote, and included didactic lectures, case discussion techniques, and materials on dementia detection and care. Outcomes included two 5-point Likert scales on acceptability, eleven on perceived dementia care competency, and the three subscales of the General Practitioners Confidence and Attitude Scale for Dementia. We used paired samples t-tests to assess the mean differences in all preliminary effectiveness outcomes., Results: The training included 28.6% of PCPs and 15.6% of HNs that self-identified as non-White or Latino and 45.5% of PCPs and 21.9% of HNs who served in rural areas. PCPs (84.2%) and HNs (91.7%) reported a high likelihood to recommend the training and high satisfaction. Most preliminary effectiveness outcomes analyzed among PCPs (11/14) and all among HNs (8/8) experienced an improvement from pre- to post-training (p &lt; 0.05)., Conclusion: A relatively brief, remote, and inclusive dementia training was associated with high levels of acceptability and improvements in perceived dementia care competency among PCPs and HNs.

Replications of evidence-based dementia care receiver-caregiver dyad interventions in the community are scarce. We aimed to assess the effectiveness of the Kansas City implementation of Reducing Disability in Alzheimer's Disease (RDAD) among a convenience sample of dyads with moderate dementia, which addressed needs identified by nine participating community agencies. We hypothesized that dyads' mental health and physical activity outcomes would improve from baseline to end-of-treatment. The final analytic sample included 66 dyads. Outcomes improved ( p < .01) from pre- to post-intervention: behavioral symptom severity (range 0-36) decreased from 11.3 to 8.6, physical activity increased from 125.0 to 190.0 min/week, caregiver unmet needs (range 0-34) decreased from 10.6 to 5.6, caregiver behavioral symptom distress (0-60) decreased from 15.5 to 10.4, and caregiver strain (0-26) decreased from 11.1 to 9.7. This adapted implementation of RDAD leads to clinically meaningful improvements and might inform scaling-up.

Background: In the COVID-19 pandemic, older adults from vulnerable ethnoracial groups are at high risk of infection, hospitalization, and death. We aimed to explore the pandemic's impact on the well-being and cognition of older adults living in the United States (US), Argentina, Chile, Mexico, and Peru., Methods: 1,608 (646 White, 852 Latino, 77 Black, 33 Asian; 72% female) individuals from the US and four Latin American countries aged ≥ 55 years completed an online survey regarding well-being and cognition during the pandemic between May and September 2020. Outcome variables (pandemic impact, discrimination, loneliness, purpose of life, subjective cognitive concerns) were compared across four US ethnoracial groups and older adults living in Argentina, Chile, Mexico, and Peru., Findings: Mean age for all participants was 66.7 ( SD  = 7.7) years and mean education was 15.4 ( SD  = 2.7) years. Compared to Whites, Latinos living in the US reported greater economic impact ( p  < .001, η p 2  =  0 .031); while Blacks reported experiencing discrimination more often ( p  < .001, η p 2  =  0 .050). Blacks and Latinos reported more positive coping ( p  < .001, η p 2  =  0. 040). Compared to Latinos living in the US, Latinos in Chile, Mexico, and Peru reported greater pandemic impact, Latinos in Mexico and Peru reported more positive coping, Latinos in Argentina, Mexico, and Peru had greater economic impact, and Latinos in Argentina, Chile, and Peru reported less discrimination., Interpretation: The COVID-19 pandemic has differentially impacted the well-being of older ethnically diverse individuals in the US and Latin America. Future studies should examine how mediators like income and coping skills modify the pandemic's impact., Funding: Massachusetts General Hospital Department of Psychiatry., Competing Interests: Dr. Thumala reports personal fees from National Agency for Research and Development, during the conduct of the study. Dr. Miranda-Castillo reports grants and personal fees from National Agency for Research and Development, during the conduct of the study. Dr. Gatchel reports grants from NIH/NIA, grants from Alzheimer's Association, and served as a one-time consultant with Huron Consulting, outside the submitted work. Dr. Sperling reports personal fees from Roche, Takeda Pharmaceuticals, Eisai, Biogen, AC Immune, Neurocentria, Janssen, Neuraly, Alnylam Pharmaceuticals, Renew, JOMDD, Acumen, Prothena, Cytox, Oligomerix, Inc., and Genentech; grants from Eisai, Eli Lilly, Janssen, NIA, and Alzheimer's Association; personal fees and honorarium (consulting) for Dr. Sperling's spouse (Dr. Keith Johnson) from Novartis, AC Immune, Janssen, and Cerveau, outside the submitted work. Dr. Rentz reports consulting from Digital Cognition Technologies, Neurotrack, and Biogen Idec, outside the submitted work. All other authors have nothing to declare., (© 2021 The Authors.)

