Browsing by Author "Johnson, Leigh"
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Item Application of Structural Retinal Biomarkers to Detect Cognitive Impairment in a Primary Care Setting(2023) Nyalakonda, Ramyashree; Petersen, Melissa; Zhang, Fan; Johnson, Leigh; Tolman, Alex; Gutierrez, Alejandra; O'Bryant, Sid; Mozdbar, SimaIntroduction Alzheimer’s Disease (AD) is the most prevalent form of dementia and a leading cause of death in the elderly. The detection of AD remains poor in primary care despite the advancement of neurodiagnostic procedures. There are no rapid and cost-effective tools available to primary care providers to conduct cognitive examinations to diagnose AD. The goal of this study is to determine the predictive ability of structural retinal biomarkers to identify cognitive impairment in a primary care setting. Methods Participants were recruited from Alzheimer’s Disease in Primary Care (ADPC) study. As part of the ADPC Retinal Biomarker Study (ADPC RBS), visual acuity, an ocular history questionnaire, eye pressure, optical coherence tomography (OCT) imaging and fundus imaging was performed. Exclusion criteria included high intraocular pressure defines as greater than or equal to 30 mmHg in either eye, history of adverse effects with pupillary relation, known hypersensitivity to tropicamide or any ingredient in the formulation, active ocular infection or inflammation, history of angle closure glaucoma, or having undergone ocular surgery within the last 6 months. Cognitive diagnoses were assigned algorithmically and verified at consensus review by an expert in the field of dementia. Results Data were examined on a total of 91 participants (59 cognitively unimpaired, 32 cognitively impaired (26 mild cognitive impairment (MCI), 6 AD)). The top biomarkers for predicting cognitive impairment included the inferior quadrant of the outer retinal layers, all four quadrants of the peripapillary retinal nerve fiber layer (pRNFL), and the inferior quadrant of the macular retinal nerve fiber layer. While all four quadrants of the pRNFL are highly important biomarkers for identifying those with cognitive impairment, the inferior and superior quadrants displayed higher relative importance compared to the temporal and nasal quadrants. Conclusion This study was the first to examine the utility of retinal biomarkers in diagnosis cognitive impairment in a primary care setting with models reflecting how it could be employed as a screening tool in practice. The current data provides strong support for continued investigation into structural retinal biomarkers, particularly the retinal nerve fiber layer, as screening tools for AD. In prior studies, preferential thinning of the inner retinal layers is found in AD compared to healthy controls. This study can help distinguish those with cognitive impairment from those cognitively unimpaired. The availability of such a biomarker could increase access to disease modifying treatments once available.Item Area deprivation index and cognitive function: A cross-sectional study of the HABS-HD cohort(2023) Benton, Abigail; Vintimilla, Raul; Hall, James; Johnson, Leigh; O'Bryant, SidPurpose: Dementia is an ever-growing group of disorders worldwide. It is proposed that neighborhood socioeconomic status (NSES) is linked with overall health, and this study will evaluate whether NSES is cross-sectionally associated with cognition in non-Hispanic White, African American, and Mexican American participants of the Health and Aging Brain: Health Disparities Study (HABS-HD). Methods: The HABS-HD is a longitudinal study conducted by the Institute for Translational Research at the University of North Texas Health Science Center. Participants (n=1634) were age 50 years or older, and underwent a clinical interview, neuropsychological exam battery, functional examination, head MRI, amyloid PET scan, and blood draw for clinical and biomarker analysis. NSES was measured using the national area deprivation index (ADI) percentile ranking, which considered the variables of education, employment, income, occupation, and housing. Cognition was assessed by the Mini-Mental State Examination, Trails B Exam, FAS Test, Spanish English Verbal Learning Test, and Digit-Symbol Substitution Test. The cognitive performance in those living in the 20% most disadvantaged neighborhoods was compared to those in the 80% least disadvantaged neighborhoods using multiple linear regression models with age, sex, education, and ethnicity as control variables. Results: Those in the most deprived neighborhood group were statistically significantly (p<0.05) younger, less educated, more likely to be female, and more likely to be Mexican American. The means of MMSE and Trails B test were lower in those living in the more deprived neighborhood group (p<0.05). When looking at the linear model of ADI and cognition, after adjusting for covariates, only Trails B scores were related to the higher deprived neighborhood group (t = -0.62, p <0.0001). Conclusion: Our study revealed that some measures of cognitive impairment were higher in people living in the top 20% disadvantaged neighborhoods. In future studies, specific markers of deprivation should be analyzed along with cognitive impairment to more specifically advocate for beneficial change. Further, due to sex and ethnicity being significant cofounders, analysis should be run by ethnicity to investigate this distinction.Item Association Between bilingualism and Amyloid Uptake Among Mexican Americans: An HABS-HD Study(2022) Wiley, Elizabeth; Johnson, Leigh; Hall, James; Petersen, Melissa; O'Bryant, SidBackground: Bilingualism is thought to provide protective benefits in regions of the brain associated with the onset of Alzheimer's Disease (AD). While there has been extensive research on bilingualism's effect on grey matter volume, there is no study to date that has examined the relationship between bilingualism and amyloid burden within brain regions characteristically impacted by AD. This study aims to fill this gap by comparing amyloid deposition in Mexican Americans who are either monolingual or bilingual. Methods: Data were analyzed on n=34 Hispanic, Mexican Americans (n=16 bilingual; n=18 monolingual) participants enrolled in a study of health disparities with available Amyloid PET scans. PET Amyloid scans were conducted using florbetaben (18F) on a Siemens Biograph Vision 450 whole-body PET/CT scanner. PET Amyloid