Alzheimer's disease and related dementias (ADRDs) are a global crisis facing the aging population and society as a whole. With the numbers of people with ADRDs predicted to rise dramatically across ...the world, the scientific community can no longer neglect the need for research focusing on ADRDs among underrepresented ethnoracial diverse groups. The Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART; alz.org/ISTAART) comprises a number of professional interest areas (PIAs), each focusing on a major scientific area associated with ADRDs. We leverage the expertise of the existing international cadre of ISTAART scientists and experts to synthesize a cross-PIA white paper that provides both a concise “state-of-the-science” report of ethnoracial factors across PIA foci and updated recommendations to address immediate needs to advance ADRD science across ethnoracial populations.
: Board certification (BC) in clinical neuropsychology
the American Board of Clinical Neuropsychology (ABCN) is a rigorous process demonstrating clinical competence to practice. While myths about BC ...have been addressed, barriers to BC have yet to be studied. The aim of this study was to identify barriers to BC among neuropsychology trainees and professionals.
: Data were collected through pre-webinar surveys administered to 1202 participants across four webinars conducted between 2018 and 2021. The surveys,
open-ended questions, captured specific concerns about BC as well as, demographic information including self-identification with racial/ethnic and culturally diverse groups. Qualitative analyses of self-reported barriers were conducted, and themes were identified.
: The themes identified included
(11.8%),
(5.8%),
(11.9%),
(13.4%),
(4.4%),
(24.7%),
(10.9%),
(3.4%),
(1.5%), and
(2.5%). Respondents that identified with a racial/ethnic diverse group were more likely to report
and
, whereas White respondents more frequently identified
and
as barriers. Trainees were more likely to report
,
,
, whereas Professionals were more likely to report
and
as barriers.
: Results from this survey demonstrate that
,
,
,
, and
related to the examination were the most frequently reported barriers. However, differences across groups (i.e. career stage, racial/ethnic) emerged, highlighting the need to develop initiatives that address the specific needs of different groups of neuropsychology trainees and professionals.
Mild cognitive impairment (MCI) confers a higher risk of developing dementia. While largely preserved, instrumental activities of daily living (IADLs) may be affected to varying degrees by MCI. The ...Memory Support System (MSS) is a curriculum and calendar/note-taking system that has proven effective in sustaining independence in IADLs for individuals with MCI and in protecting mood among care partners. Until recently, the MSS has only been utilized among English- and Spanish-speaking samples. This study investigated the use of a translated and culturally adapted MSS in four French-speaking, community-dwelling participants with MCI and their support partners. Measures of treatment adherence, daily function, self-efficacy for memory, quality of life, mood, anxiety, and caregiver burden were assessed at baseline, treatment end, and eight-week follow-up. By treatment end and follow-up, participants with MCI showed improvement in adherence to the MSS calendar, IADLs, everyday abilities requiring memory and planning, self-efficacy, depression and anxiety symptoms, and quality of life. Care partners showed improvement in quality of life and depressive symptoms, while their caregiver burden and anxiety symptoms generally remained unchanged. Findings suggest that, with appropriate training, Francophones with MCI can and will use the MSS, and that MSS training may contribute to daily functioning and aspects of participant and care partner well-being.
To describe clinical and pathologic characteristics of corticobasal degeneration (CBD) with cognitive predominant problems during the disease course.
In a series of autopsy-confirmed cases of CBD, we ...identified patients with cognitive rather than motor predominant features (CBD-Cog), including 5 patients thought to have Alzheimer disease (AD) and 10 patients thought to have behavioral variant frontotemporal dementia (FTD). We compared clinical and pathologic features of CBD-Cog with those from a series of 31 patients with corticobasal syndrome (CBD-CBS). For pathologic comparisons between CBD-Cog and CBD-CBS, we used semiquantitative scoring of neuronal and glial lesion types in multiple brain regions and quantitative assessments of tau burden from image analysis.
