Aging / Alzheimer's Disease

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    Does Sleep Improve Mental Health in Elderly Women?
    (2016-03-23) Thomas, Kathryn; Wright, Joshua; Meyer, Kim; Hartos, Jessica; Redd, Lauren
    Introduction: Sleep and mental health complaints are prevalent in the elderly. Thus, the purpose of this study was to assess the relationship between sleep and mental health in representative samples of elderly women. Methods: This cross sectional analysis used 2013 BRFSS data. Females age 65 and older from California, Pennsylvania and Florida were used since these states had high percentages of elderly populations. Bivariate and multiple logistic regression analyses were conducted to assess the relationship between sleep and mental health. Results: Most of the participants reported they had 30 days of good mental health in the past month (73-76%), and the majority slept less than an average of 8 hours per night (55-57%). After controlling for psychosocial and demographic factors, mental health was significantly related to sleep in California and Florida, and significantly related to multiple chronic health problems in all three states. Conclusions: Overall, sleep and chronic health problems were related to mental health in representative samples of elderly females. Even though this study did not determine the direction of influence, it is recommended that clinicians know about and educate their elderly female patients on the relations among sleep, chronic health problems, and mental health.
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    Workforce Enhancements in Healthy Aging and Independent Living
    (2016-03-23) Severance, Jennifer; Hartos, Jessica; Mize, Joanne; Prasad, Subhada; Carter, Elizabeth; Hadley, Lesca; Hawley, Diane; Smith, Don; Cisneros, Alexandra; Knebl, Janice
    Purpose: Older adults are among the fastest growing age group in the United States and use many health care services, have complex conditions, and require professional expertise to meet their health care needs. Having a geriatric workforce capable of carefully managing the medical conditions of seniors to assist with healthy independent lifestyles is important. The University of North Texas Health Science Center expanded unique partnerships with Texas Christian University, JPS Health Network, and United Way’s Area Agency on Aging to create the Workforce Enhancement in Healthy Aging and Independent Living (WE HAIL) Program. As the only Geriatric Workforce Enhancement Program awarded in Texas, WE HAIL advances geriatric education by aligning learning objectives and activities with community needs of an aging population. Program innovations take cross-sector approaches to integrate evidence base programs into health professional training, and expand training opportunities for rural areas and underserved populations. Applying a Rapid-cycle Continuous Quality Improvement (RCQI) method, WE HAIL provides training enhancements for the following learner groups: 1) undergraduate and graduate students; 2) faculty; 3) family medicine residents; 4) practicing health care professionals, including physicians, nurses, physician assistants, pharmacists, physical therapists, social workers, and dieticians; and 5) caregivers of older adults. Methods: Data will include trainee demographic information through the HRSA-GWEP Performance Report for Grants and Cooperative Agreements (PRGCA), feedback from trainees on usefulness, intention to use, and suggestions for future activities, and pre-post measures for practitioner knowledge, skills, and effectiveness. Additional data includes older adult outcomes from program-specific validated tools, and cross-program measures using Centers for Disease Control Healthy Days (4-items) and National Health Interview Survey Utilization (4-items). Results: Five Innovation teams of interprofessional faculty and community organizations, including Meals on Wheels, Senior Citizen Services, Alzheimer’s Association and James L. West Alzheimer’s Center, convened to plan and develop enhancements in existing programs. New programs are proposed for a Geriatric Certificate for Family Medicine Residency Programs, and a Geriatric Professional Leadership Institute. Proposed enhancements and new programs will be implemented during 2016-2018 to impact over 2,000 health professions students, almost 100 family medicine residents, over 500 primary care practices, and over 2,000 older adults and their caregivers. Conclusions: WE HAIL collaboration will deliver quality training enhancements and increase the number of geriatric-trained primary care providers to meet the needs of older adults at individual, community and population levels.
