Aging / Alzheimer's Disease
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/29957
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Item REACH in Rural North Texas(2020) Bourgin, SarahBackground: Prior studies have shown Resources for Enhancing Alzheimer's Caregiver Health (REACH), a program delivered by Alzheimer's Association to be efficacious in improving feelings of burden and depression for caregivers living in urban settings. This study was designed to examine the impact the REACH program has for caregivers living in rural areas. Methods: Data was collected from 49 caregivers, living in north Texas rural zip codes, who completed the REACH program between 2015-2018. Participants were assessed for caregiver burden using the 12-item Zarit Caregiver Burden survey and screened for depression with the 10-item Center for Epidemiological Studies Depression Scale. The surveys were completed upon initial enrollment and at the end of the 6-month program. The initial and final survey responses were compared using paired t-test analysis with p< 0.05. Results: Composite scores for depression and caregiver burden showed significant reductions from baseline to program completion. Upon initial enrollment, 53% of participants were considered depressed using the CES-D scale. At program completion, 79% of participants were no longer considered depressed. Similar results were found with the Zarit Caregiver Burden survey. Initially, 55% of participants scored in the high burden range. After completion of the program, 67% of participants were considered to have no to moderate burden. Conclusion: Completion of the six-month REACH program revealed statistically significant reduced feelings of caregiver burden and depression. Data claims that the REACH program does have a positive impact on caregivers living in rural areas, warranting wider scale implementation.Item Improv and Caregiving: Effects on levels of depression, emotional resiliency, stress, and positive aspects of caregiving for people with dementias(2020) Luk-Jones, Susanna; Davis, Sandra; Parker, Kimberlee; Reuter, Kristen; Siddiq, ZaydPurpose: Caregivers for people with dementia often experience high levels of depression, stress, and overall burden. To help reduce these negative effects and foster a positive outlook towards caregiving, we conducted nine, two-hour caregiver workshops from February 2019 to November 2019. We hoped to determine whether improv therapy improved measures of caregiver burden, resilience, depression, stress, and self-reported positive aspects of caregiving and whether these measures significantly varied based on caregiver age and gender. Methods: 37 participants enrolled in improv cohorts over the 10-month study period and completed pre-workshop Resilience Score, Zarit Caregiver Burden, Patient Health Questionnaire, Stress Thermometer, and Positive Aspects of Caregiving evaluations. 25 participants completed the same forms after two weeks. Workshops consisted of improv techniques including "yes, and...," and storytelling. Results: Of the 37 participants, 24 identified as female and 13 identified as male. On average, female caregivers had higher pre-program PHQ-8, stress, and burden scores than their male counterparts (p-value < 0.05). Caregivers under the age of 70 (n=14) exhibited a significant improvement in burden scores after completing the improv workshop. Overall, there were no significant changes in pre vs post program measures for the general population of enrolled caregivers. Conclusion: Quantitative data did not provide clear evidence of sufficient improvement of burden for caregivers based on improv alone, but improv may be a beneficial addition to an existing dementia caregiver support and education program. Results also indicate that female caregivers in particular may benefit from support programs.Item CMS MIPS Quality Measures Are Blind to High-Need High-Cost Homebound Older Adults Cared for in Home-Based Medical Care(2020) Bhatnagar, ShivaniPurpose: Multiple studies find home-based medical care a solution for high-need, high-cost homebound older adults. However, home-based medical care needs proper representation among the Merit-based Incentive Payment System (MIPS) and Center for Medicare and Medicaid Services (CMS)-specified quality measures to be financially viable in modern value-based care. Unfortunately, many useful measures for this population are unusable due to inadequate home medical visit codes in these measures' denominators. The objective of this study is to determine what proportion of the CMS 2019 MIPS Quality Measures, which are potentially appropriate for patients receiving home-based medical care, have home visit codes in their denominators. Methods: All 257 CMS 2019 MIPS Quality Measures were reviewed for applicability to homebound older adults cared for by home-based medical care providers. Measure details were