Objective: The purpose of this article is to provide a narrative review synthesizing the literature on differences between women and men in relationships among certain stressors associated with ...immune system activation and their relationship to cognitive dysfunction and dementia. Method: We review the cycle of stress leading to neuroinflammation via cortisol and neurochemical alterations, cell-mediated immune system activation, and pro-inflammatory cytokines, and how this is implicated in the development of dementia. We follow this by discussing sex differences in stress physiology and immune function. We then review the work on early life adversity (ELA) and adverse childhood experiences (ACEs), post-traumatic stress disorder, acute medical stressors, and their associations with cognitive dysfunction and dementia. Throughout, we emphasize women's presentations and issues unique to women (e.g. trauma disorder prevalence). Conclusions: There is a need for more mechanistic and longitudinal studies that consider trauma accumulation, both physical and emotional, as well as a greater focus on traumas more likely to occur in women (e.g. sexual abuse), and their relationship to early cognitive decline and dementia.
Today, the prevalence of cognitive dysfunction and the prevalence of diabetes are increasing. Research shows that diabetes increases cognitive impairment risk, and cognitive impairment makes diabetes ...self-management more challenging. Diabetes self-management, essential to good glycemic control, requires patients to assimilate knowledge about their complex disease and to engage in activities such as glucose self-monitoring and the management of their medications. To test a comprehensive cognitive rehabilitation intervention-the Memory, Attention, and Problem-Solving Skills for Persons with Diabetes (MAPSS-DM) program. Our central hypothesis is that participants who take part in the MAPSS-DM intervention will have improved memory and executive function, increased use of compensatory cognitive skills, and improved self-management. We will also explore the role of glucose variability in those changes. This is a randomized controlled trial. Sixty-six participants with cognitive concerns and type 2 diabetes will be assigned to either the full MAPSS-DM intervention or an active control. Participants will use continuous glucose monitoring pre- and post-intervention to identify changes in glycemic variability. All participants will also be evaluated systematically via questionnaires and neuropsychological tests at three timepoints: baseline, immediately post-intervention, and 3 months post-intervention. This study will fill an important gap by addressing cognitive function in the management of diabetes. Diabetes is related to accelerated cognitive aging, cognitive deficits are related to poorer self-management, and improvements in cognitive performance as a result of cognitive rehabilitation can translate into improved performance in everyday life and, potentially, diabetes self-management. The results of the proposed study will therefore potentially inform strategies to support cognitive function and diabetes self-management, as well as offer new mechanistic insights into cognitive function through the use of continuous glucose monitoring. Trial registration: This study has been registered at ClinicalTrials.gov (NCT04831775).
Objective: Mentoring is a well-known concept that is widely regarded as beneficial for personal and professional development. The concept of sponsoring is less recognized although it is considered ...critical by some for career advancement. The purpose of this study was to provide an initial exploration of differences between mentoring and sponsoring within neuropsychology and to learn what sponsors look for in protégés. Method: Twenty neuropsychologists with experience in mentorship and sponsorship were interviewed. Topics covered included the number of protégés they had mentored/sponsored, training received in mentoring/sponsoring, characteristics they look for in protégés, expectations of protégés, reasons they mentor/sponsor, and benefits of mentoring/sponsoring. Results: On average, neuropsychologists interviewed had mentored 58 protégés and sponsored 40. None had ever received formal training in mentoring or sponsoring. Key characteristics needed for neuropsychologists to feel comfortable mentoring/sponsoring protégés were similar while those characteristics valued differed slightly with sponsored protégés valued for competence and getting things done and mentored protégés valued for interpersonal qualities. Reasons for and benefits of mentorship/sponsorship were similar, with rewarding feelings, satisfaction, and pride in the protégé's successes at the top of the list. Conclusions: Neuropsychologists who provide training are in the position to mentor and sponsor individuals; mentoring relationships often entail sponsorship and vice versa such that the two constructs may be considered part of a continuum. Improving knowledge and skills in mentorship and sponsorship will not only advance personal and professional development of protégés but will also positively impact mentors/sponsors and help shape the field of neuropsychology in deliberate ways.