SUVR levels were generated from the following Regions of Interest (ROIs): Frontal, Anterior Posterior Cingulate, Lateral Parietal, Lateral Temporal, and Global, with global SUVR>1.08 determined as the cut-off for Amyloid positivity. Independent t-test and chi-square tests were conducted to examine group differences in language status across demographic variables. One-way ANOVAs were conducted to examine groups differences in APOE e4 carrier status as well as in language capabilities (monolingual, bilingual) and PET amyloid SUVR. Follow-up analyses examining language capabilities were split by APOE e4 carrier status (carrier, non-carrier). Results: In comparison to APOE e4 non-carriers, APOE e4 carriers experienced significantly increased amyloid burden across all regional areas, including global (p< 0.05). Bilingual APOE e4 non-carriers showed a significantly increased amyloid deposition in the Anterior/Posterior Cingulate cortex in comparison to monolingual APOE e4 non-carriers. Furthermore, among APOE e4 non-carriers, there was a trend towards significance for global amyloid uptake (p=0.059), with bilinguals again showing higher amyloid burden. Among APOE e4 carriers, no significant associations were found between language status (monolingual, bilingual) and amyloid uptake. Discussion: This was the first study to examine the association between bilingualism and amyloid burden within specific cortical regions of the brain. Results contradicted previous work observing the role of the posterior/anterior cingulate in bilingualism. The trend towards significance in global amyloid uptake for APOE e4 non-carriers favored increased burden in bilinguals, a result opposite of what was expected. Bilingualism is complex and multifactorial and further work is greatly needed to understand the link it has with amyloid burden particularly by disease state.Item Association between inflammation, white matter hyperintensities, and executive function: the role of ethnicity.(2022) Brown, Frank; Vintimilla, Raul; Hall, James; Johnson, Leigh; O'Bryant, SidAssociation between inflammation, white matter hyperintensities, and executive function: the role of ethnicity. Frank Brown1, Raul Vintimilla2, James Hall2, Leigh Johnson2, Sid O'Bryant2, for the HABS-HD Study Team. 1University of North Texas 2University of North Texas Health Science Center, Institute for Translational Research Background: Systemic inflammation and cardiovascular risk factors (CVRF) impact neurological health and executive function. Neutrophils produce inflammatory mediators and lymphocytes regulate the inflammatory response. Neutrophil to lymphocyte ratio (NLR) has been used as a marker of systemic inflammation, and as a predictor of cardiovascular health. CVRF are correlated with white matter hyperintensity volume (WMH), an MRI indicator of cerebrovascular health. This study seeks to compare if there is a difference in the association between inflammation (NLR), WMH, and executive function among Mexican Americans and non-Hispanic Whites. Method: We analyzed data from 1083 (505 Mexican Americans and 578 non -Hispanic Whites) cognitively normal participants from the Health and Aging Brain Study (HABS-HD). All participants signed a written consent, and underwent a 3T MRI (Siemens Skyra), clinical labs, clinical evaluation, and cognitive testing. Differential blood cell counts were used to obtain NLR. WMH volume was measured from FLAIR using the Statistical Parametric Mapping (SPM) Lesion Segmentation Tool. Linear regression was used to predict the effect of NLR and Log transformed WMH adjusted for intracranial volume (derived from Freesurferv6.0 analysis of T1 MPRAGE) on Trails B z-score (executive function), and to evaluate if NLR can predict WMH volume. Analysis was split by ethnicity. Age, sex, and education were entered as covariates in the models. Results: Sixty-four percent of the total sample were female. Means for the whole sample were: age 66.02, education years 12.98, Trails B 0.19, WMH volume -0.035, and NLR 2.16. When compared to non-Hispanic Whites, Mexican Americans were significantly younger, less educated, had lower Trails B score, NLR values and WMH volume. NLR predicted Trails B scores (B = -0.14, t =-0.12, p = 0.004) only in Mexican American, while WMH predicted Trails B scores in Mexican American (B = -0.16, t = -3.02, p = 0.003), and Non-Hispanic Whites (B = -0.14, t = -4.33, p < 0.0001). Results remained significant after adjusting for age, sex, education. NLR predicted WMH volume (B = 0.13, t = 3.38, p = 0.001) only in Mexican American. Conclusion: Our findings suggest an association between NLR, WMH and executive function in Mexican Americans. NLR and WMH volume predicted Trails B scores in Mexican Americans. WMH predicted Trails B scores, but there was no association between NLR and executive function in non-Hispanic Whites. These findings demonstrate the importance of race consideration when assessing the relationship between inflammation, CVRF, WMH, and executive function.Item Association of Area Deprivation Index and hypertension, diabetes, dyslipidemia, and obesity: a cross-sectional study of the HABS-HD cohort.(2023) Seyedahmadi, Armin; Vintimilla, Raul; Hall, James; Johnson, Leigh; O'Bryant, SidBackground: Heart disease is a leading cause of death globally and the prevalence of cardiovascular disease (CVD) is expected to increase significantly in the United States over the next decade. Previous research has shown that socioeconomic status has a significant impact on CVD prevalence and outcomes, with risk factors for CVD being more prevalent in individuals from low socioeconomic groups. We aimed to investigate the association between neighborhood deprivation and the prevalence of major CVD risk factors (hypertension, diabetes, dyslipidemia, and obesity) in a Mexican American population compared to Non-Hispanic Whites. Methods: A cross-sectional analysis was conducted to include 1867 subjects. 