reviewed in public documents from five CMS websites across 2017-2019. Results: Of the 257 CMS 2019 MIPS Quality Measures, 179 were inapplicable for this population, most commonly because they applied to specialist physicians outside of geriatric or palliative providers. Of the 78 measures that were deemed potentially appropriate, only 37 (47%) had home visit codes. Conclusions: The majority of CMS MIPS Quality Measures that are potentially appropriate for the care of homebound older adults, who receive home-based medical care, are unusable by home-based medical care practitioners for MIPS reporting. This represents a barrier for home-based medical providers in delivering effective care to this high-need, high-cost vulnerable patient population.Item Alzheimer's Dementia Prevalence in Tarrant County: Demographics and Resources Available for Individuals and Families Affected(2020) Patel, Krishna; Johnson, Emily; Denniston, Nathan; Aggarwal, Amit; Nazim, AsadPurpose: This project aimed to investigate the prevalence of Alzheimer's Disease (AD), as well as the resources available to those suffering with AD in Tarrant county and the requirements for making use of them. Methods: Multiple searches were conducted in order to find AD demographics and resources available to those suffering from it. Further inquiries were made in order to find the conditions that must be met in order to be eligible to receive the benefits. Results: There are approximately 5.9 million Americans suffering from AD. In Tarrant County, AD was the 5th leading cause of death in 2016, and is most prevalent in the Non-Hispanic white population and those over the age of 65. There are many resources available, both online and in-person to those with AD and their families. The Arlington Adult Day Health Care Center offers adult daycare services, transportation within the Arlington area, and accepts multiple payment options. Other resources provide education to those supporting Alzheimer's patients, such as UNTHSC's GAPP C.A.R.E.S. program. Alzheimer's Texas offers low cost memory screenings to monitor the cognitive health of AD patients and support groups for their caregivers. The Alzheimer's North Central Texas Chapter offers a 24/7 helpline and free information on financing care for AD patients. Conclusion: Resources exist for those in Tarrant county that aid both patients with AD and their caregivers. Some function to aid the patients directly via adult daycare services, whereas others aim to help the caregivers via information and helpline services.Item Rural Osteopathic Medical Education (ROME) Geriatric Quality Improvement Projects, 1478201-1(2020) Westberg, AlexaPurpose: Falls remain something feared by both patients and healthcare providers alike. For patients, falling can lead to an overall decreased quality of life and for providers, falls lead to spending millions of healthcare dollars each year. For a small community in rural Texas, could addressing fall risks lead to increased quality of life across the community and less healthcare dollars spent? Method: Two weeks of patient charts were reviewed prior to beginning data collection, this review looked at how many patients 65 and older were seen in the clinic that week and how many of those patients were asked about fear of falling or fall risks. Then 4 weeks of data collection began. Patients 65 and older were given a STEADI questionnaire and had the results of the questionnaire discussed with them. Results: Pre-data collection, 10-12.5% of patients 65 and older were being asked about fear of falling or fall risks each week. During data collection, the number of patients 65 and older asked about fall risks or fear of falling increased to 92-100% per week. Conclusion: Overall, patients 65 and older are at the highest risk of falling, though the majority of these patients are not having conversations with their healthcare provider about falls. As a follow-up to the completed survey about risks for falls, a physical test such as the Get Up and Go Test could be implemented as the next step in risk assessment.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 Multidisciplinary Approach towards increasing Dementia awareness: Incorporating Project ECHO and Alzheimer's Community Forum into the Social-Ecological Model(2020) Luk-Jones, Susanna; Severance, Jennifer; Griffin, Melissa; Jose, RoslinPurpose: The prevalence of Alzheimer's in the United States is anticipated to increase by three-fold over next forty years. The Social-Ecological Model could be an effective framework in designing interventions to increase dementia awareness. This study uses two different approaches that affect distinct components of the Social-Ecological Model- Project ECHO impacting individual healthcare workers, and community forums increasing the overall community awareness on dementia. Objective: To portray the Social-Ecological