Aging/Alzheimer's Disease
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Browsing Aging/Alzheimer's Disease by Author "Johnson, Leigh"
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Item COMORBID DIABETES AND DEPRESSION AND INCREASED RISK FOR COGNITIVE IMPAIRMENT IN MEXICAN AMERICANS(2014-03) Dickensheets, Tony; Johnson, Leigh; Hall, James; Obryant, SidBackground: By 2050, the percent of Hispanics in America age 65 and above will nearly triple compared to other ethnic groups. During this timeframe, the numbers of Alzheimer’s disease (AD) and Mild Cognitive Impairment (MCI, a prodromal stage to AD) cases among Hispanic elders is expected to grow exponentially. Given that 65% of the U.S. Hispanic population is Mexican American (MA), this ethnic group represent the fastest growing segment of the aging population, which will be disproportionately impacted by MCI and /AD in the near future. Recent work from our group suggest that depression is a significant risk factor for MCI and AD among Mexican Americans while many other “established” risk factors among non-Hispanic whites (i.e. education, gender, hypertension, diabetes, ApoEε4 genotype) are not. Another important risk factor among this population is diabetes (DM). Depression and DM have been shown to be pathologically linked several times in the past, however little research has examined the affect that comorbidity of depression and DM has on cognitive impairment in an ethnically diverse sample Purpose (a): To determine whether there is a connection between depression, diabetes and Alzheimer's disease in the Mexican American population. Methods (b): Methods: This study used data from three separate cohorts: HABLE, TARCC, and Project FRONTIER. In HABLE data was collected from 208 MA (AGE= 62years; EDU=7years); TARCC had 2080 Non- Hispanic white (AGE=75; EDU=15years) and 543 MA (AGE=70; EDU=11); Project FRONTIER had 330 non-Hispanic white (AGE=65; EDU=13) and 233 MA (AGE=55; EDU=7years). Logistic regression analyses were conducted to examine comorbid diagnosis of depression and diabetes on Alzheimer’s disease diagnosis or a diagnosis of Mild Cognitive Impairment. Covariates entered into the model were age, education, and gender. Results (c): Results: Comorbid diagnosis of diabetes and depression was significantly related to diagnosis of Mild Cognitive Impairment in Mexican Americans across all three cohorts: TARCC (odds ratio [OR]= 8.6, 95% CI=1.5 to 2.7); HABLE (odds ratio [OR]= 2.4, 95% CI= 1.3-3.2), and FRONTIER (odds ratio [OR]= 2.6, 95% CI=1.2 to 6.4). TARCC was the only cohort with a large enough sample of AD patients to run the analyses split by ethnicity. In TARCC, comorbidity was related to AD diagnosis in MA (odds ratio [OR]= 10.4, 95%=1.2-2.7), and narrowly related in Non-Hispanic Whites (odds ratio [OR]= 8.3, 95%=.14 to 1.4). Conclusions (d): Discussion: Comorbid diagnosis of depression and diabetes increases risk for diagnosis of cognitive impairment, and Mexican Americans were found to be at greater risk than non- Hispanic whites for Mild Cognitive Impairment. These findings were validated across multiple cohorts, and could have significant clinical implications.Item ELEVATED SERUM CREATININE LEVELS DIFFERENTIALLY IMPACT COGNITIVE FUNCTIONING AMONG MEXICAN AMERICAN ELDERS AND NON-HISPANIC WHITES: A PROJECT FRONTIER STUDY(2014-03) Regina, Stephen P.; Johnson, LeighObjective: Kidney function decreases with age and is commonly observed in the elderly. Even mildly decreased kidney function is associated with increased vascular disease and cerebrovascular disease, and is believed to influence risk of Alzheimer’s disease (AD). Mexican Americans are reported to exhibit a decreased serum creatinine (SCr) distribution relative to that of Non-Hispanic Whites . It has been suggested that blood-based measures of kidney function may have a predictive role in the future for identifying patients who may benefit from detailed cognitive screening . The aim of this study was to determine the effects of impaired renal function as assessed by elevated SCr on cognition among Mexican American and Non-Hispanic White elders. Method: Data were analyzed from 487 participants (n= 192, Mexican American; n= 295, Non-Hispanic White) enrolled in Project FRONTIER, a community-based study of health issues in rural-dwelling adults and elders. Cognition was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Serum creatinine was reported by CMP. Linear regressions were utilized to examine the relationships between decreased measures of cognitive functioning and ethnicity when SCr level is elevated. Results: Among those who are Non-Hispanic white, elevated SCr levels were associated with poorer performance on tasks related to immediate memory (RBANS Immediate Memory Index, B[SE]= -3.12[1.32], t=-2.36, p=0.019) and language (RBANS Language Index, B[SE]=-2.04[0.79], t= -2.56, p=0.011). Concerning those who were Hispanic and of Mexican American decent, elevated SCr levels were found to be significantly negative associated with attention (RBANS Attention Index, B[SE]= -4.57[2.18], t=-2.08, p=0.038) and executive functioning (EXIT25, B[SE]= 1.90[0.82], t=2.29, p=0.023). Conclusions: This study emphasizes the ethnic differences observed with elevated levels of serum creatinine, which is a marker of kidney function. The results supported a differential relationship between creatinine and cognitive functioning, implicating that among Non-Hispanic Whites, elevated levels were associated with decreased performance on tasks of memory and language; whereas, among