971 self-identified as Mexican American (MA), and 896 as Non-Hispanic White (NHW). These participants underwent a clinical interview, neuropsychological exam battery, functional examination, MRI of the head, amyloid PET scan, and blood draw for clinical and biomarker analysis. They were also assigned an ADI score based on participants living in the best and worst neighborhoods according to Area Depravation Index (ADI) model. Results: Sixty percent of the sample was female. MA were significantly younger (mean age 63.37 vs 68.64) and less educated (mean education years 9.69 vs 15.61 than NHW. Additionally, MA had a significantly higher prevalence of HTN, DM, and obesity. Only 12.3% of Non-Hispanic Whites lived in the most deprived neighborhoods (percentile 4), while 57.5% of Mexican Americans lived in the percentile 4 ranking areas (p≤ .05). There was a significant difference between non-Hispanic White participants living in the least deprived neighborhoods compared to participants living in the most deprived neighborhoods for HTN (OR = 2.14, 95% CI [1.31, 3.48]), DM (OR = 3.42; 95% CI [1.67, 7.01]), and obesity (OR = 3.03, 95% CI [1.86 to 4.95]). There was no significant difference in the odds of having dyslipidemia between non-Hispanic Whites living in the ADI quartile 1 when compared to those living in the ADI quartile 4. These results remained significant after adjusting for age, sex, education, and cardiovascular risk factors. Conclusion: In conclusion, this study found the area deprivation index (ADI) is associated with cardiovascular risk factors such as hypertension, diabetes, dyslipidemia, and obesity. These findings suggest that socioeconomic status may play a role in the prevalence of certain health conditions among different ethnic groups. Further research is needed to understand the underlying mechanisms and to develop interventions that address health disparities among different ethnic populations.Item Carotid arterial stiffness and cerebral blood flow variability in individuals with mild cognitive impairment(2023) Bhuiyan, Nasrul; Davis, K. Austin; Vintimilla, Raul; Borzage, Matthew; Pahlevan, Niema; King, Kevin; Johnson, Leigh; O'Bryant, Sid; Rickards, CarolinePurpose: It is unclear whether cerebral blood flow variability is a sign of impaired vascular function or an adaptation to chronic cerebral hypoperfusion in individuals with cognitive dysfunction. Elevated arterial stiffness increases transmission of pulsatile pressure to the brain, but the relationship between arterial stiffness, the magnitude of cerebral blood flow variability, and cognitive dysfunction is unknown. In this pilot study, we hypothesized that carotid artery stiffness would be higher in individuals with mild cognitive impairment (MCI) compared with individuals with normal cognition (NC), resulting in higher cerebral blood flow variability. Methods: In individuals with MCI (N=5) or NC (N=7), R-wave to common carotid artery (CCA) pulse wave velocity (PWV) was assessed as an index of arterial stiffness (via tonometry). CCA velocity (CCAv) and middle cerebral artery velocity (MCAv) were measured via transcranial Doppler ultrasound, with concurrent measurements of mean arterial pressure (MAP) via finger photoplethysmography. The amplitude of MAP, CCAv, and MCAv oscillations in the low frequency range (LF; 0.07-0.15 Hz) were assessed via fast Fourier transformation, and normalized to total power (0.04-0.4 Hz) for each participant to account for high inter-individual variability. Relationships between R-wave-carotid PWV and LF variability in CCAv and MCAv were assessed via correlational analyses. Results: There were no between-group differences for R-wave-carotid PWV (MCI: 0.91±0.16 m/s vs. NC: 0.87±0.07 m/s; P=0.70), mean CCAv (MCI: 31.8±8.8 cm/s vs. NC: 29.7±2.0 cm/s; P=0.54), mean MCAv (MCI: 50.9±6.5 cm/s vs. NC: 47.9±12.7 cm/s; P=0.63), or MAP (MCI: 102.1±10.2 mmHg vs. 104.7±13.8 mmHg; P=0.73). While there was also no difference between groups for nLF power of CCAv (MCI: 0.28±0.03 au vs. NC: 0.33±0.10 au; P=0.41), nLF power for MCAv was lower in the MCI group (MCI: 0.26±0.07 au vs. 0.43±0.12; P=0.02). Overall, there was a strong positive correlation between R-wave-carotid PWV and CCAv nLF power (R=0.81, P=0.005), but a weaker relationship for MCAv nLF power (R=0.56, P=0.09). While sub-group correlational analyses are limited based on the small sample sizes, relationships between R-wave-carotid PWV and CCAv nLF power were high for both MCI (R=0.98, P=0.02) and NC (R=0.79, P=0.06) groups, but were lower for MCAv nLF power (MCI: R=-0.12, P=0.88; NC: R=0.69, P=0.13). Conclusion: Contrary to our hypothesis, there were no differences in R-wave-carotid PWV between groups, and blood flow variability was either similar between groups (for CCAv), or lower in the MCI group (for MCAv). Overall, there was a strong positive relationship between R-wave-carotid PWV and blood flow variability in the CCA, which was also observed in sub-analysis of the MCI and NC groups. Future investigations with a larger sample size are needed to definitively determine the role of arterial stiffness on cerebral blood flow variability with cognitive dysfunction.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 Comparing Framingham Cardiovascular Disease Risk Score and Cognitive Performance between Cognitive Normal Non-Hispanic Whites and Mexican American Elders(2020) O'Bryant, Sid; Johnson, Leigh; Vintimilla, Raul; Hall, James; Balasubramanian, KishorePurpose: To compare the relationship between Framingham Risk Scores and cognitive function between a cohort of Mexican-Americans (MAs) and Non-Hispanic Whites (NHWs). Methods: 518 cognitively normal participants (92 NHWs and 426 MAs) from the Health and Aging Brain Among Latino Elders study were studied. Demographic and clinical data relevant to Framingham Cardiovascular Disease 10-year Risk Score (FCVDRS) were assessed. FCVDRS was calculated based on BMI and categorized as Low if < 10, Moderate if between 10-20, and High if >20. Cognitive performance was evaluated using Trails B, Wechsler Logical Memory I and II, Mini Mental State Examination (MMSE), and Animal Naming (AN) tests. Demographic data was analyzed using t-tests and chi-square tests as appropriate. Pearson correlation tests and ANOVAs were used in comparing FCVDRS and FCVDRS categories against cognitive performance respectively. Results: MAs had significantly higher BMI, Systolic BP, and prevalence of Diabetes. Significantly higher proportion of NHWs were current smokers and were undergoing Hypertension treatment. Both cohorts were primarily female and had no significant difference in FCVDRS. Pearson Correlation Tests and ANOVAs were significant for Trails B, MMSE, and AN in MAs only. Tukey post-hoc tests showed significantly decreased performance for High-Risk groups when compared to Low-Risk groups in Trails B and when compared to Moderate-Risk risk groups in MMSE and AN. Conclusion: Mexican-Americans with High FCVDRS show decreased cognitive performance when compared to NHWs. FCVDRS could be used to identify high risk Mexican-Americans for early intervention.Item Comparison of support vector machine, random forest, extreme gradient boosting and lasso and elastic-net regularized generalized linear model for Alzheimer's Disease prediction(2021) Zhang, Fan; Petersen, Melissa; Johnson, Leigh; Hall, James; O'Bryant, SidPurpose: Machine learning based blood test shows promise in detecting Alzheimer's disease (AD) and pinpointing mechanisms underlying the process of neurodegeneration. Model selection plays a crucial role in building good machine learning models for AD prediction. Methods: The paper presents a comparison of four machine learning algorithms: support vector machine (SVM), random forest (RF), extreme gradient boosting (XGBoost )and lasso and elastic-net regularized generalized linear model (GLMNET) for Alzheimer's disease prediction using blood test data from serum. First, we implemented 10 times repeated 5-fold cross-validation to split the data into training set and testing set randomly 50 times to select the best hyperparameters for each selected machine learning method. Then we selected the best learning model based on the performance metrics in the testing set. Results: Of all compared prediction results in the training set, RF and XGBoost achieved the highest negative predictive value (100%) followed by SVM with 99.40% and GLMNET with 94.45%. Of all compared prediction results in the testing set, SVM achieved the highest negative predictive value (96.96%) followed by XGBoost with 95.94%, RF with 95.59%, and GLMNET with 94.27%. With 28-cores high performance computing, RF took 1.35 hours CPU usage, SVM 1.10 hours, XGBoost 48 seconds, and GLMNET 47 seconds, respectively. Conclusions: SVM, RF, and XGBoost are the top three best models for AD prediction. SVM performs better in handling overfitting problem in the training set with small size than RF and XGBoost and also achieved best performance in the testing set.Item Effects of Diabetes and White Matter Hyperintensities on Cognition in Mexican Americans Based on APOE e4 Carrier Status: An HABS-HD Study(2022) Mai, Kevin; Petersen, Melissa; Hall, James; Johnson, Leigh; O'Bryant, SidBackground: The U.S. Hispanic population is projected to grow tremendously and face considerable increases in age-related conditions such as Alzheimer's Disease (AD). This same population also experiences a higher frequency of cerebrovascular conditions and diabetic risk factors, both of which have independently been associated with cognitive decline. Previous research demonstrates the impact of Diabetes Mellitus (DM) and white matter hyperintensities (WMHs) on cognitive functioning within the Hispanic population; however, to date, no study has looked into the effects of genetic factors such as APOE-e4 carrier status on the link between these medical conditions and cognition. Methods: Data were analyzed on Mexican American participants from a study of health disparities stratified by DM status (Yes/No) and WMH burden (Low/High): n = 696 APOE e4 non-carriers (n= 206 No DM/Low WMH, n= 73 Yes DM/Low WMH, n= 153 No DM/High WMH, n= 128 Yes DM/High WMH) and n = 157 APOE e4 carriers (n= 48 No DM/Low WMH, n= 17 Yes DM/Low WMH, n= 35 No DM/High WMH, n= 26 Yes DM/High WMH). All participants underwent cognitive testing and a medical exam. Neuropsychological test battery included Trail Making Test Part A and B, WMS-III Digit Span, Mini Mental Status Examination, Spanish and English Verbal Learning Test (Immediate and Delayed Recall), and Digit Symbol Substitution. Diagnosis of DM was categorized as "Yes/No" through past medical history and HbA1c blood work > 6.5. WMH status was based on a median value of 0.816 to separate "Low/High" burden. Genetic testing was completed for APOE e4 to determine carrier status. ANOVAs were conducted stratified by APOEe4 carrier status with medical condition group (Yes/No DM and Low/High WMH) entered as the predictor variable and cognitive test scores as the outcome variable. Tukey post-hoc tests were performed. Results: For APOE e4 non-carriers, participants in the Yes DM/Low WMH, No DM/High WMH, and Yes DM/High WMH groups performed worse than the No DM/Low WMH group on measures of attention, executive functioning, and processing speed. Those in the No DM/High WMH and Yes DM/High WMH groups also performed worse than the No DM/Low WMH group on measures of learning and memory. Among APOE e4 carriers, participants in the Yes DM/High WMH group performed worse than the Low DM/Low WMH group on measures of executive functioning, processing speed, immediate and delayed memory. Also, those in the Yes DM/High WMH group performed worse than the Yes DM/ Low WMH group on measures of global cognition, processing speed and delayed memory. Those in the No DM/ High WMH group performed worse than the No DM/Low WMH group in both immediate and delayed memory. Discussion: In APOE e4 carriers and non-carriers, DM and WMH burden were differentially associated with decreased test performance across multiple cognitive domains. This study tests the combined effect of DM and WMH on cognition in the context of APOE carrier status for Mexican Americans with findings that support the presence of specific associations thereby further highlighting the necessity to explore health disparities.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 Epigenetic Risk Factors for Mild Cognitive Impairment, Alzheimer’s Disease and Metabolic Dysfunction in Mexican Americans(2018-03-14) Silzer, Talisa; Sun, Jie; Phillips, Nicole; Johnson, Leigh; O'Bryant, Sid; Barber, Robert C.; Abraham Daniel, AnnPurpose: Alzheimer’s is the most common form of dementia and the 5th leading cause of death for those over 651. The population of Mexican American elders will grow seven-fold by 20502 with rates of mild cognitive decline (MCI) and Alzheimer’s disease (AD) increasing exponentially1. Mexican Americans are diagnosed with MCI and AD at younger ages than non-Hispanic whites3; 4. In addition, Mexican Americans who are diagnosed with AD are 1) less likely to carry the ApoEε4 genotype3-5., 2) suffer a greater burden of type 2 diabetes3; 6, 3) experience greater metabolic-related cognitive decline7; 8 and 4) display a proteomic signature of AD that is heavily metabolic in nature4; 9, compared to non-Hispanic whites, whose proteomic