Objectives: To compare the risk of mild cognitive impairment (MCI) among a wide range of ethnoracial groups in the US., Design: Non-probabilistic longitudinal clinical research., Setting: Participants enrolling into the National Alzheimer's Coordinating Center Unified Data Set recruited via multiple approaches including clinician referral, self-referral by patients or family members, or active recruitment through community organizations., Participants: Cognitively normal individuals 55 and older at the initial visit, who reported race and ethnicity information, with at least two visits between September 2005 and November 2018., Measurements: Ethnoracial information was self-reported and grouped into non-Latino Whites, Asian Americans, Native Americans, African Americans (AAs), and individuals simultaneously identifying as AAs and another minority race (AA+), as well as Latinos of Caribbean, Mexican, and Central/South American origin. MCI was evaluated clinically following standard criteria. Four competing risk analysis models were used to calculate MCI risk adjusting for risk of death, including an unadjusted model, and models adjusting for non-modifiable and modifiable risk factors., Results: After controlling for sex and age at initial visit, subhazard ratios of MCI were statistically higher than non-Latino Whites among Native Americans (1.73), Caribbean Latinos (1.80), and Central/South American Latinos (1.55). Subhazard ratios were higher among AA+ compared to non-Latino Whites only in the model controlling for all risk factors (1.40)., Conclusion: Compared to non-Latino Whites, MCI risk was higher among Caribbean and South/Central American Latinos as well as Native Americans and AA+. The factors explaining the differential MCI risk among ethnoracial groups are not clear and warrant future research.

Full and diverse participant enrollment is critical to the success and generalizability of all large-scale Phase III trials. Recruitment of sufficient participants is among the most significant challenges for many studies. The novel SARS-CoV-2 coronavirus pandemic has further changed and challenged the landscape for clinical trial execution, including screening and randomization. The Investigating Gains in Neurocognition in an Intervention Trial of Exercise (IGNITE) study has been designed as the most comprehensive test of aerobic exercise effects on cognition and brain health. Here we assess recruitment into IGNITE prior to the increased infection rates in the United States, and examine new challenges and opportunities for recruitment with a goal of informing the remaining required recruitment as infection containment procedures are lifted. The results may assist the design and implementation of recruitment for future exercise studies, and outline opportunities for study design that are flexible in the face of emerging threats., (© 2020 The Authors.)

Well-being has been measured based on different perspectives in positive psychology. However, it is necessary to measure affects and emotions correctly and to explore the independence of positive and negative affect. This cross-sectional study adapts and validates the Scale of Positive and Negative Experience (SPANE) with a non-probabilistic sample of 821 Spanish adults. A confirmatory factor analysis confirmed two related factors with two correlated errors. The average variance extracted was 0.502 for negative affect (SPANE-N) and 0.588 for positive affect (SPANE-P). The composite reliability was 0.791 for SPANE-N and 0.858 for SPANE-P. Measurement invariance analysis showed evidence of scalar invariance. Item-total corrected polyserial correlations showed values between 0.47 and 0.76. The path analysis used to test temporal stability, and the structural equation models used to test convergent and concurrent validity with other well-being measures, showed good fit. All path coefficients were statistically significant and over 0.480. For the validity models, the magnitude of the correlations was large and in the expected direction. The Spanish version of the SPANE show good psychometric properties. Future studies of emotional well-being in Spain can benefit from the use of this scale, and new studies must test cross-cultural invariance.

High intensity interval exercise (HIIE) improves aerobic fitness with decreased exercise time compared to moderate continuous exercise. A gap in knowledge exists regarding the effects of HIIE on cerebrovascular function such as cerebral blood velocity and autoregulation. The objective of this systematic review was to ascertain the effect of HIIE on cerebrovascular function in healthy individuals. We searched PubMed and the Cumulative Index to Nursing and Allied Health Literature databases with apriori key words. We followed the Preferred Reporting Items for Systematic Reviews. Twenty articles were screened and thirteen articles were excluded due to not meeting the apriori inclusion criteria. Seven articles were reviewed via the modified Sackett's quality evaluation. Outcomes included middle cerebral artery blood velocity (MCAv) (n = 4), dynamic cerebral autoregulation (dCA) (n = 2), cerebral de/oxygenated hemoglobin (n = 2), cerebrovascular reactivity to carbon dioxide (CO2) (n = 2) and cerebrovascular conductance/resistance index (n = 1). Quality review was moderate with 3/7 to 5/7 quality criteria met. HIIE acutely lowered exercise MCAv compared to moderate intensity. HIIE decreased dCA phase following acute and chronic exercise compared to rest. HIIE acutely increased de/oxygenated hemoglobin compared to rest. HIIE acutely decreased cerebrovascular reactivity to higher CO2 compared to rest and moderate intensity. The acute and chronic effects of HIIE on cerebrovascular function vary depending on the outcomes measured. Therefore, future research is needed to confirm the effects of HIIE on cerebrovascular function in healthy individuals and better understand the effects in individuals with chronic conditions. In order to conduct rigorous systematic reviews in the future, we recommend assessing MCAv, dCA and CO2 reactivity during and post HIIE., Competing Interests: The authors have declared that no competing interests exist.