Objective: Intraindividual variability (IIV) in cognitive performance has been associated with cognitive decline and reductions in white matter integrity, but the predictive utility of IIV-between ...versus IIV-within domains is unknown. The present study aimed to determine if IIV-within a "frontal-subcortical" domain may be a more robust predictor of changes in general cognitive status and functional independence over time than IIV-between cognitive domains. Method: Mixed linear modeling was used to analyze the relationship between cognitive IIV and cognitive and functional status in 651 controls, 211 people with mild cognitive impairment, and 218 people with Alzheimer's disease over a 5-year period. Results: Both IIV-between and IIV-within a frontal-subcortical domain improved prediction of cognitive and functional declines beyond demographic characteristics, genetic risk, and vascular integrity. IIV-between showed the greatest effect over time and was driven primarily by increases in IIV-within. Conclusions: Cognitive IIV, especially between cognitive domains, may be useful for identifying individuals at risk for cognitive and functional decline. Findings may facilitate investigations into mechanisms underlying declines in global cerebral integrity and aid clinical trials aimed at early detection and treatment.
Key Points
Question: Does variability in performance on cognitive tasks predict declines in cognition and functional independence? Findings: Performance variability both within and between cognitive domains predicts declines in cognition and functional independence, but the latter is a more robust predictor than the former. Importance: Performance variability may be used to identify and study those at greatest risk for subsequent decline, with the ultimate aim of improving early detection and treatment. Next Steps: Future research should examine the generalizability and replicability of these findings.
Digital technologies permit new ways of performing instrumental activities of daily living (iADLs) for older adults, but these approaches are not usually considered in existing iADL measures. The ...current study investigated how a sample of older adults report using digital versus analog approaches for iADLs.
248 older adults completed the Digital and Analog Daily Activities Survey, a newly developed measure of how an individual performs financial, navigation, medication, and other iADLs.
The majority of participants reported regularly using digital methods for some iADLs, such as paying bills (67.7%) and using GPS (67.7%). Low digital adopters were older than high adopters (F(2, 245) = 12.24, p < .001), but otherwise the groups did not differ in terms of gender, years of education, or history of neurological disorders. Participants who used digital methods relatively more than analog methods reported greater levels of satisfaction with their approach and fewer daily errors.
Many older adults have adopted digital technologies for supporting daily tasks, which suggests limitations to the validity of current iADL assessments. By capitalizing on existing habits and enriching environments with new technologies, there are opportunities to promote technological reserve in older adults in a manner that sustains daily functioning.
Early detection of Alzheimer's disease and related disorders (ADRDs) has been a focus of research with the hope that early intervention may improve clinical outcomes. The manifestation of motor ...impairment in the early stages of ADRD has led to the inclusion of gait assessments including spatiotemporal parameters in clinical evaluations. This study aims to determine the effect of adding kinetic and kinematic gait features to the classification of different levels of cognitive load in healthy individuals. A dual-task paradigm was used to simulate cognitive impairment in 40 healthy adults, with single-task walking trials representing normal, healthy gait. The Paced Auditory Serial Addition Task (PASAT) was administered at two different interstimulus intervals (ISIs) representing two levels of cognitive load in dual-task gait. We predicted that a richer dataset would improve classification accuracy relative to spatiotemporal parameters. Repeated measures analysis of variance (ANOVA) showed significant changes in 15 different gait features across all three levels of cognitive load. We used three supervised machine learning algorithms to classify data points using a series of different gait feature sets with performance based on the area under the curve (AUC). Classification yielded 0.778 AUC across all three conditions (0.889 AUC Single versus Dual) using kinematic and spatiotemporal features compared to 0.724 AUC using spatiotemporal features only (0.792 AUC Single versus Dual). These data suggest that additional kinematic parameters improve classification performance. However, the benefit of measuring a wider set of parameters compared to their cost needs consideration. Further work will lead to a clinically viable ADRD detection classifier.
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