signature for AD is dominated by inflammatory proteins. We hypothesized that differentially methylated regions of DNA (DMRs) are associated with age at onset of cognitive decline (MCI/AD) and metabolic dysfunction (metabolic syndrome/type 2 diabetes) in Mexican Americans. Methods: To test this hypothesis, we assayed genomic DNA methylation in samples from 14 female Mexican American participants enrolled in the Health and Aging Brain study in Latino Elders (HABLE). Participants were diagnosed with cognitive decline (n=4), metabolic dysfunction (n=3), both (n=4), or as a control (n=3). We isolated DNA from leukocytes and bisulfite treated the samples before running them on an Illumina MethylationEPIC chip in accordance with manufacturer’s recommendations to assay genomic DNA methylation. Results: Several interesting biological pathways showed significantly different methylation status between groups. When the participants were split on cognitive decline, DNA in the amyloid secretase, EGF receptor signaling, PDGF signaling, gonadotropin-releasing hormone receptor and Wnt signaling pathways were significantly hypermethylated in cases. In comparison, analyses based on metabolic dysfunction showed significant DNA hypomethylation in the beta1 and beta2 adrenergic receptor signaling pathways and hypomethylation of the gonadotropin releasing hormone receptor pathway in cases. Conclusions: The etiology of cognitive decline appears to differ between Mexican Americans and non-Hispanic whites. Future work will resolve how dementia risk differs between these and other ethnic groups. The knowledge gained from these studies will be critical to a better understanding of AD pathophysiology and the development of ethnicity-focused AD treatment options. Acknowledgements: Research reported here was supported by the National Institute On Aging of the National Institutes of Health under Award Number R01AG054073. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The research team also thanks the local Fort Worth community and participants of the Health & Aging Brain Study.Item Exploring the Association between Reproductive Health and Cognitive Function in Hispanic and Non-Hispanic Women: Insights from a HABS-HD Study(2024-03-21) Pham, Theresa; Johnson, LeighPurpose: Alzheimer’s disease (AD), a progressive neurodegenerative disease with nearly two-thirds of dementia cases found in women, leads to memory loss, cognitive deficits, and behavioral changes, significantly impacting daily life. Given the disproportionate effect of AD on women, it is crucial to understand the risk factors, including reproductive health variables, that may contribute to the development of dementia and AD. Such understanding can provide valuable insights for dementia prevention and the development of personalized, gender-specific medicine. This study aimed to examine the association between reproductive health variables such as bilateral oophorectomy and pregnancy complications and cognitive performance in Hispanic and non-Hispanic women. Method: Self-reported data from 309 cognitively normal women (165 non-Hispanic white and 144 Hispanic) enrolled in the Health and Aging Brain Study: Health Disparities (HABS-HD) project, an epidemiological study of aging in community-based participants, were analyzed. Reproductive health variables examined included bilateral oophorectomy, pregnancy complications, number of pregnancies, and number of children. The cognitive assessment comprised neuropsychological test scores in five domains: memory (logical memory I & II), executive functioning (digit symbol substitution), attention (digit span), language (F-A-S), and global cognition (mini‐mental state examination). Linear regression statistical analyses were conducted, with ethnicity serving as a stratification variable. Results: Linear regression analyses revealed significant associations between reproductive health variables and cognitive domains, with distinct patterns observed among ethnic groups. Bilateral oophorectomy was linked to decreased immediate memory in Hispanic women (B=.176, SE=1.691, t=2.211, p=.029) and lower language performance in non-Hispanic white women (B=-.228, SE=1.980, t=-2.682, p=.008). Pregnancy complications were associated with poorer attention scores in Hispanic women (B=.163; SE=.000, T=2.203, p=.029). However, the number of children and pregnancies were not associated with cognitive performance. Conclusion: This study suggests that reproductive health variables, such as bilateral oophorectomy and pregnancy complications, were differentially associated with cognitive assessment performance among Hispanic and non-Hispanic women. A surgical history of bilateral oophorectomy may be associated with a decline in cognitive performance in both Hispanic and non-Hispanic women. Limitations, including sample size constraints and reliance on self-reported medical history, are acknowledged. Nonetheless, this study underscores the need for continued investigation into the intersection of reproductive health and cognitive function to inform targeted interventions and personalized healthcare approaches for dementia prevention across diverse communities.Item Impact of Hypertension, Diabetes, and Dyslipidemia Comorbidity on Cognition among Hispanic Mexican Americans: An HABLE Study(2015-03) Borden, Ashley N.; Johnson, Leigh; Edwards, Melissa; O'Bryant, SidBackground: Hypertension, hyperlipidemia, and diabetes mellitus are medical diagnoses that occur at high prevalence rates among the Hispanic Mexican American population. Current research shows that each individual diagnosis is linked to cognitive decline, but this assertion is limited in that these studies have been conducted on Non-Hispanic White populations only. Additionally, an insignificant number of studies have investigated the comorbidity of these diagnoses, and how that may impact risk for cognitive impairment. This study seeks to fill this gap in the literature by determining the association between combinations of these diagnoses and cognitive functioning within a Hispanic Mexican-American population. Methods: Data were analyzed from 537 Mexican American participants who met diagnostic criteria for hypertension, dyslipidemia, and diabetes mellitus (Group 1, one diagnosis, n= 148; Group 2, two diagnoses, n=219; Group 3, three diagnoses, n=170) from the Health and Aging Brain study among Latino Elders (HABLE). Information from each participant