Background: Chronic kidney disease (CKD) is associated with cognitive impairment and dementia. We examined whether this relationship hold true in older adults, who have a higher prevalence of both CKD and dementia., Design, Setting, Participants, and Measurements: We conducted a cross-sectional secondary analysis of an established observational cohort. We analyzed data from the Alzheimer's Disease Neuroimaging Initiative (ADNI), an NIH funded, multicenter longitudinal observational study, which includes participants with normal and impaired cognition and assesses cognition with a comprehensive battery of neuropsychological tests. We included a non-probability sample of all ADNI participants with serum creatinine measurements at baseline (N = 1181). Using multivariable linear regression analysis, we related the CKD Epidemiology Collaboration equation eGFR with validated composite scores for memory (ADNI-mem) and executive function (ADNI-EF)., Results: For the 1181 ADNI participants, the mean age was 73.7 ± 7.1 years. Mean estimated glomerular filtration rate (eGFR) was 76.4 ± 19.7; 6% had eGFR<45, 22% had eGFR of 45 to <60, 51% had eGFR of 60-90 and 21% had eGFR>90 ml/min/1.73 m2. The mean ADNI-Mem score was 0.241 ± 0.874 and mean ADNI-EF score was 0.160 ± 1.026. In separate multivariable linear regression models, adjusted for age, sex, race education and BMI, there was no association between each 10 ml/ min/1.73 m2 higher eGFR and ADNI-Mem (β -0.02, 95% CI -0.04, 0.02, p = 0.56) or ADNI-EF (β 0.01, 95% CI -0.03, 0.05, p = 0.69) scores., Conclusion: We did not observe an association between eGFR and cognition in the older ADNI participants., Competing Interests: The authors declare no conflict of interest that alters their adherence to PLOS ONE policies on sharing data and materials. AG has a consultancy agreement with Novartis Pharmaceuticals and has grant funding from Novartis and Veloxis Pharmaceuticals; none of which are relevant to the current manuscript.

Introduction: Hispanics remain underrepresented in dementia clinical research. This one-arm trial aimed to assess the preliminary efficacy of a culturally tailored recruitment educational strategy among Hispanic older adults on dementia knowledge, research participation attitudes, and enrollment., Method: The recruitment strategy included 6 one-session culturally tailored dementia education events at trusted community senior centers. Participants received a pre-post survey including a 5-point Likert-type scale and the Epidemiology/Etiology Disease Scale to assess dementia knowledge, and a 4-point Likert-type scale assessing research participation attitudes. We gave participants contact information slips to complete if interested in dementia research. We also tracked participants' enrollment into the National Alzheimer's Coordinating Center Cohort., Results: Dementia knowledge increased 0.9 points (5-point Likert-type scale) and 2.2 points (epidemiology/etiology disease scale, p < .001). Interest in participating in dementia research increased from 61.7% to 80.9% ( p = .039), 64.0% returned their contact information slips, and 41.1% successfully enrolled into the National Alzheimer's Coordinating Center Cohort., Conclusion: A recruitment strategy including culturally tailored dementia education improves dementia knowledge, research participation attitudes, and enrollment among Hispanic older adults.

Introduction: Rural Americans (RA) have poorer vascular health and physical activity levels than their urban counterparts; all are dementia risk factors. Dementia risk reduction among rural individuals requires a tailored approach. The purpose of this project was to examine preliminary efficacy of a community-based physical exercise and/or dementia risk factor-reduction curriculum among rural adults 50 and older., Methods: Seventy-five rural dwelling adults 50 and older were randomized to one of three groups: 1) 10 weeks of Alzheimer's disease risk-reduction education (ED), 2) risk-reduction education and supervised exercise (EDEX) or 3) control group (CON). Outcomes included baseline to 10-week follow-up difference in dementia knowledge (primary outcome) and physical activity, muscular endurance, healthy lifestyle engagement, and anthropometrics (secondary outcomes)., Results: Sixty-nine adults successfully completed the 10-week study. Dementia knowledge increased in a Treatment Arm-dependent manner (χ 2 = 6.95 (2), p = 0.03), being ED and EDEX superior to CON. Engagement in healthy lifestyle behaviors did not change statistically. However, participation specifically in physical activity increased over time (χ 2 = 11.47 (2), p = 0.003) with EDEX reporting the greatest increases. No significant change in average daily steps was observed for any group., Conclusion: The results suggested dementia risk-reduction education, both with and without structured exercise, leads to improvements in dementia knowledge. When coupled with regular, supervised exercise, this education intervention also helped participants increase engagement in physical activity over 10 weeks. Tailored interventions that combine Alzheimer's disease education and regular, supervised exercise may help reduce dementia risk in rural communities., (© 2020 The University of Kansas Medical Center.)