Five of 15 patients with CBD-Cog never had significant motor problems during their disease course. The most common cognitive abnormalities in CBD-Cog were executive and visuospatial dysfunction. The frequency of language problems did not differ between CBD-Cog and CBD-CBS. Argyrophilic grain disease, which is a medial temporal tauopathy associated with mild cognitive impairment, was more frequent in CBD-Cog. Apathy was also more frequent in CBD-Cog. Tau pathology in CBD-Cog was greater in the temporal and less in perirolandic cortices than in CBD-CBS.
A subset of patients with CBD has a cognitive predominant syndrome than can be mistaken for AD or FTD. Our findings suggest that distribution of tau cortical pathology (greater in temporal and less in perirolandic cortices) may be the basis of this uncommon clinical variant of CBD.
Subjective cognitive decline (SCD) is prevalent in the general population, particularly among Hispanic adults. SCD increases the risk of mild cognitive impairment (MCI) and dementia. While ...non-pharmacologic interventions are recommended to mitigate cognitive decline and preserve daily function in SCD and MCI, such interventions are not readily available for Spanish-speaking Hispanic adults with SCD. This pilot study, preregistered at clinicialtrials.gov, aimed to develop a linguistically and culturally appropriate adaptation of an existing memory compensation intervention, the Memory Support System (MSS), from English to Spanish, and to gather data to assess its impact in this population. Twenty Spanish-speaking Hispanic adults with SCD and 16 support partners were recruited. Measures of treatment adherence, daily function, self-efficacy for memory, quality of life, mood, anxiety, and caregiver burden were assessed at baseline, treatment end, and 8-week follow-up. By treatment end, participants with SCD improved their general functional status, daily activities requiring organizational skills, and depression and anxiety symptoms. Partners reported improvement in anxiety by treatment end and in caregiver burden at follow-up. The MSS was successfully translated into Spanish and readily learned by participants with SCD and their partners. The MSS in Spanish may help with daily functioning and aspects of patient and family well-being.
To provide a brief presentation of preliminary data on rehabilitation services provided by clinical neuropsychologists within the United States.
This survey utilized data extracted from a larger ...international research study conducted in 39 countries including N = 173 professionals who reported to engage in neuropsychological rehabilitative services within the past year (63.6% female, 44.36 ± 11.83 years of age) took part in the study.
Neuropsychologists providing rehabilitation services in the United States in the past year were more likely to provide individual versus group therapy, likely to employ technology (e.g., personal computers, mobile phones/smartphones) as part of treatment services, see a range of diagnostic groups most prominently traumatic brain injury and stroke/vascular conditions, and work to address a range of both cognitive (e.g., memory, attention/concentration, and executive functioning) and psychological (e.g., emotional/behavioral adjustment and well-being, awareness of disability/disease) issues.
Prior published surveys suggest that clinical neuropsychologists have a growing involvement in rehabilitation services within the United States but with little clarity as to the actual characteristics of actual professional activities and practices. The present study aimed to provide such information and hopefully will be helpful in promoting additional systematic studies in this area.
Our primary goal was to examine demographic and clinicopathologic differences across an ethnoracially diverse autopsy-confirmed cohort of Alzheimer's disease cases.
A retrospective study was ...conducted in the Florida Autopsied Multi-Ethnic cohort on 1625 Alzheimer's disease cases, including decedents who self-reported as Hispanic/Latino (n = 67), black/African American (n = 19), and white/European American (n = 1539).
Hispanic decedents had a higher frequency of family history of cognitive impairment (58%), an earlier age at onset (median age of 70 years), longer disease duration (median of 12 years), and lower MMSE proximal to death (median of 4 points) compared with the other ethnoracial groups. Black decedents had a lower Braak tangle stage (stage V) and higher frequency of coexisting hippocampal sclerosis (21%); however, only hippocampal sclerosis differences survived adjustment for sex, age at onset, and disease duration. Neither Thal amyloid phase nor coexisting Lewy body disease differed across ethnoracial groups.
Despite a smaller sample size, Hispanics demonstrated longer disease duration with Alzheimer's disease, but not greater lifespan. Neuropathologic differences across ethnoracial groups supported differences in tau pathology distribution and coexisting hippocampal sclerosis, which may impact biomarker studies.