was obtained via clinical interview (including medical history, current medications, and health behaviors), informant interview, neuropsychological testing, blood draw, and physical examination. Consensus reviews were conducted weekly to review subject data, and to establish cognitive and medical diagnoses according to national guidelines. Linear regressions analyses were utilized to examine cognitive functioning, measured through the domains of memory and verbal fluency as the dependent variable, with the independent variable consisting of the number of medical diagnoses (one, two, or three). Covariates included age, gender, and education. Results: Those in Group 1 displayed poorer performance on measures of immediate (B[SE]= -2.66[1.05], t-test = -2.52, p-value=0.012) and delayed (B[SE]= -1.59[0.77], t-test= -2.04, p-value= 0.041) memory. Differentially, those in Group 2 showed poorer performance on tasks related to verbal fluency (B[SE]=-2.33[0.80], t-test= -2.88, p-value=0.004) and working memory (B[SE]=-0.59[0.24], t-test=-2.42, p-value=0.016). Group 3, which encompassed all three medical diagnoses, was not significantly related to any of the cognitive domains that were examined. Conclusion: These findings suggest that within the Hispanic Mexican American population, domains of cognitive functioning are differentially affected within each group, with Group 3 showing no significant increased risk for cognitive dysfunction. These findings do not support current research, which suggests a higher and more invariable prevalence of cognitive decline, regardless of the comorbidity of these diagnoses. Additional research is needed to investigate the neurological effects of the biological pathways associated with the varying combination of diseases, which may explain the dissimilarity in associated cognitive function.Item Life Guard Rescues at Seattle Parks’ lake beaches(2014-03) Allen, John G.; Johnson, Leigh; Loewen, Ashlee; Martin, Ashley; Johnson, Valerie; Camp, Kathlene E.; Toale, Ashley; Rice, MargaritaPurpose (a): This purpose of this project is to conduct an exploratory statistical analysis of Water Rescue/Assist Reports for nine fresh water beaches in King County, Washington, for the period 2008 to 2012. The nine beaches covered by the Water Rescue/Assist Report are East Greenlake Beach, Madison Beach, Madrona Beach, Magnuson Beach, Matthews Beach, Mount Baker Beach, Pritchard Beach, Seward Beach, and West Greenlake Beach. The project alternate hypothesis is: By describing and comparing data compiled from the Water Rescue/Assist Reports, public health leaders can make better decisions regarding water safety and can use the information for additional study. Methods (b): A total of 508 Water Rescue/Assist Reports reviewed for this analysis. The data from the reports were entered into and analyzed in Microsoft Excel. We reviewed lifeguard rescue records that collected data on: incident date and time of day; victim gender and age; parent availability during rescues for victims under age 18; victim symptoms after rescue; possible neck/back injuries; disposition to hospital; cause of incident; water depth; water temperature; park rules disobeyed; number of active and passive patrons present at time of rescue. The analysis included: age and gender based descriptive statistics; the ratio of lifeguards to patrons; water temperature correlated with rescue frequency; odds ratios and relative risks based on gender and age and the presence of a parent at the time of rescue. We searched records of the King County Medical Examiners deaths to identify drowning deaths occurring in Seattle Parks. Double entry was completed for each report to maximize data reliability. A data dictionary was developed as a guide for entering data and a blank Water Rescue/Assist Reports and was used as a reference to increase the speed of entering data.The analysis uses coded data to make data inferences using primarily descriptive statistics. Evaluations of non-coded or non-standardized report entries (such as water depth and number of guards on duty) was limited the “Other” category under “Accidents possible causes” in order to determine any possible trends based on information rescuers entered into the form. Results (c): Results: 508 rescues were completely recorded; an average of 11/park/year. Rescues steadily increased from beach opening at 11 AM and peaked at 5-7 PM when beaches closed. Most (65%) involved males; males outnumbered females between the ages of 7-50 years (RR=3.1, p5-10 feet deep; (29%) occurred in waters >10-15 feet deep.Most (65%) involved males; males outnumbered females between the ages of 7-50 years (RR=3.1, p<.05). Most (77%) rescues involved those 7-26 years of age; 55% were < 18 years. The greatest number of rescues involved those 7-10 years. Parents were on site for 90% of children <10 years of age. The most commonly listed causes were “overestimated ability”, “tired”, “waves”, and ”nonswimmer”. Drugs/alcohol were listed in 5% (28/503) of rescues. Half of rescues (51%, 236/ 462) rescues occurred in waters >5-10 feet deep; (29%) occurred in waters >10-15 feet deep. Conclusions (d): This exploratory analysis provides a snapshot of the data from the Water Rescue / Assist Reports filed from 2008-12. The data underscores some key points to be considered, including: most rescued victims were male; rescue frequency positively correlated with increasing levels of parental absence; swimmer overconfidence in their swimming abilities was the most common cause for rescues; more than 70% of rescues occurred in water depth exceeding 5 feet; the relative risk of rescues was twice what is was when there were fewer swimmers in the water as compared to more swimmers in the water. Public health leaders and others can use the information from these reports to better understand the factors involved with rescues and to conduct further study and develop effective policy.Item Link between Diabetic Treatment Modalities (Oral medication, Insulin) and Global Cognitive Functioning Among Mexican Americans: An HABLE Study(2015-03) Del Toro, Sophia V.; Edwards, Melissa; Johnson, Leigh; OBryant, SidBackground: Diabetes is a significant health concern for the Hispanic population as diagnosis occurs, on average 10 years earlier than among non-Hispanic Whites and at a higher frequency. The link between diabetes and cognitive impairment has been supported though this link is not well