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    Multifactorial effect of testing single leg stance
    (2016-03-23) Liu, Howe; Salem, Yasser; Bao, Yi; Forge, Jennifer; Truong, Tony; Brown, John
    Introduction Single leg standing (SLS) is one of the most commonly used balance assessment instrument in clinical settings. However, when a person stands on one leg, there may be many factors that may affect the person’s static standing ability. These factors could be external ones like surface firmness, shoes on or off, or standing leg straight or bent, or the internal factors like foot flat or dominant when kicking a ball. So far, there was still lack of studies investigating how these factors may affect the SLS. Therefore, the purpose of this study was to investigate whether these external and internal factors may affect the SLS assessment. Methods. Twenty-eight young subjects (age in average?) were selected with selection criteria for this study. Each of them was asked to stand on the balance platform with single leg standing for 20 seconds under the following 6 different external affecting conditions: surface firmness (hard verse soft with a foam), shoes on and off, and leg straight verse bent. All subjects have their left legs as the supporting legs and the right leg as the kicking legs when they jumped to shoot a basketball or kicked a soccer ball. To avoid fatigue effect on data results, the order of conditions for being tested was randomized. Also, the internal affecting conditions including foot flatness and leg dominance were compared. Results. There were no statistical significance (p [greater than] 0.05) noticed no mater shoes on or off under other conditions. The surface firmness affects the SLS only on the left side (p0.316) when the leg was straight with shoes off or when the leg was bent regardless of shoes on or off. Significant differences (p Conclusions This study showed that knee bending or not, and surface firmness for dominant or non-dominant leg or flat or non-flat foot to stand on could make significantly different results of SLS assessment. Clinicians should keep these affecting conditions in mind and be precautious when using the SLS for balance assessment.
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    Chronic intermittent hypoxia induces oxidative stress and inflammation in brain regions associated with neurodegeneration
    (2016-03-23) Shell, Brent; Cunningham, J. Thomas; Cunningham, Rebecca; Snyder, Brina D.
    Age is the highest risk factor for the development of neurodegenerative diseases (ND), such as Alzheimer’s disease (AD) and Parkinson’s disease (PD). As life expectancy increases, the incidence of ND is projected to rise accordingly. Increased ND incidence will be associated with high healthcare costs. Currently, no cure exists for ND and diagnosis occurs at advanced stages, which foreshadows a financial healthcare crisis. Therefore, early identification of patients at risk for ND may provide opportunities for more effective therapies. Since ND is associated with increased oxidative stress (OS) and inflammation, these markers could be used to identify patients at risk for ND. Multiple environmental factors can be an oxidative stressor, and thus exacerbate inflammation induced ND risk. One such environmental factor that increases OS is sleep apnea (SA), a common ND comorbidity. However, it is unknown if SA induced oxidative stress activates neuroinflammation in areas associated with ND. To model SA in rats, chronic intermittent hypoxia was used. Male rats were exposed to six minute chronic intermittent hypoxia (CIH) cycles, during which oxygen levels were rapidly decreased from 21% to 10% then returned to normal room air levels, eight hours a day during the light phase for seven days. Plasma and tissue from hippocampus (HIPP), entorhinal cortex (ETC), substantia nigra (SN), rostral ventrolateral medulla (RVLM), and solitary tract nucleus (NTS) were collected and tested for levels of OS and inflammation, using Advanced Oxidative Protein Products (AOPP) and multiplex immunoassays, respectively. OS markers and inflammation were elevated in the plasma of rats exposed to CIH compared to control rats. Differences in neuroinflammatory markers within tissues were observed. Specifically, inflammatory markers in the RVLM were significantly decreased in animals exposed to CIH while TNF-a and IL-6 were elevated in the SN. TNF-a was positively associated with plasma OS and the cytokine associated with inflammatory cell recruitment, KC-Gro, exhibited the same pattern in the ETC. The ETC and SN are areas associated with initial neurodegenerative processes in AD and PD, respectively. CIH may contribute to processes involved in early ND pathology by elevating OS and inflammation in critical brain regions. These results indicate that SA can exacerbate ND by increasing OS-induced neuroinflammation. Therefore, treatment of SA could be one consideration in preventing ND.