model as a framework combining two dissimilar interventions addressing the focal issue of dementia. Methods: The study includes data from the first cohort of Project ECHO, and two Alzheimer's community forums held at Hurst and Arlington in 2019. Participant attendance information and surveys of Project ECHO were analyzed using Excel, and qualitative data from the community forums were analyzed by thematic qualitative analysis. Results: The first cohort of Project ECHO had a total of twenty participants encompassing seven healthcare disciplines, and partaking five sessions on dementia care. At the community level, with a combined total of seventy-five participants, educative sessions on dementia helped increase overall community awareness. Prominent barriers of language, unawareness, and stigma were identified. Major suggestions included increasing translation services, creating awareness, and volunteer recruitment. Conclusions: The Social-Ecological model can be used as a framework to address complex chronic public health issues such as dementia. While Project ECHO increased provider knowledge on dementia, community forums had a three-fold impact of creating awareness, understanding community perspectives, and relaying it to the governing authorities.Item SMALL MOLECULE SA-2 USEFUL FOR TREATING ALZHEIMER'S DISEASE(2020) Weston, Courtney; Mahapatra, Vasu; Stankowska, Dorota; Acharya, Suchismita; Amankwa, Charles E.Purpose: Alzheimer's disease (AD) is a neurodegenerative disorder affecting mainly the aged population. Oxidative stress is known to play important role in the pathogenesis of AD and is increased in the brain with aging. Reactive oxygen species (ROS) are released in excess which leads to neuronal atrophy and long-term tissue damage. Low levels of nitric oxide (NO) is beneficial for neurogenesis and has antioxidant activity. Our goal is to synthesize novel hybrid molecules with dual antioxidant-nitric oxide donating activity against oxidative stress-induced hippocampal neuronal HT-22 cell deaths. Method: The compounds (SA-2, SA-9 and SIN-1) were synthesized and encapsulated into nanoparticles (NP). Structure of the compounds and size of nanoparticles were confirmed using 1HNMR and DLS. Mouse HT-22 cells were seeded in 96 well plates, tert-butyl hydrogen peroxide (TBHP,10µM- 5mM) was added and incubated at 2, 4, 6 and 12 hours. MTT assay (Promega) was performed to determine the effective concentration (EC50) of TBHP. For cell viability study cells were treated with/without TBHP and compounds (SA-2, SA-2 NP, SA-9, SIN-1, 1µM, 10 µM and 100 µM). After 6 hours, MTT assay was performed to assess cell proliferation. Results: We found the EC50 of TBHP is 80µM (6h). Compound SA-2 (100µM) and SA-2 NP (0.1%, equivalent to 25µM of free SA-2) provided significant protection to TBHP induced HT-22 cell death. Conclusion: SA-2 NP is highly effective than free SA-2. Further assessments are ongoing.Item Investigating Oxidative Damage: Implications in Cognitive and Metabolic Phenotypes of Alzheimer's Disease in the Mexican American Population(2020) Phillips, Nicole; Barber, Robert C.; Silzer, Talisa; Blessing, Alexandra; Reid, DanielleThe elderly population is rapidly expanding leading to increases in age-related diseases such as cardiovascular disease, metabolic disorders, cancer, and neurodegenerative diseases. The Texas Alzheimer's Research and Care Consortium (TARCC) is a collaborative research effort to identify factors involved in the development and progression of Alzheimer's Disease (AD) in Mexican Americans (MAs). In the MA population, diabetes, depression, stroke, and obesity are common risk factors for developing cognitive impairment. The reasons for the association between cognitive decline and comorbidities remain unclear. Studies have shown correlations between common pathological changes observed in AD and those that are a result of DNA damage. The mitochondrial genome is particularly vulnerable to DNA damage due to its close proximity to reactive oxygen species (ROS). Age associated declines in mitochondrial function results in accumulation of ROS, which are capable of damaging DNA and other essential biomolecules. Oxidative damage to DNA takes many forms, however oxidation of guanine (G) forming 8oxoG, is one of the most prevalent DNA lesions. Currently, the methods for detection of 8oxoG are limited and lack reproducibility due to several reasons. We propose nanopore sequencing technology as an improved alternative to current detection and quantification methods. Here we describe preliminary proof of concept results and discuss future applications of this method for analysis of mtDNA damage in participants of the TARCC cohort. Investigation of oxidative DNA damage may aid our understanding of the differences in manifestation of age-related cognitive decline in Mexican Americans as compared to non-Hispanic whites.