Hispanic Mexican Americans, there was a relationship between decreased performance on tasks of attention and executive functioning with elevations in the level of creatinine in serum.Item MOBILE INTERDISCIPLINARY GERIATRIC HEALTHCARE IN THE COMMUNITY(2014-03) O'Jile, Judith R.; Aaron, Debra; Buckley, Brielle; Sallee, Donna; Large, Stephanie E.; Johnson, Leigh; O'Bryant, Sid E.Purpose (a): This is a community-based geriatric primary care model designed to reach Medicaid eligible elders as well as childless adult “near elders” (ages 50-64) using mobile teams and clinics to reduce hospitalizations, increase access to care, and improve patient quality of life. This is a new initiative for UNTHSC that utilizes mobile teams and clinics to increase access to care by providing appropriate care within the community. Medical teams, led by physician assistants (PAs) or nurse practitioners (NPs), that incorporate Community Health Workers (CHWs) and others (pharmacy, physical therapy, social work), will provide care to patients within community settings and clinics. Additionally, CHWs will educate elders about Medicaid and assist with enrollment when necessary. The Community Health Workers will also provide case management to high risk patients.To meet the urgent care needs of our patients and reduce ER utilization, a nurse advice telephone line has been created for patients to call when they have urgent care issues or questions. This enhancement of geriatric primary care services will expand encounters to a significant portion of Medicaid- eligible elders within RHP 10. Methods (b): The MIGHTY Care program will see 3071 patients and roughly 15,000 encounters over the five year grant. Our program goals include decrease in admission rates, decrease in 30 day re-admission rates for preventable causes, increase in patient satisfaction regarding patient involvement in medical decision making, and increases in quality of life. The team identified several steps that must be completed in order to achieve the project goals, which included identifying stakeholders, geocoding population demographics in order to determine the best sites for our standing clinics, proper training on tenets ofshared decision making and customer service, community outreach, and others. Results (c): The primary community stakeholders identified were Senior Citizen Services, Goodwill Industries, and the Community Food Bank. We had several meetings with these facilities to discuss the potential of setting a community based clinic in their locations. Additionally, the team has conducted community talks, flu shot clinics, and other community outreach presentations. In preparation for seeing patients at these sites, we are deepening our relationships by providing educational programs for patients and staff members. At this time we are continuing to develop other possible candidates for alliances. Conclusions (d): The MIGHTY Care program offers an innovative solution to many of the issues that plague our current system. We will provide cost-saving community-based care that will improve patient outcomes and the patients’ satisfaction with their care.Item RELATIONSHIP BETWEEN WORRY AND DEPRESSION IN ELDERLY MEXICAN-AMERICANS(2014-03) Sosa, Horacio; Johnson, Leigh; Hall, James; Edwards, Melissa; O'Bryant, Sid E.Purpose (a): Research has found a strong correlation between worry and mental and physical health. Later stages of life particularly entail increased stress related to multiple health problems, financial matters, etc., which often are associated with increased worry, anxiety and/or depression. In addition, worry has been linked to cognitive decline in the elderly. Our research has demonstrated that specific symptoms of depression (called the DepE) are related to cognitive impairment and can be used to identify a subgroup of individuals at greater risk for developing Mild Cognitive Impairment (MCI) and Alzheimer's disease (AD). The goal of this study was to examine the relationship between DepE and worry in an elderly Mexican-American population. Methods (b): Data was collected from 253 Mexican-Americans (198 women, 60 men) enrolled in the Health and Aging Brain Study among Latino Elders (HABLE), a recently developed community-based study of factors related to aging. The mean age of the sample was 60 years, and the average years of education were 8. Worry was assessed using the Penn State Worry Questionnaire, and DepE was calculated using items from GDS30. The sample was divided into two groups based on DepE scores (high- and low-risk). Independent sample t-test was used to analyze the data. Results (c): The independent sample t-test showed a significant difference between the two groups (t = -10.4, p <0.05). Individuals with higher DepE scores have significantly higher scores in the PSWQ (Mean [SD] = 54 [16]), than those with low DepE scores (32 [13]). PSWQ items endorsed by the high-risk group include high worry under pressure (57%), an inability to dismiss worry (53%), consciousness about generalized worry (52%), a general tendency to worry (48%), and an inability to control worry (47%). Conclusions (d): DepE has been validated in multiple independent cohorts. Higher scores on the DepE are related to poor cognition and diagnosis of Mild Cognitive Impairment and Alzheimer’s disease (4). The results of this study suggest individuals with higher DepE scores have significantly higher worry, almost indicative of Generalized Anxiety Disorder according the PSWQ interpretation. This is consistent with literature linking worry to cognitive decline.