understood. Recent empirical findings have suggested the use of insulin as a potential means for improving cognitive functioning; however, only one study to date has examined the implications of diabetes medication treatment on cognitive functioning among a sample of non-Hispanic whites. The aim of this study was to examine the implications of diabetes treatment modalities (oral medication, insulin) on cognitive functioning among a sample of Hispanic adults and elders. Methods: Data was analyzed from 201 Hispanic Mexican American participants with a diagnosis of diabetes and who endorsed diabetic treatment (oral medication n=172; insulin n=54) from the Health and Aging Brain Study among Latino Elders (HABLE). Each participant underwent an interview (i.e. medical history, medications, and health behaviors), neuropsychological testing, blood draw, medical examination, and informant interviews. Diagnosis of MCI was assigned according to published criteria and was designated based on weekly consensus reviews. Global cognitive functioning was assessed utilizing the Mini Mental Status Examination (MMSE). HbA1c levels were categorized based on diabetic control status with values below 8% being considered controlled. Liner regressions were utilized with the dependent variable being global cognitive functioning and the independent variable being diabetic treatment modality. Age, gender and education were entered into the models as covariates. Results: Among the total sample, use of oral medication as a treatment for diabetes was associated with higher global cognitive functioning (B[SE] = 1.43[0.66], t-test=2.14, p-value = 0.033). When split by diabetic control status, those with uncontrolled diabetes (HbA1c level ≥ 8) and who were taking oral medications also demonstrated higher global cognitive functioning as measured by the MMSE (B[SE]= 2.28 [0.76], t-test=3.03, p-value = 0.003). Insulin treatment was not found to be significantly associated with global cognitive functioning within the total sample or when split by diabetic control status. Conclusions: The results of our study suggest that diabetic treatment modalities differentially impact cognitive functioning among a sample of Hispanic Mexican Americans with oral medication showing to be significantly impactful. Future studies should further examine the link between specific oral diabetic medications and cognitive functioning.Item Losing the Protective Effect of Cognitive Aging in Mexican American Diabetics(2018-03-14) Gomez, Julie; Munoz, Haydee; Vintimilla, Raul; O'Jile, Judith; Johnson, Leigh; O'Bryant, Sid E.; Filipetto, FrancescaBackground: Diabetes is a serious health issue, affecting nearly 29 million people in the US. Mexican Americans (MA) have higher rates of diabetes, a risk factor for Alzheimer’s disease and mild cognitive impairment. Normal cognitive aging is associated with decline, not impairment, in some areas of cognition (processing speed, memory, etc). Diabetes may contribute to age associated cognitive decline and to the development of cognitive impairment. This study examines the effect of age on memory and executive functioning (EF) among diabetic and nondiabetic MA. Methods: Data from 415 MA subjects from the Health and Aging Brain among Latino Elders study (HABLE) were analyzed. Participants were classified as diabetic (n=171) or non-diabetic (n=244) and young (50 to 64, n=326) or old (65 and older, n=89). All participants were classified as normal controls (i.e., no diagnosis of dementia or MCI). Each participant underwent an interview (i.e., medical history and medications), cognitive testing, blood tests, and medical examination, as well as informant interviews. Memory was assessed by the Ravens Auditory Verbal Learning Test (RAVLT) Recognition and Delayed Recall, while EF was measured by Trail Making Test (TMT) Parts A&B and CLOX Part 1&2. Analyses were split by diabetes status (diabetic, non-diabetic) and age group (young, old), using independent t-tests. Results: Younger non-diabetic subjects scored significantly better than older non-diabetic subjects on measures of memory: RAVLT-Delayed Recall, t (3)=3.109, p=.002 , and executive functioning: TMT-A, t(56.450)=-3.529, p=.001, TMT-B, t(206)=-2.09, p=.004, and CLOX Part 2. Younger diabetic subjects scored significantly better than older diabetic subjects on measures of memory: RAVLT-Delayed Recall, t (109)=2.57, p=.012, and EF: TMT-A, t(44.177)=-2.257, p=.03, TMT-B, t(138)= -2.250, p=.026, and CLOX Part 2. Conclusion: It was expected that younger participants would perform better than older participants on all cognitive tests, regardless of diabetic status. However, the results indicated that younger and older diabetics demonstrated a similar pattern of performance on measures of memory and executive functioning, suggesting that younger age may no longer be a protective for diabetics. This study was limited by small sample size and cross sectional nature of the data. Further research is needed to understand the impact of health risks on normal cognitive aging.Item Minimizing 30-Day Hospital Readmissions and Falls and Improving Quality of Life through the Safe Transitions for the Elderly Patient (STEP) Program(2014-03) Allen, John G.; Johnson, Leigh; Loewen, Ashlee; Martin, Ashley; Johnson, Valerie; Camp, Kathlene E.; Toale, Ashley; Rice, MargaritaBackground: The STEP Program will provide high quality transition of care services for discharged Medicaid eligible elders of Tarrant County that includes a transition of care coordinator and in home medical care team. The in home medical care team comprises a nurse practitioner, physical therapist, social worker and physician. The foundation of the STEP Program was developed by the University of North Texas Health Science Center (UNTHSC) as part of an 1115 Waiver grant proposal approved by CMS in 2012. The STEP Program was designed to improve the coordination and continuity of care for Medicaid eligible patients 65 years of age and older transitioning from the hospital to the home setting following discharge. The primary goals of the STEP program are to reduce all-cause 30 day hospital readmissions, improve quality of life, and decrease falls among the elderly. These goals were selected because these factors-unnecessary readmissions, excessive falls, and poor quality of life-are often the result of substandard medical coordination and management. Additionally, these factors unnecessarily increase