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    Vitamin D and cognition in Hispanic patients
    (2016-03-23) Large, Stephanie NP-C; O'Jile, Judith; Reyes, Miguel
    Introduction: Recent research has shown an association between vitamin D deficiency and cognitive functioning. There is also evidence to suggest that there may be a relationship between low levels of vitamin D and Alzheimer’s disease. A review revealed there was minimal research on low vitamin D levels in minorities, particularly in Hispanics. This issue is particularly salient to Hispanics as they are the fastest growing aging population in the US. Additionally, the cost of Alzheimer’s disease to the US is estimated to be $226 billion in 2015, and Hispanics and African American make up the highest racial population with the disease. Methods: A literature review used search terms including vitamin d deficiency, cognition, Alzheimer’s, Hispanics, and Mexican-American, resulting in approximately 100 abstracts. Results: The articles reviewed demonstrated strong evidence of the relationship between a vitamin D deficiency and cognition. They also revealed an increased risk of Alzheimer’s disease (AD) and other types of dementia in the context of a low vitamin D level. Interestingly, AD is a disorder of progressive memory loss and cognitive dysfunction, but in those few studies that performed cognitive testing, a low vitamin D level correlated with poor executive functioning. Memory testing has yielded equivocal results. These studies used white participants and may not therefore reflect the general population. A multiethnic cohort study showed the mean vitamin D level of the sample as 19.2 (11.7) ng/mL, with 26.2% of participants being vitamin D deficient, and 35.1% insufficient. The mean serum vitamin D levels were lower for African-American and Hispanic participants compared with white participants. Various reasons for these differences have been hypothesized including cultural differences in vitamin D intake, incidence of renal insufficiency, place of birth, and less vitamin D production due to more highly pigmented skin. Conclusion : Hispanics are the fastest growing ethnic population in the US and have higher rates of obesity, liver disease, tobacco use, heart disease, diabetes, metabolic disorder, stroke, and hypertension. Many of these disorders are related to vitamin D, and all are associated with cognitive deficits. It is unknown at this time if vitamin D supplementation will reverse cognitive deficits. Therefore, it is important to add Hispanic cohorts to future studies to explore the relationship between vitamin D and cognition.
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    Dementia Care in Tarrant County
    (2016-03-23) Hernendez, Joshua; Al Farra, Tariq; Dehbozorgi, Hangameh; Cunningham, Thomas; Ikram, Haseeb
    Purpose: The purpose of this research is to analyze local resources and barriers that will affect the quality of life of the patient and their family as the disease progresses. Methods and Materials: Information was collected from the Alzheimer’s association, WHO, CDC, Texas Department of aging and disability services, and local organizations. Results: For each stage of dementia several community resources are suggested. Conclusions: Patients and their family need to be aware of the various resources they can obtain for management of dementia.
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    The Effects of Cardiovascular Risk Factors on Depression in Elderly Mexican Americans
    (2016-03-23) Edwars, Melissa; Johnson, Leigh; Bryant, Sid; Yadav, Menaka
    Objectives: The Mexican American population is the fastest growing segment of the aging population in the United States and as such they face a disproportionate burden of health issues such as cardiovascular disease (CVD) and depression. Although evidence exists linking depression and CVD, the link between risk factors for CVD and their association with depression have not been explored, especially among the Mexican American population. This study seeks to look at the relationship between depression and CVD risk factors specifically among the Mexican American population. Methods: Data were analyzed from 525 participants (High CVD n=159; Low CVD n=131) from the Health and Aging Brain among Latino Elders (HABLE) study. Risk factors for CVD include hypertension, dyslipidemia and diabetes mellitus. A CVD risk score was created combining the risk factors with the high CVD group including all three risk factors and the low CVD group consisting of just one risk factor. Medical diagnosis was based on clinical lab work. Depression was measured through the use of the Geriatric Depression Scale and its associated four subscales (dysphoria, meaninglessness, apathy, and cognitive impairment). Linear regressions were utilized to analyze the relationship between CVD risk factors and depression. Covariates included age, gender and education. Results: Within the total sample, overall CVD risk was shown to be significantly associated with increased apathy (B[SE]= 0.17[0.07], t=2.3, p=0.01). When stratified by level of CVD risk, those in the high CVD risk group showed a significant positive association with total GDS score (B[SE]= 1.68[0.67], t=2.50, p=0.013) as well as with dysphoria (B[SE]=0.66[0.31], t= 2.17, p=0.03), apathy (B[SE]=0.36[.15], t=2.51, p=0.012) and cognitive impairment (B[SE]= 0.36[.17], t=2.20, p=0.05). The low CVD risk group showed no significant correlations to the GDS or it’s associated subscales. Conclusion: Hypertension, dyslipidemia and diabetes mellitus, all of which are risk factors for CVD were found to be associated with depression among Mexican American elders. However, this association was specific to level of risk, with the high risk CVD group showing the greatest link with geriatric depression as well as with its associated subscales (dysphoria, apathy, and cognitive impairment).