Objective: Assess the feasibility and acceptability of a culturally- and linguistically-adapted smoking cessation text messaging intervention for Latino smokers. Methods: Using a community-based strategy, 50 Latino smokers were recruited to participate in a smoking cessation pilot study. Participants received a 12-week text messaging intervention and were offered Nicotine Replacement Therapy (NRT) at no cost. We assessed biochemically verified abstinence at 12 weeks, text messaging interactivity with the program, NRT utilization, self-efficacy, therapeutic alliance, and satisfaction. Results: Participants were 44.8 years old on average (SD 9.80), and they were primarily male (66%) and had no health insurance (78%). Most of the participants were born in Mexico (82%) and were light smokers (1-10 CPD) (68%). All participants requested the first order of NRT, and 66% requested a refill. Participants sent an average of 39.7 text messages during the 12-week intervention (SD 82.70). At 12 weeks, 30% of participants were biochemically verified abstinent (88% follow-up rate) and working alliance mean value was 79.2 (SD 9.04). Self-efficacy mean score increased from 33.98 (SD 10.36) at baseline to 40.05 (SD 17.65) at follow-up ( p = 0.04). The majority of participants (90.9%, 40/44) reported being very or extremely satisfied with the program. Conclusion: A culturally- and linguistically-adapted smoking cessation text messaging intervention for Latinos offers a promising strategy to increase the use of NRT, generated high satisfaction and frequent interactivity, significantly increased self-efficacy, produced high therapeutic alliance, and resulted in noteworthy cessation rates at the end of treatment. Additional testing as a formal randomized clinical trial is warranted., (Copyright © 2020 Cartujano-Barrera, Sanderson Cox, Arana-Chicas, Ramírez, Perales-Puchalt, Valera, Díaz, Catley, Ellerbeck and Cupertino.)

Objectives: Growing evidence shows that cardiovascular health (CVH) is associated with brain health. Little is known about this topic among older adults in Latin America, where the number of people living with dementia is rising. This study aimed to assess the longitudinal association between CVH and dementia in six Latin American countries., Methods: We analyzed longitudinal data from the 10/66 study that included nondementia residents at baseline aged 65+ in six Latin American countries (n = 6447) and were followed up for 3 years. An index of modifiable CVH factors (ranging from 0 to 14) was calculated. Incident dementia was modeled using competing risk regression to adjust for risk of death., Results: The sample included 6.2% participants with poor (0-5), 81.0% with moderate (6-10), and 12.8% with ideal CVH (11-14). At follow-up, 9.4% had developed dementia and 13.1% had died. Compared with those with poor CVH, participants with moderate and ideal levels of CVH had a significantly lower risk of dementia in both the unadjusted (subhazard ratio for moderate, 0.77; ideal, 0.59) and adjusted models (moderate, 0.73; ideal, 0.66)., Conclusion: Moderate and ideal levels of CVH in old age may protect against dementia incidence. These findings may inform health promotion efforts within dementia national plans adopted recently in some Latin American countries., (© 2019 John Wiley & Sons, Ltd.)

Introduction: Sexual minority discrimination might lead to a higher risk of mild cognitive impairment (MCI) and dementia. The aim of this study was to assess the risk of MCI and dementia between older adults in same-sex relationships (SSR) and opposite-sex relationships (OSR)., Methods: We analyzed longitudinal data from the National Alzheimer's Coordinating Center up to September 2017. Analyses included cognitively normal individuals 55+ at baseline who had a spouse, partner, or companion as study partner at any assessment. Associations were calculated using survival analysis adjusting for demographics and APOE-e4 carrier status., Results: Hazard ratios of MCI and dementia did not differ statistically between SSR and OSR individuals in the total sample nor stratified by sex., Conclusion: The lack of association between SSR and MCI and dementia warrants future research into their potential resilience mechanisms and the inclusion of sexual minority status questions in research and surveillance studies. The potential recruitment bias caused by nonprobabilistic sampling of the cohort and the reporting and ascertainment bias caused by using SSR to infer sexual minority status may have influenced our findings., (© 2019 John Wiley & Sons, Ltd.)