A prior report found unusually high rates of performance validity test (PVT) failure in undergraduate research participants (31%-56%). The present study examined 110 undergraduate volunteers in three ...conditions (positive, neutral, or negative demand characteristics) in either an easy to hard or a hard to easy progression of neuropsychological tests using the Word Memory Test PVT. Neither demand characteristics nor test order had a substantial effect on test performance, and only a 6.4% failure rate was found on the PVT. These results suggest that neuropsychological testing experiments are completed faithfully by the vast majority of college undergraduates, although excluding the small number of participants failing PVTs would strengthen the internal validity of most studies.
Human kallikrein 7 (KLK7) is a potential target for the treatment of skin inflammation and cancer. Despite its potential, few KLK7-specific small-molecule inhibitors have been reported in the ...literature. As an extension of our program to design serine protease inhibitors, here we describe the in vitro assays and the investigation of the binding mechanism by molecular dynamics simulation of a novel class of pseudo-peptide inhibitors derived from isomannide. Of the inhibitors tested, two inhibited KLK7 with Ki values in the low micromolar range (9g=1.8μM; 9j=3.0μM). Eadie–Hofstee and Dixon plots were used to evaluate the competitive mechanism of inhibition for the molecules. Calculated binding free energies using molecular MM/PB(GB)SA approach are in good agreement with experimental results, suggesting that the inhibitors share the same binding mode, which is stabilized by hydrophobic interactions and by a conserved network of hydrogen bonds. The promising results obtained in this study make these compounds valid leads for further optimization studies aiming to improve the potency of this new class of kallikrein inhibitors.
Objective
To evaluate the influence of ethnicity in presentation of childhood-onset systemic lupus erythematosus (cSLE) patients.
Methods
This multicenter study included cSLE patients (American ...College of Rheumatology criteria) followed in 27 Pediatric Rheumatology services of Brazil. Ethnicities were classified in four groups according to the parents’ and all four grandparents’ self-reported ethnicity. The statistical analysis was performed using the Bonferroni’s correction (
p
< 0.0027).
Results
According to ethnic groups, 1537 cSLE patients were classified in Caucasian (
n
= 786), African-Latin American (
n
= 526), Asian (
n
= 8), and others/unknown (
n
= 217). Comparisons between 1312 African-Latin American and Caucasian revealed similar median age at cSLE diagnosis 12.2(2.6–18) vs. 12.1(0.3–18) years,
p
= 0.234, time interval to diagnosis 0.25(0–12) vs. 0.3(0–10) years,
p
= 0.034, and SLEDAI-2K score 14(0–55) vs. 14(0–63),
p
= 0.781 in both groups. The mean number of diagnostic criteria according to SLICC (6.47 ± 1.911 vs. 5.81 ± 1.631,
p
< 0.0001) and frequencies of maculopapular lupus rash (8% vs. 3%,
p
< 0.0001), palate oral ulcers (17% vs. 11%,
p
= 0.001), tongue oral ulcers (4% vs. 1%,
p
= 0.001), and nonscarring alopecia (29% vs. 16%,
p
< 0.0001) were significantly higher in African-Latin American, whereas malar rash (45% vs. 58%,
p
< 0.0001) was more frequent in Caucasian. The presence of anti-phospholipid antibody (23% vs. 12%,
p
< 0.0001), low complement levels (58% vs. 41%,
p
< 0.0001), and isolated direct Coombs test (10% vs. 5%,
p
= 0.001) was also significantly higher in the former group.
Conclusions
Our study demonstrated that disease presentation severity of African-Latin American cSLE patients is comparable with Caucasian. Mucocutaneous manifestations and autoantibodies profile were the only distinctive features of the former group. The unique mixed background of Brazilian patients probably minimized race diversity spectrum of these patients.
Key Points
• Our study demonstrated that disease presentation severity of African-Latin American cSLE patients is comparable with Caucasian.
• Mucocutaneous manifestations and autoantibodies profile were the only distinctive features of African-Latin American cSLE patients.
• African-Latin American cSLE patients had more often anti-phospholipid antibodies and hypocomplementemia.
• The unique mixed background of Brazilian patients probably minimized race diversity spectrum of these patients.
PDF