healthcare costs. Methods: The STEP Program will provide care transition services for 750 patients from October 1, 2013, to September 30, 2016, via referrals received from local hospital partners. STEP faculty and staff have developed evidence based protocols and communication strategies aimed at meeting or exceeding performance metrics for reducing hospital readmission, decreasing falls, and improving Quality of Life. The NEXTGEN EMR will be the primary means for gathering data for these metrics and assessing the impact of the evidence based protocols and communication strategies. Plan-Do-Study-Act methodology will be used to regularly evaluate and re-evaluate STEP Program practices to not only meet or exceed performance metrics, but to continuously improve performance. In addition, STEP team members have worked to finalize business agreements with hospital partners (which will serve as patient referral sources) and have begun to market to and partner with community resources that will help meet the social, spiritual, financial, physical, medical and other identified needs of the STEP Program’s target patient population. STEP Team members have met with more than 15 community resources and have hosted outreach events to provide an overview of the STEP Program. Expected Results: The STEP Program must demonstrate a 5% and 10% improvement in federal fiscal years 2015 and 2016, respectively, for reducing hospital readmissions, decreasing falls, and improving Quality of Life among the elderly. Baseline data will be gathered during federal fiscal year 2014. Conclusion: By meeting or exceeding performance metrics for reducing hospital readmission, decreasing falls, and improving Quality of Life, the STEP Program can contribute to improving the quality of and reducing the costs for care transition services. Purpose (a): The STEP Program was designed to improve the coordination and continuity of care for Medicaid eligible patients 65 years of age and older transitioning from the hospital to the home setting following discharge. The primary goals of the STEP program are to reduce all-cause 30 day hospital readmissions, improve quality of life, and decrease falls among the elderly. Methods (b): The STEP Program will provide care transition services for 750 patients from October 1, 2013, to September 30, 2016, via referrals received from local hospital partners. STEP faculty and staff have developed evidence based protocols and communication strategies aimed at meeting or exceeding performance metrics for reducing hospital readmission, decreasing falls, and improving Quality of Life. The NEXTGEN EMR will be the primary means for gathering data for these metrics and assessing the impact of the evidence based protocols and communication strategies. Plan-Do-Study-Act methodology will be used to regularly evaluate and re-evaluate STEP Program practices to not only meet or exceed performance metrics, but to continuously improve performance. In addition, STEP team members have worked to finalize business agreements with hospital partners (which will serve as patient referral sources) and have begun to market to and partner with community resources that will help meet the social, spiritual, financial, physical, medical and other identified needs of the STEP Program’s target patient population. STEP Team members have met with more than 15 community resources and have hosted outreach events to provide an overview of the STEP Program. Results (c): The STEP Program must demonstrate a 5% and 10% improvement in federal fiscal years 2015 and 2016, respectively, for reducing hospital readmissions, decreasing falls, and improving Quality of Life among the elderly. Baseline data will be gathered during federal fiscal year 2014. Conclusions (d): Care transition models are effective in providing a safer and more successful recovery for high risk elderly patients recently discharged from the hospital. Coordination of efficient, interdisciplinary transitional care is believed to be critical for reducing 30-day hospital readmissions, falls, and healthcare costs and increasing quality of life in patients. Data collected during the STEP program is expected to reflect a decrease fall and hospital readmission rates and improve quality of life outcomes. This program will demonstrate a unique transitional care model that may improve health care delivery post-hospitalization.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 Polypharmacy and self-reported health status of older adults with multimorbidities in a rural community(2020) Johnson, Leigh; Rasu, Rafia; O'Bryant, Sid; Shrestha, NisthaPURPOSE: About four in ten elderly Americans suffer from multiple chronic conditions, and 39% are taking more than five medications. Polypharmacy(using ≥five medications) is associated with age, multi-morbidities, and poor self-perceived health status. Psychological and socio-educative factors influence polypharmacy and medication adherence, with limited studies in rural elders. Hence this study aims to examine the self-reported health status among older adults with multi-morbidities in rural areas. METHODS: Project FRONTIER(Facing Rural Obstacles to Healthcare Now Through Intervention, Education & Research) is a prospective epidemiological study, using community-based participatory research(CBPR) approach to study factors affecting health in Cochran, Bailey, and Parmer County. All county residents over 40 years and were eligible for inclusion in the study after informed consent. The association between medical history and health-status was examined using logistic regression. Polypharmacy and multi-morbidities were used to predict poor health status. RESULTS: About 689 individuals participated in FRONTIER with a mean age of 68, with 43% Hispanic, and 68.7% female participants. Individuals taking ≥five medications presented 2.69 times higher odds of reporting poor health-status(AOR=2.69,CI=1.85-3.90) compared to those using < 5 medications, after controlling for demographic covariates. Individuals with ≥five co-morbidities presented 4.31 times higher odds of reporting poor health-status(AOR=4.31,CI=2.67-6.95). CONCLUSION: The presence of polypharmacy and multi-morbidities increase the odds of poor self-perceived health status. Future research should examine factors that contribute to polypharmacy among rural elders, as well as the role of patient perspectives and healthcare barriers on medication usage.