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    The effect of dietary curcumin intake on age associated neurobehavioral dysfunction
    (2016-03-23) Franks, Susan; Sumien, Nathalie; Forster, Michael; Sarker, Marjana
    We hypothesized a combination treatment of dietary curcumin and CR to improve age associated neurobehavioral dysfunction better than either treatment alone, via attenuation of inflammation and oxidative stress. Middle- aged (15 months) and aged (20 months) male and female C57BL/6 mice were grouped under four dietary interventions, (1) regular chow fed ad libitum (AL), (2) curcumin at 0.7g/kg body weight in AL (CURAL), (3) caloric restriction (CR) and (4) curcumin w/ CR (CURCR) and were kept under these interventions for 16 weeks. We administered a behavioral battery after eight weeks of dietary intervention that included tests for cognitive and psychomotor function. To measure oxidative stress and inflammation we collected plasma and red blood cells and used factory manufactured kits to detect pro and anti-inflammatory cytokines and glutathione status. CR and CURCR significantly improved various aspects of motor function including wire suspension, rotorod and bridge walking performance, indicative of cerebellum functioning, when compared to age matched control (AL) for both sexes, whereas only CURAL improved optomotor function, indicative of vision, in middle aged males and females and aged males. All three interventions had significant effects on pro and anti-inflammatory cytokines, KC-GRO concentration was significantly decreased in CR and CURCR in the middle aged males and aged females group and was correlated to body weight; TNF-α concentration was significantly decreased in both CURAL and CURCR in middle aged males and there was a significant decrease in C-reactive protein in aged males under CURCR. There were no significant differences in the redox state across groups. Based on results from the motor tests and blood based biomarkers and earlier data on cognitive function, dietary curcumin can be used as a CR mimetic for certain components of healthy functional aging but the benefits may not entirely be related to its anti-inflammatory and anti-oxidant effects. Future studies should include different doses and a tapered down caloric restriction regimen.
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    The Effects of Sleep-Disordered Breathing on Depression-Related Cognitive Impairment (DepE) in Elderly Mexican Americans
    (2016-03-23) Edwards, Melissa MA; Johnson, Leigh PhD, LMSW; Roane, Brandy PhD, CBSM; O'Bryant, Sid PhD; Weiser, Brent
    Objective: Sleep-disordered breathing (SDB), such as found in excessive sleepiness (ES) & obstructive sleep apnea (OSA), has been recognized as a common occurrence in the elderly. SDB has been linked to a number of negative health outcomes in older persons, as well as both cognitive dysfunction and depression. Research shows that the likelihood of depression increased with the frequency of SDB. Likewise, breathing problems during sleep may also be linked to early mental decline and Alzheimer’s disease in Mexican Americans, a new study suggests. There remains, however, a dearth in the literature regarding the impact of SDB on the link between depression and cognition in this population. This study seeks to address the gap in knowledge on the relationship of SDB on depression-related cognitive impairment in Mexican Americans. Methods: Data were analyzed from 516 Mexican American participants from the Health and Aging Brain among Latino Elders (HABLE) study. Excessive sleepiness (ES) was determined based on having a score ≥10 on the Epworth Sleepiness Scale (ESS). Obstructive Sleep Apnea (OSA) was identified as those with a score ≥3 on the STOP-BANG Sleep Apnea Questionnaire. Depression-related cognitive impairment was determined based on the DepE (Depression endophenotype), which was coded on a five-point scale with the GDS-30. Linear regression models were utilized with the DepE as the dependent variable and the Epworth Sleepiness Scale, as well as the STOP-BANG Sleep Apnea Questionnaire, serving as two separate, independent variables. Covariates included age, gender, education, BMI, hypertension, dyslipidemia, and diabetes mellitus. Significance was set at p Results: SDB was found to be elevated among the Mexican American population in this study, with significant associations being shown among ES and DepE, as well as among OSA and DepE. Specifically, for those who met criteria for ES, a significant positive correlation was shown between the Epworth Sleepiness Scale (B[SE]= 0.93[0.27], t=3.47, p=0.001) and DepE. Additionally, among those who met criteria for OSA, a significant positive correlation was also shown between the STOP-BANG Questionnaire (B[SE]= 0.98[0.23], t=4.21, p) and DepE. Conclusions: Elevated ES and OSA show an increased risk for depression-related cognitive impairment (DepE) among Mexican Americans. Potential implications include treatment of ES and OSA as a means of therapeutic intervention for individuals with DepE. Further research should continue examining the effects of other SDB conditions on DepE, as well as exploring the role of DepE on SDB.